RESUMO
We present a clinical situation where a 47-year old female patient consulted with left partial ptosis and miosis that started, two weeks before, with an episode of glandular fever secondary to Epstein-Barr infection. Apraclonidine 0.5% and Phenylephrine 1% drop testing was performed with results consistent with suspected left Horner Syndrome (HS), with a probable postganglionic location. Magnetic Resonance Angiography (MRA) at the moment of the acute presentation did not show any image suggesting carotid arterial dissection but showed irregular narrowing of the left internal carotid artery on its paravertebral extracranial way, consistent to enlarged intra-carotid sheath lymphoid tissue. A week later, a Doppler ultrasound was performed, showing bilateral images compatible with internal carotid arterial dissection. When Postganglionar HS is suspected, the first aetiology to rule out is a carotid arterial dissection because of its potentially fatal outcome and for being a more described entity as postganglionic HS aetiology. However, it is also evidenced that a certain diagnose is not always possible. Furthermore, we describe the enlarged internal carotid artery sheath lymphoid tissue as a possible cause of sympathetic nerve disruption causing a Postganglionar HS, although not common.
Assuntos
Infecções por Vírus Epstein-Barr , Síndrome de Horner , Mononucleose Infecciosa , Artéria Carótida Interna/patologia , Infecções por Vírus Epstein-Barr/complicações , Infecções por Vírus Epstein-Barr/patologia , Feminino , Herpesvirus Humano 4 , Síndrome de Horner/diagnóstico , Síndrome de Horner/etiologia , Síndrome de Horner/patologia , Humanos , Mononucleose Infecciosa/complicações , Mononucleose Infecciosa/patologia , Pessoa de Meia-IdadeRESUMO
Epstein-Barr virus (EBV) is the most common cause of infectious mononucleosis (IM) and IM is a clinical syndrome typically characterized by fever, pharyngitis, and cervical lymph node enlargement. We describe the case of a 19-year-old man with IM complicated by splenic infarction. The patient visited our hospital because of upper abdominal pain without a fever and sore throat. Abdominal computed tomography revealed a low-density area in the spleen, which indicated splenic infarction. The next day, he developed a fever. After diminishing abdominal pain and fever, he developed pharyngitis accompanied by fever. Acute EBV infection was confirmed by serological tests. The patient was successfully managed with no specific therapy. Splenic infarction is a rare complication of IM and this case showed that splenic infarction can precede a fever and pharyngitis.
Assuntos
Infecções por Vírus Epstein-Barr/patologia , Mononucleose Infecciosa/patologia , Baço/patologia , Infarto do Baço/patologia , Dor Abdominal/fisiopatologia , Infecções por Vírus Epstein-Barr/diagnóstico por imagem , Infecções por Vírus Epstein-Barr/virologia , Febre/fisiopatologia , Herpesvirus Humano 4/crescimento & desenvolvimento , Herpesvirus Humano 4/patogenicidade , Humanos , Mononucleose Infecciosa/diagnóstico por imagem , Mononucleose Infecciosa/virologia , Linfadenopatia/fisiopatologia , Masculino , Faringite/fisiopatologia , Remissão Espontânea , Baço/diagnóstico por imagem , Baço/virologia , Infarto do Baço/diagnóstico por imagem , Infarto do Baço/virologia , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
Chloroquine (CQ) and hydroxychloroquine (HCQ) have been used as antiviral agents for the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection. We performed a systematic review to examine whether prior clinical studies that compared the effects of CQ and HCQ to a control for the treatment of non-SARS-CoV2 infection supported the use of these agents in the present SARS-CoV2 outbreak. PubMed, EMBASE, Scopus and Web of Science (PROSPERO CRD42020183429) were searched from inception through 2 April 2020 without language restrictions. Of 1766 retrieved reports, 18 studies met our inclusion criteria, including 17 prospective controlled studies and one retrospective study. CQ or HCQ were compared to control for the treatment of infectious mononucleosis (EBV, n = 4), warts (human papillomavirus, n = 2), chronic HIV infection (n = 6), acute chikungunya infection (n = 1), acute dengue virus infection (n = 2), chronic HCV (n = 2), and as preventive measures for influenza infection (n = 1). Survival was not evaluated in any study. For HIV, the virus that was most investigated, while two early studies suggested HCQ reduced viral levels, four subsequent ones did not, and in two of these CQ or HCQ increased viral levels and reduced CD4 counts. Overall, three studies concluded CQ or HCQ were effective; four concluded further research was needed to assess the treatments' effectiveness; and 11 concluded that treatment was ineffective or potentially harmful. Prior controlled clinical trials with CQ and HCQ for non-SARS-CoV2 viral infections do not support these agents' use for the SARS-CoV2 outbreak.
Assuntos
Febre de Chikungunya/tratamento farmacológico , Cloroquina/uso terapêutico , Infecções por HIV/tratamento farmacológico , Hepatite C Crônica/tratamento farmacológico , Hidroxicloroquina/uso terapêutico , Mononucleose Infecciosa/tratamento farmacológico , Dengue Grave/tratamento farmacológico , Verrugas/tratamento farmacológico , Alphapapillomavirus/efeitos dos fármacos , Alphapapillomavirus/imunologia , Alphapapillomavirus/patogenicidade , Antivirais/uso terapêutico , COVID-19/virologia , Febre de Chikungunya/imunologia , Febre de Chikungunya/patologia , Febre de Chikungunya/virologia , Vírus Chikungunya/efeitos dos fármacos , Vírus Chikungunya/imunologia , Vírus Chikungunya/patogenicidade , Vírus da Dengue/efeitos dos fármacos , Vírus da Dengue/imunologia , Vírus da Dengue/patogenicidade , HIV/efeitos dos fármacos , HIV/imunologia , HIV/patogenicidade , Infecções por HIV/imunologia , Infecções por HIV/patologia , Infecções por HIV/virologia , Hepacivirus/efeitos dos fármacos , Hepacivirus/imunologia , Hepacivirus/patogenicidade , Hepatite C Crônica/imunologia , Hepatite C Crônica/patologia , Hepatite C Crônica/virologia , Herpesvirus Humano 4/efeitos dos fármacos , Herpesvirus Humano 4/imunologia , Herpesvirus Humano 4/patogenicidade , Humanos , Mononucleose Infecciosa/imunologia , Mononucleose Infecciosa/patologia , Mononucleose Infecciosa/virologia , SARS-CoV-2/imunologia , SARS-CoV-2/patogenicidade , Dengue Grave/imunologia , Dengue Grave/patologia , Dengue Grave/virologia , Resultado do Tratamento , Verrugas/imunologia , Verrugas/patologia , Verrugas/virologia , Tratamento Farmacológico da COVID-19RESUMO
Wakefield's harmful dysfunction analysis asserts that the concept of medical disorder includes a naturalistic component of dysfunction (failure of biologically designed functioning) and a value (harm) component, both of which are required for disorder attributions. Muckler and Taylor, defending a purely naturalist, value-free understanding of disorder, argue that harm is not necessary for disorder. They provide three examples of dysfunctions that, they claim, are considered disorders but are entirely harmless: mild mononucleosis, cowpox that prevents smallpox, and minor perceptual deficits. They also reject the proposal that dysfunctions need only be typically harmful to qualify as disorders. We argue that the proposed counterexamples are, in fact, considered harmful; thus, they fail to disconfirm the harm requirement: incapacity for exertion is inherently harmful, whether or not exertion occurs, cowpox is directly harmful irrespective of indirect benefits, and colorblindness and anosmia are considered harmful by those who consider them disorders. We also defend the typicality qualifier as viably addressing some apparently harmless disorders and argue that a dysfunction's harmfulness is best understood in dispositional terms.
Assuntos
Doença/psicologia , Teoria Ética , Filosofia Médica , Varíola Bovina/patologia , Varíola Bovina/psicologia , Humanos , Mononucleose Infecciosa/patologia , Mononucleose Infecciosa/psicologiaRESUMO
Epstein-Barr virus (EBV) is the main cause of infectious mononucleosis (IM), a self-limiting infection among immunocompetent patients. EBV is also implicated in the development of several malignancies. We describe a case of a previously healthy 34-year-old man who presented with non-tender, enlarging, right cervical lymphadenopathy for over a year that was associated with significant weight loss, fevers, and night sweats. Two fine needle core biopsies showed inconclusive then reactive tissue, respectively. A third excisional biopsy demonstrated a reactive lymph node with EBV-positive IM. There was no evidence of lymphoma by histologic examination or flow cytometry. A diagnosis of chronic active EBV (CAEBV) was rendered. Subsequent lymph node debulking six months later showed classic Hodgkin lymphoma (CHL) positive for EBV. The patient underwent chemotherapy with full treatment response. This is an unusual presentation of EBV infection that led to either a delayed onset or delayed diagnosis of CHL.
Assuntos
Infecções por Vírus Epstein-Barr/complicações , Doença de Hodgkin/patologia , Doença de Hodgkin/virologia , Mononucleose Infecciosa/patologia , Adulto , Biópsia por Agulha Fina , Erros de Diagnóstico , Infecções por Vírus Epstein-Barr/diagnóstico , Infecções por Vírus Epstein-Barr/patologia , Doença de Hodgkin/diagnóstico , Humanos , Mononucleose Infecciosa/diagnóstico , Linfonodos/patologia , MasculinoRESUMO
The Epstein-Barr virus (EBV) induces B-cell proliferation with high efficiency through expression of latent proteins and microRNAs. This process takes place in vivo soon after infection, presumably to expand the virus reservoir, but can also induce pathologies, e.g. an infectious mononucleosis (IM) syndrome after primary infection or a B-cell lymphoproliferation in immunosuppressed individuals. In this paper, we investigated the growth characteristics of EBV-infected B-cells isolated from transplant recipients or patients with IM. We found that these cells grew and withstood apoptosis at highly variable rates, suggesting that the expansion rate of the infected B-cells widely varies between individuals, thereby influencing the size of the B-cell reservoir and the ability to form tumors in infected individuals. All viruses investigated were type 1 and genetically close to western strains. EBV-infected B-cells expressed the transforming EBV latent genes and microRNAs (miRNAs) at variable levels. We found that the B-cell growth rates positively correlated with the BHRF1 miRNA levels. Comparative studies showed that infected B-cells derived from transplant recipients with iEBVL on average expressed higher levels of EBV miR-BHRF1 miRNAs and grew more rapidly than B-cells from IM patients, suggesting infection by more transforming viruses. Altogether, these findings suggest that EBV infection has a highly variable impact on the B-cell compartment that probably reflects the genetic diversity of both the virus and the host. It also demonstrates the unexpected finding that B-cells from different individuals can grow at different speed under the influence of the same virus infection.
Assuntos
Linfócitos B/virologia , Regulação Viral da Expressão Gênica , Genes Virais , Herpesvirus Humano 4/genética , Hospedeiro Imunocomprometido , Mononucleose Infecciosa/virologia , MicroRNAs/genética , Adulto , Idoso , Linfócitos B/imunologia , Linfócitos B/patologia , Linhagem Celular Transformada , Proliferação de Células , Feminino , Transplante de Células-Tronco Hematopoéticas , Herpesvirus Humano 4/crescimento & desenvolvimento , Herpesvirus Humano 4/metabolismo , Interações Hospedeiro-Patógeno/genética , Interações Hospedeiro-Patógeno/imunologia , Humanos , Mononucleose Infecciosa/imunologia , Mononucleose Infecciosa/patologia , Transplante de Rim , Masculino , MicroRNAs/imunologia , Pessoa de Meia-Idade , Cultura Primária de Células , Proteínas Virais/genética , Proteínas Virais/imunologiaAssuntos
Febre/virologia , Herpesvirus Humano 4 , Mononucleose Infecciosa/patologia , Faringite/virologia , Adolescente , Febre/patologia , Humanos , Hipertrofia/virologia , Mononucleose Infecciosa/virologia , Masculino , Pescoço/patologia , Pescoço/virologia , Tonsila Palatina/patologia , Tonsila Palatina/virologia , Faringite/patologiaRESUMO
OBJECTIVES: Spontaneous rupture of the spleen is occasionally seen as the presenting event in infectious mononucleosis (IM). Diagnosis of these cases can be very challenging. METHODS: We describe the morphologic and immunohistochemical findings in a series of seven splenectomy specimens removed after spontaneous rupture in patients with IM. Most cases were submitted for a second opinion since the histology of the cases suggested malignant lymphoma. RESULTS: All the cases showed similar findings, with red pulp expansion occupied by activated T and B cells, including scattered large lymphocytes with both T- and B-cell markers, together with a polymorphic background rich in cytotoxic T cells. Clonality analysis revealed T-cell receptor clonal patterns in four of the six cases evaluated. CONCLUSIONS: IM should be considered a possible diagnosis in any case of splenic rupture whose histology suggests possible aggressive lymphoma.
Assuntos
Mononucleose Infecciosa/diagnóstico , Linfócitos/metabolismo , Linfoma/diagnóstico , Ruptura Esplênica/etiologia , Adolescente , Adulto , Biomarcadores/metabolismo , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Mononucleose Infecciosa/complicações , Mononucleose Infecciosa/patologia , Masculino , Ruptura Espontânea , Esplenectomia , Ruptura Esplênica/diagnóstico , Ruptura Esplênica/patologia , Ruptura Esplênica/cirurgia , Adulto JovemAssuntos
Linfadenite Histiocítica Necrosante , Mononucleose Infecciosa , Adulto , Linfadenite Histiocítica Necrosante/diagnóstico , Linfadenite Histiocítica Necrosante/imunologia , Linfadenite Histiocítica Necrosante/metabolismo , Linfadenite Histiocítica Necrosante/patologia , Humanos , Mononucleose Infecciosa/diagnóstico , Mononucleose Infecciosa/imunologia , Mononucleose Infecciosa/metabolismo , Mononucleose Infecciosa/patologia , MasculinoAssuntos
Reparo do DNA , Mononucleose Infecciosa/genética , Proteína Rad52 de Recombinação e Reparo de DNA/genética , Imunodeficiência Combinada Severa/genética , Adolescente , Ciclo Celular/efeitos dos fármacos , Quebras de DNA de Cadeia Dupla , Fibroblastos/efeitos dos fármacos , Fibroblastos/imunologia , Fibroblastos/patologia , Herpesvirus Humano 4/patogenicidade , Herpesvirus Humano 4/fisiologia , Humanos , Mononucleose Infecciosa/imunologia , Mononucleose Infecciosa/patologia , Masculino , Mitomicina/farmacologia , Modelos Moleculares , Conformação Proteica em alfa-Hélice , Conformação Proteica em Folha beta , Proteína Rad52 de Recombinação e Reparo de DNA/química , Proteína Rad52 de Recombinação e Reparo de DNA/imunologia , Imunodeficiência Combinada Severa/imunologia , Imunodeficiência Combinada Severa/patologiaRESUMO
BACKGROUND: The infectious mononucleosis (IM) includes clue elements, apoptotic and atypical lymphocytes. In IM, the evaluation of dot plot provided by Sysmex XN-1000 analyzer revealed a stretched lymphocytic cluster, white cell differential channel (WDF), on cytogram. METHODS: In this study, we analyzed 698 samples that include 39 IM, 76 chronic lymphoproliferative disorders, 25 nonclonal lymphocytosis, and 40 healthy donors. Five hundred eighteen samples with other diseases or interference were evaluated. The algorithm was validated on 40,000 files that were received from internal database of Sysmex-Dasit. RESULTS: The analysis of flow cytometry standard (FCS) files in WDF channel and presumed apoptotic lymphocytes counts on side scatter/forward scatter (SSC/FSC) and SSC/SFL (where SFL is side fluorescence) dot plot revealed excellent correlation among apoptotic cells on peripheral blood smear (R(2) = 0.79 and 0.75). There was a variation of positional parameters in lymphocyte clusters WX, WY, and WZ. If WX-SSC > 500 and WY-SFL > 1,000 and WZ-FSC > 700, specificity equals to 99% and sensitivity equals to 100%. If nucleated red blood cell (NRBC) <0.03 × 10(3) /µl, specificity equals to 100%. In received files, positives were 1% adding the simultaneous presence of a percentage of events in the two gates relating to the apoptotic lymphocytes of 1.2% of WBC. CONCLUSION: On Sysmex XN-1000, dot-plot observation allowed immediate detection of IM. Meanwhile, an algorithm based on the parameters on these plots can be calculated with excellent performance.
Assuntos
Apoptose , Biomarcadores/metabolismo , Testes Hematológicos/instrumentação , Testes Hematológicos/métodos , Mononucleose Infecciosa/patologia , Linfócitos/patologia , Humanos , Microscopia , Curva ROC , Reprodutibilidade dos Testes , Espalhamento de Radiação , SíndromeRESUMO
Prospective studies of antibodies to multiple Epstein-Barr virus (EBV) proteins and EBV neutralizing antibodies in the same individuals before, during, and after primary EBV infection have not been reported. We studied antibody responses to EBV in college students who acquired primary EBV infection during prospective surveillance and correlated the kinetics of antibody response with the severity of disease. Neutralizing antibodies and enzyme-linked immunosorbent assay (ELISA) antibodies to gp350, the major target of neutralizing antibody, reached peak levels at medians of 179 and 333 days after the onset of symptoms of infectious mononucleosis, respectively. No clear correlation was found between the severity of the symptoms of infectious mononucleosis and the peak levels of antibody to individual viral proteins or to neutralizing antibody. In summary, we found that titers of neutralizing antibody and antibodies to multiple EBV proteins increase over many months after primary infection with EBV.
Assuntos
Anticorpos Neutralizantes/sangue , Anticorpos Antivirais/sangue , Herpesvirus Humano 4/imunologia , Mononucleose Infecciosa/imunologia , Imunidade Adaptativa , Ensaio de Imunoadsorção Enzimática , Humanos , Mononucleose Infecciosa/patologia , Testes de Neutralização , Estudos Prospectivos , Índice de Gravidade de Doença , Estudantes , Fatores de TempoRESUMO
We report the outcome of 30 consecutive patients with Hodgkin disease (HD) who underwent single-unit UCBT. Most (90%) patients had failed previous autologous hematopoietic stem cell transplantation. The conditioning regimens were based on combinations of thiotepa, busulfan, cyclophosphamide or fludarabine, and antithymocyte globulin. The cumulative incidence (CI) of myeloid engraftment was 90% [95% confidence interval (C.I.), 74-98%] with a median of 18 d (range, 10-48). CI of acute graft-versus-host disease (GvHD) grades II-IV was 30% (95% C.I., 17-44%), while the incidence of chronic GVHD was 42% (95% C.I., 23-77%). The non-relapse mortality (NRM) at 100 d and 4 yr was 30% (95% C.I., 13-46%) and 47% (95% C.I., 29-65%), respectively. EBV-related post-transplant lymphoproliferative disease (EBV-PTLD) accounted for more than one-third of transplant-related death, with an estimate incidence of 26% (95% C.I., 9-44). The incidence of relapse at 4 yr was 25% (95% C.I., 9-42%). Four-year event-free survival (EFS) and overall survival (OS) were 28% and 30%, respectively. Despite a high NRM and an unexpected high incidence of EBV-PTLD, UCBT in heavily pretreated HD patients is an option for patients lacking a suitable adult donor, provided the disease is not in refractory relapse.