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Fischer F, Mücke J, Werny L, Gerrer K, Mihatsch L, Zehetmaier S, Riedel I, Geisperger J, Bodenhausen M, Schulte-Hillen L, Hoffmann D, Protzer U, Mautner J, Behrends U, Bauer T, Körber N. Evaluation of novel Epstein-Barr virus-derived antigen formulations for monitoring virus-specific T cells in pediatric patients with infectious mononucleosis. Virol J 2024; 21:139. [PMID: 38877590 PMCID: PMC11179387 DOI: 10.1186/s12985-024-02411-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 06/06/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Infection with the Epstein-Barr virus (EBV) elicits a complex T-cell response against a broad range of viral proteins. Hence, identifying potential differences in the cellular immune response of patients with different EBV-associated diseases or different courses of the same disorder requires interrogation of a maximum number of EBV antigens. Here, we tested three novel EBV-derived antigen formulations for their ability to reactivate virus-specific T cells ex vivo in patients with EBV-associated infectious mononucleosis (IM). METHODS We comparatively analyzed EBV-specific CD4+ and CD8+ T-cell responses to three EBV-derived antigen formulations in 20 pediatric patients during the early phase of IM: T-activated EBV proteins (BZLF1, EBNA3A) and EBV-like particles (EB-VLP), both able to induce CD4+ and CD8+ T-cell responses ex vivo, as well as an EBV-derived peptide pool (PP) covering 94 well-characterized CD8+ T-cell epitopes. We assessed the specificity, magnitude, kinetics, and functional characteristics of EBV-specific immune responses at two sequential time points (v1 and v2) within the first six weeks after IM symptom onset (Tonset). RESULTS All three tested EBV-derived antigen formulations enabled the detection of EBV-reactive T cells during the early phase of IM without prior T-cell expansion in vitro. EBV-reactive CD4+ and CD8+ T cells were mainly mono-functional (CD4+: mean 64.92%, range 56.15-71.71%; CD8+: mean 58.55%, range 11.79-85.22%) within the first two weeks after symptom onset (v1) with IFN-γ and TNF-secreting cells representing the majority of mono-functional EBV-reactive T cells. By contrast, PP-reactive CD8+ T cells were primarily bi-functional (>60% at v1 and v2), produced IFN-γ and TNF and had more tri-functional than mono-functional components. We observed a moderate correlation between viral load and EBNA3A, EB-VLP, and PP-reactive CD8+ T cells (rs = 0.345, 0.418, and 0.356, respectively) within the first two weeks after Tonset, but no correlation with the number of detectable EBV-reactive CD4+ T cells. CONCLUSIONS All three EBV-derived antigen formulations represent innovative and generic recall antigens suitable for monitoring EBV-specific T-cell responses ex vivo. Their combined use facilitates a thorough analysis of EBV-specific T-cell immunity and allows the identification of functional T-cell signatures linked to disease development and severity.
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Affiliation(s)
- Franziska Fischer
- Children's Hospital, School of Medicine, Technical University of Munich, Munich, Germany
| | - Johannes Mücke
- Children's Hospital, School of Medicine, Technical University of Munich, Munich, Germany
| | - Louisa Werny
- Children's Hospital, School of Medicine, Technical University of Munich, Munich, Germany
- Institute of Virology, School of Medicine, Technical University of Munich and Helmholtz Munich, Schneckenburgerstr. 8, 81675, Munich, Germany
| | - Katrin Gerrer
- Children's Hospital, School of Medicine, Technical University of Munich, Munich, Germany
| | - Lorenz Mihatsch
- Children's Hospital, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stefanie Zehetmaier
- Children's Hospital, School of Medicine, Technical University of Munich, Munich, Germany
- Research Unit Gene Vectors, Helmholtz Munich, Munich, Germany
| | - Isa Riedel
- Children's Hospital, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jonas Geisperger
- Children's Hospital, School of Medicine, Technical University of Munich, Munich, Germany
| | - Maren Bodenhausen
- Children's Hospital, School of Medicine, Technical University of Munich, Munich, Germany
| | - Lina Schulte-Hillen
- Children's Hospital, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dieter Hoffmann
- Institute of Virology, School of Medicine, Technical University of Munich and Helmholtz Munich, Schneckenburgerstr. 8, 81675, Munich, Germany
| | - Ulrike Protzer
- Institute of Virology, School of Medicine, Technical University of Munich and Helmholtz Munich, Schneckenburgerstr. 8, 81675, Munich, Germany
- German Centre for Infection Research (DZIF), Munich, Germany
| | - Josef Mautner
- Institute of Virology, School of Medicine, Technical University of Munich and Helmholtz Munich, Schneckenburgerstr. 8, 81675, Munich, Germany
- Research Unit Gene Vectors, Helmholtz Munich, Munich, Germany
- German Centre for Infection Research (DZIF), Munich, Germany
| | - Uta Behrends
- Children's Hospital, School of Medicine, Technical University of Munich, Munich, Germany
- Research Unit Gene Vectors, Helmholtz Munich, Munich, Germany
- German Centre for Infection Research (DZIF), Munich, Germany
| | - Tanja Bauer
- Institute of Virology, School of Medicine, Technical University of Munich and Helmholtz Munich, Schneckenburgerstr. 8, 81675, Munich, Germany
- German Centre for Infection Research (DZIF), Munich, Germany
| | - Nina Körber
- Institute of Virology, School of Medicine, Technical University of Munich and Helmholtz Munich, Schneckenburgerstr. 8, 81675, Munich, Germany.
- German Centre for Infection Research (DZIF), Munich, Germany.
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Tsiakalos A, Schinas G, Karatzaferis A, Rigopoulos EA, Pappas C, Polyzou E, Dimopoulou E, Dimopoulos G, Akinosoglou K. Acalculous Cholecystitis as a Complication of Primary Epstein-Barr Virus Infection: A Case-Based Scoping Review of the Literature. Viruses 2024; 16:463. [PMID: 38543828 PMCID: PMC10974004 DOI: 10.3390/v16030463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 04/09/2024] Open
Abstract
Primary Epstein-Barr virus (EBV) infection manifests with diverse clinical symptoms, occasionally resulting in severe complications. This scoping review investigates the rare occurrence of acute acalculous cholecystitis (AAC) in the context of primary EBV infection, with a focus on understanding its prevalence, clinical features, and underlying mechanisms. The study also explores EBV infection association with Gilbert syndrome, a condition that potentially exacerbates the clinical picture. Additionally, a case report of an 18-year-old female presenting with AAC and ascites secondary to EBV infection enhances the review. A comprehensive literature review was conducted, analyzing reported cases of AAC secondary to EBV infection. This involved examining patient demographics, clinical presentations, laboratory findings, and outcomes. The search yielded 44 cases, predominantly affecting young females. Common clinical features included fever, cervical lymphadenopathy, tonsillitis/pharyngitis, and splenomegaly. Laboratory findings highlighted significant hepatic involvement. The review also noted a potential link between AAC in EBV infection and Gilbert syndrome, particularly in cases with abnormal bilirubin levels. AAC is a rare but significant complication of primary EBV infection, primarily observed in young females, and may be associated with Gilbert syndrome. This comprehensive review underscores the need for heightened clinical awareness and timely diagnosis to manage this complication effectively.
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Affiliation(s)
| | - Georgios Schinas
- School of Medicine, University of Patras, 26504 Rio, Greece; (G.S.); (E.A.R.); (E.P.)
| | | | | | | | - Eleni Polyzou
- School of Medicine, University of Patras, 26504 Rio, Greece; (G.S.); (E.A.R.); (E.P.)
| | | | - George Dimopoulos
- 3rd Department of Critical Care, Evgenidio Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Karolina Akinosoglou
- School of Medicine, University of Patras, 26504 Rio, Greece; (G.S.); (E.A.R.); (E.P.)
- Department of Internal Medicine and Infectious Diseases, University General Hospital of Patras, 26504 Rio, Greece
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Rutkowska M, Pokorska-Śpiewak M. The influence of steroid therapy of complications of infectious mononucleosis on the course of Epstein-Barr virus hepatitis. Clin Exp Hepatol 2023; 9:375-385. [PMID: 38774200 PMCID: PMC11103806 DOI: 10.5114/ceh.2023.133169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 10/17/2023] [Indexed: 05/24/2024] Open
Abstract
Aim of the study The purpose of the study was to characterize the differences in the course of Epstein-Barr virus (EBV) primary infection-induced hepatitis between patients treated with steroids due to complications of infectious mononucleosis (IM) and those not receiving such therapy. Material and methods We analyzed the changes in the activity of liver enzymes and differences in abdominal ultrasound results. The study was based on reviewing the medical records of children hospitalized for primary EBV infection at the Department of Children's Infectious Diseases, Medical University of Warsaw, Regional Hospital of Infectious Diseases in Warsaw, between August 2017 and March 2023. The study population was divided into two groups: patients treated with steroids (Group 1) and children not receiving steroids (Group 2). Results Significant differences were obtained for alanine aminotransferase activity only in the first week of IM (205.34 ±115.40 vs. 288.82 ±170.16 IU/l for Group 1 and 2, respectively; p = 0.024), and for aspartate aminotransferase in the first (170.63 ±159.47 vs. 218.85 ±128.22 IU/l for Group 1 and 2, respectively; p = 0.009) and the third week (151.09 ±138.57 vs. 235.50 ±170.27 IU/l for Group 1 and 2, respectively; p = 0.016). The analysis of the results of laboratory tests for the diagnosis of cholestasis (γ-glutamyl transferase and total serum bilirubin concentrations with fractions) did not show significant differences between the groups. Conclusions Our results indicated that the two cohorts of patients may differ in the course of hepatitis associated with primary EBV infection, especially at the beginning of the disease, when the laboratory features of hepatitis were less pronounced in children treated with steroids.
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Affiliation(s)
- Magdalena Rutkowska
- Department of Children’s Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
- Regional Hospital of Infectious Diseases in Warsaw, Warsaw, Poland
| | - Maria Pokorska-Śpiewak
- Department of Children’s Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
- Regional Hospital of Infectious Diseases in Warsaw, Warsaw, Poland
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Paymannejad S, Shirani K, Najafi MA, Khorvash F, Shamlou F. Epstein-Barr virus infection leading to multiorgan involvement in an immunocompetent man. Clin Case Rep 2023; 11:e7993. [PMID: 37808572 PMCID: PMC10558645 DOI: 10.1002/ccr3.7993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/16/2023] [Accepted: 09/20/2023] [Indexed: 10/10/2023] Open
Abstract
Epstein-Barr virus (EBV) is a commonly asymptomatic widespread human herpes virus affecting over 90% of the population. It mostly originates complications like simple sore throat and infectious mononucleosis but severe manifestations are rare. Herein we report a 30-year-old immunocompetent man who presented with fever, sore throat, general weakness, and drowsiness. The diagnosis was formulated based on the positive RT-PCR test for EBV DNA and serological detection of IgM antibody against viral capsid antigen. The patient developed severe meningoencephalitis, myocarditis, and bowel perforation and passed away after 72 days of hospitalization.
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Affiliation(s)
| | - Kiana Shirani
- Infectious Diseases and Tropical Medicine Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Mohammad Amin Najafi
- Department of Neurology, School of MedicineIsfahan University of Medical SciencesIsfahanIran
| | - Farzin Khorvash
- Infectious Diseases and Tropical Medicine Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Farid Shamlou
- School of medicineIsfahan university of medical sciencesIsfahanIran
- Infectious Diseases and Tropical Medicine Research CenterIsfahan University of Medical SciencesIsfahanIran
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Jerome A, Khanna V, Akagi E, Bhargava A. A rare presentation of infectious mononucleosis: cholestatic hepatitis with hyperbilirubinemia. Germs 2023; 13:80-85. [PMID: 38023960 PMCID: PMC10659742 DOI: 10.18683/germs.2023.1370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 01/30/2022] [Accepted: 02/19/2023] [Indexed: 12/01/2023]
Abstract
Introduction Epstein-Barr virus infection with mononucleosis is the most common presentation in young adults. Most infections are self-limited, although in a few cases complications can include serious conditions such as lymphoproliferative disorders or in less severe cases, mild hepatitis. Case report We present an unusual case of a young male with no liver disease, who presented with markedly elevated cholestatic pattern hyperbilirubinemia, as well as hepatitis. The patient responded well to symptomatic treatments, with spontaneous improvement of the hyperbilirubinemia and transaminitis. Conclusions Epstein-Barr virus mononucleosis can frequently present with mild elevation of transaminases, but very rarely can have marked elevation of bilirubin, which may make clinicians doubt that the infection is the sole culprit of the process.
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Affiliation(s)
- Aldin Jerome
- MD. Department of Medicine, Wayne State University SOM/Ascension Providence Rochester Hospital, 1101 W. University Dr, Rochester, MI 48307, USA
| | - Vatsal Khanna
- MD, Department of Medicine, Wayne State University SOM/Ascension Providence Rochester Hospital, 1101 W. University Dr, Rochester, MI 48307, USA
| | - Elisa Akagi
- MD, Department of Medicine, Ascension St. John Hospital, 22101 Moross Rd, Grosse Pointe Woods, MI 48236, USA
| | - Ashish Bhargava
- MD, FACP, FIDSA, Department of Medicine, Thomas Mackey Center for Infectious Disease Research, Ascension St. John Hospital. 22101 Moross Rd, Grosse Pointe Woods, MI 48236, USA
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Gomes K, Goldman RD. Corticosteroids for infectious mononucleosis. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2023; 69:101-102. [PMID: 36813516 PMCID: PMC9945889 DOI: 10.46747/cfp.6902101] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
QUESTION Infectious mononucleosis (IM) is a common viral infection year round, and we see patients with it in our family medicine clinic frequently. With fatigue, fever, pharyngitis, and cervical or generalized lymphadenopathy causing prolonged illness and school absences, we always look for treatments that will shorten the duration of symptoms. Does treatment with corticosteroids benefit these children? ANSWER Current evidence points to small and inconsistent benefits when using corticosteroids for symptom relief in children with IM. Corticosteroids alone or in combination with antiviral medications should not be given to children for common symptoms of IM. Corticosteroids should be reserved for those with impending airway obstruction, autoimmune complications, or other severe circumstances.
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Hematological Abnormalities Beyond Lymphocytosis During Infectious Mononucleosis: Epstein-Barr Virus-Induced Thrombocytopenia. Mediterr J Hematol Infect Dis 2023; 15:e2023023. [PMID: 36908863 PMCID: PMC10000900 DOI: 10.4084/mjhid.2023.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 02/27/2023] [Indexed: 03/05/2023] Open
Abstract
Background Thrombocytopenia during Epstein-Barr virus mononucleosis is well-known; however, no recent series have investigated its frequency, associated factors, and evolution. The present study aimed to investigate platelet count characteristics in adult patients with infectious mononucleosis. Methods We reviewed the clinical records of 400 patients admitted to the hospital with infectious mononucleosis (52.0% male; median age, 19 years [range, 15-87 years]), focusing on blood platelet counts, thrombocytopenia prevalence and outcomes. Results Thrombocytopenia (platelet count ≤150 ×109/L) was present in 119 (29.7%) patients. Thirty-two (8.0%) patients showed platelet counts lower than 100 ×109/L. Thrombocytopenia was severe (platelets <50 ×109/L) in 6 (1.5%) patients. Thrombocytopenia was associated with a lower frequency of typical mononucleosis symptoms such as sore throat and lymphadenopathy, lower frequency of positive heterophil antibodies, higher serum bilirubin concentration and prothrombin time, lower blood leukocyte and lymphocyte count, lower concentration of serum immunoglobulin G and immunoglobulin A concentrations, and larger spleen size. Thrombocytopenia normalized quickly during follow-up. Only 2 cases required specific therapy. Platelet counts significantly increased during follow-up, even in cases without baseline thrombocytopenia. There were no significant hemorrhagic complications. Conclusions Transient thrombocytopenia is common during infectious mononucleosis in adult patients. Patients with thrombocytopenia have distinct clinical and biological features; it is typically mild during infectious mononucleosis. Cases of severe thrombocytopenia are rare and were not associated with hemorrhagic complications in this series.
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An Unusual Presentation of Glandular Fever. Case Rep Infect Dis 2022; 2022:5981070. [PMID: 35340747 PMCID: PMC8956444 DOI: 10.1155/2022/5981070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/10/2022] [Accepted: 03/02/2022] [Indexed: 11/24/2022] Open
Abstract
Epstein-Barr virus (EBV) is an ubiquitous DNA herpesvirus with >90% of adults >40 years of age showing a serological response. While in their youth, primary EBV infection may pass unnoticed, young adults have a high incidence of infectious mononucleosis (IM). This is characterized by a triad of pharyngitis, cervical lymphadenopathy, and fever because of a self-limiting lymphoproliferative disease. Common complications include but are not limited to hepatitis, splenomegaly, encephalitis, and haemophagocytic lymphohistiocytosis (HLH) with evidence that Caucasian males and smokers are more likely to suffer severe disease. Here we present a 21-year-old male who presented with a 2-week history of fever, dry cough, and a 4-week history of pharyngitis. He had no exposure to unwell contacts and denied any new sexual partners. Examination revealed general pallor with tender bilateral cervical lymphadenopathy and pharyngeal erythema. Admission bloods revealed pancytopenia (WCC 1.5 × 109/L, Plt 84 × 109/L, and Hb 82 g/L) with normal reticulocyte count and raised mean corpuscular volume (114 fL). Serum vitamin B12 and folate were low with serum ferritin raised (1027 µg/L) suggesting a proinflammatory state. Admission liver function tests, coeliac serology, autoimmune panel (ANA, ANCA, and anti-dsDNA), hepatitic (hepatitis A, B, and E), human immunodeficiency virus (HIV), toxoplasmosis, parvovirus, and CMV serology were normal. The monospot test on day 1 of the presentation was negative. Ultrasound (US) of the abdomen on day 3 of the presentation revealed isolated splenomegaly (16.8 cm). Day 4 EBV serology (VCA IgM, VCA IgG, and EBNA IgG) was negative as such haematological investigations including JAK2, serum free light chains, and BCR-ABL were undertaken alongside cervical lymph node core biopsy. Repeat Monospot testing on day 7 came back positive. Repeat EBV serology now showed equivocal EBV VCA IgG (0.77 OD) and positive VCA IgM (9.04 OD) with concurrent new hepatitis. Histopathology of the core biopsy revealed Sternberg-reed cells and a mixed immunoblastic reaction in keeping with resolving IM. This case highlights the need for physicians to have a strong clinical suspicion of IM and understand the multiple ways in which IM may be present as well as the time lag to positivity in serological testing.
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Kuchar E, Karlikowska-Skwarnik M, Wawrzuta D. Anti-Inflammatory Therapy of Infections. ENCYCLOPEDIA OF INFECTION AND IMMUNITY 2022. [PMCID: PMC8496905 DOI: 10.1016/b978-0-12-818731-9.00181-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Anti-inflammatory treatment of infections is challenging due to the heterogeneity of etiologic agents and complex immune interactions. Nevertheless, anti-inflammatory medications are commonly used in infections to reduce unpleasant symptoms and to modify host response. They may play a fundamental role in managing infection with over-inflammation by decreasing inflammatory organ damage, e.g., COVID-19. However, by its inherent inhibition of immune functions, they might also contribute to the development of serious bacterial infections. Moreover, reducing a patient's symptoms and signs may provide a false sense of security and delay diagnosing threatening infections.
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Effect of Oral Acyclovir on Hospitalized Children with Infectious Mononucleosis: A Double-blind Clinical Trial. JOURNAL OF CLINICAL AND BASIC RESEARCH 2021. [DOI: 10.52547/jcbr.5.3.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Kryukov AI, Bessarab TP, Tsarapkin GY, Tovmasian AS, Kishinevskii AY, Agaev AG. [Infectious mononucleosis in practice of otorhinolaryngologist]. Vestn Otorinolaringol 2021; 86:79-85. [PMID: 34499453 DOI: 10.17116/otorino20218604179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Infectious mononucleosis (IM) is an acute viral infection that usually occurs with fever, acute tonsillitis, affects lymph nodes, liver, spleen, and with specific changes in the hemogram. One of the most frequent symptoms of the disease is sore throat which leads people to otorhinolaryngologist. Several pathogens may be the cause of IM, but Epstein-Barr virus(EBV) plays a key role. EBV is a γ-herpes virus and about 90% of world`s population is infected with this one. Severe IM can lead to potential life-threating conditions, for example upper airway obstruction, spleen rupture. In addition to acute IM, EBV-infection can lead to a number of neoplastic and autoimmune diseases. Due to the non-specificity of IM symptoms and the emerging difficulties in laboratory and serological diagnosis of this disease, the problem of timely diagnosis and treatment in this category of patients remains very relevant.
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Affiliation(s)
- A I Kryukov
- L.I. Sverzhevsky Otorhinolaryngology Scientific Research Clinical Institute Moscow Health Department, Moscow, Russia.,N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia
| | - T P Bessarab
- L.I. Sverzhevsky Otorhinolaryngology Scientific Research Clinical Institute Moscow Health Department, Moscow, Russia
| | - G Yu Tsarapkin
- L.I. Sverzhevsky Otorhinolaryngology Scientific Research Clinical Institute Moscow Health Department, Moscow, Russia
| | - A S Tovmasian
- L.I. Sverzhevsky Otorhinolaryngology Scientific Research Clinical Institute Moscow Health Department, Moscow, Russia
| | - A Ye Kishinevskii
- L.I. Sverzhevsky Otorhinolaryngology Scientific Research Clinical Institute Moscow Health Department, Moscow, Russia
| | - A G Agaev
- L.I. Sverzhevsky Otorhinolaryngology Scientific Research Clinical Institute Moscow Health Department, Moscow, Russia
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de Cassan S, Thompson MJ, Perera R, Glasziou PP, Del Mar CB, Heneghan CJ, Hayward G. Corticosteroids as standalone or add-on treatment for sore throat. Cochrane Database Syst Rev 2020; 5:CD008268. [PMID: 32356360 PMCID: PMC7193118 DOI: 10.1002/14651858.cd008268.pub3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Sore throat is a common condition associated with a high rate of antibiotic prescriptions, despite limited evidence for the effectiveness of antibiotics. Corticosteroids may improve symptoms of sore throat by reducing inflammation of the upper respiratory tract. This review is an update to our review published in 2012. OBJECTIVES To assess the clinical benefit and safety of corticosteroids in reducing the symptoms of sore throat in adults and children. SEARCH METHODS We searched CENTRAL (Issue 4, 2019), MEDLINE (1966 to 14 May 2019), Embase (1974 to 14 May 2019), the Database of Abstracts of Reviews of Effects (DARE, 2002 to 2015), and the NHS Economic Evaluation Database (inception to 2015). We also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared steroids to either placebo or standard care in adults and children (aged over three years) with sore throat. We excluded studies of hospitalised participants, those with infectious mononucleosis (glandular fever), sore throat following tonsillectomy or intubation, or peritonsillar abscess. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included one new RCT in this update, for a total of nine trials involving 1319 participants (369 children and 950 adults). In eight trials, participants in both corticosteroid and placebo groups received antibiotics; one trial offered delayed prescription of antibiotics based on clinical assessment. Only two trials reported funding sources (government and a university foundation). In addition to any effect of antibiotics and analgesia, corticosteroids increased the likelihood of complete resolution of pain at 24 hours by 2.40 times (risk ratio (RR) 2.4, 95% confidence interval (CI) 1.29 to 4.47; P = 0.006; I² = 67%; high-certainty evidence) and at 48 hours by 1.5 times (RR 1.50, 95% CI 1.27 to 1.76; P < 0.001; I² = 0%; high-certainty evidence). Five people need to be treated to prevent one person continuing to experience pain at 24 hours. Corticosteroids also reduced the mean time to onset of pain relief and the mean time to complete resolution of pain by 6 and 11.6 hours, respectively, although significant heterogeneity was present (moderate-certainty evidence). At 24 hours, pain (assessed by visual analogue scales) was reduced by an additional 10.6% by corticosteroids (moderate-certainty evidence). No differences were reported in recurrence/relapse rates, days missed from work or school, or adverse events for participants taking corticosteroids compared to placebo. However, the reporting of adverse events was poor, and only two trials included children or reported days missed from work or school. The included studies were assessed as moderate quality evidence, but the small number of included studies has the potential to increase the uncertainty, particularly in terms of applying these results to children. AUTHORS' CONCLUSIONS Oral or intramuscular corticosteroids, in addition to antibiotics, moderately increased the likelihood of both resolution and improvement of pain in participants with sore throat. Given the limited benefit, further research into the harms and benefits of short courses of steroids is needed to permit informed decision-making.
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Affiliation(s)
| | - Matthew J Thompson
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Rafael Perera
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paul P Glasziou
- Centre for Research in Evidence-Based Practice (CREBP), Bond University, Gold Coast, Australia
| | - Chris B Del Mar
- Centre for Research in Evidence-Based Practice (CREBP), Bond University, Gold Coast, Australia
| | - Carl J Heneghan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Gail Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Derrick J, Ryan K, Konig B, Rothenberg T. Glandular fever, Epstein-Barr virus and hypoglossal nerve palsy. Arch Dis Child 2020; 106:archdischild-2020-318827. [PMID: 32341014 DOI: 10.1136/archdischild-2020-318827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Jonathan Derrick
- Department of Paediatrics, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Kate Ryan
- Department of Paediatrics, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Birgit Konig
- Department of Paediatrics, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Tammy Rothenberg
- Department of Paediatrics, Homerton University Hospital NHS Foundation Trust, London, UK
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Yaxley KL. Infectious mononucleosis complicated by peritonsillar abscess and postural orthostatic tachycardia syndrome: A case report. SAGE Open Med Case Rep 2020; 8:2050313X20915413. [PMID: 32284866 PMCID: PMC7139175 DOI: 10.1177/2050313x20915413] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 02/23/2020] [Indexed: 12/15/2022] Open
Abstract
An unusual case of infectious mononucleosis complicated by both peritonsillar abscess and postural orthostatic tachycardia syndrome is reported. The patient was diagnosed with Epstein-Barr virus infection early in the disease course by her primary care doctor. She subsequently developed a peritonsillar abscess requiring hospitalisation. Recovery was complicated by the development of postural orthostatic tachycardia syndrome. However, resolution was achieved over the course of approximately 1 year, via conservative measures including graded exercise therapy, without resorting to pharmacotherapy.
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Poorthuis MHF, Battjes S, Dorigo-Zetsma JW, de Kruijk JR. Primary Epstein-Barr virus infection in immunocompetent patients with acute transverse myelitis and a combination of polyradiculitis and anterior horn syndrome as neurological manifestations. BMJ Case Rep 2018; 2018:bcr-2018-225333. [PMID: 30158264 PMCID: PMC6119397 DOI: 10.1136/bcr-2018-225333] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2018] [Indexed: 11/04/2022] Open
Abstract
Neurological manifestations of a primary Epstein-Barr virus (EBV) infection are rare. We describe a case with acute transverse myelitis and another case with a combination of polyradiculitis and anterior horn syndrome as manifestations of a primary EBV infection.The first case is a 50-year-old immunocompetent male diagnosed with acute transverse myelitis, 2 weeks after he was clinically diagnosed with infectious mononucleosis. The second case is an 18-year-old immunocompetent male diagnosed with a combination of polyradiculitis and anterior horn syndrome while he had infectious mononucleosis. The first patient was treated with methylprednisolone. After 1 year, he was able to stop performing clean intermittent self-catheterisation. The second patient completely recovered within 6 weeks without treatment.Primary EBV infection should be considered in immunocompetent patients presenting with acute transverse myelitis and a combination of polyradiculitis and anterior horn syndrome. Antiviral treatment and steroids are controversial, and the prognosis of neurological sequelae is largely unknown.
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Scasso F, Ferrari G, DE Vincentiis GC, Arosio A, Bottero S, Carretti M, Ciardo A, Cocuzza S, Colombo A, Conti B, Cordone A, DE Ciccio M, Delehaye E, Della Vecchia L, DE Macina I, Dentone C, DI Mauro P, Dorati R, Fazio R, Ferrari A, Ferrea G, Giannantonio S, Genta I, Giuliani M, Lucidi D, Maiolino L, Marini G, Marsella P, Meucci D, Modena T, Montemurri B, Odone A, Palma S, Panatta ML, Piemonte M, Pisani P, Pisani S, Prioglio L, Scorpecci A, Scotto DI Santillo L, Serra A, Signorelli C, Sitzia E, Tropiano ML, Trozzi M, Tucci FM, Vezzosi L, Viaggi B. Emerging and re-emerging infectious disease in otorhinolaryngology. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2018; 38:S1-S106. [PMID: 29967548 PMCID: PMC6056203 DOI: 10.14639/0392-100x-suppl.1-38-2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARY Emerging and re-emerging infectious disease in otorhinolaryngology (ENT) are an area of growing epidemiological and clinical interest. The aim of this section is to comprehensively report on the epidemiology of key infectious disease in otorhinolaryngology, reporting on their burden at the national and international level, expanding of the need of promoting and implementing preventive interventions, and the rationale of applying evidence-based, effective and cost- effective diagnostic, curative and preventive approaches. In particular, we focus on i) ENT viral infections (HIV, Epstein-Barr virus, Human Papilloma virus), retrieving the available evidence on their oncogenic potential; ii) typical and atypical mycobacteria infections; iii) non-specific granulomatous lymphadenopathy; iv) emerging paediatric ENT infectious diseases and the prevention of their complications; v) the growing burden of antimicrobial resistance in ENT and the strategies for its control in different clinical settings. We conclude by outlining knowledge gaps and action needed in ENT infectious diseases research and clinical practice and we make references to economic analysis in the field of ENT infectious diseases prevention and care.
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Affiliation(s)
- F Scasso
- SOC Otorinolaringoiatria, ASL 3 Genovese, Ospedale P.A. Micone, Genova, Italy
| | - G Ferrari
- SOC Otorinolaringoiatria, ASL 5 Genovese, Ospedale P.A. Levante Ligure, La Spezia, Italy
| | - G C DE Vincentiis
- UOC Otorinolaringoiatria, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - A Arosio
- Clinica Otorinolaringoiatria, Ospedale Macchi, ASST Settelaghi, Varese, Italy
| | - S Bottero
- UOC Chirurgia delle Vie Aeree, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - M Carretti
- UOC Otorinolaringoiatria, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - A Ciardo
- SOC Otorinolaringoiatria, ASL 5 Genovese, Ospedale P.A. Levante Ligure, La Spezia, Italy
| | - S Cocuzza
- Clinica di Otorinolaringoiatria, Università degli Studi di Catania, Catania, Italy
| | - A Colombo
- SOC Otorinolaringoiatria, Ospedale Cardinal Massaia, Asti, Italy
| | - B Conti
- Dipartimento di Scienze del Farmaco, Università degli Studi di Pavia, Pavia, Italy
| | - A Cordone
- SOC Otorinolaringoiatria, ASL 3 Genovese, Ospedale P.A. Micone, Genova, Italy
| | - M DE Ciccio
- SOC Otorinolaringoiatria, ASL 5 Genovese, Ospedale P.A. Levante Ligure, La Spezia, Italy
| | - E Delehaye
- SOC Otorinolaringoiatria, ASL 5 Genovese, Ospedale P.A. Levante Ligure, La Spezia, Italy
| | - L Della Vecchia
- Clinica Otorinolaringoiatria, Ospedale Macchi, ASST Settelaghi, Varese, Italy
| | - I DE Macina
- SOC Malattie Infettive, ASL 1 Imperiese, Ospedale di Sanremo, Italy
| | - C Dentone
- SOC Malattie Infettive, ASL 1 Imperiese, Ospedale di Sanremo, Italy
| | - P DI Mauro
- Clinica di Otorinolaringoiatria, Università degli Studi di Catania, Catania, Italy
| | - R Dorati
- Dipartimento di Scienze del Farmaco, Università degli Studi di Pavia, Pavia, Italy
| | - R Fazio
- SOC Otorinolaringoiatria, ASL 5 Genovese, Ospedale P.A. Levante Ligure, La Spezia, Italy
| | - A Ferrari
- Direzione Sanitaria, AOU Parma, Italy
| | - G Ferrea
- SOC Malattie Infettive, ASL 1 Imperiese, Ospedale di Sanremo, Italy
| | - S Giannantonio
- UOC Audiologia e Otochirurgia, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - I Genta
- Dipartimento di Scienze del Farmaco, Università degli Studi di Pavia, Pavia, Italy
| | - M Giuliani
- UOC Otorinolaringoiatria, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - D Lucidi
- UOC Audiologia e Otochirurgia, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - L Maiolino
- Clinica di Otorinolaringoiatria, Università degli Studi di Catania, Catania, Italy
| | - G Marini
- UOC Otorinolaringoiatria, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - P Marsella
- UOC Audiologia e Otochirurgia, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - D Meucci
- UOC Chirurgia delle Vie Aeree, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - T Modena
- Dipartimento di Scienze del Farmaco, Università degli Studi di Pavia, Pavia, Italy
| | - B Montemurri
- UOC Audiologia e Otochirurgia, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - A Odone
- Facoltà di Medicina e Chirurgia, Università Vita-Salute San Raffaele, Milano, Italy
| | - S Palma
- SOC Otorinolaringoiatria, Azienda Sanitaria Universitaria di Udine (ASUIUD), Italy
| | - M L Panatta
- UOC Otorinolaringoiatria, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - M Piemonte
- SOC Otorinolaringoiatria, Azienda Sanitaria Universitaria di Udine (ASUIUD), Italy
| | - P Pisani
- SOC Otorinolaringoiatria, Ospedale Cardinal Massaia, Asti, Italy
| | - S Pisani
- Dipartimento di Scienze del Farmaco, Università degli Studi di Pavia, Pavia, Italy
| | - L Prioglio
- SOC Otorinolaringoiatria, ASL 3 Genovese, Ospedale P.A. Micone, Genova, Italy
| | - A Scorpecci
- UOC Audiologia e Otochirurgia, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | | | - A Serra
- Clinica di Otorinolaringoiatria, Università degli Studi di Catania, Catania, Italy
| | - C Signorelli
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Italy; Facoltà di Medicina e Chirurgia, Università Vita-Salute San Raffaele, Milano, Italy
| | - E Sitzia
- UOC Otorinolaringoiatria, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - M L Tropiano
- UOC Chirurgia delle Vie Aeree, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - M Trozzi
- UOC Chirurgia delle Vie Aeree, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - F M Tucci
- UOS Chirurgia Cervicale ORL, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - L Vezzosi
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Italy; Dipartimento di Medicina Sperimentale, Università degli Studi della Campania Luigi Vanvitelli, Napoli, Italy
| | - B Viaggi
- SOC Neuroanestesia e Rianimazione, A.O.U. Careggi, Firenze, Italy
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Poplin V, McKinsey DS. Arcanobacterium Brain Abscesses, Subdural Empyema, and Bacteremia Complicating Epstein-Barr Virus Mononucleosis. Kans J Med 2018; 11:1-12. [PMID: 29844849 PMCID: PMC5834238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022] Open
Affiliation(s)
- Victoria Poplin
- University of Kansas Medical Center, Department of Internal Medicine, Kansas City, KS
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Derler F, Seidel S, Bengel D. [Fulminant EBV meningoencephalitis : Good clinical outcome in a young, immunocompetent female]. DER NERVENARZT 2017; 88:1186-1191. [PMID: 28730393 DOI: 10.1007/s00115-017-0381-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- F Derler
- Neurologische Klinik, Universität Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.
| | - S Seidel
- Klinik für Innere Medizin, Oberschwabenklinik gGmbH - Krankenhaus St. Elisabeth, Ravensburg, Deutschland
| | - D Bengel
- Klinik für Neurologie, Oberschwabenklinik gGmbH - Krankenhaus St. Elisabeth, Ravensburg, Deutschland
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De Paor M, O'Brien K, Fahey T, Smith SM. Antiviral agents for infectious mononucleosis (glandular fever). Cochrane Database Syst Rev 2016; 12:CD011487. [PMID: 27933614 PMCID: PMC6463965 DOI: 10.1002/14651858.cd011487.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Infectious mononucleosis (IM) is a clinical syndrome, usually caused by the Epstein Barr virus (EPV), characterised by lymphadenopathy, fever and sore throat. Most cases of symptomatic IM occur in older teenagers or young adults. Usually IM is a benign self-limiting illness and requires only symptomatic treatment. However, occasionally the disease course can be complicated or prolonged and lead to decreased productivity in terms of school or work. Antiviral medications have been used to treat IM, but the use of antivirals for IM is controversial. They may be effective by preventing viral replication which helps to keep the virus inactive. However, there are no guidelines for antivirals in IM. OBJECTIVES To assess the effects of antiviral therapy for infectious mononucleosis (IM). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 3, March 2016), which contains the Cochrane Acute Respiratory Infections (ARI) Group's Specialised Register, MEDLINE (1946 to 15 April 2016), Embase (1974 to 15 April 2016), CINAHL (1981 to 15 April 2016), LILACS (1982 to 15 April 2016) and Web of Science (1955 to 15 April 2016). We searched the World Health Organization (WHO) International Clinical Trials Registry Platform and ClinicalTrials.gov for completed and ongoing trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing antivirals versus placebo or no treatment in IM. We included trials of immunocompetent participants of any age or sex with clinical and laboratory-confirmed diagnosis of IM, who had symptoms for up to 14 days. Our primary outcomes were time to clinical recovery and adverse events and side effects of medication. Secondary outcomes included duration of abnormal clinical examination, complications, viral shedding, health-related quality of life, days missing from school or work and economic outcomes. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion, assessed the included studies' risk of bias and extracted data using a customised data extraction sheet. We used the GRADE criteria to rate the quality of the evidence. We pooled heterogeneous data where possible, and presented the results narratively where we could not statistically combine data. MAIN RESULTS We included seven RCTs with a total of 333 participants in our review. Three trials studied hospitalised patients, two trials were conducted in an outpatient setting, while the trial setting was unclear in two studies. Participants' ages ranged from two years to young adults. The type of antiviral, administration route, and treatment duration varied between the trials. The antivirals in the included studies were acyclovir, valomaciclovir and valacyclovir. Follow-up varied from 20 days to six months. The diagnosis of IM was based on clinical symptoms and laboratory parameters.The risk of bias for all included studies was either unclear or high risk of bias. The quality of evidence was graded as very low for all outcomes and so the results should be interpreted with caution. There were statistically significant improvements in the treatment group for two of the 12 outcomes. These improvements may be of limited clinical significance.There was a mean reduction in 'time to clinical recovery as assessed by physician' of five days in the treatment group but with wide confidence intervals (CIs) (95% CI -8.04 to -1.08; two studies, 87 participants). Prospective studies indicate that clinical signs and symptoms may take one month or more to resolve and that fatigue may be persistent in approximately 10% of patients at six-month follow-up, so this may not be a clinically meaningful result.Trial results for the outcome 'adverse events and side effects of medication' were reported narratively in only five studies. In some reports authors were unsure whether an adverse event was related to medication or complication of disease. These results could not be pooled due to the potential for double counting results but overall, the majority of trials reporting this outcome did not find any significant difference between treatment and control groups.There was a mean reduction in 'duration of lymphadenopathy' of nine days (95% CI -11.75 to -6.14, two studies, 61 participants) in favour of the treatment group.In terms of viral shedding, the overall effect from six studies was that viral shedding was suppressed while on antiviral treatment, but this effect was not sustained when treatment stopped.For all other outcomes there was no statistically significant difference between antiviral treatment and control groups. AUTHORS' CONCLUSIONS The effectiveness of antiviral agents (acyclovir, valomaciclovir and valacyclovir) in acute IM is uncertain. The quality of the evidence is very low. The majority of included studies were at unclear or high risk of bias and so questions remain about the effectiveness of this intervention. Although two of the 12 outcomes have results that favour treatment over control, the quality of the evidence of these results is very low and may not be clinically meaningful. Alongside the lack of evidence of effectiveness, decision makers need to consider the potential adverse events and possible associated costs, and antiviral resistance. Further research in this area is warranted.
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Affiliation(s)
- Muireann De Paor
- RCSI Medical SchoolHRB Centre for Primary Care Research, Department of General Practice123 St. Stephens GreenDublin 2Ireland
| | - Kirsty O'Brien
- RCSI Medical SchoolHRB Centre for Primary Care Research, Department of General Practice123 St. Stephens GreenDublin 2Ireland
| | - Tom Fahey
- RCSI Medical SchoolHRB Centre for Primary Care Research, Department of General Practice123 St. Stephens GreenDublin 2Ireland
| | - Susan M Smith
- RCSI Medical SchoolHRB Centre for Primary Care Research, Department of General Practice123 St. Stephens GreenDublin 2Ireland
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