Chronic Active Virus Infection Research Articles

Application value of immune index detection in differential diagnosis between infectious mononucleosis and chronic active EB virus infection

目的 探讨免疫指标检测对传染性单核细胞增多症(IM)与慢性活动性EB病毒(EBV)感染(CAEBV)的鉴别诊断价值。 方法 选取宁波市第七医院儿科2017年1月至2019年3月收治的EBV感染患儿80例，根据不同诊断分为IM组和CAEBV组，另将在该院接受体检的健康儿童50例作为对照组。比较IM组、CAEBV组和对照组之间白细胞计数、淋巴细胞计数、外周血淋巴细胞各表型、免疫球蛋白水平的差异；比较IM组和CAEBV组EBV DNA载量的差异，评估其与各免疫指标水平的相关性。 结果 三组间白细胞计数、淋巴细胞计数和外周血淋巴细胞亚群差异均有统计学意义(F＝80.423、60.442、110.203、30.109、51.425、110.323、60.312、14.234，均P 0.05)。 结论 IM患儿以T淋巴细胞大量增殖、B淋巴细胞显著减少为主，而CAEBV患儿T淋巴细胞、B淋巴细胞和NK细胞均显著减少，尤其是CD3＋，IM和CAEBV患儿处于相反的状态；另外，虽然EBV DNA载量与各免疫指标水平并无相关性，但IM患儿EBV DNA载量显著低于CAEBV患儿，该指标仍然可作为辅助鉴别IM和CAEBV的依据。外周血淋巴细胞亚群检测以及EBV DNA载量检测有助于IM和CAEBV的鉴别诊断，可在临床上广泛应用。

Characteristics study of serology and immunology of non-malignant diseases associated with Epstein-Barr virus infection in children

Objective To study the characteristics of immune function, Epstein-Barr virus(EBV) antibodies and EBV-DNA in children with different clinical types of EBV infection, which provide basis for prevention and treatment of EBV infection. Methods Clinical data of 103 patients suffering from EBV infection were retrospectively analyzed in Xijing Hospital of the Fourth Military Medical University.A total of 103 children were divided into infectious mononualeosis(IM) group(n=68), chronic active Epstein-Barr virus infection(CAEBV) group(n=13) and Epstein-Barr virus-related hemophagocytic lymphohistiocytosis(EBV-HLH) group(n=22). The changes of EBV antibodies, EBV-DNA, immunoglobulin levels, lymphocyte subpopulation and complement series were detected and compared among the three groups.A total of 26 healthy children at the same stage were enrolled as a control group, immunoglobulin levels, lymphocyte subpopulation and complement series were detected in control group, then compared with the rest of the three groups. Results The levels of C3 and C4 in CAEBV group and EBV-HLH group were significantly decreased than those in the control group(P 0.05). CD8+ T cells in IM group significantly increased than those in the rest of the three groups(P<0.05, respectively). T cells, CD8+ T cells, CD4+ T cells, CD4+ /CD8+ ratios, NK cells, B cells of EBV-HLH group significantly decreased than those in the rest of the three groups(P<0.05). The positive rates of EBV antibodies in CAEBV group and IM group were significantly higher than those in EBV-HLH group(P<0.05). EBV-DNA in EBV-HLH group were significantly higher than those of CAEBV group and IM group(P<0.05). Conclusion EBV-DNA levels in the serum are positively correlated with disease types and severity, the pathogenesis of IM, CAEBV and EBV-HLH induced by EBV infection are associated with immune dysfunction.Dynamic monitoring of EBV load and cell immune function can reflect disease status and progress risk. Key words: Epstein-Barr virus; Immunology; Children,

Research progress of chronic active Epstein-Barr virus infection

Epstein-Barr virus(EBV) infection is characterized as chronic or recurrent infectious mononucleosis (IM)-like symptoms, such as fever, extensive lymphadenopathy, hepatosplenomegaly and persistent hepatitis. Additionally, the expression of EBV specific antibody spectrum and a significant incrcase of EBV DNA copies are often demonstrated in peripheral blood of patients with chronic active Epstein-Barr virus infection (CAEBV). CAEBV is a rare fatal disease with poor prognosis and high mortality. The pathogenesis of CAEBV is unknown and there is no standarlized treatment. In order to improve understanding of CAEBV in the clinical work, this article summarizes the pathogenesis, clinical features, diagnose and therapies of CAEBV. Key words: Epstein-Barr virus infections; Diagnosis; Therapeutics

Clinical analysis of chronic active epstein-barr virus infection in children

Objective To study the clinical characteristics of chronic active Epstein-Barr virus(EBV) infection (CAEBV) in children and to provide a basis for the diagnosis and treatment of CAEBV. Methods Clinical data, laboratory serology, pathological examination, treatment and follow-up results of 10 cases with CAEBV infection who were treated in Xijing Hospital of the Fourth Military Medical University from January 2008 to January 2016 were analyzed retrospectively. Results CAEBV major manifestations were continuous or intermittent fever, hepatomegaly, splenomegaly and lymphadenopathy, and others, including general fatigue, cough, hematemesis, diarrhea, skin rash, jaundice, sore throat, muscle joint pain, and so on.And with liver dysfunction, hematologic abnormality, and so on.All patients in anti-EB virus capsid antigen IgG(EBVCA-IgG ) antibodies and EBEA-IgG antibodies had positive, while all patients in EBVCA-IgM antibodies had negative.The median load of EBV-DNA detected by real- time polymerase chain reaction(PCR ) in the peripheral blood was 7.15×105 copies/ml.Six of 10 cases CAEBV patients presented a poor clinical course, 1 case died from intracranial hemorrhage, 2 cases from respiratory failure, 1 case from gastrointestinal bleeding, 1 case from liver failure, 1 case from severe multiple pathogens infection, rest 3 cases showed an improvement and 1 cases had a recurrence. Conclusion CAEBV infection has varieties of clinical features, with poor prognosis and high mortality.If the patients had unexplained fever, hepatomegaly, splenomegaly and lymphadenectasis, we should be timely detect virology and histopathological to diagnosis as early as possible. Key words: Chronic active Epstein-Barr virus infection; Children

Inflammatory cytokine production in chronic active Epstein-Barr virus infection.

In order to clarify the mechanisms underlying the development of inflammation in chronic active Epstein-Barr virus infection (CABEV), we examined cytokine production using patient samples. Eleven patients were analyzed. The serum concentrations of IFN-γ, TNF-α, and IL-6 were significantly higher in patients than in healthy donors. The mRNAs of these cytokines in peripheral blood mononuclear cells were elevated in patients as compared with healthy donors. The mRNA of IFN-γ was significantly higher in patients than in healthy donors. We examined which fraction produced the cytokines in the CD4-, CD8-, and CD56-positive fractions of PBMCs. The mRNAs of IFN-γ, TNF-α, and IL-6 were highly expressed in EBV-infected cells, whereas expression was also observed in non-infected cells. We performed in vitro infection of EBV on a T-cell line, MOLT4. EBV infection enhanced the mRNA expressions of IFN-γ and TNF-α. These results suggest that the inflammatory cytokines in CAEBV are produced not only by EBV-infected but also non-infected cells. EBV itself may have roles in the cytokine production observed in infected cells.

Clinical analysis of 19 cases of chronic active Epstein-Barr virus infection in children

Objective To analyze the clinical characteristics and prognosis of children with chronic active Epstein-Barr virus infection (CAEBV). Methods The clinical characteristics, laboratory test findings, treatment and prognosis of 19 cases of children with CAEBV during February 2011 to August 2016 in Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science Technology were analyzed retrospectively. Results The major signs and symptoms of children with CAEBV were fever (18 cases), hepatomegaly (17 cases), splenomegaly (17 cases), lymphadenopathy (11 cases) and blister-like rash (5 cases). Blood routine and liver function results showed leukopenia (11 cases) and anemia (11 cases), neutropenia (8 cases), thrombocytopenia (2 cases), elevated alanine aminotransferase (11 cases), elevated aspartate aminotransferase (10 cases). EBV DNA load increased, viral capsid antigen(VCA)-IgG and nuclear antigen (NA)-IgG were positive in peripheral blood of all cases, and early antigen(EA)-IgG was positive in 8 cases.The results of lymphocyte subsets in 18 cases showed that the proportion of natural killer cell(NK cell) significantly increased in 7 cases, and 1 case was slightly elevated.The proportion of T cells significantly increased in 4 cases, and 2 cases were slightly elevated.The proportion of B cells significantly increased in 1 case; but the results of lymphocyte subsets had no obvious abnormalities in other 3 cases.Genetic testing of 6 cases showed that 3 cases were negative, 1 case with a homozygous mutation in the X-linked inhibitor of apoptosis protein gene(XIAP gene), and 2 cases had heterozygous mutation (the meaning of mutation was unclear in 1 case). Three out of 11 cases had hemophagocytic syndrome by bone marrow examination, and 1 case out of 4 cases had lymphoma by lymph node biopsy.All of 19 cases of CAEBV had complications, including 6 cases of pneumonia, 3 cases of hemo-phagocytic lymphoid Histiocytosis (HLH), 3 cases of thrush, and lymphoma, intestinal obstruction, intestinal perforation and intestinal bleeding, cholecystitis, multiple stones in intrahepatic bile duct, autoimmune hepatitis, purpura, perianal abscess, malnutrition and hypoalbuminemia respective in 1 case respectively.Nineteen children with CAEBV received different treatment based on patients′ condition, 3 cases discontinued, 8 cases survived (1 case diagnosed recently 1 year and 1 case underwent successfully, living for 5 years now), 8 patients died, and the mortality rate was 50.0% (8/16 cases). Conclusions The main clinical characteristics of children with CAEBV are fever, hepatosplenomegaly, lymphadenopathy, skin rash, blood system involvement and elevated transaminase; CAEBV is prone to pneumonia, then HLH and other complications may appear.EBV DNA load increases in peripheral blood cells as an important evidence of viral attack; lymphocyte subset of peripheral blood is significant for typing of CAEBV, and most cases belong to NK cell type and T cell type probably; lymph node biopsy and bone marrow examination are extremely important for identifying whether it is prone to lymphoma or HLH.The treatment should be based on the condition of individual condition to select immunosuppression and/or chemotherapy, and hematopoietic stem cell transplantation is best choice to improve the prognosis at present. Key words: Chronic active Epstein-Barr virus infection; Clinical characteristics; Diagnosis; Therapy; Prognosis; Child

Chronic active Epstein-Barr virus infection complicated with coronary aneurysm in 4 pediatric cases and the literature review

Objective To enhance the recognition of cardiovascular complications associated with chronic active Epstein-Barr virus infection (CAEBV) in children. Methods In this study, the medical records of 4 pediatric patients with CAEBV complicated with cardiovascular impairment (coronary artery lesion and artery aneurysms) at Guangzhou Women and Children′s Medical Center, Guangzhou Medical University were evaluated and the literatures were reviewed. Results (1)Apart from complicated with coronary aneurysm, these patients exhibited intermittent fever, hepatomegaly, splenomegaly, lymphadenectasis, liver dysfunction and pleural effusion.The main complications including abdominal aortic dilation, interstitial pneumonia, uveitis and hemophagocytic syndrome were also observed.(2) Epstein-Barr virus-related antibody detected by immunofluorescence assays showed that all patients were Epstein-Barr virus IgG antibodies positive against viral capsid antigen and against nuclear antigen, with anti-early antigens IgG positive in 3 patients.The plasma Epstein-Barr virus DNA level in those patients with CAEBV ranged from 1.46×107 to 3.72×1010 copies/L at diagnosis.(3)The inspection of immunological aspects showed that serum IgG levels and CD4+ T cells increased in 4 patients, but the number of natural killer cells decreased in 3 patients with CAEBV at diagnosis. Conclusions (1) The children with CAEBV could lead to cardiovascular impairment included coronary aneurysm and other artery aneurysms.(2) At present, it is difficult to justify whether Epstein-Barr virus contributed to the development of coronary artery lesions or Kawasaki disease complicated by coronary aneurysm because histopathologic examination could not be executed in living body.Differential diagnosis only depends on clinical symptom and follow-up.(3)The study reminds clinicians of the vital importance of early diagnosis and close follow-up of CAEBV-asso-ciated cardiovascular complications through echocardiography, imaging procedures such as CT and other novel techniques.Meanwhile, the relevant inspections of Epstein-Barr virus should be carried out when coronary aneurysm is found in children. Key words: Chronic active Epstein-Barr virus infection; Cardiovascular damage; Coronary aneurysm; Child

Chronic active Epstein-Barr virus infection

Chronic active Epstein-Barr virus (EBV) infection (CAEBV) is characterized by chronic or recurrent infectious mononucleosis-like symptoms, such as fever, hepatomegaly, splenomegaly, liver dysfunction, lym-phadenopathy, hypersensitivity to mosquito bites, skin rash.Patients with CAEBV have high viral loads in their periphe-ral blood and/or an unusual pattern of EBV-related antibodies.This disease is rare but severe with high mortality, the pathogenesis is unknown though there is accumulating evidence that the clonal expansion of EBV-infected T or natural killer (NK) cells plays a central role in the pathogenesis of CAEBV.Because antiviral therapy is generally ineffective for this disease, numerous agents have been tried for the treatment of CAEBV, e.g.immunosuppressive agents, immunomodulatory therapy, immune cell therapy.Allogeneic hematopoietic stem cell transplants have been reported to be successful, but there still has some risks. Key words: Epstein-Barr virus; Chronic active Epstein-Barr virus infection; Child

Chronic active Epstein-Barr virus infection in children with coronary aneurysm: a case report

Chronic active Epstein-Barr virus infection in children with coronary aneurysm: a case report

Chronic active Epstein-Barr virus infection

Chronic active Epstein-Barr virus infection (CAEBV) is characterized by chronic or re-current infectious mononucleosis-like symptoms,such as persistent or intermittent fever,hepatomegaly,sple-nomegaly, liver dysfunction,thrombocytopenia,anemia,lymphadenopathy,hypersensitivity to mosquito bites, skin rash. Patients with CAEBV have high viral loads in their peripheral blood and/or an unusual pattern of EBV-related antibodies. This disease is rare but severe with high morbidity and mortality. The pathogenesis is unknown though there is accumulating evidence that the clonal expansion of EBV-infected T or natural killer ( NK) cells plays a central role in the pathogenesis of CAEBV. New diagnostic guideline for EBV infection have now been developed. For antiviral therapy is generally ineffective for this disease, numerous agents have been tried for the treatment of CAEBV,e.g. Immunosuppressive agents,immunomodulatory therapy,immune cell therapy. Key words: Chronic active Epstein-Barr virus infection; Child

The Mechanisms of Immune Escape in Chronic Active Epstein-Barr Virus Infection

慢性活动性EB病毒感染是EB病毒相关疾病中的一种较少见类型,其发病既有病毒方面的因素,亦有机体免疫功能方面的因素.EB病毒感染T细胞或自然杀伤细胞导致的克隆性扩增在发病中起关键作用,但机制尚不十分明确.EB病毒有其特殊的策略逃避免疫监视,EB病毒基因编码产物(如EBNA-1、LMP1、LMP2、EBNA-2)与宿主基因表达产物(如白细胞介素-10、转化生长因子-β、CD40-CD40配体)都参与了EB病毒的免疫逃逸.根据其免疫逃逸原理选择新的治疗方法将是今后的研究重点。

VZV vasculopathy and postherpetic neuralgia

Two serious complications of varicella-zoster virus (VZV) reactivation are vasculopathy and postherpetic neuralgia (PHN). Clinical-virologic analyses have proven that VZV vasculopathy is caused by chronic active virus infection in cerebral arteries. Conclusive evidence that PHN is caused by persistent or productive VZV infection is less compelling because human ganglia are not accessible during life for pathologic and virologic examination. However, the notion that PHN may reflect a smoldering VZV ganglionitis is supported by 1) the detection of VZV DNA and proteins in peripheral blood mononuclear cells of many patients with PHN; 2) studies of multiple patients with zoster sine herpete, which indicate a productive VZV ganglionitis; and 3) a favorable response of some patients with zoster sine herpete and PHN to antiviral treatment. Few studies have used antiviral therapy to manage PHN with conflicting results. Larger, double-blind studies, which give IV antiviral drug, are needed.

Chronic active Epstein-Barr virus infection

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