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Epstein–Barr virus 

Epstein–Barr virus
Chapter:
Epstein–Barr virus
DOI:
10.1093/med/9780198729228.003.0079
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date: 17 November 2019

Epstein–Barr virus (EBV) is the commonest cause of infectious mononucleosis (IM). The virus infects B lymphocytes but is also capable of infecting squamous epithelial cells, smooth muscle cells, T cells, natural killer cells, plasma cells, and follicular dendritic cells. EBV exhibits a lifelong latent infection in healthy carriers harbouring EBV in B-memory lymphocytes. More than 90% of the population will have been infected by the virus in childhood, when it is most often asymptomatic. Infection during adolescence is much more likely to cause IM (glandular fever) and is typically associated with fever, exudative pharyngitis, cervical lymphadenopathy, headache, hepatosplenomegaly, and malaise. EBV infection is also associated with a variety of lymphoproliferative disoders. In immunocompromised patients (congenital or acquired), reactivation of EBV may lead to severe symptomatic infection or B-cell lymphomas. EBV is associated with post-transplant lymphoproliferative disorder (PTLD), which may be either polyclonal or true malignant lymphoma. Diagnosis is usually based on typical clinical features. The commonest serological tests are heterophile antibody test (monospot or Paul Bunnell). More specific is the antiviral capsid antigen (VCA) immunoglobulin M and immunoglobulin G test. EBV viral load determined by quantitative polymerase chain reaction is used routinely post-transplantation to detect early signs of EBV reactivation and disease, and for prevention of PTLD. IM is generally self-limiting, and therefore only supportive and/or symptomatic treatments are used.

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