Since more than 95% of the IM patients recover without specific therapy, and specific therapy does not show significant clinical benefit, the treatment is usually symptomatic. The duration of fever is reduced to 2 to 5 days using prednisolone (40mg/day decreased to 5mg/day by the 12th day). However, this treatment has gained no general acceptance because of the fear of inducing myocarditis or meningoencephalitis. Corticosteroids may be used in airway obstruction, severe thrombocytopenia, haemolytic anaemia or selected cases of prolonged prostration. Some also use similarly administered corticoids in involvement of the central nervous system, myocarditis, or pericarditis, starting at a higher dose (prednisone, 60-80 mg/day). Metronidazole has been claimed to reduce the pharyngeal symptoms, but neither this drug nor chloroquine, which has also been tried, showed any significant effect on general health. In randomized trials aciclovir showed no significant clinical effect. Oropharyngeal EBV replication, however, was temporarily inhibited. Phosphonoacetic acid (PAA), adenine arabinoside (ara-A), desciclovir, sorovudine (BV-ara-U) and interferon-a and -g have demonstrated an ability to inhibit oropharyngeal shedding, but significant clinical benefit was not observed. Oral hairy leukoplakia, however, showed a significant response to aciclovir therapy. Aciclovir is also included in treatment of erythrophagocytosis, but needs to be combined with immunoglobulin and a-interferon. Cytotoxic drug therapy, sometimes combined with irradiation, is dominating therapy for EBV-related or unrelated lymphomas in immunodeficiencies, or HIV infection. Surgical removal combined with cytotoxic drugs may be required as treatment of lymphomas in transplanted patients if the tumours are monoclonal and/or show extranodal localization. However, discontinuation of the immunosuppressive treatment may be the way to stop the tumour growth, but may require removal of a transplant. Ex vivo generated EBV-specific CTLs may prevent or treat these lymphomas. Burkitt's lymphoma is highly sensitive to cytotoxic drugs.
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