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Patients have prolonged mono-like symptoms, and most show unusual T-cells or natural killer cells.[ref] Rare mutations linked to immunodeficiency have been tied to chronic active Epstein-Barr.[ref] For some with ME/CFS, it starts not long after mononucleosis and can be directly tied to EBV infection and infection that doesnt go away rather than being reactivated.[ref] For most people, though, the Epstein-Barr virus hangs out in a latent state and avoids immune system detection in unique ways