Progress and Problems in Understanding and Managing Primary Epstein-Barr Virus Infections

Abstract

SUMMARY Epstein-Barr virus (EBV) is a gammaherpesvirus that infects a large fraction of the human population. Primary infection is often asymptomatic but results in lifelong infection, which is kept in check by the host immune system. In some cases, primary infection can result in infectious mononucleosis. Furthermore, when host-virus balance is not achieved, the virus can drive potentially lethal lymphoproliferation and lymphomagenesis. In this review, we describe the biology of EBV and the host immune response. We review the diagnosis of EBV infection and discuss the characteristics and pathogenesis of infectious mononucleosis. These topics are approached in the context of developing therapeutic and preventative strategies.

Isolated oculomotor nerve palsy revealing infectious mononucleosis

“…Concerning the treatment, the use of corticosteroids in patients with neurological manifestations related to IM remains controversial (Odumade et al 2011). It has been argued that steroids may enhance replication of herpesviruses.…”

Antibiotic Induced Cutaneous Rash in Infectious Mononucleosis: Overview of the Literature

“…Antibiotics: drugs causing rash with the highest incidence within IM There are some studies on the usefulness of antiviral, corticosteroid and anaerobic antibacterial (metronidazole) treatments in IM, however the generally accepted therapy is antipyretic and analgetic drugs, enough hydration and rest [4,[9][10][11]. The use of antibiotics is considered mostly unnecessary and is a consequence of misdiagnosis rather than the presence of a concomittant actual bacterial infection [9].…”

In vivo intratumoral Epstein–Barr virus replication is associated with XBP1 activation and early-onset post-transplant lymphoproliferative disorders with prognostic implications

“…Thus, the assessment of replicative stage of EBV should be performed before deciding any antiviral therapeutic approach in patients with post-transplant lymphomas. [46][47][48] The use of antiviral as prophylactic treatment to prevent post-transplant lymphoma development has been proved to be effective in pediatric cases. 19 However, in adults, the results are controversial, probably because most of the adults are already infected at the time of transplant and there is not a standardized protocol to study donor and recipient EBV status before transplant.…”