EBV – Epstein Barr Virus

Dr Tom Leach

9 years ago

Contents

Introduction
Epidemiology
Infectious Mononucleosis
- Presentation and Diagnosis
- Treatment
Other Infections
References
Related Articles

Introduction

Epstein-Barr virus (EBV) is a type of human herpes virus. It is extremely widespread, and is contracted by close person to person contact. It can cause a wide range of clinical consequences, and the most common clinical manifestation is Infectious Mononucleosis.

Many infections (up to 50%) are subclinical and asymptomatic. In (the other) 50% of people, primary infection with the virus will cause clinical symptoms, usually in the form of infectious mononucleosis.
In both subclinical, and clinical primary infections, the host will carry the virus asymptomatically for the rest of their life, after the initial presentation has resolved.

Long-term, it has been associated with an increased risk of B cell lymphoma, T cell lymphoma, Hodgkin’s lymphoma, and nasopharyngeal carcinoma.

Epidemiology

Up to 95% of individuals carry the virus
Approximately 50% of cases are symptomatic on primary infection, most commonly in the form of Infectious Mononucleosis
Can present at any age. May be more common in teenagers, and occasionally referred to as ‘kissing disease’

Infectious Mononucleosis

Infectious mononucleosis (IM) also known as Glandular Fever is the most common clinical manifestation of EBV.

Presentation and Diagnosis

Often described as ‘flu-like’ symptoms they can be difficult to differentiate from other viral and URTI causes. Any combination of the following may be present:

Headache
Fever
Tonsillitis / sore throat
Cervical lymph node enlargement and tenderness (usually symmetrical)
Malaise and severe fatigue
May have tonsillar exudate
Nausea / vomiting / GI symptoms. Up to 90% of patients also have a mild hepatitis
Splenomegaly occurs in 50% of patients
Jaundice and hepatomegaly are rare
Occasionally patients may present with hepatitis with none of the other features

It can be difficult to differentiate from other cause or URTI / sore throat. As in tonsillitis, there are four parameters that can help differentiate a viral from a bacterial cause. If all four are present, there is a 50% chance the cause is bacterial. Antibitoics should only be recommended if all four features are present (although in reality, they are often given when all features are not present)

Fever >38 degrees
Tender cervical lympadenopathy
Tonsillar Exudate
No cough

Often in a bacterial cause, there is asymmetrical cervical lymphadenopathy also.

It is particularly important to differentiate EBV from bacterial causes because giving amoxicillin or ampicillin in EBV infection is contraindicated and can cause a rash (which is unrelated to any penicillin hypersentivity).

Epsteine Barr Virus. This electron microscopic image of two Epstein Barr Virus virions (viral particles) shows round capsids—protein-encased genetic material—loosely surrounded by the membrane envelope. This file is taken from wikimedia commons and is licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license.

Treatment

Avoid antibiotics
Most cases resolve spontaneously within 1-2 weeks
Fatigue can persist for several weeks or months

Most individuals subsequently develop lifelong immunity to further acute infections.

Other Infections

EBV can affect almost any organ, and is associated with a wide range of diseases. It is often screened for in wide ranging presentations where no cause can be found, and is also often part of a liver screen.