Epstein Barr Virus -A Naturopathic Angle

I’m going to spend some time on the subject of Epstein Barr Virus (EBV).  -Most folks have had it, and it seems to be associated with all kinds of nasty conditions. 

First the Basics

Epstein Barr Virus (EBV) was discovered in the early 1960s, and then rapidly connected with several conditions, including infectious cancers, lymphomas, hypothyroidism, and our personal favorites:  mononucleosis (aka the infamous “mono” or “kissing disease”).

EBV is in the herpes virus family.  These are relatively large DNA viruses, which through millions of years of coevolution with humans have evolved sophisticated strategies for survival and spread.  They are masters at evading and suppressing the immune system. 

Members of the herpes family include:

·         Herpes Simplex Virus –I (HSV-I or HHV-1) –predominate oral cold sores

·         Herpes Simplex Virus-II (HSV-II or HHV-2) –predominate genital sores

·         Varicella (HHV-3) –responsible for chicken pox and herpes zoster (shingles)

·         Epstein Barr Virus (HHV-4) –infectious mononucleosis and other assorted conditions…

·         Cytomegalovirus (CMV  or HHV-5) –also associated with mononucleosis-like conditions

·         Roseoloviruses (HHV-6 & HHV-7) -6^th disease, roseola… 

 

About Epstein Barr Virus

EBV is a double stranded DNA virus that has an icosahedral protein shell, encased by a goopy outer envelope.  Proteins on that envelope stick to specific buttons on the outer surface of cells of the immune system and upper respiratory tract.  Once stuck, they are drawn into the human cells and the infection begins! 

In young children, infection with EBV may go unnoticed.  In teenagers and young adults, about half the time, acute symptoms occur in the form of infectious mononucleosis.  Since this is considered a self-limiting condition, with recovery within weeks, conventional treatment is usually just supportive.  For example, steroids like prednisone may be administered to reduce extreme swelling of the tonsils that impedes breathing and swallowing. 

Occasionally, complications occur, like ruptured spleens.  Docs need to use care when examining folks with mono.  Enlarged spleens may be very delicate -and rupture -even with just a gentle prod.  I’ve heard of folks post-mono that ruptured their spleens bumping into furniture or just jogging.  If this happens, it’s a big surgical emergency! 

Another complication I’ve seen from time to time is a self-limiting hemolytic anemia –which may result in dark brown-black urine.  This usually doesn’t need to be addressed. 

Some common signs & symptoms associated with mononucleosis: 

·         Fatigue

·         Sore throat

·         Swollen tonsils

·         Low grade fever

·         Headache, fever, chills

·         Pain with bright lights

·         Abdominal pain

·         Nausea

·         Swollen lymph nodes

·         Enlarged spleen

Next up:  Laboratory diagnosis –differentiating acute and chronic states!

                THEN… latency… acute and chronic infections!

Here are a few references:

1. Jan Andersson, “An Overview of Epstein-Barr Virus: from Discovery to Future Directions for Treatment and Prevention,” Herpes: The Journal of the IHMF 7, no. 3 (October 2000): 76-82.
2. A T Cruchley et al., “Epstein-Barr virus: biology and disease,” Oral Diseases 3 Suppl 1 (May 1997): S156-163.
3. Matthew P. Thompson and Razelle Kurzrock, “Epstein-Barr Virus and Cancer,” Clinical Cancer Research 10, no. 3 (February 1, 2004): 803 -821.
4. Shurin SB. The spleen and its disorders. In: Hoffman R, et al. Hematology: Basic Principles and Practice. 5th ed. Philadelphia, Pa.: Churchill Livingstone; 2009. Accessed Oct. 13, 2010.
5. Landaw SA, et al. Approach to the adult patient with splenomegaly and other splenic disorders. http://www.uptodate.com/home/index.html. Accessed Oct. 13, 2010.
6. Isenhour J, et al. General approach to blunt abdominal trauma in adults. http://www.uptodate.com/home/index.html. Accessed Oct. 13, 2010.
7. Clinical policy: Critical issues in the evaluation of adult patients presenting to the emergency department with acute blunt abdominal trauma. Irving, Texas: American College of Emergency Physicians. http://www.acep.org/WorkArea/DownloadAsset.aspx?id=8808. Accessed Oct. 13, 2010.
8. Practice management guidelines for the nonoperative management of blunt injury to the liver and spleen. Chicago, Ill.: Eastern Association for the Surgery of Trauma. http://www.east.org/tpg/livspleen.pdf. Accessed Oct. 13, 2010.
9. Patient information for laparoscopic spleen removal (splenectomy) from SAGES. Society of American Gastrointestinal and Endoscopic Surgeons. http://www.sages.org/sagespublication.php?doc=PI12. Accessed Oct. 13, 2010.
10. Schooley RT. Epstein-Barr virus infection. In: Goldman L, et al. Cecil Medicine. 23rd ed. Philadelphia, Pa.: Saunders; 2007. http://www.mdconsult.com/das/book/body/201609212-3/0/1492/0.html. Accessed Oct. 18, 2010.