EBV, a questionable virus

After the initial clinical evaluation, the diagnosis can be refined with medical analyses, including complete serology (using the 4 markers IgM VCA, IgG VCA, IgG EBNA, IgG EA). The comparison of these 4 markers and their value can make it possible to deduce whether the virus is in the reactivation, latency or primary infection phase, but the result is not always easy to interpret.

PCR can also be done: this technique can detect and quantify EBV DNA in various samples, such as blood. It is particularly useful for assessing viral loads in immunocompromised patients or for monitoring diseases associated with EBV.

Finally, lymphocyte typing can refine the diagnosis and evaluate the specific immune response against EBV, especially in chronic pathologies or in immunocompromised patients.

It is important to remember that these analyses must always be correlated with the patient’s clinical signs.

1. Immune balance: a balanced immune system is essential for effectively fighting infections without causing excessive inflammation. This can be supported by a balanced diet rich in vitamins and minerals, adequate sleep, and stress reduction.

2. Anti-inflammatory hygiene: inflammation can compromise immune efficiency, so it is important to adopt an anti-inflammatory lifestyle. This includes consuming anti-inflammatory foods (such as omega-3s, fresh fruits, and vegetables), avoiding pro-inflammatory foods (refined sugar, saturated fats), and practicing regular exercise.

3. Monitor clinical signs: being attentive to the clinical signs your body sends (such as fatigue, malaise, skin eruptions, etc.) will help you more easily identify symptoms related to inflammation and reactivation. Recognizing these signs at an early stage can prompt you to take appropriate measures or seek medical advice promptly.

4. Professional follow-up: it is highly recommended to consult a healthcare professional for a comprehensive immune assessment. A doctor can evaluate your overall health, identify any specific deficiencies or imbalances, and develop a personalized immunomodulatory strategy. This approach may include tailored supplements, dietary adjustments, and stress management strategies.

Additionally, we can assist you in finding a competent healthcare professional who can guide you through this process. Working closely with a professional will enable you to implement a strategy tailored to your personal situation, thus maximizing your chances of keeping viruses at bay while preserving the health of your immune system.

EBV serology is a blood test that measures the presence of specific antibodies to the Epstein-Barr virus. Antibodies are produced by the immune system in response to an infection. The 4 most important markers in a complete EBV serology are as follows:

IgM-VCA (IgM antibodies directed against the Epstein-Barr viral capsid antigen) : The appearance of IgM-VCA usually indicates recent EBV infection. If this marker is positive, it may suggest reactivation of the infection.

IgG-VCA (IgG antibodies to Epstein-Barr viral capsid antigen): IgG-VCA usually appear a few weeks after the initial infection and remain present for life. An increase in IgG-VCA levels may indicate EBV reactivation.

IgG-EBNA (IgG antibodies to Epstein-Barr viral nuclear antigen): IgG-EBNA usually appears several months after the initial infection. High levels of IgG-EBNA may suggest past or latent infection.

IgG-EA (IgG antibodies to Epstein-Barr viral early antigen): IgGEA usually appears during acute infection and then decreases. High levels of IgGEA may indicate recent EBV reactivation.

Requesting a full EBV serology with these 4 markers allows a more accurate assessment of EBV infection. This can help doctors differentiate between an acute infection, an old infection or EBV reactivation. For people with autoimmune diseases such as multiple sclerosis, EBV reactivation can worsen symptoms, particularly during relapses, and may require specific management.

It is important to stress that the interpretation of these markers should be carried out by a qualified healthcare professional, taking into account the patient’s medical history, clinical condition and other relevant factors. Full EBV serology can help guide diagnosis and treatment, and regular monitoring of these markers can be useful in assessing the course of infection. Additional tests may also be required (blood count, lymphocyte typing, liver tests, etc.).

Always consult a healthcare professional before carrying out any tests and to interpret the results.

Yes, there are lab tests available to detect the reactivation of the Epstein-Barr virus (EBV). One commonly used test is the EBV viral capsid antigen (VCA) immunoglobulin M (IgM) antibody test. This test looks for the presence of IgM antibodies, which indicate recent or current infection with EBV.

Another test commonly used is the EBV nuclear antigen (EBNA) IgG antibody test. This test detects the presence of IgG antibodies, which appear later in the infection and can indicate a past or chronic infection with EBV. Additionally, viral load testing through polymerase chain reaction (PCR) may be used to quantify the amount of EBV in the blood and determine its activity level. It is important to consult with a healthcare professional for proper diagnosis and interpretation of these lab tests.

• Impaired concentration
• Frequent forgetfulness
• Memory lapses
• Fatigue
• Mood disorders
• Headaches
• Apathy
• Disorientation
• Anxiety

… Did you know that EBV can cause this ‘brain fog’?

It is believed that it is small inflammations in the brain that create this feeling of mental confusion that makes you not think clearly and have fuzzy thoughts. The limbic system, where emotions and memories are processed, is particularly affected. Following a conversation, concentrating, remembering everyday things become very difficult exercises.

Very often it is thought to be something “merely psychological” when in fact it can be a sign of reactivation of EBV. Rarely taken seriously, it is very important to pay attention to these symptoms and to seek medical advice.
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Spread by saliva, infectious mononucleosis is nicknamed the “kissing disease” because it usually becomes symptomatic from teenage years onwards (whereas it may go unnoticed in childhood) and is mainly spread by saliva.

Saliva contains viral substances that are contagious for up to 18 months after mononucleosis. During the reactivation period, it is possible to be contagious again: be careful when sharing cutlery, glasses, toothbrushes, lip balms, etc.
More rarely, EBV can be spread by blood transfusion.

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Although depression is often a combination of multiple influences and the causes are sometimes difficult to identify, it is recommended to have an EBV test. If you have had severe mononucleosis in the past, you are even more likely to be prone to depression.

The antibodies against the activation or latency proteins of the virus are tested to determine the possibility of the virus being active (reactivation or not).

Additional tests such as lymphocyte typing can be performed to provide an in-depth assessment of the immune system. Indeed, by assessing the different lymphocyte populations, it is possible to determine the operation of the immune system and to identify any abnormalities that may be caused by EBV reactivation that is not controlled by the immune response.

EBV is a virus belonging to the Herpesviridae family (like the chickenpox virus, the herpes virus…). These viruses can, thanks to a specific latency system, “sleep” in the infected cells for as long as the host (the organism receiving the virus) lives.
EBV actually has 3 latency systems, one of which makes the virus completely invisible.

Once this system is activated, the virus becomes undetectable to the immune system and cannot be completely eliminated. This differs from other viruses, such as influenza, which do not have such a system and become visible, detected and eradicated by the immune response.

However, intense physical exercise is followed by a temporary immunodepression, the magnitude and duration of which is related to the magnitude of the exercise.

During this “window of opportunity”, sensitivity to upper airways and other infections is increased. If rest periods between exercise sessions are not long enough to allow immune recovery, susceptibility to upper airways infections and possibly other infections may occur. Such a scenario is quite possible among high performance athletes who push their physical abilities to the limit. In addition to the intensity of the training, the stress linked to the stakes and the rhythm of the competitions, the time differences, the media pressure: all these factors alter the control of the virus by the immune function.

Amongst professional athletes who have had to battle with EBV and have seen their careers threatened or interrupted, we can name Mark Cavendish (cycling), Marco Stiepermann (football), Robin Söderling (tennis), Arnaud Tonus (motocross), Stéphane Tempier (mountain bike), etc.

Repeated infections should raise a red flag! As the German doctor Dr. Petra Blum explains, “in patients with recurrent infections, a reactivated EBV is often ‘hiding’ behind it. In many cases, by helping the immune system to cope better with this virus, the vulnerability to infection is reduced.”

Reactivation of Epstein-Barr virus is often linked (cause/consequence…hard to say!) to a drop in immune defences, which can lead to recurrent infections. These infections can be respiratory, but also oral (mouth ulcers, herpes), genital (fungal) or other…
If you are described as having “fragile” health, you may think that the Epstein-Barr virus is partly responsible. A blood test can check for reactivation of this virus.

Monitoring this virus and keeping it under the control of the immune system is part of a preventive approach.

It is a bit like a thief hiding in a police station and making itself invisible…

During the evolution of the virus and its host, the EBV virus will from time to time activate the spread of B lymphocytes in order to promote its survival. In doing so, it disrupts the proper functioning of the immune system by promoting anti-immune cell activity and preventing cells from “dying” naturally (anti-apoptosis). The production of viral proteins also allows it to escape the vigilance of the immune system by reducing its ability to detect it: this is known as the virus’ “escape mechanism”.

On the other hand, once the virus is in the infected body, it can reactivate and give rise to clinical manifestations that may be similar to the symptoms of the first infection, but which may also be very different depending on the individual.

It is also important to know that sometimes the primary infection is not sufficiently managed by the immune system, and in this case, the primary infection is called persistent (CAEBV, Chronic Active EBV).

This tests for antibodies to the virus’ activation or latency proteins to determine the probability of virus activation. 
With these tests, it is possible to determine whether the patient has been infected in the past (old infection), whether they are in the primary infection phase (mononucleosis), whether they are reactivating or whether they simply do not carry the virus (it is estimated that only 5% of the world’s adult population is seronegative).

In chronic forms where there are few symptoms, and which are not specific, it is very difficult, if not impossible, to determine reactivation clinically. In these cases, it is recommended that a serology test (blood test) be performed.

The symptoms you describe, such as migratory joint pain, swollen ankles and fatigue, can sometimes be associated with EBV infection, although other causes are also possible.

Age is not necessarily a factor (contrary to popular belief, EBV does not only affect young adults). Simply put, age causes the immune system to become less efficient, which can favor virus reactivation.
To check this, it would be best to perform a complete EBV serology (with all four markers: IgM-VCA, IgG-VCA, IgG-EBNA, IgG-EA).