Epstein-Barr virus

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Epstein-Barr is the virus that causes mononucleosis. You might know this disease better by its nickname, “mono.” It’s also called the “kissing disease” because of one way you can spread it to someone else.

Even though Epstein-Barr virus (EBV) isn’t a household name, you’ve probably been infected without knowing it. Lots of people carry the virus but don’t get sick.

Symptoms

Once you’re infected with EBV, symptoms can take 4 to 6 weeks to show up. When they do, they’re often mild, especially in young children. Kids’ symptoms may be more like those of a cold or flu. Teens often have more obvious symptoms of mono.

If you do get symptoms, most likely you’ll have:

  • Fatigue
  • Fever
  • Lack of appetite
  • Rash
  • Sore throat
  • Swollen glands in the neck
  • Weakness and sore muscles

What Tests Diagnose Epstein-Barr Viral Infections?

The diagnosis of mononucleosis starts with a detailed history and physical examination. The doctor will look for fever, an inflamed or sore throat, swollen lymph nodes in the neck, and an enlarged spleen. Red dots (catechize) may be seen on the palate. Up to half of infected people will have an enlarged spleen, and 10% will have an enlarged liver on abdominal examination. People with suspected mononucleosis will have a blood sample drawn for blood counts and a “mono spot” test. If the mono spot is positive, the diagnosis is confirmed. Mono spots may be falsely negative in children under 4 years of age or in the elderly. Repeating the test at a later date may be helpful in these cases. Other viruses and pathogens may cause an illness that is similar to mononucleosis (for example, megalomaniacs, adenovirus, and Protoplasm), so additional blood may be drawn to test for other pathogens.

In infected people, the number of normal lymphocytes (B cells) in the blood is usually increased and the cells may look unusual or “atypical” under the microscope. Approximately 1%-3% of people develop anemia, which is caused by destruction of the red blood cells (hydrolysis). Platelet counts may be low in up to half of patients, although this does not usually result in bleeding. In some cases, blood cells may be destroyed by other blood cells (hemorrhagic syndrome). Mild elevations in liver enzymes in the blood are common.

Several antibody tests are available to determine if a person has had a past infection or a current/recent infection with EBV. Some antibodies occur early and are transient, thus indicating new or “acute” infection. These include IgM antibody to the viral caps id antigen (VCA). Some antibodies develop immediately and persist for life, such as the IgG antibody to the viral caps id antigen. Other antibodies develop three to four weeks into the illness and persist for life, including antibodies to the nuclear antigen (EBNA). Antibodies to early antigen (EATING) may arise during acute infection and may persist, go away, or recur. PCR tests that detect EBV DNA are available in some laboratories.

Many physicians use three laboratory criteria (lymphocytes, 10% or more lymphocytes are atypical on a peripheral blood smear, and a positive seismologic test for EBV) along with the history and physical findings listed above to confirm a diagnosis of acute infectious mononucleosis. About 90% of adults have antibodies indicating that they had infections in the past.

The Epstein-Barr virus is contagious and is spread from person to person.EBV is contagious during the incubation period and while symptoms are present; some individuals may be contagious for as long as 18 months.EBV is transmitted from person to person mainly by saliva; however, other body fluids may transmit the disease. Items contaminated with bodily fluids like saliva (toys, utensils, cups, for example) may also transmit the disease.The incubation period for an Epstein-Barr virus infection is about four to seven weeks.The symptoms and signs of an EBV infection may include malaise, fever, muscle aches, headaches, sore throat, lymph node swelling, liver swelling, rash, and spleen swelling.Preliminary diagnosis of EBV infection is based on the patient’s history and physical exam; physicians may also use immunological tests that vary in specificity.Treatment of EBV infection is mainly supportive (see home remedies section); some health care providers use cortisone treatment.Home remedies that may help reduce symptoms are rest, fluids, over-the-counter (OTC) pain medications, and avoiding trauma that can further injure organs like a swollen spleen.The possible complications of EBV infection may include an enlarged spleen, jaundice, liver inflammation, anemia, splenetic rupture, swollen tonsils, breathing difficulties, rash, irregular heartbeats, and a possible increased risk for cancer.The majority of people with EBV have a good prognosis; a few have a more guarded prognosis.There is no vaccine for EBV, and prevention is difficult. Risk can be reduced by not contacting body fluids from infected individuals and practicing good hand-washing techniques.

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