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Clinical manifestations and treatment of Epstein-Barr virus infection

INTRODUCTION

Epstein-Barr virus (EBV) is a widely disseminated herpesvirus that is spread by intimate contact between susceptible persons and asymptomatic EBV shedders. Clinical manifestations range from uncomplicated infectious mononucleosis to Burkitt lymphoma.

The majority of primary EBV infections throughout the world are subclinical and inapparent. Antibodies to EBV have been demonstrated in all population groups with a worldwide distribution; approximately 90 to 95 percent of adults are EBV-seropositive. The host range of EBV is restricted to humans and certain subhuman primates including squirrel monkeys and cotton top marmosets [1].

Like other members of the herpesvirus family, EBV has a latency phase. The host cells for the organism in humans are limited to B lymphocytes, T lymphocytes, epithelial cells and myocytes. Unlike herpes simplex (HSV) or cytomegalovirus (CMV), EBV is capable of transforming B cells and does not routinely display a cytopathic effect. (See "Virology of Epstein-Barr virus".)

EBV is the primary agent of infectious mononucleosis (IM), persists asymptomatically for life in nearly all adults, and is associated with the development of B cell lymphomas, T cell lymphomas, Hodgkin lymphoma and nasopharyngeal carcinomas in certain patients. Reactivation disease is not a prominent issue with EBV, in contrast to other common herpesviruses, but it has been associated with an aggressive lymphoproliferative disorder in transplant recipients. (See "Lymphoproliferative disorders following solid organ transplantation".)

The clinical manifestations and treatment of EBV infections will be reviewed here. The diagnosis of EBV as pertains to infectious mononucleosis is discussed separately. (See "Infectious mononucleosis in adults and adolescents".)
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