EBV

Question 1

Method of transmission

Answer 1

saliva, rarely blood transfusion or solid organ transplant

Question 2

What is the predominant type in the US

Answer 2

EBV 1

Question 3

How does EBV infect cells

Answer 3

Infects B cells through the C3d or CD21 receptor

Question 4

What is the site of latency for EBV

Answer 4

B cells

Question 5

What are the symptoms of primary infection in adolescents? Adults?

Answer 5

Adol: subclinical or mononucleosis-fever, LAD, sore troat
Adults: hepatitis and jaundice

Question 6

What diseases are EBV associated

Answer 6

Infectious mononucleosis
x-linked lymphoproliferative disorder
Hodgkins Lymphoma
Primary effusion lymphoma
Lymphomatoid granulomatosis
PTLD (post transplant lymphoproliferative disorder)
Oral hairy leukoplakia
Nasopharyngeal carcinoma

Question 7

EBV induces production of what antibodies

Answer 7

anti-I; rheumatoid factor; ANA; heterophile antibodies

Question 8

What gene is responsible for X-linked lymphoproliferative disorder (Duncan disease) and what does it encode

Answer 8

SAP gene (SH2D1A)-the SAP protein which is a transmembrane signaling protein that is involved in the usual immune response to viral infection, but results in uncontrolled activation of T/NK cells in those with the mutation

Question 9

What are the criteria for diagnosing infectious mono?

Answer 9

Hoagland’s criteria: leukocytosis >50% with >10% atypical lymphocytes, fever, pharyngitis, adenopathy and a positive serology test

Question 10

What antibodies are tested in EBV serology

Answer 10

Heterophile: early acute - acute stage
IgM Anti-viral capsid antigen (VCA): early acute - acute stage
IgG Anti-early antigen (EA): Acute, covalescent and remote stages
IgG Anti-VCA: Early acute, Acute, covalescent and maybe remote
Anti-EB nuclear antigen (EBNA): Covalescent and remote

Question 11

How can you test for EBV infection in tissue sections?

Answer 11

In situ hybridization with EBV encoded RNA (EBER): present in tumors and active EBV infected lymphoid tissues

LMP1 IHC: cytoplasmic and membranous staining; reliable in Hodgkin Lymphoma, mono, and PTLD; should be followed up with EBER if negative

Question 12

What can cause a false monospot test

Answer 12

Immune deficient states such as: HIV, Lupus and Lymphoma