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Epstein barr virus
  1. Family Herpesviridae, double stranded DNA virus
  2. EBV replicates in epithelial cells of nasopharynx and salivary glands
  3. Latent infection is established in B cells (EBV receptor: CD21 on surface of B cells)
  4. Infection acquired through kissing or contaminated utensils
a. It is associated with following diseases
  1. Heterophile +ve infectious mononucleosis
  2. Burkitt's lymphoma (equatorial Africa, children)
  3. Hodgkin's disease (mixed cellularity)
  4. Non-Hodgkin’s lymphoma
  5. Primary B cell lymphomas (in immunocompromised)
  6. Oral hairy leukoplakia
  7. X linked lymphoproliferative syndrome (DUNCAN'S DISEASE)
  8. Anaplastic nasopharyngeal carcinoma (southern provinces of China, adults) 
b. Bimodal peak of infection
  1. Early childhood (asymptomatic)   
  2. Late adolescence (symptomatic, infectious mononucleosis of glandular fever)
  3. Pathogenesis : Infects epithelium of oropharynx & salivary glands Proliferation of EBV infected B - cell , reactive T cell, enlargement of lymphoid tissue, Inverted CD4+ / CD8+ T cell ratio
c. Infectious mononucleosis
Clinical Manifestation : I.P.: 4 - 6 weeks, patient presents with sore throat, generalized lymphadenopathy, fever, malaise, myalgia,

i. Complications :
  • GBS,
  • Bells palsy,
  • meningoencephalitis,
  • transverse myelitis,
  • thrombocytopenia,
  • carditis,
  • nephritis,
  • pneumonia,
  • splenic rupture
ii. Laboratory diagnosis
  • WBC - 10,000 - 20,000 / μl
  • Lymphocytosis with > 10% atypical lymphocytes (CD8 lymphocytes)
  • Neutropenia & thrombocytopenia
iii. Serological testing :
  • Isolation: by immortalization of normal human lymphocytes
  • Nucleic acid detection: DNA hybridization, PCR
  • Antibody detection
  • IgM anti viral capsid antigen: current infection
  • IgG anti viral capsid antigen: past infection and immunity
  • Antibodies to early antigen: current infection
  • Antibodies to EBNA: past infection
  • Heterophile antibody test (Paul Bunnell test): agglutination of sheep RBCs (less specific) 
d. Treatment :
  1. Patients of IM - Supportive measures with rest & analgesics
  2. Prednisolone (40 - 60mg /d) in complicated IM like airway obstruction, autoimmune haemolytic anemia or severe thrombocytopenia
  3. Acyclovir : decreases shedding from oropharynx, no effect on symptoms of IM
7. Human herpes virus 6
  1. Infect CD4+ T cells
  2. Salivary glands major reservoir and saliva main route of transmission
a. Clinical features
  1. Most infections asymptomatic
  2. Exanthem subitum/ roseola infantum/ sixth disease: mild facial rash occurring between 6 months to 3 years of age with fever
  3. Mononucleosis with cervical lymphadenopathy: adults
8. Human herpes virus 7
  1. Like HHV 6, it may also cause roseola infantum
  2. Infect CD4+ T cells
9. Human herpes virus 8
Also called as Kaposi’s sarcoma associated herpes virus
Detected in over 90% of Kaposi’s sarcomas. Also associated with primary effusion lymphoma and multicentric Castleman’s disease.
Cercopithecine herpesvirus 1/ herpes virus simiae
Infects macaque monkeys causing vesicular eruptions in the tongue and buccal mucosa
Human infection acquired from bite or handling of infected monkeys
Local inflammation at the site of entry followed by fatal ascending paralysis

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