From the Guidelines
The main concerns for Epstein-Barr Virus (EBV) include its role in causing infectious mononucleosis, its association with certain cancers, and its link to autoimmune conditions, with management primarily focusing on supportive care and monitoring for complications. EBV is a ubiquitous herpesvirus that can cause symptomatic diseases, including infectious mononucleosis (IM) and lymphoproliferative disorders (LPD) in immunologically compromised individuals [ 1 ]. The virus is also etiologically linked to human malignancies such as endemic Burkitt lymphoma (BL) and undifferentiated nasopharyngeal carcinoma (NPC) [ 1 ].
Key Concerns and Management
- Infectious mononucleosis: managed through rest, adequate hydration, and over-the-counter pain relievers like acetaminophen or ibuprofen for fever and sore throat [ 1 ].
- Avoidance of contact sports and strenuous activity for at least 3-4 weeks to prevent splenic rupture, a rare but serious complication.
- Corticosteroids may be prescribed in severe cases with significant throat swelling or breathing difficulties.
- Long-term concerns include EBV's link to certain cancers such as Burkitt lymphoma, Hodgkin lymphoma, and nasopharyngeal carcinoma, particularly in immunocompromised individuals [ 1 ].
- EBV has also been associated with autoimmune conditions like multiple sclerosis and systemic lupus erythematosus [ 1 ].
Diagnostic Criteria and Treatment Approaches
- Proposed diagnostic criteria for chronic active EBV infection (CAEBV) aim to improve diagnostic specificity and include the accurate diagnosis of underlying diseases [ 1 ].
- Treatment approaches for CAEBV have included antiviral agents, immuno-modulative therapy, corticosteroids, and chemotherapeutic drugs, but with limited effect on morbidity and outcome [ 1 ].
- Recent successes with autologous EBV-CTL and allogeneic peripheral blood or bone marrow stem-cell transplantation offer potential treatment options for severe disease [ 1 ].
From the Research
Main Concerns for Epstein-Barr Virus
The main concerns for Epstein-Barr Virus (EBV) include:
- Splenic rupture or infarction, which can be fatal in some cases 2, 3, 4, 5
- Increased risk of splenic rupture or infarction in individuals with underlying haematological conditions 2, 5
- Potential for serious short- and long-term complications, including hepatitis and splenomegaly 3
- Risk of spontaneous splenic rupture, which can occur without trauma 3, 4, 5
- Importance of prompt diagnosis and appropriate counselling in patients with infectious mononucleosis 3, 5
- Association with various types of cancer and multiple sclerosis, although the exact mechanisms are not fully understood 6
Complications of EBV Infection
Complications of EBV infection can include:
- Splenic rupture, which can occur with or without trauma 2, 3, 4, 5
- Splenic infarction, which can occur in individuals with underlying haematological conditions 2
- Hepatitis and splenomegaly, which can occur in some cases of EBV infection 3
- Haemodynamic instability, which can occur in severe cases of splenic rupture or infarction 4
Diagnosis and Management
Diagnosis and management of EBV-related complications can include:
- Imaging studies, such as CT scans and ultrasound, to diagnose splenic rupture or infarction 2, 4, 5
- Laboratory tests, such as blood tests and serology, to diagnose EBV infection 2, 3, 5
- Surgical management, including splenectomy, in some cases of splenic rupture or infarction 2, 5
- Conservative management, including monitoring and supportive care, in some cases of splenic infarction 2