Epstein-Barr Virus (EBV)

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

Definition

Epstein-Barr virus (EBV) is a herpesvirus responsible for infectious mononucleosis and is associated with malignancies such as Burkitt’s lymphoma, nasopharyngeal carcinoma, and Hodgkin’s lymphoma.

Aetiology

  • Caused by Epstein-Barr virus (human herpesvirus 4).
  • Transmitted through saliva (commonly known as the "kissing disease").
  • Less commonly spread via blood transfusions or organ transplants.

Pathophysiology

  • EBV infects B lymphocytes, leading to polyclonal B-cell activation.
  • Results in a robust cytotoxic T-cell response, causing lymphadenopathy and systemic symptoms.
  • Persistent latent infection in B cells may contribute to oncogenesis.

Risk Factors

  • Adolescents and young adults (higher incidence of symptomatic infection).
  • Immunosuppression (e.g., HIV, post-transplant patients).
  • Geographical variation (higher malignancy risk in endemic areas).

Signs and Symptoms

  • Classic triad: fever, pharyngitis, lymphadenopathy.
  • Fatigue and malaise.
  • Splenomegaly (risk of splenic rupture).
  • Maculopapular rash (exacerbated by amoxicillin use).
  • Palatal petechiae and hepatomegaly (less common).

Investigations

  • Monospot test (heterophile antibody test): positive in most cases.
  • EBV serology: detects viral capsid antigen (VCA IgM and IgG), nuclear antigen (EBNA).
  • Full blood count (FBC): lymphocytosis with atypical lymphocytes.
  • Liver function tests (LFTs): may show mild transaminitis.
  • Abdominal ultrasound: if splenomegaly suspected.

Management

1. Supportive Care:

  • Rest and adequate hydration.
  • Paracetamol or NSAIDs for fever and throat pain.
  • Avoid contact sports for at least 3-4 weeks if splenomegaly is present (risk of rupture).

2. Antiviral Therapy:

  • Not routinely required as EBV is self-limiting.
  • Consider acyclovir in severe cases (e.g., in immunocompromised patients).

3. Management of Complications:

  • Corticosteroids for severe tonsillar swelling causing airway obstruction.
  • Monitor for secondary bacterial infections (e.g., streptococcal pharyngitis).

4. Referral:

  • Haematology/oncology: if EBV-associated lymphoma or persistent lymphadenopathy.
  • ENT: if severe tonsillar hypertrophy or airway compromise.
  • Infectious diseases: in immunocompromised patients or atypical presentations.
Infectious DiseasemypanotesEpstein-Barr Virus (EBV)