Beyond the Kissing Disease: A Quick Guide to the Epstein-Barr Virus (EBV)

• Written by Mudit Handa

  Reviewed by Ritika Malik

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Valentine week has already started—love is in the air! But beware! The microbial world is home to numerous yet less-known pathogens. Often overlooked but incredibly common, the Epstein-Barr Virus (EBV) is one of the world’s most pervasive viruses, silently infecting an estimated 9 out of 10 people by adulthood. While most people are aware of its colloquial name, ‘the kissing disease’, causing the condition Infectious Mononucleosis (mono), the impact of EBV can extend far beyond a typical bout of fatigue and fever.

This virus has been linked to a serious spectrum of long-term health concerns, including various types of cancers and autoimmune conditions like Multiple Sclerosis and Rheumatoid Arthritis.

We should examine how EBV is transmitted, its symptoms, and the serious diseases it can trigger, which is essential for a comprehensive understanding of EBV.

What is the Epstein-Barr Virus​?

Epstein-Barr Virus (EBV), also known as human herpesvirus 4, is among the most prevalent viruses in humans.

As a member of the herpesvirus family, it's estimated to infect more than by adulthood. The sheer reach of EBV is staggering: current epidemiological estimates suggest that over 90% of people worldwide are infected with the virus by the time they reach adulthood. This makes EBV a near-universal human pathogen.

When primary EBV infection occurs in adolescence or young adulthood, it often causes infectious mononucleosis (‘mono’ or ‘the kissing disease’). Mononucleosis features a triad of fever, pharyngitis, and lymphadenopathy, plus severe fatigue that can last weeks to months.

EBV is medically significant not only because it is the cause of mononucleosis, but also due to its link with various malignancies. This is particularly true for individuals who are immunosuppressed or have certain genetic predispositions. These malignancies include:

Certain B-cell and T-cell lymphomas such as:

• Burkitt lymphoma
• Hodgkin lymphoma
• Post-transplant Lymphoproliferative Disorder (PTLD) 

Nasopharyngeal carcinoma.

Ongoing research continues to explore Epstein virus's potential involvement in conditions such as chronic fatigue syndrome and various autoimmune diseases.

How can one contract the Epstein-Barr Virus?

EBV, also known as the Epstein-Barr Virus, mainly spreads through contact with infected bodily fluids. The most common way people catch it is through saliva, which is why it’s often called the ‘kissing disease’.

This highlights the ease with which the virus can spread through intimate contact, sharing drinks or utensils, exposure to droplets from coughing or sneezing, or sexual contact.

Primary triggers of EBV during sexual intercourse are discussed below:

• Beyond saliva, the virus can also be spread through blood and semen during sexual contact.
• However, transmission via saliva is the most frequent route in the general population, particularly among adolescents and young adults.

Once someone gets infected, the virus usually stays hidden (latent) in the body for life and can wake up from time to time. This means the person might be contagious even if they don’t show any symptoms.

Blood transfusions and organ transplantation are other sources of EBV infection, but the primary mode of transmission is salivary contact.

What are the Epstein-Barr Virus Symptoms?

Most initial EBV infections in children are asymptomatic or so mild that they are mistaken for a common cold. However, when infection occurs in adolescents or adults, it often results in infectious mononucleosis, commonly called mono or ‘the kissing disease’.

The symptoms of the EBV virus typically appear four to six weeks after exposure and can include:

• Fatigue: Extreme and persistent tiredness is the hallmark symptom.
• Fever: Often moderate to high.
• Sore throat: Severe and persistent, often accompanied by swollen tonsils.
• Swollen lymph nodes: Particularly in the neck and armpits.
• Headache: A common complaint.
• Skin rash: Less common, but can occur.
• Swollen spleen (splenomegaly): The spleen may become enlarged, necessitating avoidance of contact sports to prevent rupture.
• Swollen liver (hepatomegaly): Less common, but possible.

Symptoms usually resolve within 2 to 4 weeks, but fatigue can persist for several months. Once infected, EBV remains dormant in the body and can reactivate later, often without causing symptoms.

Which Disease can be caused by the Epstein-Barr Virus?

Epstein-Barr Virus (EBV) is associated with a spectrum of diseases, ranging from mild to severe, owing to its ability to persist in the body and affect immune cells.

Here is a list of diseases that are directly caused by EBV:

• Infectious Mononucleosis: Also known as ‘mono’ or ‘the kissing disease’. This is the most common and acute illness caused by EBV, typically seen in adolescents and young adults. Symptoms include fever, sore throat, extreme fatigue, and swollen lymph nodes.
• Oral Hairy Leukoplakia (OHL): A non-cancerous lesion that appears as white, hairy patches, usually on the side of the tongue. It occurs most often in people with severely compromised immune systems, such as those with HIV/AIDS.
• EBV-associated Hemophagocytic Lymphohistiocytosis: EBV-HLH is a rare, life-threatening condition where the immune system becomes overactive and damages tissues and organs.

In addition to the diseases discussed above, several types of cancer are caused by the Epstein-Barr virus.

Which Cancers are Caused by the Epstein-Barr Virus?

EBV is recognised as a Group 1 carcinogen by the World Health Organisation (WHO), which means there's strong evidence that it can lead to cancer in humans. It is a potent precursor of many forms of dreadful cancers, such as those listed below:

• Burkitt Lymphoma: A rapidly growing type of B-cell non-Hodgkin lymphoma, it is closely linked to EBV and is widespread in equatorial Africa (endemic Burkitt lymphoma).
• Hodgkin Lymphoma: EBV DNA is present in a substantial number (20% to 50%) of classic Hodgkin lymphoma cases worldwide. This cancer affects the lymphatic system.
• Nasopharyngeal Carcinoma (NPC): It is a rare cancer in the U.S. but common in parts of Asia and North Africa. Nearly all cases of undifferentiated NPC are linked to EBV infection.
• Gastric (Stomach) Cancer: EBV is thought to contribute to a subset of gastric cancers that constitute approximately 10% of the cancer cases.
• T-cell and Natural Killer (NK) cell Lymphomas: These are rare lymphomas that develop from T-lymphocytes and NK cells.

The variety of lymphomas caused by Epstein-Barr virus hints at the severity of its impact on the immune system. Hence, it is crucial to diagnose this virus early in infection before it causes cancer.

Additionally, Epstein-Barr virus can compromise the immune system, leading to various autoimmune diseases.

Which Type of Autoimmune Diseases are triggered by the Epstein-Barr virus?

While the direct causal link is still under intensive research, EBV infection has been implicated as a potential trigger or risk factor for several autoimmune diseases:

• Multiple Sclerosis (MS): Recent studies suggest an influential association between prior EBV infection and the risk of developing MS.
• Systemic Lupus Erythematosus (SLE or Lupus): This condition may affect various parts of the body, often leading to a wide range of symptoms. Understanding this illness can help us better support those who manage it and raise awareness of its impact.
• Rheumatoid Arthritis: Studies have consistently shown that individuals with Rheumatoid Arthritis often have higher levels of antibodies against various EBV antigens than healthy controls. This suggests a more active or distinct immune response to the virus in patients with RA.

While EBV infection is widespread, only a small number of infected individuals develop such serious diseases, indicating that genetic and environmental factors also significantly influence disease development.

Epstein-Barr Virus: Can it be Treated?

Although no specific antiviral treatment has been developed yet for Epstein-Barr Virus infections, treatment mainly involves supportive care, such as rest, fluids, and OTC pain relievers like acetaminophen and ibuprofen, to manage fever and sore throat. It is essential to avoid spleen rupture by limiting activities that could risk injury.

Treating autoimmune disorders requires long-term care, which can be costly and strain your finances. Therefore, it’s important to have affordable health coverage to protect against such medical emergencies.

>> Read More: How Immunity Can Help Fight Common Diseases in India

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