Diffuse pneumonia and acute respiratory failure due to infectious mononucleosis in a middle-aged adult

Epstein-Barr virus qPCR testing on bronchoalveolar lavage fluid from immunocompromised patients

BACKGROUND

Epstein-Barr Virus (EBV) is associated with lung disease in immunocompromised patients, particularly transplant recipients. EBV DNA testing of lower respiratory tract specimens may have diagnostic utility.

METHODS

This was a retrospective, observational study of all patients with bronchoalveolar lavage (BAL) fluids submitted for EBV qPCR testing from February 2016 to June 2022 at the Stanford Clinical Virology Laboratory.

RESULTS

There were 140 patients that underwent 251 EBV qPCR BAL tests (median 1; range 1 - 10). These patients had a mean age of 15.9 years (standard deviation, 15.1 years) and 50 % were female. Transplant recipients accounted for 67.1 % (94/140) of patients, including 67.0 % (63/94) solid organ transplant (SOT) and 33.0 % (31/94) hematopoietic cell transplant. Diagnostic testing was performed more commonly than surveillance testing [57.0 % (143/251) v. 43.0 % (108/251)]; 96.2 % (104/108) of surveillance samples were from lung transplant recipients. Excluding internal control failures, 34.7 % (83/239) of BAL had detectable EBV DNA, encompassing a wide range of viral loads (median=3.03 log10 IU/mL, range 1.44 to 6.06). Overall agreement of EBV DNA in BAL compared to plasma was 74.1 % [117/158; 95 % confidence interval (CI): 66.5 % to 80.7 %], with a kappa coefficient of 0.44 (95 % CI: 0.30 to 0.57). Only 20.1 % (48/239) of results were discussed in a subsequent clinical note, and one result (0.4 %; 1/239) changed clinical management.

CONCLUSIONS

EBV qPCR testing on BAL offers limited clinical impact. Additional biomarkers are required to improve the diagnosis of EBV-associated lung diseases.

EPSTEIN-BARR virus pneumonitis in a immunocompetent young adult

Background

Epstein-Barr virus (EBV) is a common human Herpesvirus with worldwide distribution. Primary EBV infection usually occurs early in life and typically presents as infectious mononucleosis consisting of fever, pharyngitis, hepatosplenomegaly, and lymphadenopathy. Usually, the disease course is benign and most patients recover uneventfully without any consequent sequel.

Method and results

We present a case of an immunologically normal young male in whom an acute EBV infection caused severe pneumonitis. He was treated empirically with Paracetamol, intravenous Ceftriaxone 1 gr/day plus Azithromycin 500 mg/day.

Conclusion

EBV-associated pneumonitis is rare, and treatment is usually supportive, whether antiviral agents (such as acyclovir) or steroids would be beneficial remains to be determined.

Association of COVID-19 and other viral infections with interstitial lung diseases, pulmonary fibrosis, and pulmonary hypertension: A narrative review

Background

Interstitial lung diseases (ILDs) include a broad range of diffuse parenchymal lung disorders and are characterized by diffuse parenchymal lung abnormalities leading to irreversible fibrosis. ILDs are correlated with the occurrence of pulmonary fibrosis (PF), which generally also results in pulmonary hypertension (PH). Interferons, secreted in larger amounts during viral infections, are an important possible risk factor contributing to this outcome.

Aims

In this narrative review, the role of 10 different viral infections on the generation/development of ILDs and their outcomes are described in detail. The aim of this review is to determine the probable risk that COVID-19 and other viral infections pose in the post-infection development of ILDs, PF, and PH.

Methods

Searches in PubMed (Medline), Google Scholar, Web of Science (ISI, Researcher ID, Publons), ResearchGate, Scopus, and secondary sources yielded 134 studies. After exclusion criteria, 92 studies containing the terms “Coronavirus” (COVID-19), “Interstitial Lung Diseases,” “Pulmonary Fibrosis,” “Pulmonary Hypertension” and “viral infections” were selected for inclusion. Selected articles were read with a focus on the roles of the 10 commonly studied viral infections on generation/intensification of ILDs and classified according to their dominant effect on the respiratory system, with a focus on each infection’s effects on parenchyma of the lungs and generation and/or intensification of ILDs.

Results

This review found that ILDs, PF, and PH can occur after a COVID-19 viral infection. Similar results are also seen in post-infection cases of other viral infections, including Epstein–Barr virus, Cytomegalovirus, Human herpesvirus-8, adenovirus, Hepatitis C, Torque-Teno (Transfusion-Transmitted) Virus, Human Immunodeficiency Virus, Severe Acute Respiratory Syndrome, and Middle East Respiratory Syndrome.

Conclusion

Results of current studies show probable possibility for generation and/or intensification of ILDs in COVID-19 infected patients like other studied viruses. Studies on determination of the actual prevalence of ILD, PF and PH in post-COVID-19 infected patients, follow-up studies on the prevention of ILDs in recovered COVID-19 patients, and meta-analyzed studies on pulmonary outcomes of pandemic corona viruses are strongly recommended as topics for future studies.

[Acute respiratory distress syndrome complicating Ebstein-Barr virus pneumonia]

Introduction

Chez l’adulte immunocompétent, l’Epstein Barr (EBV) entraîne une maladie autolimitée spontanément résolutive.

Observation

Un syndrome de détresse respiratoire aigu (SDRA) compliquant une pneumonie grave à EBV est rapporté avec le recours à une ventilation artificielle prolongée. Le diagnostic était confirmé par l’usage des sérologies spécifiques et la recherche de la charge d’ADN virale par PCR. À part la stratégie protectrice de la ventilation mécanique, le traitement médical a compris l’utilisation de l’Acyclovir et les immunoglobulines polyclonales dans la phase précoce ainsi que des corticoïdes systémiques dans la phase tardive. La guérison était progressive et complète.

Conclusion

La pneumonie à EBV compliquée d’un SDRA chez les immunocompétents existe. Sa prise en charge est un défi diagnostique et thérapeutique.

Infectious mononucleosis, diffuse pneumonia and acute respiratory failure in an elderly woman

Infectious mononucleosis (IM) is a benign disease and is frequently associated with mild respiratory symptoms. The pulmonary manifestations rarely dominate the clinical picture. We report a case of an older adult patient with IM who developed diffuse pneumonia and acute respiratory failure. The diagnosis of IM was confirmed serologically, whereas other possible causes of pneumonia were excluded in this study. Pulmonary manifestations of IM are discussed, and the atypical features that may be seen in older adults are simultaneously reviewed.

Chronic interstitial lung disease with lung fibrosis in a girl: uncommon sequelae of Epstein-Barr virus infection

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.