EBV与HCMV传染性单核细胞增多症患儿的实验室指标比较

目的观察EB病毒（EBV）与人类巨细胞病毒（HCMV）感染所致的传染性单核细胞增多症（IM）患儿超敏C-反应蛋白（hs-CRP）、白细胞（WBC）计数、嗜中性粒细胞比值（N）、异常淋巴细胞（异淋）、嗜异性抗体和血清酶的变化。方法选择70例确诊有EBV病毒感染且具备传染性单核细胞增多症临床特点的患儿（A组）进行实验室检测指标分析及总结;并与37例HCMV相关传染性单核细胞增多症患儿（B组）进行比较。结果与EB组（A组）比较,HCMV组（B组）感染患儿hs-CRP水平、肌酸激酶同功酶（CK-MB）、丙氨酸氨基转移酶（ALT）、外周血WBC计数、异型淋巴细胞增高程度较低（P〈0.05）,嗜异性抗体常为阴性,两组N值差异无统计学意义（P〉0.05）。结论 EBV与HCMV感染所致的传染性单核细胞增多症患儿的实验室指标变化不同,应重视IM患儿的实验室检查以辅助诊断。     

Epstein-Barr病毒与感染宿主间的平衡关系

正常人群中普遍存在着Epstein-Barr Virus(EBV)感染,围内普查证实3～5岁健康儿童的感染率已达90.4％。原发感染在儿童期通常无明显临床症状,青春期后感染者则约有50％的人发生传染性单核细胞增多症。原发感染之后,无论有无临床表现,均可终生携带该病毒。病毒在宿主体内潜伏,并导致机体产生一系列特异性免疫反应。     

慢性活动型EB病毒感染的致病机理研究进展

慢性活动型EB病毒(Epstein Barr virus,EBV)感染(chronic active EBV infection,CAEBV)是一类EBV相关的T/NK淋巴细胞增殖性疾病(Epstein Barr virus-associated T/NK-cell lymphoproliferative diseases,EBV~+T/NK-cell LPD),以持续反复的类似传染性单核细胞增多症(infectious mononucleosis,IM)临床病征和EBV感染细胞的克隆性增殖为主要特征,在临床上具有较高的发病率和致死率.目前对于CAEBV与其他各类EBV相关的T/NK淋巴细胞增殖性疾病之间的界定以及致病机理的研究仍处于发展阶段,临床上对于该类疾病的治疗也无完全有效的手段.本文主要从EBV如何感染T/NK细胞、EBV相关的病毒学研究、机体自身遗传及免疫背景几方面,综述了目前对于CAEBV致病机理的研究进展,旨在为进一步研究提供思路和线索.     

石家庄市儿童呼吸道感染病原体IgM抗体结果分析

目的分析石家庄市儿童呼吸道感染病原体的流行特点,为临床预防和治疗呼吸道感染提供病原学依据。方法纳入就诊于儿科的呼吸道感染患儿936例,运用间接免疫荧光法检测儿童血清的八种呼吸道病原体的IgM型抗体。根据不同季节、不同年龄和不同性别分组,分析其病原体阳性率和感染类型。结果 936例患儿血清标本中,检出病原体IgM抗体共424例,阳性率为45.30%。其中肺炎支原体阳性率(28.63%)最高,其次依次为流感病毒B型、呼吸道合胞病毒、流感病毒A型、肺炎衣原体、腺病毒、副流感病毒,未检出嗜肺军团菌。不同季节病原体的阳性率有差异,冬季的病原体阳性率(50.33%)显著高于夏、秋季的阳性率(33.71%和41.46%),差异均有统计学意义;不同年龄组中,婴儿组病原体阳性率(16.05%)显著低于其他3个年龄组,差异均有统计学意义;检出病原体的424例阳性患儿中,单一病原体感染类型者为290例(30.98%),混合感染者134例(14.32%);全部936例患儿中,男童病原体阳性率(42.33%)显著低于女童阳性率(52.29%);病原体混合感染类型中以肺炎支原体和流感病毒B型混合感染最常见,其中婴儿组混合感染病原体检出率均显著低于幼儿组、学龄前组和学龄组。结论肺炎支原体全年在儿童呼吸道感染中占主要地位。年龄和性别是石家庄市儿童呼吸道病原体感染的特异性因素,冬季为呼吸道病原体感染高峰期。     

黑龙江省儿童EB病毒的感染情况及疾病谱分析

目的:研究EB病毒(Epstein-barr virus,EBV)感染的儿童外周血单个核细胞(PBMC)中的EBV-DNA水平与疾病谱的相关性,进一步了解黑龙江省儿童EBV感染情况及流行特征。方法:选择2015年6月至2016年2月就诊于哈尔滨医科大学附属第二医院儿内科门诊疑似EBV感染收入院的患儿,用荧光定量PCR法检测外周血PBMC中的EBV-DNA含量,并收集相应临床资料。用χ2检验和秩和检验分析不同疾病中EBV-DNA水平的差异和不同EBV-DNA水平疾病谱的分布情况。结果:762例儿童中,EBV-DNA检测阳性329例,检出率为43.1%。在EBV-DNA阳性的患儿中,男性患儿198例,女性患儿131例,不同性别的阳性检出率比较无统计学差异(P=0.182);不同年龄的患儿EBV-DNA检出率的差异有统计学意义(P=0.000),学龄前组最高,婴儿组最低;EBV-DNA定量值虽然有学龄前组学龄组幼儿组婴儿组的趋势,但是无统计学差异(P=0.337);主要疾病谱所占比例从高到低依次为:呼吸系统疾病、IM、脑炎、单纯EBV感染和血液系统疾病,其中呼吸系统疾病最多40例(42.6%);IM的EBV-DNA含量最高1.522e+004(6.55e+001-4.602e+006),并且与其他各组比较均有统计学差异(P=0.000),其余各组之间无统计学差异。EBV-DNA水平不同相关疾病谱亦有差异(P=0.00),同一EBV-DNA水平中每种疾病大于10%病例数分布在(1.00-9.99)e+001-(1.00-9.99)e+006,IM最高主要分布在(1.00-9.99)e+004-(1.00-9.99)e+006之间,其余疾病主要分布在(1.00-9.99)e+001-(1.00-9.99)e+005。结论:黑龙江地区儿童EBV感染率处于较高的水平,EBV-DNA水平高低与疾病谱密切相关。     

EB病毒血清学试验进展

<正>序言 生命早期的婴儿常常发生EB病毒(EBV)感染。这些感染通常是无症状的或者伴轻度非特异性表现。EBV感染在世界发达地区和当年轻成人原发或初期感染时往往表现为传染性单核细胞增多症(IM)。此病毒最初是在伯基特氏淋巴瘤持续感染的淋巴细胞系中发现的。EBV感染首先是B淋巴细胞。B淋巴细胞在EBV原发感染后继续庇护该病毒染色体组,并保持其潜伏感染,很可     

2008-2009年南京地区儿童肺炎支原体感染情况分析

目的了解2008年至2009年南京地区儿童呼吸道肺炎支原体（MP）的感染情况。方法应用MP快速培养法对南京地区2008年1月至2009年12月980例急性呼吸道感染患儿的咽拭子标本进行MP培养检测。结果 980例急性呼吸道感染患儿的咽拭子标本中MP培养阳性384例,总阳性率为39.2%。其中〈3岁、35岁、〉5岁各年龄组患儿中MP阳性率分别是36.9%,38.5%和43.3%;不同季度MP感染的检出率分别是：春季（13月）45.7%,夏季（46月）24.8%,秋季（79月）20.4%,冬季（1012月）50.3%,其中冬、春两季MP感染的检出率明显高于其他两季（P〈0.01）。结论 MP为南京地区儿童急性呼吸道感染的重要病原体,各年龄儿童普遍易感;冬、春两季高发。     

8209例住院儿童EB病毒感染情况分析

目的了解住院儿童EB病毒感染情况。方法采用ELISA法检测患儿血清中EBV-VCA-IgM和IgG抗体,分别从年龄、性别、季节、涉及的疾病等相关因素进行统计分析。结果 8 209例儿科住院病人EB病毒总体感染率为68.84%,近期感染率为14.76%,10~15岁组总体感染率最高为93.50%,各年龄组感染率差异有统计学意义(P0.05),感染率随年龄增长而逐渐增高;男童EB病毒感染率67.52%(3 308/4 899),女童为70.79%(2 343/3 310),女童感染率高于男童(P0.05);EB病毒感染存在季节差异,1-3月份感染率最高,7-9月份相对较低;EB病毒感染累及全身多系统而引起相应的疾病,1 212例近期感染患儿中传染性单核细胞增多症186例(15.35%)、支气管肺炎142例(11.72%)、急性扁桃体炎112例(9.24%)。结论 EB病毒感染在本地区住院儿童中占有一定比例,小儿EB病毒感染症状多样,可累及全身多系统,需提高对本病的认识,综合分析,早期诊断,早期治疗,同时加强护理,提高治疗效果。     

EB病毒抗体和DNA联合检测可提高儿童传染性单核细胞增多症的诊断灵敏度

目的评估EB病毒抗体VCA-IgM、VCA-IgG、EA-IgG、EBNA-1-IgG及EBV-DNA载量检测在儿童传染性单核细胞增多症(传单)中的诊断意义。方法用ELISA方法检测70例传单患儿和25例健康儿童血清中EBV四种抗体及PCR荧光定量法检测外周血单个核细胞EBV-DNA载量。结果传单患儿组EBV-DNA的阳性率为87.14%(61/70),对照组阳性率为8.00%(2/25),传单组与对照组EBV-DNA的阳性率比较差异有统计学意义(P<0.01)。EBV抗体检测中,传单组的VCA-IgM阳性率最高,达91.43%(64/70),对照组VCA-IgM全部阴性。传单组EB病毒VCA-IgM和EBV-DNA联合检测的阳性率97.1%。结论 EBV抗体和EBV-DNA载量检测对儿童传单的诊断有极高的价值,尤其是VCA-IgM抗体和EBV-DNA联合检测,可提高儿童传单的临床诊断的敏感性。     

北京地区近5年来儿童EB病毒感染疾病中BZLF1及其启动区Zp基因特征分析

为了解儿童原发性Epstein-Barr病毒(Epstein-Barr virus,EBV)感染流行株BZLF1基因及其启动区Zp的基因特征。本文对北京儿童医院2006年至2011年收治的EBV感染传染性单核细胞增多症(EBV-associated infectious mononucleosis,EBV-IM)134例和EBV相关噬血细胞性淋巴组织细胞增生症(EBV-associated hemophagocytic lymphohistiocytosis,EBV-HLH)32例患儿的外周血来源的DNA进行了EBNA3C、BZLF1和Zp基因片段的扩增分析。根据EBNA3C基因片段扩增产物的大小进行EBV-Ⅰ/Ⅱ分型,对BZLF1和Zp基因扩增产物进行直接序列测定,并用BioEdit 7.0.9进行序列分析。实验显示①儿童EBV感染流行株以EBV-I型为主,占97.2%(140/144),EBV-Ⅱ型为2.8%(4/144);②共检测出3种BZLF1基因型,12种亚型(包括6种新发现的亚型)。BZLF1-A型和BZLF1-B型两基因型在两种疾病中的分布无统计学差异(P=0.083)。BZLF1-A1是儿童EBV感染性疾病中的常见基因型。BZLF1-A型第一内含子以3个29bp重复序列为主,而B型以30bp重复序列为主(P=0.000),且重复序列的个数波动于1-13个不等;③共检测出Zp-P、Zp-V3、Zp-V4、Zp-V1四种Zp基因型,并且这四种基因型在EBV-IM和EBV-HLH两种疾病中的检出率无统计学差异(p值分别为0.272、0.252、1.0、1.0);④BZLF1和Zp基因连锁分析显示,BZLF1-A1基因型毒株的Zp基因分型以Zp-V3为主(P=0.000),而BZLF1-B4基因型以Zp-P型为主(P=0.000)。EBV-Ⅰ+BZLF1-A1与Zp分型中Zp-V3高度连锁(P=0.000);EBV-Ⅰ+BZLF1-B4与Zp-P高度连锁(P=0.000)。结果证实:①BZLF1-A1是儿童EBV感染的常见基因型。BZLF1-A型其第一内含子重复序列以29bp为主,而BZLF1-B型则以30bp的重复序列为主。②Zp-P和Zp-V3是儿童EBV感染的常见Zp基因型,二者检出率相似。③BZLF1-A1型的Zp分型以Zp-V3为主,而BZFL1-B4型则以Zp-P分型为主。EBV-Ⅰ+BZLF1-A1与Zp分型中Zp-V3高度连锁,而EBV-Ⅰ+BZLF1-B4与Zp-P高度连锁。     

Epstein-Barr virus serology

Because of the ubiquitous nature of EBV, most people are infected with this virus by the time they are adults. People acquire the virus at an early age, earlier in developing countries and in socioeconomically deprived areas of the United States, where about 80% of 5-year-old children are seropositive. In economically privileged areas, only about 40–50% of children are seropositive by age 5. Infections during childhood are usually asymptomatic. In contrast, 50% of adolescents who become infected with EBV develop the fatigue, fever, pharyngitis, and atypical lymphocytosis characteristic of acute infectious mononucleosis (IM). Heterophil antibodies, which are the basis for screening tests for IM, usually appear in the serum of these patients. However, approximately 10% of patients (more commonly children) with EBV induced IM do not develop heterophil antibodies. For this reason, tests for specific antibody-mediated immune responses to EBV may be necessary for diagnosis.     

Hepatitis C virus and Epstein-Barr virus: dual infection or atypical antibody response

Positive serological reactions against hepatitis C virus (HCV) appeared in the course of Epstein-Barr virus (EBV) infectious mononucleosis. In 429 consecutive patients with high levels of transaminases, 28 patients with EBV primary infection were found. The presence of anti-HCV antibodies and HCV RNA was studied in these subjects. In seven patients anti-HCV antibodies (C33 and C22c RIBA bands) were detected, but all were polymerase chain reaction (PCR) negative. These results may have been due solely to a HCV infection or were an atypical response to HCV in the course of infectious mononucleosis.     

Epidemiological characteristics and disease burden of infectious mononucleosis in hospitalized children in China: A nationwide retrospective study

Epstein-Barr virus (EBV) is very common, with the infection rate in adults over 90% worldwide. Infectious mononucleosis (IM) is caused by primary infection with EBV. Most IM patients are generally considered to have a favorable prognosis, but a few patients will also develop complications. Children with severe symptoms will require hospitalization. However, the disease burden of children hospitalized with IM in China has been rarely described. In this study, we included the Face sheets of discharge medical records from 27 member children's hospitals of Futang Research Center of Pediatric Development from Jan 1st, 2016 to Dec 31st, 2020, and medical information such as gender, age, region, time of admission, length of stay and expenditure were extracted. There were 24,120 IM cases, which accounted for 0.42% (24,120/5,693,262) of all hospitalized cases during this period. The ratio of male to female was 1.48:1. Hospitalization for IM in the 4–6 years age group was the highest among inpatients of all age groups. Case numbers increased year by year between 2016 and 2020, and the monthly hospitalization was generally high from Jul to Sep but reduced from Jan to Feb per year. Bronchitis/pneumonia and hepatic dysfunction were two common complications in hospitalized IM patients. The median length of stay was 8 days, and the median cost of hospitalization was 970.59 US dollars. This study will help understand the epidemiological characteristics and disease burden of hospitalized children with IM in China.     

Laboratory diagnosis of Epstein-Barr virus infection

Laboratory confirmation of EBV infection requires proper methods and schema of investigation adequate to aim of diagnostic procedure. In paper the results of routine diagnostic tests of EBV infection performed in Department of Virology NIH in 2005-2006 years was included and also, evaluation of usefulness of different laboratory methods was done. Based on results of ELISA tests 10,7% routine investigated subjects was classified as primary EBV infection, 20,1% was seronegative, 7,4% was classified as reactivation of latent infection and serological markers in 45,6% subjects pointed past EBV infection. Positive result of PCR method was obtain in 11,2% samples subjected of routine laboratory investigation. Comparison of specific and non-specific serological methods results (ELISA versus tests of heterophile antibodies) showed the high percentage of false negative results in children tested by non-specific tests. PCR results in serum samples from patients with primary infection (confirmed by serological tests) were positive in 15% cases only. Based on analyzed results it could be stated that reliable confirmation of infectious mononucleosis, as primary EBV infection, is detection of specific IgM antibodies and in case of heterophile antibodies tests the possibility of false negative results, mainly in children, must be taken into account. The most proper samples for PCR method are whole blood, sections of tissue or cells from swabs.     

Infectious mononucleosis and Epstein-Barr virus

Epstein-Barr virus (EBV) is a gamma-herpesvirus that infects over 90% of the human population worldwide. It is usually transmitted between individuals in saliva, and establishes replicative infection within the oropharynx as well as life-long latent infection of B cells. Primary EBV infection generally occurs during early childhood and is asymptomatic. If delayed until adolescence or later, it can be associated with the clinical syndrome of infectious mononucleosis (also known as glandular fever or 'mono'), an illness characterised by fevers, pharyngitis, lymphadenopathy and malaise. EBV infection is also associated with the development of EBV-associated lymphoid or epithelial cell malignancies in a small proportion of individuals. This review focuses on primary EBV infection in individuals suffering from infectious mononucleosis. It discusses the mechanism by which EBV establishes infection within its human host and the primary immune response that it elicits. It describes the spectrum of clinical disease that can accompany primary infection and summarises studies that are leading to the development of a vaccine designed to prevent infectious mononucleosis.     

Immune activation suppresses initiation of lytic Epstein-Barr virus infection

Primary infection with Epstein-Barr virus (EBV) is asymptomatic in children with immature immune systems but may manifest as infectious mononucleosis, a vigorous immune activation, in adolescents or adults with mature immune systems. Infectious mononucleosis and chronic immune activation are linked to increased risk for EBV-associated lymphoma. Here we show that EBV initiates progressive lytic infection by expression of BZLF-1 and the late lytic genes gp85 and gp350/220 in cord blood mononuclear cells (CBMC) but not in peripheral blood mononuclear cells (PBMC) from EBV-naive adults after EBV infection ex vivo. Lower levels of proinflammatory cytokines in CBMC, used to model a state of minimal immune activation and immature immunity, than in PBMC were associated with lytic EBV infection. Triggering the innate immunity specifically via Toll-like receptor-9 of B cells substantially suppressed BZLF-1 mRNA expression in acute EBV infection ex vivo and in anti-IgG-stimulated chronically latently EBV-infected Akata Burkitt lymphoma cells. This was mediated in part by IL-12 and IFN-gamma. These results identify immune activation as critical factor for the suppression of initiation of lytic EBV infection. We hypothesize that immune activation contributes to EBV-associated lymphomagenesis by suppressing lytic EBV and in turn promotes latent EBV with transformation potential.     

Epidemiologic studies assessing the role of the Epstein-Barr virus in Hodgkin's disease.

The hypothesis that an infection plays a role in the etiology of Hodgkin''s disease (HD) is suggested by both its clinical and histologic features. Its bimodal age-incidence pattern also suggests an infectious process among younger persons. In economically advantaged populations, the first peak occurs among young adults, while in disadvantaged populations, it occurs among children at a much lower frequency. It appears that the age distribution of HD shadows that of susceptibility to common childhood infections, such as the Epstein-Barr virus (EBV); furthermore, that risk of HD is increased among those susceptible to a relatively late infection, in parallel with infectious mononucleosis (IM), and it has been found that people who have had IM have about three times the expected rate of HD. Serologically, there is a consistent association between EBV and HD. As a group, patients have an altered antibody pattern against EBV which suggests chronic reactivation, both following and preceding diagnosis. This altered pattern is common to all age groups. Severity of infection may alter host control among younger people, while diminished cellular immunity with aging may allow similar reactivation among older persons. Whether the EBV plays a direct role or simply reflects the action of a more primary factor is unknown.     

Early Virological and Immunological Events in Asymptomatic Epstein-Barr Virus Infection in African Children

Epstein-Barr virus (EBV) infection often occurs in early childhood and is asymptomatic. However, if delayed until adolescence, primary infection may manifest as acute infectious mononucleosis (AIM), a febrile illness characterised by global CD8+ T-cell lymphocytosis, much of it reflecting a huge expansion of activated EBV-specific CD8+ T-cells. While the events of AIM have been intensely studied, little is known about how these relate to asymptomatic primary infection. Here Gambian children (14–18 months old, an age at which many acquire the virus) were followed for the ensuing six months, monitoring circulating EBV loads, antibody status against virus capsid antigen (VCA) and both total and virus-specific CD8+ T-cell numbers. Many children were IgG anti-VCA-positive and, though no longer IgM-positive, still retained high virus loads comparable to AIM patients and had detectable EBV-specific T-cells, some still expressing activation markers. Virus loads and the frequency/activation status of specific T-cells decreased over time, consistent with resolution of a relatively recent primary infection. Six children with similarly high EBV loads were IgM anti-VCA-positive, indicating very recent infection. In three of these donors with HLA types allowing MHC-tetramer analysis, highly activated EBV-specific T-cells were detectable in the blood with one individual epitope response reaching 15% of all CD8+ T-cells. That response was culled and the cells lost activation markers over time, just as seen in AIM. However, unlike AIM, these events occurred without marked expansion of total CD8+ numbers. Thus asymptomatic EBV infection in children elicits a virus-specific CD8+ T-cell response that can control the infection without over-expansion; conversely, in AIM it appears the CD8 over-expansion, rather than virus load per se, is the cause of disease symptoms.     

Cytomegalovirus in the mononucleosis syndrome in children

In 7 children aged 18 months to 7 years isolated from a group of 128 children with infectious mononucleosis the cytomegalovirus infection was found. Infection was diagnosed by determination of antibodies against immediate early and late CMV antigen by means of the ELISA test. Besides that, antibodies were determined against the capsid antigen and early antigen of EB virus by the method of indirect immunofluorescence. In four children only cytomegalovirus infection was found and three had a mixed infection with both viruses and the diagnosis in these cases was: infectious mononucleosis (due to EBV) with coexistent or following CMV infection. In the sera of two children with cytomegalovirus mononucleosis changes were observed in the antibodies against EBV which is explained as a result of interactions between CMV and EBV in the organism of the host.     

Evidence for early infection of nonneoplastic natural killer cells by Epstein-Barr virus

We examined lymph nodes and tonsils from patients with infectious mononucleosis by combined detection of EBV-encoded RNA and a specific marker of natural killer (NK) cells, PEN5. A small number of Epstein-Barr virus (EBV) latently infected nonneoplastic NK cells were detected. Our data demonstrate that NK cells are natural targets of EBV and that infection of these cells is an early event observed during primary EBV infection.