Epstein-Barr Virus

Hal B. Jenson, MD* 1. *Editorial Board. After completing this article, readers should be able to: 1. Describe the epidemiology and transmission of Epstein-Barr virus (EBV) among children, adolescents, and adults. 2. Describe the pathogenesis and natural course of EBV infection and the spectrum of clinical diseases in healthy and immunocompromised persons. 3. Interpret serologic test results to diagnose acute and past EBV infections. 4. Describe the appropriate management of infectious mononucleosis and the role of corticosteroids for treatment of complications. 5. Discuss the relationship of EBV to human malignancies. Epstein-Barr virus infection results in a spectrum of diseases, with the host immune response playing a key role in shaping the clinical manifestations. Infectious mononucleosis is the prototype EBV infection and is characterized by fever, sore throat, cervical and generalized lymphadenopathy, hepatosplenomegaly, and somatic complaints of fatigue and malaise. This condition generally is a benign, self-limited illness in healthy persons. In this article, the term “infectious mononucleosis” refers to the disease caused by primary EBV infection, although other agents can cause “infectious mononucleosis-like” disorders that are clinically similar to the EBV-associated disease. Aggressive, nonmalignant EBV-associated proliferations, such as virus-associated hemophagocytic syndrome, posttransplant lymphoproliferative syndrome (PTLS), lymphoid interstitial pneumonitis, and oral hairy leukoplakia, occur in immunocompromised persons. EBV also contributes to human malignancies, including nasopharyngeal carcinoma, Burkitt lymphoma, Hodgkin disease, and leiomyosarcoma. The history of the discovery of EBV as the cause of infectious mononucleosis began with the first clinical description of a subacute febrile illness by Filatov in 1885 and the description of “glandular fever” by Pfeifer in 1889. In 1920, Sprunt and Evans described the finding of atypical lymphocytes and aptly coined the name “infectious mononucleosis” for this disease. The discovery of EBV also …