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Chronic vs Acute EBV: An Opportunistic Infection and Naturopathic Therapies

Written by Portland Clinic of Natural Health on May 8, 2023

Epstein-Barr virus (EBV) is a common and usually benign virus that belongs to the herpesvirus family. While most people experience only mild symptoms during an acute EBV infection, in some cases, the virus can persist and lead to chronic conditions. In this blog post, we will explore the differences between acute and chronic EBV, its opportunistic nature, and some evidence-based naturopathic therapies for managing EBV-related conditions.

Acute vs Chronic EBV

Acute EBV infection, also known as infectious mononucleosis or "mono," typically presents with fever, sore throat, swollen lymph nodes, and fatigue. Most people recover from an acute EBV infection within a few weeks to months, and the virus remains dormant in their system for life. (1)

Chronic EBV, on the other hand, occurs when the virus remains active in the body, causing ongoing symptoms and health issues. Chronic EBV can manifest as Chronic Fatigue Syndrome (CFS), chronic active EBV infection, and even certain types of cancers, such as Burkitt's lymphoma and nasopharyngeal carcinoma. (2, 3)

Opportunistic Infection

EBV is an opportunistic infection, meaning it can take advantage of a weakened immune system. Factors that may increase the risk of developing chronic EBV include stress, other infections, and immune system dysfunction. This is why maintaining a strong immune system is crucial in preventing the development of chronic EBV and related conditions. (4, 5)

Evidence-Based Naturopathic Therapies

  1. Lifestyle modifications: A well-balanced diet, regular exercise, and stress management techniques, such as meditation or yoga, can help support a healthy immune system and potentially prevent chronic EBV. (6)
  2. L-Lysine: L-Lysine is an essential amino acid that has been shown to inhibit the replication of herpesviruses, and clinically appears to be useful in the treatment EBV, though studies are limited (7)
  3. Astragalus: Astragalus is a traditional Chinese herb known for its immune-boosting properties. Astragalus may help modulate the immune system and possess potential antiviral effects against EBV, though studies are limited. (8, 9)
  4. Probiotics: Probiotics, such as Lactobacillus and Bifidobacterium strains, may help support a healthy gut microbiome and immune system function, and in turn provide indirect antiviral support, for infections such as chronic EBV. (10)
  5. Quercetin: Quercetin is a flavonoid with antioxidant and anti-inflammatory properties. Limited studies indicate that EBV replication may be inhibited by properties present in quercetin. (11)

Chronic EBV can be a challenging condition to manage, but evidence-based naturopathic therapies may help support immune function and reduce symptoms. It's essential to work with a qualified naturopathic or holistic healthcare professional to determine the best treatment plan for your individual needs. Always consult your healthcare provider before starting any new supplements or therapies.


  1. Hoover K, Higginbotham K. Epstein Barr Virus. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559285/
  2. Kimura H, Cohen JI. Chronic Active Epstein-Barr Virus Disease. Front Immunol. 2017 Dec 22;8:1867. doi: 10.3389/fimmu.2017.01867. PMID: 29375552; PMCID: PMC5770746.
  3. Brady G, MacArthur GJ, Farrell PJ. Epstein-Barr virus and Burkitt lymphoma. J Clin Pathol. 2007 Dec;60(12):1397-402. doi: 10.1136/jcp.2007.047977. PMID: 18042696; PMCID: PMC2095571.
  4. Sugiura M, Matsuura A, Imai S, Sakurada K, Miyazaki T, Osato T. [AIDS and opportunistic virus infections]. Hokkaido Igaku Zasshi. 1993 Sep;68(5):609-11. Japanese. PMID: 8225165.
  5. Thorley-Lawson DA. Epstein-Barr virus: exploiting the immune system. Nat Rev Immunol. 2001 Oct;1(1):75-82. doi: 10.1038/35095584. PMID: 11905817.
  6. Naenifard H, Arif AA, Huber LR, Warner J. Risk Factors of Epstein-Barr Virus Infection Among United States Children: Data From the National Health and Nutrition Examination Survey (NHANES), 2009-2010. J Prim Care Community Health. 2015 Jul;6(3):177-81. doi: 10.1177/2150131915573472. Epub 2015 Feb 23. PMID: 25711918.
  7. Mailoo VJ, Rampes S. Lysine for Herpes Simplex Prophylaxis: A Review of the Evidence. Integr Med (Encinitas). 2017 Jun;16(3):42-46. PMID: 30881246; PMCID: PMC6419779.
  8. Guo Q, Sun X, Zhang Z, Zhang L, Yao G, Li F, Yang X, Song L, Jiang G. The effect of Astragalus polysaccharide on the Epstein-Barr virus lytic cycle. Acta Virol. 2014;58(1):76-80. doi: 10.4149/av_2014_01_76. PMID: 24717032.
  9. Zheng Y, Ren W, Zhang L, Zhang Y, Liu D, Liu Y. A Review of the Pharmacological Action of Astragalus Polysaccharide. Front Pharmacol. 2020 Mar 24;11:349. doi: 10.3389/fphar.2020.00349. PMID: 32265719; PMCID: PMC7105737.
  10. Lopez-Santamarina A, Lamas A, Del Carmen Mondragón A, Cardelle-Cobas A, Regal P, Rodriguez-Avila JA, Miranda JM, Franco CM, Cepeda A. Probiotic Effects against Virus Infections: New Weapons for an Old War. Foods. 2021 Jan 9;10(1):130. doi: 10.3390/foods10010130. PMID: 33435315; PMCID: PMC7827890.
  11. Lee M, Son M, Ryu E, Shin YS, Kim JG, Kang BW, Cho H, Kang H. Quercetin-induced apoptosis prevents EBV infection. Oncotarget. 2015 May 20;6(14):12603-24. doi: 10.18632/oncotarget.3687. PMID: 26059439; PMCID: PMC4494961.

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