What are the symptoms of Epstein-Barr (EB) Virus?

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From the Guidelines

Epstein-Barr virus (EBV) infection commonly causes symptoms including extreme fatigue, fever, sore throat, swollen lymph nodes in the neck, swollen tonsils, headache, skin rash, and abdominal pain with swollen liver or spleen, as noted in a study published in the American Journal of Hematology 1. The symptoms of EBV infection can vary widely, and many people infected with EBV experience mild or no symptoms, especially young children. In adolescents and adults, EBV often causes infectious mononucleosis ("mono"), with symptoms typically appearing 4-6 weeks after exposure and lasting 2-4 weeks, though fatigue may persist longer, as described in a guide to utilization of the microbiology laboratory for diagnosis of infectious diseases 1. Some patients with chronic active EBV infection (CAEBV) may experience persistent and chronic symptoms, including prolonged or intermittent fever, lymphadenopathy, and/or hepatosplenomegaly, as well as recurrent or continuous debilitating fatigue, sore throat, lymph node tenderness and pain, headache, myalgia, and arthralgia, as reported in a study published in the American Journal of Hematology 1. The virus spreads primarily through saliva, earning mono the nickname "kissing disease." After infection, EBV remains dormant in the body for life, rarely causing problems in healthy individuals. If you experience severe symptoms like difficulty breathing, persistent high fever, severe weakness, or intense abdominal pain, seek medical attention promptly. Treatment focuses on relieving symptoms with rest, adequate fluids, and over-the-counter pain relievers like acetaminophen or ibuprofen, as recommended in a guide to utilization of the microbiology laboratory for diagnosis of infectious diseases 1. Avoiding contact sports is recommended until fully recovered to prevent potential spleen rupture. It is essential to note that EBV infection can be associated with more severe complications, such as lymphoproliferative disease, particularly in immunocompromised patients, as highlighted in a study published in Clinical Infectious Diseases 1.

From the Research

Symptoms of EB Virus

  • Fever 2, 3
  • Lymphadenopathy 2, 3
  • Pharyngitis 3
  • Hepatosplenomegaly 3
  • Fatigue 3
  • Meningoencephalitis 4
  • Cerebellitis 4
  • Guillain-Barré syndrome 4
  • Myeloradiculitis 4
  • Facial nerve palsy 4
  • Hepatitis 4
  • Adult respiratory distress syndrome 4
  • Thrombocytopenia 4
  • Aplastic anemia 4
  • Acute renal failure 4
  • Ulcerations 4
  • Myocarditis 4
  • Frosted branch vasculitis 4

Severity of Symptoms

  • Symptoms can last for weeks and occasionally months 3
  • Severe manifestations of infectious mononucleosis can occur, including CNS involvement, peripheral nervous system involvement, and hepatitis 4
  • Rarely, complications such as upper airway obstruction can occur 5

Treatment of Symptoms

  • Symptom relief and rest are commonly recommended treatments 3
  • Corticosteroids have been used for their anti-inflammatory effects, but there are no universal criteria for their use 3
  • Antiviral medications such as acyclovir and ganciclovir have been used to treat severe EBV infections, but their effectiveness is debatable 4

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Antiviral Drugs for EBV.

Cancers, 2018

Research

Steroids for symptom control in infectious mononucleosis.

The Cochrane database of systematic reviews, 2015

Research

Antiviral treatment for severe EBV infections in apparently immunocompetent patients.

Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology, 2010

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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