What is Epstein-Barr virus (EBV) infection?

From the Guidelines

Epstein-Barr virus (EBV) infection is a common herpesvirus that infects most people worldwide, typically causing mononucleosis ("mono") characterized by fever, sore throat, swollen lymph nodes, and fatigue. Most EBV infections resolve on their own with supportive care including rest, adequate hydration, and over-the-counter pain relievers like acetaminophen or ibuprofen for fever and discomfort 1. No specific antiviral treatment is routinely recommended for uncomplicated EBV infections. Recovery typically takes 2-4 weeks, though fatigue may persist longer. In rare cases, EBV can cause complications including severe hepatitis, neurological problems, or splenic rupture. Those with mono should avoid contact sports for at least 3-4 weeks to prevent splenic injury. After infection, EBV remains dormant in the body for life but rarely causes problems in healthy individuals. The virus spreads through saliva, earning mono the nickname "kissing disease," though sharing drinks or food can also transmit it. EBV has been associated with certain cancers and autoimmune conditions, but for most people, it causes only a temporary illness followed by lifelong immunity to symptomatic reinfection.

Key Points to Consider

• EBV infection can cause a range of symptoms, from mild to severe, and can be associated with various complications, including lymphoproliferative disorders and certain cancers 1.
• The diagnosis of EBV infection can be established through 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.
• Therapeutic strategies for EBV-related post-transplant lymphoproliferative disorders include prophylaxis, preemptive therapy, and targeted therapy, with rituximab, reduction of immunosuppression, and EBV-specific cytotoxic T-cell therapy recommended as first-line therapy 1.
• It is essential to note that EBV infection can have a significant impact on morbidity, mortality, and quality of life, particularly in immunocompromised individuals, and therefore, prompt diagnosis and treatment are crucial to prevent complications and improve outcomes.

Important Considerations for Management

• Supportive care, including rest, adequate hydration, and over-the-counter pain relievers, is the mainstay of treatment for uncomplicated EBV infections.
• Avoiding contact sports for at least 3-4 weeks can help prevent splenic injury in individuals with mono.
• EBV infection can be associated with certain cancers and autoimmune conditions, and therefore, long-term follow-up and monitoring are essential to detect any potential complications early.

From the Research

Definition and Prevalence of Epstein-Barr Virus (EBV) Infection

• Epstein-Barr virus (EBV) is a widely infectious pathogen that affects most of the global population at some point in their life 2.
• EBV infects up to 95% of the adult human population, with primary infection typically occurring during childhood and usually asymptomatic 3, 4.
• It is estimated that about 90% of adults worldwide are infected with EBV 5.

Clinical Manifestations and Complications

• Primary EBV infections are typically subclinical, but can cause infectious mononucleosis in approximately 35-50% of cases when infection occurs during adolescence and early adulthood 3.
• EBV can cause severe complications, including acute hepatitis, thrombocytopenia, transaminitis, and hepatocellular liver injury with acute ascites 2.
• EBV is also associated with several B-cell malignancies, including Burkitt lymphoma, Hodgkin lymphoma, and post-transplant lymphoproliferative disease 3, 4.
• In immunocompromised individuals, EBV infection has been associated with many different malignancies, including epithelial cancers and lymphomas 4.

Diagnosis and Treatment

• Diagnosis of EBV infection is typically made by heterophile antibody tests and/or EBV-specific antibody tests 5.
• There are no approved antivirals for the treatment of EBV infections, and current treatment options are limited 3, 4.
• Hematopoietic stem cell transplantation (HSCT) is considered the only curative treatment for chronic active EBV disease (CAEBV) 6.
• Chemotherapy can be administered to control disease activity before HSCT, and novel therapies targeting EBV are being developed 4, 6.