A prospective clinical study of Epstein-Barr virus and host interactions during acute infectious mononucleosis.
BACKGROUND
Characterizing virus-host interactions during self-limited infectious mononucleosis could explain how Epstein-Barr virus (EBV) replication is normally controlled and provide insight into why certain immunocompromised patients fail to contain it.


METHODS
University students had an average of 7 clinical and virologic evaluations during acute infectious mononucleosis. EBV was quantified in 697 samples of oral wash fluid, whole blood, peripheral blood mononuclear cells (PBMCs), and plasma by a real-time (TaqMan) polymerase chain reaction (qEBV) assay developed in our laboratory.


RESULTS
Twenty of 25 subjects had serologically confirmed primary EBV infection. EBV was cleared from whole blood by a first-order process with a median half-life of 3 days, and its quantity was associated with severity of illness (r2=0.82). Oral shedding persisted at a median of >or=1x104 copies/mL for 32 weeks and was unrelated to severity of illness. Subjects with nonprimary EBV infection shed virus intermittently, and median quantities for all samples became undetectable within 4 weeks.


CONCLUSIONS
Using a novel qEBV assay, we demonstrated that young adults with primary EBV infection rapidly cleared virus from blood but not from the oropharynx. High oral concentrations of EBV in asymptomatic persons who have resumed normal activities support the concept that infectious mononucleosis is most likely acquired by kissing.
Balfour
Henry H
HH
Department of Laboratory Medicine and Pathology, University of Minnesota, Fairview Clinical Virology Laboratory, Minneapolis 55455-0392, USA. balfo001@umn.edu
Holman
Carol J
CJ
Hokanson
Kristin M
KM
Lelonek
Meghan M
MM
Giesbrecht
Jill E
JE
White
Dana R
DR
Schmeling
David O
DO
Webb
Chiu-Ho
CH
Cavert
Winston
W
Wang
David H
DH
Brundage
Richard C
RC
D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D015415:Biomarkers / Q000032:analysis; D018562:Disease Transmission, Infectious; D019309:Epstein-Barr Virus Nuclear Antigens / Q000235:genetics; D005260:Female; D005814:Genes, Viral / Q000235:genetics; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D006801:Humans; D007244:Infectious Mononucleosis / Q000097:blood / Q000473:pathology / Q000635:transmission / Q000821:virology*; D008297:Male; D009960:Oropharynx / Q000821:virology; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D013997:Time Factors; D019562:Viral Load
D000914:Antibodies, Viral; D015415:Biomarkers; D019309:Epstein-Barr Virus Nuclear Antigens; C417029:EBV-encoded nuclear antigen 1