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Management of Epstein-Barr virus infections
1Department of Infectious Diseases, Danderyd Hospital, Stockholm, Sweden.
Abstract:
Both oral and intravenous acyclovir administration for seven days in the early stages of infectious mononucleosis caused an inhibition of oropharyngeal Epstein-Barr virus (EBV) replication. Minimal effect on clinical symptoms was observed. Development of normal cellular and humoral EBV-specific immunity was seen in all patients. The combination of intravenous acyclovir and prednisolone treatment for 10 days in 11 patients with fulminant mononucleosis caused transient cessation of virus shedding in all patients. A dramatic clinical effect on pharyngeal symptoms and on fever was seen in nine of 11 patients within 72 hours. Treatment with chemotherapy or irradiation is recommended in EBV-associated B cell lymphomas seen in immunosuppressed, transplanted, and human immunodeficiency virus-I seropositive patients. No effect of acyclovir has been reported, but such therapy may be considered in the early stage when EBV induces a polyclonal B cell activation. Acyclovir treatment is effective in the EBV-genome positive hairy leukoplakia in human immunodeficiency virus-seropositive patients. No effect of antiviral therapy has been reported in the X-linked lymphoproliferative syndrome. Prophylactic use of immunoglobulin or acyclovir has been suggested in susceptible children.
Insights
Acyclovir inhibited Epstein-Barr virus (EBV) replication in infectious mononucleosis but had minimal symptom relief. Combination therapy improved symptoms in severe cases, and acyclovir showed efficacy in oral hairy leukoplakia.
Area of Science:
- Virology
- Immunology
- Pharmacology
Background:
- Epstein-Barr virus (EBV) causes infectious mononucleosis and is associated with various B-cell disorders.
- Acyclovir is an antiviral medication with activity against herpesviruses, including EBV.
Purpose of the Study:
- To evaluate the efficacy of acyclovir in treating infectious mononucleosis and other EBV-associated conditions.
- To assess the impact of acyclovir on viral replication, clinical symptoms, and immune responses.
Main Methods:
- Administration of oral or intravenous acyclovir for seven days in early infectious mononucleosis.
- Combination therapy with intravenous acyclovir and prednisolone for 10 days in fulminant mononucleosis.
- Review of acyclovir's role in EBV-associated B-cell lymphomas, oral hairy leukoplakia, and X-linked lymphoproliferative syndrome.
Main Results:
- Acyclovir inhibited oropharyngeal EBV replication in infectious mononucleosis with minimal clinical symptom improvement.
- Normal EBV-specific cellular and humoral immunity developed in all patients.
- Combination therapy in fulminant mononucleosis led to transient cessation of virus shedding and significant clinical improvement in most patients.
- Acyclovir was effective in EBV-genome positive oral hairy leukoplakia in HIV-seropositive patients.
Conclusions:
- Acyclovir can inhibit EBV replication in acute infectious mononucleosis but has limited impact on symptoms.
- Combination therapy with prednisolone offers clinical benefits in severe infectious mononucleosis.
- Acyclovir is a potential treatment for oral hairy leukoplakia in HIV-positive individuals.
- Further investigation is needed for EBV-associated lymphomas and X-linked lymphoproliferative syndrome.