Definition of the Disease

Epstein-Barr virus is a human herpesvirus that is cytotropic for B lymphocytes. This virus occurs worldwide, and most people (> 90%) become infected at some point during their lifetime.1 Primary infection tends to occur at an early age, especially in lower socioeconomic groups and developing countries. When infection occurs during early childhood, there are usually only very mild symptoms or no symptoms at all. However, if a primary EBV infection occurs during adolescence or adulthood, then infectious mononucleosis (IM) often arises. In a typical case of IM, a prodromal period consisting of malaise, anorexia, and/or myalgias usually precedes the onset of the syndrome by a few days to a week. The syndrome is typically characterized by fever to 102- 104°F (39 -40°C) (90% of patients), cervical lym-phadenopathy (90%), diffuse and exudative pharyngitis (33%), and/or rash (5%). Splenomegaly is found in about half of IM patients, and usually occurs during the second or third week of illness. Liver involvement can also occur, but more rarely. This syndrome typically resolves within 2-3 weeks, but the malaise may remain for months.

Following the primary infection, EBV persists as a latent infection, likely within memory B cells. Latent virus can reactivate later in life, but this often occurs subclinically. EBV is not highly contagious in that it is spread primarily through saliva. However, because people who are latently infected can potentially shed virus, it is essentially


EBV viral capsid antigen (VCA), IgG EBV viral capsid antigen (VCA), IgM EBV early antigen, IgG EBV nuclear antigen


Positive Positive Positive Negative impossible to prevent its transmission. For these reasons, there are no special precautions or isolation procedures recommended for primarily infected patients.

In addition to being the most common cause of IM, EBV has also been associated with a variety of malignancies, including Burkitt's lymphoma, nasopharyngeal carcinoma, primary CNS lymphoma, and posttransplant lymphoproliferative diseases.2

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