Epstein-Barr virus: symptoms and consequences

Epstein-Barr virus: symptoms and consequences

The Epstein-Barr virus (EBV) is highly contagious and prevalent in the German population. It belongs to the group of herpesviruses. The Epstein-Barr virus is the cause of infectious mononucleosis, also known as mononucleosis. EBV can also trigger other diseases. For example, it plays a role in developing lymph gland cancer (lymphoma). It can also promote the development of malignant neoplasms in the nose and throat area (nasopharynx). Below, we present the peculiarities of this virus.

What is the Epstein-Barr virus?

The Epstein-Barr virus belongs to the human herpesviruses (HHV), of which eight different subtypes exist. EBV is, therefore, also known as human herpesvirus type 4 (HHV-4). There are three groups of herpesviruses: the alpha, beta and gamma herpesviruses, with EBV being one of the gamma herpesviruses. This group also includes the Kaposi sarcoma virus, which, however, only plays a role in HIV patients.

Herpes viruses have the property of remaining in the human body for life after a single infection. They do not trigger an active disease, but they cannot be ultimately killed off by the immune system . Gamma herpes viruses are mainly found in the body’s lymphatic system, which is why they are also called lymphotropic.


Spread of the Epstein-Barr virus

The Epstein-Barr virus is anything but a rare virus. It is assumed that the so-called seroprevalence in the German population is over 90 per cent. The technical term seroprevalence describes the presence of specific antibodies against the virus. Accordingly, over 90 per cent of the German population has already had contact with EBV and is likely to continue to carry the virus.

How does one get EBV?

The first infection with the Epstein-Barr virus usually occurs in childhood. The pathogens are found in the saliva of infected children and adults. The saliva is highly infectious, so infection can quickly arise. Small children are often infected by their parents.

Adolescents also often become infected through saliva, for example, through kissing. Therefore, glandular fever is also called “kissing disease” or “kissing disease”.

A vaccine against the Epstein-Barr virus does not currently exist but is the subject of research.


How long is the Epstein-Barr virus contagious?

You are already contagious during incubation, i.e., before the first symptoms appear. This infectivity can last for varying lengths of time. You can still be infectious weeks after your symptoms have subsided. Since the body cannot remove the virus, it is difficult to determine when you are no longer contagious. As a rule, the immune system controls the virus after a few weeks, so the saliva is no longer infectious.

Diagnosing EBV: Is there a test?

The diagnosis of an infection with the Epstein-Barr virus is usually made clinically, i.e. based on symptoms. In the laboratory, an examination of the blood count shows an increase in the white blood cells (leukocytosis). In addition, particular forms of T cells (a subtype of white blood cells) can be identified, also known as Pfeiffer cells.

Some tests detect antibodies against the virus in the blood. These blood values ​​are usually unnecessary, and the tests are only carried out if the diagnosis is unclear. Depending on the type of antibodies detected, a fresh EBV infection can be distinguished from an old one.

What are the symptoms of the Epstein-Barr virus?

The primary infection, i.e. an initial infection with the Epstein-Barr virus, is usually asymptomatic, i.e. the children or young people do not even notice that they have been infected. However, some diseases can trigger or promote EBV:

  • Mononucleosis (infectious mononucleosis, kissing disease)
  • Oral hair leukoplakia (in immunocompromised)
  • Burkitt-lymphoma
  • Nasopharynxcarcinoma

In the following, we present these diseases in more detail.


glandular fever

Infectious mononucleosis, better known as mononucleosis, is a febrile illness of childhood that, after an incubation period (time between infection and the onset of symptoms) of one to seven weeks, causes tonsillitis (angina tonsillitis), lymph node swelling and swollen spleen (splenomegaly ). ) goes hand in hand. Sometimes, joint pain and a skin rash also occur.

There is no causal therapy; only the symptoms can be treated. Most children survive the disease without consequences, but a pronounced exhaustion ( fatigue ) can persist for weeks.

Oral Hair Leukoplakia

Oral hairy leukoplakia is non-stripping white coatings on the tongue caused by EBV. However, they only occur in immunocompromised people. People with HIV are particularly affected.


Burkitt lymphoma takes its name from its first describer, surgeon Denis Parsons Burkitt. It is a so-called B-cell non-Hodgkin lymphoma. This complicated name hides the cell of origin (B-cell, part of the white blood cell, also: B-lymphocytes) on the one hand and the proper name Hodgkin on the other. This means the cells visible under the microscope in Hodgkin lymphoma (Hodgkin cells).

Lymphomas are divided into Hodgkin and non-Hodgkin lymphomas depending on whether or not these Hodgkin cells are present. The name of these cells goes back to the doctor and pathologist Thomas Hodgkin, who discovered these cells. Burkitt’s lymphoma is endemic (locally limited) in Central Africa and is characterized by rapid tumour growth and infestation of the cervical lymph nodes with massive lymph node swelling.



Nasopharyngeal carcinomas are malignant neoplasms of the nose and throat mucous membrane. Different subtypes exist here, depending on which cell the carcinoma originates from. Lymphoepithelial carcinoma, or Schmincke tumour, is associated with EBV infection.

Genetic material from the Epstein-Barr virus can often be detected in the tumour cells. Nevertheless, several factors, such as environmental influences (smoking, alcohol, etc.) and genetic predisposition, usually play a role in the development of such tumours.

Can the Epstein-Barr virus cause cancer?

The Epstein-Barr virus alone does not cause cancer. However, it can promote the development of certain cancers. The reason for this lies in the property of the gamma herpesviruses. They can change body cells in such a way that they become immortal (immortalized). In the case of EBV, this can affect lymph cells (B lymphocytes) on the one hand and mucous membrane cells in the nose and throat area (lymphoepithelial carcinoma) on the other.

However, the Epstein-Barr virus does not trigger these malignant neoplasms alone. There is only an association between these types of cancer and EBV infection. This applies, for example, to Burkitt’s lymphoma, which is endemic in Central Africa. However, there is no such association for sporadic Burkitt lymphoma outside this region. Such an association has also been described for nasopharyngeal carcinomas.

An EBV infection can, therefore, be regarded as a risk factor for the development of such a carcinoma, but it cannot be the sole trigger. This means that just because you are infected with the Epstein-Barr virus does not mean that you will develop cancer.

Is the Epstein-Barr virus curable?

The colonization and remaining (persistence) of the Epstein-Barr virus in the body can no longer be reversed. There is no direct treatment in the sense of a drug that kills the virus, so an EBV infection cannot be cured.

However, the consequences and symptoms can be treated. Chemotherapy is used for lymphomas, and surgery is often possible for nasopharyngeal carcinomas. In glandular fever, painkillers are given. However, these are symptomatic therapies that cannot remove the virus as such from the body.


Is the Epstein-Barr Virus Deadly?

Acute infection with the Epstein-Barr virus is only fatal in exceptional cases. However, glandular fever can result in a ruptured spleen, i.e. a ruptured spleen, as a complication that can be potentially life-threatening.

Lymphoma, which may be associated with EBV infection, can also be fatal. However, a direct lethal effect of the Epstein-Barr virus is almost impossible.

Can EBV become chronic?

Chronic courses are scarce and occur primarily in Asia. However, it is essential to know that the virus remains in the body, but in most cases, it does not result in an illness. In such cases, the carriers are symptom-free (asymptomatic).

However, the EBV infection can be reactivated if the immune system is weakened. This is usually reflected in the development of lymphomas.

Epstein-Barr virus: What late effects are possible?

Infection with the Epstein-Barr virus is usually very mild. Most children or adolescents do not show any symptoms. If glandular fever develops, most of those affected survive it very well. However, there can be medium-term consequences regarding increased fatigue (fatigue).

A possible late effect is also an increased risk of developing malignant neoplasms. For example, people with a history of infectious mononucleosis have a threefold increased risk of developing Hodgkin’s lymphoma (Hodgkin’s disease).


Multiple sclerosis as a result of the Epstein-Barr virus?

The Epstein-Barr virus has long been suspected of promoting the development of other diseases, such as multiple sclerosis (MS). A study by the Harvard Chan School published in 2022 confirms the connection: According to this, an infection with the virus is a prerequisite for developing multiple sclerosis.

For the study, blood samples taken from US military members over 20 years were examined regularly. It showed that out of 801 people with multiple sclerosis, only one person had no antibodies against the Epstein-Barr virus in their blood. In addition, the blood samples from the people who only developed multiple sclerosis during the study provided exciting insights: those who were not initially infected with EBV originally had no biomarkers for MS in their blood either. However, after the people affected had been infected with the virus, these biomarkers were detectable in the blood – even before multiple sclerosis broke out.

Even if the study cannot answer what role the Epstein-Barr virus plays in causing multiple sclerosis, it at least confirms that the virus is involved in the development of MS, i.e. it is a late consequence of EBV -Infection could act, exactly how the mechanisms are related needs to be clarified by further research.

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