Clinical Information

Primary infection with Epstein-Barr virus (EBV), a DNA virus in the Herpesviridae family, may cause infectious mononucleosis resulting in a benign lymphoproliferative condition characterized by fever, fatigue, sore throat, and lymphadenopathy. Infection occurs early in life, and by 10 years of age, 70% to 90% of children have been infected with this virus. Usually, infection in children is asymptomatic or mild and may be associated with minor illnesses, such as upper respiratory tract infection, pharyngitis, tonsillitis, bronchitis, and otitis media.

The target cell for EBV infection is the B lymphocyte. Immunocompromised individuals lacking antibody to EBV are at risk for acute EBV infection that may cause lymphoproliferative disorders in organ transplant recipients (post-transplant lymphoproliferative disorders: PTLD) and AIDS-related lymphoma. The incidence of PTLD ranges from 1% for kidney transplant recipients to as high as 9% for heart/lung transplants and 12% for pancreas transplant patients.

EBV DNA can be detected in the blood of patients with this viral infection. Increasing serial levels of EBV DNA in plasma have been shown to correlate highly with subsequent (in 3-4 months) development of PTLD in susceptible patients. Organ transplant recipients (at risk for primary EBV infection) who are seronegative  for EBV (most often children) and receive antilymphocyte globulin for induction immunosuppression and OKT-3 treatment for early organ rejection are at the highest risk for developing PTLD when compared to immunologically normal individuals with prior EBV infection.