Study of the possible association between systemic lupus erythematosus and Epstein-barr virus

Background and systemic lupus erythematosus [SLE] is an autoimmune rheumatic disease with no known cure. In predisposed individuals, the initial stimulus is likely to be one or more of the environmental agents interacting with susceptibility genes. For many years, investigators have suspected that Epstein-Barr virus [EBV] might somehow by involved in the aetiopathogenesis of systemic lupus. Studies have examined this possibility from various angles and have arrived at different conclusions. The present work was carried out to evaluate the role of EBV as an environmental risk factor for lupus in our population and to assess the role of this virus in the clinical course of the disease. the study included 25 lupus patients satisfying the American College of Rheumatology criteria for diagnosis of SLE. Twenty age and sex matched healthy subjects were chosen as controls. All patients were subjected to complete history taking and full clinical assessment. Routine laboratory investigations were carried out as well as study of immunologic parameters including antinuclear antibodies, anti-double stranded DNA and complement components C3 and C4. in all study subjects, serology for EBV viral capsid antigen [VCA] IgG was performed using both enzyme linked immunosorbent assay [ELISA] and indirect immunofluorescence assay [IFA]. EBV DNA was detected in peripheral blood mononuclear cells by polymerase chain reaction using primers specific for EBV nuclear antigen-1 gene. Besides, interleukin-10 [IL-10] levels were determined in sera by ELSA. Results and twenty three lupus patients [92%] were positive for EBV DNA compared to 12 control subjects [60%], the difference being statistically significant [p= 0.14]. Virtually all study subjects had seroconverted against EBV. When antibody titres were expressed as the geometric mean titre [GMT] after logarthmic transformation, patients with SLE had a significantly higher GMT compared to control subjects [mean +/- SD 3.46 +/- 0.34 vs 2.93 +/- 0.25, t = 5.12, p < 0.001]. When the anti-VCA titre of lupus patients was correlated with different clinical and laboratory findings, a significant positive correlation was detected with disease activity as measured by SLE disease activity index [SLEDAI], while a significant inverse correlation existed with each of C3 and C4. IL-10 levels in SLE patient were significantly higher than those in controls [mean +/- SD 61.37 +/- 90.65 vs 9.73 +/- 20.33 pg/ml. p = 0.002]. Moreover, elevated IL-10 levels correlated significantly with SLEDAI and with titre of anti-VCA in lupus patients. This study provide evidence that EBV infection contributes to the aetiology and/or pathogenesis of SLE and that the presence of the virus may influence the clinical course of the disease

Hepatitis E antibodies in Egyptian adolescent females: their prevalence and possible relevance

Hepatitis E virus has been implicated as a frequent cause of acute sporadic hepatitis among Egyptian children. Moreover, an extraordinarily high ear prevalence rate was previously reported in a semiurban Nile Delta population. A conspicuous feature of hepatitis E is the high morbidity and mortality it can cause among infected pregnant women. We therefore evaluated the prevalence of HEV antibodies in adolescent females using a solid-phase enzyme linked immunoassay based on two recombinant hepatitis E virus antigens. A high prevalence rate [38.9%] was found in 95 apparently healthy adolescent females. The mean age of the study subjects was 21.81 +/- 2.5 [SD] range 16-25 years. Eighty [84.2%] subjects resided in Alexandria, while 15 [15.8%] came from semiurban villages of Alexandria Governorate. An increased prevalence was noted with age, as anti-HEV antibodies were detected in 32.1% and 41.8% of study participants in the second and third decades of life, respectively, similarly, those illiterate or having received less than primary education exhibited a higher HEV prevalence than those with higher education [46.3% VS 29.3%]. The majority o subjects having serological evidence of HEV infection denied previous history of jaundice which shows that HEV infection was subclinical in those cases. Ten [55.6%] pregnant females participating in the study, as well as 48 [62.3%] non pregnant females lacked serological, evidence of HEV infection; i.e., 60.01% [10+48 out of 95] of women in the childbearing age may be susceptible to infection. This report suggests that HEV is endemic in Alexandria, Egypt; the epidemiologic risk factors associated with HEV infection need further exploration