#DetectEBV #VirusEpsteinBarr

EBV, a questionable virus

Frequently asked questions about the virus

Full EBV serology: which markers should be requested when the blood test is prescribed?

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.

Is there any Lab test to detect the reactivation of the virus?

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.

Brain fog is often mentioned as a symptom linked to EBV. What is it?

  • 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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Is kissing disease only spread by kissing?

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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I suffer from depression. Could EBV be the cause?

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.

How do I know if I have reactivated EBV? Which tests should I take?

To find out whether the EBV virus is reactivated or not, a blood test, called serology, is the best option.

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.

Can we get rid of EBV?

Unfortunately not, not to date.

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.

Why are athletes (especially high-level athletes) most affected by EBV?

In contrast to a sedentary lifestyle, moderate and regular physical activity is generally associated with improved health, including, for example, lower blood pressure and body weight, improved glucose tolerance and potentially reduced susceptibility to upper respiratory tract infections.

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.

I often get colds, bronchitis and sinusitis, especially in winter. Could my poor health be due to EBV?

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.

Why is EBV said to impair the immune system?

The EBV virus primarily infects the cells of the immune system, especially the so-called B cells. These are the cells that produce the antibodies that help to eliminate diseases.
Once infected, the B cells move to the germinal centres of the lymph nodes and spleen where the virus sets up its latency programmes.

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”.

Can mononucleosis " reoccur "?

Mononucleosis is by definition the “primary infection”, i.e. the first encounter of the virus with the immune system.
Also, there cannot be two first encounters, so mononucleosis cannot be repeated.

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).

How do I know if I have reactivated EBV? What tests should I use?

To find out whether or not the EBV virus is reactivated, a serological blood test is the best option.

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).

Is testing necessary?

For acute cases, the symptoms speak for themselves and there is no need for testing. Serology, however, will confirm the diagnosis.

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.

Could years of migrating joint pain, swollen left ankles and fatigue be caused by EBV? At the age of 75?

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).

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