Epstein-Barr Virus (EBV) and Infectious Mononucleosis
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The Epstein-Barr virus (EBV), or human herpes virus 4, is a part of the human herpes virus family and is the most common human virus. Most people will have evidence (antibodies to EBV in their blood) of prior EBV infection by the age of 35. Once infected with EBV, you carry the virus for the rest of your life, though usually in the dormant state.
After an initial EBV infection, the virus may go dormant and remain latent for many years until something triggers its reappearance. Occasionally, this can happen during pregnancy.
In healthy infants and adults, there is often no apparent infection from the first introduction to EBV. Teenagers and young adults, as well as patients with lower functioning immune systems (people with AIDS and other immune diseases), may see more significant symptoms and may develop infectious mononucleosis (“mono”).
Though EBV is not the only virus that can cause infectious mononucleosis, it is the most common cause. In teens and young adults, 1 in 4 infections with EBV will result in a mononucleosis infection.
EBV can also cause many other diseases and conditions, including but not limited to:
- Viral meningitis
- Transverse myelitis
- Optic neuritis
- Paralysis of facial muscles or on one side of the body
- Acute Cerebellar Ataxia
- Guillain-Barre syndrome
- Lung disease
- Weakened immune system
To find out more about these other possible illnesses, visit the CDC’s website here. If you are concerned about any symptoms that you are having, please call your doctor right away.
The virus is spread mainly through saliva but can spread through all bodily fluids. “Mono,” or infectious mononucleosis, is a common infection that can result from EBV and among teenagers is often called the “kissing disease” due to its ease of transmission in saliva.
Symptoms of an EBV infection may include:
- Sore throat
- Skin rash
- Swollen neck lymph nodes
- Enlarged liver and spleen
These symptoms should only last as long as any other common illness, typically no longer than 1-2 weeks. Occasionally, fatigue may last longer.
Remember that many children and healthy adults will not experience any symptoms, or the symptoms may seem like a normal childhood illness or the common cold. Those who are most susceptible to having these symptoms are those with compromised or low-functioning immune systems (persons with HIV/AIDS, some pregnant women, teenagers, and maybe even more so someone with a teen pregnancy.).
The symptoms of infectious mononucleosis are similar to EBV but are more severe. They may include:
- Extreme exhaustion
- Sore throat
- Skin Rash
- Body aches
- Swollen neck & armpit lymph nodes
- Swollen liver and/or spleen
You may shake these symptoms in 1-2 weeks, but occasionally it can take more time to get back to your normal level of energy (a few weeks to 6 months). If your symptoms persist six or more months past diagnosis, you may be diagnosed with rare chronic active EBV infection. You should contact your doctor if your symptoms don’t subside after two weeks, and especially after six months.
Keep in mind that though EBV is the most common cause of infectious mononucleosis, it is not the only possible cause. Other causal factors include cytomegalovirus (CMV), toxoplasmosis, hepatitis A/B/C, HIV, rubella (measles), or adenovirus.
Since EBV’s symptoms are similar to many other minor illnesses, the best way to determine EBV infection is a blood test for antibodies specific to EBV. If these antibodies are present, it indicates the presence of EBV.
I have infectious mononucleosis; how do I know if it is from EBV?
Infectious mononucleosis is typically diagnosed from symptoms alone; however, sometimes it is necessary to determine the cause. In this case, testing with the following results may indicate EBV infection:
- Abnormal white blood cells
- Higher number of white blood cells than normal
- Fewer neutrophils
- Fewer platelets
- Proteins/enzymes indicative of atypical liver function
Since it is a virus, there are not many options for treatment other than to reduce the symptoms. Pain killers and fever reducers such as ibuprofen or acetaminophen can reduce any body aches and control fever. Rest and proper hydration (water, electrolyte drinks) are useful approaches to managing the symptoms.
For pregnant women, acetaminophen can be taken to reduce fever and treat any body aches – avoid ibuprofen.
If I get infectious mononucleosis from EBV, is there a different treatment?
The answer depends on the severity of your sickness. Infectious mononucleosis will need to be monitored by your doctor and the same above measures taken to reduce the symptoms, as well as an extended resting period. If the infection negatively affects your organs (specifically the spleen and/or liver), your doctor may take steps to treat these as well. Because infectious mononucleosis can cause an enlarged spleen, do not participate in contact sports to avoid rupturing the spleen.
How can I avoid contracting or transmitting EBV and/or infectious mononucleosis?
Since the virus can pass in saliva and other bodily fluids, avoid kissing and sharing drinks, food, toothbrushes; also avoid anal, vaginal, or oral intercourse with someone you know has EBV, or if you have EBV.
Is treatment the same if I am pregnant and have EBV or infectious mononucleosis?
Typically, yes, the treatment will be the same. Acetaminophen should be used instead of ibuprofen to reduce fever and body/headaches. Rest and hydration are crucial, especially during pregnancy, since the developing fetus depends on having a hydrated and well-rested mother.
The biggest concerns would be (1) keeping any organ infection or damage to a minimum, and (2) ensuring that the mother’s temperature does not rise too high or stay high for too long. This is because the developing baby is more sensitive to temperature than the mother’s body is. High temperatures have the potential to cause miscarriage (first half of pregnancy), birth defects (first trimester), and/or preterm delivery (if fever is associated with infection of an organ).
Research since the 1980s has shown different answers to this question. Some studies show that there is no correlation between EBV reactivation during pregnancy and congenital disabilities or early delivery/low birth weight. More recently, one study demonstrated a link between significant EBV reactivation and early delivery and low birth weight. Another found a relationship between maternal depressive symptoms around week 32 and late EBV activation before delivery.
More research is needed on EBV activation and its effects on pregnancy and the fetus. Nearly all studies agree that EBV reactivation is not associated with fetal death. If we take high fever out of the equation, it is possible that EBV activation or infection during pregnancy could be related to early delivery and low birth weight.
Some studies reported infection with EBV of a newborn born to a mother with EBV, though the percentage was small. There is no clear indication of whether the virus is passed in utero or during delivery. Talk to your healthcare provider about any interventions he or she thinks is necessary to prevent transmission.
The good news is that, even if EBV is transmitted from you to your baby, EBV in infancy and childhood is typically asymptomatic, with few children seeing episodes of infection. Additionally, most people will have EBV by the time they are 35 years of age, the so chances are that your baby would someday contract EBV anyways.
Is it safe to breastfeed my baby if I have EBV and he/she does not?
Data shows that EBV can be present in breast milk, but there are no studies as of yet that determine if this results in transmission to the infant.
The best course of action is to speak with your doctor about your EBV status and how that affects your pregnancy and your baby after delivery.
Last updated: September 5, 2017 at 12:25 pm
1. CDC: About EBV.
2. CDC: About Mononucleosis.
3. CDC: For Healthcare Providers.
4. Mayo Clinic: Mononucleosis and Epstein-Barr: What’s the connection?
5. Mayo Clinic: Mononucleosis: Diagnosis & Treatment.
6. Mayo Clinic: Mononucleosis: Can it recur?
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8. Epstein-Barr Virus infection in pregnancy — a prospective controlled study. Reprod Toxicol. 25 Aug 2008. 10.1016/j.reprotox.2008.04.004
9. Infectious mononucleosis during gestation: report of three women and their infants studied prospectively. Pediatr Infect Dis. Jul 1984.
10. Epstein-Barr Virus infections in pregnancy: a prospective study. J Pediatr. Mar 1984.
11. Epstein-Barr Virus infection during pregnancy and the risk of adverse pregnancy outcome. BJOG. 22 Sep 2005. doi: 10.1111/j.1471-0528.2005.00764.x
12. Maternal depressive symptoms related to Epstein-Barr virus reactivation in late pregnancy. Scientific Reports. 31 Oct 2013. doi: 10.1038/srep03096
13. Recommendations for breastfeeding during maternal infections. J. Pediatr. (Rio J.) Nov 2004. https://dx.doi.org/10.1590/S0021-75572004000700010
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16. Livestrong: Effects of High Temperature on Pregnancy.
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