Q. I am having night sweats, fatigue and I have also lost 5% of my body weight. Is it due to EBV?

Answered by
Dr. N. Ashok Viswanath
and medically reviewed by Dr. Chithranjali Ravichandran
This is a premium question & answer published on May 01, 2021

Hi doctor,

I am 20 years old and have been having night sweats, fatigue, and have been feeling a bit hot on and off for two months, and have lost 5% of my body weight. I had really bad tonsillitis last month and have got it again now. I tested positive for strep and EBV. I started taking antibiotics four days ago, but they have not helped yet. I am quite concerned that I have had this twice now and wondered if it is likely I have chronic active EBV and how would I find out if I do?



Welcome to

I would like to ask you few questions.

Are you taking any steroid drugs?

Have any history of unprotected sexual activity?

Anything that can cause your immunity to go down and factors like bad oral hygiene can lead to recurrent upper respiratory infections like tonsillitis.

Hi doctor,

Thank you for your message.

I am not taking steroids, and I have been dating someone for four months and always use protection.

I have been stressed lately and have a habit of repetitively biting my cheek sometimes but have made an effort to stop the habit.

This infection seems to spread to my tonsils, adenoids, nose, and throat. I have lots of fairly large lymph nodes on my neck, armpits, and inguinal area. I am worried because some of the symptoms have been persistent for nearly two months (tiredness, congested nose, night sweats), and this is the second time I have had the throat infection in one month.

Do you think it could be 'chronic active EBV'? I am worried about this because there is no cure, and is it fatal?



Welcome back to

Usually, EBV (Epstein Barr virus) infection is acquired when your mucosa comes in contact with infected secretions like the saliva of infected individuals.

With a history of night sweats, lymphadenopathy, weight loss, recurrent respiratory tract infection, sexual contact (with protection). I would recommend you to get your blood tested for HIV I and HIV 2 antibodies, complete blood count with erythrocyte sedimentation rate, Epstein-Barr virus VCA (viral capsid antigen)-IgG and EA-D (early antigen-diffuse) IgG test, CD4 count. We must rule out the cause for the recurrent EBV infection, upper respiratory infection, and lymphoid tissue involvement like tonsils, adenoids, lymph nodes which will be due to an underlying cause. Finding out the underlying cause is essential for proper treatment.

Do not worry.

Please follow up with the reports.

Investigations to be done:

1 . HIV I and 2 antibodies (ELISA).
2 . Complete blood count with erythrocyte sedimentation rate, peripheral smear.
3 . Epstein-Barr Virus VCA-IgG and EA-D IgG test.
4 . CD 4 Count.

Regarding follow up:

Follow up with the reports

Hi doctor,

I had an EBV test last week, and it was positive.

How can I tell the difference between chronic EBV and recurrent EBV?



Welcome back to

I saw the test reports (attachments removed to protect the patient's identity).

Recurrent EBV infection, reactivation of chronic active EBV infection is the same. Chronic active EBV is rare and is usually seen in those with underlying low immunity.

We need to know if you are suffering from any other illness-causing low immunity leading to these manifestations. There is no need to do a complete blood count (CBC) with an erythrocyte sedimentation rate (ESR) and peripheral smear, Ebstein-Barr Virus VCA-IgG, and EA-D IgG test.

Do only CD4 count, HIV 1 and 2 antibodies ELISA.

Suppose you are not suffering from any other underlying illness. In that case, you can improve your immune system by taking Vitamin C, Vitamin A, Vitamin D3, Protein-rich food, and a healthy lifestyle like doing regular yoga, meditation, and exercise.

Take care.

Investigations to be done:

1. CD4 count.
2. HIV 1 and 2 antibodies ELISA.

Hi doctor,

Thanks for your help.



Welcome back to

I wish you a speedy recovery.

Take care.

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