Epstein-Barr Virus (EBV)

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

Epstein-Barr Virus (EBV) is a member of the herpesvirus family and is one of the most common human viruses. It is best known for causing infectious mononucleosis (glandular fever).

Aetiology

EBV is transmitted primarily through saliva, but it can also be spread through blood and semen during sexual contact, blood transfusions, and organ transplantations.

Pathophysiology

The pathophysiology of EBV involves:

• Initial infection typically occurs in the oropharyngeal epithelial cells.
• The virus then spreads to B lymphocytes, establishing a lifelong latent infection.
• EBV can reactivate and be shed in saliva, even in asymptomatic individuals.
• Primary infection leads to a vigorous immune response, causing the clinical manifestations of infectious mononucleosis.

Risk Factors

• Adolescents and young adults (especially those in close contact environments such as schools or colleges)
• Close contact with an infected person
• Immunocompromised individuals
• Individuals with a history of multiple sexual partners

Signs and Symptoms

The signs and symptoms of EBV infection can include:

• Fever
• Sore throat
• Swollen lymph nodes (lymphadenopathy)
• Fatigue
• Headache
• Swollen liver or spleen
• Rash
• Loss of appetite
• Muscle aches

Investigations

Specific investigations to diagnose EBV infection include:

• Heterophile antibody test (Monospot test): Used to detect antibodies produced in response to EBV infection.
• Serology: Detection of specific EBV antibodies (e.g., EBV VCA IgM, EBV VCA IgG, EBNA).
• Full blood count (FBC): To check for elevated white blood cell count and atypical lymphocytes.
• Liver function tests (LFTs): To assess liver function and detect hepatitis, which can occur with EBV infection.

Management

Primary Care Management

• Supportive care: Adequate rest, hydration, and symptomatic treatment (e.g., antipyretics and analgesics such as paracetamol or ibuprofen).
• Avoidance of physical activity: To prevent splenic rupture, especially during the acute phase of the illness.
• Antivirals: Generally not recommended as EBV is self-limiting and antivirals have limited efficacy in otherwise healthy individuals.

Specialist Management

• Hospitalisation: For severe cases or complications such as splenic rupture, airway obstruction, or severe hepatitis.
• Management of complications: Addressing complications such as anaemia, thrombocytopenia, or secondary bacterial infections.
• Immunocompromised patients: May require antiviral therapy and close monitoring.

References

1. NHS (2024) Epstein-Barr virus infection. Available at: https://www.nhs.uk/conditions/epstein-barr-virus-ebv/ (Accessed: 24 June 2024).
2. Centers for Disease Control and Prevention (2024) Epstein-Barr Virus and Infectious Mononucleosis. Available at: https://www.cdc.gov/epstein-barr/index.html (Accessed: 24 June 2024).
3. World Health Organization (2024) Epstein-Barr virus. Available at: https://www.who.int/news-room/fact-sheets/detail/epstein-barr-virus (Accessed: 24 June 2024).
4. British Medical Journal (2024) Infectious Mononucleosis: clinical features, diagnosis, and management. Available at: https://www.bmj.com/content/350/bmj.h1825 (Accessed: 24 June 2024).

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