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Tick-Borne Illnesses and Reactivated Epstein-Barr Virus: Shared Symptoms and Adaptability

Written by Portland Clinic of Natural Health on November 2, 2023

Tick-borne diseases, like Lyme disease, and reactivated Epstein-Barr virus (EBV) infection can be a challenging duo for both patients and healthcare professionals. Interestingly, a growing body of evidence suggests that many patients with tick-borne illnesses also exhibit reactivated EBV. This dual occurrence can muddy the diagnostic waters due to overlapping clinical presentations and the adaptability of both pathogens. Let's delve deeper into this connection.

Overlapping Clinical Presentations

Many tick-borne illnesses, especially Lyme disease, have a broad array of symptoms, often referred to as "Lyme-like" symptoms. These can include fatigue, headaches, joint pain, cognitive issues, and fever, among others. Similarly, EBV reactivation can lead to a condition known as chronic active EBV infection, which manifests with symptoms like chronic fatigue, fever, and swollen lymph nodes.

Given this similarity in clinical presentation:

  • It's possible for one condition to be misdiagnosed as the other.
  • Coinfection or simultaneous presence of both conditions can exacerbate symptoms, making it even more challenging to pinpoint the cause.

Coinfection Rates

Research has observed that patients with tick-borne diseases, especially those with persistent symptoms, often show evidence of reactivated EBV. It's not entirely clear why this happens, but a few hypotheses exist, such as:

Immunosuppression: Tick-borne illnesses can suppress the immune system, which might create an environment conducive for latent viruses like EBV to reactivate.

Adaptability - A Shared Trait

Both Borrelia burgdorferi (the bacterium that causes Lyme disease) and the EBV have evolved sophisticated mechanisms to evade the immune system:

Borrelia burgdorferi: This bacterium can change its outer surface proteins, making it difficult for the immune system to recognize and attack it. Additionally, it can hide within cells or form dormant cyst-like structures, allowing it to persist in the body.

Epstein-Barr Virus: EBV primarily infects B cells in the body. Once inside these cells, it can adopt a latent state, effectively hiding from the immune system. Periodically, it can reactivate, especially under conditions of stress or immunosuppression.

The Overlap of Clinical Symptoms and Adaptability of Tick-Borne Pathogens and EBV

The overlap in clinical symptoms and adaptability of tick-borne pathogens and EBV emphasizes the importance of comprehensive diagnostic approaches. Clinicians should be aware of the potential for coexistence of these conditions in patients presenting with nonspecific symptoms. As research continues to evolve in this area, there's hope for better diagnostic tools and treatments to address the challenges posed by these elusive pathogens.

Resouces:

  1. Pavletic AJ, Marques AR. Early Disseminated Lyme Disease Causing False-Positive Serology for Primary Epstein-Barr Virus Infection: Report of 2 Cases. Clin Infect Dis. 2017 Jul 15;65(2):336-337. doi: 10.1093/cid/cix298. PMID: 28379435; PMCID: PMC5848374.
  2. Koester TM, Meece JK, Fritsche TR, Frost HM. Infectious Mononucleosis and Lyme Disease as Confounding Diagnoses: A Report of 2 Cases. Clin Med Res. 2018 Dec;16(3-4):66-68. doi: 10.3121/cmr.2018.1419. Epub 2018 Aug 30. PMID: 30166498; PMCID: PMC6306145.
  3. Hulínská D, Roubalová K, Schramlová J. Interaction of Borrelia burgdorferi sensu lato with Epstein-Barr virus in lymphoblastoid cells. Folia Biol (Praha). 2003;49(1):40-8. PMID: 12630667.
  4. Arshad H, Oudah B, Mousa A, Kakhktsyan T, Abu-Abaa M, Agarwal A. Tick-Borne Myopericarditis With Positive Anaplasma, Lyme, and Epstein Barr Virus (EBV) Serology: A Case Report. Cureus. 2023 Jun 14;15(6):e40440. doi: 10.7759/cureus.40440. PMID: 37456368; PMCID: PMC10349210.
  5. Goossens HA, Nohlmans MK, van den Bogaard AE. Epstein-Barr virus and cytomegalovirus infections cause false-positive results in IgM two-test protocol for early Lyme borreliosis. Infection. 1999 May-Jun;27(3):231. doi: 10.1007/BF02561539. PMID: 10378140.
  6. Batinac T, Petranovic D, Zamolo G, Petranovic D, Ruzic A. Lyme borreliosis and multiple sclerosis are associated with primary effusion lymphoma. Med Hypotheses. 2007;69(1):117-9. doi: 10.1016/j.mehy.2006.11.015. Epub 2007 Jan 2. PMID: 17197115.
  7. Diedler J, Rieger S, Koch A, Parthé-Peterhans S, Schwaninger M. Bilateral facial palsy: Epstein-Barr virus, not Lyme disease. Eur J Neurol. 2006 Sep;13(9):1029-30. doi: 10.1111/j.1468-1331.2006.01434.x. PMID: 16930373.

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