EBV

Epstein-Barr virus (EBV), also known as human herpesvirus 4 (HHV-4), is a member of the Herpesviridae family. It is a double-stranded DNA virus that primarily infects B lymphocytes and epithelial cells. EBV establishes lifelong latency in B cells and can reactivate under immunosuppressive conditions. It is one of the most common human viruses; infection worldwide is widespread, and most people acquire it at some point in life.

EBV is transmitted mainly through saliva, which has led to the nickname “kissing disease” for the infectious mononucleosis form of primary EBV infection in adolescents and young adults. Primary infection in childhood is often mild or asymptomatic. In older children and adults, EBV infection frequently presents as infectious mononucleosis with fever, sore throat, cervical lymphadenopathy, fatigue, and sometimes hepatosplenomegaly. Beyond the acute illness, EBV persists in a latent form within B cells and can reactivate, particularly during immunosuppression; the virus can also infect epithelial cells and contribute to viral shedding.

EBV is linked to several diseases beyond infectious mononucleosis. It is associated with different malignancies, notably endemic Burkitt lymphoma, nasopharyngeal carcinoma, and a subset of Hodgkin lymphoma. It is also implicated in post-transplant lymphoproliferative disorder and oral hairy leukoplakia in HIV infection. Associations with autoimmune conditions have been investigated but remain less clearly defined.

Diagnosis relies on EBV-specific serology (such as VCA IgM/IgG and EBNA antibodies), heterophile antibody testing, and detection of EBV DNA by PCR in blood or tissue. Treatment is mainly supportive; there is no widely available vaccine, and antiviral therapy has limited effectiveness for routine EBV infection. In severe cases, management may involve corticosteroids for airway or edema complications, and PTLD is treated by adjusting immunosuppression and targeted therapies such as rituximab. Prevention focuses on reducing saliva-based transmission and awareness of reactivation in immunocompromised individuals.