by Dr. Bill Rawls
Are you experiencing symptoms of tiredness, achiness, sore throat, and possibly swollen lymph nodes, and low-grade fever that just won’t go away? If you Googled your symptoms, mononucleosis likely popped up as a possibility.
But if you’re well beyond your teen years or college age, mononucleosis isn’t very common. And if you have Lyme disease, ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome), or fibromyalgia, it can be difficult to know if a new onset of symptoms is due to an existing illness or something entirely different.
But as you dig a little deeper into your symptoms, you come across something called reactivated Epstein-Barr virus, which fits your symptoms to a tee. If you’re aware that Epstein-Barr virus (EBV) is the cause of mononucleosis, you may be wondering: What’s the difference between chronic reactivated EBV and mononucleosis?
And beyond that, what makes chronic reactivated EBV chronic — and how does it factor into the other chronic illnesses you might be dealing with? To find out, read on to learn more about this complex and convoluted microbe called Epstein-Barr virus and what can make it a long-term troublemaker for many people.
EBV: A Common Human Herpesvirus
EBV has swept across the globe, and it’s much more common than you might imagine: more than 95% of the world’s population has been infected with it. EBV is a herpes-type virus, and it’s a close relative of genital herpes. Known technically as human herpesvirus 4 (HHV-4), it’s #4 on the list of nine different herpes-type viruses that can infect humans.
Herpesviruses are composed of strands of DNA inside an envelope. After initial infection, they’ll lie dormant in your tissues indefinitely. In other words, if you’ve ever been infected with a herpesvirus like EBV, you’ll carry it with you for life, however, the virus can reactivate if immune system functions become depressed.
EBV Can Spread Like Wildfire
The majority of people become infected with EBV as infants or young children. The virus spreads primarily by oral route via saliva. To enter the body, it infects mucous membranes lining the mouth, throat, and stomach. From there, the virus infects B cells, the type of white blood cell (WBC) that produces antibodies. It also infects T cells and natural killer cells, but to a lesser extent.
Once the WBCs become infected, they transport the virus throughout the body. Then, the virus takes over the machinery of infected cells to reproduce new viruses. Called the active or lytic phase, this is the stage in which people are most symptomatic and contagious.
The virus spreads remarkably easily, especially in children. It’s most typically spread by people who are infectious but don’t know it — daycare workers, babysitters, grandmothers with big wet kisses. Following that, infected children rapidly pass it along to other children — which has its advantages. If you get the virus as an infant or young child, you typically don’t get very sick at all. In fact, it’s unlikely that you would even remember the infection.
However, if you don’t get EBV at a young age and get exposed later in life when your immune system is suppressed, you’re at risk for developing the form of EBV called mononucleosis. Known as “the kissing disease,” infectious mononucleosis (IM) is spread by intimate contact with someone shedding the virus. It typically occurs in young adults who weren’t exposed in their earlier years, and it sneaks up on them when immune system functions are depressed, such as during the stress of high school or college.
Compared to EBV in childhood, IM is much more severe, can drag on for months, and be quite debilitating. Common symptoms include:
- Sore throat
- Severe fatigue
- Swollen lymph nodes
- Swollen spleen
Whether the initial encounter with EBV occurs as an innocuous infection as a child or as debilitating mononucleosis as a young adult, the immune system eventually gains ground and contains the infection. The virus, however, is not eradicated; it persists inside memory B cells, a type of WBC that retains “memory” of infection for future reference.
But in this case, EBV tricks the cells into storing the actual virus and accumulating in lymphoid tissue and nerve tissue, where they’ll stay for a lifetime. This dormant state is referred to as the latent phase. Traditionally, people in the latent phase weren’t considered infectious. But evidence suggests that people often actively shed the virus from tonsillar tissues without having significant symptoms, making it possible to pass the virus without knowing it.
No matter how you acquire the virus, generally, it stays quiet and doesn’t cause any significant problems as long as immune system functions are robust. However, allow the immune system to become disrupted — by stress, poor diet, and other key factors I’ll explore below — and EBV can reactivate, causing symptoms similar to mononucleosis or worse.
Reactivated EBV Can Become Chronic
Chronic, reactivated EBV is an amped-up version of mononucleosis, with a range of symptoms, including:
- Profound fatigue
- Chronic achiness
- Ongoing sore throat
- Irritated mucous membranes
- Swollen lymph nodes
Reactivated EBV can also cause a host of debilitating neurological symptoms. The symptoms can wax and wane for years, and severe cases can involve liver dysfunction, immune suppression, and even anemia. The most plausible explanation for why chronic, reactivated EBV is so severe and unrelenting is that it’s not just EBV at play.
For instance, people often carry other herpesviruses in addition to EBV. The list includes herpes simplex types 1 and 2 (oral and genital herpes), varicella-zoster virus (causing both chickenpox and shingles), cytomegalovirus (CMV), HHV-6 types a and b, HHV-7, and HHV-8. Though they’re all related, each of these viruses infects the body in a different way — therefore, they cause slightly different symptom profiles. In important ways, they’re all remarkably prevalent and share a common characteristic:
They stay dormant in tissues and can be reactivated just like EBV. So if the disruption of a person’s immune functions allows the reactivation of multiple herpesviruses at once, symptoms can be severe and highly variable. But that isn’t the end of the story. Many people with chronic Lyme disease, fibromyalgia, and ME/CFS are found to have reactivated EBV, along with an amalgam of other herpesviruses and a list of microbes, including Mycoplasma, Bartonella, and Chlamydia, among others. Indeed, there are likely many microbes responsible for making a person ill.
The Connections Between EBV and Chronic Illness
Scientists are just beginning to explore the link between chronic EBV and other chronic illnesses, but one of the most well-researched is EBV’s relationship with multiple sclerosis (MS). Many studies have defined a variety of different mechanisms by which the virus could initiate and perpetuate MS — not enough to define EBV as the sole cause of MS, but highly suggestive that it does play a role in the illness.
Similarly, studies have shown high viral loads of active EBV in a high proportion of patients with a variety of autoimmune diseases, including rheumatoid arthritis, systemic lupus erythematosus, Sjögren’s syndrome, and autoimmune thyroiditis. Again, a strong link, but not enough to suggest EBV as the absolute cause alone. Plus, there’s a multi-microbe connection to factor in.
For example, evidence has suggested that EBV and HHV-6a might together play a role in MS. MS has also been linked to a variety of different microbes, including, but not limited to, Chlamydia pneumoniae, Mycoplasma sp., Spherula insularis, and paramyxovirus.
Autoimmune diseases have also been linked to a variety of microbes, including EBV, but also additional herpesviruses; other viruses including parvovirus; a protozoan called toxoplasmosis; and bacteria, including Mycoplasma, Yersinia, and others commonly associated with chronic Lyme disease. Often referred to as stealth pathogens, the microbes mentioned and many others share similar stealthy characteristics:
- They have the ability to live inside cells (intracellular).
- They infect white blood cells and are carried throughout the body, especially to areas of inflammation.
- They can persist in a dormant state.
- They are master manipulators of the immune system.
- They can exist in healthy people without causing illness.
- They are present in all populations of the world.
The deeper you dig, the more connections you find between chronic illnesses and stealth microbes. But after a while, you begin to appreciate that it’s not as much the microbes causing problems as it is a disruption of the host’s immune functions that allows those microbes to flourish.
The Perfect Storm
I came to see chronic illness differently than most other physicians because of my personal struggle overcoming chronic Lyme disease. My experience taught me that the microbes are always there — I had likely harbored mine since childhood. It’s not until a perfect storm of cellular stress factors comes together to disrupt cellular and immune functions that a person becomes ill.
For me, that perfect storm was caused primarily by years of chronic sleep deprivation associated with every-other-night obstetrics on-call duty and eating a poor diet on the run, and there were other minor stress factors as well. But my recovery did not progress until I started addressing the underlying chronic immune dysfunction.
As I shifted my practice toward caring for individuals with chronic illness, I began to see similar patterns in my patients — not necessarily the same cellular stress factors that I had experienced, but elements that disrupted the health of their cells and immune functions just the same.
I began cataloging them, and, interestingly, I reached a limit of just five categories of cellular stress factors, and I believe that all chronic illnesses can be traced back to these five factors. As of now, I’ve been testing this theory for more than 10 years and always find it to be reliable. I’ve also discovered solid scientific support for my theory.
The 5 Cellular Stress Factors Are:
1. Poor Diet
We live in a world saturated with artificially manipulated foods. Regular consumption of these foods disrupts all cells and systems of the body.
The modern world is saturated with artificial toxins such that normal background radiation from the sun, solar system, and the earth itself are now amplified. Toxins disrupt cellular health and all healing systems of the body.
3. Emotional Stress
Continually running from the proverbial tiger inhibits digestion, suppresses immune function, disrupts sleep, and sets the stage for chronic illness.
4. Physical Stress
Although cumulative trauma and excessive heat or cold can damage the body, living a sedentary life can be just as harmful. Your cells need adequate blood flow to flush debris and metabolic waste that has collected around them. Without regular movement, everything in the body stagnates, toxic substances accumulate, muscles turn to mush, arteries become clogged, and cell loss is increased.
The effects from this cellular stress factor set the stage for chronic illness. We share our bodies with trillions of microorganisms known as the microbiome; by numbers alone, they outnumber our cells 10:1. They all want food — the carbohydrates, fats, proteins, vitamins, and minerals that make up our cells provide everything that microbes need to replicate themselves. Therefore, infection is simply microbes trying to get inside your body to consume your cells and consume valuable resources.
For every person with chronic illness, I can always trace back to a course of events that occurred to cause the person’s illness. What type of chronic illness they ended up with depends on three things:
- The person’s genetics — which determines risk, but not whether an illness will occur
- The variety of different low-grade stealth pathogens the person has collected through life
- How cellular stress factors contribute to cell health and immune dysfunction, which allows low-grade pathogens with stealthy characteristics to flourish and upset the balance of the microbiome and homeostasis in the body
Diagnosing and Treating Chronic EBV
To help identify chronic EBV, start by ruling out infectious mononucleosis. By definition, IM is an acute infection with EBV alone, and there are antiviral agents (such as acyclovir, ganciclovir, and vidarabine) that work extremely well for IM and other acute infections of herpes-type viruses, so it’s worth doing testing to define IM over reactivated EBV. Testing for IM looks for antibodies to the virus; the presence of different types of antibodies can distinguish between IM and reactivated EBV.
But testing for IM isn’t always straightforward — mononucleosis-like syndromes can also occur with other herpesviruses (CMV, HHV-6), other viruses (typically adenoviruses), and a protozoan called Toxoplasma gondii. In other words, many different viruses can cause viral syndromes similar to EBV. If you have all the symptoms of chronic reactivated EBV, then the likelihood of EBV being present is quite high, along with other microbes. However, antivirals have shown to be an ineffective treatment for chronic EBV.
Scientists have sorted out the technical reason for this. Antiviral agents work by blocking DNA polymerase, an enzyme the virus uses to replicate inside cells. Latent or chronic EBV infection, however, does not require DNA polymerase for the virus to replicate — therefore, current antiviral agents are ineffective against chronic EBV infection.
Other conventional therapies, including steroid therapy (prednisone) and immunosuppressive drugs, have been used to treat chronic EBV infection, but success has been limited. These therapies can inhibit the destructive processes of a disrupted immune system, but they have no capacity to restore normal immune function.
Researchers are also looking at vaccines against EBV. The problem is that the characteristics of the virus vary greatly across different geographical areas, making it difficult to create a single vaccine. Other methods of eradicating EBV being contemplated by conventional medical science include B-cell depletion with monoclonal antibodies (targeting EBV-infected B cells with immunoglobulins) and new types of antiviral drugs.
Focusing all efforts on eradicating EBV, however, is short-sighted. The bottom line: The underlying problem is chronic immune dysfunction, and you will not start getting well until normal immune system functions are restored.
A Practical Approach to Regaining Wellness
Remember, EBV doesn’t cause problems unless immune system functions have been disrupted. Therefore, any solution must be restorative to suppress whatever microbes may be present and flourishing. First and foremost is minimizing the five cellular stress factors.
Following an optimal diet and making some lifestyle modifications to promote a healing environment in the body is essential for overcoming chronic EBV or any other chronic illness. Modern herbal therapy should be the cornerstone of any restorative approach. Herbal extracts have incredible abilities, including:
- Reducing destructive inflammation
- Enhancing natural killer cells and other aspects of the immune system necessary to control microbes like EBV
- Balancing hormone systems in the body that have been disrupted by chronic illness
- Suppressing stealth microbes directly to restore balance in the microbiome
While many herbs have been found to suppress EBV, you need a comprehensive regimen of herbal remedies to address the variety of low-grade stealth pathogens that are likely causing problems.
Some of my preferred herbals for restoring immune function, balancing the microbiome, and suppressing viruses such as EBV include:
Generally, most people will respond to restorative solutions alone. Drug therapy is only necessary if severe or extreme illness is not responding to the restorative therapies. It is, however, important to maintain an ongoing working relationship with your medical provider during your entire recovery.
Ultimately, all of this is great news for those with chronic reactivated EBV: It means the power to take back control of your health and feel better is in your hands. By learning how to limit the cellular stress factors in your life, you’ll start to strengthen your immune function so you can live in harmony with microbes like EBV.
1. Cohen JI. Optimal treatment for chronic active Epstein-Barr virus disease. Pediatr Transplant. 2009;13(4):393-396. doi: 10.1111/j.1399-3046.2008.01095.x
2. Hoover K, Higginbotham K. Epstein Barr Virus. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559285/
3. Fierz W. Multiple sclerosis: an example of pathogenic viral interaction? Virol J. 2017 Feb 28;14(1):42. doi: 10.1186/s12985-017-0719-3
4. Jha HC, Pei Y, Robertson ES. Epstein-Barr Virus: Diseases Linked to Infection and Transformation. Front Microbiol. 2016;7:1602. Published 2016 Oct 25. doi: 10.3389/fmicb.2016.01602
5. Lassmann H, Niedobitek G, Aloisi F, Middeldorp JM; NeuroproMiSe EBV Working Group. Epstein-Barr virus in the multiple sclerosis brain: a controversial issue–report on a focused workshop held in the Centre for Brain Research of the Medical University of Vienna, Austria. Brain. 2011 Sep;134(Pt 9):2772-86. doi: 10.1093/brain/awr197
6. Lossius A, Johansen JN, Torkildsen Ø, Vartdal F, Holmøy T. Epstein-Barr virus in systemic lupus erythematosus, rheumatoid arthritis and multiple sclerosis—association and causation. Viruses. 2012 Dec;4(12):3701-30. doi: 10.3390/v4123701
7. Pich D, Mrozek-Gorska P, Bouvet M, Sugimoto A, Akidil E, Grundhoff A, Hamperl S, Ling PD, Hammerschmidt W. First Days in the Life of Naive Human B Lymphocytes Infected with Epstein-Barr Virus. mBio. 2019 Sep 17;10(5):e01723-19. doi: 10.1128/mBio.01723-19
8. Thorley-Lawson DA. EBV Persistence–Introducing the Virus. Curr Top Microbiol Immunol. 2015;390(Pt 1):151-209. doi: 10.1007/978-3-319-22822-8_8
9. Tzellos S, Farrell PJ. Epstein-barr virus sequence variation-biology and disease. Pathogens. 2012;1(2):156-174. Published 2012 Nov 8. doi: 10.3390/pathogens1020156