Saturday, April 02, 2005

Acute versus chronic mononucleosis - By Peter H. Gott, M.D.

´┐╝Article posted at Monterey Herald online on Apr. 01, 2005

Dear Dr. Gott: I am 77 and was recently diagnosed with Epstein-Barr infection and immune deficiency, based on a blood test by my ear-nose-and-throat doctor. I had mononucleosis as a teenager and was very ill. Now I run a low-grade fever and feel tired. I have had one injection of gamma globulin without noticeable effect.

My primary care physician disagrees with the otolaryngologist, and says that there is a controversy about EBV chronic illness. Can you help me sort things out?

Dear Reader: Mononucleosis, an infectious disease that is common in adolescence, is caused by the Epstein-Barr virus. It is marked by sore throat, enlarged lymph glands and overwhelming fatigue. In the process of combating the disease, the body manufactures anti-EBV proteins that can be measured in the blood. These are called IgM proteins.

As the infection resolves (as it almost always does without therapy), the immune system "switches gears" and produces another group of proteins, called IgG, that may be present in the blood for years thereafter. This does not indicate the presence of ongoing infection or chronic EBV infection, a medical entity that is in question.

If your ENT doctor obtained an EBV panel, the test would have shown one of four possibilities:

1) Negative IgM and IgG levels. This would indicate that you never had (and don't now have) mononucleosis, or that you had it years ago and it was cured.

2) Positive IgM and negative IgG. This is consistent with acute mono, a relatively unlikely possibility given your age.

3) Negative IgM and positive IgG. This suggests that you had mono in the past.

4) Positive IgM and positive IgG. This combination could reflect a second, acute bout of mono, or simply an overactive immune system.

A decade or two ago, "chronic" EBV infection was considered to be a common cause of chronic fatigue syndrome, and was treated with gamma globulin injections to strengthen the immune system. This practice is no longer recommended because there is substantial doubt about whether chronic EBV is a disease at all.

Therefore, I side with your family physician and encourage you to have further testing performed to discover any hidden infections that could be the cause of your fever and fatigue. I would also recommend that you discontinue the gamma globulin injections; they are expensive, and not without risk, and probably aren't going to help you in the lung run.

Because I have lightly hit on blood disorders, I am sending you a copy of my Health Report "Blood: Donations and Disorders." Other readers who would like a copy should send a long, self-addressed, stamped envelope and $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title. [End of article]


Blogger carlitos said...

I do have a positive IgG and IgM on Epstein Barr Virus
IgG 400
IgM 33
PCR on Epstein Barr was positive
My Natural Cell Killers are very low
My RNASe is very high
I have high IgG on Bartonella
I have muscle tissue in my heces
I have Lactose Intolerance
and I have been diagnosed of CFS...
Do you agree on this diagnostic?

November 22, 2006  
Anonymous Anonymous said...

My EBV AB VCA IgG is 2019
EVB nuclear Anitgen AB, Igg is 756 I am 50 chronic fatigue syndrome or chronic mono?

April 11, 2007  

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