Chronic active epsteinbarr virus infection caebv is a very rare complication of an epstein barr virus ebv. The disease is progressive with markedly elevated levels of ebv dna in the blood and infiltration of organs by ebvpositive lymphocytes. Its also called the kissing disease because of one way you can spread it to. Infectious mononucleosis is the prototype ebv infection and is characterized by fever, sore throat, cervical and generalized lymphadenopathy, hepatosplenomegaly, and somatic complaints of. Mildly abnormal liver function tests lfts are common but symptomatic hepatitis is rare. Although most humans coexist with the virus without serious sequelae, a small proportion will develop tumors. Epsteinbarr virus infection occurs worldwide and most commonly arises in early childhood, with a second peak occurring during late adolescence.
Epstein barr virus hepatitis european journal of internal medicine. Epsteinbarr virus hepatitis in an immunocompetent patient with syphilis. Pdf primary epsteinbarr virus infection ebvi in children is usually asymptomatic with seroconversion. Acute cholestatic hepatitis induced by epsteinbarr virus. I nfectious mononucleosis is a clinical syndrome caused by epsteinbarr virus ebv that is particularly common in adolescents and children. Infectious mononucleosis is primarily caused by epsteinbarr virus ebv and is a common diagnosis made in emergency departments worldwide. After completing this article, the reader should be able to. The nab2 line, which was established from a north american.
Viral infections such as hepatitis c hcv, b hbv and epsteinbarr virus ebv. It is best known as the cause of infectious mononucleosis mono or glandular fever. Pdf on may 25, 2018, hany ibrahim and others published prevalence of epsteinbarr virus and hepatitis b virus. The most common manifestation of primary infection with this organism is acute infectious mononucleosis, a selflimiting clinical syndrome that most frequently affects adolescents and young adults. Normal host populations can have vastly different susceptibility to ebvrelated tumors as demonstrated by geographical and immunological variations in the prevalence. Barr virus ebv is part of the herpesvirus family that. P19 symptomatic epstein barr virus ebv hepatitis is. Patients often present with fever, lymphadenopathy, splenomegaly, ebv hepatitis, or.
Aim to describe a case of an eightyearold boy with chronic epsteinbarr virus ebv hepatitis with incipient cirrhosis, rarely found in practice. Epsteinbarr virus ebv is a widely disseminated herpesvirus that is spread by intimate contact between susceptible persons and asymptomatic ebv shedders. Epsteinbarr virus hepatitis associated withicterus. You might know this disease better by its nickname, mono. The syndrome of infectious mononucleosis is commonly seen with epsteinbarr virus ebv infection. Epsteinbarr virus as a trigger of autoimmune liver diseases. Infectious mononucleosis due to epsteinbarr virus ebv infection sometimes causes acute hepatitis, which is usually selflimiting with mildly elevated transaminases, but rarely with jaundice. We report ebv associated hepatitis that occurred in an immunocompetent 28yearold woman with concomitant syphilis infection. Most individuals with epsteinbarr virusassociated infectious mononucleosis recover with supportive therapy.
There also have been scores of recorded cases of viral hepatitis caused by herpes simplex virus. Abnormal liver blood tests are common in epsteinbarr virus ebv infection, but symptomatic hepatitis is rare. We describe a case of infectious mononucleosis that presented with cholestatasis, and summarize 23 cases from the literature to categorize this increasingly recognized clinical spectrum of ebv infection induced cholestatic hepatitis. Epsteinbarr virus and cancer clinical cancer research. The patient being reported showcases ebv infection with jaundice, which is an uncommon scenario.
In this report we present a rare case of esophageal rupture that. Hepatitis b vaccination and hepatitis b immune because there is a high risk of acquiring hbv from a needlestick injury, health care profession. However, infectious mononucleosis may be associated with several acute complications. To measure the virus load in patients with symptomatic epsteinbarr virus ebv infections, we used a realtime pcr assay to quantify the amount of ebv dna in blood. Serological cross reactivity to cmv and ebv causes problems. Epsteinbarr virus is a member of the herpesviridae family and consists of a linear, doublestranded dna core surrounded by a nucleocapsid and viral envelope. Epsteinbarr virus ebv is a widely diffused herpesvirus that is spread by close contact between susceptible persons and asymptomatic ebv shedders.
Epsteinbarr virus reactivation the lancet infectious diseases. The impact of hepatitis b virus and epsteinbarr virus in. Enhancement of hepatitis c virus replication by epstein. Frontiers chronic active epsteinbarr virus disease. The viral load of epsteinbarr virus ebv dna in peripheral. The majority of patients with infectious mononucleosis recovers without apparent sequelae. We present a case of a 6yearold boy with fever, vomiting. Epsteinbarr virusassociated cholestatic hepatitis bmj. Epsteinbarr virus ebv is the most common cause of infectious mononucleosis, but other viruses can also cause this disease. These cases demonstrate that cholestatic hepatitis may be more common than initially thought. Fulminant epsteinbarr virus journal of medical case reports. Nov 30, 2010 ebv is a linear, doublestranded, dna herpesvirus that infects and persists in 90% of humans worldwide. Introduction epstein barr virus ebv infection typically presents as infectious mononucleosis im in young adults with the classical triad of fever, sore throat and lymphadenopathy. Ebv is not generally considered a hepatotrophic virus, unlike the hepatitis a virus, which infects hepatocytes selectively, resulting in an acute inflammatory response and ballooning degeneration.
Three months after giving birth to a healthy child, she was hospitalized because of fatigue, nausea, and upper abdominal pain. Quantitative analysis of epsteinbarr virus load by using a. Department of gastroenterology and hepatology, sir charles gardiner hospital. We were interested in the detection and quantification of cellfree plasma ebvdna as an indicator of biological and clinical characteristics in ebvassociated hl. Mono is an extremely common illness in children and young adults, with many cases being mild and resolving promptly without the patient feeling sick enough to. Liver biopsy was performed on the ninth hospi tal day. It is common among teenagers and young adults, especially college students. Jun 12, 2017 however, the term hepatotropic is itself a misnomer.
In this report we presented a patient with icteric im hepatitis who have atypical lymphocytes on his peripheral blood smear. Describe the epidemiology and transmission of epsteinbarr virus ebv among children, adolescents, and adults. Hbv and ebv coinfection may cause severe acute hepatitis with hbv chronicity. Pdf epstein barr virus hepatitis diamantis kofteridis. Quantitative analysis of epsteinbarr virus load by using. Infectious mononucleosisaka mono what is infectious mononucleosis. However, in this cohort of patients, ebv hepatitis is less common than locally acquired hepatitis e. The virus was first discovered in 1964 when sir michael anthony epstein and ms.
Sep 01, 2011 epsteinbarr virus infection results in a spectrum of diseases, with the host immune response playing a key role in shaping the clinical manifestations. A range of histopathologic features can be observed in ebv hepatitis, but the most characteristic histologic feature is a diffuse lymphocytic sinusoidal. Infectious mononucleosis hepatitis in young adults. Approximately 90% of adults will have antibodies for ebv.
Pdf dual infection with hepatitis b and epsteinbarr virus. She became acutely unwell with clinical features consistent with. Autoimmune hepatitis following epsteinbarr virus infection. Epsteinbarr virus ebv is a ubiquitous human virus which infects almost all humans during their lifetime and following the acute phase, persists for the remainder of the life of the individual. Characteristics of epsteinbarr virus hepatitis among. Epsteinbarr virus is integrated between rel and bcl11a.
Ebvassociated colitis mimicking ibd in an immunocompetent. Iddf2019abs0020 acute cholestatic hepatitis induced by. Autoimmune hepatitis type 1 aih 1 is a disease of unknown etiology, which can affect children, especially girls. Hepatitis e virus, epsteinbarr virus, immunosuppression, rheumatoid. Detection of ebv, hbv, hcv, hiv1, htlvi and ii, and smrv. Epsteinbarr virus ebv is a member of the herpesvirus family that can infect humans. Symptomatic, icteric, ebv hepatitis is rarely reported in those with im and in the elderly. Epsteinbarr virus ebv infection frequently involves the liver, presenting as elevations in transaminases. Acute hepatitis due to infectious mononucleosis bmj case. The epsteinbarr virus ebv is present in the malignant hodgkinreedsternberg hrs cells of 20% to 40% cases of hodgkin lymphoma hl in western countries. The most common types of hepatitis can be prevented or treated. Dec 22, 2017 chronic active epsteinbarr virus caebv disease is a rare disorder in which persons are unable to control infection with the virus.
Describe the pathogenesis and natural course of ebv infection and the spectrum of clinical diseases in healthy and immunocompromised persons. The demographics, clinical features and outcome of ebv hepatitis are incompletely understood, particularly in the elderly people. Jan 14, 2020 the epsteinbarr virus ebv is a doublestranded dna. Ebv can affect virtually all body systems and has been associated with such different disease manifestations as acute cholestasis or hepatitis 2,3 infectious mononucleosis is an acute viral disease in children and young with a. Epsteinbarr virus europe pmc article europe pubmed central. Pdf epsteinbarr virus and autoimmune hepatitis meera. Methods a 24 years old young man with a febrile illness was noted to have a cholestatic picture of deranged liver function tests. The disease is progressive with markedly elevated levels of ebv dna in the blood and infiltration of organs by ebv positive lymphocytes. Comparison between cytomegalovirus hepatitis and epsteinbarr. Youngonset gastric cancer and epsteinbarr virus ebv a. Epsteinbarr virus ebv initially isolated from the cultured burkitt lymphoma bl cells, is one of the wellknown oncogenic virus. This is a report of a case of epsteinbarr virus ebv associated haemophagocytic syndrome in a 17 year old woman with antibody deficiency. Evidence is support and against a role of epsteinbarr virus ebv in autoimmune liver disease aild. Epsteinbarr virus ebv is a gamma herpes virus which infects humans around the world with high prevalence.
The association with the welldefined immunocompromised status of the host malignancies, hiv infection, etc is well known. Epsteinbarr virus is integrated between rel and bcl11a in. Comparison between cytomegalovirus hepatitis and epstein. Chronic active epsteinbarr virus caebv disease is a rare disorder in which persons are unable to control infection with the virus. How i treat tcell chronic active epsteinbarr virus disease. Epsteinbarr virus reactivation the lancet infectious.
Some people with ebv will develop infectious mononucleosis or other illnesses, and will recover from their illness with no other. Acute hepatitis with focal parenchymal necrosis, as well as extensive periportal and sinusoidal mononucle ar infiltration, were. Caebv infection is a persistent ebv infection in combination with infectious mononucleosis like symptoms in individuals without apparent immunodeficiency. Pdf epsteinbarr virus hepatitis associated withicterus.
Acute cholestatic hepatitis without features of infectious mononucleosis is a rare presentation of primary epsteinbarr infection, with only several cases previously reported in the medical literature. Epstein barr virus, abdominal pain, and jaundice the bmj. Pdf prevalence of epsteinbarr virus and hepatitis b virus. In 1968, the virus was linked to the disease infectious mononucleosis glandular fever infection with epsteinbarr virus ebv is common and usually occurs in childhood or early adulthood. After completing this article, readers should be able to. In the following report, we present a patient with acute isolated hepatitis due to laboratory confirmed epsteinbarr virus. Ebv infections are very common youve probably already contracted the virus without even knowing it. In order to determine the factors responsible for the differentiation of cytomegalovirus cmv hepatitis and epsteinbarr virus ebv hepatitis in previously healthy adults, the clinical features and laboratory data of both types of hepatitis were retrospectively analyzed. We describe a case of infectious mononucleosis that presented with cholestatasis. Jun 28, 2018 tcell chronic active epsteinbarr virus caebv is a rare disease in which ebv is present predominantly in t cells that infiltrate the tissues. The reactivation of ebv is a very important issue, and several factors can contribute to the process. Aid in the diagnosis of ebv infection infectious mononucleosis and ebv reactivation in conjunction with other serologic tests. The infection is mostly asymptomatic in children under 5 years, but it causes infectious mononucleosis syndrome in young adults characterized by fever, tonsillitis exudative or nonexudative and lymphadenopathy.
Primary ebv infection in children is usually asymptomatic, but in a small number of healthy individuals, typically young adults, ebv. Ebv hepatitis is an uncommon cause of hepatitis but, at least in patients presenting to the jhl clinic in cornwall uk, it is more common than either hepatitis a or acute hepatitis b. A 22 year old man presented to the emergency department with abdominal pain, jaundice, itching, and fever. In addition to common types of viral hepatitis, ie, hepatitis a, hepatitis b, and hepatitis c viruses, epsteinbarr virus ebv may result in hepatitis in some cases.
For two years before this presentation, serology showed abnormally high titres to ebv early antigen, suggestive of persistent infection with ebv. Epsteinbarr is the virus that causes mononucleosis. We investigated more than 460 primate cell lines for epsteinbarr ebv, hepatitis b hbv, hepatitis c hcv, human immunodeficiency virus type 1 hiv1, human tcell leukemialymphoma virus i and ii htlviii, and squirrel monkey retrovirus smrv infections for risk. The following is the supplementary data related to this article. Infectious mononucleosis, also called mono, is a contagious disease. For the purposes of the calculations in this report, the committee estimated that there are 118,546 new infections with epsteinbarr virus ebv each year in the united states.
Global status is one in a series of gideon ebooks which explore all individual infectious diseases, drugs, vaccines, outbreaks, surveys and pathogens in every country of the world. P19 symptomatic epstein barr virus ebv hepatitis is uncommon. Syphilis reactivates latent epsteinbarr virus reservoir. Ebv can affect virtually all body systems and has been associated with such different disease manifestations as acute cholestasis or hepatitis 2,3 infectious mononucleosis is an acute viral disease in children and. Epsteinbarr virus hepatitis is typically diagnosed clinically. Detection of hepatitis b and woodchuck hepatitis viral dna in plasma and mononuclear cells from heparinized blood by the polymerase chain reaction. Epsteinbarr virus ebv infection has the potential to establish lifelong, benign infections in their hosts. Alf management is very different acute hepatitis alf ast andor alt 400 yes yes inr jul 03, 2016 infectious mononucleosis im is usually a selflimiting infection, most often caused by epsteinbarr virus ebv, which is a human herpes virus. Epsteinbarr virus hepatitis can cause transient hepatopulmonary. Infections with hepatitis viruses, especially hbv and hbc, have been associated with a wide variety of extrahepatic manifestations. The high prevalence of contaminated cell cultures suggests that viral contaminations might be distributed among cultures. Recommendations all children at age 1 year eople experiencing p homelessness eople traveling to or working p in countries that have high or.
The infection occurs primarily in teenagers and young adults. We describe a case of a young man with autoimmune hepatitis aih following epsteinbarr virus ebv infection, in whom a long followup showed favourable outcome with complete clinical recovery and failure to relapse after cessation of immunosuppressive therapy. Elevated liver enzymes accompanied by infectious mononucleosis syndrome are widely seen in primary epsteinbarr virus infection while acute symptomatic hepatitis without typical presentations of ebv is extremely rare. Infrequent causes of viral hepatitis include adenovirus, cytomegalovirus cmv, epsteinbarr virus ebv and, rarely, herpes simplex virus hsv. Acute hepatitis e virus infection with coincident reactivation of. Chronic active epsteinbarr virus infection genetic and. Epsteinbarr virus ebv reactivation and therapeutic. Epsteinbarr virus is associated with a wide variety of clinical manifestations and can present as cholestatic hepatitis with or without features of infectious mononucleosis. Subclinical and transient transaminase elevations are a wellestablished sequela of ebv. Epsteinbarr virus ebv or human herpesvirus 4, is a b lymphotropic gammaherpesvirus that infects more than 90% of the worlds population. Background acute cholestatic hepatitis without features of infectious mononucleosis is a rare presentation of primary epsteinbarr virus ebv infection, with only several cases previously reported in the medical literature. Early investigation for epsteinbarr virus in febrile patients with deranged liver function tests and no demonstrable biliary obstruction on imaging can expedite both diagnosis and treatment.
Early investigation for epsteinbarr virus in febrile patients with deranged liver function tests and no demonstrable biliary obstruction on imaging can expedite both diagnosis. However, approximately 10% of those with im are not acutely infected with ebv and many of these have symptoms attributable to cytomegalovirus cmv infection. The appearance of igg antibodies to early antigendiffuse ead is generally associated with the primary acute stage of ebv infection. Evidence in support of ebv in the pathogenesis of autoimmune hepatitis aih is largely based around case reports noting the development of aih following ebv infection. The epsteinbarr virus ebv, formally called human gammaherpesvirus 4, is one of the nine known human herpesvirus types in the herpes family, and is one of the most common viruses in humans. Hepatitis a and hepatitis b can be prevented by vaccination. In addition, chronic hepatitis linked to ebv infection has rarely been reported and in general was not well documented 9, 10. Patients often present with fever, lymphadenopathy, splenomegaly, ebv hepatitis, or pancytopenia. Infectious mononucleosis mono is an illness caused by several viral agents, most commonly the epsteinbarr virus ebv. Symptomatic, icteric, ebv hepatitis is rarely reported in those with im and in. Cmv hepatitis showed a tendency to increase in our departement.
Ebstein barr virus ebv infection during childhood is mainly asymptomatic, whereas infectious mononucleosis, with clinical signs such as fever, pharyngitis, lymphadenopathy, hepatosplenomegaly and hepatocellular dysfunction, occurs in at least 50% of adolescents and adults with primary infection. While the diagnosis is often suggested by serological testing, epsteinbarr virus polymerase chain reaction is a new noninvasive laboratory study that can. Epsteinbarr virus ebv, a member of the herpesvirus family, infects oropharyngeal epithelial cells and b cells, resulting in an expansion of cytotoxic cd8 t cells and consequent atypical lymphocytosis. Ebv infects b lymphocytes leading to their immortalisation, with persistence of the ebv genome as an episome. Epsteinbarr virus infection is common in children, usually presenting as infectious mononucleosis, including fever, tonsillitis and lymphadenopathy associated with selfresolving increase in transaminases. Ebv is the primary agent of infectious mononucleosis im, persists asymptomatically for life in nearly all adults, and is associated with the development of b cell lymphomas, t cell. Pdf epstein barr virus infections global status download. We estimated the virus load in peripheral blood mononuclear cells pbmnc from patients with symptomatic ebv infections. Other viruses can also cause liver inflammation, including cytomegalovirus, epsteinbarr virus, and yellow fever. Ebv infection associated hepatitis, presenting with hyperbilirubinemia is rare. Serological cross reactivity to cmv and ebv causes problems in the diagnosis of acute hepatitis e virus infection. Hepatitis b virus hbv which affects the liver and the epsteinbarr virus ebv which consider as one of the. Antibodies to epsteinbarr virus showed evidence of past infection. Cholestasis is rare in children with only a few cases reported but it was described in up to 55% of the adult population affected.
It may cause acute hepatitis, which is usually selflimiting and characterised by mildly elevated liver enzymes, but rarely jaundice. The realtime pcr assay could detect from 2 to over 107 copies of ebv dna with a wide linear range. However, acute cholestatic hepatitis is a rare complication. Infectious mononucleosis is a clinical syndrome most commonly associated with primary epsteinbarr virus infection. Most people about 95% by adulthood become infected by ebv at some point of their lives and never have any health problems. Yvonne barr found it in a burkitt lymphoma cell line. Epsteinbarr virus ebv, a member of the family of herpes viruses, infects up. To identify the demographics, presenting features and natural history of ebv hepatitis.
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