Infectious Disease Specialist Questions Infectious Disease Specialist

Is it EBV or CMV?

Hello, I've been having different symptoms like joint pain, swollen lymph nodes, severe throat pain, severe fatigue, stiff head and neck, muscle aches, etc., since the third week of July. I had slept with a CSW on the 4th of July and my symptoms started later. I was very worried although it was protected. Around August when I was very sick, my CBC looked normal. Except, my absolute eosinophils count was around 470. Mind you, I was extremely sick at that point. Over the next 2 months, I tested for different STDs, all negative. Even took an HIV Viral Load test which came out negative. By October, my CMV and EBV VCA IgG tests came out positive. EBV VCA had an index of about 48.7 and CMV IgG had an index of about 150. And during these months I did multiple CBC and ESR tests. All normal but my eosinophils was slightly high. Doctors didn't really know what was happening and I was too sure that it was cmv or ebv since I slept with a CSW.

Fast forward, today...it is 28th Nov, I went to see an internal medicine specialist who happens to know a lot about infectious diseases. He told me it can't be CMV or EBV. I was clear about my sexual contact but he refused to believe that it could be CMV or EBV. I showed him all my test results and he told me it could be allergies. I still have the above mentioned symptoms to this date. He told me I'm not contagious. But I just don't know. All my symptoms aligns to mono. Can allergies cause these symptoms for 5 months? What if my IgM was positive the first few months and I just tested it when it became negative? I'm scared I'm contagious and that I'll give it to my girlfriend. Now I'm not sure if she's had it. I still don't wanna give it to her if I am contagious.

I'm awaiting my results for the following tests:
CRP, CBC, LDH, Liver Function Test, Food Allergy Panel, Absolute Eosinophils Count, Random Blood Sugar.

He told me these tests would find out what I have and that I can finally get a diagnosis. Can these tests figure out if I have an active infection of EBV or CMV?

Can eosinophils be high and other things be normal when you have CMV or EBV? I heard there were few documented cases with the same situation. I don't think these severe symptoms can be caused by allergies honestly. At the same time I know I should trust my doctor. But when he said it's hard to get EBV from kissing. That's when I stopped trusting him. He told me for that to happen I need to come in contact with a lot of virus while kissing. Then why is it called a kissing disease? He told me mostly people get it by sharing food or drinks etc etc. At the same time he refuses to believe I had either.

Male | 21 years old
Complaint duration: 5 Months

2 Answers

Good day to you! Thanks for your question.

MONONUCLEOSIS is a viral infection, especially in childhood and young people.In the mean time is quit often a double infection with CMV (Cytomegalovirus). The clinical presentation of both diseases is very much similar. EBV and CMV belong to the same viral family. I do not have any doubt as long as in October 2021 you were positive for both viruses (in medical language this is named "coinfection." In my opinion, you should not worry very much. Usually the disease last for at least SIX (6) months, even longer. There is not very much to do, except your condition is worsening. You are very wright, CMV is transmitted by/with saliva/kissing, because CMV is hosted in "salivary  glands", being disseminated by saliva (kissing/spitting...). Symptoms of infection with RBV&CMV may include fever, swollen lymph nodes, and an enlarged liver and/or spleen. More serious complications (may include anemia, nerve damage, liver failure, and/or interstitial pneumonia. Symptoms may be constant or come and go, and tend to get worse over time. Very rare (statistically) chronic mononucleosis may occur when the virus remains ‘active’ and the symptoms of an EBV infection do not go away. What also you have to take into account is the EBV my stay in a latent form (is neutral) in the body for many years, even decades, without any clinical presentation. However, recovery is generally complete, but post-viral asthenia may persist for months. If you have any comorbidities, it is strongly recommended to make periodic visits to your physician for evaluation of your health condition.
I do hope I was able to clarify some aspects of your disease.
Good luck and stay safe,
Thanks for the question.
This is a complicated list of symptoms. There is a long differential diagnosis. Considerations include more than viruses. There are diseases like lupus, syphilis, certain forms of leukemia and lymphoma, fungal infections, even hormonal diseases that can cause your precise combination of symptoms. Ask your doctor for a referral to either an infection specialist or hematologist.

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