Diagnosis of Epstein-Barr virus (EBV) infection

Epstein–Barr virus (EBV) infection is common; typically occurring in adolescents and young adults.

EBV is transmitted primarily through saliva and usually causes a self-limiting and mild infectionSylvester, 2023. Although most patients have no symptoms, EBV infection is associated with a range of clinical manifestations, including fever, fatigue and infectious mononucleosis (glandular fever).

Clinical features of infectious mononucleosis are nonspecific, making the diagnosis challengingPutukian, 2023Rezk, 2015. It typically presents with the triad of fever, pharyngitis and tender lymphadenopathy. Exudative pharyngitis with associated tonsillar enlargement is observed in more than half of patientsPutukian, 2023. Lymphadenopathy frequently involves the posterior cervical chain and axillary and inguinal lymph nodes. Other features include hepatomegaly, rash, nausea and fatigueRezk, 2015. Splenic enlargement is frequent but palpable splenomegaly is uncommon.

Symptoms typically last 2 to 3 weeks; however, fatigue can occasionally persist for monthsRezk, 2015.

Differential diagnoses include infection due to Streptococcus pyogenes (Group A streptococcus [GAS]), cytomegalovirus (CMV), acute human immunodeficiency virus (HIV) and rarely Toxoplasma gondii (see Assessment of sore throat).

Diagnostic testing is not routinely performed for EBV; however, it can be considered for patients:

• engaging in strenuous activity that may increase the risk of splenic rupture (eg contact sport)
• with severe features
• with fever lasting longer than 2 weeks
• in whom a confirmation of the diagnosis would alter management (eg stop unnecessary antibiotic therapy) and prevent additional investigations.

Diagnostic tests for Epstein-Barr virus (EBV) lists diagnostic tests for EBV.