Epstein-Barr Virus
Amit Kalra
Jonathan P. Moorman
INTRODUCTION
Epstein-Barr virus (EBV) belongs to the family of gamma herpesviridae. EBV is a double-stranded DNA lymphocytotropic virus that induces both latent and lytic infection in animals and humans. This virus can cause not only primary infection but also lymphoproliferative disorders including lymphoreticular malignancies and other systemic manifestations.
EPIDEMIOLOGY
EBV infection is ubiquitous throughout the world, and 95% of individuals generate antibodies to the virus by the time they reach adulthood. In the United States, the peak incidence is from ages 15 to 24, and the overall incidence is approximately 500 cases/100,000/year. In developing countries or lower socioeconomic populations, children contract the infection at an early age. Infection spreads primarily through salivary secretions or occasionally through sexual contact.
PATHOGENESIS AND MICROBIOLOGY OF EBV INFECTION
EBV is a linear DNA virus with core DNA surrounded by capsid and glycoprotein.
Primary target cells of EBV are human epithelial cells, human B cells, T cells, salivary gland cells, natural killer (NK) cells, macrophages/monocytes, and endothelial cells.
Reservoir for infection is the latently infected B cell.
Incubation period from infection to symptoms is 30 to 50 days.
A robust CD4+ and CD8+ T-cell response may be responsible for the clinical syndrome of mononucleosis.
CLINICAL FEATURES OF EBV-INDUCED INFECTIOUS MONONUCLEOSIS
Often subclinical in early childhood
Classic EBV infection is characterized by the triad of pharyngitis, fever, and lymphadenopathy.
Myalgia, headache, malaise, headache, anorexia, abdominal discomfort, chills, arthralgia, rash, hepatomegaly, splenomegaly, and jaundice may occur.
Treatment with ampicillin will lead to a rash in the vast majority of patients.
Complications include splenic rupture, neurologic involvement, airway obstruction, hepatitis, hemolytic anemia, and cytopenias.
Differential diagnosis would include streptococcal pharyngitis, acute HIV infection, lymphoma, cytomegalovirus (CMV), Bartonella infection/cat scratch disease, drug reactions, viral hepatitis, measles, mumps, rubella, roseola, secondary syphilis, and toxoplasmosis.
Major Diseases Attributed to EBV
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