No association fatigue and Epstein–Barr virus (EBV)
Question:
9/8/2017
I have recently seen a few patients, middle age females that contract Epstein–Barr virus (EBV) virus and then are "wiped out" as far as fatigue so severe, they cannot work or function as mothers and spend time with their kids because of the severe fatigue. There is also a history of recurrent infection in each case. The flow cytometry, quantitative antibody titers are normal. Strep pneumo titers are typically low and respond after vaccination. One has a memory defect, but I cannot explain the extreme fatigue. Recent EBV pcr, CMV pcr, thyroid labs are normal. The patients do not, persay, have psychologic issues, but they are frustrated with their medical condition. Is there anything in the immunology literature that is known about EBV infection that remains chronic for several years? Is there anything from an immune standpoint that could help? One patient I received from another immunologist started her on IVIG therapy for recurrent infections, but her fatigue is still severe despite therapy. The infectious disease doctors cannot offer anything nor find abnormal pathogen studies. Many have seen rheumatology without any real answers or improvement in symptoms with fibromyalgia treatment. I am not sure what to do next. Is there help for them?
Answer:
You ruled out the rare patient with chronic EBV infection with the lab test indicating the patients do not have active viremia. IVIG in EBV associated diseases has shown no benefit. The proposed cause and effect association with EBV and chronic fatigue syndrome now called systemic exertion intolerance disease (SEID) is understood to be incorrect. From our literature review I found no immune mediated therapies to treat fatigue temporally associated with the diagnosis of EBV infection.
Patricia McNally, MD, FAAAAI