1
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Dupuy E, Afifi L, Jonas SJ, Cheng CE, Hogeling M. A Case of severe mosquito bite allergy complicated by fatal hemophagocytic lymphohistiocytosis. Pediatr Dermatol 2022; 39:443-446. [PMID: 35322460 DOI: 10.1111/pde.14877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/03/2021] [Accepted: 11/13/2021] [Indexed: 11/28/2022]
Abstract
Severe mosquito bite allergy (SMBA) is characterized by necrotic skin lesions and systemic symptoms. Chronic active Epstein-Barr virus (EBV) infection, when superimposed with SMBA, is a key driver for catastrophic clinical consequences, such as uncontrolled lymphoproliferation. This interplay is of clinical significance due to its association with hemophagocytic lymphohistiocytosis (HLH) and/or EBV-driven malignancies. Here, we report a case of SMBA that developed in a 14-year-old Hispanic boy that led to fatal secondary HLH.
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Affiliation(s)
- Elizabeth Dupuy
- Divisions of Dermatology, University of California, Los Angeles, California, USA
| | - Ladan Afifi
- Divisions of Dermatology, University of California, Los Angeles, California, USA
| | - Steven J Jonas
- Divisions of Pediatric Hematology-Oncology, University of California, Los Angeles, California, USA
| | - Carol E Cheng
- Divisions of Dermatology, University of California, Los Angeles, California, USA
| | - Marcia Hogeling
- Divisions of Dermatology, University of California, Los Angeles, California, USA
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2
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Zhang Y, Chen M, Yu Y, Liu X, Liu W, Jiang L, Zhang W. Primary cutaneous anaplastic large-cell lymphoma with DUSP22-IRF4 rearrangement following insect bites. J Cutan Pathol 2021; 49:187-190. [PMID: 34622970 PMCID: PMC9297975 DOI: 10.1111/cup.14147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 07/31/2021] [Accepted: 09/30/2021] [Indexed: 02/05/2023]
Abstract
Primary cutaneous anaplastic large‐cell lymphoma (pC‐ALCL) is distinguished from systemic anaplastic large‐cell lymphoma (S‐ALCL) with cutaneous involvement. Although pC‐ALCL is a unique entity with different genetics, clinical characteristics, and prognosis, its causes are unknown. Herein, we report the case of a Chinese woman with a 4‐month history of a gradually enlarged ulcerative mass in her right forearm following an unidentified insect bite. Biopsy revealed an extensive infiltrate with patches of large anaplastic lymphoid cells. These cells were immunohistochemically positive for CD45, CD30, and TIA‐1 and negative for CD2, CD3, CD4, CD5, CD20, CD7, CD8, and ALK‐1. DUSP22‐IRF4 rearrangement was detected; on the other hand, TP63 rearrangement was not observed by fluorescence in situ hybridization (FISH). No Epstein‐Barr virus‐encoded small RNAs (EBERs) were detected by ISH. Rearrangement of monoclonal TCR gene was found using BIOMED‐2 polymerase chain reaction. No abnormality was found on the subsequent positron emission tomography‐computed tomography (PET‐CT) scan. After five cycles of cyclophosphamide + doxorubicin + vincristine + prednisolone (CHOP) chemotherapy, the patient achieved complete remission. This is the first report of a unique pC‐ALCL with DUSP22‐IRF4 rearrangement following an insect bite other than S‐ALCL involving the skin.
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Affiliation(s)
- Yaping Zhang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Min Chen
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Yu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoyu Liu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Weiping Liu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Lijun Jiang
- Department of Oncology, The Second People's Hospital of Neijiang, Neijiang, China
| | - Wenyan Zhang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
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3
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Yamada M, Ishikawa Y, Imadome KI. Hypersensitivity to mosquito bites: A versatile Epstein-Barr virus disease with allergy, inflammation, and malignancy. Allergol Int 2021; 70:430-438. [PMID: 34334322 DOI: 10.1016/j.alit.2021.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/16/2021] [Indexed: 02/06/2023] Open
Abstract
Hypersensitivity to mosquito bites (HMB) is a rare disease characterized by transient intense skin reaction and systemic inflammation. Clinical presentation of HMB resembles other mosquito allergic responses, and it can also be difficult to clinically distinguish HMB from other severe allergic reactions. However, a distinctive pathophysiology underlies HMB. HMB belongs to a category of Epstein-Barr virus (EBV)-associated natural killer (NK) cell lymphoproliferative disorders (LPD). Hence, HMB may progress to systemic diseases, such as hemophagocytic lymphohistiocytosis, chronic active EBV disease, and EBV-associated malignancies. A triad of elevated serum IgE, NK lymphocytosis, and detection of EBV DNA in peripheral blood is commonly observed, and identification of EBV-infected NK cells usually facilitates the diagnosis. However, the effective treatment is limited, and its precise etiology remains unknown. Local CD4+ T cell proliferation triggered by mosquito bites appears to help induce EBV reactivation and EBV-infected NK-cell proliferation. These immunological interactions may explain the transient HMB signs and symptoms and the disease progression toward malignant LPD. Further research to elucidate the mechanism of HMB is warranted for better diagnosis and treatment of HMB and other forms of EBV-associated LPD.
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4
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Epstein-Barr Virus-Associated T- and NK-Cell Lymphoproliferative Diseases: A Review of Clinical and Pathological Features. Cancers (Basel) 2021; 13:cancers13133315. [PMID: 34282778 PMCID: PMC8268319 DOI: 10.3390/cancers13133315] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/23/2021] [Accepted: 06/29/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary In most Epstein–Barr virus (EBV)-infected individuals, the virus establishes a lifelong latent infection with no specific clinical manifestation. However, EBV primary infection and secondary reactivation may cause various EBV-associated lymphoproliferative disorders (LPD), including hematologic malignancies. Among them, EBV-positive T/NK LPD are uncommon diseases defined by the proliferation of T- or NK-cells infected by EBV, more commonly encountered in Asians and Latin Americans. They encompass a spectrum of disorders ranging from indolent reactive lesions to malignant and aggressive diseases. Despite novel insights from high-throughput molecular studies, the pathogenesis of these disorders is not well understood, and EBV-positive T/NK LPD diagnoses remain challenging due to their rarity and considerable overlap. Indeed, this article discusses new insights into EBV-positive T/NK LPD and focuses on diagnosis challenges, describing the difficulties to clarify the borders between overlapping LPD subtypes. Abstract Epstein–Barr virus (EBV) is a ubiquitous virus detected in up to 95% of the general population. Most people are asymptomatic, while some may develop a wide range of EBV-associated lymphoproliferative disorders (LPD). Among them, EBV-positive T/NK LPD are uncommon diseases defined by the proliferation of T- or NK-cells infected by EBV. The 2017 World Health Organization (WHO) classification recognizes the following entities characterized by different outcomes: chronic active EBV infection of T- or NK-cell types (cutaneous and systemic forms), systemic EBV-positive T-cell lymphoma of childhood, EBV-positive aggressive NK-cell leukemia, extra nodal NK/T-cell lymphoma nasal type, and the new provisional entity known as primary EBV-positive nodal T/NK-cell lymphoma. In addition, EBV associated-hemophagocytic lymphohistiocytosis is part of EBV-positive T/NK LPD, but has not been included in the WHO classification due to its reactive nature. Despite novel insights from high-throughput molecular studies, EBV-positive NK/T-cell LPD diagnoses remain challenging, especially because of their rarity and overlap. Until now, an accurate EBV-positive NK/T LPD diagnosis has been based on its clinical presentation and course correlated with its histological features. This review aims to summarize clinical, pathological and molecular features of EBV-positive T/NK LPD subtypes and to provide an overview of new understandings regarding these rare disorders.
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5
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Insect hypersensitivity beyond bee and wasp venom allergy. Allergol Select 2020; 4:97-104. [PMID: 33275648 PMCID: PMC7709451 DOI: 10.5414/alx02123e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 11/14/2019] [Indexed: 12/11/2022] Open
Abstract
The bites of blood-feeding insects regularly induce sensitization to salivary proteins and cause local hypersensitivity reactions in over 90% of the population, representing either an IgE-mediated immediate wheal and flare reaction or a T cell-driven delayed papule. Long-lasting large local reactions and bullous reactions may cause significant discomfort and reduction in quality-of-life. Anaphylaxis is rarely reported though proven for several insects, above all mosquitoes, horse flies, and kissing bugs. Recently, salivary gland proteins have been thoroughly studied in some blood-feeding insect species, and several allergens have been identified. Interestingly, many of them belong to the same protein families as the well-known honeybee and wasp venom allergens (phospholipases, hyaluronidases, antigens 5, serine proteases) though sequence identities are mostly low. There is still insufficient evidence for the proposed cross-reactivity between salivary proteins from blood-feeding insects and Hymenoptera venom allergens.
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Miyake T, Iwatsuki K, Hirai Y, Yamamoto T, Hamada T, Fujii K, Imamura H, Morizane S. The aim of the measurement of Epstein-Barr virus DNA in hydroa vacciniforme and hypersensitivity to mosquito bites. J Med Virol 2020; 92:3689-3696. [PMID: 32255500 DOI: 10.1002/jmv.25811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/20/2020] [Accepted: 03/29/2020] [Indexed: 11/05/2022]
Abstract
Epstein-Barr virus (EBV) DNA load in the blood increases in posttransplant lymphoproliferative disorders and chronic active EBV infection. In this report, we analyzed the EBV DNA load in the peripheral blood mononuclear cells (PBMCs) and plasma of patients with hydroa vacciniforme (HV) and/or hypersensitivity to mosquito bites (HMB) to understand the clinical significance of EBV DNA load. All 30 patients showed high DNA loads in the PBMCs over the cut-off level. Of 16 plasma samples, extremely high in two samples obtained from patients with hemophagocytic lymphohistiocytosis (HLH). The amount of cell-free DNA in plasma was correlated to the serum levels of lactate dehydrogenase and inversely correlated to platelet counts. These results indicate that the EBV DNA load in PBMCs can provide one of the diagnostic indicators for HV and HMB and marked elevation of cell-free EBV DNA in plasma might be related to cytolysis such as that observed in HLH.
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Grants
- B-47 GSK grand
- 15k09744 Ministry of Education, Culture, Sports, Science and Technology
- 17K16431 Ministry of Education, Culture, Sports, Science and Technology
- 18K16063 Ministry of Education, Culture, Sports, Science and Technology
- 17ek0109098 Japan Agency for Medical Research and Development
- 17ek0109124 Japan Agency for Medical Research and Development
- H29-Measures for Rare and Intractable Diseases-016 Ministry of Health, Labour and Welfare
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Affiliation(s)
- Tomoko Miyake
- Department of Dermatology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Keiji Iwatsuki
- Department of Dermatology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Yoji Hirai
- Department of Dermatology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Takenobu Yamamoto
- Department of Dermatology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
- Department of Dermatology, Kawasaki Medical School, Okayama, Japan
| | - Toshihisa Hamada
- Department of Dermatology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
- Department of Dermatology, Takamatsu Red Cross Hospital, Kagawa, Japan
| | - Kazuyasu Fujii
- Department of Dermatology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
- Department of Dermatology, Kagoshima University, Kagoshima, Japan
| | - Hideaki Imamura
- Department of Pediatrics, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Shin Morizane
- Department of Dermatology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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7
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Jeon SH. Characteristics of Asian Mosquito Saliva Allergens for Specific Diagnoses and Effective Therapies. Curr Protein Pept Sci 2020; 21:153-158. [DOI: 10.2174/1389203720666190729122614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/20/2019] [Accepted: 06/21/2019] [Indexed: 11/22/2022]
Abstract
An allergic reaction to mosquitoes can result in severe or abnormal local or systemic reactions
such as anaphylaxis, angioedema, and general urticarial or wheezing. The aim of this review is to
provide information on mosquito saliva allergens that can support the production of highly specific
recombinant saliva allergens. In particular, candidate allergens of mosquitoes that are well suited to the
ecology of mosquitoes that occur mainly in East Asia will be identified and introduced. By doing so,
the diagnosis and treatment of patients with severe sensitivity to mosquito allergy will be improved by
predicting the characteristics of East Asian mosquito allergy, presenting the future direction of production
of recombinant allergens, and understanding the difference between East and West.
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Affiliation(s)
- Soung-Hoo Jeon
- Medical Research Center, Institute for Endemic Disease, Seoul National University, College of Medicine, Seoul, Korea
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8
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Bogdanov I, Darlenski R, Hristakieva E, Manuelyan K. The rash that presents as a vesiculobullous eruption. Clin Dermatol 2020; 38:19-34. [DOI: 10.1016/j.clindermatol.2019.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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9
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Montes-Mojarro IA, Kim WY, Fend F, Quintanilla-Martinez L. Epstein - Barr virus positive T and NK-cell lymphoproliferations: Morphological features and differential diagnosis. Semin Diagn Pathol 2019; 37:32-46. [PMID: 31889602 DOI: 10.1053/j.semdp.2019.12.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The spectrum of Epstein-Barr virus (EBV)-positive T and NK-cell lymphoproliferations is broad and ranges from reactive self-limited disorders to neoplastic processes with a fulminant clinical course. EBV plays an important role promoting lymphomagenesis, although the precise mechanisms remain elusive. EBV-positive lymphoproliferative disorders (LPD) are more common in East Asia (China, Japan, Korea and Taiwan), and Latin America suggesting a strong genetic predisposition. The revised 2016 World Health Organization (WHO) lymphoma classification recognizes the following malignant NK- and T-cell lymphomas; extranodal NK/T-cell lymphoma, nasal type (ENKTCL), aggressive NK-cell leukemia (ANKL), and the provisional entity within the group of peripheral T-cell lymphoma, not otherwise specified (PTCL, NOS) "primary EBV-positive nodal T or NK cell lymphoma". Disorders presenting mainly in children and young adults include chronic active EBV infection (CAEBV) - systemic and cutaneous forms - which are not considered malignant disorders but were included in the WHO classification for the first time because of the differential diagnosis with other T- or NK-cell lymphomas. CAEBV, cutaneous form, includes hydroa vacciniforme-like LPD (HV-LPD) and severe mosquito bite allergy (SMBA). Finally, systemic EBV-positive T-cell lymphoma of childhood was recognized as lymphoma because of its fulminant clinical course. Given the shared pathogenesis of these disorders, overlapping features are common demanding a close clinical, morphological and molecular correlation for an accurate diagnosis. This review summarizes the clinical, histopathological and molecular features of EBV-associated T and NK-cell LPD, highlighting the main features that might aid in the differential diagnosis.
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Affiliation(s)
- Ivonne A Montes-Mojarro
- Institute of Pathology and Neuropathology and Comprehensive Cancer Center Tübingen, University Hospital Tübingen, Eberhard-Karls-University, Tübingen, Germany
| | - Wook Youn Kim
- Institute of Pathology and Neuropathology and Comprehensive Cancer Center Tübingen, University Hospital Tübingen, Eberhard-Karls-University, Tübingen, Germany; Department of Pathology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Falko Fend
- Institute of Pathology and Neuropathology and Comprehensive Cancer Center Tübingen, University Hospital Tübingen, Eberhard-Karls-University, Tübingen, Germany
| | - Leticia Quintanilla-Martinez
- Institute of Pathology and Neuropathology and Comprehensive Cancer Center Tübingen, University Hospital Tübingen, Eberhard-Karls-University, Tübingen, Germany.
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10
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Mosquitoes, Infectious Diseases, and Cancer: A Connection to Study? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019. [PMCID: PMC6926606 DOI: 10.3390/ijerph16234859] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Mosquitoes (Diptera: Culicidae) are vectors of pathogens and parasites of great medical and veterinary relevance. The possible association between mosquitoes, infectious diseases, and cancer has been investigated. Despite its potential importance, there is a severe lack of research data on the topic. Herein, current knowledge, tenuous links, and related challenges on the topic were examined, grouping information under four major hypotheses. The first hypothesis is that the infection of mosquito-vectored parasites, with special reference to Plasmodium spp., may lead to cancer. The International Agency for Research on Cancer stated that being infected by Plasmodium falciparum malaria in holoendemic areas is probably carcinogenic to humans (group 2A), considering that P. falciparum infection is able to reactivate the Epstein–Barr virus, leading to endemic Burkitt lymphoma. Also, malaria was recently associated with a cancer incidence increase in the United States. The second hypothesis is that cancer may be spread directly through mosquito bites: Aedes mosquitoes transfer viable tumor cells among vertebrate hosts, even if no plausible mechanisms for these cells to develop cancer into the new host are known. As the third hypothesis, mosquito bites may lead to hypersensitivity, resulting in cancer. Hypersensitivity stimulated by mosquito bites links allergy, oncogenesis, and the Epstein–Barr virus, causing Burkitt lymphoma. One may argue that pathogens transmitted by mosquitoes, such as viruses, may be carcinogenic. However, no detailed research evidences are available to substantiate this last hypothesis. However, despite the intriguing hypotheses outlined above, there is a severe lack of data showing cancer development in organisms exposed to mosquitoes transmitting parasites or pathogens. According to One Health criteria, this benchmark is aimed to outline major questions on this public health issue, stressing the need of multidisciplinary research and discussion.
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11
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Epstein-Barr virus-associated T- and NK-cell lymphoproliferative diseases: an update and diagnostic approach. Pathology 2019; 52:111-127. [PMID: 31767131 DOI: 10.1016/j.pathol.2019.09.011] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 11/21/2022]
Abstract
Epstein-Barr virus (EBV)-positive T-cell and natural killer (NK)-cell lymphoproliferative diseases (EBV-TNKLPD) are a group of uncommon disorders characterised by EBV infection of T- and NK-cells. As a group, EBV-TNKLPD are more commonly encountered in Asians and Native Americans from Central and South America compared to Western populations. They encompass a spectrum of entities that range from non-neoplastic lesions such as EBV-associated haemophagocytic lymphohistiocytosis (EBV-HLH) to more chronic conditions with variable outcomes such as chronic active EBV infections (CAEBV) of T- and NK-cell type (cutaneous and systemic forms) and malignant diseases such as systemic EBV-positive T-cell lymphoma of childhood, aggressive NK-cell leukaemia, extranodal NK/T-cell lymphoma, nasal-type, and primary EBV-positive nodal T/NK-cell lymphoma. Due to their rarity, broad clinicopathological spectrum and significant morphological and immunophenotypic overlap, the diagnosis and precise classification of EBV-TNKLPD often pose a challenge to clinicians and pathologists. Correct classification of this group of rare diseases relies heavily on the age of onset, disease presentation, duration of symptoms and cell of origin (T- vs NK-cell lineage). In this review, we provide an update on the clinicopathological and molecular features of the various EBV-TNKLPD entities occurring in non-immunocompromised patients and present a practical algorithmic approach for the general pathologist who is confronted with these disorders in routine clinical practice.
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12
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Lee S, Park CJ, Cho YU, Jang S, Huh J, Kim H. The First Korean Case of Epstein-Barr Virus-positive Natural Killer/T-cell Lymphoma That Progressed From Severe Mosquito Bite Allergy, With Coexistence of Hemophagocytic Lymphohistiocytosis. Ann Lab Med 2019; 40:80-83. [PMID: 31432645 PMCID: PMC6713653 DOI: 10.3343/alm.2020.40.1.80] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/10/2019] [Accepted: 08/01/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- Seunghoo Lee
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Chan Jeoung Park
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
| | - Young Uk Cho
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Seongsoo Jang
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Jooryung Huh
- Department of Pathology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Hyery Kim
- Department of Pediatrics, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
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13
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Jiang S, Manandhar U, Zheng KP, Liu Q, Liang P, Song JQ. A case of nodal marginal zone lymphoma with hypersensitivity to mosquito bites as initial symptom. J Cutan Pathol 2019; 46:769-774. [PMID: 31095761 DOI: 10.1111/cup.13497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 05/08/2019] [Accepted: 05/13/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Si Jiang
- Department of Dermatology and VenereologyZhongnan Hospital of Wuhan University Wuhan China
| | - Upasana Manandhar
- Department of Dermatology and VenereologyZhongnan Hospital of Wuhan University Wuhan China
| | - Kai P. Zheng
- Department of Dermatology and VenereologyZhongnan Hospital of Wuhan University Wuhan China
| | - Qin Liu
- Department of Dermatology and VenereologyZhongnan Hospital of Wuhan University Wuhan China
| | - Pin Liang
- Department of Dermatology and VenereologyZhongnan Hospital of Wuhan University Wuhan China
| | - Ji Q. Song
- Department of Dermatology and VenereologyZhongnan Hospital of Wuhan University Wuhan China
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14
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Sato Y, Furuyama K, Suzuki T, Tanaka T, Sato A, Iguchi A, Yoshita K, Ito Y, Imai N, Yamazaki H, Narita I. Acute kidney injury in an adult patient with IgA nephropathy and chronic replicative Epstein-Barr virus infection. CEN Case Rep 2019; 8:285-291. [PMID: 31218495 DOI: 10.1007/s13730-019-00409-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/12/2019] [Indexed: 11/29/2022] Open
Abstract
Most of the adult population are infected with Epstein-Barr virus (EBV), but as EBV replication is usually under immune system control, the majority of individuals remain asymptomatic. On the other hand, some individuals continuously retain a high EBV antibody titer and a high EBV DNA load in their blood, suggesting a defect of EBV replication control. To date, only a limited number of reports have addressed the relationship between this chronic form of EBV infection and renal involvement. Here, we describe an 80-year-old woman who developed acute kidney injury shortly after an episode of mosquito bites, accompanied by a severe skin rash, which raised a suspicion of chronic EBV infection. She was subsequently diagnosed as having chronic replicative EBV infection. Renal biopsy revealed a diagnosis of IgA nephropathy with crescent formation. Although the relationship between IgA nephropathy and EBV infection has been discussed, no substantial understanding has yet emerged. The patient's characteristic clinical course suggested that the renal failure may have been partly attributable to chronic EBV infection. This case suggests that physicians may need to consider the possibility that chronic EBV infection may affect the clinical course of IgA nephropathy, or exacerbate the disease.
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Affiliation(s)
- Yuya Sato
- Department of Internal Medicine, Nagaoka Red Cross Hospital, 2-297-1 Sensyu, Nagaoka, Niigata, 940-2085, Japan.
| | - Kaito Furuyama
- Department of Internal Medicine, Nagaoka Red Cross Hospital, 2-297-1 Sensyu, Nagaoka, Niigata, 940-2085, Japan
| | - Takeshi Suzuki
- Department of Internal Medicine, Nagaoka Red Cross Hospital, 2-297-1 Sensyu, Nagaoka, Niigata, 940-2085, Japan
| | - Tomoyuki Tanaka
- Department of Internal Medicine, Nagaoka Red Cross Hospital, 2-297-1 Sensyu, Nagaoka, Niigata, 940-2085, Japan
| | - Ami Sato
- Department of Dermatology, Nagaoka Red Cross Hospital, 2-297-1 Sensyu, Nagaoka, Niigata, 940-2085, Japan
| | - Akira Iguchi
- Department of Internal Medicine, Nagaoka Red Cross Hospital, 2-297-1 Sensyu, Nagaoka, Niigata, 940-2085, Japan
| | - Kazuhiro Yoshita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8510, Japan
| | - Yumi Ito
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8510, Japan
| | - Naofumi Imai
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8510, Japan
| | - Hajime Yamazaki
- Department of Internal Medicine, Nagaoka Red Cross Hospital, 2-297-1 Sensyu, Nagaoka, Niigata, 940-2085, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8510, Japan
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15
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Darji K, Bahram-Ahi E, Dhandha M, Guo M. Mantle cell lymphoma presenting with exaggerated skin reaction to insect bites. BMJ Case Rep 2019; 12:12/3/e227590. [PMID: 30902840 DOI: 10.1136/bcr-2018-227590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present the case of a 62-year-old African-American woman with medical history of hypertension and hyperlipidaemia who presented to dermatology clinic for 'bug bites'. Skin examination showed resolving bullae on the shins and postinflammatory pigment changes. Histopathology showed eosinophilic spongiosis and direct immunofluorescence (DIF) was negative for IgG, IgM, IgA and C3. After returning to clinic with recurrent severe bullous eruptions, the patient presented with anaemia, lymphocytosis, posterior cervical lymphadenopathy and weight loss. An exuberant bite reaction in the setting of lymphoma was suspected. Further workup with haematology revealed elevated IgG level and total protein levels. Flow cytometry showed a B cell lymphoma subtype. Extensive imaging was positive for diffuse lymphadenopathy, with accompanying evidence of Ebstein-Barr virus infection. Our case highlights the importance of considering exuberant arthropod bite reaction in the setting of undiagnosed lymphoma in a patient with bullous eruption and negative DIF.
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Affiliation(s)
- Kavita Darji
- Department of Dermatology, Saint Louis University Hospital, Saint Louis, Missouri, USA
| | - Emily Bahram-Ahi
- Department of Internal Medicine, Saint Louis University Hospital, Saint Louis, Missouri, USA
| | - Maulik Dhandha
- Department of Dermatology, MDFMR Dermatology Services, Augusta, Maine, USA
| | - Mary Guo
- Department of Dermatology, Saint Louis University Hospital, Saint Louis, Missouri, USA
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Ko YH. Epstein-Barr virus-positive T/NK-cell lymphoproliferative diseases in children and adolescents. PRECISION AND FUTURE MEDICINE 2018. [DOI: 10.23838/pfm.2017.00198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Abstract
The contribution of Epstein-Barr virus (EBV) to the development of specific types of benign lymphoproliferations and malignant lymphomas has been extensively studied since the discovery of the virus over the last 50 years. The importance and better understanding of the EBV-associated lymphoproliferative disorders (LPD) of B, T or natural killer (NK) cell type has resulted in the recognition of new entities like EBV+ mucocutaneous ulcer or the addition of chronic active EBV (CAEBV) infection in the revised 2016 World Health Organization (WHO) lymphoma classification. In this article, we review the definitions, morphology, pathogenesis, and evolving concepts of the various EBV-associated disorders including EBV+ diffuse large B-cell lymphoma, not otherwise specified (DLBCL, NOS), EBV+ mucocutaneous ulcer, DLBCL associated with chronic inflammation, fibrin-associated DLBCL, lymphomatoid granulomatosis, the EBV+ T and NK-cell LPD of childhood, aggressive NK leukaemia, extranodal NK/T-cell lymphoma, nasal type, and the new provisional entity of primary EBV+ nodal T- or NK-cell lymphoma. The current knowledge regarding the pathogenesis of B-cell lymphomas that can be EBV-associated including Burkitt lymphoma, plasmablastic lymphoma and classic Hodgkin lymphoma will be also explored.
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Wada T, Toma T, Miyazawa H, Koizumi E, Shirahashi T, Matsuda Y, Yachie A. Characterization of skin blister fluids from children with Epstein-Barr virus-associated lymphoproliferative disease. J Dermatol 2018; 45:444-449. [PMID: 29352500 DOI: 10.1111/1346-8138.14226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 12/13/2017] [Indexed: 01/20/2023]
Abstract
Epstein-Barr virus (EBV)-associated T- or natural killer (NK)-cell lymphoproliferative disease (LPD) is a heterogeneous group of disorders characterized by chronic proliferation of EBV-infected lymphocytes. Patients may present with severe skin manifestations, including hypersensitivity to mosquito bites (HMB) and hydroa vacciniforme (HV)-like eruption, which are characterized by blister formation and necrotic ulceration. Skin biopsy specimens show inflammatory reactions comprising EBV-infected lymphocytes. However, blister fluids have not been fully assessed in patients with this disease. Blister fluids were collected from three patients with EBV-associated LPD: two with HMB and one with HV. Immunophenotyping of blister lymphocytes and measurement of tumor necrosis factor (TNF)-α in blister fluids were performed. The patients with HMB and HV exhibited markedly increased percentages of NK and γδ T cells, respectively, in both peripheral blood and blister fluids. These NK and γδ T cells strongly expressed the activation marker human leukocyte antigen-DR and were considered to be cellular targets of EBV infections. TNF-α was highly elevated in all blister fluids. Severe local skin reactions of EBV-associated LPD may be associated with infiltrating EBV-infected lymphocytes and a high TNF-α concentration in blister fluids.
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Affiliation(s)
- Taizo Wada
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Tomoko Toma
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Hanae Miyazawa
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Eiko Koizumi
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Tetsujiro Shirahashi
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Yusuke Matsuda
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Akihiro Yachie
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
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Yachie A. Cytologic Analysis of Epstein-Barr Virus-Associated T/Natural Killer-Cell Lymphoproliferative Diseases. Front Pediatr 2018; 6:327. [PMID: 30505828 PMCID: PMC6250743 DOI: 10.3389/fped.2018.00327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 10/12/2018] [Indexed: 12/23/2022] Open
Abstract
Rapid, precise diagnosis of Epstein-Barr virus-associated T lymphocyte or natural killer cell lymphoproliferative diseases is clinically important to prevent disease progression and avoid fatal outcomes for patients. In addition to detecting increased copy numbers of Epstein-Barr virus, identification of the lymphocyte subpopulation targeted by the virus infection is crucial to reaching the final diagnosis. However, these procedures are laborious and require large amounts of sample. In contrast, flowcytometric analysis may provide crucial information for initial screening of diseases using only small amounts of sample and involves little labor. In addition to the increase of a particular subpopulation, selective HLA-DR expression indicates selective activation and expansion of a virus-infected clone. Presence of a characteristic HLA-DRhigh CD5dim/negative fraction within CD8+ T lymphocytes indicates a possible diagnosis of Epstein-Barr virus-associateds hemophagocytic lymphohistiocytosis. One should note, however, that cases with familial hemophagocytic lymphohistiocytosis may exhibit a similar abnormal fraction within CD8+ T lymphocytes. These T cells are oligoclonally expanded reactive T cells expanding in response to B cells infected with Epstein-Barr virus.
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Affiliation(s)
- Akihiro Yachie
- Department of Pediatrics, School of Medicine, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
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Kyriakidis I, Vasileiou E, Karastrati S, Tragiannidis A, Gompakis N, Hatzistilianou M. Primary EBV infection and hypersensitivity to mosquito bites: a case report. Virol Sin 2017; 31:517-520. [PMID: 27900557 DOI: 10.1007/s12250-016-3868-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Ioannis Kyriakidis
- 2nd Department of Pediatrics, Medical School, Aristotle University of Thessaloniki, AHEPA General Hospital, Thessaloniki, 54636, Greece.
| | - Eleni Vasileiou
- 2nd Department of Pediatrics, Medical School, Aristotle University of Thessaloniki, AHEPA General Hospital, Thessaloniki, 54636, Greece
| | - Sofia Karastrati
- 2nd Department of Pediatrics, Medical School, Aristotle University of Thessaloniki, AHEPA General Hospital, Thessaloniki, 54636, Greece
| | - Athanasios Tragiannidis
- 2nd Department of Pediatrics, Medical School, Aristotle University of Thessaloniki, AHEPA General Hospital, Thessaloniki, 54636, Greece
| | - Nikolaos Gompakis
- 2nd Department of Pediatrics, Medical School, Aristotle University of Thessaloniki, AHEPA General Hospital, Thessaloniki, 54636, Greece
| | - Maria Hatzistilianou
- 2nd Department of Pediatrics, Medical School, Aristotle University of Thessaloniki, AHEPA General Hospital, Thessaloniki, 54636, Greece
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Washio K, Oka T, Abdalkader L, Muraoka M, Shimada A, Oda M, Sato H, Takata K, Kagami Y, Shimizu N, Kato S, Kimura H, Nishizaki K, Yoshino T, Tsukahara H. Gene expression analysis of hypersensitivity to mosquito bite, chronic active EBV infection and NK/T-lymphoma/leukemia. Leuk Lymphoma 2017; 58:2683-2694. [PMID: 28367723 DOI: 10.1080/10428194.2017.1304762] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The human herpes virus, Epstein-Barr virus (EBV), is a known oncogenic virus and plays important roles in life-threatening T/NK-cell lymphoproliferative disorders (T/NK-cell LPD) such as hypersensitivity to mosquito bite (HMB), chronic active EBV infection (CAEBV), and NK/T-cell lymphoma/leukemia. During the clinical courses of HMB and CAEBV, patients frequently develop malignant lymphomas and the diseases passively progress sequentially. In the present study, gene expression of CD16(-)CD56(+)-, EBV(+) HMB, CAEBV, NK-lymphoma, and NK-leukemia cell lines, which were established from patients, was analyzed using oligonucleotide microarrays and compared to that of CD56brightCD16dim/- NK cells from healthy donors. Principal components analysis showed that CAEBV and NK-lymphoma cells were relatively closely located, indicating that they had similar expression profiles. Unsupervised hierarchal clustering analyses of microarray data and gene ontology analysis revealed specific gene clusters and identified several candidate genes responsible for disease that can be used to discriminate each category of NK-LPD and NK-cell lymphoma/leukemia.
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Affiliation(s)
- Kana Washio
- a Department of Pediatrics , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences , Okayama , Japan.,b Department of Pathology , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences , Okayama , Japan
| | - Takashi Oka
- b Department of Pathology , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences , Okayama , Japan
| | - Lamia Abdalkader
- b Department of Pathology , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences , Okayama , Japan.,c Department of Pathology, Faculty of Medicine , Mansoura University , Egypt
| | - Michiko Muraoka
- a Department of Pediatrics , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences , Okayama , Japan
| | - Akira Shimada
- a Department of Pediatrics , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences , Okayama , Japan
| | - Megumi Oda
- a Department of Pediatrics , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences , Okayama , Japan
| | - Hiaki Sato
- b Department of Pathology , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences , Okayama , Japan
| | - Katsuyoshi Takata
- b Department of Pathology , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences , Okayama , Japan
| | - Yoshitoyo Kagami
- d Division of Molecular Medicine , Aichi Cancer Center Research Institute , Nagoya , Japan
| | - Norio Shimizu
- e Department of Virology, Division of Virology & Immunology , Medical Research Institute, Tokyo Medical and Dental University , Tokyo , Japan
| | - Seiichi Kato
- f Department of Pathology and Laboratory Medicine , Nagoya University Hospital , Nagoya , Japan
| | - Hiroshi Kimura
- g Department of Virology , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Kazunori Nishizaki
- h Department of Otorhinolaryngology , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences , Okayama , Japan
| | - Tadashi Yoshino
- b Department of Pathology , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences , Okayama , Japan
| | - Hirokazu Tsukahara
- a Department of Pediatrics , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences , Okayama , Japan
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Benelli G. Green synthesized nanoparticles in the fight against mosquito-borne diseases and cancer-a brief review. Enzyme Microb Technol 2016; 95:58-68. [PMID: 27866627 DOI: 10.1016/j.enzmictec.2016.08.022] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/25/2016] [Accepted: 08/30/2016] [Indexed: 12/11/2022]
Abstract
Nanobiomedicine and parasitology are facing a number of key challenges, which mostly deal with the paucity of effective preventive and curative tools against mosquito-borne diseases and cancer. In this scenario, the employ of botanical and invertebrate extracts as reducing, stabilizing and capping agents for the synthesis of nanoparticles is advantageous over chemical and physical methods, since it is one-pot, cheap, and does not require high pressure, energy, temperature, or the use of highly toxic chemicals. Considering the overlooked connection between mosquito vector activity and the spread of cancer in USA, this review focused on the current knowledge available about green synthesized nanoparticles with efficacy against mosquito-borne diseases and cancer. Green fabricated metal nanoparticles showed antiplasmodial activity that often encompasses the efficacy of currently marked drugs for malaria treatment. They have been also reported as growth inhibitors against dengue virus (serotype DEN-2), with moderate cytotoxicity on mammalian cells. However, this feature is strongly dependent to the botanical agents employed during nanosynthesis. In addition, green nanoparticles have been successfully used to reduce mosquito young instar populations in the field. The final section focuses on some issues for future research, with special reference to the chemical standardization of the botanical extracts used for nanosynthesis and the potential effects on green fabricated nanoparticles on non-target organisms.
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Affiliation(s)
- Giovanni Benelli
- Insect Behavior Group, Department of Agriculture, Food and Environment, University of Pisa, via del Borghetto 80, 56124 Pisa, Italy; The BioRobotics Institute, Sant'Anna School of Advanced Studies, Viale Rinaldo Piaggio 34, 56025 Pontedera, Italy.
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23
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Benelli G, Lo Iacono A, Canale A, Mehlhorn H. Mosquito vectors and the spread of cancer: an overlooked connection? Parasitol Res 2016; 115:2131-7. [DOI: 10.1007/s00436-016-5037-y] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 03/27/2016] [Indexed: 12/31/2022]
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Bolis V, Karadedos C, Chiotis I, Chaliasos N, Tsabouri S. Atypical manifestations of Epstein‐Barr virus in children: a diagnostic challenge. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2016. [DOI: 10.1016/j.jpedp.2016.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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25
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Bolis V, Karadedos C, Chiotis I, Chaliasos N, Tsabouri S. Atypical manifestations of Epstein-Barr virus in children: a diagnostic challenge. J Pediatr (Rio J) 2016; 92:113-21. [PMID: 26802473 DOI: 10.1016/j.jped.2015.06.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 06/04/2015] [Accepted: 06/17/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Clarify the frequency and the pathophysiological mechanisms of the rare manifestations of Epstein-Barr virus infection. SOURCES Original research studies published in English between 1985 and 2015 were selected through a computer-assisted literature search (PubMed and Scopus). Computer searches used combinations of key words relating to "EBV infections" and "atypical manifestation." SUMMARY OF THE FINDINGS Epstein-Barr virus is a herpes virus responsible for a lifelong latent infection in almost every adult. The primary infection concerns mostly children and presents with the clinical syndrome of infectious mononucleosis. However, Epstein-Barr virus infection may exhibit numerous rare, atypical and threatening manifestations. It may cause secondary infections and various complications of the respiratory, cardiovascular, genitourinary, gastrointestinal, and nervous systems. Epstein-Barr virus also plays a significant role in pathogenesis of autoimmune diseases, allergies, and neoplasms, with Burkitt lymphoma as the main representative of the latter. The mechanisms of these manifestations are still unresolved. Therefore, the main suggestions are direct viral invasion and chronic immune response due to the reactivation of the latent state of the virus, or even various DNA mutations. CONCLUSIONS Physicians should be cautious about uncommon presentations of the viral infection and consider EBV as a causative agent when they encounter similar clinical pictures.
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Affiliation(s)
- Vasileios Bolis
- Child Health Department, University Hospital of Ioannina (UHI), Ioannina, Greece.
| | - Christos Karadedos
- Child Health Department, University Hospital of Ioannina (UHI), Ioannina, Greece
| | - Ioannis Chiotis
- Child Health Department, University Hospital of Ioannina (UHI), Ioannina, Greece
| | - Nikolaos Chaliasos
- Child Health Department, University Hospital of Ioannina (UHI), Ioannina, Greece
| | - Sophia Tsabouri
- Child Health Department, University Hospital of Ioannina (UHI), Ioannina, Greece
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26
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Himuro Y, Miyagawa F, Fukumoto T, Morii T, Hasegawa M, Kobayashi N, Asada H. Hypersensitivity to influenza vaccine in a case of Epstein-Barr virus-associated T-lymphoproliferative disorder. Br J Dermatol 2015; 172:1686-1688. [DOI: 10.1111/bjd.13713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Y. Himuro
- Department of Dermatology; Nara Medical University School of Medicine; 840 Shijo-cho Kashihara Nara 634-8522 Japan
| | - F. Miyagawa
- Department of Dermatology; Nara Medical University School of Medicine; 840 Shijo-cho Kashihara Nara 634-8522 Japan
| | - T. Fukumoto
- Department of Dermatology; Nara Medical University School of Medicine; 840 Shijo-cho Kashihara Nara 634-8522 Japan
| | - T. Morii
- Department of Hematology; Nara Medical University School of Medicine; 840 Shijo-cho Kashihara Nara 634-8522 Japan
| | - M. Hasegawa
- Department of Radiation Oncology; Nara Medical University School of Medicine; 840 Shijo-cho Kashihara Nara 634-8522 Japan
| | - N. Kobayashi
- Department of Dermatology; Nara Medical University School of Medicine; 840 Shijo-cho Kashihara Nara 634-8522 Japan
| | - H. Asada
- Department of Dermatology; Nara Medical University School of Medicine; 840 Shijo-cho Kashihara Nara 634-8522 Japan
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Epstein-Barr virus: dermatologic associations and implications: part I. Mucocutaneous manifestations of Epstein-Barr virus and nonmalignant disorders. J Am Acad Dermatol 2015; 72:1-19; quiz 19-20. [PMID: 25497917 DOI: 10.1016/j.jaad.2014.07.034] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 06/23/2014] [Accepted: 07/16/2014] [Indexed: 12/22/2022]
Abstract
Epstein-Barr virus (EBV) is a ubiquitous virus that has been implicated in a wide range of human diseases, many of which have mucocutaneous manifestations. As a member of the herpesviridae family, EBV causes lifelong infection by establishing latency in B lymphocytes. An intact immune response is critical in preventing progression of EBV disease, and the clinical manifestations of infection are dependent on the intricate relationship between virus and host immune system. This review provides a comprehensive overview of the epidemiology, pathophysiology, and diagnostic testing in EBV infection. In part I of this continuing medical education article, the mucocutaneous manifestations of EBV infection are reviewed with an emphasis on pathophysiology and management.
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Chiu TM, Lin YM, Wang SC, Tsai YG. Hypersensitivity to mosquito bites as the primary clinical manifestation of an Epstein-Barr virus infection. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2014; 49:613-6. [PMID: 24662020 DOI: 10.1016/j.jmii.2014.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 11/08/2013] [Accepted: 01/15/2014] [Indexed: 11/29/2022]
Abstract
Hypersensitivity to mosquito bites (HMB) is a rare disease characterized by intense local skin reactions with general symptoms, such as high fever and regional lymphadenopathy after mosquito bites. Epstein-Barr virus (EBV) chronic infection and NK cell lymphoproliferative disease have been reported first in diagnosed HMB patients. Here, we present the case of a 6-year-old girl with 2 months' history of bullae and necrotic skin lesions, accompanied by a high temperature, visual hallucinations, and liver dysfunction after mosquito bites. A histopathologic examination of the skin lesion showed vasculitis and EBV infection. We could not detect any findings of hematologic malignancies or NK cell proliferative disease in the patient. Clinicians should closely evaluate HMB patients for possible development of lymphoproliferative status or hematologic malignant disorders.
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Affiliation(s)
- Tsu-Man Chiu
- Department of Dermatology, Changhua Christian Hospital, Changhua, Taiwan
| | - Yueh-Min Lin
- Department of Pathology, Changhua Christian Hospital, Changhua, Taiwan
| | - Shing-Chuang Wang
- Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan
| | - Yi-Giien Tsai
- Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, Kaohsiung Medicial University, Kaohsiung, Taiwan.
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30
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Lee WI, Lin JJ, Hsieh MY, Lin SJ, Jaing TH, Chen SH, Hung IJ, Yang CP, Chen CJ, Huang YC, Li SP, Huang JL. Immunologic difference between hypersensitivity to mosquito bite and hemophagocytic lymphohistiocytosis associated with Epstein-Barr virus infection. PLoS One 2013; 8:e76711. [PMID: 24204658 PMCID: PMC3800009 DOI: 10.1371/journal.pone.0076711] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 08/27/2013] [Indexed: 12/31/2022] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening, virus-triggered immune disease. Hypersensitivity to mosquito bite (HMB), a presentation of Chronic Active Epstein-Barr Virus infection (CAEBV), may progress to HLH. This study aimed to investigate the immunologic difference between the HMB episodes and the HLH episodes associated with EBV infection. Immunologic changes of immunoglobulins, lymphocyte subsets, cytotoxicity, intracellular perforin and granzyme expressions, EBV virus load and known candidate genes for hereditary HLH were evaluated and compared. In 12 HLH episodes (12 patients) and 14 HMB episodes (4 patients), there were both decreased percentages of CD4+ and CD8+ and increased memory CD4+ and activated (CD2+HLADR+) lymphocytes. In contrast to HMB episodes that had higher IgE levels and EBV virus load predominantly in NK cells, those HLH episodes with virus load predominantly in CD3+ lymphocyte had decreased perforin expression and cytotoxicity that were recovered in the convalescence period. However, there was neither significant difference of total virus load in these episodes nor candidate genetic mutations responsible for hereditary HLH. In conclusion, decreased perforin expression in the HLH episodes with predominant-CD3+ EBV virus load is distinct from those HMB episodes with predominant-NK EBV virus load. Whether the presence of non-elevated memory CD4+ cells or activated lymphocytes (CD2+HLADR+) increases the mortality rate in the HLH episodes remains to be further warranted through larger-scale studies.
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Affiliation(s)
- Wen-I Lee
- Primary Immunodeficiency Care And Research (PICAR) Institute, Chang Gung Children’s Hospital, Taoyuan, Taiwan
- Department of Pediatrics, Division of Allergy Asthma and Rheumatology, Chang Gung Children’s Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- * E-mail: (W-IL); (J-LH)
| | - Jainn-Jim Lin
- Graduate Institute of Medical Clinics, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Pediatrics, Division of Critical Care and Emergency Medicine, Chang Gung Children’s Hospital, Taoyuan, Taiwan
| | - Meng-Ying Hsieh
- Graduate Institute of Medical Clinics, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Pediatrics, Division of Neurology, Chang Gung Children’s Hospital, Taoyuan, Taiwan
| | - Syh-Jae Lin
- Department of Pediatrics, Division of Allergy Asthma and Rheumatology, Chang Gung Children’s Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tang-Her Jaing
- Primary Immunodeficiency Care And Research (PICAR) Institute, Chang Gung Children’s Hospital, Taoyuan, Taiwan
- Department Pediatrics, Division of Hematology/Oncology, Chang Gung Children’s Hospital, Taoyuan, Taiwan
| | - Shih-Hsiang Chen
- Department Pediatrics, Division of Hematology/Oncology, Chang Gung Children’s Hospital, Taoyuan, Taiwan
| | - Iou-Jih Hung
- Department Pediatrics, Division of Hematology/Oncology, Chang Gung Children’s Hospital, Taoyuan, Taiwan
| | - Chao-Ping Yang
- Department Pediatrics, Division of Hematology/Oncology, Chang Gung Children’s Hospital, Taoyuan, Taiwan
| | - Chin-Jung Chen
- Department of Pediatrics, Division of Infection, Chang Gung Children’s Hospital, Taoyuan, Taiwan
| | - Yhu-Chering Huang
- Department of Pediatrics, Division of Infection, Chang Gung Children’s Hospital, Taoyuan, Taiwan
| | - Shin-Pai Li
- Department of Microbiology and Immunology, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jing-Long Huang
- Primary Immunodeficiency Care And Research (PICAR) Institute, Chang Gung Children’s Hospital, Taoyuan, Taiwan
- Department of Pediatrics, Division of Allergy Asthma and Rheumatology, Chang Gung Children’s Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- * E-mail: (W-IL); (J-LH)
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Abstract
Natural killer (NK)/T-cell lymphomas and NK-cell leukemias are aggressive malignancies. Occurring worldwide, they show a predilection for Asian and South American populations. Neoplastic cells are surface CD3-, cytoplasmic CD3ε+, CD56+, cytotoxic-molecule positive, Epstein-Barr virus (EBV) positive, with germline T-cell receptor gene. Lymphomas occur commonly in the nasal and upper aerodigestive region. Occasional cases present in the skin, salivary gland, testis, and gastrointestinal tract. Rare cases are disseminated with lymphadenopathy, hepatosplenomegaly, and a leukemic phase. Positron emission tomography computed tomography is useful in staging, as lymphomas are 18-fluorodeoxyglucose avid. Quantification of circulating EBV DNA is an accurate biomarker of tumor load. Nasal NK/T-cell lymphomas present mostly with stage I/II disease. Concomitant/sequential chemotherapy and radiotherapy is standard treatment. Radiotherapy alone is inadequate because of high systemic failure rate. For stage III/IV nasal, nonnasal, and disseminated lymphomas, systemic chemotherapy is indicated. Regimens containing l-asparaginase and drugs unaffected by P-glycoprotein are most effective. Hematopoietic stem cell transplantation (HSCT) is not indicated for early-stage nasal lymphomas. HSCT for lymphomas not in remission has poor results. In advanced-stage nasal, nonnasal, disseminated, or relapsed lymphomas, HSCT may be considered when remission is achieved. Prognostic modeling and EBV DNA monitoring may be useful in risk stratification for HSCT.
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Mosquito allergy. Ann Allergy Asthma Immunol 2013; 110:65-9. [PMID: 23352522 DOI: 10.1016/j.anai.2012.07.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 07/25/2012] [Accepted: 07/26/2012] [Indexed: 11/24/2022]
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Seon HS, Roh JH, Lee SH, Kang EK. A case of hypersensitivity to mosquito bites without peripheral natural killer cell lymphocytosis in a 6-year-old Korean boy. J Korean Med Sci 2013; 28:164-6. [PMID: 23341729 PMCID: PMC3546098 DOI: 10.3346/jkms.2013.28.1.164] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 10/24/2012] [Indexed: 11/20/2022] Open
Abstract
Hypersensitivity to mosquito bites (HMB) is a rare disease characterized by intense skin reactions such as bulla and necrotic ulcerations at bite sites, accompanied by general symptoms such as high-grade fever and malaise occurred after mosquito bites. It has been suggested that HMB is associated with chronic Epstein-Barr virus (EBV) infection and natural killer (NK) cell leukemia/lymphoma. We describe here a Korean child who presented with 3-yr history of HMB without natural killer cell lymphocytosis. He has been ill for 6 yr with HMB. Close observation and examination for the development of lymphoproliferative status or hematologic malignant disorders is needed.
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Affiliation(s)
- Han-Su Seon
- Department of Pediatrics, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Ji-Hyeon Roh
- Department of Pathology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Seung-Ho Lee
- Department of Dermatology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Eun-Kyeong Kang
- Department of Pediatrics, Dongguk University Ilsan Hospital, Goyang, Korea
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Przybilla B, Ruëff F. Insect stings: clinical features and management. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:238-48. [PMID: 22532821 PMCID: PMC3334720 DOI: 10.3238/arztebl.2012.0238] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 02/15/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND In human beings, local and systemic reactions can be caused both by blood-sucking insects and by venomous insect stings. In Central Europe, the insects that most commonly cause such reactions are honeybees, certain social wasps, mosquitoes, and flies. METHODS This article is based on a selective literature review, including guidelines from Germany and abroad. RESULTS Insect venom induces a toxic reaction at the site of the sting. Large local reactions are due to allergy and occur in up to 25% of the population; as many as 3.5% develop IgE-mediated, potentially life-threatening anaphylaxis, of which about 20 people die in Germany each year. Mastocytosis is found in 3% to 5% of patients with sting anaphylaxis, rendering these patients prone to very severe reactions. Blood-sucking by hematophagous insects can elicit a local allergic reaction, presenting as a wheal or papule, in at least 75% of the population. Large local reactions may ensue, but other diseases are rare. The acute symptoms of an insect sting are treated symptomatically. Patients who have had a systemic reaction or a large local reaction due to insect allergy must take permanent measures to avoid further allergen contact, and to make sure they can treat themselves adequately if stung again. Most patients with systemic anaphylactic reactions to bee or wasp stings need specific immunotherapy. CONCLUSION Insect stings can cause severe disease. Anaphylaxis due to bee or wasp stings is not a rare event; specific immunotherapy protects susceptible persons from further, potentially life-threatening reactions.
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Affiliation(s)
- Bernhard Przybilla
- Clinic and Policlinic for Dermatology and Allergology, Ludwig-Maximilians-Universität, Munich.
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Park S, Bahng S, Kim EK, Park SB, Sung YK, Kim SJ, Kim WS, Ko YH. Hodgkin's Lymphoma Arising in a Patient With Hypersensitivity to Mosquito Bites: A Case Report. J Clin Oncol 2010; 28:e148-50. [DOI: 10.1200/jco.2009.25.0357] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Silvia Park
- Division of Hemato-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sunha Bahng
- Division of Hemato-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Kyoung Kim
- Division of Hemato-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Bum Park
- Division of Hemato-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Kyung Sung
- Division of Hemato-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Suk Jin Kim
- Division of Hemato-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Seog Kim
- Division of Hemato-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Hyeh Ko
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Roh JH, Kim SJ, Kim WS, Ko YH. The Prognostic Subgroups as Defined by the Patterns of Epstein-Barr Virus Infection in Patients with Hodgkin Lymphoma. KOREAN JOURNAL OF PATHOLOGY 2010. [DOI: 10.4132/koreanjpathol.2010.44.1.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ji Hyeon Roh
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Jin Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Seog Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Hyeh Ko
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Sotos JG. Case 27-2009: A woman with fever, rash, and lymphadenopathy. N Engl J Med 2009; 361:2294-5; author reply 2295. [PMID: 19955533 DOI: 10.1056/nejmc0910183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Lamant L, Pileri S, Sabattini E, Brugières L, Jaffe ES, Delsol G. Cutaneous presentation of ALK-positive anaplastic large cell lymphoma following insect bites: evidence for an association in five cases. Haematologica 2009; 95:449-55. [PMID: 19951975 DOI: 10.3324/haematol.2009.015024] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Skin involvement is frequent in ALK-positive anaplastic large cell lymphomas. The role of an insect bite as a triggering event has been postulated but not well documented. DESIGN AND METHODS We retrospectively investigated five cases of ALK-positive anaplastic large cell lymphoma who presented with skin lesions occurring after an insect bite. Biopsies were immunostained with antibodies against CD30, ALK, T- and B-cell antigens. RESULTS Persistent skin lesions developed after solitary insect bites in three patients and after multiple bites in two. Regional lymphadenopathy developed within weeks after the bite in three cases. In four cases the correct diagnosis was delayed due to misinterpretation of the findings as a reactive infiltrate in the skin (n=2) or lymph nodes (n=2); all cases subsequently showed small numbers of cells with nuclear and cytoplasmic staining for ALK. The final diagnoses were lymphohistiocytic variant (n=3) and composite common/small cell type (n=2) anaplastic large cell lymphoma. The patients were treated and three were alive at the last follow-up. Two patients died, one of pneumonia and the other of disseminated disease. CONCLUSIONS In these cases the sequence of events between the insect bites and the occurrence of both skin lesions and satellite lymphadenopathy suggest a direct relationship between the bite and the presentation with anaplastic large cell lymphoma. We postulate that insect bite-associated antigens could result in an influx of T lymphocytes, some bearing the t(2;5). The subsequent release of cytokines at the site of the bite could act as a 'second hit', eliciting activation of the latter cells, which would then express the oncogenic NPM-ALK protein and undergo uncontrolled proliferation.
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Affiliation(s)
- Laurence Lamant
- INSERM, U.563, Centre de Physiopathologie de Toulouse-Purpan, Toulouse, France
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Abstract
Hypersensitivity to mosquito bite (HMB) is defined as intense skin reactive lesion after mosquito bite. However, some kind of malignant tumor is closely associated with HMB, especially natural killer (NK)/T-cell lymphoma. We described a nasal-type NK/T-cell lymphoma in a 9-year-old girl after a history of 2 years earlier of HMB. Pathologic evaluation revealed the typical histologic features of NK/T-cell lymphoma, and the dermal and subcutaneous inflammatory reaction of HMB lesions. HMB is rarely reported and should be kept in mind as a clinical sign of subsequent NK/T-cell lymphoma in Asian country where HMB is relatively frequently encountered.
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Ascoli V, Senis G, Zucchetto A, Valerio L, Facchinelli L, Budroni M, Dal Maso L, Coluzzi M. Distribution of 'promoter' sandflies associated with incidence of classic Kaposi's sarcoma. MEDICAL AND VETERINARY ENTOMOLOGY 2009; 23:217-225. [PMID: 19712152 DOI: 10.1111/j.1365-2915.2009.00811.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The patchy geographical distributions of classic Kaposi's sarcoma (KS) and human herpesvirus type 8 (HHV-8), better known as Kaposi's sarcoma-associated herpesvirus (KSHV) remain unexplained. It has been proposed that certain species of bloodsucking insects ('promoter arthropods') promote the reactivation of HHV-8/KSHV and facilitate both HHV-8/KSHV transmission and KS development. This hypothesis was tested by sampling the presence and density of human-biting Diptera with CDC light traps in two areas of Sardinia with contrasting incidence rates of classic KS. In total, 11,030 specimens (99.9% sandflies and 0.1% mosquitoes) belonging to 10 species were collected from 40 rural sites. Five of these species are considered to be possible promoter arthropods because of the irritation their bites cause: Phlebotomus perniciosus Newstead; Phlebotomus perfiliewi Parrot (Diptera: Psychodidae); Aedes berlandi Seguy; Culiseta annulata (Schrank) and Culex theileri Theobald (Diptera: Culicidae). Five species are probable 'non-promoters' because their bites are not particularly irritating: Culiseta longiareolata (Macquart); Culex pipiens s.l.; Anopheles algeriensis Theobald; Anopheles maculipennis s.l., and Anopheles plumbeus Stephens. A significant correlation was found between the geographical distribution of promoter arthropods and incidence rates of KS (Spearman's r = 0.59,P < 0.01). Promoter arthropods were more likely to be caught in areas with cutaneous leishmaniasis and a past high prevalence of malaria, and in areas of limestone, acid volcanic soil and cereal cultivation. The study supports the association between promoter arthropods and classic KS, which may explain the geographic variability of KS and HHV-8/KSHV, and highlights the links with a number of variables previously associated with the incidence of KS.
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Affiliation(s)
- V Ascoli
- Anatomia Patologica, Dipartimento di Medicina Sperimentale, Università La Sapienza, Rome, Italy.
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Wongkamchai S, Vaiyavatjamai P, Wanachiwanawin D, Wisuthsarewong W, Kulthanan K, Eakpo P. A dot-blot and immuno-blot assay for the detection of mosquito saliva specific IgE in mosquito bite allergic subjects. J Dermatol Sci 2009; 53:155-7. [DOI: 10.1016/j.jdermsci.2008.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Revised: 05/05/2008] [Accepted: 08/25/2008] [Indexed: 11/28/2022]
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Mendoza N, Diamantis M, Arora A, Bartlett B, Gewirtzman A, Tremaine AM, Tyring S. Mucocutaneous manifestations of Epstein-Barr virus infection. Am J Clin Dermatol 2009; 9:295-305. [PMID: 18717604 DOI: 10.2165/00128071-200809050-00003] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
This review focuses on Epstein-Barr virus (EBV) infection, diagnosis, and current treatment, with emphasis on EBV-associated mucocutaneous manifestations in primary infections, acute EBV-associated syndromes, chronic infections, lymphoproliferative disorders, and lymphomas. In primary infection, EBV infects B cells and can cause mucocutaneous manifestations in infectious mononucleosis or acute EBV-associated syndromes such as Gianotti-Crosti syndrome and hemophagocytic syndrome. EBV then persists in the majority of humans generally without causing disease. In some cases, however, latent EBV infection may result in diseases such as hydroa vacciniforme, hypersensitivity to mosquito bites, and lymphoproliferative disorders such as plasmablastic lymphoma, oral hairy leukoplakia, and post-transplant lymphoproliferative disorders, particularly in immunocompromised patients. Latent EBV infection has also been implicated in a variety of malignant conditions such as Burkitt lymphoma, Hodgkin lymphoma, nasopharyngeal carcinoma, and Kikuchi histocytic necrotizing lymphadenitis. Since the immune system is critical in preventing the progression of EBV disease, the immunologic status of the patient plays a crucial role in the subsequent development of pathologies.
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Current World Literature. Curr Opin Allergy Clin Immunol 2008; 8:360-3. [DOI: 10.1097/aci.0b013e32830abac8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tosta CE. Coadaptation and malaria control. Mem Inst Oswaldo Cruz 2007; 102:385-404. [PMID: 17568946 DOI: 10.1590/s0074-02762007005000042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2007] [Accepted: 03/22/2007] [Indexed: 01/22/2023] Open
Abstract
Malaria emerges from a disequilibrium of the system 'human-plasmodium-mosquito' (HPM). If the equilibrium is maintained, malaria does not ensue and the result is asymptomatic plasmodium infection. The relationships among the components of the system involve coadaptive linkages that lead to equilibrium. A vast body of evidence supports this assumption, including the strategies involved in the relationships between plasmodium and human and mosquito immune systems, and the emergence of resistance of plasmodia to antimalarial drugs and of mosquitoes to insecticides. Coadaptive strategies for malaria control are based on the following principles: (1) the system HPM is composed of three highly complex and dynamic components, whose interplay involves coadaptive linkages that tend to maintain the equilibrium of the system; (2) human and mosquito immune systems play a central role in the coadaptive interplay with plasmodium, and hence, in the maintenance of the system's equilibrium; the under- or overfunction of human immune system may result in malaria and influence its severity; (3) coadaptation depends on genetic and epigenetic phenomena occurring at the interfaces of the components of the system, and may involve exchange of infectrons (genes or gene fragments) between the partners; (4) plasmodia and mosquitoes have been submitted to selective pressures, leading to adaptation, for an extremely long while and are, therefore, endowed with the capacity to circumvent both natural (immunity) and artificial (drugs, insecticides, vaccines) measures aiming at destroying them; (5) since malaria represents disequilibrium of the system HPM, its control should aim at maintaining or restoring this equilibrium; (6) the disequilibrium of integrated systems involves the disequilibrium of their components, therefore the maintenance or restoration of the system's equilibrium depend on the adoption of integrated and coordinated measures acting on all components, that means, panadaptive strategies. Coadaptive strategies for malaria control should consider that: (1) host immune response has to be induced, since without it, no coadaptation is attained; (2) the immune response has to be sustained and efficient enough to avoid plasmodium overgrowth; (3) the immune response should not destroy all parasites; (4) the immune response has to be well controlled in order to not harm the host. These conditions are mostly influenced by antimalarial drugs, and should also be taken into account for the development of coadaptive malaria vaccines.
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Affiliation(s)
- Carlos Eduardo Tosta
- Laboratórios de Malária e de Imunologia Celular, Faculdade de Medicina, Universidade de Brasília, Brasília, DF, Brasil.
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Abstract
PURPOSE OF REVIEW Allergic reactions, including severe local and systemic reactions to mosquito bites, are immunological in nature, and involve immunoglobulin E, immunoglobulin G, and T-lymphocyte-mediated hypersensitivities in response to allergens in mosquito saliva. Naturally acquired desensitization to mosquito saliva may occur during childhood or during long-term exposure to mosquitoes. Due to the lack of availability of mosquito salivary preparations for use in skin tests and in-vitro tests, allergic reactions to mosquito bites are under diagnosed and under treated. RECENT FINDINGS Recombinant saliva allergens with biological activity are being developed. Recombinant Aedes aegypti salivary allergen rAed a 2 has been expressed, purified, characterized and used in in-vitro diagnosis of mosquito allergy. Mosquito saliva-induced non-immunoglobulin E-mediated skin mast cell degranulation was found to induce macrophage-inflammatory protein 2 in the skin and interleukin-10 in draining lymph nodes. SUMMARY In this review, we discuss the allergic reactions to mosquito salivary allergens, the immune mechanisms involved, natural desensitization and immunotherapy with mosquito extracts, characteristics of salivary allergens and their recombinant forms, and prevention and treatment of allergic reactions to mosquito bites. Eventually, recombinant salivary allergens will significantly improve the diagnosis of mosquito allergy, and will also improve specific immunotherapy for patients with systemic reactions to mosquito bites.
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Affiliation(s)
- Zhikang Peng
- Department of Pediatrics and Child Health and Department of Immunology, University of Manitoba, Winnipeg, Manitoba, Canada.
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