The Epstein-Barr virus (EBV) is one of the most widespread human viruses and a member of the herpesvirus family, officially known as human herpesvirus 4. Most people will become infected with EBV at some point in their lives, often during childhood, and many will not experience any symptoms. Following the initial infection, the virus remains in the body in an inactive state for life.
How Epstein-Barr Virus Spreads
Epstein-Barr virus is a contagious infection that spreads through close person-to-person contact. The most common vehicle for transmission is saliva, which has led to infectious mononucleosis being nicknamed “the kissing disease.” The virus can also spread by sharing personal items that have come into contact with an infected person’s saliva, such as drinking glasses, eating utensils, or toothbrushes.
While saliva is the main route, EBV can also be transmitted through other bodily fluids like blood and semen, meaning it can be spread through sexual contact, blood transfusions, and organ transplants. A person is contagious for weeks after infection, even before any symptoms appear. Once the virus establishes a permanent, inactive presence, it can periodically reactivate, allowing an individual to spread it to others long after the initial infection.
Infectious Mononucleosis Symptoms
When EBV infection causes illness, it most often manifests as infectious mononucleosis, or mono, with symptoms appearing four to seven weeks after exposure. A defining characteristic is extreme fatigue that can be intense for the first few weeks and may linger for months. This is often accompanied by a high fever, muscle aches, and headaches.
A severe sore throat is another common symptom, which can include swollen tonsils with a whitish-yellow coating. Other signs include swollen lymph nodes, particularly in the neck, armpits, and groin. Many people with mono also experience a swollen spleen, and in some cases, the liver may become inflamed.
The presentation of symptoms depends on the age of infection. Young children who contract EBV often have no symptoms or only mild ones resembling other brief illnesses. Adolescents and young adults are more likely to develop the severe symptoms of mononucleosis that can disrupt activities for weeks or even months.
Diagnosis and Treatment of EBV Infection
A healthcare provider diagnoses an EBV infection by evaluating a patient’s symptoms and conducting a physical exam. The exam might reveal swollen lymph nodes in the neck, tonsils with a white coating, or an enlarged liver or spleen. Because mono’s symptoms overlap with other illnesses, blood tests are necessary to confirm the diagnosis.
One common tool is the Monospot test, a rapid blood test that detects specific antibodies produced during a mono infection. For more definitive results, an EBV antibody panel can determine if an infection is current, recent, or past. A complete blood count may also show an increased number of a specific type of white blood cell, known as atypical lymphocytes, which is characteristic of an EBV infection.
There is no specific antiviral medication or cure for Epstein-Barr virus. Treatment is supportive and focuses on managing symptoms. This includes getting plenty of rest, staying hydrated, and using over-the-counter medications like acetaminophen or ibuprofen to relieve fever and body aches. Individuals with an enlarged spleen must avoid contact sports and strenuous physical activity to prevent the risk of the spleen rupturing, a rare but serious complication.
Long-Term Health Associations
After an initial EBV infection resolves, the virus enters a latent phase within certain immune cells, specifically B cells, where it remains for life. For most people, this latent virus causes no further issues. However, the virus can reactivate, particularly in individuals with weakened immune systems, and has been scientifically linked to the development of several other health conditions.
EBV is recognized as an oncovirus, meaning it can play a role in the development of certain cancers. These associations include specific types of lymphomas, such as Burkitt’s lymphoma and Hodgkin’s lymphoma, as well as nasopharyngeal carcinoma and some forms of stomach cancer. The virus is thought to contribute to these cancers by altering the infected B cells and interfering with normal cell growth regulation.
There is also a strong association between EBV infection and autoimmune diseases, most notably multiple sclerosis (MS). Research indicates that having an EBV infection significantly increases the risk of developing MS later in life. One leading theory is molecular mimicry, where the virus produces proteins that resemble proteins in the nervous system, causing the immune system to mistakenly attack the body’s own nerve cells. EBV has also been linked to other autoimmune conditions like systemic lupus erythematosus and rheumatoid arthritis.