Epstein barr virus can it recur

Early work suggested that the disease might be due to mutant strains of EBV that are impaired for latency and might only result in lytic infection However, a followup study showed that the same lytic strain was present in controls Attention has focused on a host cell genetic abnormality. Many patients with CAEBV develop hemophagocytic syndrome; some patients with familial hemophagocytic lymphohistiocytosis have mutations in perforin. To date, no cases of CAEBV have been associated with mutations in SAP 3 , 13 , Cohen et al unpublished data , while one case was reported that was due to mutations in both alleles of the perforin gene Hemophagocytic syndrome was noted in this latter case and the patient had an immature form of perforin and impaired cytotoxic T lymphocyte CTL activity based on an in vitro assay.

Transcriptional profiling of cells from patients and controls showed that 3 genes-guanylate binding proteins 1 and 5, and tumor necrosis factor-induced protein 6- were upregulated in patients with CAEBV While anecdotal reports suggested that antiviral therapy e. These agents inhibit the viral DNA polymerase and therefore inhibit replication of EBV in lytically infected cells that express the viral polymerase. Replication of latent EBV in proliferating B cells does not require the viral DNA polymerase, and therefore antiviral therapy is usually ineffective.

Immunoglobulin therapy, which can neutralize cell-free virus, has not been successful. Immunosuppressive agents, such as corticosteroids and cyclosporine, are often used to temporarily reduce symptoms in patients with CAEBV. These agents have been successful for treating hemophagocytic syndrome which is a frequent complication of CAEBV However, the underlying disease must also be treated and these agents have not been successful in curing patients with CAEBV Immunosuppressive agents can inhibit the immune response to EBV and may allow virus-infected cells to proliferate further.

One patient was reported to respond to IL-2 However, most patients have not responded to these therapies A variety of agents have been used including cyclophosphamide, anthracyclines, vincristine, etoposide, and prednisone. In most cases, these agents at best result in a temporary effect, but are not curative and the disease continues to progress over time.

Immune cell therapy has been successfully used in the treatment of EBV lymphoproliferative disease that occurs after solid organ or hematopoietic stem cell transplantation. Autologous LAK cells, lymphocytes from HLA-identical siblings, and autologous EBV-specific CTLs have been used successfully to treat patients with posttransplant lymphoproliferative disease in solid organ transplant recipients.

While the patient had a transient improvement with reduced fever and reduction of the viral load, pancytopenia persisted. The authors concluded that the effect of these therapies was very limited. Matched related myeloablative 27 , 28 , matched related nonmyeloablative 29 , 30 , 31 , matched unrelated myeloablative 31 , 32 , and cord blood stem cell transplants 33 , 34 have all been reported to be successful in case reports of CAEBV.

It is important to note that most reports of transplantation for CAEBV are case reports describing one or a few patients, and as such often report successful cases. In the largest series from a single institution, 8 of 15 patients with CAEBV were alive at a median followup of 40 months Seven patients died at a median of 3 months after transplant; three patients died of transplant related causes, 3 died due to relapsed disease, and 1 died with encephalomyelitis.

Uehara et al. Cytotoxic chemotherapy might reduce the burden of EBV-infected lymphocytes, might kill suppressor or regulatory T cells, or might make space in the marrow for the new stem cells. Transplanted stem cells can kill the remaining EBV-infected lymphocytes and provide a new immune system capable controlling the virus.

Gotoh et al. Thus, safer alternatives to transplantation should be developed. National Center for Biotechnology Information , U. Pediatr Transplant. Additionally, the observed delay between EBV infection and MS disease onset may also be due to the symptoms of MS going undetected during its earliest stages, Ascherio explained in the press release.

However, this delay may also be due to the evolving and progressive relationship between EBV and the immune system of its host. Upon reactivation of the latent virus within the host, EBV is repeatedly stimulated, which may correlate with the onset of MS or its symptoms. Epstein-Barr virus may be leading cause of multiple sclerosis. January 13, Alana Hippensteele, Managing Editor. This content does not have an English version.

This content does not have an Arabic version. See more conditions. Request Appointment. Mononucleosis: Can it recur? Products and services. Can mononucleosis recur? I thought that once you got mono you couldn't get it again. Thank you for subscribing Our Housecall e-newsletter will keep you up-to-date on the latest health information. Sorry something went wrong with your subscription Please, try again in a couple of minutes Retry.

Show references AskMayoExpert. Epstein-Barr virus infection. Mayo Clinic; Sullivan JL. Clinical manifestations and treatment of Epstein-Barr infection. Accessed Dec. Aronson MD.