Epstein-Barr Virus

Epstein-Barr virus

Epstein-Barr virus (EBV) is part of the family of human herpes viruses. Infectious mononucleosis (IM) is the most common disease manifestation of this virus which, once established in the host, can never be completely eradicated. Very little can be done to treat EBV; most methods can only alleviate resultant symptoms. Sleep and rest-complete bedrest in severe cases-is still the best medicine for sufferers of this virus.

In addition to infectious mononucleosis, EBV has also been identified in association with-although not necessarily believed to cause-as many as 50 different illnesses and diseases, including chronic fatigue syndrome, rheumatoid arthritis, arthralgia (joint pain without inflammation), and myalgia (muscle pain). While studying aplastic anemia (failure of bone marrow to produce sufficient red blood cells), researchers identified EBV in bone marrow cells of some patients, suggesting the virus may be one causative agent in the disease. Also, several types of cancer can be linked to presence of EBV, particularly in those with suppressed immune systems, for example, suffering from AIDS or having recently undergone kidney or liver transplantation. The diseases include hairy cell leukemia, Hodgkin's and non-Hodgkin lymphoma, Burkitt's lym-phoma (cancer of the lymphatic system endemic to populations in Africa), and nasopharyngeal carcinoma (cancers of the nose, throat, and thymus gland, particularly prevalent in East Asia). Very recently, EBV has been associated with malignant smooth-muscle tissue tumors in immunocompromised children. Such tumors were found in several children with AIDS and some who had received liver transplants. Conversely, it appears that immunosuppressed adults show no elevated rates of these tumors.

Discovery, disease, and research

EBV was first discovered in 1964 by three researchers-Epstein, Achong, and Barr-while studying a form of cancer prevalent in Africa called Burkitt's lym-phoma. Later, its role in IM was identified. A surge of interest in the virus has now determined that up to 95% of all adults have been infected with EBV at some stage of their lives. In seriously immunocompromised individuals and those with inherited immune system deficiencies, the virus can become chronic, resulting in "chronic Epstein-Barr virus" which is extremely serious and can be fatal.

Age and the health of the immune system play important roles in EBV-related illnesses. Infectious mononucleosis is the most common illness resulting from primary EBV infection. In young children, it often takes on mild flu-like symptoms that improve with time, or the symptoms are so mild they go unnoticed. However, ill or older people, IM can become a debilitating infection, and complications can affect almost every organ of the body, including possible rupture of the spleen. In fewer than 1% of IM cases, neurologic complications develop, and the patient can develop encephalitis, meningitis, Guillian-Barre syndrome, or other serious conditions. Very rarely, IM causes complications like aplastic anemia, thrombocytopenia (reduced numbers of platelets, the clotting factor in blood, resulting in bleeding), and granulocytopenia (severe reduction in white cells in the blood allowing the potential for "superinfec-tion"). More commonly, however, IM causes persistent fevers; swollen and tender lymph glands in the neck, groin, and armpits; sore throat and even severe tonsillitis; and sometimes a rash. Because the sore throat is so prominent, and because it may in fact become secondarily infected with strep, some patients are treated with ampicillin. Almost all of these individuals will break out in a rash which is often mistaken for evidence of a penicillin allergy. IM is almost always accompanied by fatigue and general malaise which can be quite severe initially, but bouts of which become less severe and prolonged over several weeks or months. Inflammation of the spleen and liver are also common in IM. The spleen in particular may grow very large, and may rupture spontaneously in about 0.5% of patients.

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