Epstein-Barr Virus: Acute Infection, Oncogenesis, Prevention and Pitfalls

Primary infection by the Epstein-Barr virus (EBV) often occurs without symptoms, and by adulthood seroprevalence stands at approximately 95%. When symptomatic, it presents with acute mononucleosis after which most patients recover without specific therapy and without sequelae. Uncommon but potentially life-threatening complications of acute infection are discussed. Latent infection and immortalization occur, and through oncogenic pathways EBV-associated malignancies may develop. Patients receiving solid organ or hematopoietic stem cell transplants carry additional risks for EBV-associated post-transplant lymphoproliferative disorders through loss or reduction of T-cell surveillance but have differing epidemiology and presentations. These are reviewed along with treatment strategies based on consensus guidelines. Testing platforms carry specific pitfalls as detection of EBV DNA after acute infection is often episomal or non-encapsulated DNA rather than virion and varies based on the specimen tested. While no durable vaccine exists, potential targets and past trials are reviewed.