title: Pediatric epstein-barr virus carriers with or without tonsillar enlargement may substantially contribute to spreading of the virus.
abstract: BACKGROUND
  Human-to-human transmission of the persistent infection establishing Epstein-Barr virus (EBV) occurs via saliva. Tonsils act as important portal of entry and exit of EBV. The contagiousness of pediatric EBV carriers and the role played by tonsillar enlargement (TE) are not known.
  
  
  METHODS
  We compared EBV shedding in mouthwash samples from pediatric EBV carriers with or without TE to that in mouthwash samples from pediatric patients with infectious mononucleosis (IM), the symptomatic form of primary infection if delayed after the age of 5 years. EBV DNA was quantified by polymerase chain reaction, and contagiousness was assessed using the cord lymphocyte transformation assay.
  
  
  RESULTS
  EBV carriers with TE shed EBV DNA at an almost similar frequency (although in lower amounts) as pediatric patients with acute IM but more frequently (P <.001) and in higher amounts (P = .038) than EBV carriers without TE. EBV DNA levels in mouthwash samples from EBV carriers with TE mirrored levels in tonsils and gradually declined after tonsillectomy. Almost half of the mouthwash samples from pediatric EBV carriers contained infectious EBV.
  
  
  CONCLUSIONS
  Pediatric EBV carriers--in particular, those with TE-may considerably contribute to the spreading of EBV in industrialized countries.
authors.affiliation: Divisions of 1Infectious Diseases and Hospital Epidemiology, 2Otolaryngology, and 3Anesthesia, University Children's Hospital of Zurich, Zurich, Switzerland.
authors.forename: Martina
authors.initials: M
authors.lastname: Hug
authors.forename: Marcus
authors.initials: M
authors.lastname: Dorner
authors.forename: Franziska Zucol
authors.initials: FZ
authors.lastname: Fröhlich
authors.forename: Claudine
authors.initials: C
authors.lastname: Gysin
authors.forename: Diego
authors.initials: D
authors.lastname: Neuhaus
authors.forename: David
authors.initials: D
authors.lastname: Nadal
authors.forename: Christoph
authors.initials: C
authors.lastname: Berger
mesh_terms: D002460:Cell Line; D002478:Cells, Cultured; D002648:Child; D004279:DNA, Viral / Q000097:blood / Q000302:isolation & purification; D020031:Epstein-Barr Virus Infections / Q000473:pathology* / Q000635:transmission* / Q000821:virology; D004854:Herpesvirus 4, Human / Q000502:physiology; D006801:Humans; D007244:Infectious Mononucleosis / Q000635:transmission / Q000821:virology; D007963:Leukocytes, Mononuclear / Q000821:virology; D014066:Palatine Tonsil / Q000473:pathology* / Q000601:surgery / Q000821:virology*; D014068:Tonsillectomy; D017201:Virus Shedding
chemical_list: D004279:DNA, Viral