Epstein-Barr Virus (EBV)

 

 

 

Epidemiology

Classification and Characteristics

EBV is a member of the herpesviridae

 

 

Transmission and Infection

 

The 'kissing disease' is often transmitted through saliva, resulting in the infection of oral epithelium and spread to B cells.

EBV promotes B cell proliferation and inhibits apoptosis, remaining latent in memory B cells. EBV can therefore become reactivated upon memory B cell activation. T cell-mediated immunity controls infection.

Incubation is 1-2 months.

 

 

Pathogenicity and Virulence

 

Clinical Manifesations

EBV is a causative agent of infectious mononucleosis (mono).

Prodomal symptoms of malaise and anorexia can occur 1-2 days before.

 

 

 

A few days following infection, transient neutropenia can result. It is unkown of the significance of this.

Infants and young children may be asymptomatic or develop mild disease, while older children and adults can have a more characteristic condition:

Fatigue may be chronic, lasting months.

 

Complications can include:

 

 

Diagnosis

Monospot tests for heterophilic antibodies. It is 85% sensitive in older children and adults, but less so in the young.

False positives can be seen with many other conditions (ie HIV, SLE, lymphoma, rubella, parvovirus).

 

 

Serology for VCA (viral capsid antigen) is used to diagnose acute infection, while EBNA (nuclear antigen) antibodies appear later in infection.

 

throat culture should be performed to rule ou GAS pharyngitis.

 

 

Treatment

Suppirtive care is a mainstay, and includes rest, saline gargles, and acetaminophen.

Airway obstruction due to lymphadenopathy should be treaed with hospital admission and steroid administration.

Splenic enlargement can be subtle, and all patients should avoid contact sports for 6-8 weeks.

Antivirals are not helpful.