From the Guidelines
Epstein-Barr virus (EBV) is a common human herpesvirus that infects more than 90% of people worldwide during their lifetime, primarily spreading through saliva and causing infectious mononucleosis, also known as "mono" or the "kissing disease". EBV initially infects the epithelial cells in the throat before targeting B lymphocytes, where it establishes a lifelong latent infection 1. While many people infected with EBV experience no symptoms, others develop fever, sore throat, swollen lymph nodes, fatigue, and enlarged spleen. These symptoms typically resolve within 2-4 weeks, though fatigue may persist longer. Beyond mononucleosis, EBV is associated with certain cancers, including:
- Burkitt lymphoma
- Hodgkin lymphoma
- Nasopharyngeal carcinoma as well as autoimmune conditions like multiple sclerosis 1.
There is no specific treatment for EBV infection; management focuses on relieving symptoms with rest, adequate hydration, and over-the-counter pain relievers 1. Avoiding contact sports is recommended during acute infection to prevent splenic rupture. Once infected, the virus remains dormant in the body for life, with occasional reactivation that is usually controlled by a healthy immune system. In people living with HIV, EBV is associated with a higher risk of developing Hodgkin lymphoma, and the management of this condition requires careful consideration of the interaction between HIV and cancer treatment 1.
In terms of diagnosis, EBV infection can be detected through various laboratory tests, including heterophile antibody tests and EBV-specific antibody tests 1. The presence of EBV DNA, RNA, or protein in biopsy tissue can also be used to diagnose EBV-associated lymphoproliferative disease 1. However, the diagnosis of EBV infection can be complex, and it is essential to consider the clinical context and other potential causes of symptoms when interpreting test results.
Overall, EBV is a common and usually harmless virus, but it can cause significant morbidity and mortality in certain individuals, particularly those with weakened immune systems. Therefore, it is essential to prioritize the management of EBV infection based on the individual's immune status and overall health, with a focus on relieving symptoms and preventing complications.
From the Research
What is Epstein Barr Virus (EBV)
- Epstein Barr Virus (EBV) is a ubiquitous virus that infects most adults at some point in their lives 2.
- Primary EBV infection often results in infectious mononucleosis, which can be associated with serious sequelae 3.
- EBV is carried for a lifetime after the primary infection, with the great majority of adult humans being virus carriers 2.
EBV Infection and Disease
- EBV infection in humans can range from harmless to life-endangering, depending on the virus-lymphocyte interactions 2.
- The virus can transform B lymphocytes in vitro into proliferating lines, but it induces malignancy directly only in immunosuppressed hosts 2.
- EBV is associated with several human malignancies, as well as autoimmune disorders 4.
Treatment and Management
- There is no approved treatment for EBV infection, but antiviral interventions such as valacyclovir and acyclovir have been studied 3, 5.
- Valacyclovir has been shown to reduce the number of EBV-infected B cells in healthy volunteers, but not the number of EBV DNA copies per B cell 6.
- Acyclovir treatment has been shown to inhibit oropharyngeal EBV shedding and reduce the severity of illness in patients with infectious mononucleosis 5.
EBV and the Immune System
- EBV establishes life-long latency in the human host and is adept at evading host innate and adaptive immune responses 4.
- The virus-cell and cell-host interactions have evolved over time, allowing the virus to downregulate the expression of transforming proteins in virus-carrying cells 2.
- The immune system plays a crucial role in controlling EBV infection, and immune surveillance is important for preventing EBV-mediated disease pathologies 2, 4.