Epstein-Barr Virus: Symptoms, Causes, and Treatment

cancer. Therefore, it’s important not to underestimate infections. If you experience any worrying symptoms, consult a doctor.

Epidemiology 

Did you know that over 90% of adults in the world have been infected with the EBV at some point in their lives? This shows how common EBV infections are. Fortunately, in most cases, they are mild or asymptomatic. However, there are also serious situations requiring hospitalisation and specialist treatment, as EBV infections can lead to many complications.

Children are most commonly affected, but not infants. They naturally have high levels of antibodies that protect against the virus. Unfortunately, these levels decrease with age, which means that adults may suffer more severely from the disease.  

Transmission – How EBV Spreads?

The Epstein-Barr virus can enter the body in various ways. The pathogen spreads through the exchange of bodily fluids. In certain situations, the risk of infection is particularly high. Once it enters the body, the virus enters the bloodstream and then penetrates the cells of the immune system, primarily B lymphocytes, as it multiplies within them. At this point, an infection develops, and the immune system begins to respond, resulting in various symptoms. Once the body controls the infection, the virus becomes dormant and can remain inactive for many years. See how EBV can be transmitted to humans. 

Contact with an Infected Person 

The EBV virus is contagious and easily transmitted from person to person. The closer your contact with an infected person, the greater the risk of infection. It is not without reason that mononucleosis has also been referred to as the “kissing disease.” The saliva of an infected person can also transmit the virus during conversation, sneezing, or coughing. Tiny droplets float in the air and enter the nose or mouth of another person. Infection can also occur by drinking from the same bottle, using shared cutlery or other objects, as the virus can settle on surfaces.

Interestingly, doctors observe the highest number of EBV infections from June to September, during the summer months. This is due to the increased frequency of meetings and greater interpersonal contact during this period. It is also worth remembering that even those who show no signs of illness can pass the virus on to others. At the same time, there is no risk of infection from animals.

Organ Transplants and Blood Transfusions 

The EBV virus is mainly transmitted through bodily fluids, most commonly through saliva, but also through blood. For this reason, infections can happen during certain medical procedures, such as organ transplants or blood transfusions. EBV infections are one of the most common complications in recipients of organ and haematopoietic cell transplants.

However, the risk of infection depends on many factors. Individuals with weakened immune defenses face a much higher risk of infection, and the disease can develop within 4–6 months after a transplantation. In the case of blood transfusions, the risk of infection remains much lower because medical staff thoroughly test donor blood for various pathogens before giving it to the recipient.

EBV Diseases 

Epstein-Barr virus can lead to a range of diseases, and the most common among them is infectious mononucleosis. The infection primarily affects children and adolescents, although adults can also become infected. Complications may arise during or after the infection. Milder complications include pharyngitis and tonsillitis, while more severe cases may lead to pneumonia, myocarditis, or viral hepatitis. 

In rare cases, the Epstein-Barr virus can cause acute neurological disorders. This typically occurs when the pathogen enters the central nervous system. Such complications include meningitis, encephalitis, and Guillain-Barré syndrome. 

The Epstein-Barr virus may also play a role in the development of certain rare cancers. Although it usually remains dormant in cancer cells, even a small number of active infected cells can promote the development of cancerous changes by releasing growth factors and cytokines with oncogenic effects. For this reason, EBV is associated with the development of stomach cancer, lymphomas, and nasopharyngeal cancer. 

Scientists are also investigating the role of the virus in the development of certain mental disorders (depression or chronic fatigue syndrome), as well as autoimmune diseases. EBV may influence the expression of genes associated with autoimmune diseases, including Hashimoto’s disease, lupus, type 1 diabetes, rheumatoid arthritis, coeliac disease, inflammatory bowel disease and multiple sclerosis. EBV therefore remains not only an important infectious agent, but also a potential factor influencing the development of autoimmune and neurological diseases.

Symptoms 

After the Epstein-Barr virus enters the body, the first symptoms usually appear after 4–6 weeks. However, this pathogen has the ability to remain dormant and can reactivate even after many months or years following the initial infection. 

The symptoms depend on the disease caused by the virus, but most often resemble a typical viral infection. Fever, general fatigue, sore throat, and muscle pain appear. In the case of mononucleosis, the elevated temperature may persist for several weeks. A common symptom is also a rash, which can take the form of spots, blisters, or papules. In mononucleosis, it typically appears as bright red spots on the skin of the hands and feet. 

Many people also experience enlarged lymph nodes, especially in the neck, behind the ears, or under the arms. These can be felt as small lumps under the skin. Medical examinations often also reveal an enlarged spleen and liver. This can cause discomfort, pain or a feeling of fullness, usually on the left side under the ribs or in the middle of the chest.

Diagnosis

Symptoms of Epstein-Barr virus (EBV) infection are often nonspecific and can resemble other viral or bacterial infections. For this reason, doctors may order various tests to rule out other causes of the symptoms. One of the basic tests is a complete blood count. In cases of mononucleosis, doctors often see an elevated number of white blood cells and the presence of atypical lymphocytes.

To definitively confirm an EBV infection, doctors perform serological tests that detect antibodies or antigens in the blood, and sometimes in urine or saliva. By analyzing the antibody–antigen reaction, doctors can determine whether the body has encountered the virus and whether an active infection is currently present.

Additionally, a doctor may order liver function tests to check the levels of liver enzymes. Elevated enzyme levels often accompany mononucleosis and may indicate complications, such as hepatitis. 

Treatment 

Infectious mononucleosis, like other viral infections, is typically treated symptomatically. In case of fever, antipyretic and pain-relieving medications are used, and in severe airway swelling, corticosteroids may sometimes be necessary. Standard recommendations also include getting plenty of rest and drinking enough fluids. Symptoms usually resolve within a few weeks to a few months.

In some cases, when bacterial complications occur, such as throat infections, antibiotics may be indicated. In severe situations, such as airway obstruction or other serious complications, treatment is carried out in a hospital. The prognosis is generally good, except in cases of neurological or hematological complications or splenic rupture.  

The Epstein-Barr virus, once it enters immune cells, remains in them for the lifetime of the infected person. A weakened immune system can trigger the awakening of the pathogen. To reduce the risk of infection, it is important to follow preventive measures, such as maintaining good hygiene and strengthening immunity through a healthy lifestyle. Research is also currently being conducted on a potential vaccine against this virus, which could help reduce infections in the future.  

Epstein-Barr Virus – Summary

Most people carry the Epstein-Barr virus without showing any symptoms. It spreads primarily through the exchange of bodily fluids, especially saliva. Close contact with an infected patient increases the possibility of transmission. The pathogen primarily causes infectious mononucleosis, which affects children and adolescents. Symptoms typically appear several weeks after infection and resemble those of a common viral illness. Doctors diagnose EBV infections using blood and serological tests. Treatment for EBV infection is mostly symptomatic. Severe cases may require hospitalization.  

Sources

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