Epstein-Barr virus (Infectious mononucleosis)

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Epstein-Barr virus (Infectious mononucleosis)

NBME

NBME

Amino acid metabolism
Nitrogen and urea cycle
Citric acid cycle
Electron transport chain and oxidative phosphorylation
Gluconeogenesis
Glycogen metabolism
Glycolysis
Pentose phosphate pathway
Physiological changes during exercise
Cholesterol metabolism
Fatty acid oxidation
Fatty acid synthesis
Ketone body metabolism
Alkaptonuria
Cystinuria (NORD)
Hartnup disease
Homocystinuria
Maple syrup urine disease
Ornithine transcarbamylase deficiency
Phenylketonuria (NORD)
Essential fructosuria
Galactosemia
Glucose-6-phosphate dehydrogenase (G6PD) deficiency
Hereditary fructose intolerance
Lactose intolerance
Pyruvate dehydrogenase deficiency
Abetalipoproteinemia
Familial hypercholesterolemia
Hyperlipidemia
Hypertriglyceridemia
Glycogen storage disease type I
Glycogen storage disease type II (NORD)
Glycogen storage disease type III
Glycogen storage disease type IV
Glycogen storage disease type V
Mucopolysaccharide storage disease type 1 (Hurler syndrome) (NORD)
Mucopolysaccharide storage disease type 2 (Hunter syndrome) (NORD)
Fabry disease (NORD)
Gaucher disease (NORD)
Krabbe disease
Leukodystrophy
Metachromatic leukodystrophy (NORD)
Niemann-Pick disease type C
Niemann-Pick disease types A and B (NORD)
Tay-Sachs disease (NORD)
Cystinosis
Disorders of amino acid metabolism: Pathology review
Disorders of carbohydrate metabolism: Pathology review
Disorders of fatty acid metabolism: Pathology review
Dyslipidemias: Pathology review
Glycogen storage disorders: Pathology review
Lysosomal storage disorders: Pathology review
Carbohydrates and sugars
Fats and lipids
Proteins
Excess Vitamin A
Excess Vitamin D
Vitamin D deficiency
Vitamin K deficiency
Kwashiorkor
Marasmus
Iodine deficiency
Zinc deficiency
Beriberi
Folate (Vitamin B9) deficiency
Niacin (Vitamin B3) deficiency
Vitamin B12 deficiency
Vitamin C deficiency
Wernicke-Korsakoff syndrome
Fat-soluble vitamin deficiency and toxicity: Pathology review
Water-soluble vitamin deficiency and toxicity: B1-B7: Pathology review
Zinc deficiency and protein-energy malnutrition: Pathology review
Cell membrane
Cell signaling pathways
Cell-cell junctions
Cellular structure and function
Cytoskeleton and intracellular motility
Endocytosis and exocytosis
Extracellular matrix
Nernst equation
Osmosis
Resting membrane potential
Selective permeability of the cell membrane
Alport syndrome
Ehlers-Danlos syndrome
Marfan syndrome
Osteogenesis imperfecta
Primary ciliary dyskinesia
Adrenoleukodystrophy (NORD)
Zellweger spectrum disorders (NORD)
Cytoskeleton and elastin disorders: Pathology review
Peroxisomal disorders: Pathology review
DNA cloning
ELISA (Enzyme-linked immunosorbent assay)
Fluorescence in situ hybridization
Gel electrophoresis and genetic testing
Karyotyping
Polymerase chain reaction (PCR) and reverse-transcriptase PCR (RT-PCR)
Amino acids and protein folding
Cell cycle
DNA damage and repair
DNA mutations
DNA replication
DNA structure
Epigenetics
Gene regulation
Lac operon
Mitosis and meiosis
Nuclear structure
Nucleotide metabolism
Protein structure and synthesis
Transcription of DNA
Translation of mRNA
Adenosine deaminase deficiency
Lesch-Nyhan syndrome
Orotic aciduria
Bloom syndrome
Fanconi anemia
Li-Fraumeni syndrome
McCune-Albright syndrome
Xeroderma pigmentosum
Acute radiation syndrome
Purine and pyrimidine synthesis and metabolism disorders: Pathology review
Human development days 1-4
Human development days 4-7
Human development week 2
Human development week 3
Development of the digestive system and body cavities
Development of the fetal membranes
Development of the placenta
Development of the umbilical cord
Development of twins
Hedgehog signaling pathway
Ectoderm
Endoderm
Mesoderm
Development of the cardiovascular system
Fetal circulation
Development of the ear
Development of the eye
Development of the face and palate
Pharyngeal arches, pouches, and clefts
Development of the gastrointestinal system
Development of the teeth
Development of the tongue
Development of the axial skeleton
Development of the limbs
Development of the muscular system
Development of the nervous system
Development of the renal system
Development of the reproductive system
Development of the respiratory system
Evolution and natural selection
Hardy-Weinberg equilibrium
Independent assortment of genes and linkage
Inheritance patterns
Mendelian genetics and punnett squares
Achondroplasia
Alagille syndrome (NORD)
Familial adenomatous polyposis
Hereditary spherocytosis
Huntington disease
Multiple endocrine neoplasia
Myotonic dystrophy
Neurofibromatosis
Polycystic kidney disease
Treacher Collins syndrome
Tuberous sclerosis
von Hippel-Lindau disease
Albinism
Alpha-thalassemia
Beta-thalassemia
Cystic fibrosis
Friedreich ataxia
Hemochromatosis
Sickle cell disease (NORD)
Wilson disease
Cri du chat syndrome
Williams syndrome
Angelman syndrome
Prader-Willi syndrome
Beckwith-Wiedemann syndrome
Mitochondrial myopathy
Klinefelter syndrome
Turner syndrome
Fragile X syndrome
Down syndrome (Trisomy 21)
Edwards syndrome (Trisomy 18)
Patau syndrome (Trisomy 13)
Hemophilia
Muscular dystrophy
Wiskott-Aldrich syndrome
X-linked agammaglobulinemia
Autosomal trisomies: Pathology review
Miscellaneous genetic disorders: Pathology review
Muscular dystrophies and mitochondrial myopathies: Pathology review
Bacterial structure and functions
Bacillus anthracis (Anthrax)
Bacillus cereus (Food poisoning)
Corynebacterium diphtheriae (Diphtheria)
Listeria monocytogenes
Clostridium botulinum (Botulism)
Clostridium difficile (Pseudomembranous colitis)
Clostridium perfringens
Clostridium tetani (Tetanus)
Actinomyces israelii
Nocardia
Staphylococcus aureus
Staphylococcus epidermidis
Staphylococcus saprophyticus
Streptococcus agalactiae (Group B Strep)
Streptococcus pneumoniae
Streptococcus pyogenes (Group A Strep)
Streptococcus viridans
Enterococcus
Bacteroides fragilis
Bartonella henselae (Cat-scratch disease and Bacillary angiomatosis)
Enterobacter
Escherichia coli
Klebsiella pneumoniae
Legionella pneumophila (Legionnaires disease and Pontiac fever)
Proteus mirabilis
Pseudomonas aeruginosa
Salmonella (non-typhoidal)
Salmonella typhi (typhoid fever)
Serratia marcescens
Shigella
Yersinia enterocolitica
Yersinia pestis (Plague)
Campylobacter jejuni
Helicobacter pylori
Vibrio cholerae (Cholera)
Moraxella catarrhalis
Neisseria gonorrhoeae
Neisseria meningitidis
Bordetella pertussis (Whooping cough)
Brucella
Francisella tularensis (Tularemia)
Haemophilus ducreyi (Chancroid)
Haemophilus influenzae
Pasteurella multocida
Mycobacterium tuberculosis (Tuberculosis)
Mycobacterium avium complex (NORD)
Mycobacterium leprae
Chlamydia pneumoniae
Chlamydia trachomatis
Gardnerella vaginalis (Bacterial vaginosis)
Mycoplasma pneumoniae
Coxiella burnetii (Q fever)
Ehrlichia and Anaplasma
Rickettsia rickettsii (Rocky Mountain spotted fever) and other Rickettsia species
Borrelia burgdorferi (Lyme disease)
Borrelia species (Relapsing fever)
Leptospira
Treponema pallidum (Syphilis)
Malassezia (Tinea versicolor and Seborrhoeic dermatitis)
Aspergillus fumigatus
Candida
Cryptococcus neoformans
Mucormycosis
Pneumocystis jirovecii (Pneumocystis pneumonia)
Sporothrix schenckii
Blastomycosis
Coccidioidomycosis and paracoccidioidomycosis
Histoplasmosis
Pediculus humanus and Phthirus pubis (Lice)
Sarcoptes scabiei (Scabies)
Acanthamoeba
Naegleria fowleri (Primary amebic meningoencephalitis)
Toxoplasma gondii (Toxoplasmosis)
Cryptosporidium
Entamoeba histolytica (Amebiasis)
Giardia lamblia
Babesia
Plasmodium species (Malaria)
Leishmania
Trichomonas vaginalis
Trypanosoma brucei
Trypanosoma cruzi (Chagas disease)
Diphyllobothrium latum
Echinococcus granulosus (Hydatid disease)
Ancylostoma duodenale and Necator americanus
Angiostrongylus (Eosinophilic meningitis)
Anisakis
Ascaris lumbricoides
Enterobius vermicularis (Pinworm)
Guinea worm (Dracunculiasis)
Loa loa (Eye worm)
Onchocerca volvulus (River blindness)
Strongyloides stercoralis
Toxocara canis (Visceral larva migrans)
Trichinella spiralis
Trichuris trichiura (Whipworm)
Wuchereria bancrofti (Lymphatic filariasis)
Clonorchis sinensis
Paragonimus westermani
Schistosomes
Viral structure and functions
Adenovirus
Hepatitis B and Hepatitis D virus
Cytomegalovirus
Epstein-Barr virus (Infectious mononucleosis)
Herpes simplex virus
Human herpesvirus 6 (Roseola)
Human herpesvirus 8 (Kaposi sarcoma)
Varicella zoster virus
Human papillomavirus
Parvovirus B19
BK virus (Hemorrhagic cystitis)
JC virus (Progressive multifocal leukoencephalopathy)
Poxvirus (Smallpox and Molluscum contagiosum)
Lymphocytic choriomeningitis virus
Hantavirus
Norovirus
Coronaviruses
Ebola virus
Dengue virus
Hepatitis C virus
West Nile virus
Yellow fever virus
Zika virus
Influenza virus
Human parainfluenza viruses
Measles virus
Mumps virus
Respiratory syncytial virus
Hepatitis A and Hepatitis E virus
Coxsackievirus
Poliovirus
Rhinovirus
Rotavirus
HIV (AIDS)
Human T-lymphotropic virus
Rabies virus
Eastern and Western equine encephalitis virus
Rubella virus
Prions (Spongiform encephalopathy)
Antimetabolites: Sulfonamides and trimethoprim
Antituberculosis medications
Cell wall synthesis inhibitors: Cephalosporins
Cell wall synthesis inhibitors: Penicillins
DNA synthesis inhibitors: Fluoroquinolones
DNA synthesis inhibitors: Metronidazole
Mechanisms of antibiotic resistance
Miscellaneous cell wall synthesis inhibitors
Miscellaneous protein synthesis inhibitors
Protein synthesis inhibitors: Aminoglycosides
Protein synthesis inhibitors: Tetracyclines
Azoles
Echinocandins
Miscellaneous antifungal medications
Anthelmintic medications
Anti-mite and louse medications
Antimalarials
Hepatitis medications
Herpesvirus medications
Integrase and entry inhibitors
Neuraminidase inhibitors
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
Nucleoside reverse transcriptase inhibitors (NRTIs)
Protease inhibitors
Introduction to pharmacology
Enzyme function
Drug administration and dosing regimens
Pharmacodynamics: Agonist, partial agonist and antagonist
Pharmacodynamics: Desensitization and tolerance
Pharmacodynamics: Drug-receptor interactions
Pharmacokinetics: Drug absorption and distribution
Pharmacokinetics: Drug elimination and clearance
Pharmacokinetics: Drug metabolism
Adrenergic antagonists: Alpha blockers
Adrenergic antagonists: Beta blockers
Adrenergic antagonists: Presynaptic
Adrenergic receptors
Cholinergic receptors
Cholinomimetics: Direct agonists
Cholinomimetics: Indirect agonists (anticholinesterases)
Muscarinic antagonists
Sympatholytics: Alpha-2 agonists
Sympathomimetics: Direct agonists
Selective serotonin reuptake inhibitors
Atypical antidepressants
Monoamine oxidase inhibitors
Serotonin and norepinephrine reuptake inhibitors
Tricyclic antidepressants
Atypical antipsychotics
Typical antipsychotics
Anticonvulsants and anxiolytics: Barbiturates
Anticonvulsants and anxiolytics: Benzodiazepines
Lithium
Nonbenzodiazepine anticonvulsants
Psychomotor stimulants
Calcium channel blockers
cGMP mediated smooth muscle vasodilators
Class I antiarrhythmics: Sodium channel blockers
Class II antiarrhythmics: Beta blockers
Class III antiarrhythmics: Potassium channel blockers
Class IV antiarrhythmics: Calcium channel blockers and others
ACE inhibitors, ARBs and direct renin inhibitors
Thiazide and thiazide-like diuretics
Lipid-lowering medications: Fibrates
Lipid-lowering medications: Statins
Miscellaneous lipid-lowering medications
Positive inotropic medications
Adrenal hormone synthesis inhibitors
Mineralocorticoids and mineralocorticoid antagonists
Hypoglycemics: Insulin secretagogues
Insulins
Miscellaneous hypoglycemics
Hyperthyroidism medications
Hypothyroidism medications

Assessments

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USMLE® Step 1 questions

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High Yield Notes

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Flashcards

Epstein-Barr virus (Infectious mononucleosis)

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Questions

USMLE® Step 1 style questions USMLE

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A 20-year-old man presents to the clinic for evaluation of sore throat, cough, low-grade fever, and fatigue for the past four days. The patient is sexually active with a female partner and uses condoms consistently. There has been no recent travel. Temperature taken in the clinic is 38.5 ºC (101.4 ºF). Physical examination shows enlarged posterior cervical lymph nodes, palatal petechiae, and pharyngeal exudate. Laboratory workup is significant for lymphocytosis with an absolute lymphocyte count of 5000/microL. The patient is prescribed a 7-day course of amoxicillin. Two days later, the patient returns to the clinic with slightly improving symptoms and the development of a maculopapular rash on the chest and back. A peripheral smear is obtained and is shown below. Which of the following tests will confirm the diagnosis?  
 
 Reproduced from ">Wikimedia Commons  

External References

First Aid

2024

2023

2022

2021

Epstein-Barr virus (EBV) p. 162

aplastic anemia p. 427

Burkitt lymphoma p. 435

false-positive VDRL p. 146

hairy leukoplakia and p. 487

head and neck cancer p. 691

HIV-positive adults p. 174

Hodgkin lymphoma p. 434

in immunodeficient patients p. 116

labs/findings p. 726, 727

oncogenesis of p. 221

receptors for p. 163

Transcript

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The Epstein-Barr virus, or EBV, also known as human herpesvirus-4, or HHV-4, is an enveloped virus of the Herpesviridae family, which contains linear, double-stranded DNA.

It is the most common cause of infectious mononucleosis, more commonly known as “mono.”

EBV infection begins when saliva or respiratory secretions that contain the virus from one person make their way into someone else’s mouth.

Often, this happens by sharing food or drinks, or by kissing, which is why mono is sometimes called the “kissing disease” and why it is most common in adolescents and young adults, aged 15-24, because young people are often doing the smooching.

When EBV reaches the new person’s mouth, it infects two types of cells in the oropharynx: epithelial cells, which line the surfaces of the oropharynx, and B cells, which are lymphocytes, or lymphoid cells, that create antibodies to fight off infections.

In the epithelial cells, the virus undergoes the lytic cycle, whereby its DNA gets transcribed and translated by cellular enzymes, which help to form viral proteins, which are packaged into new viruses, which can leave the host cell destroyed, or lysed, and subsequently infect neighboring epithelial cells.

The viruses that reach the lymphoid tissue of the oropharynx, the tonsils, infect their main target, B cells, by attaching to their CD21 receptor, also known as the CR2 receptor.

The infected B cells then enter the latent phase, in which the virus just sort of hangs out in the host cell instead of killing it.

They then carry and spread the infection along their normal trajectory to the other lymphoid tissues of the body, including the liver, spleen, and lymph nodes.

The body’s immune system reacts to the infection by mounting a humoral response, whereby the B cells create antibodies to fight off the virus, and a cellular response, in which cytotoxic (or CD8+) T cells, which are lymphocytes that mature in the thymus, work to kill the infected B cells.

This limits their ability to continue to spread the virus throughout the lymphoid tissues, thus stopping the infection from spreading.

Now, in most EBV-infected individuals, the infection is controlled, and, as a result, most people do not develop symptoms.

When someone infected with EBV does develop symptoms, that’s called infectious mononucleosis or mono.

The most common symptoms are fever, pharyngitis, or inflammation of the throat, and lymphadenopathy, or swollen lymph nodes.

The inflammation of the throat makes sense since the epithelial cells are infected, and swollen lymph nodes makes sense since infected B cells spread throughout the lymph tissue of the body, causing it to swell up.

The lymph nodes that are most commonly swollen as a result of an EBV infection are the posterior cervical lymph nodes in the back of the neck, because those lymph nodes drain the tonsils where the B cells are initially infected.

Another very common symptom of mono is fatigue, or extreme tiredness, which can be particularly severe in mono and can last for several months.

Other possible symptoms include tonsillitis, or inflammation of the tonsils, palatal petechiae, or red spots on the palate, hepatomegaly, or an enlarged liver, and splenomegaly, or an enlarged spleen.

The tonsillitis may be exudative or non-exudative, meaning there may or may not be white-ish or gray-ish fluid oozing out of the tonsils.

The palatal petechiae is a result of damage done to the infected epithelial cells on the palate, and the hepatomegaly and splenomegaly are a result of the liver and spleen being lymph tissues through which infected B cells flow as cytotoxic T cells try to kill them, causing those organs to swell up.

The splenomegaly, though rare, is of particular importance because an enlarged spleen is more susceptible to rupture, and splenic rupture can result in excessive bleeding and even death.

Another rare symptom of mono is a rash with faint, non-itchy, pink macules or patches that show up on the trunk and arms.

A different type of rash that can be similar to this can occur if an individual with mono is misdiagnosed with a group A streptococcus infection, more commonly known as strep throat.

In this case, the person is given the antibiotics, ampicillin or amoxicillin, and, for some unknown reason, they develop an itchy maculopapular rash.

Summary

Epstein-Barr virus (EBV) also known as human herpesvirus-4, is an enveloped double-stranded DNA virus of the Herpesviridae family, commonly known to be the cause of infectious mononucleosis (IM). It is also associated with other diseases such as Burkitt's lymphoma, Hodgkin's disease, and gastric carcinoma. Most people are infected with EBV at some point in their lives. In most cases, the virus produces no symptoms and goes away on its own. However, in some people, EBV can cause serious health problems. People with IM present with fever, sore throat, swollen lymph nodes, and liver problems.