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January 13, 2011
Epstein-Barr Virus Identified in 1964 in Burkitt lymphoma
Lab technician became ill with mononucleosis EBV seroconversion
Ubiquitous Harbored by nearly all adults
No seasonal variation or clustering of cases
Epstein-Barr Virus Most infected by oral route
“kissing disease” Other modes of transmission
Blood transfusions Bone Marrow transplants Sexually transmitted
Epstein-Barr Virus Incubation period 30-50 days Age at infection varies with living
conditions Age 2 to 3
20% to 80% infected Industrialized countries:
More common primary EBV in adolescents IM in 30% to 50% of these cases
Infectious Mononucleosis
Illness ScriptInfectious Mononucleosis
FeverSore Throat (exudative pharyngitis)MalaiseLymphadenitis (Cervical)+/- HepatosplenomegalyAtypical Lymphocytosis
Infectious Mononucleosis Highly suggestive findings
Palatal petechiae Splenomegaly Posterior cervical adenopathy
Absence of cervical lymphadenopathy and fatigue make the diagnosis much less likely.
Clinical Manifestations Rash
4% of older patients With antibiotic
(ampicillin) administration Nonallergic
morbilliform rash Seen in nearly 100%. Benzyl-penicilloyl-
specific IgM
Rare Clinical Manifestations CNS (5%)
Aseptic meningitis Encephalitis Optic neuritis CN palsies Transverse myelitis Guillian-Barre
Rare Clinical Manifestations Hematologic
Splenic rupture Thrombocytopenia Neutropenia Hemolytic anemia
Others Respiratory Compromise Pneumonia Orchitis Myocarditis
Diagnostic Tests Viral culture is difficult Diagnosis implicated by:
Characteristic clinical signs Lymphocytosis (>50%)
Absolute (> 4500/mL) Atypical Lymphocytosis (>10%)
Confirmed by: Criteria above + positive heterophile
Heterophile Test (Monospot) Heterophile antibodies react to antigens
from unrelated species Monospot- Latex agglutination assay
using horse erythrocytes and patient serum. Peak levels at 2-6 weeks May remain elevated for up to 1 year Sensitivity 85%
Less sensitive in children < age 3. Specificity 100%
Diagnostic Testing Other antibody Testing (useful if
heterophile negative) anti-VCA IgM
Some evidence for active/recent infection anti-EBNA
Excludes active primary infection
Treatment “Take it easy” No contact sports until spleen no longer
palpable Avoid ampicillin and amoxicillin Steroids reserved for most severe of
cases
Associated Conditions X-linked Lymphoproliferative Disease
(XLP) Defect in signaling lymphocytic activation
molecule-associated protein Characterized by
Nodular B-cell lymphomas +/- CNS involvement Profound hypogammaglogulinemia Aplastic anemia Severe infectious mono early in life
4% survival
Associated Conditions EBV associated B-Cell
Lymphoproliferative Disease 10% of transplant recipients Donor organ is common vehicle of EBV
infection Occurs early after transplant
Time of most severe immunosuppression
Other Associated Conditions Hemophagocytic Lymphohistiocytosis Chronic Active EBV Infection Malignancies
Burkitt Lymphoma Nasopharyngeal Carcinoma Hodgkin Disease T-Cell Lymphoma Gastric carcinoma