What Is Epstein Barr Virus

The Epstein-Barr virus (EBV) is a widespread and contagious disease.

It is a viral infection that is highly common and spreads through bodily fluids like saliva. Also known as Human Herpesvirus 4, EBV is a class of herpes virus. 

Most EBV infections are asymptomatic - if you contract EBV, the infection lives inside your body for the rest of your life in a dormant state. Regardless of when you got the virus, it can reactivate and cause new symptoms later in life.¹

Complications are more likely to arise down the road if the main EBV infection is persistent - that is, if it reactivates. Moreover, Burkitt's lymphoma, nasopharyngeal carcinoma, and Hodgkin's lymphoma have all been connected to EBV. As such, knowing how to avoid it and what to look out for is crucial, as it has been linked to several serious ailments.

Overview

B lymphocytes - a type of immune cell - are the main target for infection by the Epstein-Barr virus (EBV). 

First identified in 1964, EBV is a member of the herpesvirus family. It was initially identified in cells from patients with Burkitt's lymphoma; however, later it was determined that EBV isn’t associated with cancer and is actually widely spread worldwide. In the world, EBV has infected nearly 95% of people. 

EBV can trigger an array of illnesses and is transmitted through body fluids, especially saliva. It is an infectious agent that causes mononucleosis.²

The EBV virus has a structure similar to other herpes viruses. It consists of an outside envelope with various glycoprotein spikes, viral DNA inside an icosahedral capsid, and a viral tegument that covers the space between the nucleocapsid and the outer envelope. Glycoproteins found in the virus's envelope are crucial for attachment to and entrance into the host cells (B cells and epithelial cells). After its entrance, the virus manipulates the molecular machinery in these host cells, forcing them to replicate the viral genome, allowing EBV to multiply within the infected cells. The virus induces the differentiation of B cells into memory B cells, a specialised type of immune cells that retain information about microorganisms that have previously infected us so that if the same organism infects us again, the body can create a faster and more robust defence against it. These memory B cells remain dormant in circulation until a trigger prompts their reactivation.^3,4

The Epstein-Barr virus typically affects kids, teens, and young adults; however, anybody can contract the infection. The prevalence is higher amongst children and teenagers from impoverished and less educated backgrounds, or live in older households. EBV prevalence amongst children and adolescents aged 6 to 19 was 66.5% in the United States - the prevalence amongst adolescents aged 18 to 19 and children aged 6 to 8 is 82.9% and 54% respectively. The difference in infection rates between males and females was negligible. 

The Epstein-Barr virus has a different prevalence across the globe. Among children aged 11 to 24 in England, the prevalence rate was almost 74.6%. Research in China found that the prevalence rate was over 50% at the age of three and over 90% by the time the child was 8 or 9 years old. The infection rates tend to rise between June and August, probably because more people travel throughout the summer.^1,2

Causes of epstein barr virus

Without a doubt, the Epstein-Barr virus is highly contagious. The time between exposure to the virus and the onset of symptoms, known as the incubation period, is when patients are able to spread the virus.

EBV spreads through:

• Saliva: the virus can spread while: kissing; coughing or sneezing; sharing beverages and meals; or using the same toothbrushes, utensils, or cups. This is because it remains on these objects for extended periods of time. It’s also possible to become infected when holding things that kids have drooled on
• Blood transfusions
• Organ transplants
• Exchange of bodily fluids like blood and sperm during sexual activity

As mentioned above, EBV infects epithelial cells and B cells in your body. Given the role played by B cells in our immunity, their infection hinders our body’s capacity to fight off the infection. As the virus adheres and infects cells, our immune system attempts to eliminate it, thus causing symptoms to occur.

You can spread the virus for weeks or even months before you get symptoms if you have an EBV infection for the first time. 

Further, the virus remains dormant (inactive) once it has entered your body and, no matter how long it has been since the first infection, if the virus is reactivated, you  can once again potentially infect others with EBV and experience symptoms. EBV reactivation can result from stress, a weak immune system, hormone alterations, or menopause.^1,5

Signs and symptoms of epstein barr virus

The intensity of the symptoms varies for each person.The most typical signs are:

• Fatigue - this is a common symptom of infectious mononucleosis, and is experienced by the majority of patients. Usually, it gets better after three months; however, it’s possible to develop chronic fatigue syndrome, which often lasts for around a year
• Fever - an EBV infection typically results in low-grade fever, though it is usually not accompanied by chills
• Swollen lymph nodes (also referred to as lymphadenopathy)
• Pharyngitis - a sore throat condition. Those who suffer from pharyngitis due to the EBV frequently also have painful, swollen tonsils. One of the most noticeable signs of glandular fever is a sore throat
• Nausea, vomiting, and appetite loss
• Headaches
• Body pains
• Swollen spleen and liver - Up to 50% of mononucleosis patients experience swelling of the spleen. In this case, it’s possible for the spleen to rupture, which is a serious medical emergency
• Skin rash - The rash linked to infectious mononucleosis is flimsy, red, not itchy, and usually goes away fast
• Jaundice - Older adults with infectious mononucleosis are more likely to develop jaundice⁶

Complications of epstein barr virus

There are various problems associated with Epstein-Barr virus. Serious problems are rare; however, if they do arise, given their potential severity, they should be handled immediately as a medical emergency.

Potential complications that may occur due to an infection with EBV include:

• Neurological problems: Children are more prone than adults to experience neurological involvement, but it is uncommon in both age groups. EBV can, in rare circumstances, cause enlargement of the brain and meningeal membranes, which surround and stabilise your brain. The infection of these tissues, also known as meningoencephalitis, causes symptoms like headaches, disorientation or confusion, trouble thinking clearly, lack of coordination, bizarre or inconsistent behaviour and rigid neck

• Splenic rupture: Can occur as a result of swelling and enlargement of the spleen, which typically peaks 10 to 21 days after infection. Although rupture typically causes pain, it can also occasionally result in low blood pressure (hypotension) without any discomfort

• Respiratory problems: The infection can cause lymph nodes to swell. In turn, the swelling of the lymph nodes around the pharynx and the trachea can lead to upper airway obstruction from pharyngeal or paratracheal lymphadenopathy. This causes a painful sore throat as well as enlarged tonsils (tonsillitis). In rare cases, the tonsils may grow to the point where they touch, partially or almost entirely obstructing the airway. This can occur with and without a subsequent bacterial throat infection and may manifest even when other severe symptoms of infectious mononucleosis are not present

• Hepatic problems: it affects about 95% of patients. Infected people may experience increased aminotransferase levels (about 2 to 3 times) over 3 to 4 weeks, which can indicate damage to the liver
• Cancer - EBV genes can cause cancer by altering the development and division of infected cells and making them malignant. Cancer caused by EBV infection include some types of stomach cancer, nasopharyngeal cancer, Burkitt’s lymphoma, and Hodgkin’s lymphoma. Several other malignancies, such as breast and prostate cancer, may also be affected^6,7

Diagnosis for epstein barr virus

First, a precise diagnosis of the illness is required to devise an adequate plan for its management. Infection can be confirmed through laboratory tests in addition to a physical examination and assessment of the symptoms shown by the infected person.

These tests include:

• Full Blood counts

The results of the complete blood count allows the doctor to understand whether abnormal white blood cells - which are indicative of an EBV infection - is present, as well as to assess the body's immunological response to the virus. For someone infected with EBV, the test results will typically show unusually high quantities of white blood cells and low levels of platelets

• Heterophile/ Monospot antibody test

This test is considered the most effective initial diagnostic test for infectious mononucleosis (IM) caused by EBV. Around 85% of patients with IM caused by EBV will have a positive test result. However, due to decreased antibody levels during the first week of symptoms, there is a chance of false negative results for 25% of patients

• Test for liver function

In the initial stages of infection, abnormal liver function tests are seen in about 80% of individuals with infectious mononucleosis. They typically present with elevated levels of enzymes, particularly alanine aminotransferase

• Test for EBV-specific antibodies

IgG and IgM antibody tests detect antibodies produced by the organism to specifically target the EBV viral capsid antigen (VCA). This type of test is required to establish a diagnosis when the illness is acute.

After the acute phase, patients can be diagnosed through an immunofluorescent test that detects the EBV nuclear antigen (EBNA). Immunofluorescent tests are based on a fluorescent reaction that is triggered when antigens in the patient’s sample bind with the EBNA, allowing technicians to easily visualise a positive result. The EBNA gradually appears after the acute phase of the infection, typically two to four months after the onset of symptoms, and remains in the body for the rest of the patient’s life. As such, tests that detect this antigen are particularly useful when trying to differentiate between acute and past infections.

Although the sensitivity and specificity of VCA and EBNA antibody tests are better, their cost and time requirements are high. As such, it may be preferable to opt for molecular techniques like PCR, which allows for viral detection and quantification can be accomplished.^4,6

Management and treatment for epstein barr virus

The Epstein-Barr virus has no known treatment or vaccine for preventing its spread. Instead, the treatment focuses on the symptoms that develop as a result of the infection - symptoms should subside within two to four weeks. 

In order to reduce fever, sore throats and avoid dehydration, it is important to stay hydrated and have proper rest. To ease throat pain, gargle with salt water or swallow lozenges.

Over-the-counter medications can also be used to help ease the fever and pain, such as ibuprofen and paracetamol.

It's crucial to obtain adequate sleep to avoid worsening symptoms. If you experience splenic enlargement, you should refrain from engaging in strenuous physical activity that could result in a ruptured spleen.^1,8

Most importantly, you should take precautions to prevent the virus from spreading, such as:

• Avoid kissing and sharing foods, beverages, and personal items like toothbrushes, and eating utensils with an EBV-infected person
• Avoid sharing items covered in newborns' spit and drool
• Handwashing and good personal hygiene help limit virus transmission
• The risk of virus transmission reduces by efficient viral testing and blood screening⁴

Summary

While most Epstein-Barr virus infections don't cause serious health problems, they might affect your ability to go about your typical everyday activities. Before the situation gets worse, one should be on the lookout for signs and symptoms and visit the doctor right away. You should be cautious and seek the necessary testing because coronavirus symptoms may resemble those of EBV. To avoid the infection from harming your health, be sure to keep hydrated and get enough rest. Stay at home if you have symptoms to reduce the spread of EBV.