Epstein-Barr Virus (Infectious Mononucleosis)
Basics
Description
Epstein-Barr virus (EBV) is a double-stranded DNA virus implicated as a causative agent for infectious mononucleosis by an infected laboratory worker in 1968.
Epidemiology
- Worldwide distribution
- Humans are the only known reservoir.
- Transmission occurs through saliva and, occasionally, via blood transfusions and solid organ transplant (SOT).
- Incubation period is 4 to 7 weeks.
- Antibodies to EBV are present in up to 90% of adult populations.
- Areas with a high population density or low socioeconomic status usually become primarily infected within the first 3 years of life.
Incidence
In developed countries, acquisition of EBV is biphasic.
- Initial peak in incidence occurs before the age of 5 years.
- Second peak occurs during adolescence, coinciding with an increased frequency of intimate oral contacts.
Prevalence
>90% of adults have demonstrable EBV titers.
General Prevention
- No vaccine is clinically available.
- Standard precautions should be used in the hospitalized patient.
- Restriction of intimate contact with immunosuppressed individuals may be advisable.
- Patients with recent EBV infection, either proven or suspected, should not donate blood or solid organs.
Pathophysiology
- Enters host via saliva and replicates initially in the oropharyngeal epithelium
- Selective infection of B lymphocytes occurs.
- The clinical syndrome of infectious mononucleosis results from proliferation of cells in the tonsils, lymph nodes, and spleen.
- Nonspecific humoral immune responses include the formation of heterophile antibodies and autoantibodies.
- Specific antibodies to EBV antigens are produced.
- Despite humoral responses, cellular immunity is responsible for controlling EBV infection.
- Latent, lifelong infection of B lymphocytes occurs.
- Latent virus may be reactivated during periods of immunosuppression or cellular stress.
Commonly Associated Conditions
- Subclinical infection
- Most EBV infections in children, and even in adolescents, are clinically inapparent.
- Mild, nonspecific symptoms may include coryza, diarrhea, and/or fever.
- Immunologic seroconversion does occur.
- Infectious mononucleosis (“glandular fever”): most commonly observed with late primary acquisition of EBV. The classically defined illness is characterized by the following:
- Fatigue
- Malaise
- Fever
- Tonsillopharyngitis (often exudative)
- Lymphadenopathy
- Splenomegaly
- Usually associated with increased atypical lymphocytes in the peripheral blood
- Rare illnesses of the nervous system have been reported, including the following:
- Guillain-Barré syndrome
- Bell palsy
- Aseptic meningitis
- Meningoencephalitis
- Peripheral and/or optic neuritis
- Hematologic complications have been reported in association with EBV:
- Aplastic anemia
- Hemolytic anemia
- Agranulocytosis
- Hemophagocytic syndrome
- Other illnesses associated with EBV in case reports include the following:
- Hemolytic uremic syndrome
- Hepatitis
- Pancreatitis
- Myocarditis
- Mesenteric adenitis
- Orchitis
- Genital ulcerative disease
- Lymphoproliferative disorders
- Burkitt lymphoma
- Nasopharyngeal carcinoma
- Lymphoma and non-Hodgkin lymphoma (in immunocompromised children)
- Lymphomatoid granulomatosis
- Posttransplant lymphoproliferative disorders (PTLDs)
- X-linked lymphoproliferative disease (Duncan disease)
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Citation
Cabana, Michael D., editor. "Epstein-Barr Virus (Infectious Mononucleosis)." 5-Minute Pediatric Consult, 8th ed., Wolters Kluwer, 2019. Pediatrics Central, peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617206/all/Epstein_Barr_Virus__Infectious_Mononucleosis_.
Epstein-Barr Virus (Infectious Mononucleosis). In: Cabana MDM, ed. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617206/all/Epstein_Barr_Virus__Infectious_Mononucleosis_. Accessed December 11, 2024.
Epstein-Barr Virus (Infectious Mononucleosis). (2019). In Cabana, M. D. (Ed.), 5-Minute Pediatric Consult (8th ed.). Wolters Kluwer. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617206/all/Epstein_Barr_Virus__Infectious_Mononucleosis_
Epstein-Barr Virus (Infectious Mononucleosis) [Internet]. In: Cabana MDM, editors. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. [cited 2024 December 11]. Available from: https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617206/all/Epstein_Barr_Virus__Infectious_Mononucleosis_.
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