Vírus Epstein-Barr

O vírus Epstein-Barr ( EBV EBV Epstein-barr virus (EBV) is a linear, double-stranded DNA virus belonging to the herpesviridae family. This highly prevalent virus is mostly transmitted through contact with oropharyngeal secretions from an infected individual. The virus can infect epithelial cells and B lymphocytes, where it can undergo lytic replication or latency. Epstein-Barr Virus, pela sigla em inglês) é um vírus de DNA DNA A deoxyribonucleotide polymer that is the primary genetic material of all cells. Eukaryotic and prokaryotic organisms normally contain DNA in a double-stranded state, yet several important biological processes transiently involve single-stranded regions. DNA, which consists of a polysugar-phosphate backbone possessing projections of purines (adenine and guanine) and pyrimidines (thymine and cytosine), forms a double helix that is held together by hydrogen bonds between these purines and pyrimidines (adenine to thymine and guanine to cytosine). DNA Types and Structure linear de cadeia dupla pertencente à família Herpesviridae Herpesviridae A family of enveloped, linear, double-stranded DNA viruses infecting a wide variety of animals. Subfamilies, based on biological characteristics, include: alphaherpesvirinae; betaherpesvirinae; and gammaherpesvirinae. Herpes Simplex Virus 1 and 2. Este vírus altamente prevalente é transmitido principalmente através do contacto com secreções orofaríngeas de um indivíduo infetado. O vírus pode infetar células epiteliais e linfócitos B, onde pode sofrer replicação lítica ou latência. A infeção inicial pode apresentar-se como mononucleose infeciosa e a reativação (maioritariamente nos pacientes VIH positivos) pode causar leucoplasia pilosa oral. Uma das características importantes das infeções por EBV EBV Epstein-barr virus (EBV) is a linear, double-stranded DNA virus belonging to the herpesviridae family. This highly prevalent virus is mostly transmitted through contact with oropharyngeal secretions from an infected individual. The virus can infect epithelial cells and B lymphocytes, where it can undergo lytic replication or latency. Epstein-Barr Virus é a capacidade de transformar células B, proporcionando imortalização e proliferação do vírus. Assim, o EBV EBV Epstein-barr virus (EBV) is a linear, double-stranded DNA virus belonging to the herpesviridae family. This highly prevalent virus is mostly transmitted through contact with oropharyngeal secretions from an infected individual. The virus can infect epithelial cells and B lymphocytes, where it can undergo lytic replication or latency. Epstein-Barr Virus está associado a distúrbios linfoproliferativos e neoplasias malignas, como linfoma de Burkitt, linfoma de Hodgkin, linfohistiocitose hemofagocítica, doença linfoproliferativa pós-transplante, alguns carcinomas gástricos e carcinoma nasofaríngeo.

Last updated: Dec 15, 2025

Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

Classificação

Fluxograma de classificação de vírus de DNA

Identificação de vírus de DNA:
Os vírus podem ser classificados de várias formas. Contudo, a maioria dos vírus possui um genoma formado por DNA ou RNA. Os vírus com genoma de DNA podem ainda ser caracterizados como de cadeia simples ou dupla. Os vírus com envelope são revestidos por uma camada fina de membrana celular, que geralmente é retirada da célula hospedeira. Os vírus sem envelope são apelidados de vírus “nus”. Alguns vírus com envelope traduzem DNA em RNA antes de serem incorporados no genoma da célula hospedeira.

Imagem por Lecturio. Licença: CC BY-NC-SA 4.0

Características Gerais e Epidemiologia

Principais características do vírus Epstein-Barr ( EBV EBV Epstein-barr virus (EBV) is a linear, double-stranded DNA virus belonging to the herpesviridae family. This highly prevalent virus is mostly transmitted through contact with oropharyngeal secretions from an infected individual. The virus can infect epithelial cells and B lymphocytes, where it can undergo lytic replication or latency. Epstein-Barr Virus, pela sigla em inglês)

  • Também conhecido como herpesvírus humano 4
  • Taxonomia:
    • Família: Herpesviridae
    • Subfamília: Gammaherpesvirinae
    • Género: Lymphocryptovirus
  • Vírus de DNA
    • Linear
    • Cadeia dupla
    • > 85 genes
  • Estrutura:
    • Núcleo (contém DNA)
    • Nucleocápside de proteína icosaédrica
    • Tegumento (contém proteínas e enzimas virais)
    • Envelope lipídico com glicoproteínas “spike”

Doenças associadas

  • Mononucleose infeciosa aguda
  • Leucoplasia pilosa oral
  • Doenças linfoproliferativas e neoplasias malignas:
    • Linfoma de Burkitt
    • Linfoma de Hodgkin
    • Linfohistiocitose hemofagocítica
    • Doença linfoproliferativa pós-transplante
    • Carcinoma nasofaríngeo
    • Carcinoma gástrico associado ao EBV EBV Epstein-barr virus (EBV) is a linear, double-stranded DNA virus belonging to the herpesviridae family. This highly prevalent virus is mostly transmitted through contact with oropharyngeal secretions from an infected individual. The virus can infect epithelial cells and B lymphocytes, where it can undergo lytic replication or latency. Epstein-Barr Virus
  • Outras patologias inflamatórias:
    • Miocardite
    • Pancreatite
    • Hepatite
    • Meningoencefalite

Epidemiologia

  • Os anticorpos são encontrados em todos os grupos populacionais em todo o mundo.
  • > 90% dos adultos são seropositivos para anticorpos EBV EBV Epstein-barr virus (EBV) is a linear, double-stranded DNA virus belonging to the herpesviridae family. This highly prevalent virus is mostly transmitted through contact with oropharyngeal secretions from an infected individual. The virus can infect epithelial cells and B lymphocytes, where it can undergo lytic replication or latency. Epstein-Barr Virus.

Patogénese

Reservatório

Os humanos são o único reservatório.

Transmissão

  • Contacto com secreções corporais de um indivíduo infetado
    • Saliva Saliva The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptyalin. Salivary Glands: Anatomy (“doença do beijo”)
    • Sangue
    • Sémen
  • Transfusão de sangue
  • Transplante de órgãos

Ciclo de replicação viral

Entrada na célula:

  • O EBV EBV Epstein-barr virus (EBV) is a linear, double-stranded DNA virus belonging to the herpesviridae family. This highly prevalent virus is mostly transmitted through contact with oropharyngeal secretions from an infected individual. The virus can infect epithelial cells and B lymphocytes, where it can undergo lytic replication or latency. Epstein-Barr Virus liga-se a recetores na superfície celular (particularmente CD21 CD21 Molecular sites on or in B-lymphocytes, follicular dendritic cells, lymphoid cells, and epithelial cells that recognize and combine with complement C3D. Human complement receptor 2 (CR2) serves as a receptor for both C3dg and the gp350/220 glycoprotein of Human Herpesvirus 4 and binds the monoclonal antibody OKB7, which blocks binding of both ligands to the receptor. Epstein-Barr Virus em células B)
  • Fusão com a membrana celular → nucleocápside libertada no citoplasma
  • Transportado para o núcleo da célula → pode entrar em replicação lítica ou latência

Latência:

  • Após a entrada no núcleo → o DNA DNA A deoxyribonucleotide polymer that is the primary genetic material of all cells. Eukaryotic and prokaryotic organisms normally contain DNA in a double-stranded state, yet several important biological processes transiently involve single-stranded regions. DNA, which consists of a polysugar-phosphate backbone possessing projections of purines (adenine and guanine) and pyrimidines (thymine and cytosine), forms a double helix that is held together by hydrogen bonds between these purines and pyrimidines (adenine to thymine and guanine to cytosine). DNA Types and Structure torna-se circular
  • Apenas uma parte dos genes Genes A category of nucleic acid sequences that function as units of heredity and which code for the basic instructions for the development, reproduction, and maintenance of organisms. DNA Types and Structure é expressa → não é produzido nenhum virião
  • Pode reativar → replicação lítica (o precipitante não é conhecido)

Replicação lítica:

  • Após a latência ou entrada no núcleo → o DNA DNA A deoxyribonucleotide polymer that is the primary genetic material of all cells. Eukaryotic and prokaryotic organisms normally contain DNA in a double-stranded state, yet several important biological processes transiently involve single-stranded regions. DNA, which consists of a polysugar-phosphate backbone possessing projections of purines (adenine and guanine) and pyrimidines (thymine and cytosine), forms a double helix that is held together by hydrogen bonds between these purines and pyrimidines (adenine to thymine and guanine to cytosine). DNA Types and Structure torna-se linear
  • Replicação com DNA DNA A deoxyribonucleotide polymer that is the primary genetic material of all cells. Eukaryotic and prokaryotic organisms normally contain DNA in a double-stranded state, yet several important biological processes transiently involve single-stranded regions. DNA, which consists of a polysugar-phosphate backbone possessing projections of purines (adenine and guanine) and pyrimidines (thymine and cytosine), forms a double helix that is held together by hydrogen bonds between these purines and pyrimidines (adenine to thymine and guanine to cytosine). DNA Types and Structure polimerase viral → montagem → saída da membrana nuclear
  • Envelope Envelope Bilayer lipid membrane acquired by viral particles during viral morphogenesis. Although the lipids of the viral envelope are host derived, various virus-encoded integral membrane proteins, i.e. Viral envelope proteins are incorporated there. Virology externo obtido da membrana celular

Fisiopatologia

Tipos de células infetadas:

  • Linfócitos B
  • Células epiteliais

Infeção primária:

  • O EBV infeta células epiteliais na orofaringe → replicação
  • Libertado na saliva
  • Células B infetadas em tecido rico em linfoides → permite a disseminação
  • Sistema imune:
    • Produz anticorpos heterófilos IgM
    • Ativação de células T → destruição de células líticas infetadas
  • A latência ajuda o vírus a “escapar” do sistema imune → persistência indefinida

Doenças linfoproliferativas:

  • Mecanismo latente de expressão génica → produção de proteínas virais
  • Transformação de células B em células linfoblastoides → proliferação
  • Nos estados com ↓ células T citotóxicas → ↑ células B infetadas
  • Pode levar a malignidade
  • Nota: pode ocorrer um processo semelhante em células epiteliais → neoplasias epiteliais

Doenças Causadas pelo EBV

Mononucleose infeciosa aguda

Apresentação Clínica:

  • Febre
  • Amigdalite (amígdalas edemaciadas e eritematosas que podem estar cobertas por placas de exsudado)
  • Linfadenopatia cervical (frequentemente das cadeias cervical posterior e auricular posterior)
  • Cefaleias
  • Mal-estar geral e fadiga
  • Petéquias na junção entre o palato duro e o palato mole Mole Nevi (singular nevus), also known as “moles,” are benign neoplasms of the skin. Nevus is a non-specific medical term because it encompasses both congenital and acquired lesions, hyper- and hypopigmented lesions, and raised or flat lesions. Nevus/Nevi
  • Hepatoesplenomegalia
  • Erupção cutânea maculopapular Maculopapular Dermatologic Examination (semelhante ao sarampo, presente em aproximadamente 5% dos casos)

Diagnóstico:

  • Clínico
  • Confirmado com:
    • Teste de anticorpos heterófilos
    • Serologia

Tratamento:

Leucoplasia pilosa oral

A leucoplasia pilosa oral é causada pela reativação do EBV EBV Epstein-barr virus (EBV) is a linear, double-stranded DNA virus belonging to the herpesviridae family. This highly prevalent virus is mostly transmitted through contact with oropharyngeal secretions from an infected individual. The virus can infect epithelial cells and B lymphocytes, where it can undergo lytic replication or latency. Epstein-Barr Virus latente e ocorre principalmente em pacientes VIH positivos.

Apresentação clínica:

  • Lesões não pré-malignas
  • Manchas brancas na língua
  • Aparência “peluda” (devido à hiperqueratose e hiperplasia epitelial)
  • Não desaparece com raspagem

Diagnóstico:

  • Clínico
  • Confirmado com histologia e identificação do EBV EBV Epstein-barr virus (EBV) is a linear, double-stranded DNA virus belonging to the herpesviridae family. This highly prevalent virus is mostly transmitted through contact with oropharyngeal secretions from an infected individual. The virus can infect epithelial cells and B lymphocytes, where it can undergo lytic replication or latency. Epstein-Barr Virus dentro das células epiteliais

Tratamento:

  • O tratamento não está indicado.
  • Terapêutica antirretroviral nos VIH positivos

Doenças linfoproliferativas e neoplasias associadas ao EBV EBV Epstein-barr virus (EBV) is a linear, double-stranded DNA virus belonging to the herpesviridae family. This highly prevalent virus is mostly transmitted through contact with oropharyngeal secretions from an infected individual. The virus can infect epithelial cells and B lymphocytes, where it can undergo lytic replication or latency. Epstein-Barr Virus

Tabela: Patologias associadas ao EBV EBV Epstein-barr virus (EBV) is a linear, double-stranded DNA virus belonging to the herpesviridae family. This highly prevalent virus is mostly transmitted through contact with oropharyngeal secretions from an infected individual. The virus can infect epithelial cells and B lymphocytes, where it can undergo lytic replication or latency. Epstein-Barr Virus
Doença Características Apresentação clínica Tratamento
Linfoma de Burkitt
  • Condição definidora de SIDA
  • t(8;14)
  • Superexpressão do oncogene c-myc c-MYC Basic helix-loop-helix transcription factors encoded by the c-myc genes. They are normally involved in nucleic acid metabolism and in mediating the cellular response to growth factors. Elevated and deregulated (constitutive) expression of c-myc proteins can cause tumorigenesis. Non-Hodgkin Lymphomas
  • Sintomas constitucionais
  • Massa extranodal de crescimento rápido
  • Quimioterapia
  • Imunoterapia
  • Radiação
Linfoma de Hodgkin Células de Reed-Sternberg
  • Linfadenopatia assintomática
  • Sintomas constitucionais
  • Quimioterapia
  • Radiação
  • Transplante autólogo de células-tronco
Linfohistiocitose hemofagocítica
  • Ativação sustentada e aberrante de células T CD8+ citotóxicas
  • ↑ Libertação de citocinas
  • Febre
  • Linfadenopatia
  • Hepatoesplenomegalia
  • Citopenias
  • Falência multiorgânica
  • Quimioterapia
  • Transplante de células-tronco hematopoéticas
Doença linfoproliferativa pós-transplante
  • Pode progredir para linfoma de células B
  • Sintomas constitucionais
  • Linfadenopatia
  • Massa extranodal
  • Disfunção de órgão
↓ Terapêutica imunossupressora
Carcinoma nasofaríngeo
  • Neoplasia epitelial
  • Linfadenopatia
  • Hemorragia nasal ou oral
  • Respiração nasal obstruída
  • Otites recorrentes
  • Radiação
  • Quimioterapia
Carcinoma gástrico associado ao EBV EBV Epstein-barr virus (EBV) is a linear, double-stranded DNA virus belonging to the herpesviridae family. This highly prevalent virus is mostly transmitted through contact with oropharyngeal secretions from an infected individual. The virus can infect epithelial cells and B lymphocytes, where it can undergo lytic replication or latency. Epstein-Barr Virus
  • Neoplasia epitelial
  • Melhor prognóstico do que o cancro EBV-negativo
  • Assintomática
  • Sensação de enfartamento pós-prandial
  • Anorexia Anorexia The lack or loss of appetite accompanied by an aversion to food and the inability to eat. It is the defining characteristic of the disorder anorexia nervosa. Anorexia Nervosa
  • Náuseas
  • Perda de peso
  • Resseção cirúrgica
  • Quimioterapia

Comparação de Herpesvírus

Existem 115 diferentes espécies conhecidas de herpesvírus que são agrupadas em 3 famílias:

  • Alfa (infecta células epiteliais e produz infecções latentes em neurônios pós-mitóticos)
  • Beta (infectar e produzir infecções latentes em vários tipos de células)
  • Gama (produz infecções latentes principalmente em células linfóides)
Tabela: Comparação dos 9 herpesvírus considerados endêmicos em humanos
HHV Nome comum Células de destino primárias Site de latência Apresentação clínica*
1
(grupo alfa)
HSV-1 Células mucoepiteliais Gânglios da raiz dorsal
  • Gengivoestomatite
  • Queratite
  • branqueamento herpético
  • Encefalite
  • Hepatite
  • Esofagite
  • Pneumonia Pneumonia Pneumonia or pulmonary inflammation is an acute or chronic inflammation of lung tissue. Causes include infection with bacteria, viruses, or fungi. In more rare cases, pneumonia can also be caused through toxic triggers through inhalation of toxic substances, immunological processes, or in the course of radiotherapy. Pneumonia
2
(grupo alfa)
HSV-2
  • Herpes genital
  • Meningite
  • Proctite
3
(grupo alfa)
VZV
  • Varicela
  • Herpes Zoster Herpes Zoster Varicella-zoster virus (VZV) is a linear, double-stranded DNA virus in the Herpesviridae family. Shingles (also known as herpes zoster) is more common in adults and occurs due to the reactivation of VZV. Varicella-Zoster Virus/Chickenpox (Zona)
4
(grupo gama)
EBV EBV Epstein-barr virus (EBV) is a linear, double-stranded DNA virus belonging to the herpesviridae family. This highly prevalent virus is mostly transmitted through contact with oropharyngeal secretions from an infected individual. The virus can infect epithelial cells and B lymphocytes, where it can undergo lytic replication or latency. Epstein-Barr Virus
  • Células epiteliais
  • Células B
Células B de memória
  • Mononucleose infecciosa
  • Linfoma de Hodgkin
  • Linfoma de Burkitt
  • Leucoplasia pilosa oral
  • Câncer gástrico associado ao EBV EBV Epstein-barr virus (EBV) is a linear, double-stranded DNA virus belonging to the herpesviridae family. This highly prevalent virus is mostly transmitted through contact with oropharyngeal secretions from an infected individual. The virus can infect epithelial cells and B lymphocytes, where it can undergo lytic replication or latency. Epstein-Barr Virus
5
(grupo beta)
CMV
  • Monócitos
  • Linfócitos
  • Células epiteliais
Células progenitoras hematopoiéticas na medula óssea
  • Mononucleose de CMV
  • Retinite por CMV
  • colite por CMV
  • Encefalite por CMV
6A, 6B
(grupo beta)
HHV-6 HHV-6 Human herpesvirus (HHV)-6 and HHV-7 are similar double-stranded DNA viruses belonging to the Herpesviridae family. Human herpesviruses are ubiquitous and infections are commonly contracted during childhood. Human Herpesvirus 6 and 7 células T Monócitos Roséola
7
(grupo beta)
HHV-7 HHV-7 Human herpesvirus (HHV)-6 and HHV-7 are similar double-stranded DNA viruses belonging to the Herpesviridae family. Human herpesviruses are ubiquitous and infections are commonly contracted during childhood. Human Herpesvirus 6 and 7 células T
8
(grupo gama)
KSHV
  • Linfócitos
  • Células epiteliais
células B Sarcoma de Kaposi Kaposi A multicentric, malignant neoplastic vascular proliferation characterized by the development of bluish-red cutaneous nodules, usually on the lower extremities, most often on the toes or feet, and slowly increasing in size and number and spreading to more proximal areas. The tumors have endothelium-lined channels and vascular spaces admixed with variably sized aggregates of spindle-shaped cells, and often remain confined to the skin and subcutaneous tissue, but widespread visceral involvement may occur. Hhv-8 is the suspected cause. There is also a high incidence in AIDS patients. AIDS-defining Conditions
* Negrito na coluna “apresentação clínica”: doenças definidoras de AIDS
CMV: citomegalovírus
EBV: vírus Epstein-Barr
HHV: herpesvírus humano
HSV: vírus do herpes simples
KSHV: herpesvírus associado ao sarcoma de Kaposi
VZV: vírus da varicela zoster

Referências

  1. Sullivan, J.L. (2019). Clinical manifestations and treatment of Epstein-Barr virus infection. UpToDate. Retrieved May 19, 2021, from https://www.uptodate.com/contents/clinical-manifestations-and-treatment-of-epstein-barr-virus-infection
  2. Smith, M.C., et al. (2014). The ambiguous boundary between EBV-related hemophagocytic lymphohistiocytosis and systemic EBV-driven T cell lymphoproliferative disorder. International Journal of Clinical and Experimental Pathology, 7(9), 5738-5749. https://pubmed.ncbi.nlm.nih.gov/25337215/
  3. Lee, J.H., et al. (2009). Clinicopathological and molecular characteristics of Epstein-Barr virus-associated gastric carcinoma: A meta-analysis. Journal of Gastroenterology and Hepatology, 24(3), 354-365. https://pubmed.ncbi.nlm.nih.gov/19335785/
  4. Lauwers, G. (2020). Gastric cancer pathology and molecular pathogenesis. UpToDate. Retrieved May 19, 2021, from https://www.uptodate.com/contents/gastric-cancer-pathology-and-molecular-pathogenesis
  5. Sullivan, J.L. (2021). Virology of Epstein-Barr virus. UpToDate. Retrieved May 19, 2021, from https://www.uptodate.com/contents/virology-of-epstein-barr-virus
  6. Shetty, K., Benge, E., Josef, V.E., and Vaghefi, R. (2021). Epstein-Barr virus (EBV) infectious mononucleosis (mono). Medscape. Retrieved May 21, 2021, from https://emedicine.medscape.com/article/222040-overview
  7. Hoover, K., and Higginbotham, K. (2020). Epstein Barr virus. https://www.ncbi.nlm.nih.gov/books/NBK559285/
  8. Fugl, A., and Andersen, C.K. (2019). Epstein-Barr virus and its association with disease – a review of relevance to general practice. BMC Family Practice 20(62). https://doi.org/10.1186/s12875-019-0954-3
  9. Ayee, R., Oforiwaa Ofori, M.E., Wright, E., and Quaye, O. (2020). Epstein Barr virus associated lymphomas and epithelial cancers in humans. Journal of Cancer 11(7), 1737-1759. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7052849/

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