From the Guidelines
Epstein-Barr virus (EBV) is a ubiquitous herpesvirus that infects most people worldwide, causing a range of diseases from infectious mononucleosis to lymphoproliferative disorders and certain cancers, particularly in individuals with weakened immune systems 1.
Key Characteristics of EBV
- EBV is one of eight known human herpesviruses and is associated with various diseases, including infectious mononucleosis, lymphoproliferative disorders, and certain types of cancer 2.
- The virus spreads primarily through saliva, earning it the nickname "kissing disease," though sharing drinks or food can also transmit the infection.
- After infection, EBV remains dormant in the body for life, rarely causing problems in healthy individuals but potentially leading to complications in those with compromised immune systems.
Clinical Features and Diagnosis
- Clinical features of EBV infection can include prolonged or intermittent fever, lymphadenopathy, hepatosplenomegaly, and debilitating fatigue, among other symptoms 3.
- Diagnosis of EBV infection often involves laboratory testing, including heterophile antibody tests and EBV-specific antibody tests for IgG and IgM to viral capsid antigen (VCA) and Epstein-Barr nuclear antigen (EBNA) 1.
- In cases of suspected lymphoproliferative disease, demonstration of EBV DNA, RNA, or protein in biopsy tissue is required for diagnosis.
Management and Complications
- Most EBV infections resolve on their own with supportive care, including rest, hydration, and over-the-counter pain relievers for symptom management 1.
- No specific antiviral treatment is routinely recommended for uncomplicated EBV infections, but monitoring for potential complications such as splenic rupture and liver inflammation is crucial.
- EBV has been associated with certain cancers and autoimmune conditions, particularly in individuals with weakened immune systems, highlighting the importance of managing and monitoring these patients closely.
From the Research
Definition and Prevalence of Epstein-Barr Virus (EBV)
- Epstein-Barr virus (EBV) is a widely infectious pathogen that affects most of the global population at some point in their life 4, 5, 6, 7, 8.
- EBV infects up to 95% of the adult human population, with primary infection typically occurring during childhood and usually asymptomatic 4, 6.
Association with Diseases
- EBV can cause infectious mononucleosis in approximately 35-50% of cases when infection occurs during adolescence and early adulthood 4.
- EBV is also associated with several B-cell malignancies, including Burkitt lymphoma, Hodgkin lymphoma, and post-transplant lymphoproliferative disease 4, 6, 7.
- EBV infection is implicated in post-transplant lymphoproliferative diseases (PTLD) and several other cancers in non-immunocompromised patients 7.
- Chronic active EBV (CAEBV) can cause severe complications, including acute hepatitis and hepatocellular liver injury 5.
Treatment and Prevention
- There is no treatment available for infectious mononucleosis, but virus-associated complications may be treated with various modes of immune modulation 6.
- Antiviral drugs have proven to be effective inhibitors of EBV replication, yet have resulted in limited success clinically, and none of them has been approved for treatment of EBV infections 4.
- Acyclovir has been used as a potential new treatment option for severe chronic active EBV 5.
- Allogeneic hematopoietic stem cell transplantation (HSCT) is the only cure for chronic active Epstein-Barr virus infection (CAEBV) 8.
- A vaccine based on immunization with a structural antigen, gp350, is under evaluation for the prevention of EBV infection 6.