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

From the Guidelines

Epstein-Barr virus (EBV) symptoms typically include 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. These symptoms are commonly noted in patients with chronic active EBV infection, as reported in a study published in the American Journal of Hematology 1. The clinical features of EBV infection can be persistent and chronic, and may also include other complications such as hematological, digestive tract, neurological, pulmonary, ocular, dermal, and/or cardiovascular disorders.

Some of the key symptoms of EBV infection include:

• Prolonged or intermittent fever
• Lymphadenopathy
• Hepatosplenomegaly
• Recurrent or continuous debilitating fatigue
• Sore throat
• Lymph node tenderness and pain
• Headache
• Myalgia
• Arthralgia These symptoms can be encountered in patients with chronic active EBV infection, and may be similar to those experienced during infectious mononucleosis.

It's worth noting that EBV infection can also cause complications such as skin lesions, including hypersensitivity to mosquito bites, and various cutaneous manifestations, including hydroa vacciniforme-like eruptions, as reported in patients with T-cell or NK-cell lymphoproliferative disorders having chronic activated EBV infections 1. However, these symptoms are less common and may not be present in all patients with EBV infection.

Overall, the symptoms of EBV infection can vary widely depending on the individual and the severity of the infection, and may require medical evaluation and treatment to manage symptoms and prevent complications.

From the Research

Epstein Barr Virus Symptoms

• The symptoms of Epstein Barr Virus (EBV) infection can vary, but common manifestations include:
  • Acute hepatitis, with severity ranging from asymptomatic to acute liver failure 2
  • Atypical manifestations, such as cholestasis, chronic hepatitis, and autoimmune hepatitis 2
  • Splenomegaly, which can be due to various mechanisms, including infection, malignancy, and liver disease 3
  • Pancytopenia, which is a condition characterized by a reduction in the number of red and white blood cells, as well as platelets 4
  • Lymphoproliferative disorders, which can occur in individuals with weakened immune systems, such as those taking anti-TNF agents 4, 5
• In some cases, EBV infection can be asymptomatic, especially in the acute setting, where the virus establishes a latent infection 4, 5
• Reactivation of EBV can occur later in life, leading to abnormal proliferation of infected B, T, or NK cells, and resulting in various clinical abnormalities 4, 5

Associated Conditions

• EBV infection has been associated with several conditions, including:
  • Infectious mononucleosis, which is a common cause of splenomegaly 3
  • Liver disease, such as acute hepatitis and chronic hepatitis 2
  • Malignancies, such as lymphomas and carcinomas 5
  • Autoimmune disorders, such as autoimmune hepatitis 2
• The virus can also contribute to the development of post-transplant lymphoproliferative disorders in individuals who have undergone liver transplantation 2

Mechanisms of Disease

• The mechanisms of EBV-mediated disease are complex and involve the expression of viral proteins and non-coding RNAs, which contribute to the evasion of host immune responses and the activation of immune cells 5
• The virus can also induce the production of cytokines, such as IL-27, which plays a role in regulating innate and acquired immune responses 6
• The involvement of Toll-like receptors, such as TLR7, has also been implicated in the development of splenomegaly and other clinical abnormalities associated with EBV infection 6