EBV is ubiquitous herpesvirus that is the Epstein-Barr virus (EBV) or

causative agent of acute infectious mononucleosis

(HHV-4)
(IMN), nasopharyngeal carcinoma, Burkitt's
lymphoma & other lymphoproliferative disorders in
immunodeficient hosts.
One target cell for EBV is the B lymphocytes
where it persist in a latent state. Infection occur
through binding to viral receptor (CD21). B
lymphocytes infected by EBV become immortalized.
Pathogenesis & pathology:
EBV is commonly transmitted by infected saliva
& initiate infection in the oropharynx. Viral
replication occur in epithelial cells of the pharynx &
salivary gland.
EBV infected B lymphocytes synthesize
immunoglobulin. MI is a polyclonal transformation
of B cells. Autoantibodies are typical of the disease.
Reactivation of EBV latent infection can occur
but are usually asymptomatic. Immunosuppresion is
a factor of reactivation infection.
EBV is associated with the development of
Burkitt's lymphoma (a tumor of the jaw in
Epstein-Barr virus (EBV) or
African children & young adults). > 90% of (HHV-4)
African tumor contain viral DNA. In other parts
of the world, 20% of Burkitt's lymphoma contain
EB viral DNA. EBV may be involved in the early
stage of BL by immortalizing B cells.
Nasopharyngeal carcinoma is a cancer of
epithelial cells is common in males of Chinese
origin. EB viral DNA is regularly found in
nasopharyngeal carcinoma cells.
Immunodeficient hosts are susceptible to
EBV induced lymphoproliferative diseases that
maybe fatal. Lymphoproliferative disease is tend
to develop following primary infection in
patients suffering from either congenital or drug-
induced immunodeficiency. AIDS patients are
susceptible to severe EBV associated lesions;
diffuse polyclonal lymphoma, lymphocytic
interstitial pneumonitis & oral hairy leukoplakia
of the tongue.
Clinical findings:
Most primary infections in children are Epstein-Barr virus (EBV) or
asymptomatic. In older children & adults the (HHV-4)
classical syndrome associated with primary
infection is IMN (35-75% of the cases).
The incubation period of IMN is 1-2
months, symptoms of headache, malaise, sore
throat, fever , enlargement of LNs & spleen.
The typical illness is self-limited lasts for 2-4
weeks. There leukocytosis with the
predominance of lymphocytes (many of them
are large & atypical).
Oral hairy leukoplakia is a wort-like growth
develop on the tongue of some HIV infected
patients & transplant patients.
EBV is recognized as the cause of Burkitt's
lymphoma, nasopharyngeal carcinoma &
Hodgkin's disease. EBV- associated B cell
lymphomas are a complication for
immunodeficient patients.
Atypical lymphocytes
Laboratory diagnosis: Epstein-Barr virus (EBV) or
1. isolation & identification of virus. (HHV-4)
2. Serology: The EBV genome encodes a
number of different structural and
nonstructural genes, those of most
importance for serodiagnosis are encoding
the viral capsid antigens (VCAs), the early
antigens (EAs), and the EBNAs EBNA-1 and
EBNA-2. the common serological procedure
is ELISA. Early in acute disease, a rise in IgM
to viral capsid antigen (VCA)replaced within
weeks by IgG which persist for life. The
presence of anti-VCA IgM suggestive of
recent infection, while the presence of anti-
VCA IgG indicate past infection & immunity.
EBNA-1 IgG Ab, are produced late in the
course of infection, while EBNA-2 IgG Ab
appear earlier and may be present in up to
30% of individuals at the time of onset of the
disease.
EBNA-1 IgG Ab basically persist
lifelong, but not in all individuals due
to lost under circumstances
e.g.immunosuppression.
The use of anti-EBNA-1 versus anti-EBNA-2
Abs ratio for the serodiagnosis of EBV
reactivation. Tests for anti-EBNA-2 Abs are
not always available commercially.
Anti-EA Abs of IgG and IgA types are
detectable in early after primary infection
and individuals with past infections.
However, EA Abs are also detectable in
clinically healthy individuals, Therefore, EA-
specific serological parameters do not
confirm any stage-specific diagnosis.
3.Specific heterophil agglutination test may be
used for diagnosis of EB- IMN.
4. Molecular techniques for detection of viral
DNA.
Epidemiology: Epstein-Barr virus (EBV) or
EBV is common in all parts of the world. In (HHV-4)
developing areas infections occurs early in life (>
90% of children are infected by the age of 6 ys).
Most of these infections are asymptomatic,
however, it results in permanent immunity.

In developed areas > 50% 0f EBV infections are

delayed to older children & adults & 50% of
these infections are manifested by IMN.
Burkitt's lymphoma occur throughout the
world, but Africa as high incidence. EB viral NA
present in > 90% of African Burkitt's lymphoma,
while in other parts o the world, the EB viral DNA
present in 20% of BL.
Nasopharyngeal carcinoma is a rare tumor of
adults except in China where the incidence is
high. EBV DNA present in NPC cells from different
parts of the world.