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Author: Hana Numan, Medical Writer, New Zealand. Copy edited by Gus Mitchell. October 2021
Epstein-Barr virus is one of the most ubiquitous human viruses, with up to 95% of adults worldwide having been infected.
Epstein-Barr virus (EBV) is also called Human herpesvirus 4 (HHV-4).
Epstein-Barr virus is a member of the order Herpesvirales, family Herpesviridae, subfamily Gammaherpesvirinae, genus Lymphocriptovirus.
Herpes viruses are characterised by:
Epstein-Barr virus may be passed from person to person via:
The incubation period is about six weeks. Following primary infection, EBV enters a latent phase in B lymphocytes from which it can be reactivated, especially if immunocompromised. Virus shedding and transmission can occur during primary infection or intermittently during reactivation.
Epstein-Barr virus is best known for causing infectious mononucleosis (glandular fever) in adolescents and young adults, although primary EBV infection can be asymptomatic (10%) particularly in children.
EBV can also cause other disorders with mucocutaneous features, and has been implicated in the pathogenesis of many more.
|Infectious mononucleosis||Palatal petechiae, rash, eyelid/periorbital swelling|
|Papular acrodermatitis of childhood||Papular rash over buttocks, thighs, arms, face|
|Non-sexually acquired genital ulceration||Painful deep punched out ulcer(s) on the genitalia|
|Oral hairy leukoplakia||Asymptomatic white plaques on the lateral tongue|
|Papular purpuric gloves and socks syndrome||Symmetrical painful erythema and oedema of hands and feet|
|Laterothoracic exanthem||Pink papules beginning in the armpit or groin, spreading along one side of the trunk|
|Cutaneous T-cell lymphoma||One form is classified as chronic active EBV infection in childhood|
|Chronic active EBV||Persistent or recurrent IM-like symptoms including of the skin unable to be explained by other known processes|
|Viral hepatitis||Jaundice, itch|
EBV, Epstein-Barr virus; IM, infectious mononucleosis
Epstein-Barr virus can cause these conditions
|Disorder||Role of EBV|
|Pityriasis lichenoides||Both the acute and chronic forms have been postulated to be triggered by infectious agents|
|Langerhans cell histiocytosis (LCH)||EBV DNA has been detected by PCR in some (but not all) tissue samples of LCH|
|Blueberry muffin syndrome||Congenital infection by EBV can present with this phenotype|
EBV, Epstein-Barr virus; LCH, Langerhans cell histiocytosis; PCR, polymerase chain reaction
Epstein-Barr virus is implicated in many lymphoproliferative disorders and tumours. Examples include:
Epstein-Barr virus infection will be considered on the clinical presentation and confirmed on investigations which may include:
Epstein-Barr virus infection becomes latent with the risk of reactivation in later life.
The age at which EBV is acquired influences the clinical picture and complications. Primary infection in adolescents and adults is more likely to result in infectious mononucleosis than if infection occurs in childhood, and IM carries an increased risk of subsequent development of Hodgkin lymphoma. Primary infection in early childhood is associated with subsequent nasopharyngeal carcinoma or Burkitt lymphoma.
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