The Epstein Barr Virus – A Primer

  • General Information
    • peak incidence: 15 to 24-year age range
    • UK Data: cases may be occurring later in life with increasing severity, requiring hospitalization
  • Transmission
    • Person-to-person — salivary secretions
    • Breastfeeding
    • Sexual transmission
  • Manifestations
    • Classic Infectious Mononucleosis — fever, pharyngitis, adenopathy, fatigue, and atypical lymphocytosis
    • Clinical variants —
      • Mild disease — pharyngitis and tonsillitis in the absence of a full-blown IM syndrome
      • Typhoidal form — fever and lymphadenopathy without pharyngitis . Heterophile antibody-negative.
  • Other clinical manifestations
    • Splenomegaly and splenic rupture — 50 to 60 percent of patients
    • Rash — generalized maculopapular, urticarial, or petechial rash; a maculopapular rash almost always occurs following the administration of ampicillin or amoxicillin.
    • Neurologic syndromes — GBS, aseptic meningitis, transverse myelitis, peripheral neuritis, optic neuritis, and encephalomyelitis.
  • Diagnosis
    • Heterophile antibodies — vast majority of patients are heterophile positive
    • EBV-specific antibodies — IgM and IgG antibodies directed against viral capsid antigen have high sensitivity and specificity for the diagnosis of IM
    • Viral capsid antigen — IgM VCA antibody is highly suggestive of acute EBV infection
    • Nuclear antigen — IgG antibodies to EBV nuclear antigen
    • Early antigen — IgG antibodies to early antigen (EA) are present at the onset of clinical illness.
    • Detection of EBV virus — those with detectable virus are more likely to have lymphadenopathy, higher atypical lymphocytes counts
  • EBV-associated Disorders
    • Infectious mononucleosis
    • Burkitt’s Lymphoma
    • Hodgkin’s Lymphoma
    • Post-transplant lymphoproliferative disorders
    • HIV-associated lymphoproliferative disorders
      • Primary CNS lymphoma
      • Diffuse large B-cell lymphoma
      • HHV-8 (+) primary effusion lymphoma
      • Plasmablastic lymphoma
    • Nasopharyngeal carcinoma
    • Hemophagocytic lymphohistiocytosis
    • Multiple Sclerosis
    • and many more…
  • Treament
    • Supportive care: NSAIDs, fluids, rest, and relaxation
    • Antiviral therapy: acyclovir – may reduce viral shedding, but otherwise has no effect in symptomatic relief; no significant clinical benefit
    • Steroids: some studies suggest that acyclovir + prednisolone may reduce viral shedding, but this practice is not recommended
    • Anecdotal experience: IL-2, IFN-a, IVIG