Epstein-Barr syndrome is caused by the Epstein Barr virus, or EBV, which belongs to the herpesvirus family. The Merck Manual notes that about 50 percent of children five years of age and nearly 95 percent of adults in the United States are infected with EBV. In most cases of infection symptoms are mild and similar to that of the common cold. The Centers for Disease Control and Prevention reports that between 35 and 55 percent of EBV infections that occur in adolescents can result in infectious mononucleosis, also known as Epstein-Barr syndrome.
Transmission
EBV is transmitted through contact with the saliva of an infected person. The virus is not transmitted through the air or blood; however it has been reported to infect persons that have had an organ transplant. Once infected, a person can spread the infection to others without knowing because symptoms may not appear for four to six weeks. Many people without symptoms can intermittently spread the virus throughout their lives.
Symptoms
EBV primarily infects immune system cells, but also may target cells in the throat and salivary glands. The most common symptoms of infectious mononucleosis are fever, sore throat, fatigue and swollen lymph glands. Diagnosis of mononucleosis requires a blood test, which shows an increased number of white blood cells. Infection can also be detected by a “mono-spot” test, which uses an antibody against the EBV. The symptoms may take up to two months to resolve. After infection the virus will remain in cells of the body for the rest of the person’s life.
Treatment
There is not a vaccine and no specific treatment for infectious mononucleosis. The symptoms of fever and sore throat are commonly treated with acetaminophen or non-steroidal anti-inflammatory drugs, also known as NSAIDs. If the lymph glands are severely swollen, corticosteroids may be given to prevent airway obstruction.
Autoimmune Diseases
EBV targets and infects B cells, which are the primary producers of antibodies in the immune system. There is some evidence that EBV plays a role in the development of chronic inflammatory/autoimmune diseases like rheumatoid arthritis, systemic lupus erythematosus, Sjogren's syndrome and multiple sclerosis.
A review article in the “Journal of the Neurological Sciences” reported that EBV is a possible factor in the manifestation of multiple sclerosis, but it is not known whether it contributes to the pathogenesis of the disease or if it is merely an innocent bystander. Another study in “Best Practice and Research: Clinical Rheumatology” stated people with rheumatoid arthritis and systemic lupus erythematosus have an increased viral load of EBV in their blood, but again these data are correlative and do not provide direct evidence that EBV causes these diseases.
Rare Cancers
EBV may potentially play a role in the development of certain rare cancers, including Hodgkin’s lymphoma, Burkitt's lymphoma and nasopharyngeal carcinoma. As was the case for the role of EBV in autoimmune diseases, there is no direct evidence that EBV causes these cancers. A study in the journal “Oncogene” notes that EBV promotes the growth and survival of B-cells in the laboratory, but it is only associated with cancers in people that are immunosuppressed.
References
- Centers for Disease Control and Prevention: Epstein-Barr Virus and Infectious Mononucleosis
- “Journal of the Neurological Sciences”; Epstein-Barr Virus and Multiple Sclerosis
- “Best Practice and Research: Clinical Rheumatology”; Epstein-Barr Virus in Autoimmune Diseases
- “Oncogene”; Epstein-Barr Virus Infection in Humans
- The Merck Manuals Online Medical Library: Epstein-Barr Virus
