Epstein-Barr virus infections (Smarty PANCE)

What is Epstein-Barr virus (EBV)?

A herpesvirus (HHV-4) that primarily infects B lymphocytes and causes infectious mononucleosis (IM)

In addition to infectious mononucleosis, what diseases are caused by EBV infection?

Besides infectious mononucleosis (IM), Epstein-Barr virus (EBV) is associated with several other illnesses, including:

- Burkitt's lymphoma

- Hodgkin's lymphoma

- Nasopharyngeal carcinoma

- Oral hairy leukoplakia

- Post-transplant lymphoproliferative disorder (PTLD)

How is EBV transmitted?

Via oropharyngeal secretions and saliva. Hence “The kissing disease”

What is the classic presentation of infectious mononucleosis (IM) caused by EBV?

Adolescent or young adult complaining of sore throat, fevеr, and malaise and has lуmрhаԁеոoраthy and рhаrуngitiѕ on physical examination

What additional findings are highly suggestive of infectious mononucleosis?

The presence of palatal реteсhiae, ѕрlеոоmegaly, and posterior cervical аԁеոοpаthу is highly suggestive of IM, while the absence of cervical lуmрhаԁеոоpathу and fatiguе makes the diagnosis less likely

What is the incubation period for EBV?

The incubation period for Epstein-Barr virus (EBV) is typically 30-50 days. During this time, individuals can be contagious, even though they may not show symptoms. The virus mainly spreads through saliva, so avoiding close contact like kissing or sharing utensils is recommended until symptoms resolve.

How is mononucleosis diagnosed?

Diagnosis of EBV:

- CBC: Shows lymphocytosis with atypical lymphocytes

- Monospot test: Detects heterophile antibodies

- EBV-specific antibody test: Confirms infection (VCA, EA, EBNA)

- LFTs: May show elevated liver enzymes

What does a CBC with peripheral smear reveal in EBV infection?

Lуmрhοϲуtоsiѕ defined as an absolute count >4500/microL or, on peripheral smear

What is special about the lymphocytes seen on a peripheral smear in infectious mononucleosis?

Atypical lymphocytes (Large, irregular lymphocytes) often constitute >10% of the total leukocyte count

What is the diagnostic gold standard for infectious mononucleosis?

Epstein-Barr virus (EBV) specific antibodies are the diagnostic gold standard, as they have high sensitivity and specificity for IM (97 and 94 percent, respectively)

What is the Monospot test?

A rapid slide agglutination test for heterophile antibodies used to diagnose EBV infection in the absence of EBV-specific antibody testing or when rapid results are desired (results within 1 hour)

When do heterophile antibodies typically appear during EBV infection?

Within the first two weeks of illness, with detection in 85% of adolescent/adult cases

When are the false negative rates of the Monospot test the highest?

The false-negative rates are highest at the onset of clinical symptoms (25% in the first week, 5-10% in the second week, 5% in the third week). The heterophile response is less common in infants and children and should not be used in children < 4 years of age

What should be done if a Monospot test is performed and the result is negative early in the course of illness?

Repeat the test later or check EBV-specific antibodies, especially in children

What percentage of patients treated with ampicillin develop a maculopapular rash during EBV infection?

80%

Why should patients with EBV infection avoid contact sports?

To prevent splenic rupture, especially in cases of splenomegaly (1 in 1,000 risk)

What is the role of corticosteroids in EBV management?

Used for severe complications like airway obstruction or thrombocytopenia

What malignancies are associated with EBV?

Burkitt lymphoma, Hodgkin lymphoma, nasopharyngeal carcinoma

What are the potential complications of EBV infection?

Splenic rupture, secondary bacterial infections, hemolytic anemia, thrombocytopenia

How is EBV infection treated?

Supportive care including rest, hydration, and analgesics

Who are the long-term carriers of EBV infection?

EBV establishes lifelong latent infection in B lymphocytes and can periodically reactivate - A patient will not contract mononucleosis again after the initial exposure to the Epstein-Barr virus

When can a patient diagnosed with IM return to sport?

Experts generally recommend that athletes not participate in contact or vigorous sports activities for at least the first three to four weeks of the illness

When can patients diagnosed with IM return to school or work?

Since EBV may be shed intermittently for months to years in people who have acquired infection, and the source of infection is rarely known in the patient who develops IM, there are no restrictions regarding recently ill IM patients for returning to school or the workplace