Epstein Barr virus

---

Infectious mononucleosis (kissing disease)

Transmission

Transmission is mainly through contact with saliva. 

Transmission can occur in solid organ or stem cells transplant patients.

 

Incubation period

The incubation period range between 4 to 6 weeks.

The attack rate is around 50 %.

---

Clinical presentations

---

 

Infectious mononucleosis

Ø      Fever, sore throat, lymphadenopathy.

Ø      Skin rash (petechial, and itchy)

Ø      Hepatitis (mild jaundice and abnormal LFT)

Ø      Haemolytic anaemia

 

EBV in Immunocompromised patients

Ø      Encephalitis ( mild headache, meningitis, psychosis)

Ø      Pneumonitis (shortness of breath, occasionally chest x-ray findings)

Ø      Post-Transplant Lymphoproliferative Disorder (PTLD) (progress from benign to malignant lymphoma)

 

Rare complications

ü      Chronic fatigue syndrome

ü      Leukoplakia

ü      Burkitt’s lymphoma in Africa ( in malaria endemic area)

ü      Nasopharyngeal Carcinoma ( In south East Asia)

 

---

Investigation

---

 

Monospot test may be useful however it is less sensitive in very young children.

 

Diagnostic tests

Infectious mononucleosis

Serum for EBV VCA IgM, EBV VCA IgG and EBNA

    or heterophile antibody testing

EBV stimulates polyclonal antibodies production and for these reasons it is not uncommon to detect  IgM against other viral agents.

 

EBV antibody

 

Acute/ recent infection              +                                  +                                 _

 

 

Immunocompromised patients

Serological tests are not that useful.

Blood in EDTA for EBV DNA PCR

 

Screening

Not normally carried out but transplant patients can be screened for EBV before transplant.

---

Treatment 

---

• Usually no treatment is required.

• Auto-immune disease associated with EBV may responds to treatment with steroid. 

• In some centres EBV specific cytotoxic T cells are used to treat transplant patients.

• PTLD may responds to Acyclovir or Gancyclovir at the early stage.

• Ritoximab is widely used to treat these patients.

• Reducing level of immunosuppression after transplant

• Chemotherapy and radiotherapy may be used to treat EBV associated malignancy.

 

---

Prevention 

---

 

There is no specific prevention method.

Surveillance of transplant patients for EBV reactivation may be useful to intervene at the earliest stage of infection.

 

 

---

---