Serologic testing is the mainstay of diagnostic assessment. PCR analysis can be useful in monitoring EBV DNA levels in blood from pts with lymphoproliferative disease.
- Heterophile antibodies (Figure 100-1) form the basis of most rapid testing, which assesses the ability of serum to agglutinate sheep, horse, or cow erythrocytes after adsorption with guinea pig kidney.
- - The antibodies can persist for up to 1 year after infection.
- - The monospot test for heterophile antibodies is ~75% sensitive and ~90% specific in comparison with EBV-specific serologies.
- - Pts <5 years old and elderly pts usually do not develop heterophile antibodies.
- EBV-specific antibody testing can be used in heterophile-negative pts and in pts with atypical disease. Antibodies to viral capsid antigen occur in >90% of cases, with elevated IgM titers present only during the first 2-3 months of disease.
- Antibodies to Epstein-Barr nuclear antigen are not detected until 3-6 weeks after symptom onset and then persist for life.
Treatment: Epstein-Barr Virus Infections - IM is treated with supportive measures, including rest and analgesia.
- - Excessive physical activity should be avoided in the first month of illness to reduce the possibility of splenic rupture, which necessitates splenectomy.
- - Administration of glucocorticoids may be indicated for some complications of IM; e.g., these agents may be given to prevent airway obstruction or to treat autoimmune hemolytic anemia, hemophagocytic lymphohistiocytosis, or severe thrombocytopenia.
- - Antiviral therapy (e.g., with acyclovir) is generally not effective for IM but is effective for oral hairy leukoplakia.
- Treatment of posttransplantation EBV lymphoproliferative syndrome is generally directed toward reduction of immunosuppression, although other treatments—e.g., with interferon α, antibody to CD20 (rituximab), and donor lymphocyte infusions—have been used with varying success.
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For a more detailed discussion, see Baden LR, Dolin R: Antiviral Chemotherapy, Excluding Antiretroviral Drugs, Chap. 215e; Cohen JI: Epstein-Barr Virus Infections, Including Infectious Mononucleosis, Chap. 218, p. 1186; and Kotton CN, Hirsch MS: Cytomegalovirus and Human Herpesvirus Types 6, 7, and 8, Chap. 219, p. 1190, in HPIM-19. |