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Epstein-Barr virus

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- The Epstein-Barr virus (EBV) is a member of the herpes virus family.

- Infection during adolescence or young adulthood causes infectious mononucleosis, also known as glandular fever, in 30-50 per cent of cases (Centers for Disease Control (CDC), 2002).

- In a UK study (Crawford et al, 2002), 79 per cent of women and 67 per cent of men tested seropositive for EBV, indicating that they had been infected at some time.

- It is thought that up to 50 per cent of people in the UK are infected with EBV before the age of five.

- The virus is transmitted through saliva and mucus - often by kissing an infected person.

- It can also be transmitted through airborne droplets and blood products.

- The incubation period is four to seven weeks.

- Infection is asymptomatic in children, or symptoms are indistinguishable from other illnesses of childhood such as tonsillitis.

- The virus can be reactivated periodically. This is usually asymptomatic but the carrier will be infectious.

- Severe fatigue.

- Fever.

- Sore throat.

- Depression.

- Swollen tonsils with white coating.

- Swollen lymph nodes, particularly in the throat, nose and neck.

- Headache.

- Muscular pain.

- Loss of appetite.

- Excessive sweating.

- Blotchy red or bruise-like rash.

- Swelling around the eyes.

- Infection usually causes a mild illness that can last for several weeks, although some patients continue to experience symptoms sporadically for months, particularly depression and fatigue.

On rare occasions EBV can lead to serious complications:

- Enlarged spleen - in rare cases the spleen can rupture;

- Hepatitis, which can lead to jaundice;

- Anaemia;

- Encephalitis;

- The virus also appears to play a role in two rare cancers - Burkitt's lymphoma and nasopharyngeal carcinoma, although it is unlikely to be the sole cause (CDC, 2002).

Certain patient groups are at risk of serious illness if infected with EBV:

- Organ transplant recipients;

- Those who are HIV positive;

- Those undergoing chemotherapy;

- Those with immune system disorders.

Diagnosis is usually made on the basis of symptoms and patient age.

A number of blood tests can be used for confirmation and to rule out other conditions:

- Heterophile antibody (Paul-Bunnell) test;

- Monospot test;

- Test for EBV antibodies.

There is no cure for EBV infection; treatment aims to relieve symptoms.

- Mild analgesia to relieve headache, sore throat and fever.

- Plenty of fluids - particularly if there is fever.

- Plenty of rest.

- Antibiotics if there is a secondary bacterial infection, for example in the tonsils.

- Steroids to reduce severe inflammation in the throat.


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