Monday, December 16, 2013

Chronic Infection after Mononucleosis



The Epstein-Barr virus (EBV) is a common pathogen spread by kissing and saliva exchange. This virus infects at least 90% of the world population, and 50% of children have been exposed to it by age 5. Infection with EBV may be expressed differently, depending on geographical location and ethnicity.

Infectious Mononucleosis is Caused by Epstein-Barr Virus

In the United States, acute infection usually appears as a syndrome called infectious mononucleosis. Folks in the throes of infectious mononucleosis experience fatigue, chronic fever, sore throat, and swollen cervical glands (lymphadenopathy). These symptoms stick around for about three weeks and are occasionally accompanied by other more intense complicationslike enlarged liver or spleen.
Barring extraordinary circumstances, recovery is usually complete. However, those infected become carriers for the rest of their lives. This means that though these people appear healthy, the virus is still there, and may be shed in the saliva. In fact, studies show that up to 25% of previously infected adults still shed virus. Controversy exists regarding the possible association of EBV with chronic fatigue syndrome and fibromyalgia.

Epstein-Barr Virus Hides in B-Lymphocytes

The virus is good at hiding out in cells of the upper respiratory and immune systems. Researchers are still trying to understand how this latency works and why, in some folks, reactivation occurs. Apparently there are hereditary components as well as environmental triggers.
Some genetic variations in individuals may allow the virus to hide in B-lymphocytes and turn off elements that normally kill infected cells. These antibody-producing white blood cells then act as a reservoir for future infections. From time to time, they arrive in the nasopharyngeal region, where they lyse (pop), littering local epithelial tissue with virus. Those tissues then become infected.

Stress Reactivates Epstein-Barr Virus Infection

Physical and emotional stresses appear to play a crucial role in the reactivation, and smoldering infection of EBV. Several studies with subjects ranging from astronauts to college students have shown that as individuals are stressed, saliva levels of EBV increase. One relatively recent study correlated low socioeconomic position with increased infection and chronic virus shedding. According to this study, females with little education had consistently higher levels of active virus. There was also a higher incidence in non-Caucasian groups.

No Consensus but Several Possibilities in Management of Epstein-Barr Virus Infection

Emerging therapies for addressing EBV infection may eventually include antiviral drugs, vaccines, and genetically modified proteins. Alternative measures tend to include medicinal botanicals like Echinacea species,Baptisia tinctoria , and Astragalus membranaceus. These herbs tend to ramp-up the function of white blood cells, with an overall immune-stimulating effect.

Additional Resources

Sy Kim et al., “Concurrent reactivation of latent EBV with hepatitis A can affect clinical feature of childhood hepatitis,” Acta Paediatrica 99, no. 8 (3, 2010): 1258-1262. Karen W Martin and
Edzard Ernst, “Antiviral agents from plants and herbs: a systematic review,” Antiviral Therapy 8, no. 2 (April 2003): 77-90.
Raymond P Stowe et al., “Herpesvirus reactivation and socioeconomic position: a community-based study,” Journal of Epidemiology and Community Health 64, no. 8 (2010): 666 -671.
Linda C. Tan et al., “A Re-Evaluation of the Frequency of CD8+ T Cells Specific for EBV in Healthy Virus Carriers,” The Journal of Immunology162, no. 3 (February 1, 1999): 1827 -1835.

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