What is Epstein-Barr Virus (Mononucleosis or Mono)?
The Epstein-Barr virus, or EBV, is a type of virus that infects the ‘B lymphocyte’ cells, which are a type of white blood cell that helps body fight infection. It belongs to the herpes virus family and was first found in 1964. EBV can cause a range of diseases and is mainly spread through saliva that contains cells infected by the virus.
Almost 95% of adults around the world have been infected with EBV at some point in their lives. This virus is also known for causing infectious mononucleosis, a disease often referred to as “mono,” which can make you feel very tired and weak, among other symptoms. The usual treatment for diseases caused by EBV mainly involves care directed towards relieving the symptoms.
What Causes Epstein-Barr Virus (Mononucleosis or Mono)?
The Epstein Barr virus is a type of herpesvirus. It’s composed of a pair of DNA strands surrounded by proteins. This virus has certain proteins on its outer layer which are crucial for attaching itself to, and entering, host cells like B cells and epithelial cells. The virus targets B cells – a type of white blood cell – using their internal systems to reproduce itself. This virus can also cause B cells to change into memory B cells, which can circulate in your bloodstream or stay dormant until something triggers them to become active again.
The Epstein Barr virus can be passed on in several ways, such as deep kissing or sharing food. Increased amounts of the virus’s DNA can be found in saliva after the first infection. Kids can get this virus if they eat food that’s already been chewed by someone with an Epstein Barr virus infection. The virus can also be transmitted through stem cell and organ transplants, and blood transfusions.
Risk Factors and Frequency for Epstein-Barr Virus (Mononucleosis or Mono)
Almost all adults around the world, approximately 95%, have been infected at some point by the Epstein Barr virus. This virus is common among kids and teenagers in the US, with almost 67% of them having had it between the ages of 6 and 19. The frequency tended to rise with age, from around 54% for kids aged 6-8 years old to roughly 83% for teenagers between 18 and 19 years old. Although the virus infected slightly more females than males, the difference was minimal. The virus was more present among Mexican-American kids and teens than non-Hispanic Blacks and Whites. Children and teenagers who lived in larger households, had lower family incomes, whose parents had less education, or who were born outside the U.S. also showed higher rates of infection.
- Global rates of the Epstein Barr virus infection varied. In England, for instance, nearly 75% of children aged 11 to 24 had the virus.
- In the 11-14 years age group, the virus was less prevalent than it was among older kids.
- Young adults between 22 and 24 years old had a 93% chance of having had the virus.
- In a study from Tehran, Iran, 81.4% of the population had antibodies to the virus, with almost 95% of adults over 40 having had it at some point. The frequency of people having antibodies rose with age. One exception was found in infants. These infants had a high level of Epstein Barr virus antibodies, which decreased as they got older, likely because they were losing the antibodies their mothers passed on to them over time.
- Finally, in China, more than half of the children had the virus before they reached 3 years of age, and over 90% had it by the time they were 8 to 9 years old.
A study found that the rate of infection usually goes up between June and August. This is probably because people interact more with each other during the summer months.
Signs and Symptoms of Epstein-Barr Virus (Mononucleosis or Mono)
Epstein Barr virus, also known as EBV, can cause several symptoms in people. Some might not experience any symptoms while others may suffer from a range of illnesses. Detecting if a person has EBV requires an in-depth medical history and physical examination.
Children with the virus may not show any symptoms or might have unclear symptoms. For all people, EBV could potentially lead to several health issues. This could be as simple as feeling lethargic and feverish, to more serious problems like sore throat, headache, swollen lymph nodes, and an enlarged spleen. Some people could continue showing symptoms for months, with tiredness being reported as the most regular and lasting symptom.
According to a research study, it was found certain symptoms like throat infection and swollen neck glands could persist for six months after the initial infection in approximately one-fourth of the total participants in the research group. Other common problems noticed were abnormal lymphocyte cells count, and irregular liver function tests. Research also noted that while sick, some patients experienced a decline in their physical and emotional wellbeing which improved over time during the study.
The manifestations of EBV are diverse but the following gives an overview:
- Swollen lymph nodes
- Headache
- Tiredness
- Fever
- Sore throat
- Persistent fatigue
- Irregularities in liver function tests
- Physical and emotional fatigue while sick that improves over time
Testing for Epstein-Barr Virus (Mononucleosis or Mono)
Figuring out if a patient has an infection due to the Epstein Barr virus is usually best done through blood tests. One of these tests looks at the number of unusual looking white blood cells (lymphocytes).
One of the blood tests that doctors use to identify this infection is the heterophile antibody test. This checks for specific types of antibodies (proteins your body produces in response to infections) known as IgM against Epstein Barr virus in your blood. This test is frequently used because it’s cost-effective, quick, and has a success rate of 63-84% in accurately diagnosing the virus, and a rate of 84-100% in correctly ruling it out.
However, this test does not always work well in children, because they might not produce these specific antibodies in response to the virus. Also, these antibodies could be present due to other diseases or they might remain in the system for over a year, which might lead to a positive result even if you don’t have a current Epstein Barr virus infection.
To confirm the diagnosis, doctors may use another type of blood test, called the Viral Capsid Antigen (VCA) IgM and IgG test. This test measures the levels of two types of antibodies against the virus – IgM and IgG. Higher levels of VCA IgM antibodies suggest a recent infection, while increased levels of VCA IgG antibodies suggests a past or ongoing infection. In patients with Epstein Barr virus, these antibodies usually behave in a certain way: VCA IgM levels go down after about a month, while VCA IgG levels decrease over the span of a few months.
Treatment Options for Epstein-Barr Virus (Mononucleosis or Mono)
Epstein Barr virus, or EBV, is typically managed symptomatically, meaning that doctors treat the symptoms rather than the virus itself. This often involves medication to lower fever and relieve pain. Although some research has suggested that antiviral medications can decrease the amount of EBV present in the mouth, these treatments haven’t been shown to improve overall symptoms.
corticosteroids, another type of medication, aren’t typically used to treat EBV directly. They can be helpful, however, in patients who experience certain complications due to their EBV infection, such as problems with their airways or autoimmune issues (when your immune system mistakenly attacks your body).
What else can Epstein-Barr Virus (Mononucleosis or Mono) be?
When facing diseases with similar symptoms, doctors must evaluate various possibilities to narrow down the correct diagnosis. This process is called ‘differential diagnosis’. They must consider several common reasons, including:
- Bacterial pharyngitis, which presents with a sore throat, swollen lymph nodes in the neck, throat swelling, and pus on the tonsils.
- Viral pharyngitis, usually displaying symptoms like fatigue, fever, runny nose, or redness in the eyes.
- Cytomegalovirus (CMV), another virus from the Herpesvirus family, which also shows up as a sore throat, fever, chills, abnormal liver function tests, and fatigue. However, less common are symptoms like swollen spleen or lymph nodes.
- Acute HIV infection, whose symptoms could include fevers, muscle and joint pain, fatigue, headaches, and sometimes swollen lymph nodes and a sore throat.
By considering these possibilities and conducting appropriate tests, doctors can arrive at an accurate diagnosis.
What to expect with Epstein-Barr Virus (Mononucleosis or Mono)
Infectious mononucleosis, often caused by the Epstein Barr virus, typically resolves on its own over time and generally has a good prognosis, meaning most patients get better. However, complications can occur from this viral infection, and these can vary in how often they happen.
Possible Complications When Diagnosed with Epstein-Barr Virus (Mononucleosis or Mono)
The Epstein Barr virus can lead to several health complications. One of the serious complications is spleen rupture due to infectious mononucleosis. They can occur even 6 days after showing symptoms of infection and can either be treated through careful monitoring and pain control, known as conservative management, or through surgery. The conservative approach is recommended for patients whose bodies are still maintaining a steady internal environment. Other non-surgical treatments include blocking the blood flow to the spleen. Surgeries could require aftercare that includes vaccines, antibiotics, and regular check-ups.
Another complication caused by this virus is airway blockage due to swollen throat tissues. The treatments for this condition could include steroid medication, making an incision in the windpipe, or inserting a tube into the windpipe. This complication is rare, happening in 1 – 3.5% of cases, and primarily affects children.
One more complication that can be painful is acute acalculous cholecystitis, which is inflammation of the gallbladder without gallstones. It is generally treated with pain relievers and anti-vomiting drugs. Some patients chose to have their gallbladder removed through laparoscopic surgery due to unbearable stomach pain.
In addition, the Epstein Barr virus can also lead to other issues such as inflammation of the heart muscle, brain inflammation, excessive activation of the immune system, inflammation of the pancreas, and autoimmune hemolytic anemia, where our immune system destroys our own red blood cells. Furthermore, the virus has also been implicated in causing certain types of cancer like lymphomas and nasopharyngeal cancers.
- Spleen rupture due to infectious mononucleosis
- Airway blockage due to swollen throat tissues
- Acute acalculous cholecystitis (inflammation of the gallbladder without gallstones)
- Inflammation of the heart muscle
- Brain inflammation
- Excessive activation of the immune system
- Inflammation of the pancreas
- Autoimmune hemolytic anemia
- Lymphomas (type of cancer)
- Nasopharyngeal cancers (cancer of the area where the nose and throat connect)
Preventing Epstein-Barr Virus (Mononucleosis or Mono)
If a person is infected, they should be careful not to share things like utensils and drinks with others, and they should avoid kissing. This is because EBV, a type of virus, is passed from person to person through saliva.
If the infected person plays sports, they should get approval from a doctor or a trained healthcare provider before they start playing again. They should typically wait at least three weeks and make sure any swelling in the spleen (a soft, spongy organ in your body that helps to fight infection) has completely gone down. This wait is crucial to reduce the chance of a splenic rupture, which is a serious condition where the spleen can burst.
