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Epstein-Barr virus (EBV/HHV-4)7
- Epstein-Barr virus (EBV/HHV-4) is widespread in most human populations - approximately 90% of adults in W.Europe and N. America carry EBV.
- Infection persists for life with virus regularly shed in saliva which is the usual route of transmission.
- It can persist for a lifetime in an asymptomatic state with T cells effectively controlling it.
- In vitro, it is the most potent transforming virus known, and in vivo it infects human B-lymphocytes (generally non-productive infection) and epithelial cells (productive infection). It is linked with several different types of tumour.
- Classic, acute infectious mononucleosis resolves in 2 to 6 weeks, but relapses can occur in the first 6 to 12 months following infection, and it may be linked, in the short term, to a prolonged fatigue syndrome and depression.
- Understanding normal immune control of EBV in the healthy host and increasingly the molecular basis to its involvement in oncogenesis is allowing the development of rational therapies for the management of EBV-related malignancies.
Disease
Details of EBV involvement 8
Infectious mononucleosis ("glandular fever")
Primary infection, self limiting. Occurs in ~50% of primary infections of adolescents and young adults.
Burkitt's lymphoma
EBV found as latent infection in 97% of endemic, 15-85% of sporadic and 30-40% of
AIDS-linked Burkitt's lymphoma cases (common African manifestation).
Hodgkin's disease
Sporadic lymphoma; latent EBV found in ~50% of cases.
B-lymphoproliferative disease
Lymphoproliferative disease/lymphomas, almost exclusively in the immunocompromised host, especially post-transplant (as a result of immunosuppressive drug therapy) and in AIDS. Might occur in primary infection or persistent infection.
X-linked lymphoproliferative syndrome
Rare genetic immune dysfunction results in fatal primary infection.
Nasopharyngeal carcinoma
Malignant squamous epithelial tumour of the nasopharynx; (common Chinese & SE Asian manifestation) cells contain latent virus.
Oral hairy leukoplakia
Viral replication in the superficial layers of tongue epithelium results in a benign lesion, almost exclusively in HIV-positive individuals.
Investigation
Laboratory criteria for the confirmation of acute infectious mononucleosis include:
- Leukocytosis with a moderately raised white cell count.
- >10% atypical lymphocytes on peripheral smear
- Positive serologic test result (e.g. Paul Burnell-heterophile antibody or Monospot assay)
LFTs are also temporarily elevated in the majority of acute EBV infections.
Treatment
- Infectious mononucleosis is a self-limiting illness that does not usually require specific treatment.
- Nonsteroidal anti-inflammatories may be used for symptomatic relief and corticosteroids are sometimes used to treat complicated disease e.g. thrombocytopaenia or significant upper airway obstruction due to enlarged tonsils or lymph nodes, but do not alter the course of the disease.
- The risk of rare complications such as splenic rupture should not be forgotten.
Prevention
Vaccine development, mainly based on preventing primary infection, is underway. One vaccine strategy is to generate neutralizing antibody to the viral envelope glycoprotein (gp-350) that binds to B cells in infection.
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