Epstein barr virus symptoms adults

What Is the Epstein-Barr Virus?

By age 35, almost everyone has been infected with Epstein-Barr virus, the most common cause of mononucleosis.

The Epstein-Barr virus (EBV) is in the herpes family of viruses, and is one of the most common human viruses in the world.

By age 35, almost everyone has antibodies to EBV, indicating they’ve been infected with the virus at some point in their life — whether or not they’ve ever had symptoms.

Epstein-Barr Virus and Mononucleosis

EBV is the most common cause of infectious mononucleosis, also known as glandular fever, “the kissing disease” or simply “mono.”

Its characteristic symptoms are:

  • Fatigue
  • Headache
  • Fever
  • Sore throat
  • Swollen lymph nodes

About 30 to 50 percent of the time EBV causes mono, but many EBV infections go unnoticed either because they don’t cause symptoms, or the symptoms are easily confused with other signs of infections.

Teenagers and young adults are especially vulnerable: At least 25 percent of them will develop mono.

Epstein-Barr Virus Causes

EBV is contagious and typically spreads through bodily fluids, especially saliva and other mucous fluids.

Blood and semen can also transmit the virus during sexual contact, blood transfusions, and organ transplants.

You can get EBV by sharing drinking glasses, eating utensils, or toothbrushes with a person who has the virus.

There’s no proof that disinfecting such objects will stop the spread of EBV. It’s thought that the virus can survive as long as the contaminated object remains moist.

A person who’s infected with EBV for the first time can spread the virus for weeks without realizing they’re infected.

Once you’ve had an infection, EBV stays inactive and dormant in your body.

However, if the virus reactivates, you can potentially spread it to others, no matter how much time has passed since your initial infection.

Epstein-Barr Virus Symptoms

When symptoms of EBV occur, they usually go away in two to four weeks.

However, some people may feel fatigued for several weeks or even months.

Symptoms of EBV infection may include the following:

  • Fatigue
  • Fever
  • Inflamed throat
  • Swollen lymph nodes in your neck
  • Enlarged spleen
  • Abdominal pain caused by a swollen liver
  • Rash (sometimes referred to as a “mononucleosis rash”)

Epstein-Barr Virus Diagnosis

Since symptoms of EBV resemble those of other illnesses, an infection can be difficult to diagnose.

However, there are blood tests that can confirm whether or not you’ve been infected with EBV.

The Monospot blood test, for example, checks your blood for the antibodies to EBV.

Epstein-Barr Virus Treatment

There is no treatment for EBV, but the following can help relieve symptoms:

  • Drinking lots of fluids
  • Getting plenty of rest
  • Taking over-the-counter (OTC) pain medications for pain and fever
  • Throat lozenges

Examples of OTC pain relievers and fever reducers include:

  • Tylenol (acetaminophen)
  • Aspirin, for people age 19 and older
  • Advil (ibuprofen)
  • Aleve (naproxen)

People under age 19 should not take aspirin during a viral illness (including mono or EBV) due to risk of Reye syndrome.

While there is no vaccine for EBV infection, you may prevent getting it by avoiding kissing or sharing drinks, food, or personal items (such as toothbrushes) with a person who has it.

Epstein-Barr Virus Complications

In addition to mono, EBV infection can lead to a number of other illnesses and complications, especially in people with compromised immune systems.

These complications include:

  • Viral meningitis, which involves swelling of the tissues that cover the brain and spinal cord
  • Brain swelling
  • Eye nerve swelling
  • Spinal cord swelling
  • Paralysis of facial muscles
  • Paralysis on one side of the body
  • Guillain-Barre syndrome
  • Sudden uncoordinated muscle movement
  • Sleep disorders
  • Psychoses
  • Negative effects on blood and bone marrow, creating an excessive number of white blood cells
  • Weakened immune system, leading to other infections

Epstein-Barr Virus and Cancer

Cancers associated with EBV infection include:

  • Burkitt lymphoma (lymphatic system cancer)
  • Nasopharyngeal carcinoma (upper throat cancer)
  • Hodgkin lymphoma and non-Hodgkin lymphoma (lymphatic system cancers)
  • Post-transplant lymphoproliferative disorder (too many white blood cells after an organ transplant)
  • Tumors, including soft tissue cancers and T-cell lymphomas

Other Conditions and Epstein-Barr Virus

EBV infection can also cause the following:

  • Pneumonia
  • Lung tissue scarring
  • Pancreas swelling
  • Heart muscle swelling
  • Raised, white patches on the tongue
  • Pus-filled tissue near the tonsils
  • Sinus infection (sinusitis)
  • Inflammation of the liver (hepatitis)
  • Lymph node swelling
  • Bacterial infection of the mastoid bone of the skull just behind the ear
  • Salivary gland swelling and injury
  • Blockage of the air passages in the nose and throat

15 Epstein-Barr Virus (EPV, Mono) Symptoms, Causes, Transmission, Treatments, and Prognosis

What Are the Symptoms and Signs Epstein-Barr Virus??

Once the Epstein-Barr virus is acquired (spread from person to person), it takes about four to six weeks for symptoms to appear. Children usually have nonspecific symptoms or no symptoms at all. Rarely, young children may have rashes, pneumonia, or low white blood counts.

Many teenagers and young adults develop symptoms of mononucleosis. Acute mononucleosis causes:

  1. sore throat,
  2. fever,
  3. fatigue, and
  4. swollen lymph nodes.

The sore throat is very painful and is the usual reason for infected people to seek medical attention. Signs and symptoms of mono are;

  1. swollen tonsils,
  2. loss of appetite,
  3. fatigue,
  4. chills,
  5. headache,
  6. bloating,
  7. sore muscles,
  8. body aches,
  9. weakness, and
  10. sweats.
  11. Some people may have dizziness.

Although the symptoms fade in days to weeks, some people complain of fatigue that lasts for weeks after infection, though most people eventually recover completely.

Rash

A small percentage of people develop a rash due to the infection. A rash can also develop in people with mononucleosis who are given ampicillin or amoxicillin. This common reaction does not necessarily mean the patient is allergic to penicillin or related antibiotics.

The appearance of the rash in conjunction with the above symptoms and signs also can lead to misdiagnosis of the EBV.

Enlarged Spleen

The spleen becomes swollen in up to half of people with mononucleosis. The spleen is always engorged with blood, and if it ruptures, it can cause a person with the virus to bleed to death. Blunt trauma to the abdomen, even mild trauma, may result in splenic rupture if swollen. Poeple with mono are usually advised not play sports, especially any contact sports. The spleen may also rupture spontaneously.

Neurological Complications

A very small number of infected people have neurological complications. These include inflammation of the brain (encephalitis), of the lining of the brain (meningitis), or of individual nerves. Less commonly, infection of the spinal cord may occur. The majority of patients with neurological complications recover completely. Rarely, other organs may be involved, including the lungs or heart.

X-linked lymphoproliferative syndrome in boys

Rarely, boys may develop overwhelming infection with EBV known as X-linked lymphoproliferative syndrome. In X-linked lymphoproliferative syndrome, the number of immune cells or lymphocytes (B cells) in the body increases substantially. The lymphocytes infiltrate major organs, often causing severe liver disease or death. Lymphoproliferative syndrome is probably a result of a subtle genetic defect that makes it difficult for the immune system to contain the virus. Organ transplants or bone marrow transplants are also risk factors for developing lymphoproliferative syndrome.

Cancers

In addition to lymphoproliferative syndrome, EBV is considered a risk factor for some cancers. One such cancer is lymphoma of the brain. Lymphoma of the brain is most common in people with advanced AIDS but also occurs in other immunosuppressed states. Nasopharyngeal cancer, Burkitt lymphoma (a type of non-Hodgkin lymphoma), and some types of Hodgkin’s lymphoma are also associated with EBV. The exact mechanism by which EBV helps to transform normal lymphocytes into cancer cells is not fully understood.

Leukoplakia

EBV is associated with a condition called oral hairy leukoplakia. This is a white plaque on the side of the tongue that cannot be removed by gentle scraping. It is most common in people with AIDS or other immunosuppressive states.

Misdiagnosis

Mononucleosis causes fatigue, which can sometimes last for weeks or even longer. Therefore, chronic infection with EBV (CEBV) has been investigated as a cause of chronic fatigue syndrome (CFS), also called systemic exertion intolerance disease (SEID). Studies to date have not been able to find a causal link between EBV and CFS. In CFS, there is a chronic lack of energy often associated with difficulty concentrating or generalized pain.

Chronic Fatiuge Syndrome (CFS)

CFS is more common among women than men and occurs in early to middle adulthood. Blood tests are usually normal. There is no specific diagnostic test for CFS, and the cause remains unknown.

During Pregnancy

During pregnancy, it is rare for a fetus to become infected with EBV even if the mother is infected. Even among women who do become infected while pregnant, there are no documented birth defects that have resulted.

Associated Diseases

EBV is also associated with several autoimmune diseases, including multiple sclerosis, autoimmune thyroiditis, systemic lupus erythematosus, oral lichen planus (OLP), rheumatoid arthritis (RA), autoimmune hepatitis, Sjögren’s syndrome, and Kawasaki disease.

PMC

Epstein-Barr virus (EBV) is a ubiquitous virus that infects at least 95% of the population. Most persons are infected during infancy and early childhood and are asymptomatic or have nonspecific symptoms (1). Infection of adolescents and young adults with EBV often results in infectious mononucleosis with fever, lymphadenopathy, sore throat, and splenomegaly. Additional signs and symptoms can include fatigue, headache, hepatomegaly, and rash. EBV is also associated with a number of malignancies including Hodgkin’s disease, B cell lymphomas, and nasopharyngeal carcinoma. With the exception of the latter disease, EBV is present in B cells where it can result in lytic infection, with production of virus particles, or a latent infection with various patterns of viral gene expression. EBV can result in fatal infections in some hosts. Males with the X-linked lymphoproliferative disease often develop fatal infectious mononucleosis during primary EBV infection. Those who survive the disease often have hypogammaglobulinemia and are at increased risk for developing B cell lymphomas.

Chronic active EBV (CAEBV) disease is a very rare disease in the United States and Europe, but occurs more frequently in Asia and South America. Unlike most EBV disorders, the vast majority of cases of CAEBV in Asia and South America are due to EBV present in either T cells or NK cells. In contrast, EBV is often in B cells in patients with CAEBV in the United States. This disease is defined as (a) beginning with an acute EBV infection, having markedly elevated antibodies against EBV, or having a markedly elevated EBV DNA level in the blood (<300 copies/ug DNA), (b) histologic evidence of organ infiltration with virus-infected cells, and (c) detection of EBV protein or nucleic acid in tissue (2, 3). CAEBV has been reported to be a clonal, oligoclonal, or polyclonal disease (4).

Most patients with CAEBV present with fever, liver dysfunction, and splenomegaly. About half of patients have lymphadenopathy, thrombocytopenia, and anemia (3). Other frequent symptoms (occurring in 20–40% of patients) include hypersensitivity to mosquito bites, rash, hemophagocytic syndrome, and coronary artery aneurysms. Less common features are calcification of basal ganglia, oral ulcers, lymphoma, interstitial pneumonia, and central nervous system disease. The presence of thromobocytopenia, onset at age 8 or older, and infection of T cells with EBV was associated with a poorer prognosis (5). Death is frequently due to liver failure, malignant lymphoma, or opportunitistic infections.

Several immunologic abnormalities have been noted with CAEBV. Patients with T or NK cell disease frequently have elevated levels of pro- and anti-inflammatory cytokines including interleukin (IL)-1β, interferon (IFN)-γ, IL-10, IL-13, IL-15, tumor necrosis factor (TNF)-α, and transforming growth factor (TGF)-β (4, 6). Impaired natural killer (NK) cell activity, lymphokine activated killer (LAK) activity, and EBV-specific cytotoxic T lymphocyte activity were reported in 11 patients with CAEBV when compared to controls (7). EBV-specific CD8+ T cells are often very low or undetectable in CAEBV (8) and impaired cytotoxic T cell responses to EBV-infected NK cells have been reported (9). In one report, EBV-specific cytotoxic T lymphocyte activity was impaired both in children with CAEBV and their parents (10).

The etiology of chronic active EBV is unknown. Early work suggested that the disease might be due to mutant strains of EBV that are impaired for latency and might only result in lytic infection (11). However, a followup study showed that the same lytic strain was present in controls (12). Attention has focused on a host cell genetic abnormality. In one large study 50% of patients had chromosomal abnormalities (3). CAEBV shares some features with X-linked lymphoproliferative disease, which is due to a mutation in SAP (SLAM associated protein). Many patients with CAEBV develop hemophagocytic syndrome; some patients with familial hemophagocytic lymphohistiocytosis have mutations in perforin. Therefore, attention has focused on the SAP and perforin genes as possible causes of CABEV. To date, no cases of CAEBV have been associated with mutations in SAP (3, 13, Cohen et al unpublished data), while one case was reported that was due to mutations in both alleles of the perforin gene (14). Hemophagocytic syndrome was noted in this latter case and the patient had an immature form of perforin and impaired cytotoxic T lymphocyte (CTL) activity based on an in vitro assay. Transcriptional profiling of cells from patients and controls showed that 3 genes-guanylate binding proteins 1 and 5, and tumor necrosis factor-induced protein 6- were upregulated in patients with CAEBV (15).

Numerous agents have been tried for the treatment of CAEBV. While anecdotal reports suggested that antiviral therapy (e.g. acyclovir, ganciclovir, vidarabine) might be effective in some cases of CAEBV (16, 17, 18), antiviral therapy is generally ineffective for this disease. These agents inhibit the viral DNA polymerase and therefore inhibit replication of EBV in lytically infected cells that express the viral polymerase. EBV-infected NK or T cells from patients with CAEBV generally express latent (EBV nuclear antigen -1, latent membrane protein -1, LMP2A), but not lytic (EBV BZLF1, glycoprotein 350) viral gene transcripts (4). Replication of latent EBV in proliferating B cells does not require the viral DNA polymerase, and therefore antiviral therapy is usually ineffective. Immunoglobulin therapy, which can neutralize cell-free virus, has not been successful.

Immunosuppressive agents, such as corticosteroids and cyclosporine, are often used to temporarily reduce symptoms in patients with CAEBV. These agents have been successful for treating hemophagocytic syndrome which is a frequent complication of CAEBV (19). However, the underlying disease must also be treated and these agents have not been successful in curing patients with CAEBV (20). Immunosuppressive agents can inhibit the immune response to EBV and may allow virus-infected cells to proliferate further.

Immunomodulatory therapy has also been tried for the treatment of CAEBV. IFN-α (21) and IFN-γ (22) have been reported to induce remissions in some patients with CAEBV; however, long term follow-ups have not been reported. One patient was reported to respond to IL-2 (23). However, most patients have not responded to these therapies (20). Cytotoxic chemotherapy has also been used to treat CAEBV. A variety of agents have been used including cyclophosphamide, anthracyclines, vincristine, etoposide, and prednisone. In most cases, these agents at best result in a temporary effect, but are not curative and the disease continues to progress over time.

Immune cell therapy has been successfully used in the treatment of EBV lymphoproliferative disease that occurs after solid organ or hematopoietic stem cell transplantation. Autologous LAK cells, lymphocytes from HLA-identical siblings, and autologous EBV-specific CTLs have been used successfully to treat patients with posttransplant lymphoproliferative disease in solid organ transplant recipients. Autologous EBV-specific cytotoxic T cells were used to treat persistent active EBV in one study (24). This disease was defined as fever, fatigue, lymphadenopathy, elevated EBV antibody titers, and increased levels of EBV DNA in blood. However, tissue pathology was not required for a diagnosis, the disease was likely due to EBV in B cells, and the course was much less severe than most cases of CAEBV. Autologous EBV-specific CTLs were successful in 4 of 5 cases, with a 6 to 36 month follow-up.

Infusions of EBV-specific cytotoxic T lymphocytes from an HLA-identical sibling into a boy with CAEBV resulted in transient decreases in EBV DNA in the plasma and decreases in serum levels of TNF-α; however, the patient died of an infection 4 weeks after the last infusion (25). In another report (26), a patient with CAEBV received 13 doses of LAK cells followed by 4 doses of autologous CTLs. While the patient had a transient improvement with reduced fever and reduction of the viral load, pancytopenia persisted. A second patient with NK cell CAEBV received 4 doses of autologous CTLs; however, the viral load and hepatic dysfunction did not improve (26). The authors concluded that the effect of these therapies was very limited.

Matched related myeloablative (27, 28), matched related nonmyeloablative (29, 30, 31), matched unrelated myeloablative (31, 32), and cord blood stem cell transplants (33, 34) have all been reported to be successful in case reports of CAEBV. It is important to note that most reports of transplantation for CAEBV are case reports describing one or a few patients, and as such often report successful cases. In the largest series from a single institution, 8 of 15 patients with CAEBV were alive at a median followup of 40 months (31). Seven patients died at a median of 3 months after transplant; three patients died of transplant related causes, 3 died due to relapsed disease, and 1 died with encephalomyelitis. Older age at diagnosis, higher EBV DNA load in the plasma at diagnosis, and a longer time between onset of infection and diagnosis of CAEBV correlated with a poorer prognosis after transplant.

The paper in this issue of Pediatric Transplantation (35) describes two patients with CAEBV. Both patients had low EBV-specific CTL activity, but normal NK cell activity prior to transplant. One patient had EBV in T cells and the other had virus in NK cells. Both patients were transplanted within 6 months of the diagnosis of CAEBV. After bone marrow transplantation both patients had an excellent response with rapid recovery of EBV-specific CTL activity and a precipitous fall in the level of EBV DNA in the blood. Uehara et al. (29) and Yoshiba et al. (30) reported patients who underwent allogeneic nonmyeloablative stem cell transplants for CAEBV; while EBV-specific CTL activity was not reported prior to transplantation, EBV-specific CTLs were detected 120 days (30) and one year (29) after transplant.

How might transplantation cure CAEBV? Cytotoxic chemotherapy might reduce the burden of EBV-infected lymphocytes, might kill suppressor (or regulatory) T cells, or might make space in the marrow for the new stem cells. Transplanted stem cells can kill the remaining EBV-infected lymphocytes and provide a new immune system capable controlling the virus.

What does the future hold in store for patients with CAEBV? Gotoh et al. (31) reported that patients with CAEBV may have higher rates of transplant-related complications than other patients due to multi-organ failure. Thus, safer alternatives to transplantation should be developed. More recent studies with EBV-specific CTLs target specific viral proteins. T or NK cells from many patients with CAEBV express EBV EBNA-1, LMP1, and LMP2; however, the cells may not express EBNA-2 (4) or the EBNA-3 proteins (36). The EBNA-3 proteins are the immunodominant epitopes recognized by most EBV-specific CD8+ T cells in healthy persons (37). Therefore, CTLs specific for EBV LMP1 and LMP2 may be more effective than total EBV-specific T cells (that predominantly recognize EBNA-3) for patients with CAEBV. LMP2-specific T cells have recently been used to treat patients with EBV-positive lymphomas which express EBNA-1, LMP1, LMP2, but not EBNA-2 or EBNA-3 (38). Thus, treatment directed against specific EBV proteins may provide a safer and more specific therapy for CAEBV in the future.

Epstein Barr | Mononucleosis

Prevention of illness can sometimes be tricky. Certain viruses have no vaccines and can spread from person-to-person easily.

EBV is a virus that is often seen in children, adolescents, and young adults. In young adults and adolescents EBV infection may cause an extended flu like illness commonly known as infectious mononucleosis (mono). MaineHealth wants you to know how to stay protected and when to seek medical help.

What is Epstein-Barr virus?

Epstein-Barr is a virus that comes from the herpes family. It often is the cause for mono. The virus attacks different parts of your body and can leave you feeling ill for weeks.

Like chicken-pox, EBV can stay in your body for years. Typically it causes no problems and does not pose a risk of infection to others. However, in certain situations or in patients with weak immune systems reactivation of Epstein-Barr can occur.

Is Epstein-Barr contagious?

EBV and mono are often seen in children, adolescents, and young adults. Many times children go undiagnosed, because the symptoms are similar to many other childhood illnesses. Adults can develop immunity and are less likely to get mono.

Epstein-Barr and mono are transmitted through bodily contact, especially saliva. Coming into contact with infected blood and semen can also spread the virus.

The virus can be caught from:

  • Kissing

  • Sharing food or drinks

  • Sharing cups, utensils, or toothbrushes

  • Coming into contact with children’s toys that have been drooled on

Epstein-Barr symptoms

In children first time EBV infection is typically mild and may go unrecognized. In adolescents and young adults, however, first time EBV infection frequently causes the viral syndrome known as mono. In this case symptoms do not usually appear until four to six weeks after infection and are typically more severe than EBV infection in young children. Depending on the severity of infection, symptoms can last from two weeks to six months. Typical symptoms include:

  • Fever

  • Fatigue

  • Inflamed throat

  • Swollen lymph nodes

  • Enlarged spleen

  • Enlarged liver

  • Rash

The virus can be spread weeks before symptoms appear. Contact your provider or go to your local walk-in care if you have symptoms of EBV or mono.

EBV and mononucleosis screening

Mono is typically diagnosed by evaluating symptoms. Tests can be done to determine the cause of infection in atypical mono cases.

Diagnosing EBV can be difficult, because the symptoms are similar to other illnesses. Simple blood tests can be done to determine EBV and mono presence.

An EBV antibody test can determine if the virus is in the blood. The monospot tests recognizes mononucleosis antibodies, but it may be unreliable early on in the course of illness.

Other blood tests may show:

  • An increase in white blood cells

  • Abnormal white blood cells

  • Decreased platelets

  • Abnormal liver function

Treating EBV and mono

  • Self-care and symptom treatment is typically the treatment process for EBV and mono. Medication may be prescribed to treat specific symptoms, such as corticosteroids to reduce swilling of the throat and tonsils.

  • Make sure to drink lots of fluids to stay hydrated. Getting enough rest is critical for proper recovery. Over the counter pain medication can help with symptoms. Aspirin should not be taken to combat EBV or mono due to serious risk of Reye syndrome.

  • When the spleen is enlarged and inflamed due to mono there is a risk of injury if there is any trauma. Be sure to ask your doctor about restrictions on activities such as contact sports.

  • Other illnesses like hepatitis may be develop in certain patients. Visit your doctor or local walk-in care if you show symptoms and believe you could have EBV or mono.

DOCTOR’S VIEW ARCHIVE

Medical Author: Melissa Conrad Stoppler, MD
Medical Editor: William C. Shiel Jr., MD, FACP, FACR

The Epstein-Barr virus (EBV), a member of the herpesvirus family, is found throughout the world. Studies show that up to 95% of all adults have antibodies against this common virus, meaning that they were infected at some point in their lives. Even though most infections with EBV go unnoticed or produce only very mild symptoms, in some cases, it can be associated with the development of serious conditions, including several types of cancer. Even mild or non-life-threatening infection with EBV can, occasionally, be associated with the development of serious complications from the infection. Although the virus typically targets lymphocytes, a particular blood cell involved in the immune response, almost all organs systems can ultimately be affected by EBV infection.

EBV is transmitted by close person-to-person contact. Primary, or initial, infection with EBV may not produce symptoms or there can be a number of different symptoms, especially in young children. The manifestations of primary EBV infection include:

  • Infectious mononucleosis (IM): This is the most common medical condition associated with EBV. IM is characterized by extreme fatigue, tonsillitis and/or inflamed throat (pharyngitis), enlarged, tender lymph nodes in the neck, and moderate to high fever. Although the fever and sore throat typically resolve within two weeks, fatigue may persist for months after the infection.
  • Other mild childhood illnesses: EBV infection in young children has also been linked to ear infections, diarrhea, other gastrointestinal symptoms, and cold symptoms in addition to the classic symptoms of IM.
  • In rare cases, primary infection with EBV has been associated with neurologic disturbances including Guillain-Barre syndrome and meningoencephalitis. Other rare manifestations of primary infection are abnormalities of the blood or coagulation systems such as anemia, thrombotic thrombocytopenic purpura/hemolytic-uremic syndrome (TTP/HUS), and disseminated intravascular coagulation (DIC).

Complications of primary EBV infection are not common but may be life-threatening if not treated. Rupture of the spleen (which may be enlarged in patients with IM) occurs in one to two cases per 1,000 cases of IM, almost always in males. A second potentially fatal but treatable complication is obstruction of the airway due to enlargement of lymph nodes and swelling of inflamed tissues surrounding the airway. EBV generally persists throughout life in most people who are infected and rarely causes any problems. In some cases, however, EBV has been linked to the development of cancers and serious conditions, including the following:

  • Burkitt’s lymphoma: This tumor is the most common childhood malignancy in equatorial Africa. Tumors are characteristically located in the jaw. Genetic studies have shown that in equatorial Africa (where over 95% of children have been infected with EBV by age 3), the vast majority of Burkitt lymphomas originate from an EBV-infected lymphocyte, a type of blood cell targeted by the virus.
  • Hodgkin lymphoma : In 1987, the finding of EBV genetic material was reported in up to 50% of cases of Hodgkin lymphoma, also known as Hodgkin’s disease, in certain geographic areas and patient populations.
  • Nasopharyngeal carcinoma: This cancer is rare in almost all populations, but it occurs as one of the most common cancers in southern China. Numerous studies have shown that these cancers are related to EBV infection and that EBV genetic material is contained in these cancers. Still, the majority of people in China who have been infected with EBV do not develop nasopharyngeal carcinoma.
  • EBV-associated non-Hodgkin lymphomas (usually B-cell lymphomas) have also been described in people infected with the HIV virus.
  • Rare cases of T-cell lymphomas have also been linked to EBV infection.
  • Post-transplant lymphoproliferative disease (PTLD) refers to a category of conditions that develop in people taking immunosuppressive medications following an organ transplant. The EBV virus has been implicated in the majority of cases of PTLD. Manifestations can vary, ranging from an increased number of lymphocytes in the bloodstream to blood-cell malignancies such as B-cell lymphoma.
  • Rare hematologic conditions: EBV has also been found to be associated with the development of certain rare conditions causing abnormal growth and function of specific components of the blood. Examples of these conditions are hemophagocytic lymphohistiocytosis and lymphomatoid granulomatosis.

Despite the diverse and potentially grave conditions that have been linked to EBV, the vast majority of people will experience no symptoms or have a self-limited illness such as IM when they contract the virus. It is likely that additional factors are necessary to predispose individuals to the development of cancers and other serious conditions as a result of EBV infection, and the reasons why EBV causes cancers in certain individuals and not in the majority of infected people are not fully understood. Research is underway to further characterize the broad spectrum of EBV-associated medical conditions.

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How Long Is Mono Contagious?

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The way mono works in the body is tricky, so lots of people are confused about how long it is contagious. If you get mono, the virus stays in your body for life. That doesn’t mean that you’re always

. But the virus can surface from time to time and risk infecting someone else.

Here’s how it works:

Mono, or mononucleosis, usually is caused by an infection with the Epstein-Barr virus (EBV).

People who have mono can be contagious from the time they first become infected. But they may not know that they have the virus. It takes a while for mono symptoms (like tiredness, fever, muscle aches, headache, or sore throat) to show up — about 1–2 months, in fact. This is called the incubation period.

To make things even more confusing, some people can carry the virus without ever getting any mono symptoms. So they may not know they have been infected, but they can still pass it to others. In fact, most people have been infected with EBV by the time they reach adulthood.

People are definitely contagious while they have symptoms, which can last 2–4 weeks or even longer. Health experts aren’t sure how long people with mono stay contagious after symptoms are gone, but it seems they can spread the infection for months after that. Then, the virus stays dormant (inactive) in the body for the rest of a person’s life.

Sometimes the dormant virus can “wake up” and find its way into a person’s saliva (spit). That person might not feel ill or show any mono symptoms, but can spread the virus to other people. So there’s a very small chance that people who have had mono in the past can pass it to others, even when they feel OK.

The bottom line is that it’s hard to prevent mono from spreading. Because EBV is so sneaky, infections are common. That’s why doctors urge everyone to wash their hands well and often. It’s the best way to keep germs at bay.

Reviewed by: Elana Pearl Ben-Joseph, MD Date reviewed: January 2020

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