Andersson J P
Department of Infectious Diseases, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden.
Scand J Infect Dis Suppl. 1991;80:94-104.
Epstein-Barr virus infection (EBV) was discovered 25 years ago in tumour cells from Burkitt's lymphoma. Extensive virological studies have relieved that EBV causes infectious mononucleosis and contributes to the pathogenesis of Burkitt's lymphoma and nasopharyngeal cancer. Atypical courses of the primary infection may induce meningoencephalitis or hepatitis and are attracting increasing attention. Antiviral treatment with acyclovir has been administered for 7 days, intravenously or orally, in the early stages of infectious mononucleosis, in 2 placebo controlled trials. An inhibition of oropharyngeal EBV replication was verified but minimal effects on clinical symptoms was observed. A combination of intravenous acyclovir and prednisolone treatment for 10 days was therefore tried in 15 patients with fulminant mononucleosis in a pilot study. A transient cessation of virus shedding was noticed in all patients, and a substantial clinical effect on pharyngeal symptoms and on fever was seen in 12/15 patients within 3 days. Treatment with chemotherapy or irradiation is recommended in EBV-associated B-cell lymphomas seen in immunosuppressed, transplanted, or human immunodeficiency virus-seropositive patients. No effect of acyclovir has been reported, but such therapy may be considered in the early stage when EBV induces a polyclonal B cell activation. Acyclovir treatment is effective in the EBV-genome positive hairy leukoplakia noticed in human immunodeficiency virus-seropositive patients. However, no effect of any antiviral therapy has been reported in the X-linked lymphoproliferative syndrome affecting in particular 2-7 year old boys. Prophylactic use of immunoglobulin or acyclovir has been suggested in susceptible children. These results indicate that the variety of clinical manifestations induced by EBV at least partly depend on the immune response elicited in the host and not of virus replication per se. Therefore, treatment of these various disorders cannot be generalized but must be based on the use of antiviral drugs combined with immunomodulatory agents.
爱泼斯坦-巴尔病毒感染（EBV）于25年前在伯基特淋巴瘤的肿瘤细胞中被发现。广泛的病毒学研究表明，EBV可引起传染性单核细胞增多症，并在伯基特淋巴瘤和鼻咽癌的发病机制中起作用。原发性感染的非典型病程可能诱发脑膜脑炎或肝炎，正引起越来越多的关注。在两项安慰剂对照试验中，在传染性单核细胞增多症的早期阶段，已静脉或口服给予阿昔洛韦抗病毒治疗7天。已证实对口腔咽部EBV复制有抑制作用，但对临床症状的影响极小。因此，在一项初步研究中，对15例暴发性单核细胞增多症患者尝试了静脉注射阿昔洛韦和泼尼松龙联合治疗10天。所有患者均出现病毒脱落短暂停止，12/15例患者在3天内咽部症状和发热有显著临床改善。对于免疫抑制、移植或人类免疫缺陷病毒血清阳性患者中出现的EBV相关B细胞淋巴瘤，建议采用化疗或放疗。尚未报道阿昔洛韦有疗效，但当EBV诱导多克隆B细胞活化时，可在早期考虑这种治疗方法。阿昔洛韦治疗对人类免疫缺陷病毒血清阳性患者中出现的EBV基因组阳性毛状白斑有效。然而，对于尤其影响2 - 7岁男孩的X连锁淋巴增殖综合征，尚未报道任何抗病毒治疗有疗效。已建议对易感儿童预防性使用免疫球蛋白或阿昔洛韦。这些结果表明，EBV诱发的各种临床表现至少部分取决于宿主引发的免疫反应，而非病毒本身的复制。因此，这些各种疾病的治疗不能一概而论，而必须基于抗病毒药物与免疫调节剂联合使用。
