The Epstein-Barr Virus
The Epstein-Barr virus (EBV) is named after the two pathologists who first identified it in 1964. It is a member of the herpes virus family and is also known as human herpes virus 4 (HHV-4). Acute infection causes glandular fever or infectious mononucleosis and chronic infection is suspected in some cases of persistent fatigue.
The Epstein-Barr virus is also implicated in the causation of multiple autoimmune diseases including systemic lupus erythematosus (SLE), rheumatoid arthritis, multiple sclerosis and diabetes mellitus. It is also a known cause of several lymphatic disorders and cancers including Hodgkin's disease.
Like other viruses, the Epstein-Barr virus can express either an infective cycle or a latent cycle. During the infective cycle infectious virions are produced by budding from an infected cell, whereas during the latent cycle the virus does not produce any virions. EBV can infect a number of different cell types, including B and T lymphocytes, natural killer cells, epithelial and smooth muscle cells.
Glandular fever or infectious mononucleosis
In young babies immunity to the Epstein-Barr virus is conferred by the mother, but thereafter many children contract the EBV and suffer only mild symptoms which may be indistinguishable from many of the other illnesses of childhood and as a consequence gain naturally immunity. Infection is widespread and by 5 years of age, half of all children in the US test positive for the Epstein-Barr virus.
However, when exposure occurs later in adolescence or young adulthood, the Epstein-Barr virus typically causes infectious mononucleosis or glandular fever between one-third and two-thirds of the time.
In the acute infection, the virus replicates in the epithelial cells of the mouth and throat releasing infectious virions into the saliva and causing the virus to spread. It also creates latent infections in the B-lymphocytes of the immune system and this accounts for its persistence. By adulthood up to 95% of all adults show evidence of having been infected with the EBV.
Symptoms of infectious mononucleosis/glandular fever mimic those of other infectious diseases and typically last between 1-4 weeks and include:
Swollen lymph glands in the neck
Temperature fluctuations and/or fever
Rarely: an enlarged liver or spleen and
More rarely still: heart problems or involvement of the central nervous system
Latency and reactivation
There is an incubation period from the time of initial infection to the appearance of symptoms of 4 to 6 weeks. During this phase, the Epstein-Barr virus produces large amounts of virions infecting B-lymphocytes within the host. It is thought that it is during this time that infected people are most able to spread the virus.
Transmission of the EBV requires intimate contact with the saliva, for which reason the illness is often referred to as "the kissing disease". However, most exposed individuals will have previously been infected with Epstein-Barr virus and are therefore not at risk of contracting infectious mononucleosis.
Then, during the latent cycle, the infected B-lymphocytes proliferate and distribute the infected cells to the sites within the body where they persist. Although the initial infection may resolve within 1 or 2 months, the virus will remain dormant or latent within a few cells in the throat and blood for the rest of the person's life.
The virus may periodically reactivate and this may occur with or without symptoms of illness. Some believe that the site of persistence of Epstein-Barr virus may be bone marrow because infected people who have had bone marrow transplants have become EBV negative as a result of treatment.
Many seemingly healthy people both carry and disseminate the virus throughout life and given that 95% of people are carriers this provides a constant reservoir with which to infect others in the population. For this reason, transmission of Epstein-Barr virus is almost impossible to prevent.
Part of what makes the Epstein-Barr virus so persistent is its ability to express different part of its genome at different times in order to confound the immune system. The virus may owe its cancer-inducing abilities and its tenacity to its capacity to confer immortality on certain cells by promoting cell lines that are capable of seemingly indefinite growth. For much of the time it may turn off most - or possibly all - of its genes, only occasionally reactivating to produce fresh virions.
Blood testing for the Epstein-Barr virus
During the initial infectious mononucleosis phase, blood analysis will show an increased white blood cell count with an increased percentage of atypical white blood cells. A positive reaction to a "mono spot" antibody test is considered diagnostic of EBV.
However, many asymptomatic people have high and positive EBV blood tests too and their role in reactivated or chronic infections is much less reliable, not least because almost everyone carries the virus.
Many researchers think that chronic fatigue further to an acute epsiode of infection should be renamed as "chronic mononucleosis", "chronic EBV infection" or "postviral fatigue syndrome".
It may also be that the Epstein-Barr virus is an opportunist taking advantage to proliferate in a person with compromised health rather than the cause of their fatigue and malaise.
Advice for recovery
There is no specific allopathic treatment for infectious mononucleosis, other than relief of symptoms. Naturopathic advice includes:
Allow yourself to rest 'Pushing through' the initial acute infection will take its toll in the long run. It is better to just to rest and allow your body to fight the initial infection effectively.
Get sufficient sleep Your body needs to sleep to repair, so go to bed early and get a good night's sleep.
Drink plenty of water This helps the body to flush through the toxins produced by the virus. Avoid drinking dehydrating beverages such as coffee and alcohol.
Eat well Eating foods containing sugar and refined flour will tax your body and depress your immune response, so eat plenty of fresh fruit and vegetables and a reasonable amount of high quality protein to give your body the raw materials it needs to restore.
Avoid taking antibiotics This is counterproductive as it causes overgrowth of yeasts and kills the friendly bacteria whilst doing nothing to address the viral infection.
Take supplements Supplementing a good multimineral/vitamin along with relatively high doses of vitamin C and omega 3 oils is recommended for everyone. In addition, vitamins A and E, a B vitamin complex and the trace minerals zinc, selenium and magnesium may be of particular benefit.
Herbs Olive Leaf extract, echinacea, garlic and astragalus all act to boost immune function and Cat's claw or Samento works to eliminate the virus and aid immunity.