It is unfortunate that the article in the Health section on Sept. 23 has added to the confusion about the Epstein-Barr virus. Although doctors have been studying the Epstein-Barr virus for years, it is only in the past months that certain researchers have tried to draw a connection between it and persistent fatigue.
The feeling of fatigue that is frequently experienced by normal, healthy people can also be associated with almost any medical illness you may care to consider. For this reason, doctors consider the complaint of fatigue as "non-specific," meaning that it is not a helpful symptom in diagnosing the cause of a patient's illness.
A number of other non-specific signs and symptoms are also said to be part of the "chronic Epstein-Barr virus syndrome." However, in (findings) published by Dr. James F. Jones, there was actually very little difference in the physical changes or in the symptoms reported by patients who tested positive for the Epstein-Barr virus compared with those who didn't. Therefore, when both the patient's symptoms and the findings of a physician's examination are unhelpful in making a diagnosis, as they are admitted to be in the case of "chronic Epstein-Barr virus syndrome," the doctor must turn to testing of the patient's blood.
As pointed out in your article, 90% of normal, healthy Americans over the age of 30 will test positive for the Epstein-Barr virus. This means that their blood contains infection-fighting proteins called "antibodies" against the virus. These antibodies occur as a natural consequence of an infection with this virus at some prior time.
Now we have a real predicament. Doctors can't use the patient's symptoms or signs to make the diagnosis of "chronic Epstein-Barr virus syndrome." Nor can doctors use a positive versus a negative result on a blood test to confirm or exclude the diagnosis, since nearly everyone is positive anyway. Therefore, Dr. Jones suggests that the level of antibody to the Epstein-Barr virus is the crucial factor in making the diagnosis. The problem with this approach is that every laboratory tests for these antibodies differently. To make matters worse, the tests that are used are highly subject to technician variability. Unfortunately, this is the state of the currently available technology.
Certain patients will be found to have truly high levels of antibodies against the Epstein-Barr virus, but researchers from the national Center for Disease Control have shown that these same patients have high levels of antibodies to a number of other viruses as well. The bottom line is that since the symptoms and signs are non-specific, and the currently available laboratory tests are unreliable, the diagnosis of "chronic Epstein-Barr virus syndrome" means nothing; it is a non-diagnosis.
There are other important reasons why patients should not be given the diagnosis of "chronic Epstein-Barr virus syndrome." First of all, a careful evaluation by a competent physician will often uncover a treatable condition in patients with persistent fatigue. Since there is currently no effective treatment for the "chronic Epstein-Barr virus syndrome," patients given this diagnosis may begin to feel hopeless, and give up seeking medical attention for their problem. In some cases, after a thorough evaluation, no true medical condition may be found. Even in this situation it is not constructive to tell patients that their symptoms may be due to Epstein-Barr virus, because this may dissuade these patients from returning to their prior life style and activities.
DAVID HAAKE MD
STEVEN BLANDER MD
WILLIAM HEWITT MD
UCLA School of Medicine