Epstein- Barr Virus (EBV) is one of the most widespread viruses in the world, infecting over 90% of adults. It is a member of the herpes virus and spreads most commonly through bodily fluids, primarily saliva, and can cause other illnesses, including infectious mononucleosis (3).

Many people become infected with EBV during childhood but don't realize it due to the overlapping symptoms of other common childhood illnesses. The most common symptoms show up in teenagers and adults and can last for several weeks to months.

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EBV Signs and Symptoms

Symptoms of EBV active infection (mononucleosis) can include:

• Fever
• Fatigue
• Inflamed throat
• Swollen lymph nodes in the neck
• Enlarged spleen
• Swollen liver
• Rash

After an EBV infection, the virus becomes latent (inactive) in the body. In some cases, the virus can reactivate, causing symptoms in those with weakened immune systems. (3)

What Causes Epstein Barr Virus (EBV)

EBV is one of the most common human viruses (herpes simplex 4) and is found worldwide. Most people get infected with EBV at some point in their lives, but many are unaware that it can stay inactive in the body.

How Does EBV Spread

EBV transmission is most commonly through saliva. It can also spread through blood and semen during sexual contact, blood transfusions, and organ transplantations. It can also be spread by using infected objects, such as toys children have drooled on, eating utensils, or drinking glass that an infected person recently used.

When someone gets infected with EBV, they can unknowingly spread the virus to others for weeks before they have any symptoms. EBV can reactivate at any time and spread again, no matter how long it has been since the initial infection.

How is EBV Diagnosed

EBV laboratory testing helps clinicians confirm whether there is an active or reactivated Epstein-Barr infection or if there has been an infection in the past. To find this out, we use tests to detect antigens

* Note: About nine out of ten adults have antibodies showing that they have a current or past EBV infection.

In primary EBV infection, IgM-VCA appears first, followed by rising IgG-VCA antibodies. The presence of both IgG-VCA and EBNA antibodies is indicative of past infection.

Commonly Used Test to Detect Epstein Barr Virus

• EBV viral capsid antigen IgM. anti-VCA appears early in EBV infection and usually disappears in 4-6 weeks.

• EBV viral capsid antigen IgG. Appears in the acute phase of EBV infection peaks at two to four weeks after onset, declines slightly then appears for the rest of a person's life.

• EBV Early Antigen-antibody. Anti EA- IgG antibody appears in the acute phase of illness and generally falls undetectable after 3-6 months. In many people, the presence of this antibody is a sign of an acute infection, but in 20% of people, there may be detectable antibodies against the early antigen for years.

• EBV nuclear antigen. This immunofluorescent test shows the antibody to the early nuclear antigen that is not seen in the acute phase of the infection but slowly appears 2-4 months after symptoms and persists for the rest of the person's life. There are other enzyme assays of this type of test, and if they are not performed with the correct standards, they could show a false positive result.

• EBV DNA/PCR test. This is not a recommended test by the CDC, but it may serve a purpose in detecting the DNA of the EBV virus and permit treatment with antivirals

• Monospot. This test is not recommended for general use. The antibodies detected by the mono spot can show up positive from other illnesses. The test can show false positive or false negative results. The test may indicate that a person has a typical case of infectious mononucleosis.

Other Diseases Caused by EBV

EBV can cause infectious mononucleosis and other illnesses such as diarrhea and ear infections in children (3) and has been closely associated with some autoimmune conditions.

Systemic Lupus Erythematosus (SLE)

Lupus (SLE) is an autoimmune condition that causes immune dysregulation. SLE has been thought to be associated with EBV reactivation since its first report in 1969. A study performed in 2019 reviewed 33 studies focusing on SLE and EBV reactivation. It showed that prior EBV is an essential factor for Lupus development by finding higher EBV IgG and EBV DNA in those participants with Lupus. The limitations were small group sizes in studies, and more extensive prospective studies are needed to establish the EBV/SLE relationship.

Multiple Sclerosis (MS)

EBV has long been thought to be associated with Multiple Sclerosis (MS). In 2022, the journal Science tested the hypothesis that EBV causes MS in a cohort of 10 million young adults on active duty in the military, 955 of whom were diagnosed with MS during their service period. The risk of MS increased 32-fold after infection with EBV but did not increase with infection from other viruses.

Changes in a biomarker of neuroaxonal degeneration (a part of the nerve cell that degenerates in MS) increased only after EBV seroconversion.

After years of research, the researchers proved that the association between EBV and MS risk was too strong to be explained by any other known MS risk factors. "The findings strongly suggest that EBV is part of the chain of events that leads to most cases of MS. However, other unknown factors certainly play a role."

Conventional Treatment for EBV

There is no specific treatment for EBV. However, some things can be done to help relieve symptoms, including

• Staying Hydrated
• Getting Plenty of Rest
• Taking over-the-counter medications for pain and fever

EBV is typically a self-limiting illness, but with any disease, there can be complications. Supportive medications may sometimes be needed depending on the severity of the symptoms (6).

Functional Medicine Treatment of EBV

Functional medicine treatment of EBV focuses on supporting the immune system with nutrition and decreasing stress on the body.

Numerous vitamin, mineral, and herbal supplements can help boost the immune system, in turn getting the EBV reactivation under control.

Vitamin C

A small study done in 2014 of 178 patients showed data that there is evidence for high-dose intravenous vitamin C in the treatment of EBV reactivation- duration of disease and viral antibody levels. The authors' correlations suggested that patients with higher levels of vitamin C tended to have lower levels of antigens in the acute stage of the disease. In addition, there was a correlation between higher vitamin D levels and lower EBV EA IgG levels (reactivation).

Herbs

Many herbs have been studied and may help with boosting the immune system. These are garlic, astragalus, green tea, ginger, Echinacea, black cumin, licorice, and St. John's Wart. Herbs should be reviewed with your practitioner and medications to ensure no cross-interactions (11).  

Nutrition

Nutrition for Epstein-Barr Virus depends on the patient's microbiome, food allergies and intolerances, possible nutritional deficiencies, inflammation levels, and medications. Many practitioners chose to promote anti-inflammatory diets to help lower inflammatory markers and boost immune function. The most common anti-inflammatory diet that has been scientifically researched for lowering inflammation and boosting immunity and longevity is the Mediterranean diet. This way of eating includes whole, fresh foods and limits processed foods, dairy products, and gluten.

Stress Reduction

Decreasing stress is one of the most important treatments for EBV since stress can cause reactivation. Ways to reduce stress are to form a meditation habit, do breathing exercises, work on calming down the vagus nerve, and sometimes the use of adaptogenic herbs can help to calm the adrenal response (cortisol).

Essentially when someone has EBV reactivation in the clinic, it is essential to figure out what triggered the reactivation, get that under control, and then focus on supporting the immune system to get the virus back to the latent phase (inactive).

Summary

EBV affects over 90% of the adult population. Most of us have been exposed to or have had this infection.

The virus can reactivate by being triggered by another illness or stress.

There are labs to order that can identify if you've had EBV before and if it is reactivated or affecting your body.

Conventional treatment relies on treating the symptoms and is generally self-limiting unless a complication needs to be treated.

Functional medicine treatment relies on boosting the immune system to aid in balancing the body.