Epstein-Barr virus: responsible for multiple sclerosis?

[Mis à jour le 18 janvier 2022 à 12h47] The multiple sclerosis (MS) could be caused by Epstein-Barr virus (EBV), showed a large American epidemiological study, published on January 13, 2022 in Science magazine. “The risk of multiple sclerosis would be multiplied by 32 after infection with Epstein-Barr virus, but did not increase after infection with other viruses, including similarly transmitted cytomegalovirus“, say the authors, after analyzing a cohort of more than 10 million young adults on active duty in the United States military, 955 of whom were diagnosed with MS during their service. All but one presented with antibody anti-EBV in the serum at the time of their diagnosis. It is “the first study providing convincing evidence of causation“, said Alberto Ascherio, lead author and professor of epidemiology at the Harvard School of Public Health. A first link to the Epstein-Barr virus was made more than 30 years ago, with a risk three times the chance of developing the disease if you had infectious mononucleosis late in adolescence or adulthood.These new results go further and could help todevelop a treatment capable of curing this autoimmune disease, which concerns approximately 100,000 people in France, the majority of whom are women, and with more than 2,000 new cases diagnosed every year. However, according to researchers at Stanford University, who published a commentary on the study in the journal Science, other factors, genetic for example, could have a role in the development of the disease. The Epstein-Barr virus can also causegenital herpes or even the mononucleosis. What symptoms does it cause? Is there a vaccine to prevent it?

Definition: what is the Epstein-Barr virus?

“The Epstein-Barr virus is a virus that is part of the large family of Herpes virus, the best known of them being HSV-1, responsible for the cold sore and HSV-2, responsible for thegenital herpes, an STD (sexually transmitted disease),“Informs Professor Charles Cazanave, specialist in infectious and tropical pathology at the Bordeaux University Hospital.

What diseases can it cause?

“The disease most often linked to the EBV virus is infectious mononucleosis. This is a primary infection with the EBV virus, during the first contact with this virus. This primary infection is more or less symptomatic depending on the case and the person” says Professor Charles Cazanave. “This disease often called “kissing disease” preferentially affects teenagers and young adults, with a peak incidence between 15 and 25 years ” he clarifies. “This virus remains in our lymphocytes and can be talked about again in certain circumstances of immune deficiency as for example in the case of untreated and advanced HIV infection. Lymph node diseases (lymphomas : Hodgkin’s lymphoma, Burkitt’s lymphoma) due to the EBV virus are however very exceptional” he reassures. According to an American study published on January 13, 2022 in the journal Science, there is a high prevalence of the Epstein-Barr virus associated with multiple sclerosis.

Is it contagious?

“Infectious mononucleosis is a disease very contagious. It is considered that approximately 65% ​​of the population has encountered this virus and that 90% of adults aged 30 are immune. They were able to make a form that was not very symptomatic or even asymptomatic” (without symptoms) informs this specialist.

What are the causes and mode of transmission?

“The Epstein-Barr Virus spread mainly through saliva“ says Professor Charles Cazanave. This is why it mainly affects adolescents during “first kisses”. “It can also affect children but this is rarer “says the specialist. In this case, the transmission takes place by putting toys in the mouth, possibly by kissing relatives.

What are the symptoms ?

“The classic form of infectious mononucleosis in people between the ages of 15 and 25 is characterized by a fever which can be high (39.5-40°C), fatigue, headache, feeling unwell, signs most often associated with angina which can be very troublesome with difficulty swallowing, glands in the neck, armpits and groin ” informs Professor Charles Cazanave. “Exceptionally, when the person finds himself almost unable to swallow because of severe angina, infectious mononucleosis can lead to hospitalization with infusion and anti-inflammatory treatment “says the doctor.

What is the diagnosis? What tests?

“The diagnosis of infectious mononucleosis is based on a Complete Blood Count (NFS) and specific EBV serology. The NFS reveals a mononucleosis syndrome: increase in lymphocytes which have a particular shape. Specific EBV serology consists of look for the presence of antibodies at the beginning of the disease, in the intermediate phase or in the late phase. Added to this is an analysis of transaminases, markers of the liver, which can be increased in mononucleosis“explains Professor Charles Cazanave.

Rate results: what does that mean?

“The elevation of the lymphocyte count in the Complete Blood Count and the EBV antibodies which are positive a few days after the onset of symptoms make it possible to make the diagnosis of infectious mononucleosis“Informs the specialist. An EBV serology can reveal an old infection with the EBV virus, a beginning primary infection, an ongoing infection or a reactivation of the virus.

What are the risks of complications?

“The main complication of infectious mononucleosis is rupture of the spleen, informs Professor Charles Cazanave. The spleen being a ganglion, it increases in volume“. This complication is very rare.”It can be prevented by rest and by not doing combat sports. Exceptionally, there may be neurological complications, such as facial paralysis or lymphoma-like conditions “says the specialist.

What are the treatments ?

“As with all viral illnesses there is no specific treatment except rest and treatment of symptoms (taking paracetamol to relieve fever and headaches)“says the doctor. In more serious forms, cortisone can be administered under cover of hospital supervision..

Prevention: is there a vaccine?

There is no vaccine against the EBV virus or prevention. “Infectious mononucleosis is one of these diseases of the first part of life for which one becomes immune. It is a mild disease in the majority of cases, which is why there is no research to develop a vaccine” emphasizes Professor Charles Cazanave.

Thanks to Professor Charles Cazanave, doctor specializing in infectious and tropical pathology at the Bordeaux University Hospital.