Epstein Barr Virus - Herpes Viruses

Epstein Barr Virus

·        DNA virus

·        One of Herpes Group

·        Spread by respiratory secretions (e.g. sneeze, kiss) 

·        Pre-schoolers an important reservoir: usually just a non-specific URT infection. In later life (e.g. adolescent) get it more acutely plus hepatitis. 1 – 5% present as hepatitis 

·        Associated with Burkett‟s lymphoma & nasopharyngeal carcinoma

Clinical

·        Highly variable course.  Often asymptomatic if < 5 years

·        Sore throat (often exudative)

·        Fever

·        Lymph nodes up 

·        Tender liver (liver involvement ® ¯appetite and ­feeling unwell), maybe big spleen

·        Rash in 10%

·        Doesn‟t resolve (especially after antibiotics)

·        Will be tired for weeks/months

·        Incubation 30 – 50 days

·        Association with symptoms:

Investigations

·        Throat swab 

·        FBC: may be ­atypical mononuclear lymphocytes

·        EBV serology

Treatment

·        Symptomatic

·        Don’t give penicillin if risk of EBV: leads to rash that can be interpreted as penicillin allergy. (E.g. amoxycillin, rash in 80 – 90%)

·        Infectious for months.  No isolation required

·        Steroids if upper airway obstruction in kids

Antibodies to EBV

·        IgM Anti-VCA (Virus capsid antigen) and IgG Anti-VCA

o  Usually appear in blood 7 days after symptoms develop in acute primary EBV infection

o  IgM: usually persists for 2 – 4 months

o  IgG: usually persists for life

·        Anti EBNA (Epstein-Barr nuclear antigen): Appears 2 months after primary infection and persists for life

·        Profiles:

·        Paul-Bunell now largely obsolete.  Negative in 10 – 15 % of cases

Associated diseases

·        Burkett‟s lymphoma

·        Nasopharyngeal carcinoma

·        Hodgkin‟s disease (EBV in 40 – 60% of cases)

·        Chronic EBV may occur but is very uncommon (recurrent sore throat, cervical lymphadenopathy)