Epstein-Barr virus

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at February 4, 2016
StartDiseasesEpstein-Barr virus

Epstein-Barr virus commonly referred to as EBV, mononucleosis, or simply mono for short, is one expression of the herpes virus. EBV comes from herpes virus 4 and is so prevalent that nearly all people will become infected at some stage of their life, most as children.


Definition & Facts

The Centers for Disease Control (CDC) lists Epstein-Barr virus as latent in 90 percent of adults in the United States, which indicates a current or past infection. The virus itself can stay latent for a long time or forever in some cases. Only when it produces symptoms, which is approximately 25 percent of the time, will it be termed infectious mononucleosis instead of EBV.

Mono is not the only illness the Epstein-Barr virus can cause. EBV can also cause or contribute to the onset of ear infections, diarrhea, Guillain-Barre syndrome, Burkitt's lymphoma, gastric cancer, and throat cancer.

Symptoms & Complaints

When symptoms do develop, the severity can vary greatly from one case to another. In general, young children become exposed most frequently, usually through infected classmates. In youth, symptoms can be so mild as to be mistaken for other ailments with similar symptoms. Some affected individuals show no symptoms at all.

With age comes an increase in symptom severity and duration of illness. Here again, because so many EBV symptoms mimic symptoms of other common illnesses, it can often require laboratory tests to correctly diagnose infectious mononucleosis. Common symptoms of mono include:

Because mono is extremely contagious, most employers would prefer employees refrain from coming into the office. However, it is the extreme fatigue that makes mono truly dangerous. Here, it is wise to have someone else drive the patient if they need to go to the doctor or elsewhere during the worst phase of the illness.


Human to human contact is the cause of transmission of the Epstein-Barr virus. Commonly called "the kissing disease" for precisely this reason, EBV is readily transmitted through sharing a glass, kissing, using the same toothbrush or inhaling infected air when someone nearby who is infected sneezes. Because the virus can be so easily and casually transmitted, it can be tough to control an outbreak once it begins. Schoolteachers in particularly tend to be all too aware of this fact.

Diagnosis & Tests

As mentioned earlier, diagnosis of infectious mononucleosis can be challenging at first because so many of the virus's symptoms can easily pass for other illnesses. For this reason, the best way to determine an accurate diagnosis is to do a lab test.

Family physicians can do (or order) these tests. Once EBV is suspected, there are several possible lab tests that can be done to verify:

  • Antibodies test. This test looks to see if the body has developed antibodies associated with the immune system as it tries to fight off EBV.
  • White blood cell test. This test looks for a similar indication that specific types of white blood cells associated with fighting off EBV have formed in the blood.
  • More specialized tests. There are also additional blood tests that a doctor can do if symptoms are less clear or atypical in some way.

Treatment & Therapy

Treatment for infectious mononucleosis is mostly about easing symptoms since there is no known vaccine or cure. In very mild cases, sometimes it is possible to simply rest until the virus works itself out of the system.

In many cases, symptoms tend towards the uncomfortable side of the spectrum. Sometimes lymph gland swelling in the neck and throat can become severe enough to impede swallowing. In these rare cases, steroids can be helpful in bringing down the swelling.

Sometimes the spleen can become very enlarged, which can cause a sharp pain on the left side of the abdomen. It is best to see a doctor for treatment if this occurs. Otherwise, treatment steers towards comfort care. Here are some things that are often recommended to ease symptoms of mono:

It is very important to avoid strenuous physical activity, including sports involving physical contact, until the doctor has given express permission. This is due to the swelling of the spleen and liver.

It is also critical to stay hydrated. Many patients tend to get dehydrated because it can become so painful to swallow. Dehydration can be a very serious issue in its own right, so the pain associated with swallowing should be managed with a doctor's help if need be to avoid dehydration. Once begun, infectious mononucleosis usually runs its course in 2-4 weeks.

Prevention & Prophylaxis

At this time, there is now known way to prevent the transmission of Epstein-Barr virus except to take care to avoid coming into contact with bodily fluids from an infected person. That includes not kissing someone with mono. Practicing good hygiene including frequent hand washing may help reduce transmission of EBV.

Once infected, the virus stays in a person's system their entire life and can reactivate later and produce symptoms once again. This is not common, but it has been known to occur.