From the Guidelines
Epstein-Barr virus (EBV) infection can lead to several long-term complications, including an increased risk of certain malignancies, autoimmune conditions, and chronic active EBV infection, which can significantly impact morbidity, mortality, and quality of life. The most concerning long-term complications include an increased risk of certain malignancies such as Hodgkin lymphoma, Burkitt lymphoma, nasopharyngeal carcinoma, and some gastric cancers, as EBV has been implicated in the development of these cancers due to its ability to immortalize B cells and interfere with cellular growth regulation 1. Additionally, EBV has been associated with autoimmune conditions including multiple sclerosis, systemic lupus erythematosus, and rheumatoid arthritis, though the exact causative relationship remains under investigation 1. Some patients may develop chronic active EBV infection, a rare but serious condition characterized by persistent symptoms, organ damage, and high viral loads, which can be diagnosed using specific laboratory tests such as detection of EBV DNA, RNA, and related antigens in affected tissues, including the peripheral blood 1. Post-viral fatigue syndrome or chronic fatigue syndrome can follow EBV infection in some individuals, with symptoms persisting for months or years 1. Neurological complications such as Guillain-Barré syndrome, encephalitis, and meningitis can occur rarely 1. In immunocompromised patients, EBV can cause lymphoproliferative disorders, particularly following organ transplantation or in HIV/AIDS patients, which can be managed by reducing or discontinuing immunomodulator therapy and considering antiviral therapy with ganciclovir or foscarnet 1.
Key considerations for management include:
- Monitoring for complications such as lymphoproliferative disorders and neurological complications
- Symptom relief and supportive care
- Avoiding immunomodulator therapy in EBV seronegative patients, especially adolescents and young adults
- Considering alternative immunomodulators in patients at risk of EBV-associated complications
- Discontinuing immunosuppressive therapy in cases of suspected lymphoproliferative disease/lymphoma, which may result in spontaneous regression of EBV-associated lymphoproliferative disease 1.
Overall, the management of EBV infection and its long-term complications requires a comprehensive approach that takes into account the individual patient's risk factors, clinical presentation, and laboratory results, with the goal of minimizing morbidity, mortality, and improving quality of life.
From the Research
EBV Long Term Complications
- EBV infection can lead to various long-term complications, including:
- Malignancies such as nasopharyngeal carcinoma, gastric carcinoma, Burkitt lymphoma, and post-transplant lymphoproliferative disorder (PTLD) 2, 3, 4
- Autoimmune diseases like multiple sclerosis, with early age at primary EBV infection being a strong risk factor for the development of MS 3
- Chronic fatigue syndrome, although the role of EBV in this condition is still debated 5, 6
- EBV infection can also masquerade as acute leukemia, making diagnosis challenging 5
- The virus can establish a life-long latent persistence in the host, with periodic reactivation being an important issue in transplantology 2, 4
Associated Diseases
- EBV infection has been associated with various diseases, including:
- Infectious mononucleosis, which can manifest as a benign disease in healthy individuals or as a more severe condition in immunocompromised individuals 2, 5, 4
- Hodgkin lymphoma, with strong associations between EBV infection and the development of this disease 4
- Gastric carcinoma, with EBV infection being a major cause of this disease 2, 4
- Carcinomas derived from smooth muscle tissue, with EBV infection being a potential risk factor 4
Diagnosis and Treatment
- Diagnosis of EBV infections can be made using serological methods, such as detecting specific antibodies, or molecular biological methods like PCR or in situ hybridization 4
- Treatment of EBV infection is challenging, with no approved antivirals active in PTLD or other malignancies 2
- Novel therapies targeting EBV are being developed, with emerging therapies targeting EBV-infected cells showing promise 2