mono, low body weight

April 21, 2004

Ok, so now I'm wondering.

Could a person who has low body weight get struck with other problems - like

catching lots of bugs, and so on.

I think this would make sense. I am gonna ask the dr, but maybe that's why

has been catching everything. Can it give you migraines? Can it make

you bruise? Or could the bruises be from her low potassium? (I forgot to ask

the dr)

Does it make your resistance low - does it make your imune system sluggish?

Or, is it just the virus itself that makes you so sick?

And, from the way I understand it, there are 2 viruses that cause mono - one of

them being the one our dr thinks she has - Epstein Barr. Does anyone know what

this means?

Like, is one virus worse than the other?

How long can you go on with that Epstein Barr virus simmering away? Could you

have it for years and years?

I think I read that somewhere.

Is it one of those viruses that just " hangs out " and comes to life from time to

time?

Is she gonna be sick for a long time?

Is she gonna be able to go to her medical forum this July?

Does anyone know?

I'm really wondering how long this virus can hang out in a person's body, cause

I'm wondering if I should get checked for it.

I'm remembering about 3-4 years ago, I got really sick - like the flue.

Terrible sore, swollen throat, just sick as a dog.

I lost about 20 pounds. I've gained back about 15, and have been stuck there

for a couple years.

I should probably gain 5-10 more.

Lately I've been thinking I don't eat enough, and if I just started eating more,

maybe I'd feel better.

Now, with having mono, I'm wondering if maybe I have had it all this

time. I've been so tired for so long - even having that sleep disorder study

(which came out with nothing wrong).

So, - Main question - does anyone know if that epstien barr virus can inhabit

your body for years and years?

April 21, 2004

Epstein-Barr virus, frequently referred to as EBV, is a member of the

herpesvirus family and one of the most common human viruses. The virus

occurs worldwide, and most people become infected with EBV sometime during

their lives. In the United States, as many as 95% of adults between 35 and

40 years of age have been infected. Infants become susceptible to EBV as

soon as maternal antibody protection (present at birth) disappears. Many

children become infected with EBV, and these infections usually cause no

symptoms or are indistinguishable from the other mild, brief illnesses of

childhood. In the United States and in other developed countries, many

persons are not infected with EBV in their childhood years. When infection

with EBV occurs during adolescence or young adulthood, it causes infectious

mononucleosis 35% to 50% of the time.

Symptoms of infectious mononucleosis are fever, sore throat, and swollen

lymph glands. Sometimes, a swollen spleen or liver involvement may develop.

Heart problems or involvement of the central nervous system occurs only

rarely, and infectious mononucleosis is almost never fatal. There are no

known associations between active EBV infection and problems during

pregnancy, such as miscarriages or birth defects. Although the symptoms of

infectious mononucleosis usually resolve in 1 or 2 months, EBV remains

dormant or latent in a few cells in the throat and blood for the rest of the

person's life. Periodically, the virus can reactivate and is commonly found

in the saliva of infected persons. This reactivation usually occurs without

symptoms of illness.

EBV also establishes a lifelong dormant infection in some cells of the

body's immune system. A late event in a very few carriers of this virus is

the emergence of Burkitt's lymphoma and nasopharyngeal carcinoma, two rare

cancers that are not normally found in the United States. EBV appears to

play an important role in these malignancies, but is probably not the sole

cause of disease.

Most individuals exposed to people with infectious mononucleosis have

previously been infected with EBV and are not at risk for infectious

mononucleosis. In addition, transmission of EBV requires intimate contact

with the saliva (found in the mouth) of an infected person. Transmission of

this virus through the air or blood does not normally occur. The incubation

period, or the time from infection to appearance of symptoms, ranges from 4

to 6 weeks. Persons with infectious mononucleosis may be able to spread the

infection to others for a period of weeks. However, no special precautions

or isolation procedures are recommended, since the virus is also found

frequently in the saliva of healthy people. In fact, many healthy people can

carry and spread the virus intermittently for life. These people are usually

the primary reservoir for person-to-person transmission. For this reason,

transmission of the virus is almost impossible to prevent.

The clinical diagnosis of infectious mononucleosis is suggested on the basis

of the symptoms of fever, sore throat, swollen lymph glands, and the age of

the patient. Usually, laboratory tests are needed for confirmation.

Serologic results for persons with infectious mononucleosis include an

elevated white blood cell count, an increased percentage of certain atypical

white blood cells, and a positive reaction to a " mono spot " test.

There is no specific treatment for infectious mononucleosis, other than

treating the symptoms. No antiviral drugs or vaccines are available. Some

physicians have prescribed a 5-day course of steroids to control the

swelling of the throat and tonsils. The use of steroids has also been

reported to decrease the overall length and severity of illness, but these

reports have not been published.

It is important to note that symptoms related to infectious mononucleosis

caused by EBV infection seldom last for more than 4 months. When such an

illness lasts more than 6 months, it is frequently called chronic EBV

infection. However, valid laboratory evidence for continued active EBV

infection is seldom found in these patients. The illness should be

investigated further to determine if it meets the criteria for chronic

fatigue syndrome, or CFS. This process includes ruling out other causes of

chronic illness or fatigue. For additional information about chronic fatigue

syndrome, please call CDC's toll-free line at ; after the call

goes through, press 22136 to get the CFS menu.

DIAGNOSIS OF EBV INFECTIONS

In most cases of infectious mononucleosis, the clinical diagnosis can be

made from the characteristic triad of fever, pharyngitis, and

lymphadenopathy lasting for 1 to 4 weeks. Serologic test results include a

normal to moderately elevated white blood cell count, an increased total

number of lymphocytes, greater than 10% atypical lymphocytes, and a positive

reaction to a " mono spot " test. In patients with symptoms compatible with

infectious mononucleosis, a positive -Bunnell heterophile antibody test

result is diagnostic, and no further testing is necessary. Moderate-to-high

levels of heterophile antibodies are seen during the first month of illness

and decrease rapidly after week 4. False-positive results may be found in a

small number of patients, and false-negative results may be obtained in 10%

to 15% of patients, primarily in children younger than 10 years of age. True

outbreaks of infectious mononucleosis are extremely rare. A substantial

number of pseudo-outbreaks have been linked to laboratory error, as reported

in CDC's Morbidity and Mortality Weekly Report, vol. 40, no. 32, on August

16, 1991.

When " mono spot " or heterophile test results are negative, additional

laboratory testing may be needed to differentiate EBV infections from a

mononucleosis-like illness induced by cytomegalovirus, adenovirus, or

Toxoplasma gondii. Direct detection of EBV in blood or lymphoid tissues is a

research tool and is not available for routine diagnosis. Instead, serologic

testing is the method of choice for diagnosing primary infection.

EBV-Specific Laboratory Tests

Laboratory tests are not always foolproof. For various reasons,

false-positive and false-negative results can occur for any test. However,

the laboratory tests for EBV are for the most part accurate and specific.

Because the antibody response in primary EBV infection appears to be quite

rapid, in most cases testing paired acute- and convalescent-phase serum

samples will not demonstrate a significant change in antibody level.

Effective laboratory diagnosis can be made on a single acute-phase serum

sample by testing for antibodies to several EBV-associated antigens

simultaneously. In most cases, a distinction can be made as to whether a

person is susceptible to EBV, has had a recent infection, has had infection

in the past, or has a reactivated EBV infection.

Antibodies to several antigen complexes may be measured. These antigens are

the viral capsid antigen, the early antigen, and the EBV nuclear antigen

(EBNA). In addition, differentiation of immunoglobulin G and M subclasses to

the viral capsid antigen can often be helpful for confirmation. When the

" mono spot " test is negative, the optimal combination of EBV serologic

testing consists of the antibody titration of four markers: IgM and IgG to

the viral capsid antigen, IgM to the early antigen, and antibody to EBNA.

IgM to the viral capsid antigen appears early in infection and disappears

within 4 to 6 weeks. IgG to the viral capsid antigen appears in the acute

phase, peaks at 2 to 4 weeks after onset, declines slightly, and then

persists for life. IgG to the early antigen appears in the acute phase and

generally falls to undetectable levels after 3 to 6 months. In many people,

detection of antibody to the early antigen is a sign of active infection,

but 20% of healthy people may have this antibody for years.

Antibody to EBNA determined by the standard immunofluorescent test is not

seen in the acute phase, but slowly appears 2 to 4 months after onset, and

persists for life. This is not true for some EBNA enzyme immunoassays, which

detect antibody within a few weeks of onset.

Finally, even when EBV antibody tests, such as the early antigen test,

suggest that reactivated infection is present, this result does not

necessarily indicate that a patient's current medical condition is caused by

EBV infection. A number of healthy people with no symptoms have antibodies

to the EBV early antigen for years after their initial EBV infection.

Therefore, interpretation of laboratory results is somewhat complex and

should be left to physicians who are familiar with EBV testing and who have

access to the entire clinical picture of a person. To determine if EBV

infection is associated with a current illness, consult with an experienced

physician.

Additional Information about EBV Antibody Tests and Interpretation

Antibody tests for EBV can measure the presence and/or the concentration of

at least six specific EBV antibodies. By evaluating the results of these

different tests, the stage of EBV infection can be determined. However,

these tests are expensive and not usually needed for the diagnosis of

infectious mononucleosis.

It is not appropriate for CDC to interpret test results or to handle

counseling for the public. We suggest that questions be directed to a local

physician who is familiar with the patient's history and laboratory test

results. In addition, CDC cannot recommend specific physicians for referral.

Our general recommendation is for patients to consult with an infectious

disease specialist or their local or state public health department.

SUMMARY OF INTERPRETATION

The diagnosis of EBV infection is summarized as follows:

Susceptibility

If antibodies to the viral capsid antigen are not detected, the patient is

susceptible to EBV infection.

Primary Infection

Primary EBV infection is indicated if IgM antibody to the viral capsid

antigen is present and antibody to EBV nuclear antigen, or EBNA, is absent.

A rising or high IgG antibody to the viral capsid antigen and negative

antibody to EBNA after at least 4 weeks of illness is also strongly

suggestive of primary infection. In addition, 80% of patients with active

EBV infection produce antibody to early antigen.

Past Infection

If antibodies to both the viral capsid antigen and EBNA are present, then

past infection (from 4 to 6 months to years earlier) is indicated. Since 95%

of adults have been infected with EBV, most adults will show antibodies to

EBV from infection years earlier. High or elevated antibody levels may be

present for years and are not diagnostic of recent infection.

Reactivation

In the presence of antibodies to EBNA, an elevation of antibodies to early

antigen suggests reactivation. However, when EBV antibody to the early

antigen test is present, this result does not automatically indicate that a

patient's current medical condition is caused by EBV. A number of healthy

people with no symptoms have antibodies to the EBV early antigen for years

after their initial EBV infection. Many times reactivation occurs

subclinically.

Chronic EBV Infection

Reliable laboratory evidence for continued active EBV infection is very

seldom found in patients who have been ill for more than 4 months. When the

illness lasts more than 6 months, it should be investigated to see if other

causes of chronic illness or CFS are present.

April 22, 2004

Hi Jill,

Well, this gave me everything I needed to know, and then some! haha

Thanks so much.

We still have to go back to the oncologist/hemotologist on Tues to follow up on

some other blood work he did.

got a high fever and very swollen throat (with puss) and swollen glands

about a month ago, along with a cough, and was dx'd with bronchitis. I'm

assuming that this is when it all started.

What confuses me, is when the dr showed us her blood tests that showed something

amiss back in October. Maybe that was her UTI.

He said it looks like she's had the same UTI for over a year, and the

antibiotics she's been given for them hasn't done anything. So, he's doing a

culture or something to find out which antibiotic to give her to clear it up

completely.

It's like she gets it bad, and the antibiotic she's been given for it each time

didn't get rid of it completely, just enough to take away the bad symptoms.

If she's been going around with a low grade UTI for over a year, which flares up

about every 3 weeks, then no wonder she's been feeling so bad for so long.

But, she's had different antibiotics during this time - at the hospital after

her lung surgery - a few different ones for her sinus infections - well I can't

remember how many, but she's had at least 4 different kinds.

It must be a bugger of an UTI. I never heard of having one for so long.

Now that I think about it, her pediatrician never took a test at the end of her

course of antibiotics to see if the infection cleared. She was just sent to an

urologist, had an ultrasound and a cystogram (which found nothing but a very

large bladder). I thought maybe she just isn't peeing as much as she should -

or maybe not emptying her bladder cause it's so big, and the pee is sitting in

there too long.

Who knows?

I'm anxious to get back to the dr on tues to find out what the heck is going on.

She is eating a lot now - cause I'm making her!

Can't wait to see if she has gained any weight yet.

Thanks a lot for all the info!

April 22, 2004