High incidence of Epstein Barr virus infection in childhood acute lymphocytic lukemia: A preliminary study.

Introduction: Epstein Barr virus (EBV) has a unique association with several human malignancies, especially lymphoproliferative disorders, mainly lymphomas in adults. There is paucity of data pertaining to EBV association with various cancers in India . Objective : The study aims to investigate the association of EBV in childhood leukemia. Material and Methods: Patients attending pediatric oncology services of the referral center have been included in the study. Twenty-five consecutive pediatric patients with acute lymphocytic lukemia (ALL) were subjected to EBV studies employing sensitive polymerase chain reaction followed by hybridization for presence of Bam H1-W region of EBV genome and detection of anti Z EBV replication activator (ZEBRA) antibodies using Western blot. Positive control included a case of Burkitt's lymphoma and infectious mononucleosis each. Raji cells were used as positive control with each test. Results: The PCR for EBV was positive in 8/25 patients of ALL. Western blot test using anti ZEBRA antibodies was positive in 5/25(20%) cases of ALL. Considering PCR as the gold standard, 32% of the children with ALL had evidence of active EBV replication. The positive controls were consistently positive. None of the 30 healthy laboratory controls, 22 age matched disease controls, 12 cases of AML and 15 cases of multiple myeloma were positive either by PCR or Western blots assays (P < 0. 01). There was no statistically significant correlation between duration of therapy and EBV positivity (P > 0.05). Conclusion: These studies indicate that a significant number of patients with ALL show evidence of active EBV replication.

Coinfection with epstein barr virus in north Indian patients with HIV/AIDS.

Acquired immunodeficiency syndrome (AIDS) has emerged as a serious health problem in India. Although tuberculosis appears to be the commonest opportunistic infection, studies pertaining to opportunistic viruses are scant In the present study co infection with EBV was evaluated in patients with AIDS using a highly sensitive polymerase chain reaction besides anti Zebra antibody assays for diagnosis of an active EBV infection in 37 patients of full-blown AIDS and 32 healthy seropositives. Thirty healthy laboratory workers were used as controls. Out of 37 patients with AIDS, 12 were positive for anti Zebra antibodies and 23 were positive for EBV by the PCR reaction. Out of the 32 seropositives, 3 were positive for anti Zebra antibodies and 4 were positive by PCR assay. The difference between seropositives and AIDS was significant (p < .05). None of the controls were positive for an active EBV infection. It is concluded that active EBV infection is an important co infection in patients with AIDS and may contribute significantly to morbidity and mortality in these patients.

Cytomegalovirus co-infection in patients with HIV/AIDS in north India.

BACKGROUND & OBJECTIVES: Cytomegalovirus (CMV) is a frequent opportunistic infection in immunocompromised individuals particularly those receiving organ transplants and harbouring HIV infection. The classical CMV syndrome may be seen in only a small percentage of patients and tissue diagnosis is cumbersome, costly and requires hospitalization. Hence there is an urgent need to establish accurate and early diagnosis for proper institution of therapy. An attempt was made to detect active CMV co-infection in patients with HIV/AIDS using three assays and the positivity rates in the 2 groups compared. METHODS: In the present study, we used a highly sensitive polymerase chain reaction (PCR) for immediate early gene of CMV, pp65 antigenaemia assay and IgM ELISA assay to detect the presence of CMV co-infection in 37 patients with AIDS and 32 healthy HIV seropositives. Thirty healthy laboratory workers served as normal controls. RESULTS: Of the 37 patients with AIDS, 12 (32.4%) showed a positive reaction by PCR and only 4 patients were positive by the antigenaemia assay. Of the 32 HIV seropositives, only one was positive by PCR (3%), and all were negative for antigen assay. None of the controls showed positivity by any of the tests. The difference in PCR positivity rates between HIV seropositives and patients with AIDS was significant (P < 01). IgM antibodies were positive in four (10.3%) AIDS patients and only one (3%) HIV seropositive, the difference was insignificant. The difference in antigen positivity between IIIV seropositives and AIDS patients was also insignificant. INTERPRETATION & CONCLUSION: CMV appears to be an important co-infection in patients with AIDS in India and PCR is a powerful tool for detection of CMV in blood and is superior to the antigenaemia assay. PCR can be performed with a small volume of blood avoiding any invasive procedure, and can provide quick information for timely institution of therapy.