I am a history buff, when it comes
to medicine; I am naturally fascinated by the history of medicine, having a
penchant of wanting to know how things came into being in medicine.
The story of Epstein-Barr virus
(EBV) infectious mononucleosis is a good example. Recently a friend as me about a relationship
between mononucleosis and some sort of lymphoma. I have to tell a
story (which is history) to answer this question.
First a few facts:
- Infectious mononucleosis is
transmitted by EB virus.
- Burkitt lymphoma is caused by
EB virus, mostly in Africa.
- Nasopharyngeal cancer (鼻咽癌）is caused by EB virus,
mostly in China,Taiwan
- Some of the stomach cancers
are caused by EB virus.
- Mononucleosis may lead to
Hodgkin’s lymphoma.
From above facts, one can see EB
virus can cause seemingly harmless mononucleosis, but may cause various
cancers, including lymphoma. It should come no surprise that it has been
observed that mononucleosis may lead to Hodgkin’s lymphoma.
 |
| Dr. Denis Burkitt |
The British surgeon (Dr. Denis
Burkitt) served in Africa during WWII and he stayed to do missionary medical
practice in Uganda after the war. He
observed that many young children were stricken with an aggressive tumor/cancer,
and the distribution seemed to be corresponded to the rainy areas with a high
year-round temperature. He suspected it
could be caused by some sort of viral infection. He first reported in the British Journal of
Surgery in 1958, the tumor now bears his name.
On March 22, 1961 Dr. Burkitt
returned to England and gave a talk about his findings in Africa at a medical
school in London, Dr. Michael Anthong Epstein was among the audience. After the talk Dr. Epstein asked Dr. Burkitt
to send him the tumor samples so he could do further research.
 |
| Dr. Michael Anthony Epstein |
Dr. Epstein has worked on Rous
sarcoma virus.
Dr. Rous was the first
one to discover a virus (now bears his name) can cause cancer in chicken,
whereas EBV was the first virus known to cause cancer in human.
Dr. Rous was in his 80s when he was awarded a
Nobel Prize in 1966, 40 years after his discovery.
Dr. Yvonne Barr joined Dr. Epstein
in her PhD study. There are numerous
others, including several distinguished American virologists, made contribution
in establishing EBV as the culprit in causing Burkitt lymphoma; an oncogene was also identified. The intriguing
course of discovery is beyond the scope of this writing.
 |
| Dr. Yvonne Barr |
The virus was christened as
Epstein-Barr virus in 1965. The
historical paper was published in Lancet
(3/28/1964) with a title of “Virus particles in cultured lymphoblasts from
Burkitt Lymphoma”. Actually, Dr Burt
Achong was also the co-author, but, poor Dr Achong, his name was somehow
dropped at the naming of the virus and forgotten, except by a history buff like
me. Dr Achong was a pathologist, using electron microscope to identify the
virus.
There is an article in New England Journal of Medicine (NEJM) with a
title of Hodgkin's lymphoma after infectious mononucleosis, in which it states there is casual connection between mononucleosis and Hodgkin’s lymphoma.
The evidence is that 40-50% of the
Reed-Sternberg cells (the hallmark of Hodgkin’s lymphoma, 我看連退休或生銹的婦產科醫師都還記得)
contain Epstein-Barr virus antigen. And
those patients did have history of mononucleosis. The median interval between getting
mononucleosis and the onset of Hodgkin’s lymphoma is only 4.1 years.
 |
| Dr. Burt Achong |
Fortunately in this report among the 38,000 patients with mononucleosis, only 29 cases
of Hodgkin’s lymphoma discovered. Still
some uncertainty present, as only one third of the adolescents with Hodgkin’s
lymphoma with Reed-Sternberg cells containing EBV; so there is still much
we don't know.
It is regrettable that none of these four British doctor-scientists was honored with Lasker awards ("American Nobel"), I think this an oversight.
EBV is also implicated in causing chronic fatigue syndrome; that calls for another post.
