Peter Hibberd, M.D., is a doctor whose advice is based on more than 28 years of hospital outpatient and inpatient experience. He is an experienced emergency medicine physician, surgeon, and consultant. Dr. Hibberd is certified by the American Board of Emergency Medicine. He is also a fellow and active member of the American Academy of Family Physicians, an active member of the American College of Emergency Physicians, and a member and fellow of the American Academy of Emergency Medicine. Dr. Hibberd has earned numerous national and international professional certifications, memberships, and awards.

What Causes Recurrent Epstein-Barr Virus?

Monday, 19 July 2010 11:18 AM

Question: A 42-year-old friend of mine has the Epstein-Barr virus again. He had the virus two years ago and now it has returned much worse than before. He has been to his doctor but it seems there is really nothing to cure it except to just wait it out. Do you have any recommendations?

Dr. Hibberd's Answer:

Recurrence EBV infection is unusual and should trigger a review of the patient’s immune function. EBV is often implicated in certain B cell tumors in patients with compromised immune systems as well as nasopharyngeal carcinoma and Burkitt's lymphoma. Patients should be evaluated for various disorders of immune dysfunction and underlying associated diseases that may require aggressive treatment.

EBV (Epstein-Barr Virus or human herpes virus type 4) is a herpes virus which infects 50% of children before the age of five, and causes infectious mononucleosis in young adults. Doctors make patients more comfortable by treating the symptoms, and although they sometimes prescribe oral acyclovir (which is also used to treat herpes and other viral infections), there is no evidence of any reasonable benefit.

Many conditions mimic EBV infection, especially cytomegalovirus, HIV infection, toxoplasmosis, and various hepatitis viral infections.

After the initial primary infection, EBV remains in the B cells (our antibody-forming cells) for life, and can sometimes be detected in oral secretions. Amounts of the virus increase in patients whose immune systems are compromised, especially those who have organ transplants or HIV.

EBV is not very contagious, and does not cause chronic fatigue syndrome. On initial infection, it usually causes sore throat, glandular swelling, and spleen enlargement with occasional cases of hepatitis. It usually lasts several weeks but can last up to several months in 1-2% of cases. Occasionally the virus causes a syndrome that includes fever, fatigue, inflammation of lung tissue, pancytopenia (a reduction in blood cells), and uveitis (eye inflammation). Recovery is usually complete.

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