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Epstein-Barr Virus (EBV) Infection

Dr. Ajay Mohan (AIIMS)MBBS

July 08, 2020

July 08, 2020

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Epstein-Barr Virus Infection
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Epstein-Barr virus (EBV) infection is a very common disease. Researchers say that most people get this viral infection by the age of six. Though the infection itself tends to be mild—with flu-like symptoms in children up to 10 years of age—the virus does not leave the body even after the infection clears. Instead, the virus remains latent (inactive) and may be reactivated later in life.

The symptoms of EBV infection tend to be relatively stronger when people contract it in their teen years or as grown-ups. The main signs of infection are fever, inflamed or sore throat, swelling in the lymph nodes of the throat, fatigue, enlarged spleen and/or liver and skin rashes.

The pathogen that causes this infection, Epstein-Barr virus, is a type of herpes virus that can infect people. Some of the other herpes viruses that affect humans are herpes simplex virus 1 and 2, varicella-zoster virus (which causes chickenpox) and cytomegalovirus.

Transmission of EBV usually occurs through saliva—the most well-known EBV infection, infectious mononucleosis, is sometimes called the kissing disease. That said, the virus can be transmitted by sharing drinks and utensils with an infected person. It can also spread through bodily fluids like blood. And though rare, EBV can be transmitted sexually, through semen.

The virus is most commonly associated with mononucleosis, also known as mono or the kissing disease. However, it has also been known to cause post-transplant lymphoproliferative disorder (PTLD), a type of cancer, in organ recipients and chronic active Epstein-Barr virus disease, a rare disorder in which the person is unable to beat the infection.

Additionally, research shows that EBV infection may increase the risk of nasopharyngeal cancer (or cancer of the back of the nose) and some autoimmune diseases such as systemic lupus erythematosus, multiple sclerosis, juvenile idiopathic arthritis, inflammatory bowel disease and type 1 diabetes.

Usually, mild infection in children clears up on its own within two weeks to one month. In grown-ups, EBV-linked fatigue can last for months. The treatment usually involves rest, drinking lots of fluids and over-the-counter medication for pain and fever. For complications of EBV infection such as PTLD, the duration of illness and prognosis can vary.

The virus gets its name from Anthony Epstein and Yvonne Barr—two of the three scientists, along with Burt Achong—who found out that EBV could cause cancer. This was the first virus known to be able to do this.

Here's everything you need to know about EBV infection and the kissing disease, mononucleosis:

Epstein-Barr Virus (EBV) Infection symptoms

The infection tends to be mild in infants and young children with flu-like symptoms. Teens and adults are more likely than children to experience symptoms, which can include:

Grown-ups who get infectious mononucleosis as a result of EBV may also get:

  • Swollen eyelids
  • Mild jaundice

Usually, patients get better in two weeks to one month. However, fatigue can last longer in people who get this infection as teenagers or as adults.

Researchers are looking into the reasons why adolescents and adults tend to get more severely affected. One theory is that they have a more developed immune system than babies and young children. This is significant because lymphocytes, more specifically the B-cells of our immune system, are one of the main hosts for the virus in the human body.

Epstein-Barr Virus (EBV) infection causes

Epstein-Barr virus, previously known as the human herpesvirus 4, can cause mild primary infection and infectious mononucleosis or mono (kissing disease).

To be sure, EBV isn't the only virus that can cause mono—cytomegalovirus can also cause this disease. (Read more: Cytomegalovirus infection)

The virus spreads mainly through swapping saliva with an infected person. But other bodily fluids like blood and semen can also transmit the pathogen. Droplet transmission—through sneeze and cough droplets from an infected person—is also possible.

Children usually pick up the infection from their peers in the playground (play gym) or playschool. Sharing cups, spoons, chew toys, etc., can spread the virus.

In teens and grown-ups, kissing is an additional way in which the virus can spread.

The virus may also get reactivated in some adults who had the infection as children. Although the exact cause for this isn't known, medical researchers say it has a correlation with compromised immunity.

Epstein-Barr Virus (EBV) infection prevention

Epstein-Barr virus (EBV) infection is actually very common all over the world. Many patients tend to be asymptomatic. Where symptoms do show up, they can take up to six weeks after someone contracts the infection to become evident. As such, it is difficult to identify sick people to maintain distance from them or to avoid infection.

The best precautionary advice for this infection is to avoid sharing utensils and drinks with other people and maintain hygiene.

Epstein-Barr virus (EBV) infection diagnosis

Diagnosis of Epstein-Barr virus (EBV) infection is difficult because the symptoms—when they do show up—tend to be non-specific. That said, a doctor would do the following to reach a diagnosis:

  • Ask about your symptoms
  • Do a physical examination to check for swollen tonsils or lymph nodes in the neck. He or she would also check for any swelling in the spleen by pressing on your abdomen to check if it hurts anywhere
  • Run an antibody test for EBV-specific antibodies in the blood. Research has also shown that grown-up patients tend to have increased CD8+ cytotoxic lymphocytes (a type of antiviral immune cell) in their blood.

Epstein-Barr Virus (EBV) infection treatment

Treatment for primary Epstein-Barr virus (EBV) infection typically involves getting lots of rest, drinking lots of fluids and taking over-the-counter medication to ease the pain and fever.

Epstein-Barr Virus (EBV) infection complications

Epstein-Barr virus (EBV) infection is usually mild in children under 10 years of age. That said, anyone can get this infection irrespective of their age. Less than 1% of patients have complications, mostly due to an overreaction of the immune system to the virus. These complications may include:
  • Difficulty breathing due to airway obstruction. This obstruction could be because of swelling in the oropharyngeal area (back of the throat)
  • Meningoencephalitis or swelling in the meninges or membranes of the brain
  • Haemolytic anaemia: A condition in which red blood cells are destroyed faster than the body can make them, leading to anaemia
  • Thrombocytopenia or low platelet count.
  • Maculopapular rashes: These are skin lesions that are sometimes caused by viral infections

EBV infection can also have implications for organ transplant—recipients may be at risk for post-transplant lymphoproliferative disorder (PTLD), a type of cancer that can occur after organ transplant.

Research has also linked EBV infection to increases risk of:

  • Nasopharyngeal cancer
  • Systemic lupus erythematosus, an autoimmune disorder which affects the connective tissues in the skin, joints, blood vessels, brain, lungs and kidneys, among other organs of the body. 
  • Multiple sclerosis, an autoimmune condition that depletes the protective covering of the nerve cells.
  • Juvenile idiopathic arthritis, an autoimmune disease in which people develop arthritis or joint inflammation before the age of 16 years.
  • Inflammatory bowel disease, in which there is constant inflammation of the gut
  • Type 1 diabetes, or insulin-dependent diabetes


References

  1. Rickinson A.B. and Fox C.P. Epstein–Barr virus and infectious mononucleosis: what students can teach us The Journal of Infectious Diseases, 1 January 2013; 207(1): 6–8.
  2. Abbott R.J., Pachnio A., Pedroza-Pacheco I., Leese A.M., Begum J., Long H.M., Croom-Carter D., Stacey A., Moss P.A.H., Hislop A.D., Borrow P., Rickinson A.B. and Bell A.I. Asymptomatic primary infection with Epstein-Barr virus: observations on young adult cases. Journal of Virology, 13 October 2017; 91(21): e00382-17. PMID: 28835490.
  3. Odumade O.A., Hogquist K.A. and Balfour H.H. Jr. Progress and problems in understanding and managing primary Epstein-Barr virus infections. Clinical Microbiology Reviews, January 2011; 24(1): 193-209. PMID: 21233512.
  4. Kimura H. and Cohen J.I. Chronic active Epstein–Barr virus disease. Frontiers in Immunology, 2017; 8: 1867.
  5. Centres for Disease Control and Prevention [Internet]. Epstein-Barr virus (EBV) and infectious mononucleosis. CDC, U.S. Department of Health & Human Services.
  6. Nandi M., Hazra A., Das M.K., Bhattacharya S., Sarkar U.K. Infectious mononucleosis due to Epstein-Barr virus infection in children: A profile from eastern India. Medical Journal of Dr D.Y. Patil Vidyapeeth, 2017; 10(5): 438-444.

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