Pediatric epstein-barr virus carriers with or without tonsillar enlargement may substantially contribute to spreading of the virus.
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.
Hug
Martina
M
Divisions of 1Infectious Diseases and Hospital Epidemiology, 2Otolaryngology, and 3Anesthesia, University Children's Hospital of Zurich, Zurich, Switzerland.
Dorner
Marcus
M
Fröhlich
Franziska Zucol
FZ
Gysin
Claudine
C
Neuhaus
Diego
D
Nadal
David
D
Berger
Christoph
C
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
D004279:DNA, Viral