Signs and Symptoms of Epstein-Barr Virus (EBV) Infection
EBV infection commonly presents with prolonged or intermittent fever, lymphadenopathy, and hepatosplenomegaly, often accompanied by debilitating fatigue, sore throat, lymph node tenderness, headache, myalgia, and arthralgia. 1
Primary EBV Infection (Infectious Mononucleosis)
Common Symptoms
- Fever: Often persistent for 1-2 weeks
- Sore throat: Typically severe and exudative
- Lymphadenopathy: Primarily cervical, but can be generalized
- Fatigue: Often profound and may persist for weeks to months
- Hepatosplenomegaly: Present in many cases
Additional Clinical Manifestations
- Pharyngitis: Often with tonsillar enlargement and exudates
- Palatal petechiae: Characteristic finding
- Periorbital edema: May be present
- Maculopapular rash: Occurs in 5-15% of cases, more common if ampicillin or amoxicillin is administered 2
- Splenomegaly: Present in up to 50% of cases, with risk of splenic rupture 2
Ocular Manifestations
- Follicular conjunctivitis: Typically unilateral
- Ipsilateral lymphadenopathy
- Hemorrhagic conjunctivitis: With subconjunctival hemorrhage and periorbital edema
- Conjunctival nodules: Uncommon finding 1
Laboratory Findings
- Lymphocytosis: With atypical lymphocytes (>10% of white blood cells)
- Mild to moderate elevation of liver enzymes: Common
- Positive heterophile antibody test (Monospot): Approximately 85% detection rate, peaks 2-3 weeks after symptom onset 2
- Elevated EBV-specific antibodies: VCA IgM and IgG, EA antibodies 2
Age-Related Differences
- Children under 10 years: Usually asymptomatic or with nonspecific symptoms
- Adolescents and young adults: Classic infectious mononucleosis syndrome
- Adults: May have more severe presentations 3
Chronic Active EBV Infection (CAEBV)
CAEBV is characterized by:
- Persistent or recurrent infectious mononucleosis-like symptoms lasting more than 6 months
- Unusual pattern of anti-EBV antibodies: Elevated anti-VCA (≥1:640) and anti-EA (≥1:160) 1
- High viral load: >10^2.5 copies/mg DNA in peripheral blood mononuclear cells 1, 2
- Chronic illness not explained by other known diseases 1
Complications of CAEBV
- Hematological disorders: Including hemophagocytic lymphohistiocytosis
- T-cell or NK-cell lymphoproliferative disorders/lymphomas
- Skin lesions: Including hypersensitivity to mosquito bites
- Cardiovascular disorders: Coronary aneurysms or valvular disease 1
Rare Complications of EBV Infection
- Cholestatic hepatitis: Presenting with jaundice and elevated liver enzymes 4
- Hemophagocytic lymphohistiocytosis (HLH): Characterized by fever, hepatosplenomegaly, cytopenias, hyperferritinemia, and hypertriglyceridemia 4
- Neurological complications: Including encephalitis, meningitis, Guillain-Barré syndrome
- Airway obstruction: Due to severe tonsillar hypertrophy
- Splenic rupture: Risk highest 2-3 weeks after symptom onset 2
- Lymphoma development: EBV infection is associated with certain lymphomas including Hodgkin's lymphoma and Burkitt's lymphoma 5
Clinical Course
- Incubation period: Unusually long, approximately 4-6 weeks 6
- Symptomatic phase: Typically 2-4 weeks in uncomplicated cases
- Resolution: Most symptoms resolve within 1-2 months
- Fatigue: May persist for several months in some patients
Key Diagnostic Considerations
- EBV infection should be considered in patients presenting with prolonged fever, pharyngitis, and lymphadenopathy
- Diagnosis is confirmed by serological testing or PCR for EBV DNA
- Differential diagnosis includes other viral infections, streptococcal pharyngitis, toxoplasmosis, and cytomegalovirus infection
Remember that while most EBV infections are self-limiting, recognition of potential complications and monitoring for their development is essential, particularly in immunocompromised patients.