Case Of Epstein-Barr Virus Infection Research Articles

Dynamics of Epstein-Barr virus after cord blood transplantation: A nationwide survey in Japan.

Epstein-Barr virus (EBV) is a common virus that latently infects most adults and has a tropism to B lymphocytes. In 1988, two cases of EBV infection were reported to be eradicated by hematopoietic stem cell transplantation from an EBV-negative donor. However, the dynamics of EBV after cord blood transplantation (CBT), namely, the kinetics of anti-EBV antibodies, the incidence of negative/adverse seroconversion (from positive to negative), and the clinical course of re-infection (second primary infection) by EBV, have not yet been characterized in detail. Therefore, we performed a nationwide survey that focused on the dynamics of EBV after CBT 1 year or later after CBT. Negative seroconversion occurred in 23% of previously EBV-infected patients. The incidence of late-onset EBV-associated events was 1.9% (13/674): 5 infectious mononucleosis, 2 hemophagocytic lymphohistiocytosis (HLH), and 6 remaining typical lymphoproliferative disease. HLH occurred in newly infected patients (primary or second primary) and also in those with reactivation and was fatal. The annual monitoring of anti-EBV antibody titers may facilitate the early detection of these late-onset EBV-associated events and treatment initiation before disease progression.

Epidemiology, Outcome and Risk Factors Analysis of Viral Infections in Children and Adolescents Undergoing Hematopoietic Cell Transplantation: Antiviral Drugs Do Not Prevent Epstein-Barr Virus Reactivation.

ObjectiveThe analysis of epidemiology, risk factors and outcome of viral infections in children and adolescents after hematopoietic cell transplantation (HCT).MethodsIn this multicenter nationwide study a total of 971 HCT procedures (741 allo-HCT; 230 auto-HCT) over a period of 6 years were analyzed.ResultsDuring this period 801 episodes of viral infections were diagnosed in 442 patients. The incidence of viral infections was 57.9% in allo-HCT and 4.8% in auto-HCT patients. The most frequent infections after allo-HCT were caused by cytomegalovirus (CMV), polyoma BK virus (BKV) and Epstein–Barr virus (EBV). The majority of infections occurred within the first 4 months after allo-HCT and over 80% required pharmacotherapy or symptomatic therapy. The median time of treatment of specific viral infection ranged from 7 (for EBV) to 24 (for CMV) days. The highest mortality was observed in case of CMV infection. The risk factors for viral infections were allo-HCT, acute leukemia, acute and chronic graft versus host disease (a/cGVHD), and matched unrelated donor (MUD)/mismatched unrelated donor (MMUD)-HCT. The risk factor for death from viral infection were CMV-IgG seropositivity in acute lymphoblastic leukemia recipient, and MUD/MMUD-HCT. The incidence of EBV infection requiring pre-emptive treatment with rituximab in allo-HCT children was 19.3%. In 30.8% cases of EBV infection, these episodes were preceded by other viral infection and treated with antivirals, which did not prevent development of EBV-DNA-emia with need of rituximab treatment in 81.5% cases. In 47.7% of these cases, GVHD was a factor enabling development of significant EBV-DNA-emia during antiviral therapy of other infection.ConclusionWe have shown that antiviral drugs do not prevent EBV reactivation in allo-HCT pediatric patients.

NONCONVULSIVE STATUS EPILEPTICUS CAUSED BY VIRAL ENCEPHALITIS: CASE REPORT

In pediatric patients Epstein-Barr virus (EBV) infection may have miscellaneous neurological manifestations. Children with acute viral encephalopathy may present prolonged electrographic seizure activity consistent with non-convulsive status epilepticus (NCSE). NCSE condition is difficult to diagnose due to absence of motor seizures, presenting only changes in behavior and consciousness. In this report we present a clinical case of EBV infection in 3.5-year-old girl. On admission she suffered of confusional state and irritability after an episode of motor partial complex seizure being in good health. The condition evolved twenty five days after an episode of respiratory infection diagnosed as bacterial tonsillitis by the family physician and treated with antibacterials. Laboratory blood evaluation as well as chest radiography, urinalysis, bleeding time, fibrinogen were within the normal range. Magnetic resonance imaging of the brain and spinal cord revealed a subcortical increased signal in the left occipital lobe on T2-weighted image. Electroencephalography (EEG) pattern revealed non-convulsive status epilepticus (NCSE). EBV infection was revealed by serum antibody test. The present case emphasizes the importance to evaluate the role of EBV in acute neurological syndromes in pediatric patients, in particular, in presence of behavioral changes with EEG evidence of seizures. NCSE in children denotes electrographic seizures without convulsive activity and often manifests as altered mental status. It may be difficult to diagnose in pediatric patients in whom changes of behavior and consciousness may not be as easily recognized as in adults.

Modulation of IL-10-Specific B Cell MicroRNAs by Latent Membrane Protein 1 and Epstein-Barr Virus

Post-Transplant Lymphoproliferative Disorder (PTLD) is a potentially fatal side effect of the immunosuppressive agents used to prevent allograft rejection. PTLD is associated with Epstein-Barr Virus (EBV) infection and can result in malignant B cell lymphoma. Latent membrane protein 1 (LMP1), a viral mimic of the B cell costimulatory protein CD40, is the major oncogene of EBV and can usurp host cell pathways to promote cell survival. LMP1 activates the Akt/PI3K signaling pathway to drive IL-10 production, which is essential for the autonomous proliferation of EBV+ B cell lymphomas. MicroRNAs are small, non-coding RNAs that post-transcriptionally regulate gene expression to control cellular events such as differentiation, proliferation, and cell survival. As aberrant expression of microRNAs is found in a variety of human malignancies, our goal was to determine if microRNAs participate in LMP1-induced IL-10 production in PTLD-derived cell lymphomas. To first establish that EBV infection can modulate host cell microRNA, we used Taqman microRNA qPCR arrays to detect the microRNA expression profiles of six B cell tumor lines derived from patients with PTLD, two B cell lines generated by infection with the B95.8 strain of EBV obtained from a patient with mononucleosis, and one EBV-negative B cell line. Expression data was then normalized internally and to the EBV-negative B cell line. Our analysis showed that compared to the EBV-negative B cell line, B cells infected with the benign B95.8 strain of EBV had the altered expression (2-fold) of 294 microRNAs while the PTLD-derived EBV+ B cell lines had the altered expression of 224 microRNAs. Twenty-eight microRNAs were altered in both cases of EBV infection. To examine the specific role of LMP1 in host cell microRNA expression, we used an inducible system of LMP1 activation and expressed different LMP1 molecules in an EBV negative B cell lymphoma line. Activation of the B95.8 form of LMP1 modulated 62 cellular microRNAs and 142 microRNAs were modulated by all five of the PTLD-derived LMP1 molecules. Notably, only 28 microRNAs were modulated by both benign and tumor LMP1. The microRNAs aberrantly regulated by either EBV infection or LMP1 activation were next analyzed with target prediction software for potential binding to the 3″UTR of IL-10. MicroRNA-21, -106A, -106B, -194, -340, -374 and -374-5p fit these criteria and were tested for direct binding to the 3″UTR of IL-10 in luciferase reporter assays. The overexpression of microRNA-106A, -106B, -194, -374, -374-5p each negatively regulated the IL-10 3″UTR. Conversely, microRNA-21 overexpression positively modulated the 3″UTR of IL-10 while microRNA-340 overexpression had no effect. Together, these findings indicate that EBV infection and LMP1 activation induce host cell microRNAs that regulate production of the autocrine growth factor IL-10 in EBV+ B cell lymphomas. Thus, cellular microRNAs are a potential target for inhibiting the growth of PTLD-associated B cell lymphomas.

Prospective Evaluation of the Toxicity Profile of Proteasome Inhibitor–Based Therapy in Renal Transplant Candidates and Recipients

A prospective intermediate-term evaluation of toxicities associated with bortezomib therapy for antibody-mediated rejection (AMR) and desensitization was conducted. Patients were graded for bortezomib-related toxicities: hematologic and gastrointestinal toxicities by Common Terminology Criteria for Adverse Events and peripheral neuropathy by modified Functional Assessment of Cancer Therapy questionnaire and Common Terminology Criteria for Adverse Events. Fifty-one patients treated for AMR and 19 patients treated for desensitization received 96 bortezomib cycles (1.3 mg/m(2) ×4 doses); mean (SD) follow-up was 16.3 (9.0) months. Patients treated for AMR and patients treated for desensitization were similar in age, gender, ethnicity, and baseline peripheral neuropathy. Patients treated for AMR received a mean (SD) of 4.9 (2.0) bortezomib doses in 1.3 (0.5) cycles; and patients treated for desensitization, a mean of 7.3 (1.6) doses in 1.8 (0.4) cycles. Prevalence of diabetes and anemia were higher at baseline in patients treated for AMR. In the AMR cohort, two cases of cytomegalovirus infection, two cases of BK virus infection, and one case of Epstein-Barr virus infection were observed. No cases of viral infection were observed in the desensitization cohort. Malignancies were not observed. Significant bortezomib toxicities included anemia and peripheral neuropathy, which were manageable. Anemia was more common in patients treated for AMR; and peripheral neuropathy, more common in patients treated for desensitization. Bortezomib-related toxicities in kidney transplant candidates and recipients are low in incidence and severity and vary based on treatment population.

A Case of Epstein-Barr Virus Infection with Gall Bladder and Common Bile Duct Stones in an Otherwise Healthy Child

Cholelithiasis and choledocholithiasis are uncommon pediatric diseases, although clinicians have seen them with increasing frequency in children in recent years. Moreover, no case of Epstein-Barr virus (EBV) infection with cholelithiasis and choledocholithiasis has been previously reported in the English literature. We report a pediatric patient with EBV infection, a gall bladder stone, and a common bile duct stone, may have had GB and CBD stones prior to her EBV infection, whom we successfully treated with antibiotics and laparoscopic cholecystectomy for cholecystitis. (Pediatr Gastroenterol Hepatol Nutr 2012; 12: 57∼61)

A Case of Epstein-Barr Virus Infection with Gall Bladder and Common Bile Duct Stones in an Otherwise Healthy Child

A Case of Epstein-Barr Virus Infection with Gall Bladder and Common Bile Duct Stones in an Otherwise Healthy Child

A case of Epstein-Barr virus infection complicated with Guillain-Barré syndrome involving several cranial nerves

This report presents a case of infectious mononucleosis with severe neurological complications in a previously healthy young female. Both peripheral and cranial nerves were affected causing paralysis and need for assisted ventilation. There was a clear correlation between the symptoms and the serological findings, indicating that the causative agent was Epstein-Barr virus. The patient was treated with acyclovir, methylprednisolone and immunoglobulins. Two months later she had recovered completely. Epstein-Barr virus infection must be considered among the possible causes in patients with cranial nerve affection or Guillain-Barré syndrome.

Cranial and peripheral neuropathy due to Epstein-Barr virus infection.

A case of Epstein-Barr virus infection with neurological complications is described. An 18-year-old man developed cranial neuropathy and peripheral sensorimotor polyneuropathy three weeks after a sore throat. Though severely affected...

Assessment of serologic markers for Epstein-Barr virus.

Antibody responses to early antigen (EA) and viral capsid antigen (VCA) were analyzed in 48 proven cases of Epstein-Barr Virus infection and in 48 age- and sex-matched healthy controls to establish optimal cutoff values for diagnosing EBV infection. Predictive values were determined for individual EA and VCA antibody titers and for EA to VCA antibody ratios and the optimal dilution cutoff values for positivity of EA (1:20), VCA (1:640), and EA to VCA (0:031) were selected. When evaluated on a subset of 10 VCA IgM positive cases and 35 negative controls, the three selected cutoff values identified as infections nine of 10, four of 10, and 10 of 10 of the cases and one of 35, none of 35, and one of 35 of the controls, respectively. When evaluated individually on 22 cases of suspected EBV infection who were heterophile antibody-negative and presented with symptoms compatible with EBV infection, an equal number of VCA IgM-positive and negative cases were identified as EBV infections. Overall, the cutoffs EA, VCA, and ratio identified 19 of 22 (86.4%), 14 of 22 (63.6%), and 18 of 22 (81.8%), respectively, and all cases could be identified using combinations of these values. Although these serologic values may be used with some accuracy, until more definitive markers are described a combination of heterophile responses, lymphocyte analysis, clinical symptoms, and serologic cutoff values should be used to assess the role of EBV in patient evaluation.

Acute Renal Failure and Jaundice Associated With Epstein-Barr Virus Infection

We have described a case of Epstein-Barr virus infection associated with acute renal failure and jaundice. Atypical lymphocytes and absolute lymphocytosis were absent, and the patient recovered completely.