Epstein-Barr Virus-associated Infectious Mononucleosis Research Articles

Retracted: Difference between Acyclovir and Ganciclovir in the Treatment of Children with Epstein-Barr Virus-Associated Infectious Mononucleosis.

[This retracts the article DOI: 10.1155/2021/8996934.].

Epstein\u2013Barr virus-associated infectious mononucleosis with acute epididymitis: a case report

BackgroundInfectious mononucleosis due to the Epstein–Barr virus is an infectious disease that causes the appearance of atypical lymphocytes in the peripheral blood; it mainly presents with fever, tonsillar pharyngitis, and lymphadenopathy. In addition to hepatitis, splenomegaly, and rashes, it can involve different organs. Here, a case of epididymitis as a rare complication in a patient with Epstein–Barr virus-associated infectious mononucleosis was reported.Case presentationA healthy 23-year-old man visited an outpatient clinic with fever and pharyngitis. Tonsillar pharyngitis, lymphadenopathy, atypical lymphocytes in the peripheral blood, liver dysfunction, and splenomegaly were observed. The patient was diagnosed with infectious mononucleosis based on clinical signs. The next day, the patient developed left testicular pain and was immediately transferred to the emergency outpatient ward. Pain, redness, and swelling were observed in the left scrotum. Ultrasonography revealed swelling of the epididymis and increased blood flow, and the patient was hospitalized with a diagnosis of left epididymitis. The patient’s symptoms improved with symptomatic treatment and was discharged on day 16 after admission. Changes in antibody titers established a definitive diagnosis of infectious mononucleosis caused by the Epstein–Barr virus. Based on the disease course, the patient was also diagnosed with infectious mononucleosis associated with unilateral epididymitis.ConclusionsThis is the first case report of Epstein–Barr virus-associated infectious mononucleosis complicated with acute epididymitis. Infectious mononucleosis can cause numerous organ-related complications; thus, physicians and healthcare workers should remain cognizant of Epstein–Barr virus-associated complications throughout the body and not just in the primary organs affected by infectious mononucleosis.

Analysis of two laboratory tests for determination of EBV‐IM in children

This study aimed to explore the application value of two laboratory tests in the diagnosis of Epstein-Barr virus-associated infectious mononucleosis (EBV-IM) in children. From January 2018 to December 2020, 166 patients with EBV-IM were included in this study. Two methods were used in the analysis. The results of both tests were compared and analyzed. The age of onset of EBV-IM is mainly distributed in the range of 0-6 years, and no difference by gender is observed. The sensitivity and specificity of EBV testing by PCR were 49.4% and 89.8%, respectively, and the area under the receiver operating characteristic curve (AUC) was 0.714 (0.662-0.762). When using the immunofluorescence method to detect EBV antibodies, the two indices with the highest diagnostic efficacy were low-affinity EBV-CA IgG and EBV-CA IgM, and their AUC values were 0.798 (0.751-0.840) and 0.663 (0.609-0.713), respectively. When combining the two indices for testing, the AUC values of EBV-CA IgM + low-affinity EBV-CA IgG, EBV-DNA+EBV-CA IgM, and EBV-DNA+low-affinity EBV-CA IgG were 0.904 (0.867-0.933), 0.768 (0.719-0.812), and 0.963 (0.937-0.981), respectively. The diagnostic efficacy of the combined EBV-DNA+EBV-CA IgM + low-affinity EBV-CA IgG test was optimal compared with that of a single index or the combination of two indices, with an AUC of 0.999 (0.986-1.000;p < 0.05), sensitivity of 100%, and specificity of 89.8%. The combined immunofluorescence and real-time PCR methods have high sensitivity and specificity and good application value in the clinical diagnosis of EBV-IM.

Difference between Acyclovir and Ganciclovir in the Treatment of Children with Epstein-Barr Virus-Associated Infectious Mononucleosis.

Objective To investigate the efficacy differences between acyclovir and ganciclovir in the treatment of children with Epstein–Barr virus (EBV)- associated infectious mononucleosis (IM). Methods A total of 128 children with EBV-IM who were admitted to our hospital from February 2019 to February 2021 were selected and randomly divided into the acyclovir group (n = 64) and the ganciclovir group (n = 64) according to the random number table method. All the children were given symptomatic treatments such as protecting the liver and reducing fever. On this basis, the acyclovir group was given an intravenous drip of acyclovir, while the ganciclovir group was given an intravenous drip of ganciclovir. The treatment was continued for 7 days. After the treatment, the clinical efficacy, disappearance time of symptoms and signs, related blood routine indexes, EBV-DNA negative conversion rate, and the incidence of adverse reactions during the treatment were compared between the two groups. Results After treatment, the total effective rate of the ganciclovir group (92.19%) was higher than that of the acyclovir group (73.44%) and the difference was statistically significant (P < 0.05). The disappearance time for the symptoms and signs of angina, fever, lymphadenopathy, hepatomegaly, and splenomegaly in the ganciclovir group was lower than that in the acyclovir group, and the difference was statistically significant (P < 0.05). After treatment, the levels of atypical lymphocyte proportion, lymphocyte proportion, and WBC count in the two groups were lower than those before treatment, the levels in the ganciclovir group were lower than those in the acyclovir group, and the difference was statistically significant (P < 0.05). After treatment, the EBV-DNA negative conversion rate (81.25%) in the ganciclovir group was higher than that in the acyclovir group (60.93%) and the difference was statistically significant (P < 0.05). During treatment, the incidence of adverse reactions in the ganciclovir group was significantly lower than that in the acyclovir group and the difference was statistically significant (P < 0.05). Conclusion In the treatment of children with EBV-IM, the therapeutic effect of ganciclovir is obviously superior to that of acyclovir. Ganciclovir can quickly eliminate the symptoms of angina, fever, enlarged lymph nodes, and other signs in children, can improve abnormal blood indicators, and has a higher negative conversion rate of EBV and less adverse reactions.

Clinical features of Epstein-Barr Virus-associated Infectious Mononucleosis According to Age Group in Children

Objectives Few studies of pediatric Epstein-Barr virus (EBV)-associated infectious mononucleosis (IM) have been conducted in Korea. We evaluated the clinical features of children with IM to define differences according to age. Methods We conducted retrospective chart reviews of 68 children aged 0 to 15 years who were diagnosed by EBV-associated IM with EBV-Viral Capsid Antigen(VCA) IgM at laboratory test and were admitted between 2010 and 2014. The children were classified into four age groups: aged 0–3, 4–6, 7–9, and 10–15 years. Results The age distribution of patients was as follows: 19 (27.9%) 0–3, 25 (36.8%) 4–6, 13 (19.1%) 7–9, and 11 (16.2%) 10–15. Fever was the most common presentation regardless of age. It was more common in the 0–3 group than the 4–6 group ( P = 0.018). Pharyngitis was more common in the 7–9 group than the 0–3 group ( P = 0.048), and myalgia was more common in the 10–15 group than the 0–3 group ( P = 0.007). Pharyngitis was accompanied by lymphadenopathy, protracted fever, and rash. In the 0–3 age group, the prevalence of rash was higher while the percentage of atypical lymphocytes was lower, but there was no statistical support for this tendency. There were no differences in the frequency of hepatosplenomegaly or laboratory findings between age groups. Conclusions IM is not uncommon in young children and its clinical presentation varies with age. Therefore, IM should be suspected in young febrile children with pharyngitis and rash despite low percentages of atypical lymphocytes.

Causes and management of pediatric spontaneous tonsillar haemorrhage

Objective: To analyze the causes and management plan of pediatric spontaneous tonsillar haemorrhage(STH). Methods: According to the criteria of STH difined by Griffies, patients with STH from December 2013 to January 2016 were included in this retrospective study. Results: A total of 11 patients were reviewed. The etiological diagnosis included 3 pediatric Epstein-Barr virus associated infectious mononucleosis(EBV-IM), 3 suspected pediatric EBV-IM to 3 acute suppurative tonsillitis, 1 acute viral tonsillitis and 1 hemophilia A. The management strategies included antiviral, antibacteria, transfusion, surgical examination followed with bipolar coagulation hemostasis under general anesthesia. No patient treated with tosillectomy. Conclusions: STH is now a rare condition, the causes of which in child are more or less different from adult.This emergency can be treated in time if a detailed management plan for pediatric STH is formulated.

Cytomegalovirus and Epstein-Barr Virus Infections.

1. Swetha Pinninti, MD* 2. Catherine Hough-Telford, MD† 3. Sunil Pati, PhD† 4. Suresh Boppana, MD† 1. *Department of Pediatrics, University of Nebraska Medical Center/Children’s Hospital and Medical Center, Omaha, NE. 2. †Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL. 1. Although most infants with symptomatic congenital cytomegalovirus (cCMV) infection are at risk of developing sensorineural hearing loss, 10% to 15% of asymptomatic infants also develop hearing loss and require audiologic screening at regular intervals in the first few years after birth. 2. Unlike with other congenital infections, CMV seropositivity is not protective for fetal transmission. An estimated 75% of infants with cCMV are born in the United States following nonprimary maternal infections. 3. Most individuals with Epstein-Barr virus-associated infectious mononucleosis recover with supportive therapy; contrary to common belief, corticosteroid use is not the mainstay of treatment because airway compromise and splenic rupture can be rare complications. After completing this article, the reader should be able to: 1. Recognize routes of acquisition of cytomegalovirus (CMV) in the neonatal and postneonatal periods. 2. Recognize differences in presentations of congenital CMV infection, childhood infections, and infections in the immunocompromised individual. 3. Plan the diagnostic evaluation for congenital or acquired CMV infection in immunocompetent and immunocompromised children of various ages. 4. Understand management and long-term follow-up plans for infants with congenital CMV infection. 5. Describe the management and treatment of CMV infections in the immunocompromised host. 6. Explain the epidemiology of Epstein-Barr virus (EBV) infections and identify the clinical features associated with EBV infection in immunocompetent and immunocompromised children of various ages. 7. Recognize the potential complications of EBV infection in immunocompetent and immunocompromised children of various ages. 8. Plan management of children with uncomplicated infectious mononucleosis. Cytomegalovirus (CMV) is the most common cause of congenital infection and the leading nongenetic cause of sensorineural hearing loss (SNHL). CMV is also a significant cause of morbidity in preterm neonates who acquire infection postnatally …

Benign lymphadenopathies

Benign lymphadenopathy is a common biopsy finding, and may often be confused with malignant lymphoma. It may be separated into major morphologic patterns, each with its own differential diagnosis with certain types of lymphoma. Most cases of reactive follicular hyperplasia is easy to diagnosis, but some cases may be confused with follicular lymphoma, but key morphologic, immunohistochemical, and molecular findings may usually distinguish between the two, particularly assessment of bcl-2 staining. Molecular studies to demonstrate B-cell clonality, as well as the t(14;18), may also be of great use in difficult cases. IgG4-associated sclerosing disease is discussed, as one recently described example of a specific type of reactive follicular hyperplasia in which the etiology may be suggested based on pathologic studies. While overlapping with the other types of hyperplasia, a high index of suspicion as well as IgG and IgG4 immunostains will help raise the possibility of the diagnosis that can be confirmed by further clinical studies. Reactive paracortical/interfollicular hyperplasia is another pattern of reactive hyperplasia, which may easily be confused with Hodgkin and non-Hodgkin lymphoma, particularly T-cell lymphoma. Epstein-Barr virus-associated infectious mononucleosis is an example of reactive paracortical/interfollicular hyperplasia, which may often simulate a malignant lymphoma. Attention to clinical findings, as well as a combination of immunohistochemical stains and in situ hybridization studies for Epstein-Barr early RNA (EBER) will usually allow a definitive diagnosis. In addition, lymph nodes with extensive necrosis may simulate malignant lymphoma. Kikuchi necrotizing histiocytic lymphadenitis is an example of a benign process with extensive necrosis, which may easily be confused with non-Hodgkin lymphoma. Clinical and morphologic features, particularly the presence of abundant karyorrhectic debris along with a paucity of granulocytes, as well as immunohistochemical studies to rule out lymphoma, are most helpful in establishing the correct diagnosis.

Clinical features of Epstein-Barr virus-associated infectious mononucleosis in hospitalized Korean children

PurposeFew studies have been conducted on the recent status of infectious mononucleosis (IM) in Korean children. The aim of this study was to evaluate the recent trend in the clinical manifestations of Epstein-Barr virus (EBV)-associated IM as well as the clinical differences according to age.MethodsA retrospective study was performed on 81 children hospitalized with EBV-associated IM who fulfilled the serological criteria for the diagnosis of EBV infection (viral capsid antigen immunoglobulin M positive). The patients were divided into 3 age groups: <5 years, 5 to 9 years, and ≥10 years. We evaluated the recent trend in clinical manifestations and the differences in clinical and laboratory findings among the 3 age groups.ResultsThirty (37%) children were under 5 years of age, 38 (46.9%) were 5 to 9 years of age, and 13 (16%) were 10 years of age or older. The differences in the symptoms and signs among the 3 age groups were not statistically significant, except for headache. The mean duration of fever was 7.7 days (range, 0 to 18 days). A comparison of liver enzyme elevation among the age groups showed an association with advancing age (26.6%, 63.1%, and 76.9%, respectively, P=0.04)ConclusionThis study showed that EBV-associated IM in Korean children continues to occur mostly in children under 10 years of age. In children with EBV-associated IM, the incidence of headache and liver enzyme elevation, the duration of fever, and the proportion of females to males were all positively associated with advancing age.

Epstein-Barr virus-associated infectious mononucleosis and risk of systemic lupus erythematosus

Elevated levels of serological markers of EBV infection in patients with SLE and observations that infectious mononucleosis (IM) may precede some cases of SLE suggest a possible role of EBV in the aetiology of SLE. We evaluated the relationship between EBV-associated IM and subsequent risk of SLE in a population-based cohort study. We followed cohorts of Danes tested serologically for IM using the Paul-Bunnell (PB) heterophile antibody test between 1939 and 1989, and patients hospitalized with IM between 1977 and 2007 for subsequent first hospitalizations with SLE in the period 1977-2008. Standardized incidence ratios (SIRs) with 95% CI served as measures of relative risk. Risk of SLE was not increased either in individuals with a positive PB test (SIR = 1.1; 95% CI 0.8, 1.6; n = 27) or in individuals hospitalized with IM (SIR = 1.3; 95% CI 0.7, 2.2; n = 12). However, SLE risk in PB-negative individuals was significantly increased (SIR = 2.6; 95% CI 2.1, 3.2; n = 82), a risk that was particularly high 1-4 years after the PB test (SIR = 6.6; 95% CI 3.3, 13.2) and remained significantly elevated for >25 years. EBV-associated IM does not seem to be a risk factor for SLE. The temporal pattern of increased SLE risk in individuals with a negative PB test suggests that some patients who go on to develop SLE may present with unspecific symptoms, for which they may be tested for IM, long in advance of their SLE diagnosis.

A case of adolescent Kawasaki disease with Epstein-Barr virus-associated infectious mononucleosis complicated by splenic infarction

= Abstract = Kawasaki disease (KD) is an acute systemic vasculitis of unknown etiology that affects children. There are few reports that describe the Epstein-Barr virus (EBV) as the possible infectious agent of KD. Here, we describe a case of KD in a 15- year-old boy complicated with giant coronary artery aneurysms, pericardial effusion, and splenic infarction. The clinical course of KD was refractory to intravenous gamma globulin and aspirin. Our patient also showed typical findings of concomitant EBV-associated infectious mononucleosis, such as hepatosplenomegaly and generalized lymphadenopathy, with EBV-positive atypical lymphoid hyperplasia. He improved dramatically after receiving intravenous methylprednisolone followed by oral prednisolone. Ultimately, the coronary artery aneurysms remained as the only sequelae. We report a rare case of adolescent KD with EBV-associated infectious mononucleosis and splenic infarction. (Korean J Pediatr 2009; 52:1029-1034)

Epstein-Barr virus-associated infectious mononucleosis in Chinese children.

According to seroprevalence studies the majority of children in Hong Kong are infected by Epstein-Barr virus (EBV) before 10 years of age, but the characteristics of EBV-associated infectious mononucleosis (IM) in Chinese children are largely unreported. This study aims at defining the clinical presentation and complications of Chinese childhood IM in relation to age of the children. A retrospective study was performed on 77 consecutive Chinese childhood IM patients who fulfilled the serologic criteria for the diagnosis of primary EBV infection (viral capsid antigen IgM+ viral capsid antigen IgG+ Epstein-Barr nuclear antigen-). The clinical, hematologic and biochemical findings were evaluated among four age groups of <2 years, 2 to 4 years, 5 to 9 years and 10 to 15 years. EBV-associated IM occurred at all age groups with a peak incidence at 2 to 4 years, corresponding to the rapid rise in the seroprevalence of EBV in early childhood in the Hong Kong Chinese. The majority of children presented with fever, tonsillopharyngitis, lymphadenopathy and hepatosplenomegaly, similar to the adult IM patients, and recovered without major complications. Marked lymphocytosis with the presence of atypical lymphocytes was a consistent hematologic finding in all age groups. The occurrence of hepatitis showed a clear association with advancing age (P = 0.003). The age-related increase in IM-associated hepatitis may reflect difference in the host immune response against EBV between the infants and older children.

Massive Splenomegaly and Epstein-Barr Virus-Associated Infectious Mononucleosis in a Patient With Gaucher Disease

Gaucher disease should be considered in the differential diagnosis of a patient with Epstein-Barr virus (EBV) infection who has unexplained or disproportionate splenomegaly. A previously asymptomatic adolescent with EBV-associated infectious mononucleosis and massive splenomegaly is described. He was found to have Gaucher disease on bone marrow biopsy, which was performed to exclude a hematologic malignancy. The diagnosis was confirmed by assay of beta-glucosidase enzyme activity. Regression of splenomegaly and improving hematologic indices. Patients with infectious mononucleosis and disproportionate organomegaly should be investigated to exclude a hematologic malignancy or an underlying storage disorder such as Gaucher disease.

Epidemiologic study of a leukocyte-transforming agent in a general population

Studies by others have demonstrated a leukocyte-transforming agent(s) (LTA) in the oropharyngeal secretions of a significant number of individuals with Epstein-Barr virus-associated infectious mononucleosis, cancer, and, to a lesser extent, an outpatient population. This present study determines by systematic sampling the prevalence of LTA in 27 families of a semirural community. Throat swab inoculums from three of 54 adults and none of 44 children induced transformation of umbilical cord lymphocytes. Complement-dependent Epstein-Barr virus nuclear antigen was detected in two of the three transformed cell cultures. The three LTA-positive individuals were characterized by the absence of serologic evidence of a recent Epstein-Barr virus infection and the lack of elevated antibodies against the viral capsid antigen of Epstein-Barr virus.