More than 30 diseases have been linked directly or indirectly to EBV to date.
After the very first infection (whether symptomatic mononucleosis or not), EBV, like most viruses of the Herpes family, remains dormant until it has the opportunity to reactivate under certain circumstances, usually related to immune failure. At this point, it leaves its dormant state, becomes active and can infect our cells and disrupt our immune system. Subsequently, it can spread to other tissues and become a long-term fixture and a trigger for many diseases such as autoimmune diseases, various digestive disorders, neuro-inflammations and even cancers.
Infectious mononucleosis or glandular fever is a condition involving a blood mononucleosis syndrome (i.e. a temporary but significant increase in specific white blood cells called monocytes), which gives the disease its name.
Although usually considered harmless and asymptomatic during childhood, infectious mononucleosis can have long-lasting consequences ( long-term or even chronic fatigue, liver and spleen disease, immune disorders, etc.). In adulthood, infectious mononucleosis is often diagnosed late in life, once the symptoms have become long-lasting. Early diagnosis of mononucleosis could reduce diagnostic delays and the deterioration of the patient’s health.
A Danish study published in 2021 shows that patients suffering from severe mononucleosis have a greater risk of developing depression in the weeks and up to 4 years after the disease. Therefore, this disease is not to be taken lightly.
Autoimmune diseases (general)
Various studies have also shown that EBV is involved in thyroid autoimmunity events. One publication clearly showed a link between markers of EBV reactivation and Hashimoto’s thyroiditis outbreaks.
Multiple sclerosis (MS)
A recent study confirms the link between Epstein-Barr virus infection and MS, with a 32-fold increase in the risk of developing the disease following seroconversion, with a median delay of 7.5 years. EBV may be involved in both the peripheral and central immune responses believed to be involved in MS.
Nearly 2/3 of patients with long Covid are found to have reactivated EBV according to a recent study.
This study suggests that reactivation of the Epstein-Barr virus may be one of the triggers of long Covid. In order to determine a causal link between EBV and long Covid, American scientists recruited 185 people who had been infected by the coronavirus, 55 of whom had developed a long strain. They then looked for the presence of antibodies specifically linked to the Epstein-Barr virus in their blood.
The result: 73% of the patients with long Covid had antibodies to EBV, proving its reactivation.
The researchers also found that the reactivation of the Epstein-Barr virus occurred shortly after or even at the same time as the coronavirus infection. “Many of the long-standing symptoms of Covid may not be the direct result of SARS-CoV-2 but may be the result of EBV reactivation induced by Covid inflammation,” the study authors conclude.
While further studies are needed to understand the exact role of EBV in the occurrence of long Covid, it is a prospect that could improve the diagnosis of people with this long type of coronavirus and thus improve their treatment. Indeed, researchers are urging screening for EBV reactivation in coronavirus-positive patients to reduce its intensity and duration, which could help inhibit the possible development of long Covid in patients.
EBV can directly or indirectly infect neurons through B cells and result in various alterations in the brain. Various mechanisms have been described by which EBV may contribute to the development and progression of Alzheimer’s disease, including:
Activation of chronic inflammatory processes and degeneration and/or progressive death of neurons (neurodegeneration).
Accumulation of β-amyloid proteins, which is involved in Alzheimer’s disease.
Controlling EBV infections is important to reduce the risk of neurological diseases such as Alzheimer’s disease.
Myalgic encephalomyelitis / Chronic fatigue syndrome (ME/CFS)
Chronic fatigue syndrome is a serious neuro-immunological disease. People with this condition suffer from severe exhaustion for more than 6 months or on a recurrent basis, hence the word chronic. Recently, the term chronic fatigue immune dysfunction syndrome has also been coined. In ME/CFS, immune dysfunction is often associated with malfunctioning of the mitochondria, the energy centres of the cells. It has also been shown that reactivation of the Epstein-Barr virus is involved in the onset and progression of the disease.
This also appears to be the case in fibromyalgia
EBV is an oncogenic virus, in fact when B lymphocytes are infected they acquire oncogenic mutations that can promote the development of cancer. It is currently estimated that about 15% of cancers can be linked to viruses with oncogenic capabilities. The most documented EBV-related cancers are Hodgkin’s or non-Hodgkin’s lymphoma, nasopharyngeal carcinoma, stomach cancer, breast cancer, lung cancer, papillary thyroid carcinoma…
The role of viruses and bacteria in the origin of periodontitis is increasingly being discussed. Dr. Bruno Donatini, an esteemed gastroenterologist and oncologist specialised in immunity, mentions EBV in particular: “We must think about it especially when faced with gingivitis: the first cause of periodontal disease is the Epstein-Barr virus. It is essential to treat it, it is a cancerous condition, there will be a risk of epithelial transformation. Gingivitis should not be tolerated, it is not a harmless thing.”
A gum that bleeds regularly is potentially a sign of the presence of a virus. Indeed, herpes viruses, in particular EBV-1 and HCMV, have been associated with various forms of periodontal disease. Viruses can have pathogenic potential directly on the periodontium, either by acting on bacterial pathogenicity or by altering the host response mechanisms to bacterial aggression.
One study found that in over 200 documented cases of encephalitis, about 10% were caused by the EBV virus. Encephalitis is an inflammation of the brain tissue, the typical signs of which are a change in the level of consciousness, changes in behaviour, difficulty in walking or talking and even strange sensations of tingling and numbness, called paresthesias. In addition, a person with encephalitis may develop hemiparesis, which is weakness on one side of the body.
EBV infection can lead to optic neuritis. In this case, eye pain and progressive vision loss may occur.
Cranial nerve palsies
Cranial nerve palsies are disorders of one of the nerves in the head. In patients infected with EBV, the most commonly affected cranial nerve is the facial nerve. Signs of facial nerve palsy include the sudden onset of paralysis on one side of the face – the side in which the nerve is affected. A drooping eyebrow and an inability to close an eye are other signs that a facial nerve is affected by VBE.
A mononeuropathy is a disease or disorder of a single nerve. It is often caused by compression, entrapment or trauma to a specific nerve. Symptoms of mononeuritis include pain, tingling, burning or numbness. EBV infection can also cause mononeuritis: one study documented the case of a young man who had axillary nerve damage caused by EBV infection. This resulted in shoulder pain and weakness that took several months to improve.
These neurological problems should be a cause for alarm and a search for reactivation of the Epstein-Barr virus is recommended to investigate the possible causes.
Gastritis and inflammatory bowel diseases
EBV could also be a possible trigger for inflammatory bowel diseases such as ulcerative colitis – Crohn’s disease. In one study, biopsies from patients suffering from these diseases showed the presence of EBV in the intestinal tissues, which was not found in the control groups, indicating a definite link between EBV and inflammatory bowel disease.
Severe mononucleosis and 40% increased risk of depression: a study by a Danish team shows that patients hospitalised or admitted to hospital as an emergency patient with infectious mononucleosis have an increased risk of developing depression afterwards (in the weeks and up to 4 years after the mononucleosis episode).
The identification of this correlation between severe mononucleosis and depressive symptoms suggests that long-term severe fatigue, activation of the immune system, and possibly even brain damage may be factors in this increased risk of depression.
This link between EBV and depression should lead to two considerations:
– It is essential to ensure medium-term follow-up of patients who have suffered from severe infectious mononucleosis and to inform the patient’s relatives that they should be alert to any signs of depression.
– In patients suffering from depression, it may be useful to ask them about any previous mononucleosis they may have had.
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Co-infections: Sars-Cov2, Papillomavirus (HPV), Herpes, Cytomegalovirus (CMV), Lyme
According to Dr. Bruno Donatini, a prominent gastroenterologist and cancer specialist, “viruses help each other: type 1 herpes virus will be favoured by the Epstein-Barr virus. Think of the synergy that can exist between viruses and ancient bacteria such as Elicobacter Pilori, mycobacterium (linked to Crohn’s disease)…”.
In fact, billions of bacteria, almost as many viruses and other life forms live together in our bodies, creating an eco-system in which the elements interact with each other.
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