From the Guidelines
Epstein-Barr virus (EBV) infection is typically diagnosed through blood tests that detect antibodies to the virus, including heterophile antibodies (monospot test) and specific EBV antibodies that indicate acute or past infection, with treatment primarily focusing on supportive care as it is a self-limiting viral illness. The diagnosis of EBV infection can be confirmed by the presence of VCA IgM antibodies, which indicate recent primary infection 1.
Diagnosis
- Blood tests to detect heterophile antibodies (monospot test)
- Specific EBV antibodies to indicate acute or past infection
- EBV antibody testing for IgG and IgM to viral capsid antigen (VCA) and Epstein-Barr nuclear antigen (EBNA) to differentiate EBV infection from other mononucleosis-like illnesses
Treatment
- Supportive care, including rest, adequate hydration, and over-the-counter pain relievers like acetaminophen or ibuprofen (400-600mg every 6-8 hours) to manage fever and sore throat
- Severe cases may require corticosteroids like prednisone (40-60mg daily for 5-7 days) to reduce significant throat swelling or other complications
- Patients should avoid contact sports and strenuous activity for at least 3-4 weeks to prevent splenic rupture, as EBV often causes splenomegaly
- Alcohol should be avoided during recovery due to potential liver involvement
- Antiviral medications are not routinely recommended as they show limited effectiveness against EBV
Special Considerations
- In patients with immunodeficiency, EBV infection can lead to lymphoproliferative disease, and treatment may involve rituximab, reduction of immunosuppressive therapy, and cellular therapy as adoptive immunotherapy with in vitro generated donor or third-party EBV-specific CTLs 1
- The virus establishes lifelong latency after infection, but most people develop immunity that prevents recurrent symptoms.
From the Research
Diagnosis of Epstein Barr Virus (EBV) Infection
- The diagnosis of EBV infection can be made using serology, which is the best method for diagnosis of primary EBV infections 2.
- The presence of immunoglobulin G (IgG) and IgM to antigens from the replicative cycle of the virus, in combination with absence of antibodies to the EBV nuclear antigens (EBNA 1-6), is a diagnostic for a primary EBV infection 2.
- Heterophile antibody tests, such as the Monospot test, can also be used to diagnose EBV infection, but may have limitations, such as false negative results in the early stages of infection 3, 4.
- Molecular diagnostic tests, such as polymerase chain reaction (PCR), can be used to monitor EBV replication and diagnose EBV-associated diseases, especially in immunocompromised patients 5, 4.
Treatment of Epstein Barr Virus (EBV) Infection
- The treatment of EBV infection is mainly supportive, with rest, hydration, and antipyretics being the mainstay of treatment 3, 4.
- Antiviral therapy has a limited, short-term effect on oropharyngeal shedding, but has proven ineffective for the clinical manifestations of infectious mononucleosis 5.
- Corticosteroids may be used to treat selected complications, such as severe pharyngitis or lymphadenopathy, but their use should be carefully considered due to potential side effects 3, 5.
- Reduction of immunosuppression may be necessary in patients with EBV infection who are immunocompromised, such as those with renal transplants 4.
Special Considerations
- In immunocompromised patients, such as those with AIDS or renal transplants, EBV infection can cause more severe disease, and diagnosis and treatment may need to be tailored to the individual patient's needs 2, 4.
- In children who are EBV-seronegative prior to renal transplantation, serological markers may have a limited role in the early diagnosis of EBV infection, and PCR may be a more useful diagnostic tool 4.
- The development of a prophylactic EBV vaccine and treatment strategies for persons already infected with EBV remain significant challenges in EBV research 6.