Stephen E. Straus, MD; Jeffrey I. Cohen, MD; Giovanna Tosato, MD; Jeffery Meier, MD
Epstein-Barr virus (EBV) encodes genes that ensure its persistence in human B lymphocytes. Some of the genes encourage B-cell proliferation; others are poised to evade or defeat immune recognition. Immune restraints on the virus, however, are typically so effective that most infections are never symptomatic. In contrast, acute infectious mononucleosis, a self-limited lymphoproliferative illness, is common in adolescents and young adults. Unbridled proliferative illnesses arise when cellular immunity is grossly defective. Treatment of EBV-associated syndromes is largely supportive. Antiviral drugs have no proven role except in patients with oral hairy leukoplakia. Vaccine development is technically feasible but is not considered a high priority for developed nations.
The genome consists of about 172 000 base pairs of double-stranded DNA (top line) that are organized in a series of unique (U1 to U5), internal repeat (IR1 to IR4), and terminal repeat (TR) domains (second line). Shorter repeated regions occur but are not shown. Several of the Epstein-Barr virus genes expressed during the viral replication cycle (third line) and during viral latency in B lymphocytes (fourth line) are depicted. The coding regions of EBNA (Epstein-Barr virus nuclear antigen)-LP, LMP (latent membrane protein)-1, and LMP-2A and LMP-2B are spliced (-o) from discontinuous portions of the genome; LMP-2A and LMP-2B begin at the right end of the circularized genome and extend across the terminal repeats to the left end of the genome. EBERs = Epstein-Barr virus encoded RNAs; ZEBRA = Z Epstein-Barr virus replication activator.
Specimens were stained with monoclonal antibody to Epstein-Barr virus nuclear antigen 2 (EBNA-2) or latent membrane protein 1 (LMP-1) (bottom panel). Note the nuclear staining with nucleolar exclusion with EBNA-2 antibody and cytoplasmic membrane staining with LMP-1 antibody. Reproduced with permission from Gilligan and colleagues and Cohen .
The geometric mean is indicated by the horizontal bar.
The T cells were cultured for 3 days in phytohemagglutinin (PHA), 0.5 µg/mL, either alone or with interleukin-10, 0.1 to 10 U/mL. Proliferation was measured as counts per minute (cpm) of Hydrogen-3-thymidine incorporation during the final 18 hours of culture. IL = interleukin.
Straus SE, Cohen JI, Tosato G, et al. Epstein-Barr Virus Infections: Biology, Pathogenesis, and Management. Ann Intern Med. 1993;118:45–58. doi: https://doi.org/10.7326/0003-4819-118-1-199301010-00009
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Published: Ann Intern Med. 1993;118(1):45-58.
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