Epstein-Barr virus (EBV); human herpesvirus 4 (HHV4)
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Epidemiology
- humans are the sole source of the virus
- may be isolated from genital & oral secretions
- 67% of college men & 79% of college women are seropositive
- oral & genital transmission
- transmission occurs most commonly through prolonged & repeated contact with infected saliva & rarely through blood transfusions or bone-marrow transplantation
Pathology
- EBV infects epithelial cells of the oropharynx, cervix & resting B lymphocytes which disseminate & proliferate until checked by activated T-cells
- virus remains latent in B-lymphocytes
- putative receptor: CD21
- EBV is associated with:
- infectious mononucleosis (symptomatic primary infection)
- Burkitt's lymphoma
- Gianotti-Crosti syndrome
- B-cell lymphoma in immunocompromised hosts
- primary CNS lymphoma in AIDS patients
- Hodgkin's disease[4]
- T-cell lymphoma[4]
- oral hairy leukoplakia (most commonly with HIV1 infection)[4]
- nasopharyngeal carcinoma
- aseptic meningitis, encephalitis
- febrile neutropenia
- hepatitis
- hemolytic anemia
- thrombocytopenia[4]
- post-transplantation lymphoproliferative disorder[4]
- 32-fold increased risk of multiple sclerosis[8]
- EBV nuclear antigen 1 (EBNA1), is very similar to GlialCAM, prominent in astrocytes & oligodendrocytes & expressed heavily in plaques of multiple sclerosis
- antibodies against EBNA1 also bind tightly to GlialCAM
Genetics
- double-stranded DNA virus of the Herpes virus family
- human proteins implicated in EBV infection:
- EBV induces ZNF271
Laboratory
- heterophile antibody
- EBV serology, if heterophile antibody negative
- acute primary infection
- elevated EBV capsid IgM in serum & EBV capsid IgG in serum
- elevated EBV early IgG in serum
- low or undetectable EBV nuclear IgG in serum
- past infection
- undectable EBV capsid IgM in serum
- elevated EBV capsid IgG in serum
- undectable EBV early IgG in serum
- elevated EBV nuclear IgG in serum
- also see EBV CSF serology
- acute primary infection
- Epstein-Barr virus DNA
- see ARUP consult[5]
Management
Comparative biology
- nanoparticle vaccine prevents EBV infection in mice & nonhuman primates
More general terms
Additional terms
- B-cell lymphoid neoplasm (B-cell lymphoma)
- Burkitt's lymphoma
- CC chemokine receptor type 7; C-C CKR-7; CC-CKR-7; CCR-7; MIP-3 beta receptor; EBV-induced G-protein coupled receptor 1; EBI1; BLR2; CDw197; CD197 (CCR7, CMKBR7, EBI1, EVI1)
- Epstein-Barr virus DNA
- G-protein coupled receptor 183; EBV-induced G-protein coupled receptor 2 (GPR183, EBI2)
- gammaherpesvirinae
- Gianotti-Crosti syndrome (papular acrodermatitis of childhood)
- hairy leukoplakia
- heterophile antibody
- infectious mononucleosis
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 872-73
- ↑ Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 769
- ↑ Journal Watch 22(21):157, 2002 Crawford DH et al Sexual history and Epstein-Barr virus infection. J Infect Dis 2002, 186:731 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12198605
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 Medical Knowledge Self Assessment Program (MKSAP) 14, 16, 17, 19. American College of Physicians, Philadelphia 2006, 2012, 2015, 2021
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ 5.0 5.1 ARUP Consult: Epstein-Barr Virus - EBV The Physician's Guide to Laboratory Test Selection &bInterpretation https://www.arupconsult.com/content/epstein-barr-virus
- ↑ Wikipedia: Epstein-Barr virus https://en.wikipedia.org/wiki/Epstein%E2%80%93Barr_virus
- ↑ AbuSalah MAH, Gan SH, Al-Hatamleh MAI et al Recent Advances in Diagnostic Approaches for Epstein-Barr Virus. Pathogens. 2020 Mar 18;9(3):226 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32197545 Free PMC article. Review.
- ↑ 8.0 8.1 George J MS Risk Skyrockets After Epstein-Barr Virus, but Not Other Infections. Findings show "compelling evidence of causality". MedPage Today January 13, 2022 https://www.medpagetoday.com/neurology/multiplesclerosis/96656
Bjornevik K, Cortese M, Healy BC et al Longitudinal analysis reveals high prevalence of Epstein-Barr virus associated with multiple sclerosis. Science. 2022. Jan 13. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35025605 https://www.science.org/doi/10.1126/science.abj8222 - ↑ Lanz TV et al. Clonally expanded B cells in multiple sclerosis bind EBV EBNA1 and GlialCAM. Nature 2022 Mar 10; 603:321. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35073561 https://www.nature.com/articles/s41586-022-04432-7
Wekerle H. Epstein-Barr virus sparks brain autoimmunity in multiple sclerosis. Nature 2022 Mar 10; 603:230. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35169323 https://www.nature.com/articles/d41586-022-00382-2
Mullard A. The quest to prevent MS - And understand other post-viral diseases. Nature 2022 Mar 10; 603:784. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35354995 https://www.nature.com/articles/d41586-022-00808-x