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Epstein-Barr virus (EBV); human herpesvirus 4 (HHV4)

Epidemiology: 1) humans are the sole source of the virus 2) may be isolated from genital & oral secretions 3) 67% of college men & 79% of college women are seropositive 4) oral & genital transmission 5) transmission occurs most commonly through prolonged & repeated contact with infected saliva & rarely through blood transfusions or bone-marrow transplantation Pathology: 1) EBV infects epithelial cells of the oropharynx, cervix & resting B lymphocytes which disseminate & proliferate until checked by activated T-cells - virus remains latent in B-lymphocytes 2) putative receptor: CD21 3) EBV is associated with: a) infectious mononucleosis (symptomatic primary infection) b) Burkitt's lymphoma c) Gianotti-Crosti syndrome d) B-cell lymphoma in immunocompromised hosts - primary CNS lymphoma in AIDS patients e) Hodgkin's disease [4] f) T-cell lymphoma [4] g) oral hairy leukoplakia (most commonly with HIV1 infection) [4] h) nasopharyngeal carcinoma i) aseptic meningitis, encephalitis j) febrile neutropenia k) hepatitis l) hemolytic anemia m) thrombocytopenia [4] n) post-transplantation lymphoproliferative disorder [4] o) 32-fold increased risk of multiple sclerosis [8] - EBV nuclear antigen 1 (EBNA1), is very similar to GlialCAM, prominent in astrocytes & oligodendrocytes & expressed heavily in plaques of multiple sclerosis - antibodies against EBNA1 also bind tightly to GlialCAM Genetics: - double-stranded DNA virus of the Herpes virus family - human proteins implicated in EBV infection: - CCR7, GPR183, CTBP1 - EBV induces ZNF271 Laboratory: 1) heterophile antibody - Monospot vs heterophile antibody titer 2) EBV serology, if heterophile antibody negative a) acute primary infection 1] elevated EBV capsid IgM in serum & EBV capsid IgG in serum 2] elevated EBV early IgG in serum 3] low or undetectable EBV nuclear IgG in serum b) past infection 1] undectable EBV capsid IgM in serum 2] elevated EBV capsid IgG in serum 3] undectable EBV early IgG in serum 4] elevated EBV nuclear IgG in serum c) also see EBV CSF serology 3) Epstein-Barr virus DNA 4) see ARUP consult [5] Management: - see infectious mononucleosis Comparative biology: - nanoparticle vaccine prevents EBV infection in mice & nonhuman primates

Related

B-cell lymphoid neoplasm (B-cell lymphoma) Burkitt's lymphoma CC chemokine receptor type 7; C-C CKR-7; CC-CKR-7; CCR-7; MIP-3 beta receptor; EBV-induced G-protein coupled receptor 1; EBI1; BLR2; CDw197; CD197 (CCR7, CMKBR7, EBI1, EVI1) Epstein-Barr virus (EBV) IgA Epstein-Barr virus (EBV) IgG Epstein-Barr virus (EBV) IgM Epstein-Barr virus (EBV) serology Epstein-Barr virus DNA G-protein coupled receptor 183; EBV-induced G-protein coupled receptor 2 (GPR183, EBI2) gammaherpesvirinae Gianotti-Crosti syndrome (papular acrodermatitis of childhood) hairy leukoplakia heterophile antibody infectious mononucleosis

General

herpesviridae oncogenic virus

Figures/Diagrams

Diseases Associated with Inhibition of Apoptosis

Properties

KINGDOM: virus GENOME-TYPE: deoxyribonucleic acid (DNA) DOUBLE-STRANDED GENOME-SIZE: entity length :VALUE RANGE :LOW 120 :HIGH 200 :UNITS KB ENVELOPE: PRESENT CAPSID-SYMMETRY: ICOSAHEDRAL

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 872-73
  2. Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 769
  3. Journal Watch 22(21):157, 2002 Crawford DH et al Sexual history and Epstein-Barr virus infection. J Infect Dis 2002, 186:731 PMID: 12198605
  4. Medical Knowledge Self Assessment Program (MKSAP) 14, 16, 17, 19. American College of Physicians, Philadelphia 2006, 2012, 2015, 2021 - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  5. ARUP Consult: Epstein-Barr Virus - EBV The Physician's Guide to Laboratory Test Selection &bInterpretation https://www.arupconsult.com/content/epstein-barr-virus
  6. Wikipedia: Epstein-Barr virus https://en.wikipedia.org/wiki/Epstein%E2%80%93Barr_virus
  7. AbuSalah MAH, Gan SH, Al-Hatamleh MAI et al Recent Advances in Diagnostic Approaches for Epstein-Barr Virus. Pathogens. 2020 Mar 18;9(3):226 PMID: 32197545 Free PMC article. Review.
  8. George J MS Risk Skyrockets After Epstein-Barr Virus, but Not Other Infections. Findings show "compelling evidence of causality". MedPage Today January 13, 2022 https://www.medpagetoday.com/neurology/multiplesclerosis/96656 - Bjornevik K, Cortese M, Healy BC et al Longitudinal analysis reveals high prevalence of Epstein-Barr virus associated with multiple sclerosis. Science. 2022. Jan 13. PMID: 35025605 https://www.science.org/doi/10.1126/science.abj8222
  9. Lanz TV et al. Clonally expanded B cells in multiple sclerosis bind EBV EBNA1 and GlialCAM. Nature 2022 Mar 10; 603:321. PMID: 35073561 https://www.nature.com/articles/s41586-022-04432-7 - Wekerle H. Epstein-Barr virus sparks brain autoimmunity in multiple sclerosis. Nature 2022 Mar 10; 603:230. PMID: 35169323 https://www.nature.com/articles/d41586-022-00382-2 - Mullard A. The quest to prevent MS - And understand other post-viral diseases. Nature 2022 Mar 10; 603:784. PMID: 35354995 https://www.nature.com/articles/d41586-022-00808-x