Epstein Barr Virus and Infectious Mononucleosis (pathophysiology, investigations and treatment)
272,896
Publicado 2019-05-27
"EBV causes typically an asymptomatic infection or can cause acute tonsillitis as a part of bigger infection called infectious mononucleosis also known as glandular fever. EBV typically occurs in adolescents and young adults and is transmitted orally via saliva. This is the reason EBV infections are also known as the kissing disease. Nearly everyone will become infected with EBV at some point, the good thing is for most of us it is asymptomatic. In this videos we will talk about a primary EBV infection which is asymptomatic and how the infection can evolve to be become infectious mononucleosis which is a symptomatic condition.
The pathophysiology of EBV infection begin with saliva transmission and the EBV virus targeting the tonsils which is a lymphoid tissue made up of T cells and B cells. In the tonsil the EBV target B cells and tonsillar epithelial cells. This is called the EBV primary infection and is usually asymptomatic. Once EBV infects the B cells the EBV has an Incubation period of about 2-6 weeks. During the incubation period a number of things happen:
EBV replicates in B-cell and the virus is shed intermittently into pharyngeal secretions, particularly saliva. Saliva is therefore how EBV is transmitted between people.
The cycle can continue and the person can be completely asymptomatic of course during this incubation and reactivation time the immune system will respond.
EBV Induces an immune response where by b cells capture an antigen of EBV and processes it, The b-cells can mount an immune response locally in the tonsils and the B cells enter circulation and mount an immune response in the lymph node, spleen and liver. Here the B cells stimulate CD8 T cell activity. CD8 t cells also known as cytotoxic t cells are important in the suppression of primary EBV infection. On a side note the CD8+ are thought to be the important players in preventing EBV reactivation and EBV associated lymphoproliferative disease. The B cells also activate CD4+ T cells through costimulation, which means the B cells also become activated. Activated B cells become plasma cells. The plasma cells are the antibody producing cells. The plasma cells will produce EBV specific antibodies which mean antibodies against components of the EBV - firstly the viral capsid antigen with IgM followed by the viral capsid antigen with igG. Plasma cells then eventually produce epstein Barr nuclear antigen igG once infection is resolved. The activation of other immune cells in the lymph nodes, spleen and liver is part of the immune response against EBV.
During the incubation period the EBV can also enter circulation. Here the immune cells in the blood will try to destroy them and also mount an immune response releasing cytokines. This interaction is one of the reasons why people in EBV infection become febrile and feel miserable.
During the incubation period the abnormal infiltrated B cells produce heterophile antibodies which is an important and quick marker for diagnosing EBV"
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Todos los comentarios (21)
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It brings me comfort the we are all suffering together here. I haven't slept in 3 days due to the pain. I have a diet of broth and popsicle sticks right now. I am a freshmen in college and am falling severely behind in school. WERE IN THIS TOGETHER GUYS AND WE WILL SURVIVE AND NEVER FEEL THIS AMOUNT OF PAIN AGAIN!
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This is by far the worst sickness i’ve ever undergone. I had a severe sinus infection on top of it. Couldn’t eat for 7 days lost over a year of work in the gym my body turned to noodles. The sore throat lasted 16 days for me. Coughed up an unbelievable amount blood and mucus. Fever got up to 105.9 degrees and lasted probably half the day anywhere from 101-103 degrees usually. The fever didn’t affect me honestly. The sore throat was unbearable, to the point where my nose closed up becaude of congestion, then i had to breathe through my mouth, my throat completely closed up during sleep and i started choking and forcing water down my throat to frantically try to open it up or my nose and after a few seconds of panic i was able to. I’m only 19 and i was at the height of my health. I am the healthiest in my family. This shit is something other wordly. Covid wasn’t shit compared to this. i was put in the hospital for 13 days because it was so severe. My spleen was so inflamed every time i swallowed anything it was so bad that my whole body jumped and that caused my spleen to hurt every single time. This was created by the devil himself. i’m still trying to get over this shit. God bless anyone who has this right now.
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Undoubtedly one of the worst and most painful things I’ve ever experienced. It left me with a physical exhaustion that lasted much beyond the tonsil swelling, pus, and burning throat pain. Worst part was that I caught it during a time that I wasn’t kissing or coming into contact with someone’s saliva. Best I can assume was that it came from eating out while abroad (I started presenting symptoms a bit after coming back from South Korea and Japan. My girlfriend at the time stayed back in America so I obviously hadn’t been kissing anyone and she never ended up catching it.)
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I had mono when I was 18 and it was the SICKEST I’ve ever been in my life. I had a 104 degree fever for several days, EXTREME fatigue for 2 weeks (I could not stand long enough to take a shower), body aches, constant vomiting and strong aversion to food. Just thinking of food made me gag. I had strep throat at the same time. The scariest symptoms I had were jaundice (my eyes were very yellow too) and brown urine. The doctor was very concerned about my liver as it was highly inflamed. I lost a lot of weight and finally recovered at just 95 lbs and I’m 5’5!! Honestly, I would rather have just about any other virus than this again. I really thought I might die.
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First ! Thanks for t these educational tools. The medium is very good for a recap..especially as a young doctor looking to keep my knowledge fresh.
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Thank you SO much for this video. I understand most of it, You were really taking me back to the beginning of Nursing School. I am currently in a state of a reactivation phase of the EBV. I have luekopenia at 2.2 and my tonsils are currently swollen with fever and headaches, achy joints and severe fatigue. I have had my homocysteine levels checked out elevated as well as my Methymalonic Acid serum at 1062. What's horrible about this is that it's not something you can see. There is no sympathy for a person who is stricken with EBV. I certainly appreciate this video. Maybe I can show it to the naysayers. Thank you for your insights into the life of a person undergoing an reactivation of the EBV and how it affects one's body.
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You are literally a med stud life saver.
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Great video! I enjoyed watching it!
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i've been sick since april 28 \ 2019 . almost a year of evb and citomegalo virus , life like this is not worth it . you need to find a cure because no one deserved to live like this .
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By far the best and most comprehensive explanation of EBV
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@Armando Hasudungan Very very excellent video, your presentation is clear and accurate ! Thank you for this good job
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“In summary,” starts 9:40. Great info, thanks..
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Continue with this slow explanation I like it so much and understand each part of this subject well down👏👏
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EBV is now confirmed as the cause of 7 auto immune diseases including MS https://www.nih.gov/news-events/nih-research-matters/epstein-barr-virus-autoimmune-diseases
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Currently going thru this. My first symptom was unbelievable spleen pain and then slowly slowly i developed the rest of the symptoms. I wake up in panic every time i try to sleep, gasping for air as my tonsils r so enflamed that my airways r nearly completely blocked and my nose is so congealed with mucus. Ive had symptoms for a week. I hope it gets better from here.
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This was incredibly helpful!!
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It took years for me to get back to somewhat normal after having this over 30 years ago. My liver became inflamed and the doctor originally thought I had some type of viral hepatitis. The bloodwork showed that it was EBV. It got so bad it felt like I had a mild stroke. My entire body had gone numb, especially my extremities. My reaction time had extremely slowed down, also. The malaise turned into debilitating depression. Several years later, the autoimmune problems started, such as IBD and then inflammatory arthritis.
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Concise and to the point, thanks!
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Imagine just making out with someone and a month later you develop encephalitis. Stay safe friends
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Thank you for such a clear explanation of what Epstein Barr virus is and what happens in the body once infected.
