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Microbiology · Human herpesviruses

Epstein–Barr virus !

  • Virus
  • Enveloped
  • Exam priority: medium

A virus spread by saliva that causes infectious mononucleosis and is linked to some lymphomas and carcinomas.

Updated 2026-11-01

Also called: EBV, HHV-4, kissing disease

At a glance

Shape
Icosahedral with tegument and envelope
Genome
Linear double-stranded DNA
Envelope
Enveloped
Family
Herpesviridae (gammaherpesvirus)
Size
About 150 to 200 nm

Morphology

  • Typical herpesvirus structure
  • Infects oropharyngeal epithelial cells and B cells through the CD21 receptor

Transmission

  • Saliva and intimate contact (kissing, shared utensils)
  • Less often, transplantation and transfusion

Reservoir: Humans

Isolation precautions

What the care team adds to standard precautions.

  • Standard

Virulence factors

  • Latency in memory B cells
  • Transforms and immortalizes B cells (latent proteins such as EBNA and LMP-1)
  • The CD8 T-cell response produces the atypical lymphocytes seen in blood

Diseases it causes

Clinical picture

  • Teenagers and young adults: fever, exudative pharyngitis, cervical lymphadenopathy and fatigue
  • Splenomegaly with a risk of rupture: contact sports are avoided while it lasts
  • Rash if amoxicillin or ampicillin is given for a presumed bacterial sore throat
  • Other links: Hodgkin lymphoma, post-transplant lymphoproliferative disorder and oral hairy leukoplakia in HIV

Diagnosis

  • Heterophile antibody test (Monospot): supports typical mononucleosis but is often negative in young children
  • Lymphocytosis with atypical lymphocytes on the smear
  • Anti-VCA IgM without anti-EBNA: recent primary infection
  • Anti-VCA IgG with anti-EBNA: past infection; anti-EBNA appears months later

Treatment

There is no routine antiviral: care is supportive. Corticosteroids are kept for complications such as airway obstruction from very large tonsils.

Drug class only; doses and regimens are set by the clinician from the current guideline.

Prevention

  • No sharing of utensils or kissing during acute illness
  • Standard precautions in hospital

Test yourself

Think of the answer, then tap the question to see it.

Which receptor does EBV use to enter B cells?

CD21, the complement receptor type 2 (CR2).

What happens if a patient with mononucleosis gets amoxicillin?

A widespread maculopapular rash often appears, which does not necessarily mean penicillin allergy.

Which antibody pattern shows a recent primary EBV infection?

Positive anti-VCA IgM with no anti-EBNA antibodies.

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← Back to the group: Human herpesviruses

Educational content on microorganisms; not a treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: Clinical Overview of Epstein-Barr Virus (EBV) (CDC, 2024); Laboratory Testing for Epstein-Barr Virus (EBV) (CDC, 2024); Mononucleosis (MedlinePlus (NLM), 2024).

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Representative model, for educational purposes only.