Anonymous
Not logged in
Talk
Contributions
Create account
Log in
Search
Editing
Epstein-Barr virus
From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history
Namespaces
Page
Discussion
More
More
Page actions
Read
Edit
Edit source
History
Warning:
You are not logged in. Your IP address will be publicly visible if you make any edits. If you
log in
or
create an account
, your edits will be attributed to your username, along with other benefits.
Anti-spam check. Do
not
fill this in!
The '''Epstein-Barr virus''' or '''EBV''' or Human '''Herpesvirus 4''' or '''HHV-4''' is a [[herpesvirus]].<ref name="CDC" /> It is the most common cause of infectious [[mononucleosis]] or "glandular fever," and infects 90% of adults worldwide.<ref name="Saha2016">{{Cite journal | last1 = Saha | first1 = Abhik | last2 = Robertson | first2 = Erle S | title = Epstein-Barr Virus–Associated B-cell Lymphomas: Pathogenesis and Clinical Outcomes | journal =Clinical Cancer Research | issn = 1557-3265| volume = 17 | issue = 10| pages = 3056–3063 | date = 2011-05-15 | pmid = 21372216 | doi = 10.1158/1078-0432.CCR-10-2578| url = http://clincancerres.aacrjournals.org/content/17/10/3056}}</ref> It has been implicated in numerous immune diseases and chronic illnesses, including [[chronic fatigue syndrome]], [[multiple sclerosis]], [[myasthenia gravis]], and [[systemic lupus erythematosus]]. It is known to turn on "risk genes" for autoimmune disease in the cells it infects.<ref name="Harley2018">{{Cite journal | title = Transcription factors operate across disease loci, with EBNA2 implicated in autoimmunity | date = 2018| url = https://www.nature.com/articles/s41588-018-0102-3|journal=Nature Genetics|volume=50|issue=5 | pages = 699–707 | last = Harley | first = John B. | authorlink = | last2 = Chen | first2 = Xiaoting | authorlink2 = | last3 = Pujato | first3 = Mario | authorlink3 = | last4 = Miller | first4 = Daniel | authorlink4 = | last5 = Maddox | first5 = Avery | authorlink5 = | last6 = Forney | first6 = Carmy | authorlink6 = | last7 = Magnusen | first7 = Albert F. | last8 = Lynch | first8 = Arthur | last9 = Chetal | first9 = Kashish | last10 = Yukawa | first10 = Masashi | last11 = Barski | first11 = Artem|language=en|doi=10.1038/s41588-018-0102-3|pmc=|pmid=|access-date=|issn=1546-1718|quote=|via=}}</ref><ref name="NIHNews2018">{{Cite web | url=https://www.nih.gov/news-events/news-releases/epstein-barr-virus-protein-can-switch-risk-genes-autoimmune-diseases | title = Epstein-Barr virus protein can “switch on” risk genes for autoimmune diseases | last = | first = | date = 16 April 2018 | website = National Institutes of Health|archive-url=|archive-date=|url-status=|access-date=}}</ref> == Initial infection == [[File:Epstein-barr virus (ebv).jpg|thumb|A stained sample of Epstein-Barr virus.]] Symptoms of EBV infection include: * [[fatigue]] * [[fever]] * [[rash]] * inflamed [[sore throat|throat]] * [[swollen lymph nodes]] * enlarged [[spleen]] * swollen [[liver]]<ref name="CDC">{{Cite web | url=http://www.cdc.gov/epstein-barr/about-ebv.html | title = Epstein-barr {{!}} Mononucleosis {{!}} About Virus {{!}} Mono | date = 2018-05-10 | website = [[Centers for Disease Control and Prevention]]|language=en-us|access-date=2018-11-14}}</ref> ===Age of infection=== Most people acquire EBV before the age of ten. Typically, young children who acquire EBV are either not symptomatic or have mild symptoms that are hard to distinguish from a cold or other other mild, childhood illnesses.<ref>{{Cite book|title=Fields Virology|chapter=Epstein-Barr virus|date=2001|publisher=Lippincott Williams & Wilkins|location=Philadelphia, PA|pages=2575–2627|editor-last=Knipe|editor-first=DM|editor-last2=Howley|editor-first2=PM|last=Rickinson|first=AB|last2=Kieff|first2=E}}</ref> In adolescents and young adults, EBV can cause [[infectious mononucleosis]] (IM), also known as glandular fever.<ref name="CDC" /> IM is characterized by [[fever]], [[sore throat]], [[swollen lymph nodes]], [[pain|body aches]], and [[fatigue]]. It generally resolves with rest and only rarely causes serious complications. It typically occurs in people who have not been exposed to EBV in early childhood, and in comparison, is more severe than infection in childhood (i.e., it can last for months). Following initial infection, EBV can reactivate and has been shown to have many connections with various chronic illnesses. Relative to initial infections, reactivated EBV is much more severe. ==Transmission== EBV is transmitted through bodily fluids, most commonly through saliva. The first time a person is infected with EBV, the person is contagious for weeks (even when not displaying symptoms). The virus then transitions to the latent or inactive form, and stays in the body. If the virus reactivates, the person will be contagious again.<ref name="CDC" /> == Diagnosis == EBV infection is confirmed with blood tests that detect presence of [[:Category:Antibodies|antibodies]]. Nine out of ten adults have these antibodies, indicating that they have a current or past EBV infection.<ref name="CDC" /> Anti-VCA (Viral capsid antigen) IgG and EBV nuclear antigen (EBNA) IgG antibodies persist throughout a person's life. Thus, positive results merely indicate a current or past infection. A current EBV infection is diagnosed based on the presence of Anti-VCA IgM and Anti-EA (Early Antigen) IgG. VCA IgM appears early in EBV infection and usually disappears within four to six weeks. Positive VCA IgM suggests current active acute EBV infection. EA IgG appears in the acute phase of illness and generally falls to undetectable levels after three to six months. Positive EA IgG can suggest current active EBV infection or EBV re-activation. <ref name="CDC-testing">{{Cite web | url=https://www.cdc.gov/epstein-barr/laboratory-testing.html | title = Epstein-barr {{!}} Mononucleosis {{!}} Laboratory Testing {{!}} Mono | date = 2019-01-28 | website = [[Centers for Disease Control and Prevention]]|language=en-us|access-date=2020-10-08}}</ref> ==Latency== In healthy adults, the virus remains latent for life in memory [[B cell]]s. It is estimated that one in every one hundred thousand to one million circulating B cells carry EBV.<ref name="Hsu2000">{{Cite journal | last = Hsu | first = J.L. | last2 = Glaser | first2 = S.L. | date = Apr 2000 | title = Epstein-barr virus-associated malignancies: epidemiologic patterns and etiologic implications |url =https://www.ncbi.nlm.nih.gov/pubmed/10781747/|journal=Critical Reviews in Oncology/Hematology|volume=34|issue=1 | pages = 27–53|issn=1040-8428|pmid=10781747}}</ref> In healthy hosts, EBV populations are kept in check by [[CD4+ T cell|CD4<sup>+</sup>]] and [[CD8|CD8<sup>+</sup>]] [[T cell|T-cell]] responses. The equilibrium can be disrupted in individuals with compromised [[immune system]]s such as patients with [[AIDS]] or transplant patients taking immune system suppressing drugs.<ref name="Priatel2014">{{Cite journal | last = Priatel | first = John J | last2 = Chung | first2 = Brian K | last3 = Tsai | first3 = Kevin | last4 = Tan | first4 = Rusung | date = 2014-04-09 | title = Natural killer T cell strategies to combat Epstein–Barr virus infection | url =https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4063158/|journal=Oncoimmunology|volume=3|issue=| pages = e28329|doi=10.4161/onci.28329|issn=2162-4011|pmc=4063158|pmid=25050206|quote=|via=}}</ref> It has been observed that these patients are more susceptible to EBV-related [[cancer]]s, such as certain [[lymphoma]]s and carcinomas.<ref>{{Cite journal | last = Pattle | first = Samuel B. | last2 = Farrell | first2 = Paul J. | date = Nov 2006 | title = The role of Epstein-Barr virus in cancer |url =https://www.ncbi.nlm.nih.gov/pubmed/17049016|journal=Expert Opinion on Biological Therapy|volume=6|issue=11 | pages = 1193–1205|doi=10.1517/14712598.6.11.1193|issn=1744-7682|pmid=17049016|quote=|via=}}</ref> In immunocompromised patients, EBV can induce lymphoproliferation, [[lymphoma]], and hemophagocytic lymphohistiocytosis (HLH).<ref>{{Cite journal | title = Human immunity against EBV—lessons from the clinic | date = 2017-01-20| url = https://doi.org/10.1084/jem.20161846|journal=Journal of Experimental Medicine|volume=214|issue=2 | pages = 269–283 | last = Tangye | first = Stuart G. | last2 = Palendira | first2 = Umaimainthan | last3 = Edwards | first3 = Emily S.J.|doi=10.1084/jem.20161846|issn=0022-1007}}</ref> ===Natural killer T cells=== It is thought that [[natural killer T cell]]s (NKT) play a pivotal role in the control of EBV-infected B cells through their recognition of [[CD1d]] expressing cells.<ref name="Priatel2014" /> ==Neuronal infection== A 2015 study<ref name="JhaHC2015">{{Cite journal | last1 = Jha | first1 = HC | author-link1 = | last2 = Mehta | first2 = D | authorlink2 = | last3 = Lu | first3 = J | authorlink3 = | last4 = El-Naccache | first4 = D | authorlink4 = | last5 = Shukla | first5 = SK | authorlink5 = | last6 = Kovacsics | first6 = C | authorlink6 = | last7 = Kolson | first7 = D | author-link7 = | last8 = Robertson | first8 = ES | author-link8 = | title = Gammaherpesvirus Infection of Human Neuronal Cells| journal = mBio | volume = 6 | issue =6 | pages = e01844-15 | date = 2016-12-01| doi = 10.1128/mBio.01844-15 | pmid = 26628726| url =http://mbio.asm.org/content/6/6/e01844-15 }}</ref> demonstrated that human [[neuron]]al cells could be directly and actively infected with EBV and another [[herpesvirus]], Kaposi's sarcoma-associated herpesvirus (KSHV). Neuronal cells were infected with EBV or KSHV viruses which had been combined with a fluorescent protein so that the infection could be observed. The infection was seen to produce new virus cells (productive) and spread efficiently. Significantly, it not only infected surrounding neuronal cells but also nearby [[Peripheral blood mononuclear cell|peripheral blood mononuclear cells]]. EBV is known to be linked to many neuronal diseases<ref name="Kleines2011">{{citation | last1 = Kleines | first1 = M | last2 = Schiefer | first2 = J | last3 = Stienen | first3 = A | last4 = Blaum | first4 = M | last5 = Ritter | first5 = K | last6 = Häusler | first6 = M | title = Expanding the spectrum of neurological disease associated with Epstein-Barr virus activity | journal =European Journal of Clinical Microbiology & Infectious Diseases | issn = 1435-4373| volume = 30 | issue = 12| pages = 1561–1569 | date = 2011-05-15| doi = 10.1007/s10096-011-1261-7| url = http://link.springer.com/article/10.1007/s10096-011-1261-7}}</ref> but this is the first evidence of how this may occur. The researchers note that this research supports the presence of EBV in neuronal diseases, but does not indicate why this is so. ==In human disease== Epstein-Barr virus has been associated with a wide number of immune diseases including [[multiple sclerosis]], [[rheumatoid arthritis]], [[systemic lupus erythematosus]],<ref name="Lossius2012">{{Cite journal | title = Epstein-Barr Virus in Systemic Lupus Erythematosus, Rheumatoid Arthritis and Multiple Sclerosis—Association and Causation | date = December 2012| url = https://www.mdpi.com/1999-4915/4/12/3701|journal=Viruses|volume=4|issue=12 | pages = 3701–3730 | last = Lossius | first = Andreas | author-link = | last2 = Johansen | first2 = Jorunn N. | authorlink2 = | last3 = Torkildsen | first3 = Øivind | authorlink3 = | last4 = Vartdal | first4 = Frode | authorlink4 = | last5 = Holmøy | first5 = Trygve | authorlink5 = |language=en|doi=10.3390/v4123701|pmc=PMC3528287|pmid=|issn=1999-4915|via=|quote=}}</ref> c[[Chronic fatigue syndrome|hronic fatigue syndrome]], and [[myasthenia gravis]]. EBV was recently discovered to turn on "risk genes" for autoimmune disease in the cells it infects. [[Epstein-Barr virus nuclear antigen 2|EBNA2]], a protein produced by EBV-infected cells, and its related transcription factors activate half the human genes known to be associated with the risk for lupus as well as genes associated with several other autoimmune diseases including [[multiple sclerosis]], [[rheumatoid arthritis]], [[inflammatory bowel disease]], [[Diabetes#Types|type 1 diabetes]], [[juvenile idiopathic arthritis]] and [[celiac disease]]. EBV activation can thus increase the risk of developing these diseases.<ref name="Harley2018" /><ref name="NIHNews2018" /> ===Chronic fatigue syndrome=== A prospective study of 250 primary care patients revealed a higher prevalence of [[chronic fatigue syndrome]] after infectious [[mononucleosis]] (glandular fever) when compared to an ordinary upper respiratory tract infection.<ref name="White1998">{{Cite journal | last = White | first = P.D. | last2 = Thomas | first2 = J.M. | last3 = Amess | first3 = J. | last4 = Crawford | first4 =D.H. | last5 = Grover | first5 = S.A. | last6 = Kangro | first6 = H.O. | last7 = Clare | first7 = A.W. | date = Dec 1998 | title = Incidence, risk and prognosis of acute and chronic fatigue syndromes and psychiatric disorders after glandular fever |url =https://www.ncbi.nlm.nih.gov/pubmed/9926075|journal=The British Journal of Psychiatry: The Journal of Mental Science|volume=173 | pages = 475–481|issn=0007-1250|pmid=9926075|issue=|doi=|pmc=|quote= | author-link = Peter White|via=}}</ref> Anti-early antigen titers to EBV were elevated in CFS patients and associated with worse symptoms.<ref name="Schmaling1996">{{Cite journal | last = Schmaling | first = K.B. | last2 = Jones | first2 = J.F. | date = Jan 1996 | title = MMPI profiles of patients with chronic fatigue syndrome | url =https://www.ncbi.nlm.nih.gov/pubmed/8730646|journal=Journal of Psychosomatic Research|volume=40|issue=1 | pages = 67–74|issn=0022-3999|pmid=8730646}}</ref> A 2006 Australian prospective study found that 12% of subjects infected by EBV met the criteria for [[chronic fatigue syndrome]] six months after their infection, and 9% still had CFS 12 months after infection.<ref name="Hickie2006">{{Cite journal | last = Hickie | first = Ian | author-link = Ian Hickie | last2 = Davenport | first2 = Tracey | authorlink2 = Tracey Davenport | last3 = Wakefield | first3 = Denis | authorlink3 = Denis Wakefield | last4 = Vollmer-Conna | first4 = Ute | authorlink4 = Uté Vollmer-Conna | last5 = Cameron | first5 = Barbara | authorlink5 = | last6 = Vernon | first6 = Suzanne D | authorlink6 = Suzanne Vernon | last7 = Reeves | first7 = William C | author-link8 = William Reeves | last8 = Lloyd | first8 = Andrew | author-link8 = Andrew Lloyd | date = 2006-09-16 | title = Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1569956/|journal=BMJ : British Medical Journal|volume=333|issue=7568 | pages = 575|doi=10.1136/bmj.38933.585764.AE|issn=0959-8138|pmc=1569956|pmid=16950834|access-date=|quote=|via=}}</ref> (The same rate held true for [[Ross River virus]] and [[Q fever]].) In another study sample, 110 of 178 patients with increased antibodies against EBV had a diagnosis of CFS.<ref name="Mikirova2014" /> === Long COVID === Long COVID may be associated [[herpesvirus]] reactivation such as EBV.<ref>{{Cite journal | last = Proal | first = Amy D. | authorlink = Amy Proal | last2 = VanElzakker | first2 = Michael B. | authorlink2 = Michael VanElzakker | date = 2021 | title=Long COVID or Post-acute Sequelae of COVID-19 (PASC): An Overview of Biological Factors That May Contribute to Persistent Symptoms |url =https://www.frontiersin.org/articles/10.3389/fmicb.2021.698169/full|journal=Frontiers in Microbiology|language=English|volume=12|issue= | pages = 698169|doi=10.3389/fmicb.2021.698169|issn=1664-302X}}</ref><ref name=":0">{{Cite journal | title = Investigation of Long COVID Prevalence and Its Relationship to Epstein-Barr Virus Reactivation | date = June 2021| url = https://www.mdpi.com/2076-0817/10/6/763/htm|journal=Pathogens|volume=10|issue=6 | pages = 763 | last = Gold | first = Jeffrey E. | authorlink = | last2 = Okyay | first2 = Ramazan A. | authorlink2 = | last3 = Licht | first3 = Warren E. | author-link3 = | last4 = Hurley | first4 = David J. | author-link4 = | last5 = | first5 = | authorlink5 = | last8 = | first8 = |language=en|doi=10.3390/pathogens10060763|pmc=|pmid=|access-date=|issn=2076-0817|quote=|via=}}</ref> ===Multiple sclerosis=== Infection later in life, high serum titers against EBV, and [[mononucleosis]] have all been associated with an increased risk of multiple sclerosis. MS relapses are correlated with EBV reactivation.<ref name="Holmoy2008">{{Cite journal | title = Vitamin D status modulates the immune response to Epstein Barr virus: Synergistic effect of risk factors in multiple sclerosis | date = 2008-01-01| url = https://www.sciencedirect.com/science/article/pii/S0306987707003167|journal=Medical Hypotheses|volume=70|issue=1 | pages = 66–69 | last = Holmøy | first = Trygve|language=en|doi=10.1016/j.mehy.2007.04.030|issn=0306-9877}}</ref> Several studies by Alberto Ascherio, MD, DrPH, and his team at the Harvard School of Public Health have suggested that EBV is involved in [[multiple sclerosis]], specifically in people with a certain immune-related gene and high levels of antibodies to EBV in their blood.<ref>{{Cite web | url=https://www.nationalmssociety.org/What-is-MS/What-Causes-MS/Viruses | title = Viruses | last = | first = | date = |website=National Multiple Sclerosis Society|archive-url=|archive-date=|url-status=|access-date=2018-11-14}}</ref> === Systemic lupus erythematosus === In a study of young patients with lupus, 99% had EBV as compared to 70% of healthy controls.<ref name="James1997">{{Cite journal | title = An increased prevalence of Epstein-Barr virus infection in young patients suggests a possible etiology for systemic lupus erythematosus. | date = 1997-12-15| url = https://www.jci.org/articles/view/119856|journal=The Journal of Clinical Investigation|volume=100|issue=12 | pages = 3019–3026 | last = James | first = J.A. | last2 = Kaufman | first2 = K.M. | last3 = Farris | first3 = A.D. | last4 = Taylor-Albert | first4 = E. | last5 = Lehman | first5 = T.J. | last6 = Harley | first6 = J.B.|language=en|doi=10.1172/JCI119856|pmid=9399948|issn=0021-9738}}</ref> Another study found that patients with systemic lupus erythematosus had a roughly 40-fold increase in EBV viral loads compared with controls, likely stemming from altered [[t cell]] responses against EBV.<ref>{{Cite journal | title = Defective Control of Latent Epstein-Barr Virus Infection in Systemic Lupus Erythematosus | date = 2004-01-15| url = https://www.jimmunol.org/content/172/2/1287|journal=The Journal of Immunology|volume=172|issue=2 | pages = 1287–1294 | last = Kang | first = Insoo | last2 = Quan | first2 = Timothy | last3 = Nolasco | first3 = Helena | last4 = Park | first4 = Sung-Hwan | last5 = Hong | first5 = Myung Sun | last6 = Crouch | first6 = Jill | last7 = Pamer | first7 = Eric G. | last8 = Howe | first8 = John Greg | last9 = Craft | first9 = Joe|language=en|doi=10.4049/jimmunol.172.2.1287|pmid=14707107|issn=0022-1767}}</ref> ===Myasthenia gravis=== [[Myasthenia gravis]] is an [[autoimmune disease]] which has been associated with a large number of different viruses, particularly EBV, [[Human papillomavirus|HPV]], and [[Poliovirus|polioviruses]]. In several studies EBV infection of the thymus has been found in myasthenia gravis patients, but not all studies have found this.<ref name=":1">{{Cite journal | title = A Systematic Review of the Potential Implication of Infectious Agents in Myasthenia Gravis | date = 2021 | url=https://www.frontiersin.org/article/10.3389/fneur.2021.618021|journal=Frontiers in Neurology|volume=12 | last = Leopardi | first = Victoria | last2 = Chang | first2 = Yu-Mei | last3 = Pham | first3 = Andrew | last4 = Luo | first4 = Jie | last5 = Garden | first5 = Oliver A.|doi=10.3389/fneur.2021.618021/full|issn=1664-2295}}</ref> [[B cell|B cells]] from [[myasthenia gravis]] patients stimulated ''in vitro'' by Epstein-Barr virus produced [[acetylcholine]] autoantibodies.<ref>{{Cite journal | last = Brenner | first = T. | last2 = Timore | first2 = Y. | last3 = Wirguin | first3 = I. | last4 = Abramsky | first4 = O. | last5 = Steinitz | first5 = M. | date = Oct 1989 | title = In vitro synthesis of antibodies to acetylcholine receptor by Epstein-Barr virus-stimulated B-lymphocytes derived from patients with myasthenia gravis |url =https://www.ncbi.nlm.nih.gov/pubmed/2553772|journal=Journal of Neuroimmunology|volume=24|issue=3 | pages = 217–222|issn=0165-5728|pmid=2553772}}</ref> While EBV infection of the [[thymus]] has been posited as a causative agent for the production of [[acetylcholine]] receptor autoantibodies in [[myasthenia gravis]].<ref>{{Cite journal | last = Kaminski | first = Henry J | last2 = Minarovits | first2 = Janos | title = Epstein-barr virus: Trigger for autoimmunity?| url = http://www.academia.edu/20258853/Epstein-barr_virus_Trigger_for_autoimmunity/|journal=Annals of Neurology|language=en|issn=0364-5134 | date = 2010 | volume=67|issue=6 | pages = 697-698| doi = | pmc = | pmid = | quote = |access-date=|via=}}</ref>, there is only limited evidence supporting EBV or other viruses as a cause of myasthenia gravis.<ref name=":1" /> === Gastrointestinal disease === One study of EBV in patients with [[gastritis]], [[Crohn's disease]], and [[ulcerative colitis]] and normal controls found essentially undetectable levels of EBV in normal gastric mucosa. However, EBV was detected in 46% of gastritis lesions, 44% of normal colonic mucosa, 55% of Crohn’s disease, and 64% of ulcerative colitis samples.<ref>{{Cite journal | title = Epstein-Barr Virus Infection Is Common in Inflamed Gastrointestinal Mucosa | date = 2012-07-01| url = https://doi.org/10.1007/s10620-012-2116-5|journal=Digestive Diseases and Sciences|volume=57|issue=7 | pages = 1887–1898 | last = Ryan | first = Julie L. | last2 = Shen | first2 = You-Jun | last3 = Morgan | first3 = Douglas R. | last4 = Thorne | first4 = Leigh B. | last5 = Kenney | first5 = Shannon C. | last6 = Dominguez | first6 = Ricardo L. | last7 = Gulley | first7 = Margaret L.|language=en|doi=10.1007/s10620-012-2116-5|pmc=PMC3535492|pmid=22410851|issn=1573-2568}}</ref> ===Lyme disease=== Several herpesviruses including Epstein-Barr virus may cause false positives on [[Lyme disease]] tests.<ref name="Goossens1999">{{Cite journal | last1 = Goossens | first1 = HA | last2 = Nohlmans | first2 = MK | last3 = van den Bogaard | first3 = AE | title = Epstein-Barr virus and cytomegalovirus infections cause false-positive results in IgM two-test protocol for early Lyme borreliosis| journal = Infection | date = May-Jun 1999 | volume = 27 | issue = 3| pages =231| doi = 10.1007/BF02561539 | pmid = 10378140| url = https://www.ncbi.nlm.nih.gov/pubmed/10378140}}</ref> ===XMEN disease=== A 2014 study found chronic Epstein-Barr infection was linked to a magnesium transporter [[magnesium transporter 1|MAGT]] mutation.<ref name="MAGT1">{{Cite web | url=https://www.ncbi.nlm.nih.gov/gene/84061 | title = MAGT1 magnesium transporter 1 [Homo sapiens (human)] | last = | first = | authorlink = | date = | website = NCBI|archive-url=|archive-date=|url-status=|access-date=2022-05-21}}</ref> Dysfunction in this transporter also resulted in decreased NK cell function, and neoplasia (sometimes-cancerous growths).<ref name="X-men_disease_1">{{Cite journal | last1 = Li | first1 = F.-Y. | author-link1 = | last2 = Chaigne-Delalande | first2 = B | authorlink2 = | last3 = Su | first3 = H | last4 = Matthews | first4 = H | last5 = Lenardo |first5 = M.J. | authorlink3 = | title = XMEN disease: a new primary immunodeficiency affecting Mg2+ regulation of immunity against Epstein-Barr virus. | journal =Blood| date = 2014| doi = 10.1182/blood-2013-11-538686| url = https://ashpublications.org/blood/article/123/14/2148/32463/XMEN-disease-a-new-primary-immunodeficiency|volume=123|issue=14 | pages = 2148–2152|pmc=|pmid=|quote=|via=}}</ref> This disorder, termed "XMEN" (for X-linked, EBV, and neoplasia) was identified as a recessive, X-linked disorder that would therefore be many times more common in men. Since chronic EBV infection has been associated with chronic fatigue syndrome, this error in [[magnesium]] transport may be worth considering in male patients, especially with slow onset and history of childhood infection.<ref name="X-men_disease_1" /><ref name="X-men_disease_2">{{Cite journal | title = X-linked immunodeficiency with magnesium defect, Epstein–Barr virus infection, and neoplasia disease: a combined immune deficiency with magnesium defect | date = Dec 2014| url = https://journals.lww.com/co-pediatrics/Abstract/2014/12000/X_linked_immunodeficiency_with_magnesium_defect,.16.aspx|journal=Current Opinion in Pediatrics|volume=26|issue=6 | pages = 713–719 | last = Ravell | first = Juan | author-link = | last2 = Chaigne-Delalande | first2 = Benjamin | authorlink2 = | last3 = Lenardo | first3 = Michael | authorlink3 = |language=en-US|doi=10.1097/MOP.0000000000000156|pmc=PMC4306042|pmid=25313976|access-date=|issn=1040-8703|quote=|via=}}</ref> However, in this disorder, EBV would be seen as an indicator of the illness rather than the cause. ==Vitamin D== Some recent research is finding links between EBV and [[Vitamin D]]. An EBV protein, EBNA-3, has an affinity for the vitamin D receptor ([[VDR]]) and may actually block the activation of VDR-dependent genes by [[Vitamin D]].<ref>{{Cite journal | last = Yenamandra | first = Surya Pavan | last2 = Hellman | first2 = Ulf | last3 = Kempkes | first3 = Bettina | last4 = Darekar | first4 = Suhas Deoram | last5 = Petermann | first5 = Sabine | last6 = Sculley | first6 = Tom | last7 = Klein | first7 = George | last8 = Kashuba | first8 = Elena | date = Dec 2010 | title = Epstein-Barr virus encoded EBNA-3 binds to vitamin D receptor and blocks activation of its target genes |url =https://www.ncbi.nlm.nih.gov/pubmed/20593215|journal=Cellular and molecular life sciences: CMLS|volume=67|issue=24 | pages = 4249–4256|doi=10.1007/s00018-010-0441-4|issn=1420-9071|pmid=20593215}}</ref> [[Vitamin D receptor]] may be required for the normal development of [[natural killer T cell]]s that react to cells expressing [[CD1d]], as in cells infected by EBV.<ref>{{Cite journal | last = Yu | first = Sanhong | last2 = Cantorna | first2 = Margherita T. | date = 2008-04-01 | title = The vitamin D receptor is required for iNKT cell development| url = http://www.pnas.org/content/105/13/5207|journal=Proceedings of the National Academy of Sciences|language=en|volume=105|issue=13 | pages = 5207–5212|doi=10.1073/pnas.0711558105|issn=0027-8424|pmid=18364394}}</ref> VDR is expressed on B cells infected with EBV, and bioactive Vitamin D<sub>3</sub> alters T cells to be less detrimental to the immune response.<ref name="Holmoy2008" /> As low Vitamin D is also a risk factor for MS, some studies have attempt to find a link between low Vitamin D status, EBV, and MS. One study of healthy individuals found no link between EBV load and Vitamin D status. However, over half the subjects were Vitamin D deficient and none had optimal levels<ref>{{Cite journal | last = Ramien | first = Caren | last2 = Pachnio | first2 = Annette | last3 = Sisay | first3 = Sofia | last4 = Begum | first4 = Jusnara | last5 = Leese | first5 = Alison | last6 = Disanto | first6 = Giulio | last7 = Kuhle | first7 = Jens | last8 = Giovannoni | first8 = Gavin | last9 = Rickinson | first9 = Alan | date = May 2014 | title = Hypovitaminosis-D and EBV: no interdependence between two MS risk factors in a healthy young UK autumn cohort| url = https://www.ncbi.nlm.nih.gov/pubmed/24192216?dopt=Abstract|journal=Multiple Sclerosis (Houndmills, Basingstoke, England)|volume=20|issue=6 | pages = 751–753|doi=10.1177/1352458513509507|issn=1477-0970|pmid=24192216}}</ref> (i.e., above 100 nmol/l). ==Treatment== There is no specific treatment for EBV, only treatment of symptoms, such as taking over-the-counter medications for pain and fever.<ref name="CDC" /> EBV is thought to persistent harmlessly in immunocompetent individuals, but in those with compromised immune systems it has been associated with certain cancers and possibly autoimmune disease. ===Antivirals=== Several [[antiviral]]s are active against EBV including [[valganciclovir]], [[valacyclovir]]<ref name="Hoshino2009">{{Cite journal | title = Long-term administration of valacyclovir reduces the number of Epstein-Barr virus (EBV)-infected B cells but not the number of EBV DNA copies per B cell in healthy volunteers | date = Nov 2009| url = https://pubmed.ncbi.nlm.nih.gov/19740997/|journal=Journal of Virology|volume=83|issue=22 | pages = 11857–11861 | last = Hoshino | first = Yo | author-link = | last2 = Katano | first2 = Harutaka | authorlink2 = | last3 = Zou | first3 = Ping | authorlink3 = | last4 = Hohman | first4 = Patricia | authorlink4 = | last5 = Marques | first5 = Adriana | authorlink5 = | last6 = Tyring | first6 = Stephen K. | author-link6 = | last7 = Follmann | first7 = Dean | last8 = Cohen | first8 = Jeffrey I.|doi=10.1128/JVI.01005-09|pmc=2772668|pmid=19740997|access-date=|issn=1098-5514|quote=|via=}}</ref>, [[acyclovir]]<ref name="Rafaillidis2013">{{Cite journal | title = Antiviral treatment for severe EBV infections in apparently immunocompetent patients | date = Nov 2010| url = https://pubmed.ncbi.nlm.nih.gov/20739216/|journal=Journal of Clinical Virology: The Official Publication of the Pan American Society for Clinical Virology|volume=49|issue=3 | pages = 151–157 | last = Rafailidis | first = Petros I. | authorlink = | last2 = Mavros | first2 = Michael N. | authorlink2 = | last3 = Kapaskelis | first3 = Anastasios | authorlink3 = | last4 = Falagas | first4 = Matthew E. | author-link4 = |doi=10.1016/j.jcv.2010.07.008|pmc=|pmid=20739216|access-date=|issn=1873-5967|quote=|via=}}</ref>, and [[spironolactone]].<ref name="Verma2016">{{Cite journal | last1 = Verma | first1 = Dinesh | last2 = Thompson | first2 = Jacob | last3 = Swaminathan | first3 = Sankar| title = Spironolactone blocks Epstein–Barr virus production by inhibiting EBV SM protein function | journal =Proceedings of the National Academy of Sciences | issn = 1091-6490 | volume = 113 | issue = 13| pages = 3609–3614 | date = 2016-03-29 | doi = 10.1073/pnas.1523686113 | pmid = 26976570| url = http://www.pnas.org/content/113/13/3609}}</ref> [[Acyclovir]], an [[antiviral]] drug which inhibits (but does not destroy) herpesviruses, was shown to also inhibit the virus production. This suggests that EBV replicates via lytic replication. A theoretical [[immunotherapy]] treatment proposes that inducing [[CD1d]] expression on EBV-infected B cells could prompt effective immune suppression of EBV by natural killer T cells.<ref name="Priatel2014"/> ===Rituximab=== [[Rituximab]] may be effective in completely eliminating EBV infection from the peripheral blood.<ref>{{Cite journal | last = Diamantopoulos | first = Panagiotis T. | last2 = Polonyfi | first2 = Katerina | last3 = Sofotasiou | first3 = Maria | last4 = Papadopoulou | first4 = Vasiliki | last5 = Kalala | first5 = Fani | last6 = Iliakis | first6 = Theodoros | last7 = Zervakis | first7 = Kostantinos | last8 = Tsilimidos | first8 = Gerassimos | last9 = Kouzis | first9 = Panagiotis | date = Dec 2013 | title = Rituximab in the treatment of EBV-positive low grade B-cell lymphoma| url = https://www.ncbi.nlm.nih.gov/pubmed/24324119|journal=Anticancer Research|volume=33|issue=12 | pages = 5693–5698|issn=1791-7530|pmid=24324119}}</ref> A study of seventeen patients with low-grade [[B cell]] lymphoma found that after three cycles of rituximab, the virus had been completely eliminated from the peripheral blood in all but one patient. ===Herbs and nutraceuticals=== Though not tested in clinical trials, licorice derivatives quercetin and isoliquiritigenin inhibit EBV in cell cultures.<ref>{{Cite journal | title = Quercetin-induced apoptosis prevents EBV infection | date = 2015-05-20| url = https://pubmed.ncbi.nlm.nih.gov/26059439|journal=Oncotarget|volume=6|issue=14 | pages = 12603–12624 | last = Lee | first = Minjung | last2 = Son | first2 = Myoungki | last3 = Ryu | first3 = Eunhyun | last4 = Shin | first4 = Yu Su | last5 = Kim | first5 = Jong Gwang | last6 = Kang | first6 = Byung Woog | last7 = Cho | first7 = Hyosun | last8 = Kang | first8 = Hyojeung|doi=10.18632/oncotarget.3687|pmc=4494961|pmid=26059439|issn=1949-2553}}</ref> [[Vitamin C]]<ref name="Mikirova2014">{{Cite journal | title = Effect of high dose vitamin C on Epstein-Barr viral infection | date = 2014-05-03| url = https://pubmed.ncbi.nlm.nih.gov/24793092/|journal=Medical Science Monitor: International Medical Journal of Experimental and Clinical Research|volume=20 | pages = 725–732 | last = Mikirova | first = Nina | last2 = Hunninghake | first2 = Ronald|doi=10.12659/MSM.890423|pmc=4015650|pmid=24793092|issn=1643-3750}}</ref> and Vitamin D<sub>3</sub><ref name="Rolf2017">{{Cite journal | title = Exploring the effect of vitamin D3 supplementation on the anti-EBV antibody response in relapsing-remitting multiple sclerosis | date = Sep 2018| url = https://pubmed.ncbi.nlm.nih.gov/28731372/|journal=Multiple Sclerosis (Houndmills, Basingstoke, England)|volume=24|issue=10 | pages = 1280–1287 | last = Rolf | first = Linda | author-link = | last2 = Muris | first2 = Anne-Hilde | authorlink2 = | last3 = Mathias | first3 = Amandine | authorlink3 = | last4 = Du Pasquier | first4 = Renaud | authorlink4 = | last5 = Koneczny | first5 = Inga | authorlink5 = | last6 = Disanto | first6 = Giulio | authorlink6 = | last7 = Kuhle | first7 = Jens | last8 = Ramagopalan | first8 = Sreeram | last9 = Damoiseaux | first9 = Jan | last10 = Smolders | first10 = Joost | last11 = Hupperts | first11 = Raymond|doi=10.1177/1352458517722646|pmc=6108041|pmid=28731372|access-date=|issn=1477-0970|quote=|via=}}</ref> might also decrease duration and severity of the symptoms of EBV infection. ===Vaccine=== A [[vaccine]] for the prevention of Epstein-Barr virus is being explored.<ref name="Vaccine2019">{{Cite web | url=https://www.nih.gov/news-events/news-releases/nih-researchers-make-progress-toward-epstein-barr-virus-vaccine | title = NIH researchers make progress toward Epstein-Barr virus vaccine | date = 2019-04-09 | website = National Institutes of Health (NIH)|language=en|access-date=2019-04-10}}</ref> ==Notable studies== *1996, MMPI profiles of patients with chronic fatigue syndrome<ref name="Schmaling1996" /> - ([[pubmed:8730646|Abstract]]) *1998, Incidence, risk and prognosis of acute and chronic fatigue syndromes and psychiatric disorders after glandular fever<ref name="White1998" /> - ([[pubmed:9926075|Abstract]]) *2006, Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study<ref name="Hickie2006" /> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1569956/ (Full text)] *2019, EBV-requisitioning physicians' guess on fatigue state 6 months after acute EBV infection<ref name="Asprusten2019">{{Cite journal | last = Asprusten | first = Tarjei Tørre | authorlink = | last2 = Pedersen | first2 = Maria | authorlink2 = Maria Pedersen | last3 = Skovlund | first3 = Eva | authorlink3 = Eva Skovlund | last4 = Wyller | first4 = Vegard Bruun | authorlink4 = Vegard Bruun Wyller | date = 2019 | title=EBV-requisitioning physicians' guess on fatigue state 6 months after acute EBV infection | url =https://www.ncbi.nlm.nih.gov/pubmed/30957026|journal=BMJ paediatrics open|volume=3|issue=1| pages = e000390|doi=10.1136/bmjpo-2018-000390|issn=2399-9772|pmc=|pmid=30957026|quote=|via=}}</ref> - ([[pubmed:30957026|Abstract]]) *2019, Predictors of chronic fatigue in adolescents six months after acute Epstein-Barr virus infection: A prospective cohort study<ref name="Pedersen2019a">{{Cite journal | last = Pedersen | first = Maria | author-link = Maria Pedersen | last2 = Asprusten | first2 = Tarjei Tørre | authorlink2 = | last3 = Godang | first3 = Kristin | authorlink3 = Kristin Godang | last4 = Leegaard | first4 = Truls Michael | authorlink4 = | last5 = Osnes | first5 = Liv Toril | authorlink5 = | last6 = Skovlund | first6 = Eva | authorlink6 = Eva Skovlund | last7 = Tjade | first7 = Trygve | author-link7 = | last8 = Øie | first8 = Merete Glenne | author-link8 = | last9 = Wyller | first9 = Vegard Bruun Bratholm | author-link9 = Vegard Bruun Wyller | date = Jan 2019 | title = Predictors of chronic fatigue in adolescents six months after acute Epstein-Barr virus infection: A prospective cohort study| url = https://www.ncbi.nlm.nih.gov/pubmed/30261303|journal=Brain, Behavior, and Immunity|volume=75|issue= | pages = 94–100|doi=10.1016/j.bbi.2018.09.023|issn=1090-2139|pmid=30261303|quote=}}</ref> - ([[pubmed:30261303|Abstract]]) *2019, Lifestyle factors during acute Epstein-Barr virus infection in adolescents predict physical activity six months later<ref name="Pedersen2019b">{{Cite journal | last = Pedersen | first = Maria | author-link = Maria Pedersen | last2 = Asprusten | first2 = Tarjei Tørre | authorlink2 = Tarjei Tørre Asprusten | last3 = Godang | first3 = Kristin | last4 = Leegaard | first4 = Truls Michael | authorlink4 = | last5 = Osnes | first5 = Liv Toril | authorlink5 = | last6 = Skovlund | first6 = Eva | authorlink6 = Eva Skovlund | last7 = Tjade | first7 = Trygve | last8 = Øie | first8 = Merete Glenne | last9 = Wyller | first9 = Vegard Bruun Bratholm | author-link9 = Vegard Bruun Wyller | date = 2019-01-27 | title = Lifestyle factors during acute Epstein-Barr virus infection in adolescents predict physical activity six months later |url =https://www.ncbi.nlm.nih.gov/pubmed/30685875|journal=Acta Paediatrica (Oslo, Norway: 1992)|volume=108|issue=8 | pages = 1521-1526|doi=10.1111/apa.14728|issn=1651-2227|pmid=30685875|quote=|via=}}</ref> - ([[pubmed:30685875|Abstract]]) *2019, Epstein-Barr Virus dUTPase Induces Neuroinflammatory Mediators: Implications for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome<ref>{{Cite journal | last = Williams | first = Marshall V. | authorlink = | last2 = Cox | first2 = Brandon | authorlink2 = | last3 = Lafuse | first3 = William P. | author-link3 = | last4 = Ariza | first4 = Maria Eugenia | authorlink4 = | authorlink5 = | date = May 2019 | title = Epstein-Barr Virus dUTPase Induces Neuroinflammatory Mediators: Implications for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome | url =https://linkinghub.elsevier.com/retrieve/pii/S0149291819301730|journal=Clinical Therapeutics|language=en|volume=41|issue=5 | pages = 848–863|doi=10.1016/j.clinthera.2019.04.009|pmc=6525645|pmid=31040055|quote=|via=}}</ref> - ([https://www.clinicaltherapeutics.com/article/S0149-2918(19)30173-0/fulltext Full text)] *2019, Review article - Epstein-Barr virus induced gene-2 upregulation identifies a particular subtype of Chronic Fatigue Syndrome / Myalgic Encephalomyelitis<ref name="Kerr2019EBV">{{Cite journal | last = Kerr | first = Jonathan R. | authorlink = Jonathan Kerr | date = Feb 2019 | title = Epstein-Barr virus induced gene-2 upregulation identifies a particular subtype of Chronic Fatigue Syndrome / Myalgic Encephalomyelitis | url =https://www.frontiersin.org/articles/10.3389/fped.2019.00059/abstract|journal=Frontiers in Pediatrics|volume=72|issue=10 | pages = 651-8|doi=10.3389/fped.2019.00059|quote=|via= | pmc=|pmid= }}</ref> - [https://www.frontiersin.org/articles/10.3389/fped.2019.00059/full (Full text)] *2019, Epstein-Barr virus (EBV) reactivation and therapeutic inhibitors<ref name="Kerr2019a">{{Cite journal | last = Kerr | first = Jonathan R | author-link = Jonathan Kerr | date = 2019-07-17 | title = Epstein-Barr virus (EBV) reactivation and therapeutic inhibitors |url =http://jcp.bmj.com/lookup/doi/10.1136/jclinpath-2019-205822|journal=Journal of Clinical Pathology|language=en|volume=|issue=| pages=jclinpath–2019–205822|doi=10.1136/jclinpath-2019-205822|issn=0021-9746|quote=|via=}}</ref> - [[pubmed:31315893|(Abstract)]] *2020, Cytomegalovirus, Epstein-Barr Virus, and Human herpesvirus-6 Infections in Patients With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome<ref name="Shikova2020">{{Cite journal | last = Shikova | first = Evelina | author-link = | last2 = Reshkova | first2 = Valentina | authorlink2 = | last3 = Kumanova | first3 = Аntoniya | authorlink3 = | last4 = Raleva | first4 = Sevdalina | authorlink4 = | last5 = Alexandrova | first5 = Dora | authorlink5 = | last6 = Capo | first6 = Natasa | authorlink6 = | last7 = Murovska | first7 = Modra | date = 2020 | title=Cytomegalovirus, Epstein-Barr virus, and human herpesvirus-6 infections in patients with myalgic еncephalomyelitis/chronic fatigue syndrome | url =https://onlinelibrary.wiley.com/doi/abs/10.1002/jmv.25744|journal=Journal of Medical Virology|language=en|volume=|issue=| pages=|doi=10.1002/jmv.25744|issn=1096-9071|pmc=|pmid=|access-date=|quote=|via=}}</ref> - [https://doi.org/10.1002/jmv.25744 (Abstract)] *2021, Epstein-Barr Virus and the Origin of Myalgic Encephalomyelitis or Chronic Fatigue Syndrome<ref>{{Cite journal | title = Epstein-Barr Virus and the Origin of Myalgic Encephalomyelitis or Chronic Fatigue Syndrome | date = Nov 15, 2021| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8634673/|journal=Frontiers in Immunology|volume=12|issue= | pages = 656797 | last = Ruiz-Pablos | first = Manuel | authorlink = | last2 = Paiva | first2 = Bruno | authorlink2 = | last3 = Monter-Mateo | first3 = Rosario | authorlink3 = | last4 = Garcia | first4 = Nicolas | authorlink4 = | last5 = Zabaleta | first5 = Aintzane | authorlink5 = |doi=10.3389/fimmu.2021.656797|pmc=|pmid=34867935|access-date=June 10, 2022|quote=|via=}}</ref> - ([https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8634673/ Full text]) *2021, Lasting Immunological Imprint of Primary Epstein-Barr Virus Infection With Associations to Chronic Low-Grade Inflammation and Fatigue<ref>{{Cite journal | title = Lasting Immunological Imprint of Primary Epstein-Barr Virus Infection With Associations to Chronic Low-Grade Inflammation and Fatigue | date = 2021 | url=https://pubmed.ncbi.nlm.nih.gov/34987499|journal=Frontiers in Immunology|volume=12 | pages = 715102 | last = Fevang | first = Børre | last2 = Wyller | first2 = Vegard Bruun Bratholm | last3 = Mollnes | first3 = Tom Eirik | last4 = Pedersen | first4 = Maria | last5 = Asprusten | first5 = Tarjei Tørre | last6 = Michelsen | first6 = Annika | last7 = Ueland | first7 = Thor | last8 = Otterdal | first8 = Kari |doi=10.3389/fimmu.2021.715102|pmc=8721200|pmid=34987499|issn=1664-3224}}</ref> - ([https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8721200/ Full text]) *2021, Investigation of Long COVID Prevalence and Its Relationship to Epstein-Barr Virus Reactivation<ref name=":0" /> [https://www.mdpi.com/2076-0817/10/6/763/htm (Full text)] *2021, Risks for Developing Myalgic Encephalomyelitis/Chronic Fatigue Syndrome in College Students Following Infectious Mononucleosis: A Prospective Cohort Study<ref>{{Cite journal|title=Risks for Developing Myalgic Encephalomyelitis/Chronic Fatigue Syndrome in College Students Following Infectious Mononucleosis: A Prospective Cohort Study|date=2020-12-25|url=http://dx.doi.org/10.1093/cid/ciaa1886|journal=Clinical Infectious Diseases|volume=73|issue=11|pages=e3740–e3746|last=Jason|first=Leonard A|last2=Cotler|first2=Joseph|last3=Islam|first3=Mohammed F|last4=Sunnquist|first4=Madison|last5=Katz|first5=Ben Z|doi=10.1093/cid/ciaa1886|pmc=8664491|pmid=33367564|issn=1058-4838}}</ref> - ([[pmc:8664491/|Full text]]) *2022, EBV/HHV-6A dUTPases contribute to myalgic encephalomyelitis/chronic fatigue syndrome pathophysiology by enhancing T<sub>FH</sub> cell differentiation and extrafollicular activities<ref>{{Cite journal | title = EBV/HHV-6A dUTPases contribute to myalgic encephalomyelitis/chronic fatigue syndrome pathophysiology by enhancing TFH cell differentiation and extrafollicular activities | date = 2022-06-08| url = https://insight.jci.org/articles/view/158193|journal=JCI Insight|volume=7|issue=11 | last = Cox | first = Brandon S. | last2 = Alharshawi | first2 = Khaled | last3 = Mena-Palomo | first3 = Irene | last4 = Lafuse | first4 = William P. | last5 = Ariza | first5 = Maria Eugenia|language=en|doi=10.1172/jci.insight.158193|issn=0021-9738}}</ref> - ([https://insight.jci.org/articles/view/158193 Full text]) == See also == * [[List of herpesvirus infection studies]] * [[Abortive infection theory of ME/CFS]] (Dr. Lerner's theory that abortive herpesviruses cause ME/CFS) ==Learn more == *[https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011487.pub2/full Antiviral agents for infectious mononucleosis (glandular fever) (2016)] - [[Cochrane]] review * [https://www.nationalmssociety.org/About-the-Society/News/Study-Provides-Strongest-Evidence-Yet-for-the-Role Study Provides Strongest Evidence Yet for the Role of Epstein-Barr Virus in Triggering Multiple Sclerosis (2022)] - Multiple Sclerosis Society ==References== {{Reflist}} [[Category:Infectious agents]] [[Category:Triggers and risk factors]] [[Category:Virology]] [[Category:Viruses]] [[Category:Herpesviruses]]
Summary:
Please make sure your edits are consistent with
MEpedia's guidelines
.
By saving changes, you agree to the
Terms of use
, and you irrevocably agree to release your contribution under the
CC BY-SA 3.0 License
and the
GFDL
. You agree that a hyperlink or URL is sufficient attribution under the Creative Commons license.
Cancel
Editing help
(opens in new window)
Templates used on this page:
Template:Citation
(
edit
)
Template:Cite book
(
edit
)
Template:Cite journal
(
edit
)
Template:Cite web
(
edit
)
Template:Main other
(
edit
)
Template:Reflist
(
edit
)
Module:Check for unknown parameters
(
edit
)
Module:Citation/CS1
(
edit
)
Module:Citation/CS1/COinS
(
edit
)
Module:Citation/CS1/Configuration
(
edit
)
Module:Citation/CS1/Date validation
(
edit
)
Module:Citation/CS1/Identifiers
(
edit
)
Module:Citation/CS1/Utilities
(
edit
)
Module:Citation/CS1/Whitelist
(
edit
)
Module:No globals
(
edit
)
Navigation
Navigation
Skip to content
Main page
Browse
Become an editor
Random page
Popular pages
Abbreviations
Glossary
About MEpedia
Links for editors
Contents
Guidelines
Recent changes
Pages in need
Search
Help
Wiki tools
Wiki tools
Special pages
Page tools
Page tools
User page tools
More
What links here
Related changes
Page information
Page logs