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Smiley Evans T, Lowenstine LJ, Gilardi KV, Barry PA, Ssebide BJ, Kinani JF, Nizeyimana F, Noheri JB, Cranfield MR, Mudakikwa A, Goldstein T, Mazet JAK, Johnson CK. Mountain gorilla lymphocryptovirus has Epstein-Barr virus-like epidemiology and pathology in infants. Sci Rep 2017; 7:5352. [PMID: 28706209 PMCID: PMC5509654 DOI: 10.1038/s41598-017-04877-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 05/22/2017] [Indexed: 01/10/2023] Open
Abstract
Epstein-Barr virus (EBV) infects greater than 90% of humans, is recognized as a significant comorbidity with HIV/AIDS, and is an etiologic agent for some human cancers. The critically endangered mountain gorilla population was suspected of infection with an EBV-like virus based on serology and infant histopathology similar to pulmonary reactive lymphoid hyperplasia (PRLH), a condition associated with EBV in HIV-infected children. To further examine the presence of EBV or an EBV-like virus in mountain gorillas, we conducted the first population-wide survey of oral samples for an EBV-like virus in a nonhuman great ape. We discovered that mountain gorillas are widely infected (n = 143/332) with a specific strain of lymphocryptovirus 1 (GbbLCV-1). Fifty-two percent of infant mountain gorillas were orally shedding GbbLCV-1, suggesting primary infection during this stage of life, similar to what is seen in humans in less developed countries. We then identified GbbLCV-1 in post-mortem infant lung tissues demonstrating histopathological lesions consistent with PRLH, suggesting primary infection with GbbLCV-1 is associated with PRLH in infants. Together, our findings demonstrate that mountain gorilla's infection with GbbLCV-1 could provide valuable information for human disease in a natural great ape setting and have potential conservation implications in this critically endangered species.
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Affiliation(s)
- Tierra Smiley Evans
- Karen C. Drayer Wildlife Health Center, One Health Institute, School of Veterinary Medicine, University of California, Davis, CA, 95616, USA.
| | - Linda J Lowenstine
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California, Davis, CA, 95616, USA
| | - Kirsten V Gilardi
- Karen C. Drayer Wildlife Health Center, One Health Institute, School of Veterinary Medicine, University of California, Davis, CA, 95616, USA
| | - Peter A Barry
- Center for Comparative Medicine, Department of Pathology and Laboratory Medicine, California National Primate Research Center, University of California, Davis, CA, 95616, USA
| | - Benard J Ssebide
- Gorilla Doctors, Mountain Gorilla Veterinary Project, Inc., Kampala, Uganda
| | - Jean Felix Kinani
- One Health Approach for Conservation, Gorilla Health, Kigali, Rwanda
| | - Fred Nizeyimana
- Gorilla Doctors, Mountain Gorilla Veterinary Project, Inc., Kampala, Uganda
| | - Jean Bosco Noheri
- Gorilla Doctors, Mountain Gorilla Veterinary Project, Inc., Musanze, Rwanda
| | - Michael R Cranfield
- Karen C. Drayer Wildlife Health Center, One Health Institute, School of Veterinary Medicine, University of California, Davis, CA, 95616, USA
| | | | - Tracey Goldstein
- Karen C. Drayer Wildlife Health Center, One Health Institute, School of Veterinary Medicine, University of California, Davis, CA, 95616, USA
| | - Jonna A K Mazet
- Karen C. Drayer Wildlife Health Center, One Health Institute, School of Veterinary Medicine, University of California, Davis, CA, 95616, USA
| | - Christine Kreuder Johnson
- Karen C. Drayer Wildlife Health Center, One Health Institute, School of Veterinary Medicine, University of California, Davis, CA, 95616, USA
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Abstract
PURPOSE OF REVIEW To review the role of microorganisms in interstitial lung disease (ILD) and to emphasize their importance in initiation and course of ILD. RECENT FINDINGS ILD can be idiopathic but often causality such as drugs or connective tissue disease can be found. Multiple microorganisms have been associated with ILD. On the one hand, pulmonary infection can cause extensive pulmonary damage with patterns of an ILD. On the other hand, microorganisms can trigger the immune system and provoke an abnormal response- not directed against the causative pathogen- that may result in ILD. Moreover, patients with ILD often are susceptible to infection, and infections can importantly influence the course of ILD. Furthermore, not only an infection but also its treatment can result in a drug-induced pneumonitis, eventually resulting in long-term lung damage. SUMMARY Microorganisms can initiate and/or influence the course of ILD. Early recognition, adequate diagnostic evaluation and therapy are essential to prevent permanent damage. Prevention of infection in patients with established ILD is strongly recommended.
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Cell reservoirs of the Epstein-Barr virus in biopsy-proven lymphocytic interstitial pneumonitis in HIV-1 subtype E infected children: identification by combined in situ hybridization and immunohistochemistry. Appl Immunohistochem Mol Morphol 2010; 18:212-8. [PMID: 19801937 DOI: 10.1097/pai.0b013e3181baec3a] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Lymphoid interstitial pneumonitis (LIP), a frequent pulmonary complication in human immune deficiency virus (HIV)-infected pediatric patients, is characterized histologically by marked infiltration of lymphoid cells. Several theories have been suggested that LIP may be caused by Epstein-Barr virus (EBV). To identify the reservoir of EBV and pathogenesis of lymphoid infiltrates in HIV subtype E infected pediatric LIP, we examined the distribution and expression of EBV in the inflammatory cell recruitment in surgical lung biopsy-proven LIP from 9 vertically HIV subtype E-infected pediatric patients. The dominant microscopic feature of LIP demonstrated widespread widening of alveolar septum by mononuclear inflammatory cell infiltrate mainly composed of mature lymphocytes and plasma cells surrounding airways and expanding to the lung interstitium. EBV-encoded RNA (EBER) in situ hybridization, performed from paraffin-embedded lung tissues, revealed positive intranuclear signals in all 9 LIP cases. Interestingly, combined immunohistochemical and in situ hybridization analyses in 6 out of 9 LIP cases revealed 30% to 50% of the Langerhans and related dendritic cells were infected with EBV, whereas <30% of the T and B cells were infected with EBV. These results suggested that a chronic antigenic stimulus of EBV played important roles in the pathogenesis of LIP in these patients. This supports the notion that Langerhans cells (LCs) are more readily infected with EBV, indicating that LCs are reservoirs for EBV in lungs of HIV subtype E-infected pediatric LIP. And possibly LCs may play an important role in the recruitment of inflammatory cell infiltrates, especially T cells into these tissues. In addition, HIV may provide a milieu or microenvironment for the evolution of LIP, which represent an immunologic response to EBV infection. Interactions between LCs and related dendritic cells together with T cells are important for effective HIV and EBV replications.
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Toro AADC, Altemani AMA, da Silva MTN, Morcillo AM, Vilela MMS. Epstein-Barr virus (EBV) gene expression in interstitial pneumonitis in Brazilian human immunodeficiency virus-1-infected children: is EBV associated or not? Pediatr Dev Pathol 2010; 13:184-91. [PMID: 19968485 DOI: 10.2350/09-04-0644-oa.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
To gain further knowledge on the subject we evaluated Epstein-Barr virus (EBV) gene expression and TCD4+, TCD8+, and B lymphocyte counts in lung tissue samples from 20 human immunodeficiency virus (HIV)-infected children with chronic lung disease. Twenty HIV-1 infected children with chronic pulmonary disease underwent open lung biopsy to define the diagnosis. Histological section of this material was submitted to nonisotopic in situ hybridization (ISH) using EBV-encoded RNA (EBER) 1/2 probes and TCD4+, TCD8+, and CD20+ B-cell counts by immunohistochemistry. The histology of 16 out of the 20 children (median age 53.5 months) proved to be examples of pulmonary lymphoid hyperplasia/lymphoid interstitial pneumonitis (PLH/LIP) complex, 13 of which were EBER positive, but no significant association was found (Fisher exact test P = 0.439). Four patients had non-LIP diseases (3, nonspecific interstitial pneumonia; 1, diffuse advanced alveolar damage), two being EBER negative. Nineteen children showed a predominant T-CD8+ cell response (CD4+/CD8+ <1) in lung tissue. The mean TCD4+ and theTCD4/TCD8 ratio in lung tissue were significantly higher in the sections with PLH/LIP complex, but without significant difference between EBER positive and EBER negative samples. EBV gene expression was detected in the majority of the lung samples but without significant association with PLH/LIP complex or with TCD4+, TCD8+, B cells and the TCD4+/TCD8+ ratio. Regarding the pattern of lung disease in HIV-1 infected children, associated or not to EBV, the findings are of importance concerning the possible role of EBV in the pathogenesis of PLH/LIP.
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Affiliation(s)
- Adyléia A D C Toro
- Center for Investigation in Pediatrics, Pediatrics Department, University of Campinas Medical School, Rua Tessália Vieira de Camargo 126, Campinas, São Paulo-SP, Brazil
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5
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Abstract
The development of chronic lung disease is common in HIV-infected children. The spectrum of chronic HIV-associated lung disease includes lymphocytic interstitial pneumonia (LIP), chronic infections, immune reconstitution inflammatory syndrome (IRIS), bronchiectasis, malignancies, and interstitial pneumonitis. Chronic lung disease may result from recurrent or persistent pneumonia due to bacterial, mycobacterial, viral, fungal or mixed infections. In high tuberculosis (TB) prevalence areas, M. tuberculosis is an important cause of chronic respiratory illness. With increasing availability of highly active antiretroviral therapy (HAART) for children in developing countries, a rise in the incidence of IRIS due to mycobacterial or other infections is being reported. Diagnosis of chronic lung disease is based on chronic symptoms and persistent chest X-ray changes but definitive diagnosis can be difficult as clinical and radiological findings may be non-specific. Distinguishing LIP from miliary TB remains a difficult challenge in HIV-infected children living in high TB prevalence areas. Treatment includes therapy for specific infections, pulmonary clearance techniques, corticosteroids for children with LIP who are hypoxic or who have airway compression from tuberculous nodes and HAART. Children who are taking TB therapy and HAART need adjustments in their drug regimes to minimize drug interactions and ensure efficacy. Preventative strategies include immunization, chemoprophylaxis, and micronutrient supplementation. Early use of HAART may prevent the development of chronic lung disease.
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Affiliation(s)
- Heather J Zar
- School of Child and Adolescent Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa.
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Abstract
PURPOSE OF REVIEW We describe a patient in whom Epstein-Barr virus infection appears to have caused an unusual interstitial lung disease with multisystem involvement resembling sarcoidosis and interstitial lung disease. We have reviewed the relevant literature about the relation of Epstein-Barr virus and interstitial lung disease. RECENT FINDINGS Epstein-Barr virus replication within type II alveolar cells was shown to occur in adult cryptogenic fibrosing alveolitis. Latent membrane protein 1 is one of the Epstein-Barr-virus-associated proteins and is expressed on the surface of Epstein-Barr-virus-infected cells in the latent and replicating phases. Latent membrane protein 1 was positive in the cuboidal epithelial cells of the lungs from some patients with idiopathic pulmonary fibrosis, and that its positivity correlated with poor prognosis. Epstein-Barr virus was also found in the lungs of children with lymphocytic interstitial pneumonia, AIDS and Langerhans cell histiocytosis. Epstein-Barr virus DNA was not detectable in patients with sarcoidosis. There was also lack of evidence for a role of Epstein-Barr virus in the increase of lung cancer in idiopathic pulmonary fibrosis. SUMMARY Using monoclonal antibodies against viral antigen Epstein-Barr virus was shown to replicate within type II alveolar cells of adult idiopathic pulmonary fibrosis patients. Latent membrane protein 1positivity indicates poor prognosis; Epstein-Barr virus positivity did not increase the incidence of lung cancer in these patients. Epstein-Barr virus was also associated with lymphocytic interstitial pneumonia, AIDS and Langerhans cell histiocytosis but not with sarcoidosis.
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Affiliation(s)
- Kamel Marzouk
- Division of Pulmonary and Critical Care Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA.
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Lee B. Eighteen-month-old girl with respiratory syncytial virus infection and diffuse nodular lung infiltrates. Pediatr Infect Dis J 2005; 24:281-2, 289-90. [PMID: 15750473 DOI: 10.1097/01.inf.0000154590.00291.4e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Brian Lee
- Division of Infectious Diseases, Children's Hospital and Research Center, Oakland, CA, USA
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Mueller GA, Pickoff AS. Pediatric lymphocytic interstitial pneumonitis in an HIV-negative child with pulmonary Epstein-Barr virus infection. Pediatr Pulmonol 2003; 36:447-9. [PMID: 14520729 DOI: 10.1002/ppul.10341] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Lymphocytic interstitial pneumonitis (LIP) in children has been most commonly associated with human immunodeficiency virus (HIV) infection. Epstein-Barr virus (EBV) associated LIP without HIV infection has been reported only in adults. EBV associated LIP has been reported in children, but only with concurrent HIV infection. We report a case of EBV associated, HIV negative LIP in a child.
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Affiliation(s)
- Gary A Mueller
- Department of Pediatrics, Wright State University School of Medicine, Children's Medical Center, Dayton, Ohio 45404, USA.
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9
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Abstract
OBJECTIVES To describe current knowledge on the aetiology, pathology, presentation, diagnosis, and treatment of lymphocytic interstitial pneumonitis in HIV infected adults. METHODS A Medline search was performed using the key words "HIV," "pneumonitis," and "lymphocytes." A further search was performed with the MESH heading "interstitial lung disorders." Related articles were also searched using Pubmed. RESULTS Lymphocytic interstitial pneumonitis is a common complication in HIV infected children. In adults it is uncommon and is described most commonly among black African and Afro-Caribbean patients. The aetiology and pathogenesis of lymphocytic interstitial pneumonitis in HIV infection is not clear. The clinical and radiological presentations may be indistinguishable from Pneumocystis carinii infection and a lung biopsy is necessary to establish the diagnosis. Recent evidence suggests that lymphocytic interstitial pneumonitis in HIV infected patients may respond to combination antiretroviral therapy with dramatic improvements in clinical and radiological abnormalities. CONCLUSION Lymphocytic interstitial pneumonitis in HIV infected patients is a treatable condition. This condition should be considered in HIV infected patients presenting with respiratory symptoms as they may gain considerable benefit from antiretroviral therapy.
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Affiliation(s)
- S Das
- Department of Genitourinary and HIV Medicine, Whittall Street Clinic, Whittall Street, Birmingham B4 6DH, UK
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Ankermann T, Claviez A, Wagner HJ, Krams M, Riedel F. Chronic interstitial lung disease with lung fibrosis in a girl: uncommon sequelae of Epstein-Barr virus infection. Pediatr Pulmonol 2003; 35:234-8. [PMID: 12567394 DOI: 10.1002/ppul.10244] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A 12-month-old immunocompetent girl presented with tachypnea, inspiratory crackles, mild hypoxemia, and failure to thrive after an acute Epstein-Barr virus (EBV) infection. The course of acute EBV infection was demonstrated by viral load measurement in plasma and peripheral blood mononuclear cells (PBMC) by using real-time polymerase chain reaction (PCR). EBV DNA was further detected by PCR in bronchoalveolar lavage (BAL) fluid and from a lung-tissue specimen obtained by open-lung biopsy, which indicates the pulmonary involvement of active EBV infection. Histology revealed an uncharacteristic interstitial infiltration and fibrosis. Following topic and systemic treatment with corticosteroids, the child became asymptomatic and showed normal weight gain as well as mental and physical development. Pulmonary parenchymal involvement during the course of primary EBV infection may result in interstitial lung disease and fibrosis not only in immunodeficient, but in immunocompetent children as well. Treatment with combined inhaled and oral steroids seems to be a treatment option in these patients.
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Affiliation(s)
- Tobias Ankermann
- Department of Pediatrics, Christian-Albrechts-University of Kiel, Schwanenweg, Kiel, Germany.
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Swigris JJ, Berry GJ, Raffin TA, Kuschner WG. Lymphoid interstitial pneumonia: a narrative review. Chest 2002; 122:2150-64. [PMID: 12475860 DOI: 10.1378/chest.122.6.2150] [Citation(s) in RCA: 156] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Lymphoid interstitial pneumonia (LIP) is regarded as both a disease and a nonneoplastic, inflammatory pulmonary reaction to various external stimuli or systemic diseases. It is an uncommon condition with incidence and prevalence rates that are largely unknown. Liebow and Carrington originally classified LIP as an idiopathic interstitial pneumonia in 1969. Although LIP had since been removed from that category, the most recent consensus classification sponsored by the American Thoracic Society and the European Respiratory Society recognizes that some cases remain idiopathic in origin, and its clinical, radiographic, and pathologic features warrant the return of LIP to its original classification among the idiopathic interstitial pneumonias. LIP also belongs within a spectrum of pulmonary lymphoproliferative disorders that range in severity from benign, small, airway-centered cellular aggregates to malignant lymphomas. It is characterized by diffuse hyperplasia of bronchus-associated lymphoid tissue. The dominant microscopic feature of LIP is a diffuse, polyclonal lymphoid cell infiltrate surrounding airways and expanding the lung interstitium. Classically, LIP occurs in association with autoimmune diseases, most often Sjögren syndrome. This has led to consideration of an autoimmune etiology for LIP, but its pathogenesis remains poorly understood. Persons who are seropositive for HIV, and children in particular, are at increased risk of acquiring LIP. Some studies suggest causal roles for both HIV and Epstein-Barr virus. The incidence of LIP is approximately twofold greater in women than men. The average age at diagnosis is between 52 years and 56 years. Symptoms of progressive cough and dyspnea predominate. There is great variability in the clinical course of LIP, from resolution without treatment to progressive respiratory failure and death. Although LIP is often regarded as a steroid-responsive condition, and oral corticosteroids continue to be the mainstay of therapy, response is unpredictable. Approximately 33 to 50% of patients die within 5 years of diagnosis, and approximately 5% of cases of LIP transform to lymphoma.
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Affiliation(s)
- Jeffrey J Swigris
- Division of Pulmonary and Critical Care Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA 94305-5236, USA.
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Mosseri R, Finkelstein Y, Monselize Y, Garty BZ. Large T-cell lymphoma in a 13-year-old girl with hyperimmunoglobulinemia E syndrome. Pediatr Allergy Immunol 2002; 13:143-6. [PMID: 12000489 DOI: 10.1034/j.1399-3038.2002.00088.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Large T-cell lymphoma was diagnosed in a 13-year-old girl with hyperimmunoglobulinemia E syndrome (HIES). Her past medical history included severe dermatitis, recurrent pneumonia, urinary tract infections, mucocutaneous herpetic infections, fungal skin infections, and staphylococcal sepsis. The diagnosis of HIES, based on the clinical features and a serum IgE level of >20000 IU/ml, was established when the girl was 6 years old. This is the eighth case of lymphoma in a patient with HIES reported in the English-language medical literature. HIES has not usually been considered a predisposing factor for malignancy, but in view of the rarity of HIES and the young age of the patients, this association seems to be more than coincidental. A link between lymphoma and Epstein-Barr virus (EBV) infection in patients with HIES has been proposed. Serological tests for EBV in our patient were positive 6 years prior to the development of the lymphoma; however, examination for EBV DNA in the lymph node biopsy failed to detect EBV in the tumor.
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Affiliation(s)
- Ronen Mosseri
- Department of Pediatrics B and Pediatric Immunology, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel
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Simmank K, Meyers T, Galpin J, Cumin E, Kaplan A. Clinical features and T-cell subsets in HIV-infected children with and without lymphocytic interstitial pneumonitis. ANNALS OF TROPICAL PAEDIATRICS 2001; 21:195-201. [PMID: 11579857 DOI: 10.1080/02724930120077763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Lymphocytic interstitial pneumonitis (LIP) is a non-infective lung condition common in untreated older children with vertically acquired HIV infection. Little is known about the prognosis in children with LIP, and diagnosis remains a problem where lung biopsy is not feasible. Our aim was to determine which clinical features aid the diagnosis of LIP in conjunction with the typical reticulonodular radiological picture, and whether the prognosis in children with LIP is different from that in HIV-infected children of the same age without LIP. We retrospectively compared the clinical features and T-cell subsets of 49 children with LIP with those of 56 children of similar age without LIP. Diagnosis of LIP was made radiologically. All children were apyrexial at the time of X-ray and acute intercurrent infections and tuberculosis had been excluded as far as possible. Ages ranged from 24 to 112 months in the non-LIP group and from 24 to 120 months in the LIP group. Digital clubbing and reticulo-endothelial hyperplasia were significantly more common in children with LIP than in those without. Children with LIP tended to have lower CD4+ counts and CD4% and higher CD8+ counts and CD8%, which resulted in significantly lower CD4/CD8 ratios in children under 5 years with LIP. It is possible in most cases to diagnose LIP using a combination of clinical and X-ray findings, as long as every effort is made to exclude tuberculosis. Lower CD4+ counts and CD4% as well as more frequent hospital admissions suggest that LIP adversely affects prognosis in children with HIV.
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Affiliation(s)
- K Simmank
- Department of Paediatrics, Chris Hani Baragwanath Hospital, South Africa.
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Katz BZ, Salimi B, Kim S, Nsiah-Kumi P, Wagner-Weiner L. Epstein-Barr virus burden in adolescents with systemic lupus erythematosus. Pediatr Infect Dis J 2001; 20:148-53. [PMID: 11224832 DOI: 10.1097/00006454-200102000-00006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We sought to determine whether patients with systemic lupus erythematosus (SLE) and a presumed primary or reactivated Epstein-Barr virus (EBV) serologic response had evidence of an active EBV infection. BACKGROUND Patients with SLE often have what appears to be a primary or reactivated EBV serologic response. If these patients then present with fever, fatigue, adenopathy or leukopenia, it is not clear whether these symptoms are caused by worsening SLE or EBV infection. Establishing the correct diagnosis is crucial for management. METHODS We examined the EBV burden in 13 adolescents with SLE and a presumed primary or reactivated EBV serologic response. All were taking prednisone; 2 each were also on azathioprine or intravenous pulse cyclophosphamide. EBV serologies were performed for all, and EBV burdens were assessed via immortalization assays and EBV DNA amplification of blood and saliva at least once. RESULTS Seven patients had serologic patterns indicative of a primary EBV infection, while six had serologies indicative of a reactivated (secondary) EBV infection. Two of the latter were the only ones in whom a small amount of biologically active EBV was detected. CONCLUSION In our series active EBV infection was not seen in most patients, despite serologic data that could be interpreted as a primary or reactivated infection. Thus the serologic profiles were more likely a consequence of immune dysregulation secondary to SLE or its therapy rather than rampant infection with EBV.
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Affiliation(s)
- B Z Katz
- Children's Memorial Hospital, Division of Infectious Diseases, Chicago, IL, USA
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Stable expression of Epstein-Barr virus BZLF-1–encoded ZEBRA protein activates p53-dependent transcription in human Jurkat T-lymphoblastoid cells. Blood 2000. [DOI: 10.1182/blood.v96.2.625.014k27_625_634] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Interaction between viral proteins and tumor suppressor p53 is a common mechanism of viral pathogenesis. The Epstein-Barr virus (EBV) BZLF-1 ORF-encoded ZEBRA protein (also denoted EB1, Z, Zta) binds to p53 in vitro and has been associated with the altered transcription of p53-regulated genes in B lymphocytes and epithelial cells. In this work, Jurkat T-lymphoblastoid cells that express ZEBRA were characterized by the use of transiently transfected p53 and p53 reporter genes. Stable expression of ZEBRA was associated with the activation of p53-dependent transcription and increased p53 dependent apoptotic cell death. In Jurkat cell lines, stably expressed ZEBRA protein was apparently localized to the cell cytoplasm, in contrast to the typical nuclear localization of this protein in other cell types. Previous studies have suggested that EBV infection of T lymphocytes may contribute to the malignant transformation of T cells and the increased replication of human immunodeficiency virus. Our observations suggest a mechanism through which ZEBRA protein expressed in human T lymphocytes could alter T-cell proliferation and apoptosis during EBV infection.
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Stable expression of Epstein-Barr virus BZLF-1–encoded ZEBRA protein activates p53-dependent transcription in human Jurkat T-lymphoblastoid cells. Blood 2000. [DOI: 10.1182/blood.v96.2.625] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractInteraction between viral proteins and tumor suppressor p53 is a common mechanism of viral pathogenesis. The Epstein-Barr virus (EBV) BZLF-1 ORF-encoded ZEBRA protein (also denoted EB1, Z, Zta) binds to p53 in vitro and has been associated with the altered transcription of p53-regulated genes in B lymphocytes and epithelial cells. In this work, Jurkat T-lymphoblastoid cells that express ZEBRA were characterized by the use of transiently transfected p53 and p53 reporter genes. Stable expression of ZEBRA was associated with the activation of p53-dependent transcription and increased p53 dependent apoptotic cell death. In Jurkat cell lines, stably expressed ZEBRA protein was apparently localized to the cell cytoplasm, in contrast to the typical nuclear localization of this protein in other cell types. Previous studies have suggested that EBV infection of T lymphocytes may contribute to the malignant transformation of T cells and the increased replication of human immunodeficiency virus. Our observations suggest a mechanism through which ZEBRA protein expressed in human T lymphocytes could alter T-cell proliferation and apoptosis during EBV infection.
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Scarborough M, Lishman S, Shaw P, Fakoya A, Miller RF. Lymphocytic interstitial pneumonitis in an HIV-infected adult: response to antiretroviral therapy. Int J STD AIDS 2000; 11:119-22. [PMID: 10678481 DOI: 10.1177/095646240001100210] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Jenson H, McIntosh K, Pitt J, Husak S, Tan M, Bryson Y, Easley K, Shearer W. Natural history of primary Epstein-Barr virus infection in children of mothers infected with human immunodeficiency virus type 1. J Infect Dis 1999; 179:1395-404. [PMID: 10228060 PMCID: PMC4360073 DOI: 10.1086/314764] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The natural history of Epstein-Barr virus (EBV) infection in 556 infants born to 517 human immunodeficiency virus (HIV) type 1-infected mothers was studied in a prospective, multicenter, cohort study. HIV-1-infected children had a cumulative EBV infection rate similar to HIV-1-uninfected children at age 3 years (77.8% vs. 84. 9%) but had more frequent oropharyngeal EBV shedding (50.4% vs. 28. 2%; P<.001). The probability of shedding decreased with longer time from EBV seroconversion and was similar to that of HIV-1-uninfected children 3 years after seroconversion. HIV-1-infected children identified as rapid progressors shed EBV more frequently than nonrapid progressors (69.4% vs.41.0%; P=.01). HIV-1-infected children with EBV infection had higher mean CD8 cell counts. EBV infection did not have an independent effect on mean CD4 cell counts, percent CD4, IgG levels, HIV-1 RNA levels, lymphadenopathy, hepatomegaly, or splenomegaly. Early EBV infection is common in children born to HIV-1-infected mothers. Children with rapidly progressive HIV-1 disease have more frequent EBV shedding.
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Affiliation(s)
- H Jenson
- Department of Pediatrics, University of Texas Health Science Center, San Antonio, TX 78284-7811, USA.
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Zingg W, Bossart W, Berli E, Nadal D. Detection and quantification of cell-free Epstein-Barr virus by polymerase chain reaction and subsequent DNA enzyme immunoassay. J Virol Methods 1999; 79:141-8. [PMID: 10381084 DOI: 10.1016/s0166-0934(99)00013-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Amplification by polymerase chain reaction and subsequent DNA enzyme immunoassay (DEIA) were employed to determine the number of genome equivalents of cell-free Epstein Barr virus (EBV) DNA in peripheral blood. The assay detected cell-free EBV DNA in the serum of 14 out of 18 patients with primary, productive EBV infection (sensitivity 77.7%) but not in healthy EBV carriers with latent infection (specificity 100%). Our assay has the potential for a clinical diagnostic tool to monitor patients at risk for EBV reactivation and productive infection with subsequent EBV-induced lymphoproliferative diseases.
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Affiliation(s)
- W Zingg
- Infectious Diseases Unit, University Children's Hospital of Zurich, Switzerland
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20
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Jeena PM, Coovadia HM, Thula SA, Blythe D, Buckels NJ, Chetty R. Persistent and chronic lung disease in HIV-1 infected and uninfected African children. AIDS 1998; 12:1185-93. [PMID: 9677168 DOI: 10.1097/00002030-199810000-00011] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The causes of persistent lung disease (PLD) and chronic lung disease (CLD) are unknown in HIV-infected children in developing countries. We describe the causes and course of PLD and CLD in HIV-infected and uninfected children. METHOD Of 194 children with lung disease persisting for at least 1 month who were seen at the paediatric respiratory clinic over a 2-year period, 42 underwent invasive investigations after failed initial management over 3 months. PLD was defined as the presence of clinical and radiological features of lung disease for more than 1 month, and CLD as these features for more than 3 months. RESULTS One hundred and thirty-eight (71%) of the 194 children with PLD were HIV-infected, 52 (27%) were not infected and four (2%) were of undetermined HIV status. Forty-eight per cent of the HIV-infected children and 52% of the HIV-uninfected children responded to initial treatment over 3 months; the presumptive diagnoses in these were tuberculosis, interstitial pneumonitis, bronchiectasis and post-ventilation lung syndrome. Of the 28 HIV-infected children with CLD who underwent invasive investigations 16 (57%) had lymphoid interstitial pneumonitis, eight (29%) had tuberculosis and four (14%) had non-specific interstitial pneumonitis. Of the 14 HIV-uninfected children with CLD who had invasive testing there were four cases (29%) each of tuberculosis and interstitial pneumonitis, three (22%) cases of bronchiectasis and one case of each of extrinsic allergic alveolitis, crytogenic fibrosing alveolitis and non-Hodgkin's lymphoma. CONCLUSION This is the first set of data on the causes of CLD in HIV-infected children in a developing country. Every effort should be made to identify the infectious agent, whether M. tuberculosis or a secondary bacterial infection in LIP, in order to treat most appropriately these children with lung disease.
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Affiliation(s)
- P M Jeena
- Department of Paediatrics and Child Health, Faculty of Medicine, University of Natal, Durban, South Africa
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21
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Reddy A, Lyall EG, Crawford DH. Epstein-Barr virus and lymphoid interstitial pneumonitis: an association revisited. Pediatr Infect Dis J 1998; 17:82-3. [PMID: 9469404 DOI: 10.1097/00006454-199801000-00020] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- A Reddy
- Department of Clinical Sciences, London School of Hygiene and Tropical Medicine, United Kingdom
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22
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Sharland M, Gibb DM, Holland F. Respiratory morbidity from lymphocytic interstitial pneumonitis (LIP) in vertically acquired HIV infection. Arch Dis Child 1997; 76:334-6. [PMID: 9166026 PMCID: PMC1717142 DOI: 10.1136/adc.76.4.334] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The aim of the study was to define the respiratory morbidity caused by lymphocytic interstitial pneumonitis (LIP) in children with vertically acquired HIV infection. A retrospective case note review was performed on 95 children attending three London hospitals. Clinical and radiological evidence of LIP, acute lower respiratory tract infections, and chronic lung disease was obtained using a structured protocol. A diagnosis of LIP had been made in 33%, and an acute admission due to acute lower respiratory tract infection had occurred in 42% of all children (despite 99% taking regular cotrimoxazole prophylaxis). Admission rates because of acute lower respiratory tract infection were significantly higher in the LIP group (0.38 admissions/child year) than in the non-LIP group (0.17 admissions/child year) (p = 0.0002). Encapsulated bacteria (Streptococcus pneumoniae, Haemophilus influenzae) were most frequently isolated. Improved methods of prevention of acute lower respiratory tract infection may help to reduce the severe respiratory morbidity seen in children with LIP and HIV infection.
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Affiliation(s)
- M Sharland
- Paediatric Infectious Disease Unit, St George's Hospital, London
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23
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Abstract
Because children acquire HIV infection differently than adults, this article begins with a discussion of the epidemiology of AIDS in children. This is followed by a discussion of factors related to progression of the disease and survival in pediatric AIDS. A discussion of the pulmonary manifestations in children is followed by a suggested approach to the HIV-infected child with respiratory symptoms.
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Affiliation(s)
- M R Bye
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York, USA
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24
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Stoane JM, Haller JO, Orentlicher RJ. THE GASTROINTESTINAL MANIFESTATIONS OF PEDIATRIC AIDS. Radiol Clin North Am 1996. [DOI: 10.1016/s0033-8389(22)00508-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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25
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Abstract
The causes of fever in a child can vary from minor brief illnesses to life-threatening infectious, malignant, or autoimmune diseases. The physician often has to evaluate children with fevers of as yet undiagnosed cause lasting fewer than 2 weeks, in whom it is important to determine whether localizing findings are present. Fever without localizing signs and fevers complicating chronic disease and resulting from specific localized infection are considered in the sections concerning infectious causes, immunodeficiency diseases, and rheumatic diseases. The diagnostic and therapeutic approaches to the child with both prolonged fever and fever of unknown origin are then discussed, with emphasis on rheumatic diseases.
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Affiliation(s)
- M L Miller
- Department of Pediatrics, Northwestern University Medical School, Chicago, Illinois, USA
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26
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Affiliation(s)
- C Peckham
- Institute of Child Health, London, United Kingdom
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27
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Chintu C, Athale UH, Patil PS. Childhood cancers in Zambia before and after the HIV epidemic. Arch Dis Child 1995; 73:100-4; discussion 104-5. [PMID: 7574850 PMCID: PMC1511204 DOI: 10.1136/adc.73.2.100] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Human immunodeficiency virus (HIV) related cancers in children are not as common and as well described as in adults. An HIV epidemic has been prevalent in Zambia since 1983-1984. To study the effect of the epidemic on the epidemiology of cancers in children a retrospective study was undertaken at the University Teaching Hospital (UTH), Lusaka, Zambia. All the histopathological records from 1980 to 1992 were reviewed and all cases of cancers in children less than 14 years of age were analysed. In order to define the effect of the HIV epidemic, the epidemiological features of various childhood cancers occurring before (during the years 1980-1982) and after (during the years 1990-1992) the onset of the HIV epidemic were compared. A significant increase in the occurrence of total childhood cancers was found. This is mostly due to a highly significant increase in the incidence of paediatric Kaposi's sarcoma (p = 0.000016), which is causally related to HIV infection, and a significant increase in the incidence of retinoblastoma (p = 0.02), which has an unknown relation to HIV infection. Though not yet statistically significant, there has also been a gradual and sustained increase in the incidence of non-Hodgkin's lymphoma, nasopharyngeal carcinoma, and rhabdomyosarcoma. There has been a significant reduction in the incidence of Burkitt's lymphoma. A prospective in depth epidemiological study of HIV related childhood cancers in Africa is urgently needed.
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Affiliation(s)
- C Chintu
- School of Medicine, University of Zambia, Department of Paediatrics and Child Health, Lusaka
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28
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Affiliation(s)
- G Gaidano
- Dipartimento di Scienze Biomediche e Oncologia Umana, Università di Torino, Ospedale San Luigi Gonzaga, Italy
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29
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OPPORTUNISTIC INFECTIONS IN HIV-INFECTED CHILDREN. Immunol Allergy Clin North Am 1995. [DOI: 10.1016/s0889-8561(22)00836-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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30
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Dunn NL, Massey GV. NEOPLASIA. Immunol Allergy Clin North Am 1995. [DOI: 10.1016/s0889-8561(22)00838-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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31
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Affiliation(s)
- M R Bye
- Department of Pediatrics, Columbia University College of Physicians & Surgeons, New York, NY 10032, USA
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32
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Jevon GP, Elavathil LJ, Harnish DG, deSa DJ. Epstein-Barr virus in non-Hodgkin's lymphomas and lymphoid tissue in children. PEDIATRIC PATHOLOGY & LABORATORY MEDICINE : JOURNAL OF THE SOCIETY FOR PEDIATRIC PATHOLOGY, AFFILIATED WITH THE INTERNATIONAL PAEDIATRIC PATHOLOGY ASSOCIATION 1995; 15:283-90. [PMID: 8597815 DOI: 10.3109/15513819509026963] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In developed countries the majority of adolescent children show serological evidence of past Epstein-Barr virus (EBV) infection. This virus is associated with non-Hodgkin's lymphomas in immunocompromised children, but the relationship of EBV DNA to these tumors in children without documented immunodeficiency has not been investigated by the polymerase chain reaction (PCR). We used a PCR method with primers from the Bam W and Bam HI regions to study non-Hodgkin's lymphomas in children, with tonsillar tissue of age-matched children as controls for the presence of EBV DNA. Six of the 20 tonsils were positive using the Bam W primers; another four showed this DNA with Bam HI primers. EBV DNA was detected in only one tumor (a lymphoblastic lymphoma) by both primer sets. The demonstration of EBV DNA in the tonsils reflects past infections and the incidence is in accordance with that expected from serologic epidemiological studies. The absence of demonstrable EBV DNA in 19 lymphomas suggests that this virus is of little consequence in the pathogenesis of non-Hodgkin's lymphomas in children who are not known to be immunocompromised. The lymphoblastic lymphoma had a mixed cell population, and the virus was not necessarily related to the malignancy.
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Affiliation(s)
- G P Jevon
- Department of Pathology, McMaster University Medical Center, Hamilton, Ontario, Canada
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33
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Mueller BU, Pizzo PA. Cancer in children with primary or secondary immunodeficiencies. The journal The Journal of Pediatrics 1995. [DOI: 10.1016/s0022-3476(95)70491-4] [Citation(s) in RCA: 118] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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34
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Affiliation(s)
- G Gaidano
- Dipartimento di Scienze Biomediche e Oncologia Umana, Università di Torino, Ospedale San Luigi Gonzaga, Turin, Italy
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35
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Nadal D, Caduff R, Frey E, Hassam S, Zimmermann DR, Seigneurin JM, Plüss HJ, Seger RA. Non-Hodgkin's lymphoma in four children infected with the human immunodeficiency virus. Association with Epstein-Barr Virus and treatment. Cancer 1994; 73:224-30. [PMID: 8275430 DOI: 10.1002/1097-0142(19940101)73:1<224::aid-cncr2820730138>3.0.co;2-d] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Reports on lymphoid malignancy and its treatment in children infected with human immunodeficiency virus (HIV) are limited. METHODS Antibodies to Epstein-Barr virus (EBV) were detected by indirect immunofluorescence. DNA was extracted from peripheral blood lymphocytes or biopsy specimens. Polymerase chain reaction was run using primers for EBV. Reaction products underwent Southern blot analysis to confirm EBV specificity. Tumor clonality was assessed by immunohistochemistry and by Southern blot analysis of immunoglobulin heavy-chain and T-cell receptor beta-gene rearrangement. RESULTS Within 1 year, non-Hodgkin's lymphoma (NHL) was diagnosed in four children infected with HIV. All four were EBV-seropositive and had detectable EBV DNA in peripheral blood lymphocytes. The EBV-linked disorders lymphoid interstitial pneumonia and recurrent parotid enlargement preceded NHL in three and two of the children, respectively. In all four patients, NHL involved at one time the central nervous system (CNS). All three tested NHL tissues were positive for EBV DNA: A 12-week course of chemotherapy given to two children resulted in rapid tumor regression. One of these children experienced meningeal relapse and died 16 months after diagnosis. The other child, who in addition received local irradiation of the affected eye and who underwent surgical removal of the involved ovaries, has been in continuous remission for 20 months. CONCLUSIONS EBV-associated NHL may be seen more frequently in pediatric patients with HIV. Treatment protocols taking into account NHL propensity for the CNS in this age group need to be developed.
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MESH Headings
- Abdominal Neoplasms/microbiology
- Abdominal Neoplasms/pathology
- Adolescent
- Brain Neoplasms/microbiology
- Brain Neoplasms/pathology
- Burkitt Lymphoma/microbiology
- Burkitt Lymphoma/pathology
- Child
- Child, Preschool
- Eye Neoplasms/microbiology
- Eye Neoplasms/pathology
- Female
- Genotype
- HIV Infections/microbiology
- HIV Infections/therapy
- Herpesviridae Infections/diagnosis
- Herpesviridae Infections/therapy
- Herpesvirus 4, Human/classification
- Herpesvirus 4, Human/genetics
- Herpesvirus 4, Human/isolation & purification
- Humans
- Lymphoma, AIDS-Related/genetics
- Lymphoma, AIDS-Related/microbiology
- Lymphoma, AIDS-Related/pathology
- Lymphoma, AIDS-Related/therapy
- Lymphoma, Large B-Cell, Diffuse/microbiology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Non-Hodgkin/genetics
- Lymphoma, Non-Hodgkin/microbiology
- Lymphoma, Non-Hodgkin/pathology
- Lymphoma, Non-Hodgkin/therapy
- Male
- Ovarian Neoplasms/microbiology
- Ovarian Neoplasms/pathology
- Submandibular Gland Neoplasms/microbiology
- Submandibular Gland Neoplasms/pathology
- Tumor Virus Infections/diagnosis
- Tumor Virus Infections/therapy
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Affiliation(s)
- D Nadal
- University Children's Hospital, Division of Immunology, Zurich, Switzerland
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36
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Affiliation(s)
- L L Fan
- Pediatric Pulmonary Section, National Jewish Center for Immunology and Respiratory Medicine, Denver, CO 80206
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37
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Abstract
Central nervous system disease has emerged as an important manifestation of acquired immunodeficiency syndrome in both the adult and pediatric populations, with neurologic abnormalities occurring in up to 90% of pediatric patients in some series. Neuropathologic studies, based primarily on the autopsy, have provided valuable insights into the spectrum and pathogenesis of acquired immunodeficiency syndrome-associated neurologic disorders, including primary human immunodeficiency virus encephalopathy and as the spectrum of infectious, neoplastic, and cerebrovascular diseases that may complicate the course of acquired immunodeficiency syndrome. Progressive encephalopathy represents the single most common neurologic disorder in pediatric acquired immunodeficiency syndrome and appears to be caused in most cases by direct infection in brain parenchyma by human immunodeficiency virus. Central nervous system lymphoma and cerebrovascular disease continue to account for most focal central nervous system lesions in the pediatric population. In contrast to adults with acquired immunodeficiency syndrome, opportunistic central nervous system infections remain relatively uncommon in the pediatric population. Our understanding of acquired immunodeficiency syndrome-associated neurologic disease remains far from complete. A plea is made for regular postmortem examination of the central nervous system in all patients dying with human immunodeficiency virus infection.
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Affiliation(s)
- D K Burns
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas 75235-9072
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