 | Dr. Aruna Subramanian, Co-Director of the Hopkins Transplant Infectious Disease team answers some common questions about infectious disease. 1. What is EBV? EBV stands for Epstein-Barr virus, the virus that causes mononucleosis. EBV belongs to the family of herpes viruses like cytomegalovirus (CMV) and herpes simplex virus (HSV). Like these viruses, it is able to become latent and persist in the body even after someone has recovered from the illness caused by their initial infection with EBV. |
2. What are the typical signs/symptoms of EBV infection?
Many people do not even know that they have had EBV infection in the past. Children with EBV infection may not have any symptoms, or may have an upper respiratory tract infection, diarrhea, etc.
Adolescents and young adults are more likely to have symptoms of mononucleosis, mainly fever, pharyngitis (sore throat) and lymph node (gland) enlargement if they develop infection.
3. How does a transplant patient get an EBV infection?
By the time we reach adulthood, 90-95% of us have been previously infected with EBV so most adult transplant patients are not at risk of developing new infection. However, in the US only a minority of children have been exposed, so pediatric and adolescent transplant recipients may be at risk for new infections. Infection is spread by contact with infected bodily fluids (e.g. saliva through kissing), and also can be transmitted through an organ transplant if the donor had been exposed and the recipient was not.
4. Are there specific concerns about EBV in transplant patients?
Since EBV becomes latent in some white blood cells it can contribute to a condition called post-transplant lymphoproliferative disease (PTLD). Children and young people who were never exposed in the past and develop their first EBV infection after transplant are at higher risk of developing PTLD. Adults who were previously exposed also can have reactivation of the EBV which can to a lesser extent lead to PTLD. This is quite uncommon but is something the transplant team is vigilant for after transplant.
5. When does Johns Hopkins first begin to educate patients about EBV?
At the pre-transplant visit the coordinators educate patients about viruses that can potentially be a problem to patients after the transplant. Blood tests are taken which let us know whether the patient has been exposed to EBV in the past.
6. How does Johns Hopkins protect transplant patients’ health from active EBV infection?
Unfortunately there are no antiviral medications that will completely prevent EBV infection or prevent PTLD. Acyclovir has some activity but does not eradicate EBV. The way we protect our patients’ health is to try to avoid or aggressively treat other viral infections that may make EBV worse (such as CMV). Also, if someone is having fevers post-transplant we have a low threshold for looking for active EBV infection or reactivation in the blood. If we find EBV in the blood we try to reduce the anti-rejection medicines if possible and look carefully for any evidence of PTLD.
