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Pathogenesis Of Epstein-Barr Virus Associated Infectious Mononucleosis

Tsvetelina Kostadinova, Gabriela Tsankova


Infectious mononucleosis (IM) is a clinical syndrome that is most commonly associated with primary Epstein – Barr virus (EBV) infection. It was discovered in 1964 by electron microscopy of cells cultured from Burkitt`s lymphoma tissue by Michael Anthony Epstein and Yvonne Barr in a child from Africa. This is the first human oncogenic virus described. At present, in the international classification of viruses it is Human gammaherpesvirus 4, the fourth in order of discovery representative of this family. EBV is widespread and over 90% of the adult population in the world is infected with it. The infection is transmitted mostly by oropharyngeal secretions and because of this in the literature, IM is also referred to as the “Kissing Disease”. Initially, the virus replicates in the pharynx epithelium and then infects the lymphocytes of the underlying lymphoid tissue. Infection is spread in the whole body by circulating lymphocytes. EBV remains dormant in the B-lymphocyte population and these cells are a reservoir of the virus throughout life. The incubation period is 4-6 weeks and disease occurs with the classical triad - a fever with severe fatigue, lymphadenopathy and pharyngitis. Leukocytosis with lymphocytosis, predominantly with atypical lymphocytes, are detected during the second or third week of the disease. For serological diagnosis, antibodies against viral antigens such as anti-VCA Ig M and Ig G are positive, and antibodies to EBNA1 (EB nuclear antigen) are not seen in the acute phase of EBV infection. The connection between IM and Hodgkin's lymphomas makes IM a socially significant illness and requires accurate diagnosis supported by appropriate laboratory studies.


EBV, infectious mononucleosis, Human gammaherpesvirus 4, EBV infection

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