Epstein-Barr Virus Infection (cont.)
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Epstein-Barr Virus Infection Symptoms and Signs
Once the virus is acquired, it takes about four to six weeks for symptoms to appear. Children usually have nonspecific symptoms or are asymptomatic. Rarely, young children may have rashes, pneumonia, or low white blood counts. Teenagers and young adults many develop symptoms of mononucleosis. Interestingly, mononucleosis is more common in whites than in African-American populations. Acute mononucleosis causes sore throat, fever, and swollen lymph nodes. The sore throat is very painful and is the usual reason for infected people to seek medical attention. Tonsils may become very swollen. Loss of appetite, fatigue, chills, headache, bloating, and sweats are common. Although the symptoms fade in days to weeks, some patients complain of fatigue that lasts for weeks after infection. The virus is eventually contained by the immune system and the patient recovers.
Approximately 5% of people have a rash. However, a rash develops in 95% of people with mononucleosis who are given amoxicillin. This common reaction does not necessarily mean that the patient is allergic to penicillin or related antibiotics.
The spleen becomes swollen in up to half of people with mononucleosis. The spleen is always engorged with blood, and if it ruptures, it can cause a patient to bleed to death. Blunt trauma to the abdomen, even mild trauma, may result in splenic rupture. The spleen may also rupture spontaneously.
Less than 1% of infected people have neurological complications. These include inflammation of the brain (encephalitis), of the lining of the brain (meningitis), or of individual nerves. Less commonly, infection of the spinal cord may occur. Approximately 85% of patients with neurological complications recover completely. Rarely, other organs may be involved, including the lungs or heart.
Rarely, boys may develop overwhelming infection with EBV known as X-linked lymphoproliferative syndrome. In X-linked lymphoproliferative syndrome, the number of lymphocytes in the body increases substantially. The lymphocytes infiltrate major organs, often causing severe liver disease or death. Lymphoproliferative syndrome is probably a result of a subtle genetic defect that makes it difficult for the immune system to contain the virus. Patients who have had organ transplants or bone marrow transplants are also at risk for lymphoproliferative syndrome.
In addition to lymphoproliferative syndrome, EBV is associated with some cancers. One such cancer is lymphoma of the brain. Lymphoma of the brain is most common in people with advanced AIDS but also occurs in other immunosuppressed states. Nasopharyngeal cancer, Burkitt's lymphoma, and some types of Hodgkin's lymphoma are also associated with EBV. The exact mechanisms by which EBV helps to transform normal lymphocytes into cancer cells is not fully understood.
EBV is associated with a condition called oral hairy leukoplakia. This is a white plaque on the side of the tongue that cannot be removed by gentle scraping. It is most common in people with AIDS or other immunosuppressive states.
Mononucleosis causes fatigue, which can sometimes last for weeks or even longer. Therefore, chronic infection with EBV (CEBV) has been investigated as a cause of chronic fatigue syndrome (CFS). Studies to date have not been able to find a causal link between EBV and CFS. In CFS, there is a chronic lack of energy often associated with difficulty concentrating or generalized pain. CFS is more common among women than men and occurs in early to middle adulthood. Blood tests are usually normal. There is no specific diagnostic test for CFS and the cause remains unknown.
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