Key points
- Epstein-Barr virus (EBV) can cause illnesses and complications aside from infectious mononucleosis.
- EBV infection can affect a person's brain, spinal cord, and nerves.
- People with weakened immune systems may develop more severe illness caused by EBV infection.
Who is at risk
People with weakened immune systems may develop more severe symptoms and complications from EBV infection. They may also have more severe illness caused by EBV infection.
Clinical features
EBV infection can affect a person's brain, spinal cord, and nerves. EBV infection can cause conditions such as:
- Viral meningitis (swelling of the tissues that cover the brain and spinal cord)
- Encephalitis (swelling of the brain)
- Optic neuritis (swelling of the eye nerve)
- Transverse myelitis (swelling of the spinal cord)
- Facial nerve palsies (paralysis of facial muscles)
- Guillain-Barré syndrome (an immune system disease)
- Acute cerebellar ataxia (sudden uncoordinated muscle movement)
- Hemiplegia (paralysis on one side of the body)
- Sleep disorders
- Psychoses
EBV infection can affect a person's blood and bone marrow. The virus can cause the body to produce an excessive number of white blood cells called lymphocytes (lymphocytosis).
EBV can also weaken the immune system, making it more difficult for the body to fight infection. Examples of some of these conditions include—
- Neutropenia with secondary infections
- Hemophagocytic syndrome (hemophagocytic lymphohistiocytosis)
- Acquired hypogammaglobulinemia
- X-linked lymphoproliferative disease
- Burkitt's lymphoma (cancer of the lymphatic system)
- Nasopharyngeal carcinoma (cancer of the upper throat)
- Hodgkin's disease and non-Hodgkin's lymphoma (cancers of the lymphatic system)
- Post-transplant lymphoproliferative disorder (white blood cells are produced in excess)
- Other tumors including leiomyosarcomas (cancer in the soft tissue) and T-cell lymphomas
EBV infection can also cause:
- Pneumonia (injury of the lungs)
- Interstitial lung disease (a large group of disorders, most of which cause scarring of lung tissue)
- Pancreatitis (swelling of the pancreas)
- Myocarditis (swelling of the heart muscle)
- Oral cavity-oral hairy leukoplakia (raised, white patches on the tongue), which is usually seen in people infected with HIV
Testing and diagnosis
Diagnosing EBV infection can be challenging because the symptoms are similar to other illnesses. EBV infection can be confirmed with a blood test that detects antibodies. Testing can help distinguish whether someone is susceptible to EBV infection or has a recent or past infection.
Laboratory tests are not usually needed to diagnose infectious mononucleosis. Specific tests may be needed for patients who do not have a typical case of infectious mononucleosis.
Complications
Complications of EBV infection include:
- Peritonsillar abscesses (pus-filled tissue near the tonsils)
- Acute bacterial sinusitis (bacterial infection of the sinus cavities)
- Suppurative lymph nodes (swelling of lymph nodes)
- Mastoiditis (bacterial infection of the mastoid bone of the skull)
- Sialadenitis (swelling and injury of salivary glands)
- Blockage of the air passages in the nose and throat