Epstein-Barr Virus

Terry Kotrla, MS, MT(ASCP)BB

Diseases
African

or Burkitts Lymphoma

malignant B-cell neoplasm

presents as a rapidly growing tumour of
the jaw, face or eye
grows very quickly, and without
treatment most children die within a few
months
Epstein-Barr virus (EBV) has been
strongly implicated

African or Burkitts Lymphoma

Although BL is a very rapidly growing tumour

it responds well to treatment.
Three pictures: before treatment, 3 days and
6 days after treatment

Nasopharyngeal Carcinoma

Endemic in South China, Africa, Arctic

Eskimos
This is a malignant tumour of the squamous
epithelium of the nasopharynx.
100% contain EBV DNA
Rates are less than 1 per 100,000 in most
populations
Nasopharyngeal carcinomas are found in
association with reactivation of latent
Epstein-Barr Virus.
The exact mechanisms of association are
unknown

B-Cell Lymphoma

In most individuals infected with EBV, the

virus is present in the B-cells, which are
normally controlled by T-lymphocytes
When T-cell deficiency exists, one clone of
EBV-infected B-lymphocytes escapes
immune surveillance to become
autonomously proliferating.
EBV induced B cell lymphomas are most
prevalent in immunocompromised patients.

Oral Hairy Cell Leukoplakia

Viral infection of the oral cavity.

Indicator of HIV infection as well as of a
person's lessening or weakening immunity

Infectious Mononucleosis

Downey cells may be present

Heterophile
Antigens/Antibodies
An

antigen or antigenic determinant

which is found in different tissues in
more than one species.
These are antibodies found in one
specie of animal (such as humans)
which react against a component of
another specie.

Paul Bunnell Test

The original Paul-Bunnell test was a simple titration of

sheep cell agglutinins but this procedure was subsequently
modified in order to distinguish between sheep cell
agglutinins formed in IM and the Forssman-type antibodies
found in normal serum, serum sickness and in certain other
conditions.
Tissues rich in Forssman antigen (guinea pig kidney) absorb
Forssman antibodies but do not affect the heterophil
antibodies in IM.
Heterophil antibodies are absorbed by beef cells,
Forssman hapten is a glycolipid usually associated with a
protein, the determinant being largely carbohydrate and
therefore heat stable.

Davidsohn Differential

The principle behind the Paul-Bunnell-Davidsohn test is that

the two types of sheep agglutinins are distinguished by
titrating them before and after absorption with guinea pig
kidney and ox cells.
Patients serum containing antibodies due to IM is added to
guinea pig kidney cells. These antibodies are not absorbed
by the kidney cells. These antibodies then react with Beef
(Ox) red blood cells which causes agglutination and is a
positive test for IM.
Patients serum containing Forssman antibodies are added to
guinea pig kidney cells. Antibodies are absorbed by the
kidney cells. These antibodies are then allowed to react with
Beef red blood cells which does not cause agglutination.
This is a positive test for Forssman antigens.

Davidsohn Differential

* To be considered absorbed there must be greater than a three tube

difference between the presumptive titer and the differential titer.

Heterophil Antibody
------------------------

Kidney Extract
------------------

Beef Erythrocyte
---------------------

Infectious Mono

Not Absorbed

Absorbed

Forssman

Absorbed

Not Absorbed

Serum Sickness

Absorbed

Absorbed

Davidsohn Differential
Advantages

When properly performed,

this test is specific for
Infectious Mononucleosis
and false-positive results
are rare.

Disadvantages

Davidsohn Differential test

is very time consuming
and burdensome.