Infección por virus de Epstein-Barr y hepatitis aguda colestásica / Infection with Epstein-Barr virus and acute cholestatic hepatitis

El Virus de Epstein-Barr (VEB) es un herpes virus cuyo medio de transmisión es a través de secreciones de una persona portadora del virus, siendo el hombre el único huésped. La primo infección por lo general es asintomática o puede manifestarse como mononucleosis infecciosa con la triada clásica de fiebre, faringitis y adenopatías. Esta cursa con elevación leve y autolimitada de transaminasas, por lo que solo un 5% de los casos se ha asociado con hepatitis aguda colestásica. Presentamos a un paciente con una infección por virus de Epstein-Barr y hepatitis aguda colestásica con historia de aparición de una masa cervical lateral derecha. Al examen físico evidencia ictericia a nivel de escleras, mucosas y ambos miembros superiores. Niveles de bilirrubina en sangre elevados. Paciente con ultrasonido hepático y vías biliares normal, colangiopancreatografía retrograda endoscópica normal por lo que se procede a realizar pruebas serológicas para VEB siendo esta positiva. Se da tratamiento con ganciclovir, mejorando pruebas de función hepática y disminuyendo ictericia, teniendo así una evolución favorable del paciente...(AU)

Epstein-Barr Virus (EBV) is a herpes virus, whose means of transmission is through secretions of a person carrying the virus, the man being the only host. The cousin infection is usually asymptomatic or may manifest as infectious mononucleosis with the classical triad of fever, pharyngitis and lymphadenopathy. This is a mild and self-limiting elevation of transaminases, which means that only 5% of the cases have been associated with acute cholestasis hepatitis. We present a patient with an Epstein-Barr virus infection and acute cholestasis hepatitis with a history of the appearance of a right lateral cervical mass. Physical examination shows jaundice at the level of sclera, mucosa and both upper limbs. Elevated blood bilirubin levels. Patient with hepatic ultrasound and normal bile ducts, normal endoscopic retrograde cholangiopancreatography, so serological tests for EBV are performed and this is positive. Ganciclovir is given, improving liver function tests and decreasing jaundice, thus having a favorable evolution of the patient...(AU)

Clinical Characteristics of Primary Epstein Barr Virus Hepatitis with Elevation of Alkaline Phosphatase and gamma-Glutamyltransferase in Children

PURPOSE: The aim of the present study was to evaluate the clinical characteristics of the primary Epstein-Barr virus (EBV) hepatitis with elevation of both serum alkaline phosphatase (ALP) and gamma-glutamyltransferase (gamma-GT) levels in children. MATERIALS AND METHODS: A retrospective study was performed by reviewing of the medical records of 36 patients who were diagnosed with primary EBV hepatitis. The patients were divided into 2 groups: patients with elevated serum ALP and gamma-GT levels (group 1) and patients without (group 2). RESULTS: The classic features of infectious mononucleosis (fever, pharyngitis and/or tonsillitis, and cervical lymphadenitis) were seen in 20 (57.1%) of group 1 patients and 18 (50.0%) of group 2 patients. Hepatitis with elevated serum ALP and gamma-GT levels were present in 14 (38.9%) of the all patients. Of these patients, Jaundice occurred in only 2 (5.6%). The mean levels of aspartate aminotransferase and alanine aminotransferase (ALT) as well as the number of patients with ALT greater than 400 IU/L were significantly different between the groups (177 IU/L vs. 94 IU/L, 418 IU/L vs. 115 IU/L, and 50.0% vs. 13.6%; p=0.001, p=0.001, p=0.026, respectively). The mean duration of elevated serum ALT levels was 17.5 days in group 1 and 9.0 days in group 2 (p=0.013). All patients recovered fully without any chronic or serious complications. CONCLUSION: Primary EBV hepatitis with predominant biochemical abnormalities of the elevation of ALP and gamma-GT is frequent and mostly anicteric. This may represent a benign disease, but a delay in recovery of liver function as well.

Comparative analysis of presence of Cytomegalovirus (CMV) and Epsteinbarr virus -1 (EBV-1) in cases of chronic periodontitis and aggressive periodontitis with controls.

Aim : The aim of the present study was to evaluate the presence of Cytomegalovirus (CMV) and Epsteinbarr virus -1 (EBV-1)viruses in sub gingival plaque of chronic periodontitis (groupA), aggressive periodontitis patients (group B), periodontally healthy controls (group C) and to compare the clinical parameters between virus negative and positive sites in each of these groups. Materials and Methods : Sixty subjects were included in the study and equally divided into the 3 groups (group A - 20, group B - 20, group C - 20). Sub gingival plaque samples were obtained from the 3 deepest periodontal pocket sites in case of subjects suffering from periodontitis, and from one random bleeding site per quadrant in healthy groups. Clinical parameters like plaque index (PI), gingival index (GI), pocket depth (PD) and clinical loss of attachment (CAL) were recorded. Viral Deoxyribonucleic acid (DNA) was extracted using Proteinase-K DNA Extraction method, and the presence of CMV and EBV-1 was detected by polymerase chain reaction and 2% agarose gel. Results: Results of our study showed a 45% prevalence of CMV and EBV-1 in Aggressive periodontitis cases. Prevalence of CMV in chronic periodontitis and healthy subjects was 20% and 10%, respectively; while for EBV-1 it was 25% and 0%, respectively. In terms of comparison of the clinical parameters with virus presence, both CMV and EBV-1 positive sites showed a significantly higher mean pocket depth compared to virus negative sites. Conclusion: Our studyshowed that the prevalence of EBV1 was higher in chronic and aggressive periodontitis subjects compared to controls and the prevalence of CMV was higher in aggressive periodontitis patients. The virus positive sites showed higher pocket depth compared to virus negative sites.

An Adult Case of Severe Chronic Active Epstein-Barr Virus Infection with T-Cell Lymphoproliferative Disorder

No abstract available.

Pustulosis exantemática aguda generalizada asociada a Epstein Barr: A propósito de un caso / Acute generalized exanthematous pustulosis associated to Epstein Barr: A propose of a case

Acute generalized exanthematous pustulosis (AGEP) is a rare skin eruption most commonly caused by medications. It is characterized by an acute eruption of sterile pustules and it is accompanied by an episode of fever, which regresses a few days after discontinuation of the drug that caused the condition. We report a case 23 year-old woman without history of psoriasis, that consults for fever and an acute generalized pustular eruption after amoxicillin, with clavulanic acid administration in a mononucleosis infection context, which resolved spontaneously. The microbiologic culture was negative for pathogenic germens.

La pustulosis exantemática aguda generalizada (PEAG) es una rara afección de hipersensibilidad, inducida principalmente por drogas y se manifiesta por una erupción aguda de pústulas estériles, acompañada de fiebre, que regresa en pocos días luego de discontinuar el fármaco causante. Se comunica el caso de una paciente de 23 años de edad, sin antecedentes de psoriasis que consulta por fiebre y una erupción pustulosa generalizada, asociada a la ingesta previa de amoxicilina y ácido clavulánico en el contexto de una mononucleosis infecciosa, con resolución espontánea del cuadro. El cultivo microbiológico no objetivó gérmenes patógenos.

[Detection of EBV by PCR in fresh and paraffin-embedded naso pharyngeal carcinoma biopsies]

The nasopharyngeal carcinoma [NPC] is frequent in Tunisia. It's the second ORL cancer of men after the larynx one. To analyse the NPC characteristics in our population, we determined the frequency of EBV infection in 47 paraffin-embedded and 6 fresh NPC biopsies. We first extracted the DNA from tumoral tissus and then amplified viral sequences by PCR to detect and to type the infecting virus [EBV-A or ABV-B]. Our results showed that amplifiable DNA has been obtained from 34/47 paraffin-embedded NPC biopsies while 13/47 of the others biopsies contained degraded and not amplifiable DNA. All the fresh biopsies allowed to obtain DNA with good quality. The EBV infection frequency in paraffin-embedded NPC biopsies is 35% while EBV is detected in all fresh biopsies [6/6]. Our analyse also showed that the EBV-A is predominant in our population compared to EBV-B as it was shown in most countries of the world. This study clearly shows that PCR results obtained with paraffin-embedded NPC biopsies are divergeant from those obtained with fresh biopsies. Because of DNA degradation in paraffin-embedded NPC biopsies, the biology molecular results from that kind of samples is criticable. Moreover, the results obtained from fresh NPC biopsies confirmed the quasi-constant association of EBV with undifferenciated carcinoma nasopharyngeal type

Epstein-barr virus expression in Hodgkin's disease in Jordan

Epstein-Barr virus [EBV] has been associated with many hematopoietic malignancies including Hodgkin's disease [HD]. The association of HD correlates with the histologic subtype, age of presentation and geographic location. Our aims were to find out if EBV is associated with Jordanian HD; and if EBV association exists, to determine its relationship to certain age groups or specific histologic subtypes of HD; and finally to establish whether such association follows patterns seen in developing or developed countries. We have examined 64 cases of HD diagnosed in 2 major medical centers in Jordan for evidence of EBV association. We used immunohistochemistry and in-situ hybridization techniques to detect latent membrane protein [LMP-1] and Epstein-Barr virus encoded RNA [EBER] in the Reed-Sternberg cells. The study was conducted at the Department of Pathology, Jordan University of Science and Technology, Irbid, Jordan in the years 2000 and 2001. Epstein Barr virus was seen in 47% of our cases: 22 [65%] of the 34 mixed cellularity and 8 [29%] of 28 nodular sclerosis HD. None of our 2 lymphocyte predominant HD cases showed evidence of EBV. Epstein-Barr virus was seen in 73% of HD cases in children below 15 years of age as opposed to 34% of the young adult group. Our results confirm the presence of EBV in Jordanian HD in approximately half of the cases, a figure close to those reported in the West. Epstein-Barr virus association with HD in Jordan is seen mostly in the mixed cellularity subtype and childhood HD

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

Los virus herpes linfotrópicos humanos: epstein-Barr (VEB), 6 y 7 (HHV-6 y HHV-7) en la patogenia de enfermedades mielodisplásicas (SMD) y mieloproliferativas (SMP) / Lymphotropic human herpesviruses: epstein-Barr (EBV), 6 y 7 (HHV-6 and HHV-7) in the pathogenia of myelodysplastic (MDS) and mieloproliferative diseases (MPS)

Con base en alteraciones mielodisplásicas y mieloproliferativas observadas en pacientes con enfermedades linfoproliferativas asociadas a virus herpes linfotrópicos humanos, se realizaron estudios de escrutinio para demostrar eventualmente la reactivación de éstos y su posible implicación en la patogenia y curso de síndrome mielodisplásico (SMD) y de síndrome mieloproliferativo (SMP). Se investigaron 74 biopsias de médula ósea y sueros de pacientes con SMD y 49 biopsias de médula ósea y 36 sueros de pacientes con leucemia mieloide crónica (LMC), a 13 casos de México no se les realizó serología. El diagnóstico y clasificación se hizo según los criterios del Grupo Franco-Americano-Británico (FAB). Se realizaron pruebas séricas de anticuerpos contra antígeno de la cápsula viral (VCA) y antígeno temprano (EA) del VEB con las técnicas de ELISA y de inmunofluorescencia y de HHV-6 y HHV-7 mediante inmunofluorescencia. La inmunohistología se realizó con la técnica de APAAP (fosfatasa alcalina-antifosfatasa alcalina) para expresión antigénica de los 3 virus y por anticuerpos monoclonales. Se determinó proliferación celular con APAAP y con anticuerpo monoclonal contra el antígeno nuclear de proliferación celular (PCNA). Se encontraron títulos de IgG anti-VEB-EA en 62 por ciento de los casos con SMD y en 33 por ciento con LMC, títulos de IgG HHV-6 elevados en 19 por ciento de los casos con SMD y en 9.3 por ciento de LMC y los de HHV-7 elevados en el 37.8 por ciento y 13.9 por ciento, respectivamente. Los títulos de IgM fueron negativos para los tres virus. La expresión de antígeno en la médula ósea fue positiva en el 76 por ciento de SMD a VEB-EA, 48.6 por ciento a HHV-6 p41 y 37.8 por ciento a HHV-7. Los casos de LMC expresaron VEB-EA en el 77 por ciento, HHV-6 en el 54.5 por ciento y HHV-7 en el 21.8 por ciento.

Pseudotumor inflamatorio del pulmón en la infancia / Lung inflammatory pseudotumor in childhood

Introducción. El pseudotumor inflamatorio del pulmón es una lesión no neoplásica que puede simular un proceso maligno y que explica más de la mitad de los casos de masas pulmonares en la infancia. Existen escasas publicaciones de esta enfermedad en la edad pediátrica. Casos clínicos. Se describen 2 pacientes con pseudotumor inflamatorio del pulmón tratados quirúrgicamente, haciendo énfasis en los hallazgos clínicos, radiológicos e histopatológicos.Conclusión. Debe sospecharse esta enfermedad ante la presencia de masa intrapulmonar en la radiografía de tórax con antecedente de proceso infeccioso. El diagnóstico es forzosamente histopatológico y el tratamiento siempre es quirúrgico. Lesión intrapulmonar; pseudotumor inflamatorio; granuloma de células plasmáticas.

Angioedema y urticaria asociadas con infección activa del virus de Epstein-Barr en un adulto / Angioedema and urticaria associated with active Epstein-Barr virus infection in an adult patient

Un paciente de 43 años de edad consultó por una historia de dos años con episodios recurrentes de urticaria en miembros y tronco, y edema de labios y párpados. Se le realizaron varios estudios de diagnóstico, incluyendo mediciones del C1 inhibidor y análisis de marcadores para infecciones virales, entre otras cosas. Los resultados fueron dentro de los parámetros normales salvo los títulos de IgG anti-EBV que resultaron positivos en dilucione de 1/80. Se efectuó la técnica de transcripción reversa y PCR (RT-PCR) para determinar la presencia de EBV en forma replicativa, y se determinó la presencia de ARN con secuencias del gen BLLF1. El paciente recibió un tratamiento durante 40 días con acyclovir 200 mg 4 veces al día. Al final de dicho período, los síntomas (urticaria y angioedema) desaparecieron por completo, y la técnica de RT-PCR resultó negativa para el gen BLLF1 del virus de Epstein-Barr. Sobre las bases del seguimiento clínico y los resultados de la técnica de RT-PCR, concluimos que la infección activa por el EBV puede jugar un rol en la expresión de urticaria y angioedema en pacientes susceptibles

EBV infection of esophageal cancer tissue as determined by pcr

The Epstein-Barr Virus [EBV] belongs to the genus lymphocrypto-virus and subfamily gamma-herpesvirinae. This virus infects the lymphocytes of primates and causes a latent infection in the B lymphocytes of these animals in vitro and in vivo. It also infects epithelial cells which are permissive for virus replication. A correlation between infection with EBV and Burkitt's lymphoma and nasopharyngeal carcinoma has long been known to exist, although the role of the virus in these cancers is not well understood. A less clear correlation between infection and other cancers, including cancer of the esophagus, has also been reported. Given the high incidence of cancer of the esophagus in Iran, we set out to study the level of infection with this virus in Iranians afflicted with the cancer. For detection of the virus, we performed half-nested PCR reactions using primers complementary to a well preserved region of the EBV virus genome. DNA extracted from LCLPI 4 cells, which is a B lymphocyte cell line infected with EBV, acted as positive control. The length of the product of first PCR reaction was 168 bp and of the second reaction 121 bp, which are the expected lengths. Our samples were DNA extracted from mounted tissue sections of the esophagus or unmounted sections cut from paraffin blocks. Both types of samples were obtained from the archives of the pathology department of a national hospital. Thirty-four squamous cell carcinoma, 8 adenocarcinoma and 29 esophagitis samples were tested. DNA from 28,7 and 26, respectively, of these sample groups, corresponding with 86% of all the samples, served effectively as template in the PCR reactions. Twelve [42.8%], 3[42.8%] and 11[42.3%] of the effective squamous cell carcinoma, adenocarcinoma, and esophagitis samples, respectively, were EBV positive as established by the PCR technique. Only one of eleven normal esophageal sections was positive [9.1%]. Tentatively, there appears to be a correlation between EBV infection of esophageal tissue and abnormalities of the esophagus

Leiomiosarcoma asociado con el virus de Epstein-Barr en un adulto con trasplante renal / Leiomyosarcoma associated with epstein-barr virus in an adult with renal transplant

Recientemente se informó la asociación del virus de Epstein-Barr (VEB) y los tumores de músculo liso, principalmente en niños inmunosuprimidos; pero el papel que juega en la patogenia de estos tumores, no se ha esclarecido. Informamos un caso en que establecimos la presencia de VEB y leiomiosarcoma en un hombre de 28 años con insuficiencia renal crónica terminal que en 1994, recibió un trasplante renal. En 1996 ingresó con lesiones nodulares en ambas bases pulmonares, hígado, bazo, car anterior del muslo izquierdo y ganglios retroperitoneales; un año después falleció. En las biopsias de muslo e hígado se observó leiomiosarcoma. Las reacciones de inmunoperoxidasa fueron positivas para vimentina y para actina de músculo liso. La hibridación in situ fue positiva para antígenos nucleares del VEB (EBNA-2) en células neoplásicas. Este caso corresponde al primer sarcoma observado en pacientes trasplantados en nuestra institución como un caso poco frecuente de leiomiosarcoma asociado a VEB en adulto

Desórdenes linfoproliferativos postrasplante hepático (DLPT): hallazgos clínicos e imagenológicos / Lymphoproliferative disorders after liver trasplantation: clinical and diagnostic imaging features

Los desórdenes linfoproliferativos postransplante (DLPT) constituyen un grupo de proliferaciones linfoides que se observan en pacientes transplantados cuyos sistemas inmunes están deprimidos. Se asocian a infecciones por el virus de Epstein Barr (VEB), que puede presentarse como una primoinfección o reactivación de su forma latente. Se analiza un caso de DLPT que se revela como masa abdominal con sus características clínicas e imagenológicas encontrando que los estudios de imágenes realizados (ecografía, RM, colangioRM y videorrectosigmoidescopia) y la punción biopsia constituyen una herramienta fundamental para el diagnóstico precoz y correcto de esta patología

Infecçäo pelo vírus Epstein-Barr em crianças com AIDS / Epstein-Barr virus infection in children with AIDS

Objetivo: A associaçäo das infecçöes por HIV e vírus Epstein-Barr tem sido relatada em diversos estudos, especialmente em crianças que apresentam pneumonia intersticial linfóide. Analisou-se a incidência da infecçäo pelo vírus Epstein-Barr em crianças com AIDS, naquelas com AIDS com ou sem pneumonia intersticial linfóide, comparando-se com crianças näo infectadas ppelo HIV. Métodos: Realizou-se um estudo transeccional com 60 crianças com AIDS e 54 näo infectadas pelo HIV, pareadas por sexo e idade, no Hospital Infantil Joana de Gusmäo em Florianópolis, Santa Catarina, Brasil, de junho de 1994 a junho de 1995. A seleçäo dos casos seguiu a ordem de atendimento. Pesquisou-se anticorpos anticapsídeo do vírus Epstein-Barr por imunofluorescência indireta e ELISA, e antinucleares por ELISA. Definiu-se o estágio da infecçäo conforme as respostas sorológicas. Resultados: A linfandenopatia ocorreu em 59 casos (98,3 por cento), hepatomegalia em 51 (85,0 por cento), a esplenomegalia em 46 (76,7 por cento), broncopneumonias recorrentes em 41 (68,3 por cento). Observou-se peneumonia intersticial linfóide em 21 casos (35,0 por cento), dos quais 19 (90,5 por cento) tinham sorologia positiva ao vírus Epstein-Barr. A média geométrica dos títulos de IgG anticapsídeo, por imunofluorescência indireta, foi de 1:439,5 nos casos e 1:42,8 nos controles...

Síndrome de mononucleosis: enfrentamiento pediátrico / Mononucleosis syndrome: pediatric facing

Al conocer las diferentes etiologías y manifestaciones clínicas del síndrome de monucleosis infecciosa se ha observado una mayor frecuencia en su diagnóstico. Es así que se debe tener presente en lactantes con síntomas de infección respiratoria alta prolongada, y en niños mayores con síndrome febril o amigdalitis acompañada de esplenomegalia. Actualmente es imprescindible la corroboración del diagnóstico con serología específica para el virus de Epstein Barr u otras etiologías

Exámenes virológicos disponibles en la actualidad / Virological tests available today

Actualmente se ha hecho imprescindible la confirmación del diagnóstico etiológico de las infecciones virales. Para los médicos que trabajan alejados de los centros de estudio y universidades, es útil disponer de las posibilidades de diagnóstico viral y su correcta forma de certificación y envío de muestras. Se describen aquí las indicaciones de algunos exámenes virológicos disponibles en la Universidad de Chile y Universidad Católica de Chile