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The Epstein-Barr virus (EBV) is a member of the herpes group and cause of infectious mononucleosis. It primarily affects young adults and children, although in children it is usually so mild that it is often overlooked. Infectious mononucleosis is fairly common and both sexes are affected equally; prognosis is excellent, and major complications are uncommon.
In the early 1990s several papers were published that described patients with CFS and serologic test results consistent with reactivated or persistent Epstein-Barr virus (EBV) infection. This proposed connection led to the use of terms such as "chronic mononucleosis", "chronic EBV infection" and "postviral fatigue syndrome". Further investigation failed to establish a pattern of disease and chronic infection with EBV.
Signs & Symptoms
Acute EBV Infection. Symptoms of mononucleosis mimic those of other infectious diseases, including hepatic dusfunction (hepatitis), rubella and toxoplasmosis. Early symptoms include headache, malaise, and fatigue followed by a triad of symptoms: sore throat, cervical lymphadenopathy, and temperature fluctuations / fever. Other consequences include increased lymphocytes and monocytes, and development of heterophil antibodies. Symptoms typically subside about 6 to 10 days after onset of the disease but may persist for weeks.
'Chronic' EBV Infection. It is important to note that symptoms related to infectious mononucleosis caused by EBV infection seldom last for more than 4 months. When such an illness lasts more than 6 months, it is frequently called chronic EBV infection. However, valid laboratory evidence for continued active EBV infection is seldom found in these patients. The illness should be investigated further to determine if it meets the criteria for chronic fatigue syndrome (CFS). This process includes ruling out other causes of chronic illness or fatigue.
Diagnosis & Tests
In most cases of infectious mononucleosis the clinical diagnosis can be made from the characteristic triad of fever, pharyngitis, and lymphadenopathy lasting for 1 to 4 weeks. Serologic test results include a normal to moderately elevated white blood cell count, an increased total number of lymphocytes, greater than 10% atypical lymphocytes, and a positive reaction to a "mono spot" test. In patients with symptoms compatible with infectious mononucleosis, a positive Paul-Bunnell heterophile antibody test result is diagnostic, and no further testing is necessary.
Laboratory tests are not always foolproof. For various reasons, false-positive and false-negative results can occur for any test. However, the laboratory tests for EBV are for the most part accurate and specific. Because the antibody response in primary EBV infection appears to be quite rapid, in most cases testing paired acute- and convalescent-phase serum samples will not demonstrate a significant change in antibody level. Effective laboratory diagnosis can be made on a single acute-phase serum sample by testing for antibodies to several EBV-associated antigens simultaneously. In most cases, a distinction can be made as to whether a person is susceptible to EBV, has had a recent infection, has had infection in the past, or has a reactivated EBV infection.
Antibodies to several antigen complexes may be measured. These antigens are the viral capsid antigen, the early antigen, and the EBV nuclear antigen (EBNA). In addition, differentiation of immunoglobulin G and M subclasses to the viral capsid antigen can often be helpful for confirmation. When the "mono spot" test is negative, the optimal combination of EBV serologic testing consists of the antibody titration of four markers: IgM and IgG to the viral capsid antigen, IgM to the early antigen, and antibody to EBNA.
IgM to the viral capsid antigen appears early in infection and disappears within 4 to 6 weeks. IgG to the viral capsid antigen appears in the acute phase, peaks at 2 to 4 weeks after onset, declines slightly, and then persists for life. IgG to the early antigen appears in the acute phase and generally falls to undetectable levels after 3 to 6 months. In many people, detection of antibody to the early antigen is a sign of active infection, but 20% of healthy people may have this antibody for years.
Antibody to EBNA determined by the standard immunofluorescent test is not seen in the acute phase, but slowly appears 2 to 4 months after onset, and persists for life. This is not true for some EBNA enzyme immunoassays, which detect antibody within a few weeks of onset.
Finally, even when EBV antibody tests, such as the early antigen test, suggest that reactivated infection is present, this result does not necessarily indicate that a patient's current medical condition is caused by EBV infection. A number of healthy people with no symptoms have antibodies to the EBV early antigen for years after their initial EBV infection.
Therefore, interpretation of laboratory results is somewhat complex and should be left to physicians who are familiar with EBV testing and who have access to the entire clinical picture of a person. To determine if EBV infection is associated with a current illness, consult with an experienced physician.
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Signs, symptoms & indicators of Epstein-Barr virus (EBV):
Conditions that suggest Epstein-Barr virus (EBV):
Recommendations and treatments for Epstein-Barr virus (EBV): | | | | | Chemical |  BHT (Butylated Hydroxytoluene) | Butylated hydroxytoluene (BHT) is a potent inactivator of lipid-enveloped viruses. |
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Diet |
Coconut| | May be an effective aid in the destruction of lipid-enveloped viruses, such as HIV, HHV-6 (strains A and B), EBV, CMV, and herpes. |
 Aspartame (Nutrasweet) Avoidance |
Oxygen / Oxidative Therapies |
Ozone / Oxidative Therapy| | The inactivation of viral particles by ozone may take place by a variety of mechanisms which range from direct physical-chemical effects to a more indirect immunological effect. Virii coated by a lipid glycoprotein envelope such as Epstein-Barr are vulnerable to the influence of ozone by its intense oxidizing properties. |
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KEY | | Weak or unproven link |  | | Strong or generally accepted link |  | | Proven definite or direct link | | | May do some good | | | Likely to help |
GLOSSARY
Acute
An illness or symptom of sudden onset, which generally has a short duration.
Antibody (Antibodies)
A type of serum protein (globulin) synthesized by white blood cells of the lymphoid type in response to an antigenic (foreign substance) stimulus. Antibodies are complex substances formed to neutralize or destroy these antigens in the blood. Antibody activity normally fights infection but can be damaging in allergies and a group of diseases that are called autoimmune diseases.
Antigen (Antigenic, Antigens)
A substance, usually protein or protein-sugar complex in nature, which, being foreign to the bloodstream or tissues of an animal, stimulates the formation of specific blood serum antibodies and white blood cell activity. Re-exposure to similar antigen will reactivate the white blood cells and antibody programmed against this specific antigen.
Aspartame
A low-calorie sweetener used in a variety of foods and drinks and as a tabletop sweetener. It is about 200 times sweeter than sugar and is commonly known by names such as NutraSweet, Equal, Spoonful or Equal-Measure.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
Chronic Fatigue Syndrome (CFS, Chronic Fatigue)
A disorder of unknown cause that lasts for prolonged periods and causes extreme and debilitating exhaustion as well as a wide range of other symptoms such as fever, headache, muscle ache and joint pain, often resembling flu and other viral infections. Also known as Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS), Chronic Epstein-Barr Virus (CEBV), Myalgic Encephalomyelitis (ME), "Yuppy Flu" and other names, it is frequently misdiagnosed as hypochondria, psychosomatic illness, or depression, because routine medical tests do not detect any problems.
Cytomegalovirus (CMV)
A member of the herpes virus family which may induce the immune-deficient state or cause active illness, such as pneumonia, in a patient already immune-deficient due to chronic illness, such as cancer or organ transplantation therapy.
Enzymes (Enzyme)
Specific protein catalysts produced by the cells that are crucial in chemical reactions and in building up or synthesizing most compounds in the body. Each enzyme performs a specific function without itself being consumed. For example, the digestive enzyme amylase acts on carbohydrates in foods to break them down.
Epstein Barr Virus (EBV, Epstein-Barr Virus)
A virus that causes infectious mononucleosis and that is possibly capable of causing other diseases in immunocompromised hosts.
Gland (Glands)
The glandular system is one of the most important and complicated systems of the body. Gland tissue can be either an organ or general tissue that secretes chemicals and there are two types of gland: exocrine and endocrine. Those glands which secrete chemicals through tubules or ducts are called exocrine and include sweat, tear and salivary glands. Ductless glands - part of the endocrine system - secrete special chemicals (hormones) directly into the blood.
Glandular (Glandulars, Raw Glandulars)
Either referring to a gland, OR glands and organs from animals specially processed at temperatures not exceeding body heat and put into supplement form.
Hepatitis
Inflammation of the liver usually resulting in jaundice (yellowing of the skin), loss of appetite, stomach discomfort, abnormal liver function, clay-colored stools, and dark urine. May be caused by a bacterial or viral infection, parasitic infestation, alcohol, drugs, toxins or transfusion of incompatible blood. Can be life-threatening. Severe hepatitis may lead to cirrhosis and chronic liver dysfunction.
Herpes
A small group of capsid-forming DNA viruses, sometimes divided into Type I (forming vesicles and blisters on the mouth, lips-generally above the waist) and Type II (usually sexually-transmitted, with symptoms mostly below the waist). Both types form acute initial outbreaks, go dormant, reactivate, and so forth. For most folks, frequent outbreaks are clear signs of stress or immunosuppression. Both types are equally dangerous for infants.
Human Immunodeficiency Virus (HIV)
A retrovirus associated with onset of advanced immunodeficiency syndrome (AIDS).
Lipid (Lipids)
Fat-soluble substances derived from animal or vegetable cells by nonpolar solvents (e.g. ether); the term can include the following types of materials: fatty acids, glycerides, phospholipids, alcohols and waxes.
Liver (Hepatic)
The largest and one of the most complex organs of the body, the liver is responsible for much of the metabolism of fats, proteins and carbohydrates. It is the site of much of the body's detoxification. It is connected very closely with digestion and the regulation of blood sugar, among many other functions. Found behind the ribs on the right side of the abdomen, it has many important functions such as removing harmful material from the blood, making enzymes and bile that help digest food, and converting food into substances needed for life and growth. Hepatic: Pertaining to the liver.
Lymph Nodes (Axillary Nodes, Inguinal Nodes, Lymph Gland, Lymph Glands, Lymph Node, Lymphatic)
Small, bean-shaped nodes at various points throughout the body that function to filter the lymph fluid and attempt to destroy the microorganisms and abnormal cells which collect there. The most common locations are the neck (both sides and front), armpit (axillary) and groin (inguinal), but also under the jaw and behind the ears. Swollen or painful lymph nodes generally result from localized or systemic infection, abscess formation, or malignancy. Other causes of enlarged lymph nodes are extremely rare. Physical examination for lymph nodes includes pressing on them to check for size, texture, warmth, tenderness and mobility. Most lymph nodes can not be felt until they become swollen, and then will only be tender when pressed or massaged. A lymph node that is painful even without touching indicates greater swelling. Lymph nodes can usually be distinguished from other growths because they generally feel small, smooth, round or oval-shaped and somewhat mobile when attempts are made to push them sideways. Because less fat covers the lymph nodes in children, they are easier to feel, even when they are not busy filtering germs or making antibodies. Childrens' nodes enlarge faster, get bigger in response to an infection and stay swollen longer than an adult's. Also known (incorrectly) as lymph glands.
Lymphadenopathy
A lymph gland enlargement in response to any foreign substance or disease.
Lymphoma (Lymphomas)
Any tumor of the lymphatic tissues.
Malaise
A vague feeling of bodily discomfort, as at the beginning of an illness. A general sense of depression or unease.
Mononucleosis
Infectious Mononucleosis: An acute, infectious disease caused by the herpes virus or Epstein-Barr virus, with fever and inflamed swelling of the lymph nodes around the neck, under the arms, and in the groin. The general symptoms are fever,
sore throat, exhaustion, and abnormal white blood cells.
Pharyngitis
Inflammation of the pharynx, either from irritation or infection. A sore throat.
Prognosis
A prediction (estimate) of the future course and outcome of a disease and an indication of the likelihood of recovery from that disease.
Serum
The cell-free fluid of the bloodstream. It appears in a test tube after the blood clots and is often used in expressions relating to the levels of certain compounds in the blood stream.
Syndrome
A medical condition characterized by a collection of related symptoms (what the patient feels) and signs (what a doctor can observe or measure).
Virus (Viri, Viruses)
Any of a vast group of minute structures composed of a protein coat and a core of DNA and/or RNA that reproduces in the cells of the infected host. Capable of infecting all animals and plants, causing devastating disease in immunocompromised individuals. Viruses are not affected by antibiotics, and are completely dependent upon the cells of the infected host for the ability to reproduce.
White Blood Cell (WBC, White Blood Cells)
A blood cell that does not contain hemoglobin: a blood corpuscle responsible for maintaining the body's immune surveillance system against invasion by foreign substances such as viruses or bacteria. White cells become specifically programmed against foreign invaders and work to inactivate and rid the body of a foreign substance. White blood cells are composed primarily of neutrophils, monocytes and lymphocytes. Lymphocytes are either T-cells or B-cells. T-cells (CD3 cells) are divided into T-helper (CD4 cells) and T-suppressor/cytotoxic (CD8 cells) cells.
Last updated: Sep 05, 2009
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