Epstein-Barr Virus PDF

Preface

Epstein-Barr virus is an important and fascinating human pathogen. A member of the herpesvirus family, Epstein-Barr virus infects almost all humans worldwide. It is the direct cause of or a contributing factor to a wide variety of human diseases, ranging from subacute febrile illness to classic infectious mononucleosis to acute complications such as encephalitis and, perhaps most intriguing, to several forms of cancer. There have been numerous recent advances along many lines of investigation in our understanding of this ubiquitous virus and its myriad pathogenic effects. The time has come to summarize them in a single monograph.

The story of the discovery of Epstein-Barr virus and its associated diseases is an epic tale that continues to evolve. The first chapter of the book lays the foundations, beginning with the story of the discovery of the virus and links to human disease. An exposition follows of the molecular biology of the virus by Jeffrey Cohen. A comprehensive chapter by Warren Andiman details the epidemiology of the virus and its many associated diseases. These clinical and epidemiological observations were crucial to the discovery of Epstein-Barr virus and its relationship to disease. Gerald Niedobitek and Hermann Herbst authoritatively discuss the distinctive pathogenesis and pathology of Epstein-Barr virus disease in a chapter that includes the characterization of persistent and latent infection. The interaction between the virus and the immune system is an important, indeed crucial, aspect of Epstein-Barr virus disease that is detailed in a chapter by Scott Burrows and Andrew Hislop.

The next two chapters discuss many of the general clinical aspects of acute infection. Jan Andersson details the quintessential clinical form of Epstein-Barr virus infection, infectious mononucleosis, including the differential diagnosis and the diagnostic criteria. Atypical presentations, clinical complications, and therapy of the acute infection are included. Greg Storch, Joseph Merline, and Alex Tselis review the methods of laboratory diagnosis, including characterization of the serologic response to Epstein-Barr virus, which is an important means of differentiating recent from remote infection. This chapter also reviews the specific application of many newer diagnostic methods, including direct detection of viral antigens by immunohistochemistry and of the viral genome by polymerase chain reaction.

The manifestations of specific organ involvement of Epstein-Barr virus form the core of the book, beginning with a chapter by Alex Tselis and Kumar Rajamani detailing the acute neurological complications of Epstein-Barr virus infection, which have a very broad spectrum of clinical manifestations and can be fatal. The long-term consequences of Epstein-Barr virus infection are increasingly significant in this era of immunosuppressed populations. Complications of Epstein-Barr virus, including oral hairy leukoplakia, are prominent among persons with acquired immunodeficiency syndrome and are surveyed in the chapter by Richard Ambinder. Many of the lifelong risks of Epstein-Barr virus infection entail development of Epstein- Barr virus-associated tumors. Discussions of the oncologic aspects of Epstein-Barr virus infection are covered in separate chapters, including Burkitt lymphoma by Jeffery Sample and Ingrid K. Ruf, Hodgkin's disease by Gerald Niedobitek and Hermann Herbst, posttransplant lymphoproliferative disease by Lode Swinnen, T-cell lymphomas by James Jones, nasopharyngeal carcinoma by Sai Wah Tsao and colleagues, and leiomyosarcoma by Hal Jenson. The intriguing X-linked lymphoproliferative disease is thoroughly reviewed by Thomas Seemayer and colleagues.

The remainder of the book addresses issues that are less well understood and remain to be clarified and conquered. Because Epstein-Barr virus infection involves so many organ systems in a chronic and sometimes unsuspected, often unpredictable manner that makes it difficult to distinguish the contribution of persistent Epstein- Barr virus infection to disease, a number of illnesses are postulated to have a complete or partial etiologic relationship to Epstein-Barr virus. This has given rise to some controversy. The issue of how to ascribe the cause of a disease to Epstein- Barr virus is taken up in a chapter by James Jones, and a number of such diseases are cataloged. A comprehensive survey of the available and potential therapies of Epstein-Barr virus disease appears in the chapter by Cliona Rooney and Patrizia Comoli. This includes not only conventional antiviral medications, but also newer modes of immunotherapy, particularly adoptive therapy with human leukocyte antigen- matched, Epstein-Barr virus-specific T-cell immunotherapy. The last chapter of the book, by Andrew Morgan and A. Douglas Wilson, discusses the prevention of Epstein-Barr virus infection by vaccination, presenting the case for the development of a vaccine, possible vaccine strategies, and the status of vaccine research.

The book is a broad and comprehensive survey for both clinicians and basic researchers with sufficient detailed information to serve as a springboard for further basic and clinical studies, including studies of pathogenesis. The basic science and molecular virology necessary to understand the manifold manifestations of Epstein- Barr virus infection are emphasized throughout to facilitate the understanding and foster further investigations of this important and intriguing human pathogen.