Epstein-Barr virus reactivation may contribute to long COVID fatigue

October 24, 2022

2 minute read

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According to a letter published in Allergy.

Up to 10% of patients with COVID-19 develop long COVID, Johanna Rohrhofer, MRS, Doctoral student at the Institute for Pathophysiology and Allergy Research, Medical University of Vienna, and his colleagues wrote.

Data are from Rohrhofer J, et al. Allergy. 2022;doi:10.1111/all.15471.

Although Epstein-Barr virus (EBV) has been associated with post-viral fatigue, the researchers said the mechanisms that lead to post-viral fatigue syndrome in general and long COVID in particular are unresolved. .

Researchers hypothesized that long COVID-induced fatigue could be triggered by persistence of SARS-CoV-2 in the gastrointestinal or respiratory tract after acute illness or by reactivation of COVID-associated EBV -19.

The study involved 30 patients (mean age, 37.73 years ± 9.96; 73.4% female) with long-lasting COVID and suffering from persistent fatigue, post-exertional malaise, autonomic dysfunction and /or orthostatic intolerance.

The researchers collected stool, throat washes and blood samples from these patients between 74 and 471 days (median, 235 days) after the onset of their acute SARS-CoV-2 infections.

The study also included 20 age- and sex-matched patients (mean age, 33.9 years ± 11.95; 65% female) who had fully recovered from acute SARS-CoV infection -2 as controls, with stool, throat washing and blood samples taken from them between 106 and 571 days (median, 275 days) after their infections began.

SARS-CoV-2 infections were mild in both groups and occurred between spring 2020 and fall 2021. There were no hospitalizations for any of these patients.

The researchers found no SARS-CoV-2 RNA in any of the throat wash or stool samples.

Additionally, there were no differences in SARS-CoV-2 IgA or IgG antibody titers between the cohorts. The researchers noted that 24 of 30 patients with long COVID and 17 of 20 controls received the COVID-19 vaccination after developing the disease but before samples were taken.

Blood and stool samples were all negative for EBV, while throat wash samples from 15 (50%) long-COVID patients and four (20%) controls were positive for EBV DNA. ‘EBV (P = 0.0411). EBV load levels did not differ significantly between groups.

With the exception of one patient in the control group, all patients in the study had previous EBV infections. The researchers concluded that the EBV replication they observed was caused by EBV reactivation and not by primary infection. Additionally, the groups had no difference in EBV-specific antibody titers.

Overall, the researchers said they detected no persistence of SARS-CoV-2 in any of the study participants up to 10 weeks after infection, although patients with or without long COVID fatigue had more EBV reactivation in their throats months after acute SARS. -CoV-2 infection.

These results indicate that cofactors of long fatigue due to COVID may include EBV replication, the researchers wrote, adding that they did not assess human leukocyte antigen subtype or other factors. contributory.

The researchers acknowledged that they could not confirm previous reports of differences in EBV antibody profiles in patients with long COVID and that additional and larger studies are needed to clarify the impact and mechanism of the long COVID fatigue associated with EBV.

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