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Kanai K, Kageyama S, Yoshie O. Involvement of TLR4 in Acute Hepatitis Associated with Airway Infection of Murine γ-Herpesvirus 68. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2023; 211:1550-1560. [PMID: 37772812 DOI: 10.4049/jimmunol.2200653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/11/2023] [Indexed: 09/30/2023]
Abstract
Extrahepatic viral infections are often accompanied by acute hepatitis, as evidenced by elevated serum liver enzymes and intrasinusoidal infiltration of CD8+ T cells, without direct infection of the liver. An example is infectious mononucleosis caused by primary infection with EBV. Previously, we demonstrated that airway infection of mice with murine γ-herpesvirus 68 (MHV68), a murine model of EBV, caused liver inflammation with elevated serum liver enzymes and intrahepatic infiltration of IFN-γ-producing CD8+ T cells and NK cells. Mechanistically, the expression of the CXCR3-ligand chemokines, which are commonly induced by IFN-γ and attract IFN-γ-producing Th1-type cells via CXCR3, was upregulated in the liver. Importantly, the liver inflammation was suppressed by oral neomycin, an intestine-impermeable aminoglycoside, suggesting an involvement of some products from the intestinal microbiota. In this study, we showed that the liver inflammation and the expression of the CXCR3-ligand chemokines in the liver were effectively ameliorated by i.p. administration of anti-TLR4 mAb or C34, a TLR4 blocker, as well as in TLR4-deficient mice. Conversely, intrarectal inoculation of Escherichia coli as an extraintestinal source of LPS aggravated liver inflammation in MHV68-infected mice with increased expression of the CXCR3-ligand chemokines in the liver. In contrast, the lung inflammation in MHV68-infected mice was not affected by oral neomycin, i.p. administration of C34, or TLR4 deficiency. Collectively, the LPS-TLR4 pathway plays a pivotal role in the liver inflammation of MHV68-infected mice at least in part by upregulating the CXCR3-ligand chemokines in the liver.
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Affiliation(s)
- Kyosuke Kanai
- Division of Virology, Department of Microbiology and Immunology, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Seiji Kageyama
- Division of Virology, Department of Microbiology and Immunology, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Osamu Yoshie
- Health and Kampo Institute, Sendai, Miyagi, Japan
- Aoinosono Sendai Izumi Long-Term Health Care Facility, Sendai, Miyagi, Japan
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Jeong CY, Choi GH, Jang ES, Kim YS, Lee YJ, Kim IH, Cho SB, Yoon JH, Kim KA, Choi DH, Chung WJ, Cho HJ, Na SK, Kim YT, Lee BS, Jeong SH. Etiology and clinical characteristics of acute viral hepatitis in South Korea during 2020-2021: a prospective multicenter study. Sci Rep 2023; 13:14271. [PMID: 37652984 PMCID: PMC10471758 DOI: 10.1038/s41598-023-40775-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/16/2023] [Indexed: 09/02/2023] Open
Abstract
This prospective, 12-center study investigated the etiology and clinical characteristics of acute viral hepatitis (AVH) during 2020-2021 in South Korea, and the performance of different diagnostic methods for hepatitis E virus (HEV). We enrolled 428 patients with acute hepatitis, of whom 160 (37.4%) were diagnosed with AVH according to predefined serologic criteria. The clinical data and risk factors for AVH were analyzed. For hepatitis E patients, anti-HEV IgM and IgG were tested with two commercial ELISA kits (Abia and Wantai) with HEV-RNA real-time RT-PCR. HAV, HEV, HBV, HCV, Epstein-Barr virus (EBV), cytomegalovirus, and herpes simplex virus accounted for AVH in 78.8% (n = 126), 7.5% (n = 12), 3.1% (n = 5), 1.9% (n = 3), 6.9% (n = 11), 1.2% (n = 2), and 0.6% (n = 1) of 160 patients (median age, 43 years; men, 52.5%; median ALT, 2144 IU/L), respectively. Hospitalization, hemodialysis, and intensive care unit admission were required in 137 (86.7%), 5 (3.2%), and 1 (0.6%) patient, respectively. Two patients developed acute liver failure (1.3%), albeit without mortality or liver transplantation. Ingestion of uncooked clams/oysters and wild boars' blood/bile was reported in 40.5% and 16.7% of patients with HAV and HEV, respectively. The concordance rate between the anti-HEV-IgM results of both ELISA kits was 50%. HEV RNA was detected in only 17% of patients with HEV. The diagnosis of HEV needs clinical consideration due to incomplete HEV diagnostics.
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Affiliation(s)
- Chan Young Jeong
- Departments of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea
| | - Gwang Hyeon Choi
- Departments of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea
| | - Eun Sun Jang
- Departments of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea
| | - Young Seok Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Youn-Jae Lee
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - In Hee Kim
- Department of Internal Medicine, Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Sung Bum Cho
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Jae Hyun Yoon
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Kyung-Ah Kim
- Departments of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Dae Hee Choi
- Departments of Internal Medicine, Kangwon National University Hospital, Chunchon, Republic of Korea
| | - Woo Jin Chung
- Departments of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Hyun-Jin Cho
- Departments of Internal Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Seong Kyun Na
- Departments of Internal Medicine, Jeju National University Hospital, Jeju, Republic of Korea
| | - Yun-Tae Kim
- Seoul Clinical Laboratories, Yongin, Republic of Korea
| | - Byung Seok Lee
- Departments of Internal Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea.
| | - Sook-Hyang Jeong
- Departments of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea.
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Zhao M, Ma L, Jiang H, Gu Y, Yang X, Liu R, Sun C, Li Y. Interleukin-37 is involved in the immunopathogenesis of infectious mononucleosis. Ital J Pediatr 2023; 49:93. [PMID: 37507743 PMCID: PMC10386628 DOI: 10.1186/s13052-023-01498-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Multiple immunopathological responses to viruses are observed in infectious mononucleosis (IM), a manifestation of primary infection with Epstein-Barr virus (EBV). Protective effects of the negative immunoregulatory molecule interleukin-37 (IL-37) have been observed in various bacterial and viral infections. However, the function of IL-37 in IM remains unknown. METHODS Flow cytometry and enzyme-linked immunosorbent assay (ELISA) were used to determine the expression of IL-37 in the peripheral blood of patients diagnosed with IM, and the variation of lymphocyte subsets. Furthermore, the associations between IL-37 expression and the percentage of lymphocyte subgroups were analyzed. RESULTS Patients with IM had severe immune dysfunction. The control group had a lower expression of IL-37 than the patients with IM. There were significant associations between IL-37 expression and both the proportion of CD3+T cells and the ratio of CD3+CD4+ to CD3+CD8+T cells. Patients with higher levels of IL-37 expression had lower levels of the liver inflammation indicators, alanine aminotransferase (ALT) and aspartate aminotransferase (AST). CONCLUSIONS IL-37 may affect the immune pathogenesis of patients with IM infected with EBV, and may have immunotherapeutic benefit for EBV-associated illnesses.
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Affiliation(s)
- Mingsheng Zhao
- Institute of Immunology and Molecular Medicine, Jining Medical University, Jining, China
| | - Li Ma
- Center for Laboratory Diagnosis, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, China
| | - Huihui Jiang
- Center for Laboratory Diagnosis, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, China
| | - Yufeng Gu
- Center for Laboratory Diagnosis, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, China
| | - Xin Yang
- Center for Laboratory Diagnosis, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, China
| | - Riming Liu
- Center for Laboratory Diagnosis, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, China
| | - Chengming Sun
- Center for Laboratory Diagnosis, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, China
| | - Yulan Li
- Center for Laboratory Diagnosis, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, China
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Rodrigues Santos L, Silva Cruz M, Veiga Ferraz R, Ferraz Moreira V, Castro A. Jaundice as a Rare Manifestation of Epstein-Barr Virus Primary Infection. Cureus 2021; 13:e15609. [PMID: 34277228 PMCID: PMC8275053 DOI: 10.7759/cureus.15609] [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] [Accepted: 06/11/2021] [Indexed: 11/05/2022] Open
Abstract
Epstein-Barr virus (EBV) primary infection usually presents with classic symptoms of infectious mononucleosis (IM) like fever, lymphadenopathies and tonsillopharyngitis. Liver damage is frequently mild and self-limited and there are only a few cases of severe EBV-induced cholestatic hepatitis and jaundice reported in the literature. The authors present the case of a 22-year-old woman who was admitted with acute fever and jaundice. Physical examination revealed posterior cervical lymphadenopathies and painful hepatosplenomegaly. Laboratorial findings suggested an obstructive cause for jaundice but ultrasound and magnetic resonance cholangiopancreatography excluded biliary duct pathology. Heterophile antibodies were negative but EBV-specific antibodies revealed isolated positive viral capsid antigen (VCA) immunoglobin (Ig) M suggesting the diagnosis of early phase of EBV primary infection. The diagnosis of EBV-induced cholestatic hepatitis was confirmed after identification of EBV deoxyribonucleic acid (DNA) in blood and by liver biopsy. Supportive management was provided and, despite an initial clinical deterioration, the patient had a favorable outcome. EBV is a virus with a high prevalence worldwide, mainly subclinical, and jaundice is a rare manifestation of the infection. Although the majority of the patients recover without sequelae, progression to liver failure has been described and a careful assessment for complications is mandatory. Therefore, EBV infection should be included in the comprehensive differential diagnosis of jaundice in all age groups.
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Affiliation(s)
| | | | - Rita Veiga Ferraz
- Infectious Diseases, Centro Hospitalar do Tâmega e Sousa, Penafiel, PRT
| | | | - Alice Castro
- Internal Medicine, Centro Hospitalar do Tâmega e Sousa, Penafiel, PRT
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Bunchorntavakul C, Reddy KR. Epstein-Barr Virus and Cytomegalovirus Infections of the Liver. Gastroenterol Clin North Am 2020; 49:331-346. [PMID: 32389366 DOI: 10.1016/j.gtc.2020.01.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Epstein-Barr virus (EBV) and cytomegalovirus (CMV) infections are common and are associated with a variety of liver manifestations. EBV and CMV infections, in immunocompetent hosts, commonly manifest as acute hepatitis, with severity varying from asymptomatic, self-limited icteric hepatitis to acute liver failure. Atypical manifestations, such as cholestasis, chronic hepatitis, precipitation of acute-on-chronic liver failure, and autoimmune hepatitis, are reported with EBV infection, whereas cholestasis, portal vein thrombosis, and Budd-Chiari syndrome are reported with CMV infection. In the setting of liver transplantation, CMV is the most common infectious complication and carries significant morbidity; EBV is the major cause of post-transplant lymphoproliferative disorders.
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Affiliation(s)
- Chalermrat Bunchorntavakul
- Division of Gastroenterology and Hepatology, Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, 2 Phayathai Road, Ratchathewi, Bangkok 10400, Thailand
| | - K Rajender Reddy
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania, 2 Dulles, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Hirsiger JR, Fuchs PS, Häusermann P, Müller-Durovic B, Daikeler T, Recher M, Hirsch HH, Terracciano L, Berger CT. Syphilis Reactivates Latent Epstein-Barr Virus Reservoir via Toll-Like Receptor 2 and B-Cell Receptor Activation. Open Forum Infect Dis 2019; 6:ofz317. [PMID: 31660400 PMCID: PMC6736073 DOI: 10.1093/ofid/ofz317] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 07/02/2019] [Indexed: 11/17/2022] Open
Abstract
Latent Epstein-Barr virus (EBV) infection can clinically reactivate in immunosuppressed individuals causing lymphoproliferative disease and rarely hepatitis. In this study, we provide in vivo and in vitro evidence that Treponema pallidum infection can cause EBV reactivation with hepatitis in an immunocompetent patient. We report the diagnostic challenges and immunological findings of coinciding syphilis and EBV-associated hepatitis. Using an in vitro EBV-reactivation assay, we demonstrate that T pallidum reactivates latent EBV in a Toll-like receptor (TLR)2/B-cell receptor signaling-dependent manner. Epstein-Barr virus-associated reactivation or lymphoproliferation should be considered in infections with pathogens that activate TLR2.
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Affiliation(s)
- Julia R Hirsiger
- Translational Immunology, Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Philipp S Fuchs
- Clinical Immunology, Medical Outpatient Unit, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Peter Häusermann
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Bojana Müller-Durovic
- Immunobiology Laboratory, Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Thomas Daikeler
- Rheumatology Clinic, University Hospital Basel, Basel, Switzerland
| | - Mike Recher
- Immunodeficiency Clinic and Laboratory, Departments of Internal Medicine and Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Hans H Hirsch
- Division Infection Diagnostics, Department Biomedicine, University Hospital Basel, Basel, Switzerland.,Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Luigi Terracciano
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - Christoph T Berger
- Translational Immunology, Department of Biomedicine, University Hospital Basel, Basel, Switzerland.,Clinical Immunology, Medical Outpatient Unit, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
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7
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Novel Therapeutics for Epstein⁻Barr Virus. Molecules 2019; 24:molecules24050997. [PMID: 30871092 PMCID: PMC6429425 DOI: 10.3390/molecules24050997] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/01/2019] [Accepted: 03/04/2019] [Indexed: 12/11/2022] Open
Abstract
Epstein–Barr virus (EBV) is a human γ-herpesvirus that infects up to 95% of the adult population. Primary EBV infection usually occurs during childhood and is generally asymptomatic, though the virus can cause infectious mononucleosis in 35–50% of the cases when infection occurs later in life. EBV infects mainly B-cells and epithelial cells, establishing latency in resting memory B-cells and possibly also in epithelial cells. EBV is recognized as an oncogenic virus but in immunocompetent hosts, EBV reactivation is controlled by the immune response preventing transformation in vivo. Under immunosuppression, regardless of the cause, the immune system can lose control of EBV replication, which may result in the appearance of neoplasms. The primary malignancies related to EBV are B-cell lymphomas and nasopharyngeal carcinoma, which reflects the primary cell targets of viral infection in vivo. Although a number of antivirals were proven to inhibit EBV replication in vitro, they had limited success in the clinic and to date no antiviral drug has been approved for the treatment of EBV infections. We review here the antiviral drugs that have been evaluated in the clinic to treat EBV infections and discuss novel molecules with anti-EBV activity under investigation as well as new strategies to treat EBV-related diseases.
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8
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Pagano JS, Whitehurst CB, Andrei G. Antiviral Drugs for EBV. Cancers (Basel) 2018; 10:cancers10060197. [PMID: 29899236 PMCID: PMC6025560 DOI: 10.3390/cancers10060197] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/07/2018] [Accepted: 06/12/2018] [Indexed: 12/16/2022] Open
Abstract
Epstein–Barr virus (EBV) infects up to 95% of the adult human population, with primary infection typically occurring during childhood and usually asymptomatic. However, EBV can cause infectious mononucleosis in approximately 35–50% cases when infection occurs during adolescence and early adulthood. Epstein–Barr virus is also associated with several B-cell malignancies including Burkitt lymphoma, Hodgkin lymphoma, and post-transplant lymphoproliferative disease. A number of antiviral drugs have proven to be effective inhibitors of EBV replication, yet have resulted in limited success clinically, and none of them has been approved for treatment of EBV infections.
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Affiliation(s)
- Joseph S Pagano
- Department of Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Christopher B Whitehurst
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Graciela Andrei
- Department of Microbiology and Immunology, University of Leuven, BE-3000 Leuven, Belgium.
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Kanai K, Park AM, Watanabe A, Arikawa T, Yasui T, Yoshida H, Tsunoda I, Yoshie O. Murine γ-Herpesvirus 68 Induces Severe Lung Inflammation in IL-27-Deficient Mice with Liver Dysfunction Preventable by Oral Neomycin. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2018; 200:2703-2713. [PMID: 29500240 DOI: 10.4049/jimmunol.1700412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 02/06/2018] [Indexed: 02/05/2023]
Abstract
IL-27 is an immunoregulatory cytokine consisting of p28 and EBI3. Its receptor also has two subunits, WSX1 and gp130. Although IL-27 promotes Th1 differentiation in naive T cells, it also induces IL-10 expression in effector Th1 cells to curtail excessive immune responses. By using p28-deficient mice and WSX1-deficient mice (collectively called IL-27-deficient mice), we examined the role of IL-27 in primary infection by murine γ-herpesvirus 68 (MHV68), a murine model of EBV. Upon airway infection with MHV68, IL-27-deficient mice had more aggravated lung inflammation than wild-type mice, although MHV68 infection per se was better controlled in IL-27-deficient mice. Although epithelial cells and alveolar macrophages were primarily infected by MHV68, interstitial macrophages and dendritic cells were the major producers of IL-27. The lung inflammation of IL-27-deficient mice was characterized by more IFN-γ-producing CD8+ T cells and fewer IL-10-producing CD8+ T cells than that of wild-type mice. An infectious mononucleosis-like disease was also aggravated in IL-27-deficient mice, with prominent splenomegaly and severe hepatitis. Infiltration of IFN-γ-producing effector cells and upregulation of the CXCR3 ligand chemokines CXCL9, CXCL10, and CXCL11 were noted in the liver of MHV68-infected mice. Oral neomycin effectively ameliorated hepatitis, with decreased production of these chemokines in the liver, suggesting that the intestinal microbiota plays a role in liver inflammation through upregulation of these chemokines. Collectively, IL-27 is essential for the generation of IL-10-producing effector cells in primary infection by MHV68. Our findings may also provide new insight into the mechanism of hepatitis associated with infectious mononucleosis.
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Affiliation(s)
- Kyosuke Kanai
- Department of Microbiology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan.,Division of Virology, Department of Microbiology and Immunology, Tottori University Faculty of Medicine, Yonago, Tottori 683-8503, Japan
| | - Ah-Mee Park
- Department of Microbiology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan
| | - Akiko Watanabe
- Department of Microbiology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan
| | - Tomohiro Arikawa
- Division of General Education, Department of Biology, Kanazawa Medical University, Uchinada, Kahoku-gun, Ishikawa 920-0293, Japan
| | - Teruhito Yasui
- Laboratory of Infectious Diseases and Immunity, National Institute of Biomedical Innovation, Health and Nutrition, Ibaraki, Osaka 567-0085, Japan
| | - Hiroki Yoshida
- Division of Molecular and Cellular Immunoscience, Department of Biomolecular Sciences, Faculty of Medicine, Saga University, Saga 840-8502, Japan; and
| | - Ikuo Tsunoda
- Department of Microbiology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan
| | - Osamu Yoshie
- Department of Microbiology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan; .,The Health and Kampo Institute, Sendai, Miyagi 981-3205, Japan
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Shkalim-Zemer V, Shahar-Nissan K, Ashkenazi-Hoffnung L, Amir J, Bilavsky E. Cholestatic Hepatitis Induced by Epstein-Barr Virus in a Pediatric Population. Clin Pediatr (Phila) 2015; 54:1153-7. [PMID: 25676835 DOI: 10.1177/0009922815570618] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We present 5 cases of Epstein-Barr virus (EBV)-induced cholestatic hepatitis (CH) and review all additional pediatric cases from the literature. DESIGN The medical records of 5 patients with EBV-induced CH were reviewed. A comprehensive review of the literature was performed. RESULTS Including our patients, a total of 17 patients with EBV-induced CH were reviewed. The average age was 11 years (range 1-18 years); male to female ratio was 0.9:1. The most common presenting symptoms included fever, jaundice, and cervical lymphadenopathy. However, a significant number of patients presented with jaundice alone, without other suggestive signs of an EBV infection. Hepatocellular enzyme levels were significantly higher than in classical infectious mononucleosis. In many cases, serum alkaline phosphatase was also elevated, accompanied by direct hyperbilirubinemia. CONCLUSION EBV infection should be included in the differential diagnosis of CH in all age groups. In the vast majority, full recovery is expected.
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Affiliation(s)
- Vered Shkalim-Zemer
- Schneider Children's Medical Center of Israel, Petah Tikva, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Keren Shahar-Nissan
- Schneider Children's Medical Center of Israel, Petah Tikva, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liat Ashkenazi-Hoffnung
- Schneider Children's Medical Center of Israel, Petah Tikva, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Amir
- Schneider Children's Medical Center of Israel, Petah Tikva, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efraim Bilavsky
- Schneider Children's Medical Center of Israel, Petah Tikva, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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11
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Pisapia R, Mariano A, Rianda A, Testa A, Oliva A, Vincenzi L. Severe EBV hepatitis treated with valganciclovir. Infection 2012; 41:251-4. [DOI: 10.1007/s15010-012-0303-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 07/06/2012] [Indexed: 12/29/2022]
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12
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Eligio P, Delia R, Valeria G. EBV Chronic Infections. Mediterr J Hematol Infect Dis 2010; 2:e2010022. [PMID: 21415952 PMCID: PMC3033110 DOI: 10.4084/mjhid.2010.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 08/09/2010] [Indexed: 01/04/2023] Open
Abstract
The infection from Epstein-Barr virus (EBV) or virus of infectious mononucleosis, together with other herpes viruses' infections, represents a prototype of persistent viral infections characterized by the property of the latency. Although the reactivations of the latent infection are associated with the resumption of the viral replication and eventually with the "shedding", it is still not clear if this virus can determine chronic infectious diseases, more or less evolutive. These diseases could include some pathological conditions actually defined as "idiopathic"and characterized by the "viral persistence" as the more credible pathogenetic factor. Among the so-called idiopathic syndromes, the "chronic fatigue syndrome" (CFS) aroused a great interest around the eighties of the last century when, just for its relationship with EBV, it was called "chronic mononucleosis" or "chronic EBV infection".Today CFS, as defined in 1994 by the CDC of Atlanta (USA), really represents a multifactorial syndrome characterized by a chronic course, where reactivation and remission phases alternate, and by a good prognosis. The etiopathogenetic role of EBV is demonstrated only in a well-examined subgroup of patients, while in most of the remaining cases this role should be played by other infectious agents - able to remain in a latent or persistent way in the host - or even by not infectious agents (toxic, neuroendocrine, methabolic, etc.). However, the pathogenetic substrate of the different etiologic forms seems to be the same, much probably represented by the oxidative damage due to the release of pro-inflammatory cytokines as a response to the triggering event (infectious or not infectious).Anyway, recently the scientists turned their's attention to the genetic predisposition of the subjects affected by the syndrome, so that in the last years the genetic studies, together with those of molecular biology, received a great impulse. Thanks to both these studies it was possibile to confirm the etiologic links between the syndrome and EBV or other herpesviruses or other persistent infectious agents.The mechanisms of EBV latency have been carefully examined both because they represent the virus strategy to elude the response of the immune system of the host, and because they are correlated with those oncologic conditions associated to the viral persistence, particularly lymphomas and lymphoproliferative disorders. Just these malignancies, for which a pathogenetic role of EBV is clearly documented, should represent the main clinical expression of a first group of chronic EBV infections characterized by a natural history where the neoplastic event aroused from the viral persistence in the resting B cells for all the life, from the genetic predisposition of the host and from the oncogenic potentialities of the virus that chronically persists and incurs reactivations.Really, these oncological diseases should be considered more complications than chronic forms of the illness, as well as other malignancies for which a viral - or even infectious - etiology is well recognized. The chronic diseases, in fact, should be linked in a pathogenetic and temporal way to the acute infection, from whom start the natural history of the following disease. So, as for the chronic liver diseases from HBV and HCV, it was conied the acronym of CAEBV (Chronic Active EBV infection), distinguishing within these pathologies the more severe forms (SCAEBV) mostly reported in Far East and among children or adolescents. Probably only these forms have to be considered expressions of a chronic EBV infection "sensu scrictu", together with those forms of CFS where the etiopathogenetic and temporal link with the acute EBV infection is well documented. As for CFS, also for CAEBV the criteria for a case definition were defined, even on the basis of serological and virological findings. However, the lymphoproliferative disorders are excluded from these forms and mantain their nosographic (e.g. T or B cell or NK type lymphomas) and pathogenetic collocation, even when they occur within chronic forms of EBV infection. In the pathogenesis, near to the programs of latency of the virus, the genetic and environmental factors, independent from the real natural history of EBV infection, play a crucial role.Finally, it was realized a review of cases - not much numerous in literature - of chronic EBV infection associated to chronic liver and neurological diseases, where the modern techniques of molecular biology should be useful to obtain a more exact etiologic definition, not always possibile to reach in the past.The wide variety of clinical forms associated to the EBV chronic infection makes difficult the finding of a univocal pathogenetic link. There is no doubt, however, that a careful examination of the different clinical forms described in this review should be useful to open new horizons to the study of the persistent viral infections and the still not well cleared pathologies that they can induce in the human host.
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Affiliation(s)
- Pizzigallo Eligio
- Clinic of Infectious Diseases – Department of Medicine and Aging – “G. D’Annunzio” University of Chieti (Italy)
| | - Racciatti Delia
- Clinic of Infectious Diseases – Department of Medicine and Aging – “G. D’Annunzio” University of Chieti (Italy)
| | - Gorgoretti Valeria
- Clinic of Infectious Diseases – Department of Medicine and Aging – “G. D’Annunzio” University of Chieti (Italy)
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Pagidipati N, Obstein KL, Rucker-Schmidt R, Odze RD, Thompson CC. Acute hepatitis due to epstein-barr virus in an immunocompetent patient. Dig Dis Sci 2010; 55:1182-5. [PMID: 19459045 DOI: 10.1007/s10620-009-0835-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Accepted: 04/30/2009] [Indexed: 12/09/2022]
Affiliation(s)
- Neha Pagidipati
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Vince A, Lepej SZ, Kurelac I, Barsic B, Kozic S, Klinar I, Zarkovic K. Virological and immunological characteristics of fatal Epstein-Barr virus mononucleosis in a 17-year-old Caucasian male presenting with meningoencephalitis and hemophagocytic syndrome. J Neurovirol 2007; 13:389-96. [PMID: 17849323 DOI: 10.1080/13550280701447042] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In this report, the authors present a detailed immunological and virological assessment of an immunocompetent 17-year-old Caucasian male with a fatal Epstein-Barr virus (EBV) infectious mononucleosis presenting with meningoencephalitis and hemophagocytic syndrome. The patient with serologically confirmed EBV infectious mononucleosis was admitted to the hospital because of 3 weeks' fever. Fine-needle aspiration of lymph nodes showed reactive hyperplasia with prominent hemophagocytosis. Percentages of intracellular interferon-gamma (IFN-gamma) in CD4(+) and CD8(+) T cells in the peripheral blood progressively increased during the course of disease (10.2% and 8.5% on day 35; 30.1% and 53.2% on day 44; 42.2% and 75.2% on day 50; 36.1% and 50.6% on day 59, respectively). On day 50, the patient developed meningoencephalitis. Brain computed tomography (CT) was normal. Brain magnetic resonance imaging (MRI) showed multifocal inflammatory lesions in frontal and temporal cortex of the right hemisphere as well as severe perivascular inflammatory reaction. The patient was treated with steroids, cyclosporin A, and methotrexate intratecally. Following treatment, EBV viremia in the blood and cerebrospinal fluid (CSF) decreased from pretreatment values (54,490 copies of EBV DNA/ml and 39,500 copies/ml, respectively) to 8715 copies/ml in the blood and 14,690 in the CSF. Despite treatment, the patient remained unconscious and died of sepsis and pneumonia 3 months after initial symptoms. Immunohistochemical staining showed the presence of EBV in both perivascular infiltrates and grey matter. Enhanced Th1 response as shown by high levels of IFN-gamma in peripheral blood lymphocytes may be a predictor of severe complications during acute EBV infection. Early implementation of immunosuppressive therapy in these patients should be considered.
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Affiliation(s)
- Adriana Vince
- Department for Viral Hepatitis and Laboratory for Molecular Diagnostics, University Hospital for Infectious Diseases "Dr. Fran Mihaljevic,", Zagreb, Croatia
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Abstract
PURPOSE OF REVIEW Recent papers on disorders of the liver and biliary tract which clarify their pathogenesis and attendant morphologic changes are highlighted. RECENT FINDINGS The concept of 'bystander hepatitis' was cited in studies showing hepatic infiltration of CD8-positive T cells in the setting of extrahepatic infections such as influenza virus and severe acute respiratory syndrome. Diabetic liver lesions include glycogenic hepatopathy (in which poor diabetic control leads to swollen, glycogen-filled hepatocytes without fat, steatohepatitis or fibrosis) and diabetic hepatosclerosis in which there is diffuse perisinusoidal fibrosis (type IV collagen) without zonal predilection. Ground-glass hepatocellular inclusions (positive with periodic acid-Schiff stain for glycogen) were reported in three separate series of patients who were hepatitis B virus-negative, often transplant recipients, immunosuppressed and on multiple medications. A Banff consensus paper expertly compared and contrasted the histologic features which characterize the various causes of late liver allograft dysfunction. SUMMARY Informative papers emerged this past year concerning collateral damage to the liver in extrahepatic infections, diabetic lesions and causes of liver dysfunction after transplantation, among other topics.
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Affiliation(s)
- Jay H Lefkowitch
- Department of Pathology, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.
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