Reactivation Of Epstein-Barr Virus Infection Research Articles

Можливості лікування хворих на неконтрольовану бронхіальну астму з реактивацією епштейн-барр вірусної інфекції у постковідному періоді

Abstract. Both before the beginning of the pandemic of the coronavirus disease (COVID-19), and now, the problems of uncontrolled bronchial asthma (BA) are extremely relevant. The COVID-19 negatively affects the control of BA. Often, loss of asthma control after acute COVID-19 occurs due to secondary infectious complications, including reactivation of chronic Epstein-Barr virus (EBV) infection. The aim: to develop a treatment scheme for patients with uncontrolled asthma with reactivation of EBV infection in the post-COVID period and determine its effectiveness. Materials and methods. Clinical and functional indicators, laboratory results and data of chest computed tomography (CT) in dynamics in 114 patients (aged 18 to 85 years) with post-COVID syndrome who were being treated in clinical departments of National institute of phthisiology and pulmonology, National Academy of Medical Sciences of Ukraine (NIFP NAMNU) were analyzed. Among them, the diagnosis of BA was found in 17 patients. The presence of EBV infection was determined by PCR of saliva and nasopharyngeal samples. Patients with reactivation of EBV infection were treated additionally to the basic BA therapy with acyclovir, tablets, 400 mg 4 times a day for 20 days; 15 drops of proteflazid for 15-30 minutes before meals 2 times a day for 2 months and local healing therapy. Asthma control before and after treatment was determined by the Asthma Control Test (ACT) and Asthma Control Questionnaire (ACQ-7) according to the GINA-2022 guidelines. All patients underwent a study of the pulmonary function before and after treatment according to spirometry data. Results. In 12 out of 17 (70.6 %) patients with BA with post-COVID syndrome, reactivation of chronic EBV infection was detected and treated. After 20 days of treatment, the patients had an improvement in the control of asthma symptoms: ACT increased from (11.4 ± 0.7) points to (20.8 ± 0.7) points, ACQ-7 decreased from (2.6 ± 0.2) points to (0.9 ± 0.1) points, p < 0.05. Improvement of the condition was observed in all patients, and the clinical effectiveness of treatment in terms of symptom control (minimum clinically important difference for the AKT index — 3 points, and for ACQ-7 — 0.5 points) was achieved in 10 (83.3 %) of 12 patients. After treatment, all parameters of spirometry improved, and peak expiratory flow, forced expiratory volume in 1 second, and parameters of large-, medium-, and small- airway patency increased with reliably significant differences. The functional efficiency of the studied treatment regimen was 75.0 %. Conclusions. For patients with uncontrolled BA with reactivation of EBV infection in the post-COVID period, in whom control of the symptoms of the disease cannot be achieved by standard methods, in addition to the basic treatment, the appointment of acyclovir, proteflazid and local healing therapy is indicated. The clinical effectiveness of the proposed treatment is 88.3 %, and the functional effectiveness is 75.0 %. Key words: bronchial asthma, asthma control, COVID-19, post-COVID-19 period, Epstein-Barr virus.

Increased EBV DNAemia after Anti-SARS-CoV-2 Vaccination in Solid Organ Transplants.

The reactivation of latent viruses during SARS-CoV-2 infection is well recognized, and coinfection with Epstein–Barr virus (EBV) has been associated with severe clinical cases of COVID-19 infection. In transplant patients, EBV infection presents a significant challenge. Assessing the potential impact of SARS-CoV-2 vaccinations on EBV infections in stable kidney and liver transplant recipients was the objective of our study. Ten solid-organ-transplant (SOT) patients (eight kidney and two liver) vaccinated with standard doses of mRNA COVID-19 vaccines were included. EBV DNA viral load measurements were conducted prior to the vaccination and during a follow-up period (at the first month and after six months) after the second vaccine dose. After the second dose, a significant increase in median viremia was observed (p < 0.01) in 9 patients, and in one patient, the reactivation of EBV infection was found. Six months later, the median viremia decreased significantly (p < 0.05). The EBV viral load should be closely monitored as it could lead to the earlier diagnosis and treatment of EBV-related complications. Despite experiencing a decrease in the viral load six months post-vaccination, some patients still had a viral load over the baseline, which increased the risk of potential complications.

Hemophagocytic lymphohistiocytosis following reactivation of Epstein–Barr virus infection – A rare case report

Hemophagocytic lymphohistiocytosis (HLH) is a catastrophic condition, leading to the rapid incitement of immune-mediated cells. Asymptomatic primary Epstein–Barr virus (EBV) infection is common in the general population, while EBV causing acute hepatitis and jaundice is uncommon and acute liver failure has been rarely reported. Here, we report a case of fulminant hepatic failure and HLH following the reactivation of EBV infection that was successfully treated with dexamethasone therapy.

СТАН НОВОНАРОДЖЕНИХ ТА ПЕРЕБІГ РАННЬОГО НЕОНАТАЛЬНОГО ПЕРІОДУ В ДІТЕЙ ВІД МАТЕРІВ ІЗ ВІРУСНОЮ ЕПШТЕЙНА–БАРР ІНФЕКЦІЄЮ.

&lt;p&gt;Проаналізований стан новонароджених від матерів із реактивацією вірусної Епштейна–Барр&lt;br /&gt;інфекції характеризується вірогідно високим рівнем перинатальних ускладнень: асфіксії різного ступеня тяжкості (47,8 %),&lt;br /&gt;синдрому затримки розвитку плода, асиметричної форми (34,8 %), постгіпоксичної енцефалопатії (23,2 %), гіпербілірубінемії&lt;br /&gt;(21,7 %), геморагічного синдрому (13,0 %) та реалізації інтраамніального інфікування (8,7 %). Вищенаведене вказує на&lt;br /&gt;високу частоту захворюваності дітей у ранній неонатальний період (68,2 %), що, безсумнівно, зумовлює важливу медико-&lt;br /&gt;соціальну проблему.&lt;br /&gt;&lt;br /&gt;&lt;/p&gt;

Prevalencia de la esclerosis múltiple en la Región de Murcia

Multiple sclerosis (MS) is a demyelinating inflammatory disease of the central nervous system with immune-mediated pathogenesis. Recent research points to an increase in its prevalence, and a number of studies relate Epstein-Barr virus (EBV) with its aetiology. This study seeks to analyse the prevalence of MS in the Region of Murcia, and includes a description of the clinical characteristics at the time of onset of the disease, and of the EBV serological status of patients with MS. We conducted a retrospective epidemiological study based on a sample consisting of the population living within the central-west healthcare area of the Region of Murcia (257,865 inhabitants). Clinical and serological data extracted from different sources were analysed. Prevalence of MS in the population under study: 88 cases/100,000 inhabitants. Prevalence of MS together with isolated demyelinating syndrome: 98.4 cases/100,000 inhabitants. Mean incidence of MS: 5.8 cases/100,000 inhabitants/year. At the onset of MS, 67.8% were females, 81.9% presented a relapsing-remitting course, the mean age was 31.4 years, the sensory system was the most frequently compromised (45.1%), onset was monofocal in 55.4% and the degree of disability on the Expanded Disability Status Scale was 2.1 points. The seroprevalence of EBV was 99.3%. The reactivation of EBV infection was related to the clinical activity of MS in 10 patients (45.4%). Currently, the prevalence of MS in the Region of Murcia is similar to that estimated in other Spanish autonomous regions. The study confirms the trend of increased prevalence observed over the last few decades.

Stillbirth following severe symmetric fetal growth restriction due to reactivation of Epstein–Barr virus infection in pregnancy

Epstein-Barr virus (EBV) infection in pregnancy and consequent fetal outcomes are rarely reported. The majority of cases described strongly support the possibility of transmission of this virus in utero and during delivery, resulting in stillbirth and/or congenital defects. We present a case of EBV reactivation in pregnancy that caused a severe symmetrical fetal growth restriction (FGR) and ultimately spontaneous fetal death. A 36-year-old woman, whose infection status was undetermined, was diagnosed with severe FGR at 24 weeks' gestation. The fetal karyotype was normal. EBV DNA was detected in the amniotic fluid and maternal immunoglobulin G antibodies were positive. At 30 weeks' gestation, the fetus died spontaneously. Placental examination found evidence of deciduitis and villitis. Reactivation of EBV infection appears to be related to FGR and warrants further research to determine the optimal management strategy in pregnancy.

Cyclophosphamide Therapy for Corticoresistant Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) Syndrome in a Patient With Severe Kidney and Eye Involvement and Epstein-Barr Virus Reactivation

DRESS (drug reaction with eosinophilia and systemic symptoms) syndrome is a severe adverse drug reaction with significant mortality, characterized by erythroderma, fever, lymphadenopathy, and visceral involvement. We report a case of multivisceral DRESS syndrome with posterior multifocal placoid pigment epitheliopathy and acute tubulointerstitial nephritis responsible for dialysis-dependent acute kidney failure in the context of reactivation of Epstein-Barr virus infection. Because of resistance of the skin and kidney manifestations to prolonged corticosteroid therapy, a 6-month course of oral cyclophosphamide resulted in complete recovery of all symptoms. To our knowledge, this is the first case showing the efficacy of cyclophosphamide in severe DRESS syndrome.

Lymphoma Diagnosis and Plasma Epstein‐Barr Virus Load during Vicriviroc Therapy: Results of the AIDS Clinical Trials Group A5211

Lack of functional CCR5 increases the severity of certain viral infections, including West Nile virus and tickborne encephalitis. In a phase II trial of the investigational CCR5 antagonist vicriviroc (AIDS Clinical Trials Group protocol A5211), 4 lymphomas occurred in study patients who received vicriviroc. Because of the known association between unregulated Epstein-Barr virus (EBV) replication and lymphoma in immunocompromised patients, we evaluated whether vicriviroc exposure was associated with lymphoma EBV antigen positivity and/or had an effect on plasma levels of EBV DNA. Clinical findings for all 4 patients enrolled in the A5211 study who developed lymphoma (2 Hodgkin and 2 non-Hodgkin) were reviewed, and tumor specimens were assessed for evidence of ongoing EBV replication. Longitudinal plasma samples from 116 patients in the A5211 study were analyzed, and EBV DNA was quantified by real-time polymerase chain reaction. Plasma EBV DNA was not detected in the 2 patients with non-Hodgkin lymphoma; both patients with Hodgkin lymphoma who had samples tested had EBV DNA levels <3200 copies/mL. One patient with Hodgkin lymphoma had a lymph node core biopsy specimen that was strongly positive for EBV; the other 3 lymphomas were histochemically EBV negative. None of the 116 patients with available samples experienced sustained increases in plasma EBV levels. CCR5 antagonism by vicriviroc treatment in treatment-experienced patients was not associated with reactivation of EBV infection.

Epstein-Barr Virus-Induced Infectious Mononucleosis after Two Separate Episodes of Virus-Associated Hemophagocytic Syndrome

A 24-year-old man, who had suffered previous two episodes of non- Epstein-Barr virus (EBV)-associated hemophagocytic syndrome (HPS) at the ages of 16 and 18, developed EBV-induced infectious mononucleosis. His antibody pattern to EBV highlighted the initial infection. The disease took a self-limited course without developing into HPS. No reactivation of EBV infection was noted over the following 6 years. The patient may have attained immune competency in adulthood, which was somehow impaired during his adolescence.

Reversal in fatigued athletes of a defect in interferon γ secretion after administration of Lactobacillus acidophilus

Background: Fatigue and impaired performance in athletes is well recognised and has been loosely linked to “overtraining”. Reduced concentration of IgA in the saliva and increased shedding of Epstein Barr...

Reactive Epstein-BarrVirus--Related Polyclonal Lymphoproliferative Disorder in a Patient with AIDS

Reactivation of Epstein-Barr virus infection and polyclonal expansion of lymphocytes is well-documented in solid organ and hematopoietic stem cell transplant recipients and is considered a potential precursor to lymphoma. We report an analogous case of posttransplantation polyclonal lymphoproliferative disorder in a patient with human immunodeficiency virus infection who was successfully treated with antiretroviral therapy.

Viral Infections and Prolonged Fever after Liver Transplantation in Young Children with Inborn Errors of Metabolism

Liver transplantation could be a useful treatment for selected inborn errors of metabolism. This study evaluated the outcome and viral infections after liver transplantation in young children and infants with these diseases. The outcome of liver transplantation and clinical characteristics of the following 4 patients were assessed: 1 infant with ornithine transcarbamylase deficiency (OTCD) who received liver transplant aged 3 years and 4 months; 1 infant with carbamyl phosphate synthetase I deficiency (CPSID) who received liver transplant at 14 months of age; and 2 infants with methylmalonic acidemia (MMA) who received liver transplant at 8 months and 11 months of age, respectively. All donors, except the 8-month-old infant with MMA, showed serologic evidence of previous cytomegalovirus (CMV) infection before transplantation. All 4 of these donors showed serologic evidence of previous infection of Epstein-Barr virus (EBV). None of the recipients had previous CMV infection. Both the infant with OTCD and the 8-month-old infant with MMA had previous EBV infection, while the other 2 patients did not. Preoperative hemodialysis was performed in both infants with MMA. Postoperative follow-up included metabolic stability, disability degree, and viral infections. None of the patients developed severe metabolic decompensation after transplantation and all increased protein intake postoperatively. Symptomatic viral infections, however, were present in all patients postoperatively, including CMV infection in the infant with OTCD and the 11-month-old infant with MMA, reactivation of EBV infection in the infant with OTCD and the 8-month-old infant with MMA, and primary EBV infection in the infant with CPSID. Liver transplantation was an effective treatment for all 4 of these patients with inborn errors of metabolism. The risk of symptomatic viral infections for these patients was high. This was likely associated with conditions including immunosuppression, young age, endemic nature of CMV and EBV infections, and lack of CMV prophylaxis.

HTLV-1 Enhances Epstein-Barr Virus (EBV) Infectivity and EBV Infection Attributes to an Aggressive Organ Involvement in Adult T-Cell Leukemia.

The frequent involvement of adult T-cell leukemia (ATL) cells in organs such as the skin and lymph nodes is observed in ATL. Epstein-Barr virus (EBV) infection has been observed in the clinical course of ATL, and ATL cells in all skin cases were strongly positive for EBV nuclear antigen (EBNA)-1 and latent membrane protein (LMP)-1 by immunohistochemical staining. Interestingly, ATL cells in all skin cases were positive for CD45R0 (UCHL1) and CD20 (L26), indicating that they have both T and B cells characterization. We suggested that HTLV-1 enhances the entry of EBV into endothelial cells, epithelial cells and EBV presents for an active role of HTLV-1 in the development of ATL. Here, we established two B-cell lines from peripheral blood of patients with ATL. EBV DNA, proviral DNA for HTLV-1 and Tax mRNA were detected in both B cell lines. On characterization of the cell lines, enhanced expression of intercellular adhesion molecule-1 or-3 (CD54, CD50), lymphocyte function-associated antigen-1 (CD11a/CD18) and Mac-1 (CD11b/CD18) was observed compared to an EBV-infected B cell line, Raji. Moreover, EBV oncogenes such as EBV-encoded small RNA (EBER)-1, EBNA-1,-2 and LMP-2A were also detected. To investigate the role of the interaction of these viruses, we transfected EBV and/or HTLV-1 into a healthy donor's lymphocytes, Raji cells and a HTLV-1 negative T-cell line, Jurkat. Enhanced expression of adhesion molecules was observed in double transfectants (EBV and HTLV-1). Furthermore, we detected high production levels of interleukin-4 (IL-4) in those B-cell lines and transfectants. These results indicated co-expression of HTLV-1 and EBV may induce aggressive organ involvement by enhanced expression of adhesion molecules via IL-4 signaling. Furthermore, HTLV-1 could greatly enhance EBV infectivity and attribute to increased replication of EBV. EBV also could be a necessary cofactor for ATL development in immunodeficiency states. ATL patients who have been coinfected with EBV and HTLV-1 have a high risk of worse progress of disease. ATL patients have a poor treatment outcome, even with strong chemotherapy, especially who have severe skin involvements have a resistance for chemotherapy. Viewed from a different angle, our observations suggest that EBV infection may be used as one of bad prognostic factors and an identification of bad-risk patients who need to benefit from early high dose chemotherapy. Collectively, a reactivation of EBV infection and EBV oncogenes can provide an acceleration of organ involvement in ATL.These results can explain why EBV-associated ATL is more frequent and clinically more aggressive.

Epstein–Barr virus-related plasmablastic lymphomas arising from long-standing sacrococcygeal cysts in immunosuppressed patients

Epstein–Barr virus-related plasmablastic lymphomas arising from long-standing sacrococcygeal cysts in immunosuppressed patients

Persistent erythema multiforme: Report of two new cases and review of literature

Within the clinical spectrum of erythema multiforme, two subgroups have been recently identified: recurrent erythema multiforme and the rare persistent erythema multiforme. Two additional cases of persistent erythema multiforme are described. Lesions were widespread and resistant to traditional therapies. One of the patients had an underlying malignancy; the other exhibited a symptom complex characterized by fatigue, fever, sore throat and lymphadenopathy, and an abnormal Epstein-Barr virus serologic profile suggestive of endogenous reactivation of Epstein-Barr virus infection.

Simultaneous Occurrence of Pneumocystis carinii Pneumonia, Cytomegalovirus Infection, Kaposi's Sarcoma, and B-Immunoblastic Sarcoma in a Homosexual Man

The most common manifestations of the acquired immunodeficiency syndrome include Pneumocystis carinii pneumonia and/or Kaposi's sarcoma. High-grade B-cell lymphomas have also been reported in homosexual men at risk for the acquired immunodeficiency syndrome. We herein present the case of a homosexual man, who presented simultaneously with Pneumocystis carinii pneumonia, acute cytomegalovirus infection, Kaposi's sarcoma, and B-cell immunoblastic sarcoma. Severe compromise of both the B- and T-cell arms of the immune system was documented. The patient had evidence of exposure to the human T-lymphotropic retrovirus III, evidence of reactivation of Epstein-Barr virus infection, and cytomegalovirus inclusions within Kaposi's sarcoma tissue. We conclude that exposure to these viral agents in the setting of severe immunocompromise may have led to the observed "opportunistic" neoplasms.

Posttransplantation Syndrome in Children: Cytomegalovirus vs Epstein-Barr Virus

Sir.—In a prospective study in the Journal by Betts et al (131:759-763, 1977) on 77 renal transplant recipients, it was found that primary cytomegalovirus (CMV) infection rather than reactivation of a latent CMV infection was associated with clinically apparent illness. The CMV posttransplantation syndrome consisted of prolonged fever, pneumonia, and mild hepatitis. Primary EpsteinBarr virus (EBV) infection after renal transplantation rarely occurs in adults because older allograft recipients have already experienced their initial infection with this virus in childhood. Reactivation of EBV infection seems to be a more common event, although the incidence among different series ranges from 2% to 56%.1-5One reason for this great variation has been pointed out by Strauch et al4who demonstrated that EBV reactivation may be associated with excretion of virus in the throat without elevation of antibody (antiviral capsid antigen). Reactivation has not been accompanied by a heterophil antibody response