Epstein-Barr virus

• Epstein-Barr virus is a virus that is the cause of mononucleosis and is involved in Burkitt’s lymphoma.

Epstein-barr virus (EBV)

Epidemiology

Epstein-Barr virus, or EBV, is one of the most common human viruses in the world. It spreads primarily through saliva. EBV can cause infectious mononucleosis, also called mono, and other illnesses. Most people will get infected with EBV in their lifetime and will not have any symptoms. Mono caused by EBV is most common among teens and adults.

Symptoms

Symptoms of EBV infection can include

Epstein Barr Virus virions

• Sick child in bed
• fatigue
• fever
• inflamed throat
• swollen lymph nodes in the neck
• enlarged spleen
• swollen liver
• rash

Many people become infected with EBV in childhood. EBV infections in children usually do not cause symptoms, or the symptoms are not distinguishable from other mild, brief childhood illnesses. People who get symptoms from EBV infection, usually teenagers or adults, get better in two to four weeks. However, some people may feel fatigued for several weeks or even months. After you get an EBV infection, the virus becomes latent (inactive) in your body. In some cases, the virus may reactivate. This does not always cause symptoms, but people with weakened immune systems are more likely to develop symptoms if EBV reactivates.

Autoimmune disease and EBV - proposed sequence of events

• EBV Spreads Easily
• EBV is spread by saliva through:
• kissing
• sharing drinks and food
• using the same cups, eating utensils, or toothbrushes
• having contact with toys that children have drooled on

Transmission

• EBV spreads most commonly through bodily fluids, especially saliva. However, EBV can also spread through blood and semen during sexual contact, blood transfusions, and organ transplantations.

• EBV can be spread by using objects, such as a toothbrush or drinking glass, that an infected person recently used. The virus probably survives on an object at least as long as the object remains moist.

• The first time you get infected with EBV (primary EBV infection) you can spread the virus for weeks and even before you have symptoms. Once the virus is in your body, it stays there in a latent (inactive) state. If the virus reactivates, you can potentially spread EBV to others no matter how much time has passed since the initial infection.

Proposed role of EBV infection in the development of chronic autoimmune diseases

Diagnosis

• Diagnosing EBV infection can be challenging because the symptoms are similar to other illnesses. EBV infection can be confirmed with a blood test that detects antibodies. About nine out of ten of adults have antibodies that show that they have a current or past EBV infection.

• For more information, see Laboratory Testing.

Prevention & Treatment

• There is no vaccine to protect against EBV infection. You can help protect yourself by not kissing or sharing drinks, food, or personal items, like toothbrushes, with people who have EBV infection.

There is no specific treatment for EBV. However, some things can be done to help relieve symptoms, including

• drinking fluids to stay hydrated
• getting plenty of rest
• taking over-the-counter medications for pain and fever

Infectious mononucleosis

• Infectious mononucleosis, also called “mono,” is a contagious disease. Epstein-Barr virus (EBV) is the most common cause of infectious mononucleosis, but other viruses can also cause this disease. It is common among teenagers and young adults, especially college students. At least one out of four teenagers and young adults who get infected with EBV will develop infectious mononucleosis.

• Epstein-Barr virus (EBV) can cause illnesses and complications aside from infectious mononucleosis. People with weakened immune systems may develop more severe symptoms and complications from EBV infection. They may also have more severe illness caused by EBV infection.

B-cell budding virus

• Nervous System
• EBV infection can affect a person’s brain, spinal cord, and nerves.

It can cause conditions such as—

• Viral meningitis (swelling of the tissues that cover the brain and spinal cord)
• Encephalitis (swelling of the brain)
• Optic neuritis (swelling of the eye nerve)
• Transverse myelitis (swelling of the spinal cord)
• Facial nerve palsies (paralysis of facial muscles)
• Guillain-Barré syndrome (an immune system disease)
• Acute cerebellar ataxia (sudden uncoordinated muscle movement)
• Hemiplegia (paralysis on one side of the body)
• Sleep disorders
• Psychoses
• Hematological System

EBV infection can affect a person’s blood and bone marrow. The virus can cause the body to produce an excessive number of white blood cells called lymphocytes (lymphocytosis).

EBV can also weaken the immune system, making it more difficult for the body to fight infection.

Examples of some of these conditions include—

• Neutropenia with secondary infections
• Hemophagocytic syndrome (hemophagocytic lymphohistiocytosis)
• Acquired hypogammaglobulinemia
• X-linked lymphoproliferative disease

Other Conditions

EBV infection can also cause—

• Pneumonia (injury of the lungs)
• Interstitial lung disease (a large group of disorders, most of which cause scarring of lung tissue)
• Pancreatitis (swelling of the pancreas)
• Myocarditis (swelling of the heart muscle)
• Oral cavity-oral hairy leukoplakia (raised, white patches on the tongue), which is usually seen in people infected with HIV

Cancers associated with EBV

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Leukemia cells that contain Epstein Barrvirus

• Burkitt’s lymphoma (cancer of the lymphatic system)
• Nasopharyngeal carcinoma (cancer of the upper throat)
• Hodgkin’s disease and non-Hodgkin’s lymphoma (cancers of the lymphatic system)
• Post-transplant lymphoproliferative disorder (white blood cells are produced in excess)
• Other tumors including leiomyosarcomas (cancer in the soft tissue) and T-cell lymphomas

Complications of EBV

• Peritonsillar abscesses (pus-filled tissue near the tonsils)
• Acute bacterial sinusitis (bacterial infection of the sinus cavities)
• Suppurative lymph nodes (swelling of lymph nodes)
• Mastoiditis (bacterial infection of the mastoid bone of the skull)
• Sialadenitis (swelling and injury of salivary glands)
• Blockage of the air passages in the nose and throat

Laboratory Testing

• Epstein-Barr virus (EBV), also known as human herpesvirus 4, is a gamma herpes virus that occurs only in humans. Laboratory testing can help distinguish whether someone is susceptible to EBV infection or has a recent or past infection.

Epstein Barr Virus virions

• Healthcare providers can test for antibodies to the following EBV-associated antigens:
• Viral capsid antigen (VCA)
• Anti-VCA IgM appears early in EBV infection and usually disappears within four to six weeks.
• Anti-VCA IgG appears in the acute phase of EBV infection, peaks at two to four weeks after onset, declines slightly then persists for the rest of a person’s life.
• Early antigen (EA)
• Anti-EA IgG appears in the acute phase of illness and generally falls to undetectable levels after three to six months. In many people, detection of antibody to EA is a sign of active infection. However, 20% of healthy people may have antibodies against EA for years.
• EBV nuclear antigen (EBNA)
• Antibody to EBNA, determined by the standard immunofluorescent test, is not seen in the acute phase of EBV infection but slowly appears two to four months after onset of symptoms and persists for the rest of a person’s life. Other EBNA enzyme immunoassays may report false positive results.
• Monospot test

The Monospot test is not recommended for general use. The antibodies detected by Monospot can be caused by conditions other than infectious mononucleosis. Moreover, studies have shown that the Monospot produces both false positive and false negative results. For example, the heterophile antibodies detected by Monospot are often not present in children with infectious mononucleosis. At best, the Monospot test may indicate that a person has a typical case of infectious mononucleosis, but does not confirm the presence of EBV infection.

Interpretation of EBV Antibody Tests

• EBV antibody tests are not usually needed to diagnose infectious mononucleosis. However, specific antibody tests may be needed to identify the cause of illness in people who do not have a typical case of infectious mononucleosis or have other illnesses that can be caused by EBV infection. Symptoms of infectious mononucleosis generally resolve within four weeks. If a person is ill for more than six months and does not have a laboratory-confirmed diagnosis of EBV infection, other causes of chronic illness or chronic fatigue syndrome should be considered.

External links

• Transcriptome and epigenome of EBV

Epstein-Barr virus Resources
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