Epstein-Barr Virus Infection Reactivation

Once the Epstein-Barr virus enters your body, it stays there for life in a sleeping state. For most people, it remains quiet, but certain triggers can wake it up, leading to symptoms that can range from mild fatigue to more serious health challenges.

Table of contents

• What Is Epstein-Barr Virus?
• Understanding EBV Reactivation
• What Triggers Reactivation?
• Symptoms of EBV Reactivation
• Testing for EBV
• Treatment and Management
• Possible Complications

What Is Epstein-Barr Virus?

Epstein-Barr virus (EBV) is a very common virus that infects most people at some point during their lives. It is a type of herpesvirus, specifically known as human herpesvirus 4, which belongs to a family of viruses that can stay in your body for life^[1]. In the United States, an estimated 50% of all children up to 5 years of age and about 95% of adults experience an EBV infection in their lifetime^[2].

EBV is highly contagious and spreads easily through bodily fluids, especially saliva. You can get infected by kissing someone with the virus, sharing drinks or eating utensils, or touching items a child might have put in their mouth^[2]. The virus can also spread through blood and semen during sexual contact, blood transfusions, and organ transplants^[10].

When people first catch EBV, especially during adolescence or young adulthood, they may develop infectious mononucleosis, commonly called “mono” or the “kissing disease”^[1]. Children who get infected usually don’t show symptoms, or their symptoms look like a mild cold or flu^[2].

Understanding EBV Reactivation

Once you get EBV, the infection stays within your body for your entire life in a dormant state where it’s inactive or sleeping^[2]. The virus hides out in part of your immune system called B cells, which are a type of white blood cell^[5]. As long as you remain relatively healthy, your immune system is able to keep EBV dormant, specifically through specialized white blood cells called CD4+ T cells^[5].

EBV establishes lifelong latency in infected lymphocytes following acute infection. It can reactivate under appropriate conditions, namely those associated with diminished cell-mediated immunity^[3]. When the virus reactivates, you may or may not experience symptoms. Most people who have a reactivation will probably not have any symptoms^[1]. However, if you have a weak immune system due to cancer, chronic fatigue syndrome, or other conditions, you may experience the same symptoms that you had when you first contracted the virus^[1].

You can spread the virus to others even when it reactivates without causing symptoms. Once EBV is in your body, if it reactivates, you can potentially infect others no matter how much time has passed since the first infection^[10].

What Triggers Reactivation?

Several factors can trigger EBV to wake up and become active again. These triggers typically involve situations that weaken or stress your immune system:

• Stress: Both psychological and cellular stress can stimulate viral reactivation^[3]. The interaction between stress and the immune system plays an important role in EBV reactivation^[2].
• Weakened immune system: If your immune system becomes significantly weakened due to illness or other factors, this can cause the virus to come out of hiding^[2][5].
• Taking immunosuppressants: Medications that suppress the immune system, such as those used after organ transplants or to treat autoimmune diseases, can trigger reactivation^[1].
• Hormonal changes: Changes such as those occurring during menopause can trigger the virus to reactivate^[1][2].
• Exposure to toxins: Environmental toxins, including mold or water-damaged building exposure, may contribute to immune system weakening^[5].
• Other infections: Having other infections can overtax your immune system and increase the risk of reactivation^[5].

People with compromised immune systems are more likely to develop symptoms if EBV reactivates^[10].

Symptoms of EBV Reactivation

It’s not always clear when you have EBV reactivation since many people with the virus don’t experience obvious symptoms^[1]. When symptoms do occur, they typically last around two to four weeks, though symptoms could linger for months, especially fatigue^[1].

Common symptoms of EBV reactivation may include:

• Extreme fatigue: Chronic and often debilitating tiredness is one of the most common symptoms^[5]
• Sore throat and throat inflammation^[1]
• Fever^[10]
• Swollen lymph nodes, particularly in the neck^[1]
• Swollen tonsils^[1]
• Headaches^[1][5]
• Rash on the skin^[1]
• Enlarged spleen (splenomegaly) and liver^[1][5]
• Severe body aches^[5]

In rare cases, EBV infections can last for more than six months. If you are constantly fatigued and experience some of the other symptoms above, you may have been infected with EBV or have an older EBV infection reactivate^[1].

Children are less likely than teens and adults to have recognizable symptoms^[1]. Children diagnosed with Epstein-Barr virus either don’t show symptoms or their symptoms are similar to short-term illnesses like a cold or the flu^[2].

Testing for EBV

Diagnosing EBV infection can be challenging because the symptoms are similar to other illnesses^[10]. There are several blood tests that are used to detect an EBV infection:

Monospot test: This test detects antibodies that are caused by an EBV infection. However, the Centers for Disease Control and Prevention says it isn’t very accurate, since it may also detect antibodies caused by other conditions^[1].

EBV nuclear antigen (EBNA): This tests for antibodies to EBNA. These antibodies will be seen if you’ve been infected by EBV for more than two to four months. You may continue to test positive for EBNA for the rest of your life after you’ve been infected^[1].

Early antigen (EA): This tests for antibodies to EA, which appear in the first three to six months after you get infected by EBV. However, this test isn’t always conclusive, since 20% of healthy people already have antibodies to EA^[1].

Viral capsid antigen (VCA): This tests for antibodies to VCA, which appears in the first few weeks of infection. One antibody to VCA will disappear after a few weeks, but another will remain in your body for the rest of your life^[1].

If you have an EBV infection, your blood work may show suggestions of mild liver damage, more unusual white blood cells than is typical, or more white blood cells than is typical^[1]. About 9 out of 10 adults have antibodies that show that they have a current or past EBV infection^[10].

Treatment and Management

There is no specific treatment for EBV. EBV infections can’t be treated with medicine or a vaccine^[1][10]. Because these are viral infections, antibiotics don’t work against them. Most people get better in 2 to 4 weeks without any specific treatment^[10].

Management typically focuses on supporting the immune system and managing symptoms. Some things can be done to help relieve symptoms:

• Getting plenty of rest: Rest is essential during recovery^[10]
• Drinking fluids to stay hydrated^[10]
• Taking over-the-counter medications for pain and fever^[10]
• Avoiding excessive physical activity to prevent a ruptured spleen, since swollen spleens are a core symptom^[5]

Some people explore additional approaches to support their immune system, such as supplements, reducing sugar intake, and adopting an anti-inflammatory diet^[5]. However, it’s important to discuss any complementary approaches with your healthcare provider.

In severe cases called chronic active EBV (CAEBV), more intensive treatment may be needed. CAEBV is a very rare disease that is more common in Asia and South America than in the United States and Europe^[6]. For this condition, treatment approaches may vary and should be determined by specialists.

Possible Complications

While most people recover from EBV without any long-term complications, some individuals may experience lingering symptoms of fatigue and other issues for several weeks or months after their initial infection or reactivation^[1].

EBV is also associated with a number of health conditions, including various cancers such as certain types of lymphomas and nasopharyngeal carcinoma^[6]. In individuals with compromised immune systems, EBV reactivation can lead to more serious complications, including lymphoproliferative disease^[6].

Some people with chronic active EBV may develop autoimmune disorders, liver dysfunction, or other organ involvement^[5]. Death from CAEBV is frequently due to liver failure, malignant lymphoma, or opportunistic infections^[6].

If you experience persistent or severe symptoms, it’s important to seek medical attention for proper evaluation and management.