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Tuesday, September 22, 2020

Epstein-Barr Virus (EBV): Overview, Mode of Transmission, Symptoms and Treatment

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Epstein-Barr virus, which is also known as EBV, is one of the members of the herpes family. Another name for Epstein-Barr Virus is human herpes 4. This virus is one virus that can infect human and causes mononucleosis.

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Many doctors call mononucleosis by its nickname “Mono.” Mononucleosis is also known as the kissing disease. This is because it is often transmitted by saliva, which is usually shared while kissing.

Epstein-Barr Virus is one of the most common viruses that there is. It is found all around the world, and it isn’t restricted to infecting one race, culture, or a particular part of the world. This means that this disease can infect anybody, and you just may be affected, but you wouldn’t know.

In fact, according to research, most people have gotten infected with the Epstein-Barr Virus, but they aren’t aware of it and have become carriers of the virus as well. Although infectious mononucleosis is one of the major diseases caused by EBV, some doctors speculate that EBV may cause other conditions such as cancer and autoimmune diseases.

This information hasn’t been considered as accurate, and researchers are still looking for links between several diseases and EBV.

Mode of transmission

The common mode of transmission of the Epstein-Barr Virus is via the sharing of saliva. This is why the disease caused by EBV, which is mononucleosis, has been nicknamed as the kissing disease. However, this is not the only mode of transmission.

Epstein-Barr Virus can also be transmitted through sexual contacts, through blood(hence, why blood transfusion is also a common method of transmission), and also via organ transplants.

Also, the sharing of objects such as toothbrushes, drinking cups, and generally anything that has recently touched the saliva of an infected person can cause the spread of this virus and also the disease.

There are two phases of the infection caused by the Epstein-Barr Virus. The first stage is known as the primary active stage. At this point, the person is only a carrier. A patient in this stage can have the EBV and not show any symptoms at all. Some doctors refer to this stage as the asymptomatic stage.

Although the patient isn’t showing any symptoms and the disease can be said to be in its latent stage. However, the patient is still a carrier of the virus. Once an uninfected person comes in contact with a person that has this virus (even though he/she is at the asymptomatic stage), the uninfected person can still contract the disease and become a carrier.

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The second phase of this virus is Chronic EBV. Once the virus crosses its latent period, the person will begin to experience the symptoms that are associated with the disease mononucleosis.

Also, at this stage, the virus is said to be active, and the person is said to be symptomatic.

Symptoms

Once you have been infected with the Epstein-Barr Virus, you will be a carrier for about 6weeks. This means that during this time, you already have the disease; however, you are not showing any symptoms.

After this time, you begin to show gradually experience signs that will tell you that you probably have Epstein-Barr Virus. However, in some people, especially in kids, it takes a more extended period for them to start exhibiting symptoms.

In children, once the virus has passed its latent(asymptomatic) stage, the child may begin to present with symptoms that can easily be mistaken for the flu or for the common cold. However, teenagers will show more obvious signs that the teen has infectious mononucleosis.

The symptoms you will likely show once you have mononucleosis include:

  1. An increase in temperature resulting in the development of fever.
  2. Severe fatigue
  3. Acute inflammation present in the throat.
  4. The lymph nodes on the neck, as well as under your arms, will become swollen.
  5. The spleen becomes enlarged(splenomegaly).
  6. The liver becomes inflamed and swollen
  7. The presence of a rash on the neck

It is important to note that children are much more susceptible to this infection. This means that many people have gotten this infection as a child; however, there are hardly any signs in children.

In some children who may show signs, the parents can easily get the symptoms mixed up with the sings of other mild illnesses such as the common cold.

One sure way to determine if your child is having the symptoms of EBV or any other disease is to wait it out. Most times, the symptoms of Epstein-Barr Virus usually resolves itself within two or three weeks. In some cases of EBV, some patients may show still show signs after several weeks or months.

However, if you suspect that you have any other disease, especially the common cold, their symptoms may not last as long as the signs for EBV does.

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Symptoms of reactivation

Once a person becomes infected with Epstein-Barr Virus, the person doesn’t begin to show symptoms immediately. In other words, a person who gets infected with EBV at not know that he or she is infected.

This period in which the disease doesn’t show any symptoms is known as the latency period. However, after the latency period, the person will begin to some of the symptoms that have been listed above.

In some cases, after the disease has been treated but not properly, the virus may be reactivated. There are times when the virus becomes reactivated, but the patient still doesn’t show any symptoms.

However, after a period, the person can begin to show similar symptoms like that which was seen at the initial stage of the infection.

People who already have weakened immune systems due to an underlying condition will experience a combination of symptoms upon reactivation of the disease.

What are the testing methods to detect EBV?

Generally, a person who carries a potential Epstein-Barr Virus may be detected without the use of any testing kit. However, one of the significant ways which doctors employ to detect any Epstein-Barr Virus is by carrying out blood testing.

The body is built in such a way that there is a particular system that helps fight against infections. This system is known as your immune system.

When a foreign body enters into your body system (example: a Virus), your body’s immune system will respond by producing special agents known as antibodies to help fight that infection.

It is important to note that there are different groups of antibodies, and it is necessary to understand what kind of antibodies will respond to a particular foreign body. This means that your doctor must be able to carefully note which antibodies are released in the bloodstream in response to EBV.

If a person has EBV, the body will release antibodies in response to the attack. These antibodies are what will help your doctor to determine if you have EBV.

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There are different kinds of blood tests that can be used to find out of you have EBV or have had it in recent times. Some of those tests include:

1. Viral Capsid Antigen(VCA)Testing

Generally, the viral structure of most viruses includes a particular layer known as the Capsid. The Capsid is like the outer covering of the virus.

When a virus enters the body, the body’s immune system will first release antibodies specific to fighting that particular viral Capsid.

Hence, early in the infection, your body will develop viral Capsid antibodies in response to the antigen (foreign body). Initially, the first type of antibody, which is usually seen to fight VCA is IgM (Immunoglobulin M).

However, after a few weeks, IgM disappears. Then another antibody known as VCA Immunoglobulin G (IgG) replaces anti VCA-IgM and may persist for as long as the virus is within the person’s body system.

It is important to note that these immunoglobulins help to fight the virus, and as such, when they are detected in the blood, you can easily tell that the person has contacted the Epstein-Barr Virus.

2. Early Antigen Testing

There are specific antibodies that are often released during an active infection. The test that is usually carried to determine these antibodies is the early antigen testing. However, sometimes, this form of testing can’t be wholly relied on to determine the kind of virus the person has.

This is because the antibodies which are specific for this virus in its early stages tend to disappear and may not reappear anymore except when there is a reactivation of disease.

Hence, if the person has had the infection for some time without going for testing if this test is carried out on the patient, it will be challenging to determine the kind of virus that is in the body.

Therefore, your doctor may have to revert to Viral Capsid Testing to determine which virus is present within your body.

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However, because there are variations, in some people, sometimes, the early antibodies may persist and, as such making it easier for your doctor to determine if the virus present within the body system is the Epstein-Barr Virus.

3. Epstein-Barr Virus(EBV) Nuclear Antigen Testing

During a viral infection that has persisted for some time, there are specific antigens that are released, which can be detected in a nuclear Antigen Test.

These antigens during an active infection will slowly develop over time and sometimes, may persist as long as the person has the virus.

Taking all these tests into account, your health care provider will take the results of these tests as well as other factors such as the symptoms you have been showing, your overall health status as well as underlying conditions into account before determining if the person has EBV or not.

Is there a particular Treatment option available?

Unfortunately, the disease mononucleosis, which is mainly caused by Epstein-Barr Virus has no treatment or vaccine available yet. This is because EBV mostly doesn’t respond to antibiotics.

However, this disease can be managed. Most doctors try to focus on managing the symptoms of this disease and, as such, keep the viral load at a minimal level. To help manage your symptoms, your doctor will recommend that you do the following:

  1. Have a lot of rest.
  2. Take a lot of fluids, especially water.
  3. Take some over-the-counter medications such as aspirin, which can help you relieve the sore throat as well as reduce your fever.
  4. Avoid all contact sports or any heavy lifting until you feel better and complete relief.

Can untreated EBV lead to complications?

It is very possible for one to develop complications due to untreated EBV. However, in some cases, these complications may be mild or severe, depending on how far the virus has spread in the body. Some of these complications include:

  1. Severe rupture of the spleen.
  2. A reduction in the red blood cell count which will lead to anemia
  3. A reduction in the platelet count which causes thrombocytopenia
  4. Infection of the liver causing hepatitis, which sometimes can cause liver damage.
  5. Infection of the myocardium(muscular layer) of the heart causing myocarditis
  6. Some conditions, such as Guillain-Barre syndrome, encephalitis, or even meningitis, can be as a result of untreated EBV.

Are there other diseases that can be caused by the Epstein-Barr Virus?

Although EBV is generally known to cause mononucleosis, however, it has been seen to cause certain diseases. These diseases include:

  • Ear infection in children
  • Severe diarrhea in children
  • Guillain-Barre syndrome
  • Certain scientists claim that it may cause multiple sclerosis as well, but the results of this research remain inconclusive.

Autoimmune disorders

For a long time, scientists have tried to prove the connection between EBV and certain autoimmune diseases such as lupus. Some scientists believe that EBV has the capacity to change the way the genes are expressed and, as a result altering the genetic code of an individual.

Once the genetic code has been changed, it increases the chances of the person developing several autoimmune disorders by 90%. A particular recent study has been able to discover the link between EBV and lupus, which is an autoimmune disease.

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The authors of the research currently believe that the same way EBV causes lupus is the same way by which EBV causes other autoimmune disorders such as multiple sclerosis, rheumatoid arthritis, type 1 diabetes, celiac disease, inflammatory bowel diseases, Hashimoto’s disease, Graves disease as well as Juvenile Idiopathic Arthritis.

Schizophrenia

In a recent study that looked at the connection between EBV and schizophrenia, it was discovered that more than 700 people who had schizophrenia had treated EBV at one point in their lives.

People who had schizophrenia were seen to have an elevated level of EBV proteins when compared to other people who didn’t have schizophrenia. This result suggests that people with schizophrenia may have an unusual immune response to the Epstein-Barr Virus.

These researchers also went a step further to find out that participants of this study who had a genetic predisposition to schizophrenia as well as had high levels of antibodies were ten times more likely to develop schizophrenia than those who didn’t have the genetic factors or the increased levels of antibodies(control group).

However, other scientists who didn’t take part in this study declare that they need more researches to prove that EBV may cause schizophrenia.

Cancer

Epstein-Barr Viral infection has been seen to increase the chances of one developing certain types of rare cancers. This is due to the fact that mutations in the cells affected by EBV can cause severe changes causing cancers to occur.

It is important to note that cancers generally occur when there is an abnormal growth or an unusual mutation of a particular body cell. Some of the rare cancers which have been associated with EBV over time include Nasopharyngeal cancers, Hodgkin’s lymphoma, Gastro adenocarcinoma, which is otherwise known as stomach cancer, as well as Burkitt’s lymphoma.

Although these cancers are described to be rare, they mostly occur to people who live outside Africa and some parts of Southeast Asia.

Chronic EBV

In some rare cases, the infections caused by EBV can go on to become a severe condition, which is known as Chronic Active EBV(CAEBV). CAEBV is often characterized by symptoms and blood tests that are used to detect an active EBV infection.

Generally, CAEBV starts out as any other EBV infection does. However, due to specific reasons such as an underlying health condition and so on, the patient’s immune system may not be able to fight against the infection allowing the virus to continue in its active state for an extended period.

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Some experts aren’t sure people begin to develop CAEBV. However, others have attributed it to genetic mutations, and some factors which may have caused a change in the person’s already infected EBV cells can lead to the development of chronic active EBV.

According to research, CAEBV is mostly common in Central America, Asia as well as some parts of South America.

Most people who have Chronic Active EBV can have some complications such as lymphomas, a severely weakened immune system, organ failure, or the development of a rare autoimmune disorder, which is known as a hemophagocytic syndrome.

The Bottom Line

The Epstein-Barr Viral infection is a very common infection that is often spread mainly through kissing or by coming in contact with the body fluid of an infected person. Mostly, people experience infections in childhood but may not develop any symptoms.

However, if a teenager or an adult is infected, they may develop specific symptoms such as fever, severe fatigue as well as the inflammation of their lymph nodes, especially those present in the neck.

In some rare cases in which the infection is not managed correctly, it can result in the development of Chronic Active EBV, which can be very fatal if left untreated.

Although EBV has been linked to several autoimmune disorders as well as cancers, however, more research needs to be carried out to determine the role of Epstein-Barr Virus in all these conditions.

References;

  • Epstein-Barr Virus and mononucleosis; CDC
  • Epstein-Barr Virus; WebMD
  • Everything you need to know about Epstein-Barr Virus; Healthline
Epstein-Barr virus
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Disclaimer: This article is purely informative & educational in nature and should not be construed as medical advice. Please use the content only in consultation with an appropriate certified medical or healthcare professional.

Deborah Akinola
Wirter, poet and public speaker
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