scholarly journals Chronic active Epstein–Barr virus infection manifesting as coronary artery aneurysm and uveitis

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Haijuan Xiao ◽  
Bing Hu ◽  
Rongmu Luo ◽  
Huili Hu ◽  
Junmei Zhang ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Peripheral Blood ◽  
Epstein Barr Virus ◽  
Coronary Artery Aneurysm ◽  
Artery Aneurysm ◽  
Epstein Barr Virus Infection ◽  
Hematopoietic Stem ◽  
Barr Virus ◽  
Ebv Dna ◽  
Epstein Barr

Abstract Background Chronic active Epstein–Barr virus (CAEBV) infection is a type of lymphoproliferative disorder characterized by chronic or recurrent infectious mononucleosis (IM)-like symptoms, which can have less-frequent clinical presentations. The prognosis of CAEBV is poor, and hematopoietic stem cell transplantation (HSCT) has been shown to be the only potentially effective treatment. In this article, we present a special CAEBV case of a patient who had no typical IM-like symptoms at the early stage, but manifested with severe and progressive coronary artery aneurysm (CAA), abdominal aortic lesions, and severe uveitis. These manifestations were uncommon features and could only be blocked by HSCT. Case presentation A 4-year-old girl with no special medical history complained of decreased vision for 10 months and cough after physical activities for three months. The blurred vision grew rapidly worse within one month, until only light perception remained. She was diagnosed with uveitis and cataract, and received prednisone and ciclosporin A treatment. However, her vision did not improve. Physical examination showed slight hepatosplenomegaly. Ultrasonic cardiogram showed bilateral CAA (5.0 mm and 5.7 mm for inner diameters), and abdominal CT scan revealed a thickened aortic wall, as well as stenosis and dilation of the segmental abdominal aorta. Other significant findings were increased EBV-DNA (3.29 × 104 copies/mL) from peripheral blood, positive EBV antibodies (EBV-CA-IgG, EBV-EA-IgA, and EBV-NA-IgG), and positive EBV-encoded small RNAs found by bone marrow biopsy. Based on her clinical manifestations and evidence for EBV infection, we diagnosed CAEBV. She received allogeneic HSCT, and the cataract operation was performed after HSCT. EBV-DNA could not be detected in peripheral blood after HSCT. Her CAAs did not progress, and uveitis was well controlled. Her vision recovered gradually over the 3 years after HSCT. Conclusions We present a rare CAEBV case of a patient who suffered from uncommon and severe cardiovascular and ocular involvement that was relieved by HSCT. Therefore, early recognition and diagnosis of CAEBV are of vital importance to improve its prognosis. In summary, this atypical CAEBV case could help us recognize similar cases more easily, make the right diagnosis as early as possible, and deliver proper and timely treatment.

scholarly journals Clinical analysis of chronic active EBV infection with coronary artery dilatation and a matched case–control study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ang Wei ◽  
Honghao Ma ◽  
Liping Zhang ◽  
Zhigang Li ◽  
Yitong Guan ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Serum Ferritin ◽  
Epstein Barr Virus ◽  
Epstein Barr Virus Infection ◽  
Hematopoietic Stem ◽  
Barr Virus ◽  
Coronary Artery Dilatation ◽  
Tnf Α ◽  
Epstein Barr

Abstract Objective To investigate the clinical characteristics, treatment, prognosis and risk factors for chronic active Epstein–Barr Virus infection (CAEBV) associated with coronary artery dilatation (CAD) in children. Methods Children with CAEBV associated with CAD hospitalized at Beijing Children’s Hospital, Capital Medical University from March 2016 to December 2019 were analyzed. Children with CAEBV without CAD were selected as the control group and matched by sex, age, treatment and admission time. The clinical manifestations, laboratory and ultrasound examinations, treatment and prognosis of the children were collected in both groups. Results There were 10 children with CAEBV combined with CAD, including 6 males and 4 females, accounting for 8.9% (10/112) of CAEBV patients in the same period, with an onset age of 6.05 (2.8–14.3) years. The median follow-up time was 20 (6–48) months. All the patients had high copies of EBV-DNA in whole blood [1.18 × 107 (1.90 × 105–3.96 × 107) copies/mL] and plasma [1.81 × 104 (1.54 × 103–1.76 × 106) copies/mL], and all biopsy samples (bone marrow, lymph nodes or liver) were all positive for Epstein–Barr virus-encoded small RNA. Among the 10 children, 8 had bilateral CAD, and 2 patients had unilateral CAD. After diagnosis, 7 children were treated with L-DEP chemotherapy in our hospital. After chemotherapy, four patients underwent allogeneic hematopoietic stem cell transplantation (HSCT). The others were waiting for HSCT. At the time of the last patients follow up record, the CAD had returned to normal in 3 patients, and the time from the diagnosis of CAD to recovery was 21 (18–68) days. LDH, serum ferritin, TNF-α and IL-10 levels were statistically significantly different between the two groups (P = 0.009, 0.008, 0.026 and 0.030). There were no significant differences in survival rate between the two groups (P = 0.416). Conclusion The incidence of CAEBV with CAD was low. CAEBV with CAD did not influence the prognosis. Patients who had high LDH, serum ferritin, TNF-α, and IL-10 levels early in their illness were more likely to develop CAD.

scholarly journals Subclinical Cytomegalovirus and Epstein-Barr Virus Shedding Is Associated with Increasing HIV DNA Molecular Diversity in Peripheral Blood during Suppressive Antiretroviral Therapy

2020 ◽  
Vol 94 (19) ◽  
Author(s):  
Antoine Chaillon ◽  
Masato Nakazawa ◽  
Stephen A. Rawlings ◽  
Genevieve Curtin ◽  
Gemma Caballero ◽  
...  
Keyword(s):  
Peripheral Blood ◽  
Epstein Barr Virus ◽  
Molecular Diversity ◽  
Viral Shedding ◽  
Barr Virus ◽  
Hiv Dna ◽  
Ebv Dna ◽  
Epstein Barr ◽  
Over Time ◽  
Dna Reservoir

ABSTRACT Cytomegalovirus (CMV) almost universally infects persons with HIV (PWH), and it is a driver of persistent inflammation and HIV persistence. The mechanisms underlying the association between CMV (and possibly other herpesviruses) and HIV persistence are unclear. Serially collected blood samples were obtained from men who have sex with men (MSM) who started antiretroviral therapy (ART) within 1 year of their estimated date of HIV infection (EDI). Total CMV and Epstein-Barr virus (EBV) DNA were quantified in peripheral blood mononuclear cells by droplet digital PCR (ddPCR). Deep sequencing of the HIV DNA partial env gene was performed, and the dynamics of viral diversity over time were analyzed in relation to CMV and EBV shedding status. In total, 37 MSM PWH were included and followed for a median of 23 months (IQR, 22 to 28). Participants started ART within a median of 3.1 months (IQR, 1.5 to 6.5) after EDI and remained virally suppressed thereafter. A total of 18 participants (48.6%) were classified as high EBV shedders, while 19 (51.4%) were classified as CMV shedders. In longitudinal analyses, normalized molecular diversity levels tended to increase over time among participants with detectable CMV and high EBV DNA (0.03 ± 0.02, P = 0.08), while they significantly declined among participants with no/low viral shedding (−0.04 ± 0.02, P = 0.047, interaction P < 0.01). Subclinical CMV and EBV shedding could contribute to the dynamics of the HIV DNA reservoir during suppressive ART. Whether persistent CMV/EBV replication could be targeted as a strategy to reduce the size of the latent HIV reservoir is an avenue that should be explored. IMPORTANCE As part of this study, we evaluated the molecular characteristics of the HIV DNA reservoir over time during antiretroviral treatment (ART) in relation to those of other chronic viral infections (i.e., cytomegalovirus [CMV] and Epstein-Barr virus [EBV]). We demonstrated that the presence of CMV and high-level EBV DNA in peripheral blood cells was associated with changes in HIV DNA molecular diversity. Specifically, HIV DNA molecular diversity increased over time among participants with detectable CMV and high-level EBV DNA, while it significantly declined among participants with no/low viral shedding. Although the current study design does not allow causality to be inferred, it does support the theory that persistent CMV and EBV shedding could contribute to the dynamics of the HIV DNA reservoir during suppressive ART, even when ART is initiated during the earliest phases of HIV infection.

scholarly journals Outcome of L-DEP Regimen for Treatment of Pediatric Chronic Active Epstein-Barr Virus Infection

2021 ◽  
Author(s):  
Honghao Ma ◽  
Liping Zhang ◽  
Ang Wei ◽  
Jun Yang ◽  
Dong Wang ◽  
...  
Keyword(s):  
Virus Infection ◽  
Clinical Response ◽  
Virological Response ◽  
Epstein Barr Virus ◽  
Survival Rates ◽  
Epstein Barr Virus Infection ◽  
Hematopoietic Stem ◽  
Barr Virus ◽  
Epstein Barr ◽  
Barr Virus Infection

Abstract Purpose We intended to investigate the clinical features of pediatric patients with chronic active Epstein-Barr virus infection (CAEBV) and effectiveness of the L-DEP regimen before HSCT (hematopoietic stem cell transplantation).Methods A retrospective analysis was performed on 35 patients with CAEBV at Beijing Children’s Hospital from January 2016 to January 2020. The efficacy and adverse events of the L-DEP regimen were evaluated.Results The median age of 35 patients was 7.0 years (range 2.5-17.5 years). 28 patients achieved clinical response (80.0%, 22 in clinical CR, 6 in clinical PR) after L-DEP. In terms of virological response, 7 patients (20%) were assessed as virological CR and 23 patients (65.7%) were virological PR. Finally, 29 patients underwent allo-HSCT. Median survival time was 18 months (2-50 months). The 3-year overall survival rates in patients treated with chemotherapy only (n=6), chemotherapy followed by HSCT (n=25) were 33.3% and 75.4%, respectively. After L-DEP 1st treatment, the amount of EBV-DNA loads in blood and plasma were significantly reduced than that before chemotherapy (median: 4.29×105 vs. 1.84×106, Mann-Whitney U：P=0.0004; 5.00×102 vs. 3.17×103, Mann-Whitney U：P=0.003). And, compared with liver and spleen size before chemotherapy, the size of liver and spleen shrank significantly after L-DEP 2nd (median 3.8cm vs. 1.9cm, P=0.003; 3.8cm vs. 0cm, P＜0.008). In addition, after L-DEP treatment, there was no difference in clinical or virological response rate whether HLH was accompanied or not (clinical response: 77.3% vs. 84.6%：P=0.689; virological response: 90.9% vs. 76.9%, P=0.337). Conclusion L-DEP regimen is an effective therapy in treating CAEBV for bridging to allo-HSCT.

scholarly journals Increasing Epstein-Barr virus infection in Chinese children: A single institutional based retrospective study.

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 1211 ◽  
Author(s):  
Kiran Devkota ◽  
Maio He ◽  
Meng Yi Liu ◽  
Yan Li ◽  
You Wei Zhang
Keyword(s):  
Retrospective Study ◽  
High Risk ◽  
Virus Infection ◽  
Epstein Barr Virus ◽  
Severe Illness ◽  
Epstein Barr Virus Infection ◽  
Barr Virus ◽  
Ebv Infection ◽  
Ebv Dna ◽  
Epstein Barr

The Epstein-Barr virus (EBV) is a common virus in humans and the most common causative agent of Infectious Mononucleosis. EBV primary infection has recently risen in some countries and children below 2 years of age are highly susceptible. The clinical manifestations in children with EB virus infection involve multiple systems, causing severe illness, meaning attention should be paid during diagnosis and treatment. Objective:  This single institution based retrospective study was carried out with the aim of estimating the overall prevalence of EBV infection and identifying high-risk age group among children.  Methods: This study include total 253 patients under 15 years of age found to be  positive for EBV DNA by PCR who were admitted to the Pediatrics Department of Renmin Hospital,(Shiyan, China) during a 4-year period from 2014 to 2017. Patients were divided into three groups; 0-<4years, 4-<6years and 6-<15years. We then calculated the percentage and prevalence of EBV DNA-positive cases. Results: The yearly EBV prevalence rate was 4.99 per 1000 admissions in 2014, 6.97 per 1000 admissions in 2015, 10.42 per 1000 admissions in 2016, and 12.16 per 1000 admissions in 2017. Out of 253 EBV-positive cases, those under 4 years had the highest rate of EBV infection (74.7%). The rate drops to 11.06% in the 4-6 years group, and was 14.22% in the 6-15 years group. Those between 6 months and 1 year are those at the highest risk.  Conclusion: The rate of hospital admission of children due to EBV infection is increasing day by day. Children under 4 years of age are highly susceptible to infection and children of age between 6 months and 1 year are the high-risk group for EBV infection.

scholarly journals Epstein–Barr virus infection is associated with clinical characteristics and poor prognosis of multiple myeloma

2019 ◽  
Vol 39 (10) ◽  
Author(s):  
Bing Xia ◽  
Xi Wang ◽  
Ruifang Yang ◽  
Li Mengzhen ◽  
Kunpeng Yang ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Clinical Characteristics ◽  
Epstein Barr Virus ◽  
High Expression ◽  
Epstein Barr Virus Infection ◽  
Dna Concentration ◽  
Barr Virus ◽  
Ebv Infection ◽  
Ebv Dna ◽  
Epstein Barr

Abstract The aim of the present study was to evaluate the relationship of Epstein–Barr virus (EBV) infection and multiple myeloma (MM) and its impact on clinical characteristics and prognosis. Fresh peripheral blood mononuclear cells (PBMCs) from 139 MM patients who had been diagnosed and treated from January 2010 to May 2018 and 50 PBMC samples from healthy donors were obtained. PCR was carried out for detection of EBV-DNA. The results indicated a significantly higher EBV-DNA concentration among 139 MM patients compared with healthy controls (P&lt;0.05). Correlation analysis showed that the expression of EBV-DNA was positively correlated with the serum free light chain ratio (sFLCR) and progressive disease (PD)/relapse (P&lt;0.05). Especially, in EBV-DNA high-expression MM patients, EBV-DNA concentration for patients with sFLCR ≥100 was higher than that of patients with sFLCR &lt;100. EBV-DNA concentration was higher in patients with disease PD/relapse than those without disease PD/relapse. In univariate analysis, the progress free survival (PFS) was inferior in MM patients with high expression of EBV-DNA, high lactate dehydrogenase (LDH), and high-risk according to mSMART and International Myeloma Working Group (IMWG), stage III according to R-ISS staging, extramedullary lesions, and genetic changes (P&lt;0.05). However, in multivariate analysis, LDH, poor karyotype, R-ISS staging, and mSMART were independent prognostic factors for PFS. Taken together, our studies suggest that an association exists between EBV infection and clinical characteristics of MM patients, and EBV infection appears to have a slight impact on the prognosis of MM. However, the results require further validation in other independent prospective MM cohorts.

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