Virologic diagnosis, viral monitoring, and treatment of epstein-barr virus infectious mononucleosis

Abstract

Epstein-Barr virus (EBV) is the cause of infectious mononucleosis and is associated with severe infections in immunocompromised patients. EBV is also causally linked with several human malignancies. The heterophile antibody test and EBV-specific antibody tests remain the principal means of diagnosis of initial infection in otherwise healthy patients. Enzyme-linked immunosorbent assays have replaced the traditional immunofluorescence assays for EBV-specific antibodies. Several newer molecular diagnostic tests have become available that facilitate accurate monitoring of infection. The role of these tests for patients with uncomplicated infectious mononucleosis is limited, although these tests are being increasingly used to monitor the state and level of EBV replication for severe infections and among immunocompromised patients. Antiviral therapy has a limited, short-term effect on oropharyngeal shedding but has proven ineffective for the clinical manifestations of infectious mononucleosis. Patients with selected complications frequently benefit from short-term corticosteroid therapy.

Serological diagnosis of Epstein-Barr virus infection: Problems and solutions

“…Dot blotting, Southern blotting, PCR and in situ hybridization have all been applied to various materials, but their differences in sensitivity and specificity have led to the results that need to be considered cautiously [28] as they vary from laboratory to laboratory [73,74] . More recent studies indicate that real-time PCR is particularly sensitive [28] , and very useful for defining infection status, especially in immunocompromised patients [45,75,76] and those at risk of developing EBVrelated disorders [45] . However, there is still no consensus concerning the best material to use, units of measurement, or the quantitative levels requiring intervention or predicting prognosis [16,74,[77][78][79] .…”

“…However, in immunocompetent patients with acute infection, it is not usually necessary to look for EBV DNA as serology is sufficient except in cases with negative or doubtful serological findings in which there is a strong clinical suspicion of infection [89,97,98] . A search for EBV DNA is particularly important in immunocompromised patients with an incomplete humoral response and patients who have received transfusions or immunoglobulins that confound serological test results [28] . It has been reported that immunocompromised patients have higher baseline viral levels than healthy carriers [99,100] , which decline after treatment.…”

“…EA (R) IgG levels may remain high for up to 2 years and, in cases of protracted disease, can be detected after the disappearance of EA (D) IgG [29] . EA (R) IgG has been found in children aged less than 2 years with silent infection, in patients with Burkitt's lymphoma, and also in the previously infected subjects at low levels [28] . High levels of EA (D) and/or EA (R) IgG can also be seen in cases of reactivation and in immunocompromised patients [29] .…”

“…Approximately, 20%-30% of healthy subjects who have previously been infected by EBV have EA (D) IgG [2,23,25] . High titers have also been seen during reactivation [26] and in patients with nasopharyngeal carcinoma [27] , who also have high titers of VCA and EA IgA [28] . EA (R) IgG levels may remain high for up to 2 years and, in cases of protracted disease, can be detected after the disappearance of EA (D) IgG [29] .…”

“…Furthermore, in cases of past infection diagnosed on the basis of a high level of VCA IgG avidity, none of the serum samples were positive for EBV DNA [86] . A search for heterophile antibodies may be useful in patients with isolated VCA IgG if the result is positive, although there have been reports of their presence for 6-12 mo [28,35,48] . About 60% of patients with acute infection and isolated VCA IgG present heterophile antibodies, as against none of those with past infections [107] .…”