What is it?
Epstein-Barr virus (EBV) is a member of the herpesvirus family that can infect humans. EBV infections are very common — you’ve probably already contracted the virus without even knowing it.
The condition that you may associate EBV infection with is infectious mononucleosis, or mono. However, experts are researching potential links between EBV and other conditions, including cancer and autoimmune diseases.
Read on to learn more about EBV, including common symptoms of an infection and how the virus spreads.
What are the symptoms?
EBV infections don’t always cause symptoms. This is especially true for children.
Teens and adults are more likely to experience symptoms, which can include:
- feeling tired or fatigued
- sore throat
- swollen lymph nodes in your neck or under your arms
- swollen tonsils
- enlarged spleen (splenomegaly)
- skin rash
These symptoms can last for two to four weeks, though feelings of fatigue may linger for weeks or months.
What about symptoms of reactivation?
Once you’ve been infected with EBV, the virus remains inactive within your body for the rest of your life. This is called latency.
In some cases, the virus can reactivate. But this usually doesn’t cause any symptoms.
However, reactivated EBV may cause symptoms similar to those of an initial EBV infection in people who have a weakened immune system.
How does the virus spread?
EBV spreads from person to person through bodily fluids, particularly saliva. This is why mononucleosis, one of the most well-known EBV infections, is casually known as the “kissing disease.”
But you can also get the virus by sharing personal items, such as toothbrushes or eating utensils, with someone who has an active EBV infection. EBV can also be spread through blood and semen.
You can start spreading EBV to others as soon as you contract it. This means you can pass it on to others before you even start to have symptoms of an active infection.
You’ll be able to pass EBV on to others as long as the virus is active, which could mean weeks or even months. Once the virus becomes inactive, you can no longer spread it to others, unless it reactivates.
Is there a test for it?
Potential EBV infections are often diagnosed without any testing. However, blood tests can detect the presence of antibodies associated with EBV.
One of these is known as the monospot test. However, the Centers for Disease Control doesn’t recommend it for general use because the results aren’t always accurate.
In addition to the monospot test, there are other blood tests for more specific antibodies to EBV, including:
- Viral capsid antigen (VCA). Antibodies to VCA appear early in the infection. One type (anti-VCA IgM) disappears after several weeks while another (anti-VCA IgG) persists for life.
- Early antigen (EA). Antibodies to EA appear during an active infection. They typically become undetectable after several months, although they may persist for longer in some people.
- EBV nuclear antigen (EBNA).Antibodies to EBNA slowly appear in the months following infection and can be detected throughout a person’s life.
A healthcare provider will take these results and other factors into account, including a person’s overall health and any underlying health conditions, to make a diagnosis.
How’s it treated?
There’s no specific treatment or vaccine for EBV. And because they’re caused by a virus, EBV infections don’t respond to antibiotics.
Instead, treatment focuses on managing common symptoms. This includes:
- getting enough rest
- drinking plenty of fluids
- taking over-the-counter pain relievers to ease fever or sore throat
- avoiding contact sports or heavy lifting
Can it lead to complications?
In some cases, EBV infections can lead to complications, some mild and some serious.
- rupture of the spleen
- low platelet count (thrombocytopenia)
- conditions affecting the nervous system, including encephalitis, meningitis, and Guillain-Barre syndrome
If you suspect you may have an active EBV infection, it’s best to see a healthcare provider if you are concerned about your symptoms. They can monitor you for signs of complications and give your more information about what to look for as you recover.
Can it cause cancer?
EBV infection can increase the risk of developing certain rare cancers. This is because mutations in cells infected with EBV can lead to cancerous changes.
Some types of cancer that are associated with EBV include:
- Nasopharyngeal cancers
- Burkitt’s lymphoma
- Hodgkin’s lymphoma
- Gastric adenocarcinoma (stomach cancer)
EBV-associated cancers are uncommon, particularly outside of Africa and some parts of Southeast Asia. Most people who have had an EBV infection will not go on to develop one of these cancers. Experts are still trying to identify these specific mutations and why EBV infection seems to cause them. But overall, it’s estimated that EBV infection contributes to only one and a half percent of cancers worldwide.
Can it cause other health conditions?
EBV may also play a role in the development of other health conditions, including autoimmune disorders and schizophrenia.
EBV has long been thought to be linked to autoimmune disorders, such as lupus. Experts believe that EBV may cause changes in the way some genes are expressed. This altered gene expression could increase your risk of developing an autoimmune disorder.
One recent study found a potential link between EBV and an increased risk of developing lupus, an autoimmune condition.
The study’s authors believe that same mechanism linking EBV and lupus may also link EBV to other autoimmune conditions, including:
- multiple sclerosis
- rheumatoid arthritis
- celiac disease
- type 1 diabetes
- inflammatory bowel disease
- juvenile idiopathic arthritis
- thyroid autoimmune diseases, including Hashimoto’s disease and Grave’s disease
Still, more research is needed to fully understand the potential link between EBV and autoimmune conditions.
A recent study looked at the rates of EBV infection in more 700 people both with and without schizophrenia. Those with schizophrenia had higher levels of antibodies to some EBV proteins than those who didn’t, suggesting they had an unusual immune response to the virus.
The researchers also found that participants with genetic risk factors for schizophrenia as well as elevated antibodies were over eight times more likely to have schizophrenia than the control group. Further research is needed to study any possible link between EBV infection and schizophrenia.
What about chronic EBV?
In very rare cases, EBV infection can lead to a chronic condition called chronic active EBV (CAEBV). CAEBV is characterized by ongoing symptoms and blood test evidence of an active EBV infection.
It starts out as a typical EBV infection. However, some people’s immune systems aren’t able to control the infection, allowing the active virus to linger instead of going dormant.
Experts aren’t sure why some people develop CAEBV. But they believe genetic factors or mutations in EBV-infected cells may play a role. In addition, CAEBV is more common in Asia, Central America, and South America.
Currently, the only effective treatment for CAEBV is a hematopoietic stem cell transplant.
Over time, CAEBV can cause several complications, including:
- weakened immune system
- hemophagocytic syndrome, a rare immune disorder
- organ failure
The bottom line
EBV infection is very common and is spread by coming into contact with infected bodily fluids. Often, people are infected during childhood and don’t experience any symptoms. If a teenager or adult is infected, they may experience symptoms like fatigue, swollen lymph nodes, and fever.
In very rare cases, EBV can cause a chronic infection, which can be fatal if left untreated. EBV has also been linked with a variety of conditions, including cancers and autoimmune disorders. However, additional research is needed to determine EBV’s overall role in these conditions.