From the Research
For patients with Epstein-Barr virus (EBV) infection prior to surgery, the primary recommendation is to postpone elective procedures until the acute infection resolves, typically 4-6 weeks after symptom onset. No specific pre-surgical medication is routinely given for EBV itself, as antiviral drugs have shown limited success in treating EBV infections 1. Management focuses on symptomatic relief with acetaminophen (500-1000mg every 6 hours) or ibuprofen (400-600mg every 6-8 hours) for fever and pain. Ensure adequate hydration and rest. If surgery is urgent and cannot be delayed, the anesthesiologist and surgeon should be informed about the active EBV infection, as these patients may have hepatic involvement affecting medication metabolism, potential airway complications from tonsillar enlargement, and increased bleeding risk if splenic enlargement is present. Some studies suggest that surgical intervention may be beneficial in certain cases, such as EBV-associated smooth muscle tumor (EBV-SMT) with central nervous system invasion 2, or EBV otomastoiditis complicated by facial nerve paralysis 3. However, these cases are rare and require individualized treatment approaches. Laboratory tests including complete blood count, liver function tests, and heterophile antibody testing should be obtained to assess disease severity. This approach is recommended because EBV infection can complicate surgical recovery and anesthesia management, and the immunosuppression from surgery could potentially worsen viral symptoms. In cases of chronic active EBV infection (CAEBV), allogeneic hematopoietic stem cell transplantation (HSCT) may be considered as a treatment option, with a 3-year overall survival rate of 87.3% 4. However, this is a complex and high-risk procedure that should only be considered in severe cases. Overall, the management of EBV infection prior to surgery should prioritize symptomatic relief, disease severity assessment, and individualized treatment approaches.