Clinical Information

Epstein-Barr virus (EBV), a member of the herpesvirus group, is the etiologic agent of infectious mononucleosis. EBV infections are difficult to diagnose in the laboratory since the virus does not grow in standard cell cultures. The majority of infections can be recognized, however, by testing the patient's serum for heterophile antibodies (rapid latex slide agglutination test, eg, MONOS / Infectious Mononucleosis, Rapid Test, Serum), which usually appear within the first 3 weeks of illness but then decline rapidly within a few weeks. The heterophile antibody, however, fails to develop in about 10% of adults, more frequently in children, and almost uniformly in infants with primary EBV infections. Most of these heterophile antibody-negative cases of infectious mononucleosis-like infections are due to cytomegalovirus, but in a series of 43 cases, EBV was the cause in 7. In cases where EBV is suspected but the heterophile antibody is not detected, an evaluation of the EBV-specific antibody profile (eg, EBV viral capsid antigen [VCA] IgM, EBV VCA IgG, and EBV nuclear antigen [EBNA]) may be useful.

Infection with EBV usually occurs early in life. For several weeks to months after acute onset of the infection, it is spread by upper respiratory secretions that contain the virus. Among the clinical disorders due to EBV infection, infectious mononucleosis is the most common. Other disorders due to EBV infection have been recognized for several years, including African-type Burkitt lymphoma and nasopharyngeal carcinoma. EBV infection may also cause lymphoproliferative syndromes, especially in patients who have undergone kidney or bone marrow transplantation and in those who have AIDS.