title: A prospective clinical study of Epstein-Barr virus and host interactions during acute infectious mononucleosis.
abstract: 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.
authors.affiliation: Department of Laboratory Medicine and Pathology, University of Minnesota, Fairview Clinical Virology Laboratory, Minneapolis 55455-0392, USA. balfo001@umn.edu
authors.forename: Henry H
authors.initials: HH
authors.lastname: Balfour
authors.forename: Carol J
authors.initials: CJ
authors.lastname: Holman
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Hokanson
authors.forename: Meghan M
authors.initials: MM
authors.lastname: Lelonek
authors.forename: Jill E
authors.initials: JE
authors.lastname: Giesbrecht
authors.forename: Dana R
authors.initials: DR
authors.lastname: White
authors.forename: David O
authors.initials: DO
authors.lastname: Schmeling
authors.forename: Chiu-Ho
authors.initials: CH
authors.lastname: Webb
authors.forename: Winston
authors.initials: W
authors.lastname: Cavert
authors.forename: David H
authors.initials: DH
authors.lastname: Wang
authors.forename: Richard C
authors.initials: RC
authors.lastname: Brundage
mesh_terms: 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
chemical_list: D000914:Antibodies, Viral; D015415:Biomarkers; D019309:Epstein-Barr Virus Nuclear Antigens; C417029:EBV-encoded nuclear antigen 1