[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Microbiology](https://durgical.com/en/microbiology/) › [Human herpesviruses](https://durgical.com/en/microbiology/groups/human-herpesviruses/) › Epstein–Barr virus

[Microbiology](https://durgical.com/en/microbiology/) · [Human herpesviruses](https://durgical.com/en/microbiology/groups/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

## Key points

- Mononucleosis: fever, pharyngitis, lymphadenopathy, splenomegaly and atypical lymphocytes.
- A positive Monospot supports the diagnosis; a negative one in a child does not rule it out.
- A rash after amoxicillin or ampicillin is a classic clue.
- Infects B cells through CD21; oncogenic: Burkitt, nasopharyngeal carcinoma, Hodgkin.

## 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

- Infectious mononucleosis [Infectious mononucleosis →](https://durgical.com/en/conditions/infectious-mononucleosis/)
- Burkitt lymphoma (endemic African form) [Non-Hodgkin lymphoma →](https://durgical.com/en/conditions/non-hodgkin-lymphoma/)
- Nasopharyngeal carcinoma [Nasopharyngeal carcinoma →](https://durgical.com/en/conditions/nasopharyngeal-carcinoma/)

## 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

## Memory aid

EBV goes for the B: it enters B cells through CD21, and its test is hetero because it looks for antibodies against another species' red cells.

## 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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## Related

- [Cytomegalovirus](https://durgical.com/en/microbiology/cytomegalovirus/)
- [Human herpesvirus 8](https://durgical.com/en/microbiology/human-herpesvirus-8/)

## Related conditions

- [Infectious mononucleosis](https://durgical.com/en/conditions/infectious-mononucleosis/)
- [Non-Hodgkin lymphoma](https://durgical.com/en/conditions/non-hodgkin-lymphoma/)
- [Nasopharyngeal carcinoma](https://durgical.com/en/conditions/nasopharyngeal-carcinoma/)

## What the colours mean

**Gram-positive**
Thick peptidoglycan wall: stains purple.

**Gram-negative**
Thin wall with an outer membrane: stains pink.

**Acid-fast**
Lipid-rich wall (mycobacteria): Ziehl–Neelsen stain.

[← Back to the group: Human herpesviruses](https://durgical.com/en/microbiology/groups/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)](https://www.cdc.gov/epstein-barr/hcp/clinical-overview/index.html) (CDC, 2024); [Laboratory Testing for Epstein-Barr Virus (EBV)](https://www.cdc.gov/epstein-barr/php/laboratories/index.html) (CDC, 2024); [Mononucleosis](https://medlineplus.gov/ency/article/000591.htm) (MedlinePlus (NLM), 2024).

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Representative model, for educational purposes only.

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