Disseminated Epstein
Download
Report
Transcript Disseminated Epstein
Epstein Barr Virus in
Immunosuppressed Host
Epstein Barr Virus
= Human herpesvirus 4
Infects more than 95% of the world's population.
Humans are the only known reservoir of Epstein-Barr virus.
EBV is present in oropharyngeal secretions and is most commonly
transmitted through saliva.
The virus replicates in nasopharyngeal epithelial cells.
Viral replication viremia lymphoreticular system, including the
liver, spleen, and B lymphocytes in peripheral blood.
Host immune response to the viral infection includes activation of
CD8+ T lymphocytes
= atypical lymphocytes found in the peripheral blood.
The T lymphocytes kill EBV-infected B cells and eventually reduce
the number of Epstein-Barr virus–infected B lymphocytes to less
than 1 per 106 circulating B cells.
Latent viral infection of memory B cells
Clinical Manifestations
Most commonly associated with infectious
mononucleosis
Classically affects adolescents and young
adults
Children often asymptomatic
Self-limited course
Classic triad of symptoms
Sore throat
+/- tonsillar
Exudate
(85% of pts)
Lymphadenopathy
(usually posterior
cervical chain)
Present in ~100% of pts
Fever! – 98% of pts
** e.g. Saturday Night Fever
Splenomegaly – seen in 50% pts
Rash!
Generalized
maculopapular,
urticarial or petechial
rash
Erythema nodosum has
been reported, but is
rare
Rash more common in
pts treated with
antibiotics (esp.
ampicillin or amoxicillin)
Reactive Lymphocytes!
Lymphocytosis = most
common lab finding
Absolute count >
4500
Differential count >
50%
Most pt’s have >10%
atypical lymphocytes
on peripheral smear
= CD8+ Tcells
Less common manifestations of EBV
“EBV can affect virtually any organ.”
Hepatitis Fulminant liver failure
Jaundice is rare
Glomerulonephritis/ Acute Kidney Injury
Pneumonia/Pleural effusion
Myocarditis
Pancreatitis
Myositis
Hepatitis!
Increased infiltration by CD8+ T cells
Inflammation of the liver Transaminitis
Neurologic syndromes
Guillian-Barre
Cranial nerve palsies
Encephalitis
Aseptic meningitis
Transverse myelitis
Optic neuritis
Oral Hairy Leukoplakia!
Vs. Oral Candidiasis
Epstein-Barr virus serology
Antibodies to Epstein-Barr virus antigens
Antibodies to viral capsid antigen (VCA),
early antigens (EAs)
Epstein-Barr nuclear antigen (EBNA).
Primary acute Epstein-Barr virus infection is
associated with VCA-IgM, VCA-IgG, and absent
EBNA antibodies.
The antibody pattern in recent infection (3-12 mo)
includes positive findings for VCA-IgG and EBNA
antibodies, negative VCA-IgM antibodies, and,
usually, positive EA antibodies.
Patients who are immunocompromised and have
persistent or reactivated Epstein-Barr virus
infections often have high levels of antibodies to
EA/D or EA/R.
Monospot
Rapid slide agglutination tests, including Monospot
assays, have been developed to measure acute
infectious mononucleosis heterophile antibodies in a
rapid qualitative fashion. Slide tests use either horse
RBCs or bovine RBCs.
All commercial kits for rapid diagnosis of acute
infectious mononucleosis heterophile antibodies have
low sensitivity (63-84%), with a negative predictive
value of more than 10%.
Spot tests rarely yield false-positive results in patients
with lymphoma or hepatitis.
Treatment
In most cases, no treatment is necessary
--------------------------------------------------- Corticosteroids for tonsillar edema /
respiratory distress
In vitro trials of acyclovir
Our patient was treated with Valcyte 900mg po
q day
IVIG for immune-mediated thrombocytopenia
THE END