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Epstein-Barr Virus (EBV) and Cytomegalovirus (CMV) by Dr. Himanshu Khatri
- 1. Epstein-Barr Virus (EBV)and Cytomegalovirus (CMV) Dr. Himanshu Khatri Email: [email protected]
- 2. Epstein-Barr Virus (EBV) •Enveloped virus • Icosahedral capsid symmetry • ds-DNA virus • Antigens: 1. Viral capsid antigen (VCA), 2. Early antigens (EA), and 3. Epstein-Barr nuclear antigen (EBNA) • Infects lymphoid cells (primarily B-cells) and eipthelial cells of pharynx
- 3. Pathogenesis • Present inoropharyngeal secretions spreads by kissing (kissing disease), sharing drinking glasses, toothbrushes • Oropharynx blood B-lymphocytes: 1. Primary infection by replication in B-cells 2. Latent infection in B-cells 3. Transformation of B-cells malignancy • Cytotoxic T cells react against infected B-cells and increase in number: lymphocytosis with atleast 10% atypical lymphocytes
- 4. Clinical syndromes • Primaryinfection: Infectious mononucleosis • Tumors • Infection in immunocompromised host
- 5. Infectious mononucleosis (Glandular fever) •90% of young children experience an asymptomatic primary infection • Symptomatic primary infection is seen in adolescents and young adults • Non-specific symptoms like high fever, headache, myalgia, fatigue etc. • Also sore throat, lymphadenopathy, abdominal pain (due to hepatitis and splenomegaly) • Symptoms usually resolve in 2-3 weeks
- 6. Complications • Upper airwayobstruction • Splenic rupture • Meningoencephalitis • Guillain-Barre syndrome
- 7. • EBV isfound in 90% cases of infectious mononucleosis • CMV is most common cause of EBV-negative infectious mononucleosis
- 9. Tumors • Burkitt lymphoma •Nasopharyngeal carcinoma: endemic in males of Chinese origin • Some forms of Hodgkin’s lymphoma and non- Hodgkin’s lymphoma • Post-transplant lymphoproliferative disorder (PTLD): B-cell lymphoma in post-transplant patients
- 10. Burkitt lymphoma • Poorlydifferentiated monoclonal B-cell lymphoma • Endemic in Africa • Usually occurs in children • Usually associated with Plasmodium falciparum malaria infection • Swelling of the jaw
- 11. EBV infection inimmunocompromised host • Fatal form of infectious mononucleosis • Oral hairy leukoplakia: non-malignant, whitish, hairy plaques on the lateral side of tongue
- 12. Laboratory diagnosis • Lymphocytosiswith atleast 10% atypical lymphocytes • Presence of heterophile antibodies bind to Paul-Bunnell antigen on sheep, horse or bovine erythrocytes agglutinate them (Paul- Bunnell test) • Monospot test is a slide agglutination test based on the principle of Paul-Bunnell test
- 13. Serology • Recent infection:IgM VCA and antibodies to EAs • Past infection: IgG VCA and antibodies to EBNA
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- 15. Cytomegalovirus (CMV) • Cytomegaloas large swollen cells are seen in infection with CMV • Presence of Owl’s eye inclusion body (dense central basophilic inclusion) in infected cells
- 16. Pathogenesis • It infectssalivary glands enters blood infects epithelial cells and other glands of the body • It is shed in secretions and urine • Transmission is usually by contact with saliva • Sexual transmission by semen and cervical secretions in adults is possible • Transmission by blood and organ transplant is also possible
- 17. Clinical syndromes • Congenitaland perinatal CMV infection • Infectious mononucleosis (2nd most common cause) • Infection in the immunocompromised (disseminated disease with high fatality)
- 18. Congenital CMV infection •Most common viral cause of congenital infection • Usually through placenta • If mother already has antibodies asymptomatic congential CMV infection or mental/growth retardation • If mother does not have antibodies Cytomegalic inclusion disease in newborn: microcephaly, intracerebral calcifications, hepatosplenomegaly, and petechial rash
- 20. Perinatal infections 1. Expsoureto genital secretions in the birth canal 2. Through breast milk • Most infections are asymptomatic
- 21. Laboratory diagnosis • Specimens:saliva and other secretions, urine, blood, and tissue • Direct antigen detection in secretions: pp65 and pp67 proteins • Isolation of virus • Serology • Molecular diagnosis: PCR
- 22. Treatment • Ganciclovir • Foscarnetfor ganciclovir resistant cases
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