Epstein-Barr Virus

Abstract

1. Anne K. Junker, MD* 1. *Associate Professor, Division of Infectious and Immunological Diseases, Department of Pediatrics, University of British Columbia and Children’s & Women’s Health Centre of British Columbia, Vancouver, BC, Canada Author Disclosure Dr. Junker did not disclose any financial relationships relevant to this article. After completing this article, readers should be able to: 1. Outline the epidemiology of primary Epstein-Barr virus (EBV) infection. 2. Describe and explain the physiologic basis of the clinical features of infectious mononucleosis. 3. Describe and explain the physiologic basis of the common complications of infectious mononucleosis. 4. List the diagnostic tests that can help distinguish acute primary from distant past EBV infection. 5. Review the EBV-associated lymphoproliferative disorders and malignancies. EBV was identified initially in 1964 in tumor tissue from a patient who had African Burkitt lymphoma (BL), a rapidly growing, usually fatal malignancy of the B lymphocyte. When a laboratory technician working with this new virus became ill with mononucleosis and seroconverted to EBV, the link between EBV and mononucleosis became apparent. Soon thereafter, seroepidemiologic studies revealed that EBV infects virtually all of the world’s population, usually as a subclinical or trivial illness in childhood. A decade later, reports of a familial X-linked disorder of fatal infectious mononucleosis highlighted the importance of immunogenetic factors in the management of EBV infection. Now, nearly 40 years after its discovery, EBV continues to captivate clinicians, virologists, oncologists, geneticists, and immunologists attempting to understand this highly successful human pathogen. EBV is a ubiquitous, worldwide pathogen that is harbored persistently by virtually all adults, regardless of geographic location. After primary infection, the virus latently infects circulating B cells and is shed silently into saliva and genital secretions. The colloquial term “kissing disease” acknowledges the oral route by which most people are infected. Spread is associated with close personal contact, so it is not surprising that the age at first infection varies according to living conditions. Infection occurs at an earlier age in the presence of poor hygiene and crowded living conditions; infection rates in …