ABSTRACT
Objective To study the clinical characteristics of chronic active Epstein-Barr virus (EBV) infection (CAEBV) in children and to provide a basis for the diagnosis and treatment of CAEBV.Methods Clinical data,laboratory serology,pathological examination,treatment and follow-up results of 10 cases with CAEBV infection who were treated in Xijing Hospital of the Fourth Military Medical University from January 2008 to January 2016 were analyzed retrospectively.Results CAEBV major manifestations were continuous or intermittent fever,hepatomegaly,splenomegaly and lymphadenopathy,and others,including general fatigue,cough,hematemesis,diarrhea,skin rash,jaundice,sore throat,muscle joint pain,and so on.And with liver dysfunction,hematologic abnormality,and so on.All patients in anti-EB virus capsid antigen IgG (EBVCA-IgG)antibodies and EBEA-IgG antibodies had positive,while all patients in EBVCA-IgM antibodies had negative.The median load of EBV-DNA detected by real-time polymerase chain reaction(PCR) in the peripheral blood was 7.15× 105 copies/ml.Six of 10 cases CAEBV patients presented a poor clinical course,1 case died from intracranial hemorrhage,2 cases from respiratory failure,1 case from gastrointestinal bleeding,1 case from liver failure,1 case from severe multiple pathogens infection,rest 3 cases showed an improvement and 1 cases had a recurrence.Conclusion CAEBV infection has varieties of clinical features,with poor prognosis and high mortality.If the patients had unexplained fever,hepatomegaly,splenomegaly and lymphadenectasis,we should be timely detect virology and histopathological to diagnosis as early as possible.
ABSTRACT
Objective To study the characteristics of immune function,Epstein-Barr virus(EBV) antibodies and EBV-DNA in children with different clinical types of EBV infection,which provide basis for prevention and treatment of EBV infection.Methods Clinical data of 103 patients suffering from EBV infection were retrospectively analyzed in Xijing Hospital of the Fourth Military Medical University.A total of 103 children were divided into infectious mononualeosis(IM) group(n=68),chronic active Epstein-Barr virus infection(CAEBV) group(n=13) and Epstein-Barr virus-related hemophagocytic lymphohistiocytosis(EBV-HLH) group(n=22).The changes of EBV antibodies,EBV-DNA,immunoglobulin levels,lymphocyte subpopulation and complement series were detected and compared among the three groups.A total of 26 healthy children at the same stage were enrolled as a control group,immunoglobulin levels,lymphocyte subpopulation and complement series were detected in control group,then compared with the rest of the three groups.Results The levels of C3 and C4 in CAEBV group and EBV-HLH group were significantly decreased than those in the control group(P0.05).CD8+T cells in IM group significantly increased than those in the rest of the three groups(P<0.05,respectively).T cells,CD8+T cells,CD4+ T cells,CD4+/CD8+ ratios,NK cells,B cells of EBV-HLH group significantly decreased than those in the rest of the three groups(P<0.05).The positive rates of EBV antibodies in CAEBV group and IM group were significantly higher than those in EBV-HLH group(P<0.05).EBV-DNA in EBV-HLH group were significantly higher than those of CAEBV group and IM group(P<0.05).Conclusion EBV-DNA levels in the serum are positively correlated with disease types and severity,the pathogenesis of IM,CAEBV and EBV-HLH induced by EBV infection are associated with immune dysfunction.Dynamic monitoring of EBV load and cell immune function can reflect disease status and progress risk.
ABSTRACT
Aim To study cytokine(CK) changes of IL-6,IL-8,sIL-2R and TNF-a levels in sera from patients with juvenile rheumatoid arthritis(JRA) and rheumatoid arthritis(RA) and its correlation with the conventional inflammation indexes,erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP). Methods Levels of IL-6,IL-8,sIL-2R and TNF-a in serum from 30 JRA patients and 34 RA patients,in the synovial fluid (SF)from 4 JRA patients,7 RA patients,6 osteoarthritis(OA) patients and 9 meniscitis(MT) patients were detected by sandwich ELISA. Results As compared with control group,① levels of IL-6 and SIL-2R in sera from 30 JRA patients and 34 RA patients and levels of IL-8 in sera from 30 JRA patients possessed marked difference P∨ 0.01 and P∨ 0.05,respectively.② There were significant difference among serum IL-8 and sIL-2R levels from systemic JRA patients, pauciaticular JRA patients,and serum IL-6 levels from polyarticular JRA patients(P<0.01). ③ There were remarkable difference among SF sIL-2R levels from 4 JRA patients and 7 RA patients and in SF IL-6 levels from 7 with RA patients.④ There were obvious correlativity between serum IL-6,sIL-2R levels and changes of serum ESR and CRP from the JRA patients(r=0.532 and r=0.621,respectively). Conclusion ① IL-6 and sIL-2R exhibit a close correlativity with the activity of JRA and RA,which is the main index of activity of JRA and RA diseases.② sIL-2R might not only participate in systemic pathologic process in JRA and RA diseases,but also serves as a major CK in local articular injuries.IL-6 participates in local articular injuries too,and seems to play a more important role in local articular injuries of RA.③ IL-8 may participate in systemic pathologic process of JRA,but play a minor part in local articular injuries.