Epstein-Barr virus in gastric cancer and association with 30 bp del-latent membrane protein 1 polymorphism

SUMMARY OBJECTIVE: This study aimed to determine the frequencies of Epstein-Barr virus, types 1 and 2 infection, and 30 bp del-latent membrane protein 1 viral polymorphism in gastric adenocarcinomas, as well as to investigate the association between Epstein-Barr virus infection and tumor location, type, and the patient's sex. METHODS: Samples were collected from 38 patients treated at a university hospital in Rio de Janeiro, Brazil. Epstein-Barr virus detection and genotyping were performed by polymerase chain reaction, followed by polyacrylamide gel electrophoresis and staining by the silver nitrate method. RESULTS: Overall, 68.4% of patients had Epstein-Barr virus-positive tumors. Of these, 65.4% presented infection by Epstein-Barr virus type 1, 23.1% by Epstein-Barr virus type 2, and 11.5% had coinfection with types 1 and 2. The 30 bp del-latent membrane protein 1 polymorphism was found in 42.3% of Epstein-Barr virus-positive tumors, 23.1% had the wild-type virus, and 23.1% had the wild-type and the polymorphism concomitantly. In 11.5% of Epstein-Barr virus-positive tumors, it was impossible to determine whether there was polymorphism or not. Tumor location in the antrum (22 of 38) and diffuse type (27 of 38) were predominant. There was no significant difference in Epstein-Barr virus infection or the 30 bp del-latent membrane protein 1 polymorphism between men and women. CONCLUSION: Epstein-Barr virus infection was found in 68.4% of tumors investigated in this study. To the best of our knowledge, this is the first article showing the coinfection of Epstein-Barr virus types 1 and 2 in gastric carcinoma in Brazil.

Treatment-related fluctuations in Guillain-Barré syndrome​: clinical features and predictors of recurrence / Fluctuaciones relacionadas al tratamiento en el Síndrome de Guillain-Barré: características clínicas y predictores de recurrencia

ABSTRACT Background: A treatment-related fluctuation (TRF) in a patient with Guillain-Barré syndrome (GBS) is defined as clinical deterioration within two months of symptom onset following previous stabilization or improvements with treatment. Objective: To investigate the clinical characteristics and factors that could increase the risk of relapse of GBS in patients with and without TRFs. Methods: Retrospective review of medical records of patients (>18 years) with GBS evaluated between January/2006 and July/2019. Demographic and clinical characteristics, ancillary studies, treatment received, and the clinical course of patients with and without TRFs were analyzed. Results: Overall, 124 cases of GBS were included; seven (5.6%) presented TRFs. GBS-TRF cases were triggered more frequently by infectious mononucleosis (28.57 vs. 8.55%; p=0.01). GBS-TRF were initially treated with plasmapheresis more frequently than those without TRF (14.29 vs. 1.70%; p=0.0349). Combined treatment (71.43 vs. 4.27%; p<0.001) and corticosteroids (42.86 vs. 1.71%; p<0.001) were more commonly used in the GBS-TRF group. GBS-TRF patients presented a higher median initial disability score (4 vs. 2; p=0.01). Conclusions: Patients with GBS triggered by infectious mononucleosis and a high degree of initial disability have higher chances of developing TRFs. Although patients with TRF were treated with plasmapheresis more often, the total number was too low to suggest a link between plasma exchange and TRF.

RESUMEN Antecedentes: Una fluctuación relacionada al tratamiento (FRT) en un paciente con síndrome de Guillain-Barré (SGB) se define como un deterioro clínico dentro de los dos meses posteriores al inicio de los síntomas después de una estabilización previa o mejoría con el tratamiento. Objetivo: Investigar las características clínicas y los factores que podrían incrementar el riesgo de recaída, comparando pacientes con SGB, con y sin FRT. Métodos: Revisión retrospectiva de historias clínicas de pacientes (>18 años) con SGB evaluados entre enero/2006 y julio/2019. Se analizaron las características demográficas y clínicas, los estudios complementarios, el tratamiento recibido y la evolución clínica de los pacientes con y sin FRT. Resultados: Se incluyeron 124 casos de SGB en el total; 7 (5,6%) presentaron FRT. Los casos de SGB con FRT se desencadenaron con mayor frecuencia por mononucleosis infecciosa (28,57 vs. 8,55%; p=0,01). Los casos de SGB con FRT se trataron inicialmente con plasmaféresis con más frecuencia que aquellos sin FRT (14,29 vs. 1,70%; p=0,0349). El tratamiento combinado (71,43 vs. 4,27%; p<0,001) y los corticosteroides (42,86 vs. 1,71%; p<0,001) se utilizaron con mayor frecuencia en el grupo de SGB con FRT. Los pacientes con FRT presentaron una escala de discapacidad inicial mediana más alta (4 vs. 2; p=0,01). Conclusiones: Aquellos SGB desencadenados por mononucleosis infecciosa y un alto grado de discapacidad inicial tienen una mayor probabilidad de desarrollar FRT. Aunque los pacientes con FRT fueron tratados con plasmaféresis con mayor frecuencia, el número total fue demasiado bajo para sugerir un vínculo entre la plasmaféresis y FRT.

Extranodal nk/t-cell lymphoma, nasal type: case report

ABSTRACT Introduction: Extranodal NK/T-cell lymphoma, nasal type (ENKL), is a highly aggressive non-Hodgkin's lymphoma of unknown etiology. Clinical manifestations are usually nasal obstruction, epistaxis, and inflammatory signs. Diagnosis can be difficult to achieve and requires histo-pathology and immunohistochemistry studies. Radiotherapy and chemotherapy have been proposed as treatment, depending on the stage of the disease. Case presentation: A 44-year-old male patient, previously healthy, attended the outpatient service due to clinical nasal obstruction, secretion, edema, and facial erythema for 2 months. Facial cellulitis was initially diagnosed, but since there was no improvement with antibiotic treatment, the patient was referred to the emergency department of a higher complexity center, where complementary imaging showed a mass in the right nasal cavity. A histopathological analysis established that it was an ENKL, so radiotherapy was indicated; however, as a result of the advanced stage of this neoplasm, the patient died. Conclusion: Timely diagnosis of ENKL is crucial to improve life expectancy. Nevertheless, it may represent a clinical challenge due to its nonspecific presentation.

RESUMEN Introducción. El linfoma extranodal nasal de células T/natural killer (ENKL) es un linfoma no Hodgkin altamente agresivo y de etiología desconocida. Sus manifestaciones clínicas suelen ser obstrucción nasal, epistaxis y signos inflamatorios; sin embargo, el diagnóstico puede llegar a ser difícil, requiriendo histopatología e inmunohistoquímica para su detección. Como tratamiento se han propuesto radioterapia y quimioterapia, según el estadio de la enfermedad. Presentación del caso. Paciente masculino de 44 años de edad, previamente sano, quien asistió al servicio de consulta externa por cuadro clínico de 2 meses de evolución consistente en síntomas de obstrucción y secreción nasal, edema y eritema facial. Se realizó diagnóstico inicial de celulitis facial, pero dado que no hubo mejoría con el tratamiento antibiótico, el sujeto fue remitido al servicio de urgencias de una institución de mayor complejidad, donde se le practicaron imágenes complementarias que mostraron una masa en la cavidad nasal derecha; mediante análisis histopatológico se estableció que se trataba de un ENKL, por lo que se indicó radioterapia; sin embargo, a consecuencia del estadio avanzado de dicha patología, el paciente falleció. Conclusión. El diagnóstico oportuno de ENKL es crucial para mejorar la expectativa de vida de quienes lo padecen; sin embargo, puede representar un reto clínico debido a su presentación inespecífica.

Síndrome Hemofagocítico en Niños Reporte de Caso / Hemophagocytic Syndromein children: a case report

Introducción:El síndrome hemofagocítico (SHF) es reconocido como un conjunto de signos clínicos y hallazgos laboratoriales que tienen un grave compromiso en la salud y vitalidad de los niños con una incidencia de 1.2 casos/millón/año. Puede pasar subdiagnosticado y confundido con sepsis de foco inespecífico Caso clínico:Niño de 4 años de edad, sin antecedentes de importancia. Ingresado desde el servicio de emergencia por presentar 20 días de fiebre y dolor abdominal. Requirió intubación por franca falla respiratoria y el ingreso a la Unidad de Cuidados Intensivos Pediátricos. Con hipotensión e insuficiencia hepática, pancitopeniay esplenomegalia. Evolución: Se descartaron infecciones bacterianas con policultivos, SARS-Cov 2negativo,se descartaron inmunodeficiencias congénitas y adquiridas.TORCHnegativo, VDRL no reactivo.La prueba de Epstein Barr fue positivo para IgM.Se determinó endocarditis con derrame pericárdico global. Estudio de biopsia medular normocromía, normocitosis, pancitopenia y blastos <5%, sin infiltración tumoral. Se estableció el Diagnóstico de SHFse inicióciclosporina y corticoterapia.Requirió ventilación mecánica por 20 días con período de pronación de 36 horas. Fue dado de alta a pediatríay posteriormente a domicilio, para control por consulta externa. Conclusión: El diagnóstico del SHF es inusual y subestimado al momento de la evaluación clínica. En el presente reporte se asocia a la presencia del Virus Epstein Barr

Introduction: Hemophagocytic syndrome (HPS) is recognized as a set of clinical signs and laboratory findings that have a serious compromise on the health and vitality of children with an incidence of 1.2 cases / million / year. It can be underdiagnosed and confused with sepsis with a non-specific focus. Clinical case: 4-year-old boy, with no significant history. Admitted from the emergency service due to 20 days of fever and abdominal pain. She required intubation due to frank respiratory failureand admission to the Pediatric Intensive Care Unit. With hypotension and liver failure, pancytopenia and splenomegaly. Evolution: Bacterial infections were ruled out with polycultures, SARS-Cov 2 negative, congenital and acquired immunodeficiencies were ruled out. Negative TORCH, non-reactive VDRL. The Epstein Barr test was positive for IgM. Endocarditis with global pericardial effusion was determined. Medullary biopsy study normochromia, normocytosis, pancytopenia, and blasts <5%, without tumor infiltration. The diagnosis of SHF was established, cyclosporine and corticosteroid therapy were started. He required mechanical ventilation for 20 days with a 36-hour pronation period. He was discharged to pediatrics and later at home, for outpatient control. Conclusion: The diagnosis of HHS is unusual and underestimated at the time of clinical evaluation. In this report it is associated with the presence of the Epstein Barr Virus

Síndrome hemafagocítico, enfrentamiento diagnóstico y terapéutico actual. Revisión a partir de un caso relacionado a virus Epstein-Barr / Hemophagocytic syndrome, current diagnostic and therapeutic approach

Hemophagocytic syndrome or hemophagocytic lymphohistiocytosis (HLH) is a highly lethal hyper-inflammatory disorder that leads to a storm of cytokines, hemophagocytosis and multiple organ failure. It can be primary, which is inherited, or secondary. In the latter, virus infections are a frequent trigger, predominantly the family of herpes viruses, such as Epstein-Barr virus. An early treatment is recommended. Until recently there was no consensus about the management of secondary cases. The protocols for the treatment of primary HLH were used, which include cytotoxic agents and corticosteroids. We herein review the current diagnostic and therapeutic approach of HLH, based on a case associated with a reactivation of the Epstein-Barr virus in an immunocompetent adolescent. We highlight the importance of suspecting this disease in patients with a persistent inflammatory response state or with a fever of unknown origin, in order to carry out a timely treatment, with the least toxicity, and appropriate to the characteristics of each individual, which is the current therapeutic trend.

Caracterización clínica y epidemiológica del carcinoma nasofaríngeo y su relación con el virus Epstein-Barr / Nasopharyngeal carcinoma and its relationship with the Epstein-Barr virus, clinical and epidemiological description

RESUMEN Fundamento: El carcinoma nasofaríngeo es el tumor maligno más frecuente del cavum. Estos tumores se diferencian de otros carcinomas epidermoide de la cabeza y cuello por su histología característica y su relación con el virus de Epstein-Barr. Objetivo: Caracterizar clínica y epidemiológicamente el carcinoma de nasofaringe y su relación con el virus Epstein-Barr, en el Instituto Nacional de Oncología y Radiobiología, Ciudad de la Habana, en el período de enero a diciembre de 2012. Metodología: Se realizó un estudio retrospectivo; se trabajó con un total de 16 historias clínicas. Se observaron variables como edad, sexo, tipo histológico, estadiamiento clínico, presencia del virus Epstein-Barr en el tumor, tratamiento aplicado, respuesta al tratamiento, recaída y estado del paciente. Resultados: El 50 % tenían entre 45-55 años de edad, 75 % eran hombres, el 50 % diagnosticados con tipo 3, 100 % negativo a la inmunohistoquímica para virus Epstein-Barr, predominó la etapa III con 43.75 %, el 56.25 % de los casos se trataron con radio-quimioterapia más quimioterapia, el 50 % tuvo respuesta completa, la recaída fue de 37.50 % y el 68.75 % de los pacientes estaba vivo a los 60 meses. Conclusiones: En esta pequeña población con carcinoma nasofaríngeo, la totalidad de la población fue negativa a la presencia de virus Epstein-Barr por técnicas de inmunohistoquímica, por lo que su negatividad se hizo representativa en los tipo 3 y etapas avanzadas y no tuvo impacto en la respuesta al tratamiento y la supervivencia global.

ABSTRACT Background: Nasopharyngeal carcinoma is the most common malignant tumor of the cavum. These tumors differ from some other epidermoid carcinomas of the head and neck by their histology features and their Epstein-Barr virus relationship. Objective: To describe clinically and epidemiologically the nasopharyngeal carcinoma and its relationship with the Epstein-Barr virus, at the National Institute of Oncology and Radiobiology, Havana City, from January to December 2012. Methodology: A retrospective study was conducted; with a total of 16 medical records. Variables such as age, sex, histological type, clinical staging, and presence of Epstein - Barr virus in the tumor, applied treatment, response to treatment, relapse and patient status were observed. Results: 50 % were between 45-55 years old, 75 % were men, 50 % diagnosed with type 3, 100 % negative to Epstein-Barr virus immunohistochemistry, stage III predominated with 43.75 %, 56.25 % of the cases were treated with radio-chemotherapy plus chemotherapy, 50 % had a complete response, relapse was 37.50 % and at 60 months 68.75 % of the patients were still alive. Conclusions: In this small population with nasopharyngeal carcinoma, the entire population was negative to the presence of Epstein-Barr virus applying immunohistochemical techniques, so its negativity became representative in type 3 and advanced stages and had no impact on the treatment response and overall survival.

Encefalitis severa por el virus de Epstein-Barr en paciente inmunocompetente: reporte de caso / Severe encephalitis due to Epstein-Barr virus in an immunocompetent patient: case report

RESUMEN El virus de Epstein Barr (VEB) infecta a cerca del 90 % de las personas en la primera década de vida y, como los demás herpes virus, se mantiene en estado de latencia con riesgo de reactivaciones posteriores. La infección por VEB puede tener un curso asintomático o causar mononucleosis infecciosa (MI), especialmente en adolescentes y adultos. Rara vez, es responsable de infecciones en el sistema nervioso central como encefalitis, cerebelitis, mielitis, neuritis, encefalomielitis aguda diseminada y, más comúnmente, en relación con la infección por el virus de inmunodeficiencia humana (VIH), relacionado con el linfoma primario del sistema nervioso central (SNQ. La encefalitis por VEB no difiere en su presentación clínica de las demás encefalitis virales. Su diagnóstico se realiza mediante detección serológica de anticuerpos de respuesta aguda contra el virus o por reacción en cadena de la polimerasa (PCR) en líquido cefalorraquídeo (LCR). Las opciones terapéuticas en el momento son limitadas y con una baja evidencia de efectividad. A continuación, se presenta el caso de una mujer adulta, inmunocompetente, con clínica de encefalitis aguda severa y marcadas anormalidades en las neuroimágenes. El diagnóstico se hizo mediante la detección de ADN viral en LCR, apoyado por la exclusión de otros agentes patógenos y otras posibles etiologías mediante estudios microbiológicos, patológicos y serológicos.

SUMMARY Epstein Barr virus (EBV) infects about 90 % of people in the first decade of life and, like other herpes viruses, remains dormant with risk of subsequent reactivations. EBV infection can have an asymptomatic course or cause infectious mononucleosis (IM), especially in teenagers and adults. Rarely, it can be responsible for infections in the central nervous system such as encephalitis, cerebellitis, myelitis, neuritis, acute disseminated encephalomyelitis and, more commonly, primary lymphoma of the central nervous system (PLCNS) related to infection by human immunodeficiency virus (HIV). VEB encephalitis does not differ from other viral encephalitis in its clinical presentation. Its diagnosis is performed by serological detection of acute antibody response against the virus or by polymerase chain reaction (PCR) in cerebrospinal fluid (CSF). Treatment options are limited and with a low evidence of effectiveness. We report an unusual case of an immunocompetent mid adult woman, who presented clinically severe acute encephalitis and marked abnormalities in neuroimaging. The diagnosis was made by EBV DNA detection in CSF, supported by the exclusion of the presence of other pathogens and etiologies by microbiological and pathological studies.

Epstein-Barr virus and skin

Abstract: Epstein-Barr virus is a DNA virus infecting human beings and could affect 90% of human population. It is crucial to take in account that in Latin America, unlike what happens in developed countries, the exposure to the virus is very early and therefore people have a much longer interaction with the virus. The virus is related to many diseases, mainly the oncological ones, and when the onset is in cutaneous tissue, it can present many clinical variants, as well acute as chronic ones. Among the acute ones are infectious mononucleosis rash and Lipschutz ulcers; the chronic presentations are hypersensivity to mosquito bites, hydroa vacciniforme, hydroa vacciniforme-like lymphoma, its atypical variants and finally nasal and extra-nasal NK/T-cell lymphoma. Although they are not frequent conditions, it is crucial for the dermatologist to know them in order to achieve a correct diagnosis.

Manifestação sistêmica atípica causada pelo vírus Epstein-Barr. Relato de caso / Atypical Systemic Manifestation caused by Epstein-Barr virus: case report

A infecção pelo vírus Epstein-Barr tem alta prevalência, ao passo que 90% da população mundial adulta já teve contato com ele. A primo-infecção geralmente ocorre na infância, apresentando- -se de forma subclínica. Com o avançar da idade, a incidência de infecção sintomática aumenta progressivamente, atingindo o pico entre 15 e 24 anos de idade. Em geral, trata-se de uma doença benigna, na qual a manifestação clínica mais comum é a mononucleose infecciosa. No entanto, a infecção pode acometer qualquer órgão ou sistema, e podem estar presentes tosse, dor abdominal, náuseas, vômitos, hepatoesplenomegalia, icterícia, entre outros. As complicações são raras e podem acometer o fígado, os rins, o sistema nervoso central, o coração, os pulmões e os genitais. Relatamos o caso de paciente adolescente previamente hígido com infecção por vírus Epstein-Barr e evolução para icterícia, pericardite e lesões importantes em orofaringe e genitais. O diagnóstico de infecção pelo Epstein-Barr foi feito por sorologia, e houve boa evolução do caso.

Epstein-Barr virus infection has a high prevalence, since 90% of the adult population worldwide have already had contact with the virus. The primary infection usually occurs in childhood, being subclinically presented. With aging. the incidence of a symptomatic infection progressively increases, reaching the peak between 15 and 24 years of age. In general, it is a benign disease,in which the most common clinical manifestation is Infectious Mononucleosis; however, the infection can occur in any organ or system, and cough, abdominal pain, nausea, vomiting, hepatosplenomegaly, jaundice, and other symptoms may be present. Complications are rare and can affect the liver, kidneys, central nervous system, heart, lungs and genitals. We report the case of a previously healthy adolescent patient with Epstein-Barr Virus infection and progression to jaundice, pericarditis, and important lesions in the oropharynx and genitals. The diagnosis of Epstein-Barr infection was made through serology, and the patient had good evolution.

Detecção do HPV e EBV por nPCR em líquen plano bucal e tecido normal de cavidade bucal / Detection of HPV and EBV by nPCR in oral lichen planus and normal tissue of oral cavity

O líquen plano caracteriza-se como uma doença inflamatória crônica mucocutânea relativamente comum na população. Possui etiologia incerta, sendo possivelmente associado a fatores genéticos, psicológicos e infecciosos, dentre os quais o último vem ocupando um maior destaque devido a uma possível correlação com o vírus do papiloma humano (HPV) e com o Epstein-Barr vírus (EBV). O HPV possui alguns tipos considerados oncogênicos associados ao câncer de colo de útero e fortemente associado ao carcinoma espinocelular (CEC) de orofaringe. O EBV pertence à família herpesvirus humano e está relacionado com o carcinoma nasofaríngeo, linfoma de Burkitt e linfoma não-Hodgkin e sua possível relação com o CEC vem sendo estudada. O objetivo deste estudo foi detectar a presença do DNA do HPV e do EBV em amostras de tecido fresco, plasma sanguíneo, saliva e células esfoliadas orais, extraídas de um grupo pareado por sexo e idade de pacientes portadores de líquen plano bucal (LPB) e de um grupo de pacientes sem lesões de LPB, além de correlacionar as variáveis epidemiológicas dos grupos estudados com a presença viral e verificar se as fontes materiais testadas por este estudo são fontes viáveis para detecção do HPV e do EBV. Foram avaliados 24 pacientes portadores de LPB (Grupo caso) e 17 pacientes sem lesões de LPB (Grupo controle). A extração de DNA das amostras foi realizada após confirmar a presença e integridade do DNA. Os resultados obtidos foram submetidos à análise estatística (Teste exato de Fisher e Teste do Qui-Quadrado Mantel-Haenszel, ambos, com nível de significância de 5%). A nPCR foi utilizada para detecção do HPV e do EBV. Obteve-se a positividade viral para o HPV em 41,7% das amostras teciduais, em 12,5% das amostras de células esfoliadas e em nenhuma amostra de plasma sanguíneo e saliva dos pacientes do Grupo caso e em 52,9% das amostras teciduais e de saliva, 47,1% e 58,8% amostras de células esfoliadas e plasma sanguíneo, respectivamente, no Grupo controle...

Lichen planus is characterized as a chronic inflammatory mucocutaneous disease relatively common in the population. It has uncertain etiology, possibly associated with genetic, psychological and infectious factors. The infectious factor has excelled due the possible correlation of lichen planus with human papilloma virus (HPV) and Epstein-Barr virus (EBV). HPV has some types considered oncogenic, associated with cervical cancer and strongly associated with squamous cell carcinoma (SCC) of oropharynx. EBV belongs to human herpesvirus family and is associated with nasopharyngeal carcinoma, Burkitt’s lymphoma and non-Hodgkin lymphoma. Its possible relation to SCC has been studied. The aim of this study was to detect the presence of the DNA of the HPV and EBV in fresh tissue samples, blood plasma, saliva and oral exfoliated cells extracted from a group of patients with oral lichen planus (OLP) paired by age and gender and from a group of patients without OLP lesions, and also correlate the epidemiological variables of the studied groups with the viral presence and verify that the source materials tested in this study are viable for HPV and EBV detection. It was evaluated 24 patients with OLP (Case group) and 17 patients without OLP lesions (Control group). DNA extraction of samples was performed after confirming the presence and integrity of DNA. The results were subjected to statistical analysis (Fisher’s exact test and Mantel-Haenszel 19 chi-square test, both with a significance level of 5%). The nPCR was used to detect the presence of HPV and EBV. Was obtained the viral positivity for HPV in 41.7% of tissue samples and in 12.5% of exfoliated cells samples. No samples of blood plasma and saliva were positive in the Case group. On the other hand, the Control group showed a viral positivity of 52.9% in fresh tissue and saliva samples, 47.1% and 58.8% in samples of exfoliated cells and blood plasma, respectively. Was found positivity for EBV in 62.5% of tissue...

Detecção do HPV e EBV por nPCR em líquen plano bucal e tecido normal de cavidade bucal / Detection of HPV and EBV by nPCR in oral lichen planus and normal tissue of oral cavity

O líquen plano caracteriza-se como uma doença inflamatória crônica mucocutânea relativamente comum na população. Possui etiologia incerta, sendo possivelmente associado a fatores genéticos, psicológicos e infecciosos, dentre os quais o último vem ocupando um maior destaque devido a uma possível correlação com o vírus do papiloma humano (HPV) e com o Epstein-Barr vírus (EBV). O HPV possui alguns tipos considerados oncogênicos associados ao câncer de colo de útero e fortemente associado ao carcinoma espinocelular (CEC) de orofaringe. O EBV pertence à família herpesvirus humano e está relacionado com o carcinoma nasofaríngeo, linfoma de Burkitt e linfoma não-Hodgkin e sua possível relação com o CEC vem sendo estudada. O objetivo deste estudo foi detectar a presença do DNA do HPV e do EBV em amostras de tecido fresco, plasma sanguíneo, saliva e células esfoliadas orais, extraídas de um grupo pareado por sexo e idade de pacientes portadores de líquen plano bucal (LPB) e de um grupo de pacientes sem lesões de LPB, além de correlacionar as variáveis epidemiológicas dos grupos estudados com a presença viral e verificar se as fontes materiais testadas por este estudo são fontes viáveis para detecção do HPV e do EBV. Foram avaliados 24 pacientes portadores de LPB (Grupo caso) e 17 pacientes sem lesões de LPB (Grupo controle). A extração de DNA das amostras foi realizada após confirmar a presença e integridade do DNA. Os resultados obtidos foram submetidos à análise estatística (Teste exato de Fisher e Teste do Qui-Quadrado Mantel-Haenszel, ambos, com nível de significância de 5%). A nPCR foi utilizada para detecção do HPV e do EBV. Obteve-se a positividade viral para o HPV em 41,7% das amostras teciduais, em 12,5% das amostras de células esfoliadas e em nenhuma amostra de plasma sanguíneo e saliva dos pacientes do Grupo caso e em 52,9% das amostras teciduais e de saliva, 47,1% e 58,8% amostras de células esfoliadas e plasma sanguíneo, respectivamente, no Grupo controle...

Lichen planus is characterized as a chronic inflammatory mucocutaneous disease relatively common in the population. It has uncertain etiology, possibly associated with genetic, psychological and infectious factors. The infectious factor has excelled due the possible correlation of lichen planus with human papilloma virus (HPV) and Epstein-Barr virus (EBV). HPV has some types considered oncogenic, associated with cervical cancer and strongly associated with squamous cell carcinoma (SCC) of oropharynx. EBV belongs to human herpesvirus family and is associated with nasopharyngeal carcinoma, Burkitt’s lymphoma and non-Hodgkin lymphoma. Its possible relation to SCC has been studied. The aim of this study was to detect the presence of the DNA of the HPV and EBV in fresh tissue samples, blood plasma, saliva and oral exfoliated cells extracted from a group of patients with oral lichen planus (OLP) paired by age and gender and from a group of patients without OLP lesions, and also correlate the epidemiological variables of the studied groups with the viral presence and verify that the source materials tested in this study are viable for HPV and EBV detection. It was evaluated 24 patients with OLP (Case group) and 17 patients without OLP lesions (Control group). DNA extraction of samples was performed after confirming the presence and integrity of DNA. The results were subjected to statistical analysis (Fisher’s exact test and Mantel-Haenszel 19 chi-square test, both with a significance level of 5%). The nPCR was used to detect the presence of HPV and EBV. Was obtained the viral positivity for HPV in 41.7% of tissue samples and in 12.5% of exfoliated cells samples. No samples of blood plasma and saliva were positive in the Case group. On the other hand, the Control group showed a viral positivity of 52.9% in fresh tissue and saliva samples, 47.1% and 58.8% in samples of exfoliated cells and blood plasma, respectively. Was found positivity for EBV in 62.5% of tissue...

Epstein-Barr virus: general factors, virus-related diseases and measurement of viral load after transplant

The Epstein-Barr virus is responsible for infectious mononucleosis syndrome and is also closely associated to several types of cancer. The main complication involving Epstein-Barr virus infection, both in recipients of hematopoietic stem cells and solid organs, is post-transplant lymphoproliferative disease. The importance of this disease has increased interest in the development of laboratory tools to improve post-transplant monitoring and to detect the disease before clinical evolution. Viral load analysis for Epstein-Barr virus through real-time polymerase chain reaction is, at present, the best tool to measure viral load. However, there is not a consensus on which sample type is the best for the test and what is its predictive value for therapeutic interventions.

Epstein-Barr virus: general factors, virus-related diseases and measurement of viral load after transplant.

The Epstein-Barr virus is responsible for infectious mononucleosis syndrome and is also closely associated to several types of cancer. The main complication involving Epstein-Barr virus infection, both in recipients of hematopoietic stem cells and solid organs, is post-transplant lymphoproliferative disease. The importance of this disease has increased interest in the development of laboratory tools to improve post-transplant monitoring and to detect the disease before clinical evolution. Viral load analysis for Epstein-Barr virus through real-time polymerase chain reaction is, at present, the best tool to measure viral load. However, there is not a consensus on which sample type is the best for the test and what is its predictive value for therapeutic interventions.

Detecção de Epstein-Barr vírus no carcinoma da nasofaringe: implicações numa área de baixo risco / Epstein-Barr virus detection in nasopharyngeal carcinoma: implications in a low-risk area

Several studies have been published concerning Epstein-barr virus (EBV) infection and nasopharyngeal cancer (NPC) development. The incidences of histological types are different according to endemic or non-endemic regions. Latent EBV infection is found in almost all cases of NPC in endemic regions, but normally absent in type I carcinomas, more common in non-endemic regions. AIM: The purpose of this hospital-based study was to analyze the presence of EBV in nasopharyngeal tumor tissues and in peripheral blood of nasopharyngeal cancer patients and healthy individuals, in a low risk, non-endemic area. METHODS: EBV detection in samples of nasopharyngeal cancer patients and healthy individuals. RESULTS: This study indicates that the frequency of EBV positive cases in peripheral blood is higher in advanced tumor stages. CONCLUSIONS: The incidence rates of NPC have a distinct distribution. Since the prevalence of this disease is low in occidental countries, little is known about the biology of these tumors in non-endemic areas. We observed statistically significant differences in EBV detection between the NPC patient group and the control group. This study may help to understand the biological mechanisms of NPC and the correlation of EBV infection with this disease, in a low risk, non-endemic region.

Têm sido publicados vários estudos acerca da infecção por Epstein-Barr vírus (EBV) e o desenvolvimento de carcinoma da nasofaringe (NPC). As prevalências dos tipos histológicos e a presença de infecção latente pelo EBV são diferentes em regiões endémicas e não endémicas. OBJETIVO: O objectivo deste estudo consistiu na detecção de EBV em tecido tumoral da nasofaringe e sangue periférico de doentes com NPC e em indivíduos saudáveis, provenientes duma área não-endémica, de baixo risco. MÉTODOS: Detecção de EBV em amostras de doentes com carcinoma da nasofaringe e indivíduos saudáveis. Neste estudo de série foram avaliadas as implicações clínicas da presença de EBV circulante no sangue periférico de doentes com carcinoma da nasofaringe. RESULTADOS: Este estudo indica que a frequência de casos EBV positivos detectados no sangue periférico é superior em tumores de estádio mais avançado. CONCLUSÕES: Estes resultados indicam que se observam diferenças na pesquisa do vírus Epstein-Barr no grupo de doentes com NPC e no grupo controlo, sem tumor. Este estudo pode ajudar na compreensão dos mecanismos biológicos do cancro da nasofaringe e da correlação destes tumores com a infecção por EBV numa área não-endémica, de baixo risco.

Enfermedad de Kawasaki asociada a virus de Epstein-Barr

Se presenta el caso clínico de una niña de tres años en quién se hizo el diagnóstico de enfermedad de Kawasaki (EK). Se confirmó, además, la presencia de una infección concomitante por virus de Epstein-Barr (VEB). La paciente presentó una reacción de hipersensibilidad al ácido acetilsalicílico (AAS) durante el tratamiento, que determinó la necesidad de sustituirlo por otro antiplaquetario. Se discuten las posibles relaciones entre EK e infección por VEB y se analiza la reacción de hipersensibilidad.

Apresenta-se o caso clínico de uma menina de 3 anos na qual se fez o diagnóstico da doença de Kawasaki (ER). Também se confirmou a presença de uma infeção concomitante por virus de Epstein-Barr (VEB). Durante o tratamento a paciente apresentou uma reação de hipersensibilidade ao ácido acetil salicílico (AAS), que determinou a necessidade de substitui-lo por outro antiplaquetario. Discutem-se as possíveis reações entre EK e infeção por VEB e se analisa a reação de hipersensibilidade.

We present a three year old girl with diagnosis of Kawasaki disease (KD) in whom the existence of a concomitant infection with Epstein-Barr virus (EBV) was confirmed. During treatment she presented a hypersensitivity response to aspirin which was then switched to another antiplatelet agent. Relationship between KD and EBV infection is discussed. Hypersensitivity response is analysed.

Anticuerpos monoclonales anti-Rh(D): antecedentes y estado actual / Anti-Rh (D) monoclonal autoantibodies: Antecedents and present state

Se describen los antecedentes y el estado actual de los anticuerpos monoclonales (AcM) anti-Rh(D). Estos AcM han dado lugar a una vía alternativa de producción de reactivos hemoclasificadores no dependientes de la inmunización deliberada de humanos basada en la tecnología de hibridomas. Los AcM contra el antígeno D son imposibles de obtener en roedores por la poca immunogenicidad de este antígeno en dichas especies, pero los linfocitos B de los humanos sensibilizados con hematíes Rh(D) positivos pueden producir anticuerpos anti-Rh(D) en cultivo de tejidos después de la infección y la transformación de las células con el virus de Epstein Barr (VEB). No obstante, la complejidad de esta obtención viene dada por la existencia de individuos con hematíes con fenotipos D débiles (D U) que tienen una expresión cualitativamente menor del antígeno y los D parciales (variantes de D) (categorías) donde el antígeno se puede presentar incompleto, ya que carecen de uno o más epítopes del mosaico D "normal", que posee más de 30. Para lograr una especificidad adecuada de un reactivo basado en AcM, este debe reconocer varios epítopes de los más comunes, y usualmente se prefiere una mezcla de anticuerpos clase IgG e IgM. Gracias a la nueva generación de reactivos anti-Rh(D) basados en AcM se ha incrementado la proporción de individuos previamente reconocidos como D U, que ahora son agrupados por pruebas directas de hemaglutinación como Rh(D) francamente positivos.

Antecedents and present state of Anti-Rh (D) monoclonal antibodies (MAB) are described. Theses MAB have give rise to alternative way of production of non-dependent hemoclassifiers of deliberate immunization of humans, based on hybridomes technology. The MAB to D antigens are impossible to obtain in rodents because of low immunogenicity of this antigen in such species, but human B lymphocytes sensitized with positive Rh (D) red cells, may produce anti-Rh (D) antibodies in tissue culture after infection and cell transformation using Epstein Barr virus (EBV). Nevertheless, complexity of this obtention is in ciew of existence of individuals carriers of red cells with weak D phenotypes (Du) showing an expression qualitatively minor of antigen, and partials D(variants of D) (category), where presentation of antigen may be incomplete, since they lack of one or more epitopes of "normal" D mosaic, which has more than 30. To obtain a proper specificity of a reagent based on MAB, this must recognize some of the commonest epitopes, and usually is prefered a mixture of class IgG and IgM antibodies. Thaks to the fact that there is a new generation of anti-RH (D) reagents, based on MAB, it was possible increase in ratio of individuals previously recognized as Du, that at present time are grouped by hemagglutination direct tests as Rh (D) obviously positives.