O vírus Epstein-Barr e a mononucleose infecciosa / Epstein-Barr virus and infectious mononucleosis

JUSTIFICATIVA E OBJETIVOS: A mononucleose infecciosa (MI) é uma doença viral, contagiosa, causada pelo vírus Epstein-Barr (EBV). Apresenta distribuição universal e pode ocorrer em qualquer faixa etária. O presente estudo teve como objetivo descrever a interação entre o EBV e o Homo sapiens sapiens, no que diz respeito especialmente à MI. Para isso, realizou busca no Pubmed e no Scielo, bem como em livros-textos. Os artigos selecionados foram lidos e as informações organizadas de forma a contemplar os aspectos patogênicos - enfatizando o papel do EBV na doença -, epidemiológicos e diagnósticos dessa entidade. CONTEÚDO: A infecção do epitélio da orofaringe permite a replicação do vírus, o qual passa a ser eliminado na saliva, o que explica a transmissão pelo contato com tal fluido biológico. O período de incubação é de quatro a seis semanas. Manifesta-se do ponto de vista clínico, usualmente, com febre, faringite e linfadenomegalia generalizada de caráter agudo ou subagudo. As alterações laboratoriais incluem leucocitose, reações leucemoides, trombocitopenia e anemia hemolítica autoimune, além de aminotransferases elevadas e bilirrubina aumentada, destacando-se que a linfocitose atípica é habitualmente observada. O diagnóstico diferencial da MI abrange as demais causas de síndrome de mononucleose. O tratamento é sintomático, não havendo fármaco antiviral específico. Analgésicos habituais podem ser usados para a terapêutica da dor. CONCLUSÃO: Díspares grupos têm trabalhando no desenvolvimento de vacinas para o EBV, porém, a possibilidade de tumorigênese pelo vírus tem trazido inúmeras dificuldades para a confecção de imunoprofilaxia efetiva.

BACKGROUND AND OBJECTIVES: Infectious mononucleosis (IM) is a widespread viral disease caused by Epstein-Barr virus (EBV). It occurs worldwide and can reach any age group. This article aims at describing the interaction between EBV and Homo sapiens sapiens, regarding especially IM. Thus, a research on PubMed and Scielo was performed, as well as on books. The selected articles were read and the information was organized inorder to contain the pathological - emphasizing the role of EBV on the disease -, epidemiological aspects and its diagnosis. CONTENTS: The infection of the epithelium of the oropharynx leads to the replication of the virus, which is eliminated via saliva, and accounts for the transmission through contact with this biological fluid. The incubation period lasts from four to six weeks. Clinically, the classic symptoms are usually fever, faryngitis and generalized lymphadenopathy, which can be acute or subacute. The laboratorial changes include leukocytosis, leukemoid reactions, thrombocytopenia and severe autoimmune hemolytic anemia, besides high levels of transaminases and bilirubin; atypical lymphocytosis is usually observed. The differential diagnosis of IM includes the other causes of mononucleosis syndrome. Treatment is symptomatic and there is not a specific antiviral medicine. Common analgesics can be used to treat pain. CONCLUSION: Diverse groups have worked on the development of a vaccine for EBV; however, the possibility of tumorigenesis by the virus has brought up several difficulties to the production of an effective immunoprophylaxis.

Reporte de una posible correlación entre la gingivitis ulceronecrotizante y la mononucleosis / Report a possible correlation between necrotizing ulcerative gingivitis and mononucleosis

Necrotizing ulcerative gingivitis is a relatively uncommon periodontal disease, characterized by ulceration, necrosis, pain and gingival bleeding. Factors often related to its occurrence include stress and systemic viral infections, such as those caused by cytomegalovirus and Epstein-Barr virus type 1, the latter being also considered the causative agent of infectious mononucleosis. This article aims to describe a clinical case of a female patient who presented with necrotizing ulcerative gingivitis associated with a clinical picture of infectious mononucleosis, as well as to review the literature concerning a possible correlation between these pathologies. This patient presented to our health care facility with necrotizing ulcerative gingivitis accompanied by lymphadenopathy, fever and prostration, after laboratory tests, Epstein-Barr virus type 1 infection was confirmed, as well as the co-occurrence of pathologies: necrotizing ulcerative gingivitis and infectious mononucleosis. Symptom remission in both disorders also occurred concomitantly, after instruction in plaque control measures and palliative medication for control of systemic symptoms. Therefore, although there is no scientific validation of an association between these two pathologies, it is imperative that all diagnostic alternatives be considered and investigated, in order to establish the therapeutic approach most appropriate to the patient(AU

La gingivitis ulcerativa necrótica es una enfermedad periodontal no común caracterizada por ulceración, necrosis, dolor y sangrado gingival. Los factores a menudo relacionados con su ocurrencia incluyen el estrés y las infecciones virales sistémicas como aquellas causadas por Cytomegalovirus y el virus Epstein-Barr tipo 1, donde este último es el agente causal de la mononuclerosis infecciosa. El objetivo de este trabajo fue describir el caso clínico de una mujer con gingivitis ulcerativa necrótica asociada a un cuadro clínico de mononucleosis infecciosa, así como hacer una revisión de la literatura concerniente a una posible correlación entre estas enfermedades. Esta paciente se presentó con una gingivitis ulcerativa necrótica acompañada de linfadenopatía, fiebre y postración después de las pruebas de laboratorio, donde se confirmó una infección por Epstein-Barr tipo 1 así como la ocurrencia conjunta de gingivitis ulcerativa necrótica y mononucleosis infecciosa. También se produjo una remisión concomitante de los síntomas en ambos trastornos después de la instrucción en medidas para el control de placas y una medicación paliativa para el control de los síntomas sistémicos. Por lo tanto, aunque no existió una validación científica de una asociación entre estas dos entidades, es imperativo que se consideren e investiguen todas las alternativas diagnósticas para establecer el enfoque terapéutico más apropiado para el paciente(AU)

Ultrasonografía doppler color en el diagnostico de mononucleosis infecciosa en el niño / Color doppler ultrasonography in the diagnosis of the infectious monucleosis in children

La mononucleosis infecciosa (MNI) es una enfermedad frecuente que afecta a niños y adolescentes y es causada por el virus Epstein-Barr. En la mayor parte de los casos (80 por ciento) se presenta como un cuadro agudo, caracterizado por fiebre, faringoamigdalitis y linfoadenopatías (forma anginosa). Con menor frecuencia, puede presentarse con poliadenopatías asociadas a fiebre baja y faringitis leve. La ultrasonografía (US) Doppler color ha demostrado ser de utilidad en el estudio de adenopatías en el niño y puede ser de utilidad en el diagnóstico de MNI. Objetivos: Describir los hallazgos de la US Doppler color en la MNI. Pacientes y Método: Se revisó en forma retrospectiva los antecedentes clínicos y estudios por imágenes de 10 niños con diagnóstico confirmado de MNI y en quienes se efectuó US como parte de su estudio. Resultados: El estudio US Doppler color de las adenopatías cervicales mostró hallazgos relativa-mente constantes en todos los pacientes: adenopatías bilaterales múltiples, ovaladas o semi-rredondeadas, con una razón largo-ancho < 2, hiper o isoecogénicas con respecto al músculo, sin necrosis o alteración de estructuras vecinas. Mostró además aumento de flujo vascular en todas las adenopatías. En los cuatro pacientes con US abdominal, se encontró hepatoesplenomegalia (3 pacientes) o esplenomegalia (1 paciente). En dos pacientes, el bazo mostraba un aspecto reticular y nodular fino, que podría ser secundario a la hiperplasia linfática reactiva, con compromiso fundamentalmente de la pulpa blanca, que ha sido descrita en el estudio histológico del bazo en pacientes con esta patología(9). Conclusiones: La MNI es una enferme-dad frecuente en el niño y en la mayoría de los casos el diagnóstico se sospecha clínicamente y se confirma con el estudio serológico específico. La US Doppler color muestra un aspecto relativamente constante en el estudio de las adenopatías periféricas en esta enfermedad y puede ser de utilidad en el diagnóstico.

Síndrome de mononucleosis infecciosa en pacientes adolescentes y adultos / Infectious mononucleosis syndrome in adolescents and adult patients

Infectious mononucleosis syndrome, characterized in typical cases by fever, sore throat, tonsillar exudates, cervical adenopathies and atypical lymphocytosis is associated in most cases to Epstein-Barr virus (EBV) infection. Other potential causes for this syndrome are acute cytomegalovirus (CMV), Human Immunodeficiency Virus, Toxoplasma gondii or Human Herpes virus 6 infection. These alternative etiologies evolve with a modified clinical picture that includes sometimes leukopenia or rash. Diagnosis of EBV is easily accomplished by atypical lymphocytosis (> 10 por ciento), positive heterophil antibodies and IgM antibodies directed against the EB viral capsid antigen (VCA). The latter is needed for cases without positive heterophil antibodies. Acute CMV infection is the second most important cause and can be diagnosed by CMV antigen detection, PCR or shell vial culture of blood samples, although experience with these tests among immunocompetent patients in primary care settings is sparse. Acute primary HIV infection is an important cause for this syndrome and should not be neglected when other causes are discarded. Third or fourth generation HIV ELISA tests, p24 antigen or HIV-PCR detection in blood samples allow recognition of this agent from the second or third week of inoculation. T. gondii and human herpes virus 6 infection can be diagnosed by serological methods. Evolution of EBV or CMV infection is favorable with infrequent complications.

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

Mononucleosis infecciosa / Infectious mononucleosis

Se describen diversos aspectos de la mononucleosis infecciosa: transmisión, etiología, anatomopatología,manifestaciones clínicas, diagnóstico, pronóstico, tratamiento y complicaciones posibles de esta enfermedad y se menciona la patogenicidad del Virus Epstein-Barr

La importancia clínica del citomegalovirus humano / The clinical importance of human citomegalovirus

La frecuencia del citomegalovirus humano (CMVH) es aún más elevada que la de muchos otros destacados agentes patógenos e incluye infecciones sintomáticas y asintomáticas que se transmiten por las vías aérea, oral, genital, transplacentaria, transfusional y/o a través de transplantes de órganos. En diversos casos, los daños implicados pueden conducir a serios trastornos neurológicos o hacia la muerte, sobre todo cuando las personas afectadas padecen de inmadurez o depresión inmunitarias, tal como ocurre durante la etapa de gestación, en los recién nacidos, en los receptores de órganos provenientes de donadores seropositivos para CMVH y en quienes padecen patologías altamente debilitantes, tales como el síndrome de inmunodeficiencia adquirida (SIDA). El material nucleico del CMVH contiene abundante información genética que le permite a este agente infeccioso evadir y/o reducir eficazmente el sistema inmunitario de su hospedero, a fin de garantizar su propia sobrevivencia

Cytomegalovirus infection in children: frequency, anatomopathologic characteristics and underlying risk factors in 1618 autopsies

The aim of this study was to determine the frequency of cytomegalovirus (CMV) infection in children with postmortem study. The records of 1618 autopsies performed during 1980 - 1989 at the Hospital Infantil de Mexico Federico Gomez were reviewed. Characteristic cytomegalovirus inclusion bodies were identified, in one or several organs, in 47 cases (2.9 per cent of the autopsies). None of these cases was cultured for viruses prior to ar at the time of autopsy. Of the 47 cases, 24 (51 per cent) with CMV were younger than 3 months of age. In eight cases, the infection was juged as generalized and considered the cause of death. Two of these patients were premature and the infection was most probably intrauterine. The risk factor most frequently identified was secondary immunosuppression. The lung was the most common affected organ, followed by kidney, adrenals, pancreas, liver, brain and salivary glands. In seven cases the inclusion bodies were seen in the brain and in three others periventricular calcifications without inclusion bodies were observed. Although not a rarity in Mexico, CMV infection is not often suspected. Additional studies are needed in order to determine the prevalence of CMV infection in Mexico

Mononucleose infecciosa: a síndrome e a doença / Infectious mononucleosis: the syndrome and the disease

Descrita nos EUA, em 1920, a mononucleose infecciosa (MI) causada pelo vírus Epstein-Barr (EBV), continua hoje, 70 anos depois, a depertar interesse. A distribuiçäo universal. a alta incidência, a significativa prevalência e a possível associaçäo com dois tipos de câncer humano - o linfoma de Burkitt e o carcinoma de nasofaringe - justificam a redobrada atençäo que médicos e pesquisadores dispensam a essa matéria. A descoberta de que outros vírus, bactérias, protozoários e algumas drogas säo capazes de desencadear mononucleose renovou o interesse pelo estudo da MI e pelo diagnóstico diferencial da infecçäo aguda pelo vírus da imunodeficiência humana (HIV). As implicaçöes entre EBV e os tumores malignos, e entre o HIV e mononucleose, levaram os autores a esta revisäo, onde säo estudadas a história natural, a epidemiologia, a etiopatogenia e as manifestaçöes clínicas da síndrome

Aetiology of acute hepatitis in Malaysia.

Icteric patients with clinical and biochemical evidence of liver disease, admitted into various hospitals in Malaysia, were investigated to determine the cause of their infection. Of these patients, 11.0% (16/145) were found positive for IgM anti-HAV (EIA), 4.1% (6/145) for IgM anti-HBc (EIA), 1.0% (1/102) for IgM anti-CMV (ELISA), 17.2% (16/64) for rising titres of leptospiral agglutinin, and none for heterophile antibody of EBV. Hepatitis NANB accounted for 67.9% of cases. The mean serum transaminases (ALT and AST) values in patients with hepatitis A and B were higher (more than 500IU) than in patients with leptospirosis or non-A, non-B hepatitis, whereas serum bilirubin levels were higher in patients with hepatitis A and leptospirosis than in patients with hepatitis B.