Epstein-Barr Virus

A member of the herpes group, Epstein-Barr virus (EBV) is one of the most common viral infections and affects most people at some point during their life. The illness is mostly asymptomatic, or symptoms are mild and brief. EBV commonly affects adolescents and causes infectious mononucleosis in up to 50% of cases. Infectious mononucleosis is an acute infection that causes fever, sore throat, and cervical lymphadenopathy, the hallmarks of the infection. It also causes hepatic dysfunction, increased lymphocytes and monocytes, and development and persistence of heterophil antibodies. Mononucleosis primarily affects young adults and children, although in children it’s usually so mild that it’s commonly overlooked.

EBV has been associated with several neoplasms, the most common of which are nasopharyngeal carcinoma and lymphoma. It has also been associated with Hodgkin disease and non-Hodgkin’s lymphoma in AIDS. Chronic EBV can cause oral hairy leukoplakia, which presents as a white lesion on the tongue or oral mucosa and is treatable with antiviral agents.

EBV is not a reportable condition, so its exact incidence is not known. The prognosis is excellent, and major complications are uncommon.

Causes

Apparently, humans are the only reservoir of EBV. It is probably contagious starting before symptoms develop until the fever subsides and oropharyngeal lesions disappear. EBV is spread by contact with oral secretions and is frequently transmitted from adults to infants and among young adults by kissing. It has also been transmitted during bone marrow transplantation and blood transfusion.

Complications

Although major complications are rare, mononucleosis may cause splenic rupture, aseptic meningitis, encephalitis, hemolytic anemia, pericarditis, and Guillain-Barré syndrome.

Assessment Findings

The patient’s history may reveal contact with a person who has infectious mononucleosis.

After an incubation period of about 4 to 6 weeks, the young adult patient may experience prodromal symptoms, such as headache, malaise, profound fatigue, anorexia, myalgia and, possibly, abdominal discomfort. After 3 to 5 days, the patient develops a sore throat, which may be described as the worst he or she has ever had, and dysphagia related to adenopathy. A fever is usually present, typically with a late afternoon or evening peak of 101° to 102° F (38.3° to 38.9° C).

Inspection commonly reveals exudative tonsillitis, pharyngitis and, sometimes, palatal petechiae, periorbital edema, a maculopapular rash that resembles rubella, and jaundice.

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