What Is an Epstein-Barr Virus Infection (EBV Infection)?
The virus was first discovered in 1964 when Sir Michael Anthony Epstein and Ms. Yvonne Barr found it in a Burkitt lymphoma cell line. In 1968, the virus was linked to the disease infectious mononucleosis (glandular fever). Infection with Epstein-Barr virus (EBV) is common and usually occurs in childhood or early adulthood. EBV is the cause of infectious mononucleosis (also termed "mono"), an illness associated with symptoms and signs like:
fever,
fatigue,
swollen tonsils,
headache, and
sweats,
sore throat,
swollen lymph nodes in the neck, and
sometimes an enlarged spleen (BPH, benign prostatic hyper dysplasia)
It is also known as human herpesvirus4. Although EBV can cause mononucleosis, not everyone infected with the virus will get mononucleosis. White blood cells called B cells are the primary targets of EBV infection. Less commonly, EBV can cause more serious disease. Symptoms caused by EBV are usually mild and self-limited, but the virus persists in the body for life. It can be reactivated quietly without causing symptoms and may contaminate saliva. Thus, otherwise healthy people can spread the virus to uninfected people through kissing or sharing food. This is why mononucleosis is referred to as the "kissing disease." EBV probably plays a role in the development of some cancers, including certain lymphomas and nasopharyngeal cancer. No specific treatments cure mononucleosis caused by EBV. What Is an Epstein-Barr Virus Infection (EBV Infection)?
What Causes Epstein-Barr Viral Infections? Is It Contagious?
EBV is a contagious virus that is transmitted from person to person and occurs throughout the world. The cause of infection is generally close person-to-person contact through bodily fluids, especially saliva. It may also be transmitted during sexual contact through semen, and can also be spread by blood transfusions or organ transplants. The virus contains double-stranded DNA and multiplies in white blood cells (a certain type of lymphocyte called a B cell) and other cells, such as those lining the mouth, tongue, and nose. The human immune system usually contains the virus effectively, reducing but not eliminating the viruses. A few living viruses will persist in a line of lymphocytes for the rest of the person's life. This is known as "latent" infection (inactive stage). Occasionally, the virus may multiply (reactivate), but this does not cause symptoms unless the person's immune response system is not working properly. Most people in the U.S. have been infected with EBV, mononucleosis is more common in whites than in the African-American populations. Some risk factors associated with acquiring EBV include being female, living in tropical countries, having immunodeficiency, and being sexually active.
What Are the Symptoms and Signs Epstein-Barr Virus??
Once the Epstein-Barr virus is acquired (spread from person to person), it takes about four to six weeks for symptoms to appear. Children usually have nonspecific symptoms or no symptoms at all. Rarely, young children may have rashes, pneumonia, or low white blood counts. Many teenagers and young adults develop symptoms of mononucleosis. Acute mononucleosis causes:
Although the symptoms fade in days to weeks, some people complain of fatigue that lasts for weeks after infection, though most people eventually recover completely. Rash A small percentage of people develop a rash due to the infection. A rash can also develop in people with mononucleosis who are given ampicillin or amoxicillin. This common reaction does not necessarily mean the patient is allergic to penicillin or related antibiotics. The appearance of the rash in conjunction with the above symptoms and signs also can lead to misdiagnosis of the EBV. Enlarged Spleen The spleen becomes swollen in up to half of people with mononucleosis. The spleen is always engorged with blood, and if it ruptures, it can cause a person with the virus to bleed to death. Blunt trauma to the abdomen, even mild trauma, may result in splenic rupture if swollen. Poeple with mono are usually advised not play sports, especially any contact sports. The spleen may also rupture spontaneously. Neurological Complications A very small number of infected people have neurological complications. These include inflammation of the brain (encephalitis), of the lining of the brain (meningitis), or of individual nerves. Less commonly, infection of the spinal cord may occur. The majority of patients with neurological complications recover completely. Rarely, other organs may be involved, including the lungs or heart. X-linked lymphoproliferative syndrome in boys Rarely, boys may develop overwhelming infection with EBV known as X-linked lymphoproliferative syndrome. In X-linked lymphoproliferative syndrome, the number of immune cells or lymphocytes (B cells) in the body increases substantially. The lymphocytes infiltrate major organs, often causing severe liver disease or death. Lymphoproliferative syndrome is probably a result of a subtle genetic defect that makes it difficult for the immune system to contain the virus. Organ transplants or bone marrow transplants are also risk factors for developing lymphoproliferative syndrome. Cancers In addition to lymphoproliferative syndrome, EBV is considered a risk factor for some cancers. One such cancer is lymphoma of the brain. Lymphoma of the brain is most common in people with advanced AIDS but also occurs in other immunosuppressed states. Nasopharyngeal cancer, Burkitt lymphoma (a type of non-Hodgkin lymphoma), and some types of Hodgkin's lymphoma are also associated with EBV. The exact mechanism by which EBV helps to transform normal lymphocytes into cancer cells is not fully understood. Leukoplakia EBV is associated with a condition called oral hairy leukoplakia. This is a white plaque on the side of the tongue that cannot be removed by gentle scraping. It is most common in people with AIDS or other immunosuppressive states. Misdiagnosis Mononucleosis causes fatigue, which can sometimes last for weeks or even longer. Therefore, chronic infection with EBV (CEBV) has been investigated as a cause of chronic fatigue syndrome (CFS), also called systemic exertion intolerance disease (SEID). Studies to date have not been able to find a causal link between EBV and CFS. In CFS, there is a chronic lack of energy often associated with difficulty concentrating or generalized pain. Chronic Fatiuge Syndrome (CFS) CFS is more common among women than men and occurs in early to middle adulthood. Blood tests are usually normal. There is no specific diagnostic test for CFS, and the cause remains unknown. During Pregnancy During pregnancy, it is rare for a fetus to become infected with EBV even if the mother is infected. Even among women who do become infected while pregnant, there are no documented birth defects that have resulted. Associated Diseases EBV is also associated with several autoimmune diseases, including multiple sclerosis, autoimmune thyroiditis, systemic lupus erythematosus, oral lichen planus (OLP), rheumatoid arthritis (RA), autoimmune hepatitis, Sjögren's syndrome, and Kawasaki disease.
Brief Facts about EBV:
--Mono is caused by the Epstein-Barr virus, which is named after the scientists who first identified it in the mid-1960s. The virus enters the lymph nodes and attacks the lymphocytes (the white blood cells manufactured there). As the white blood cells come into contact with the virus, they change shape and multiply. At first, there are no symptoms because it takes several weeks before enough of the altered cells can accumulate to generate infection. --Young children are usually protected from infection because their immune systems are primed while they are still in the womb, however, this immunity gradually wears off as they get older. --The vast majority of EBV infections in children either cause no symptoms at all, or very mild symptoms indistinguishable from the other mild, brief illnesses of childhood. --When EBV infection occurs during adolescence or young adulthood, it causes infectious mononucleosis in up to 50% of cases. --The symptoms of infectious mononucleosis include- fever, sore throat, and swollen lymph glands. Sometimes, the spleen or liver may also begin to swell. On very rare occasions it may also cause heart disorders and problems with the central nervous system. --If the virus lasts more than six months, it is frequently called chronic EBV infection. Some doctors think EBV is the cause of a chronic condition called Chronic Fatigue Syndrome (CFS), although this has not been definitively proven. --Symptoms of CEBV- Fatigue, pain present in any area of the body, fever, insomnia and hyperinsomnia, vertigo, nausea, headache, sensitivity to light, heat, and cold, presyncope, "foggy head", depression/anxiety, heart palpitations, tremors, swollen lymph glands and more. --Many with CEBV can suffer from a wide range of symptoms. While others with CEBV only suffer from one or two symptoms. --EBV remains dormant or latent in a few cells in the throat and blood for the rest of the person's life. --Periodically, the virus can reactivate and is commonly found in the saliva. --This reactivation usually occurs without symptoms of illness. --EBV also establishes a lifelong dormant infection in some cells of the body's immune system. --It is possible, though very unlikely, that this may lead to the development of two very rare cancers - Burkitt's lymphoma and nasopharyngeal carcinoma. --Most individuals exposed to people with infectious mononucleosis have previously been infected with EBV and are not at risk. --Transmission of EBV requires intimate contact with the saliva or bodily fluids of an infected person. --Transmission of this virus through the air or blood does not normally occur. --After the initial infection, EBV remains in the body, mainly in white blood cells, for life. Infected people shed the virus periodically in their saliva. They are most likely to infect others during shedding, which usually causes no symptoms. --The virus is also found frequently in the saliva of healthy people. --Many healthy people can carry and spread the virus intermittently for life. --Transmission of the virus is almost impossible to prevent. --There is no specific treatment for infectious mononucleosis, other than treating the symptoms. --No antiviral drugs or vaccines are available. --Antibody tests for EBV measure the presence and/or the concentration of specific EBV antibodies. Different laboratory tests can measure specific EBV antibodies. Some of these tests can be performed on a single sample of blood, while others compare different samples of blood over a period of time