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Chronic Epstein-Barr Infection: Diagnosis and Self Treatment

Once, maybe long ago, you came down with variation of mono, what your doctor called infectious mononucleosis. You have the antibodies in your blood to prove it. These are antibodies to a specific human herpesvirus (called human herpesvirus 4), better known as Epstein-Barr virus (EBV).

Back then, you may have felt a sudden onset of spookily severe fatigue, fever, a terribly sore throat, painful glands in your neck, and maybe even pain in your abdomen from a swollen spleen. Your doctor tested to make sure it wasn’t strep throat (whose symptoms are virtually identical to those of mono) and likely ordered a screening test for mono called Monospot.

This test may or may not have returned positive results because it sometimes takes two to three weeks for EBV antibodies to appear. If your Monospot test was negative, your doc relied on her clinical judgement to decide whether or not you had mono. It’s certainly possible to have both strep and mono, in which case you received an antibiotic for the former. If no strep, only mono, you were told to rest up until you felt better.

With both mono and strep, virtually everyone gets better and forgets they ever had it. But now, years or maybe decades later, you’ve developed some persistent and worrisome symptoms, like chronic fatigue, muscle aches, and brain fog.

Your doctor runs a battery of diagnostic tests related to fatigue, including tests for EBV. If you have antibodies you might hear her say “Ah, I see you once had mono.” Sometimes patients remember this (“Oh yes, I’d just arrived at college”), sometimes not.

EBV reactivation linked to wide range of other conditions
Let’s say that after this diagnostic test panel all your tests are negative (no anemia, no thyroid problem, everything is fine) except for the EBV antibody evidence of your old mono. At this point, you should get checked for the possibility of Epstein-Barr reactivation.

Interestingly, although you yourself may suggest it, your doctor may be less than enthusiastic. After all, since there’s no known treatment in conventional medicine for EBV, she just might say “Go rest up.”

An important takeaway: if you’re seeing your doctor for persistent fatigue symptoms, getting tested for EBV reactivation is important. Not only can reactivation of EBV cause lots of symptoms, but it’s also now associated with numerous other conditions. These include neurological diseases, like Parkinson’s and multiple sclerosis, certain cancers (lymphoma, nasopharyngeal), digestive issues (ulcerative colitis, Crohn’s), and autoimmune disease (lupus, rheumatoid arthritis, Hashimoto’s thyroiditis, celiac disease, and Sjogren’s). See last week’s Health Tip for links to these and other associated conditions.

When you take the EBV questionnaire I suggest below, you may be surprised at the risks of having unchecked EBV in your body. However, if you’re feeling well you don’t have to worry about it being there. Just take care of yourself and it will stay asleep and harmless. All the usual recommendations apply. Eat a nutritious diet, move/exercise regularly, get good restful sleep.

Testing for EBV reactivation
Complete testing for EBV includes five separate tests on a single blood draw: VCA IgM, VCAIgG, EA-D, EBNA IgG, and EBNA IgM. I won’t bother you with what each of these means, but will say that a doctor looking at all five together can determine where you are on the EBV spectrum.

Most of the 98% of all people who test positive for EBV have two or three positives out of five. This pattern indicates past infection, but no current problem.

If a person is ill and tests positive for the last four, then the likely diagnosis is reactivated EBV. The first of the group, VCA IgM, tests for acute, not chronic EBV.

At this point, your doctor might say, “You were right! Looks like EBV reactivation,” adding that there’s really nothing for you to do but take care of yourself and let your immune system do the rest.

To a certain extent, she’s right. But you can make the situation a lot better, and quite quickly.

Understanding and treating EBV reactivation
Treatment is presented here in four parts, to make it easier for the DIYers:

1–Give careful thought to what reactivated your EBV (the trigger). Usually, it’s a period of physical or emotional stress (an illness or death of a loved one, a health scare, a painful breakup, the job from hell, exposure to environmental toxins, or just not taking care of yourself). You’ll very likely identify something. For future reference, now that you know your EBV reactivation requires a trigger, when confronted with potentially stressful situations you’ll remember how you became ill and learn to control the situation.

Maybe it just means saying no to one more request for your time or cutting way back on after-work drinks with colleagues. It’s worth noting that the concept of reactivation is not limited to EBV. The rules for preventing reactivation also apply to cold sores, shingles, chronic Lyme disease, Bartonella, Mycoplasma, Cytomegalovirus, and even HIV, tuberculosis, and malaria.

2–Whether or not you’re in a reactivation phase, your new lifetime hobby will be using different strategies to support your immune system. This will benefit you in numerous ways: fewer infections, reduced cancer risk, and better odds for a healthy longevity. Immune support means eating a healthful whole-foods diet (consider all processed foods as working directly against good health), regular exercise (go slow if you’re feeling ill, e.g., a nice walk, yoga, tai chi), sound sleep, and regular total body detoxification (twice a year is plenty, many products are available–here’s ours).

3–Immune support supplements: N-Acetyl L-Cysteine, Selenium, and Five Defenders Chinese mushroom blend, available in our Apothecary. Use them together during a reactivation; use them in monthly rotation for prevention.

4–During a reactivation period, the following herbs and supplements are EBV-specific (meaning they target EBV) as shown in testing labs: turmeric (Theracumin HP), berberine, boswellia, selenium, and vitamins A, C, and E. Interestingly, since conventional medicine seems to have thrown in the towel regarding antiviral medicines for EBV, other physicians have become quite skilled at working with reactivated EBV. They include homeopaths, naturopaths, functional physicians, and traditional Chinese medicine practitioners.

For more reading, a very useful resource is the website of Dr. Kasia Kines, author of The Epstein-Barr Virus Solution. When you visit her site, I urge you to take the EBV quiz, if for no other reason than to learn all the ways chronic EBV has been shown to manifest itself.

However, don’t be too worried if your score says you likely have EBV. After all, at least 98% of us show EBV antibodies and fortunately most of us are just fine, living a balanced life in peaceful coexistence with these and many other fellow travelers.

Be well,
David Edelberg, MD

Leave a Comment

  1. Dawn M Barajas says:

    I met my husband in 1981, he was a Marine, and when he went back to his base I ended up with strep throat. Four years ago my husband had Guillane Barre after having the flu, he had a flu shot, he spent six days in the hospital getting treatment. His recovery was excellent with only slight nerve damage in hands and feet. Most aren’t that lucky. I believe we both have EBV.

  2. Laura Fortney says:

    I never knew some of those things were abnormal; such as sensitivity to mosquito bites and swollen lymph nodes during stress. I always thought that was “normal”!
    My score was 37. Looks like I know what bloodwork we are doing at my next checkup!

  3. James says:

    I’ve been sick on in off since I had mono at the age of 35, 13 years ago. After that I always had high EBV test results but the doctors said everyone has the virus in their blood. A few years later I was diagnosed with Lyme disease and did all the anntibacterial and steroid treatments several time. I finally found a doctor who believes in the reactivated EBV. Just last year I started getting very strange reactions to mosquito bites which would just disappear the next day. That was what put the diagnoses over the top. My lastest results:

    EBV Ab VCA, IgM
    58.3 H
    0.0-35.9 (U/mL)
    – Negative 43.9
    EBV Early Antigen Ab, IgG
    0.0-8.9 (U/mL)
    – Negative 10.9
    EBV Ab VCA, IgG
    183.0 H
    0.0-17.9 (U/mL)
    – Negative 21.9
    EBV Nuclear Antigen Ab, IgG
    163.0 H
    0.0-17.9 (U/mL)
    – Negative 21.9

  4. Sherry PIerce says:

    I have Chronic Active Epstein Barr Virus and am wondering if you treat this form of EBV. I’ve read that it can only be treated with stem cell therapy. What types of therapy do you offer to treat CEBV?

    • cliffmaurer says:

      Hi Sherry,
      Our functional medicine providers offer a number of treatment approaches, and these depend on your history, current health, and symptoms. There are a variety of IV therapies that can be helpful as well as supplements and specific dietary recommendations. There are more things to do than just stem cell therapy. Feel free to set up a telemedicine consultation with one of our functional medicine practitioners; they’ll help sort things out and make treatment recommendations.

      Hope we can help – please give our scheduling staff a call at 773-296-6700.
      Best wishes,
      Dr M

  5. MelO says:

    I’ve had ‘chronic fatigue for more than 10 years now. By 2016, my new female PCP at the time was concerned and ordered EBV tests and several others in June 2016, but I don’t recall her ever commenting on the EBV results.

    She moved to another city and another Dr. also ordered labs (I don’t even recognize the name on my labcorp patient portal that I only discovered I could access recently and these lab results were there), again I don’t recall any comments regarding EBV results by either doctor.

    It was only after I received CMV positive IgG test results tonight ordered by a specialist for a procedure unrelated to chronic fatigue, and have been looking for what the results mean and came across an “EBV” reference in one article…so I went back to see what all those other Labcorp tests had been and this is what I just found, now I’m quite curious if my chronic fatigue could be chronic EBV and that I need to be concerned and bring this up with my new VA doctor (since losing my private insurance) and who’ve I’ve not actually met other than virtual (due to the pandemic). I don’t know what my previous PCP tested me for as there are no Labcorp results for her.

    Often when I’m not sleeping and able to stay awake or can shake the nearly paralysis feeling of my like limp body to even get out of bed, I’m often in an emotionally high-stressed state from a still unresolved evil set of events against me that began around the time I started falling asleep at work just over 10 years ago, which progressively worsened. I’ve not been employed for 9 years, do little, and I’m nearly always exhausted physically and mentally, and so sleepy. I often have digestive pains no matter my choice of foods (but that has been a longer problem than the chronic fatigue, although ‘sleepy attacks’ were not uncommon previously, but I felt rested afterwards, not like now), probiotics and organic digestive enzymes seem to help some in the past few years. I also started having occasional mild migraines in 2002, a traumatic frontal head injury in 2007,and by 2011 chronic 3-6 day migraines every 2-4 weeks. (Finally got Rx relief 2 years ago for when they surface and has helped with migraines immensely, ‘diagnosed’ with what he referred to as chronic atypical ‘ghost’ migraines as well).

    I would appreciate any input on what these two sets of 2016 EBV tests numbers that were never discussed with me might suggest:

    6/30/16 Dr. C
    EBV Ab VCA, IgM 45.4 High
    EBV Early Antigen Ab, IgG 55.4 High
    EBV Ab VCA, IgG >600.0 High
    EBV Nuclear Antigen Ab, IgG <18.0

    8/26/16 Dr. R
    EBV Ab VCA, IgM 38.9 High
    EBV Early Antigen Ab, IgG 49.0 High
    EBV Ab VCA, IgG 449.0 High
    EBV Nuclear Antigen Ab, IgG <18.0


    • cliffmaurer says:

      Hi MelO,

      This is certainly a complex case and very much deserves some time and attention from a functional medicine specialist. Please give our Patient Services desk a call and schedule a telemedicine visit with a functional medicine practitioner at our office. They can be reached at 773-296-6700, and it’s likely that someone could see you this week or next.

      My best wishes to you,

      Dr M

  6. Lisa Roes says:


    I have been struggling for some time now and was diagnosed with CAEBV and was told to see a specialist.

    My latest labs are

    EBV ab VCA IgM : >160
    EBV ab VCA IgG : > 600
    EBV Nuclear Antigen : 395.0
    Lymphs : 5.2

    I’ve had intermittent fevers from 96.2-102. It comes and goes depending on how active I am.

    Currently, I feel like I’m in cement most of the time with chronic headaches and brain fog. I don’t have an appetite at all so I’ve been drinking smoothies to force myself to eat and take my herbs and vitamins.

    I would love to talk to someone that actually understands CAEBV and can guide me to get past it.


    • cliffmaurer says:

      Hi Lisa,

      This sounds like something that any of our functional medicine practitioners can help you with. Please give our Patient Services staff a call and they can set you up with either a telemedicine consultation or an in-person visit. 773-296-6700.

      Looking forward to helping you with this!

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Far and away, the commonest phone call/e mail I receive asks about COVID-19 diagnosis.
Just print this out, tape it on your refrigerator door, and stay calm.


• Runny nose
• Sneezing
• Red, swollen eyes
• Itchy eyes and nose
• Tickly throat
• No fever

• Runny nose
• Sneezing
• Sore throat
• Mild muscle aches
• Mild dry cough
• Rarely a low fever

• Painful sore throat
• Hurts to swallow
• Swollen glands in neck
• Fever

FLU (Standard seasonal flu)
• Fever
• Dry cough (no mucus)
• Sudden onset over few hours
• Headache
• Sore throat
• Fatigue, sometimes quite severe
• Muscle aches, sometimes quite severe
• Rarely, diarrhea

• Shortness of breath
• Fever (usually above 100 degrees)
• Dry cough (no mucus)
• Slow onset (2-14 days)
• Mild muscle aches
• Mild fatigue
• Mild sneezing

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