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Human Herpes Virus Type 4
  • Classification
    • Virus
      • Enveloped
        • Herpesviridae
          • EBV (HHV-4)
  • Pathogenesis
    • transmission
      • respiratory secretions
      • saliva
        • "kissing disease"
        • peak incidence 15-20 years of age
    • molecular biology
      • latent infection of B cells
        • EBV binds to CD21 and acts as a B cell mitogen 
      • results in production of atypical reactive T cells known as Downey cells
        • Downey cells may be up to 70% of WBC count
    • oncogenicity associated with expression of latency-associated membrane protein 1 (LMP-1)
Diseases
  • Infectious mononucleosis
    • positive monospot (heterophile positive)
    • characterized by
      • fever
      • hepatosplenomegaly
      • pharyngitis
      • lymphadenopathy (especially posterior cervical nodes)
  • Oral hairy leukoplasia (OHL)
    • seen in AIDS (CD4 < 400)
  • Non-Hodgkin's lymphoma
  • Burkitt's lymphoma
    • cancer of the mandible, maxilla, or abdomen
  • Diffuse large B cell lymphoma
    • can be CNS associated
  • Nasopharyngeal carcinoma
  • CNS lymphoma
    • in HIV+ patients
  • Post-transplant lymphoproliferative disorder
    • in allograft recipients
Laboratory
  • Downey type II atypical T lymphocytes 
  • Monospot test
    • heterophile IgM antibodies detected by agglutination of sheep RBCs
      • EBV stimulates infected B cells to make heterophile antibodies
  • Characteristics
    • DNA
      • double-stranded
      • linear
    • enveloped
Treatment
  • Treat symptoms
 

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