From the Guidelines
Reactive Epstein-Barr virus (EBV) requires no specific treatment as it indicates past infection, and symptoms like fatigue, fever, or swollen lymph nodes should be investigated separately for other causes. For patients with reactive EBV, it is essential to differentiate between past infection and active infection, as the management and treatment differ significantly. According to the guidelines for managing EBV infections and post-transplant lymphoproliferative disorders 1, the focus should be on supportive care and monitoring for potential complications.
Key Considerations
- Reactive EBV is a common finding, with over 90% of adults worldwide having been infected by age 35
- No specific treatment is needed for reactive EBV, as it simply shows the immune system has developed antibodies after previous exposure to the virus
- Symptoms like fatigue, fever, or swollen lymph nodes should be investigated separately to determine the underlying cause
- For symptomatic acute EBV infection (infectious mononucleosis), treatment is supportive care, including rest, adequate hydration, and over-the-counter pain relievers like acetaminophen or ibuprofen (400-600mg every 6-8 hours as needed) for fever and discomfort
Diagnostic Approach
- The diagnosis of post-transplant lymphoproliferative disorders can be established on a proven or probable level, using non-invasive and invasive methods, including quantitative viral load measurement, imaging with positron emission tomography, and tissue biopsy for histopathology and detection of EBV 1
- The proposed guidelines for diagnosing chronic active EBV infection emphasize the importance of accurate diagnosis and differentiation from other underlying diseases 1
Treatment Options
- For patients with chronic active EBV infection, treatment options may include antiviral agents, immuno-modulative therapy, and/or chemotherapeutic drugs, although the effectiveness of these treatments is still being evaluated 1
- Allogeneic peripheral blood or bone marrow stem-cell transplantation may be considered as a treatment option for severe cases 1
From the Research
Reactive EBV Infection
- Reactive EBV infection can occur as a primary or reactivated infection, with different clinical characteristics and manifestations 2
- Primary EBV infection often presents as infectious mononucleosis, while reactivated infection can occur as an infectious mononucleosis-like disease, hemophagocytic syndrome, chronic active EBV infection, or lymphoma 2
- Reactivated EBV infection can affect immunocompromised subjects and is associated with diverse and complex manifestations, including multi-systemic damage 2
Treatment and Management
- Antiviral drugs such as ganciclovir have been used to treat EBV hepatitis and other EBV-related diseases 3
- Allogeneic hematopoietic stem cell transplantation (HSCT) is the only cure for chronic active EBV infection (CAEBV), with a 3-year overall survival rate of 87.3% after planned allogeneic HSCT 4
- A 3-step strategy, including allogeneic HSCT, has been established for the treatment of CAEBV, with earlier initiation and completion of treatment recommended to maximize survival rates and minimize late sequelae 4
Prevention
- Chemoprophylaxis (using acyclovir or ganciclovir) and immunoprophylaxis (using intravenous immunoglobulin) have been proposed as potential strategies for preventing EBV infection and post-transplant lymphoproliferative disease (PTLD) following solid organ transplantation 5
- However, well-designed clinical trials are necessary to evaluate the potential role of these agents in preventing EBV/PTLD in organ transplant recipients 5