Epstein-Barr Virus
and Mononucleosis



Epstein-Barr Virus-What is it?

The Epstein-Barr virus (EBV), or human herpes virus, infects more than 95 percent of the world's population.  This type of herpes virus, type 4, manifests in one of its most common forms, called acute infectious mononucleosis syndrome. The syndrome is most frequently seen in adolescents and young adults. Epstein-Barr virus is also common in childhood, however, symptoms tend to be very mild or not present at all.  But during adolescence and young adulthood, up to 50 percent of EBV cases result in mononucleosis.

Understanding Epstein-Barr Virus

There are characteristically two types of Epstein-Barr virus, Type A and Type B.  Differences in the two types while the viruses are dormant are slight, almost nonexistent.  Both strains of active Epstein-Barr virus can infect a person simultaneously. Epstein-Barr is transmitted through intimate contact and exchange of saliva of an infected person.  Blood transmission or transmission through the air of the virus is rare.  Many people exposed to those with infectious Epstein-Barr virus have already been infected with the virus and are not at risk for .

The time from infection to appearance of any symptoms can be anywhere from 4 to 7 weeks. Once infected, Epstein-Barr virus sufferers may be able to spread the virus to others for a period of weeks.  Because the virus is spread through saliva, no quarantines or special precautions are needed.  The virus is also common in healthy people - many can carry and periodically spread the virus throughout their lives.  These healthy carriers are usually the main source of person-to-person transmission, making transmission of the Epstein-Barr virus almost impossible to prevent.

Symptoms and Diagnosis of Epstein-Barr virus

Clear cut symptoms suggest infection of EBV. The most common symptoms include fever, swollen lymph glands, a sore throat, and the age of the patient. Laboratory tests generally confirm the presence of the Epstein-Barr virus.  Lab results for infected people include an elevated white blood cell count, an increase in certain atypical white blood cells and a positive reaction to a "mono spot" or antibody test.  Results from a mono spot are usually available within days.   

Occasionally an enlarged spleen or liver may develop in the infected person, as well as problems with the central nervous system and heart problems.  These symptoms help to pinpoint the diagnosis. Luckily, Epstein-Barr is almost never fatal.

Symptoms usually subside within one or two months and seldom last more than four months.

While Epstein-Barr is rarely fatal, but the virus can remain dormant in throat cells and the blood for the remainder of the infected person's life.  The virus has the potential to reactivate, most commonly in the saliva of infected persons, yet may occur without any visible symptoms of illness.  Epstein-Barr virus also creates a lifelong latent infection in some blood cells of the body's immune system.

Treating Epstein-Barr virus

There are no specific treatments for Epstein-Barr virus, exclusive of treating the symptoms.  NSAIDS (Non-Steroidal Anti-Inflammatory Drugs) are used to treat fever and discomfort. Glucocorticoids, an anti-inflammatory, may help decrease the size of tonsils and upper airway lymph nodes that can become swollen as a result of the active presence of Epstein-Barr virus.  Anti-inflammatory drugs do not speed up or slow down the course of the virus in the body.

Inhibiting the replication of Epstein-Barr virus within the immune system may be one of the more effective ways to control the virus.  Anti-viral drugs, including acyclovir can help to inhibit replication.  Clinical trials for infectious Epstein-Barr with acyclovir have been conducted and show that acyclovir inhibits viral shedding of the virus from the area of the throat in the back of the mouth.  Clinical research has not shown the effects of acyclovir on uncomplicated infectious EBV.

Immunoglobulins are also used to regulate the immune system in the presence of autoantibodies. These drugs have been used successfully in the treatment of platelet disorders associated with infectious Epstein-Barr virus.