By Gary M. White, MD
- Human herpes virus 4, gamma subfamily.
- Double stranded DNA
- Prefers B cells.
- EBV-1 worldwide. EBV-2 mostly Africa
- More than 95% of the world's population is seropositive and chronically infected.
- CME article JAAD 2015;71;1-34.
- Oral contact with saliva ("kissing disease")
- May be sexually transmitted via genital secretions.
- May be transmitted by blood transfusion or organ donation.
- < 4 years old: asymptomatic infection or mild viral illness.
- 4-30 years of age: infectious mononucleosis (~50% of infections)
Chronic Active EBV
- There is debate as to whether this represents an infectious disease, lymphoproliferative disorder, or immunodeficiency? [Rev Med Virol 2006; 16: 251- 61]
- High viral load of EBV
- Clonal expansion of lymphocytes
- May present with persistent fever, arthralgias, myalgias, and
- Recurrent mononucleosis with risk of hemophagocytic syndrome
- Hypersensitivity to Mosquito Bites
- Severe cases of Hydroa Vacciniforme
- PCR in peripheral blood or tissue.
EBV Antibody Tests
- IgM VCA (Viral Capsid Antigen)
- The single most valuable test in confirming the diagnosis of acute EBV infection
- Rheumatoid factor may cause a false-positive
- IgG VCA
- Present early with IgM
- Persists for life
- IgG EBNA
- Gradually appears 3-4 months after infection
- Persists for life
Infectious Mononucleosis (IM)
Antibiotic Rash with Mononucleosis
- Rash in 70 – 100% of IM patients receiving antibiotics – Incidence may be lower – approximately 33% with ampicillin most common [Pediatrics 2013; 131; e1424-7]
- Ampicillin is classic, but others as well: amoxicillin, cephalexin, erythromycin,
- Lasts 7 – 10 days, heals with desquamation
- Pathophysiology: ? Immune complexes of the drug
with EBV-induced antibodies
- Not a permanent allergy to the antibiotic
- EBV is the most common cause of the Gianotti-Crosti syndrome in the United States
- May be seen with primary EBV infection or with reactivation
Oral Hairy Leukoplakia
- EBV found in oral hairy leukoplakia lesions
- White veracious plaques sides of the tongue.
- Asymptomatic and benign
- Immunocompromised hose, e.g. HIV positive.
- Most common in United States, UK, Europe and Japan
- Lesions are photo induced, face, and lip typical
- When severe, e.g. fever hepatic, Hydroa vacciniforme may be associated with EBV infection
- Some cases have progressed to fatal hemophagocytic syndrome and HV-like T- cell lymphoma
Severe Hypersensitivity to Mosquito Bites
- Chronic EBV infection may be associated with Hypersensitivity to mosquito bites
- Geographically most common in Japan, Taiwan, Mexico
- Represents proliferation of EBV-infected NK cells
- Patients may have fever, malaise, hepatosplenomegaly, proteinuria
- Associations include hemophagocytic syndrome and lymphoma/leukemia
- When hypersensitivity to mosquito bites (HMB) is associated with EBV infection and NK cell lymphocytosis, the term "HMB-EBV-NK" disease is used.
Chronic active Epstein–Barr virus infection in a French woman. Lesions started in childhood and progressed over 25 years. Lesions would heal spontaneously leaving depressed scars. BJD 2015;173;1266–1270.
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