Epstein-Barr virus (EBV) is one of eight human herpesvirus. Primary infection with EBV in childhood is generally asymptomatic or mild, however, often causes overt diseases such as infectious mononucleosis (IM) and lymphoproliferative disorder (LPD), the latter occursing in immunologically compromised individuals. Historically, EBV has been considered to be etiologically linked to human malignancies such as EBV genome positive Burkitt's lymphoma and nasopharyngeal carcinoma. Recently, however, another category of EBV-related disease, "chronic active EBV infection", has been made to describe persons without a clearly defined underlying disease. We report 4 cases of patients, presented with episodic fever of unknown origin (FUO), who were diagnosed as severe chronic active EBV infection. A combined application of serology for EBV and in-situ hybridization established the diagnosis of the EBV infection.
Burkitt Lymphoma ; Diagnosis ; Epstein-Barr Virus Infections ; Fever of Unknown Origin* ; Fever* ; Genome ; Herpesvirus 4, Human* ; Humans ; Infectious Mononucleosis ; Lymphoproliferative Disorders

Epstein-Barr virus (EBV) is one of eight human herpesvirus. Primary infection with EBV in childhood is generally asymptomatic or mild, however, often causes overt diseases such as infectious mononucleosis (IM) and lymphoproliferative disorder (LPD), the latter occursing in immunologically compromised individuals. Historically, EBV has been considered to be etiologically linked to human malignancies such as EBV genome positive Burkitt's lymphoma and nasopharyngeal carcinoma. Recently, however, another category of EBV-related disease, "chronic active EBV infection", has been made to describe persons without a clearly defined underlying disease. We report 4 cases of patients, presented with episodic fever of unknown origin (FUO), who were diagnosed as severe chronic active EBV infection. A combined application of serology for EBV and in-situ hybridization established the diagnosis of the EBV infection.
Burkitt Lymphoma ; Diagnosis ; Epstein-Barr Virus Infections ; Fever of Unknown Origin* ; Fever* ; Genome ; Herpesvirus 4, Human* ; Humans ; Infectious Mononucleosis ; Lymphoproliferative Disorders

Infectious mononucleosis is most commonly caused by Epstein-Barr virus(EBV) and is a self-limited but occasionally life-threatening. Its peculiar characteristics are sore throat, cervical lymphadenopathy and hepatosplenomegaly. Recently, the age of primary EBV infection is becoming late in Korea due to socioeconomic development. So the authors retrospectively reviewed the cases of infectious mononucleosis. The results of clinical and laboratory findings suggest that infectious mononucleosis should be considered as a cause of pharyngotonsillitis and the assessment of viral capsid antigen(VCA) IgM is necessary for the diagnosis of this disease.
Capsid ; Diagnosis ; Epstein-Barr Virus Infections ; Immunoglobulin M ; Infectious Mononucleosis* ; Korea ; Lymphatic Diseases ; Pharyngitis ; Retrospective Studies

BACKGROUND: Epstein-Barr virus (EBV) is causative agent of infectious mononucleosis and nasopharyngeal carcinoma and associated with Burkitt lymphoma and other tumors. The recombinant protein is needed for the rapid and sensitive serodiagnosis of EBV infection. METHODS: EBV gene encoding the protein reactive with the sera of EBV-infected patient was cloned and characterized with lambda gt11 expression library of cDNA of EBV B95-8 strain. RESULTS: The recombinant proteins from clone 12, 15 and 21 were expressed as 120, 118, 160 kDa-usion protein with beta-galactosidase, respectively, which were reactive with IgG anti-EBV antibody-positive sera, but not with anti-EBV antibody-negative sera. A homology search of the DNA sequence of the cloned gene with EBV B95-8 sequences revealed that those were located at 61716~62087, 61898~62085, and 102128~103158, respectively. These positions correspond to BFRF3, BFRF3, and BZLF1, respectively, which were reported as immunogenic protein which evoked strong and longstanding antibody response and had no sequence homology with the proteins of other herpesviruses. All the patients' sera were reactive with clone 12 protein, but only 5 out of 9 patients' sera were reactive with clone 21 protein. CONCLUSION: Clone 21 protein expressing BFRF3 fragment was immunoreactive in patient sera from natural EBV infection and was regarded as useful candidate for the serodiagnosis of EBV infection.
Antibody Formation ; Base Sequence ; beta-Galactosidase ; Burkitt Lymphoma ; Clone Cells* ; Cloning, Organism* ; DNA, Complementary ; Epstein-Barr Virus Infections ; Herpesviridae ; Herpesvirus 4, Human* ; Humans ; Immunoglobulin G ; Infectious Mononucleosis ; Recombinant Proteins ; Sequence Homology ; Serologic Tests

Defective Viruses ; metabolism ; Epstein-Barr Virus Infections ; diagnosis ; prevention & control ; therapy ; Herpesvirus 4, Human ; isolation & purification ; Histiocytosis, Non-Langerhans-Cell ; diagnosis ; Humans ; Infectious Mononucleosis ; diagnosis ; Leukoplakia, Hairy ; diagnosis ; Lymphoproliferative Disorders ; diagnosis ; Vaccination ; Virus Latency

OBJECTIVETo determine the plasma level of Epstein Barr virus (EBV) DNA in children with EBV associated diseases, and to investigate the dynamic changes of EBV DNA level after initial infection as well as the relationship between EBV DNA level and the diseases severity.

METHODSThe subjects consisted of 73 children with primary EBV infection (infectious mononucleosis, pneumonia,etc.) and 18 children with severe EBV-associated diseases (chronic active EBV infection, hemophagocytic lymphohistiocytosis, etc.). The plasma EBV DNA level was detected by a real-time PCR assay.

RESULTSThe plasma EBV DNA level decreased with the infection time in children with primary EBV infection. Two weeks after infection, plasma EBV DNA was almost undetectable. The positive rate of plasma EBV DNA in children with severe EBV associated diseases increased significantly when compared with that in children with primary EBV infection (89% vs 16%; p<0.05).

CONCLUSIONSThe level of EBV replication may be reduced with the infection time. Dynamic determination of blood EBV DNA is useful for the evaluation of disease severity in children with EBV infection.

DNA, Viral ; blood ; Epstein-Barr Virus Infections ; virology ; Humans ; Infectious Mononucleosis ; virology ; Lymphohistiocytosis, Hemophagocytic ; virology ; Virus Replication

Acute acalculous cholecystitis (AAC) is an inflammation of the gallbladder in the absence of demonstrated stones. AAC is frequently associated with severe systemic inflammation. However, the exact etiology and pathogenesis of AAC still remain unclear. Acute infection with Epstein Barr virus (EBV) in childhood is usually aymptomatic, whereas it often presents as typical infectious mononucleosis symptoms such as fever, cervical lymphadenopathy, and hepatosplenomegaly. AAC may occur during the course of acute EBV infection, which is rarely encountered in the pediatric population. AAC complicating the course of a primary EBV infection is usually associated with a favorable outcome. Most of the patients recover without any surgical treatment. Therefore, the detection of EBV in AAC would be important for prediction of better prognosis. We describe the case of a 10-year-old child who presented with AAC during the course of primary EBV infection, the first in Korea, and review the relevant literature.
Acalculous Cholecystitis* ; Child ; Epstein-Barr Virus Infections ; Fever ; Gallbladder ; Herpesvirus 4, Human* ; Humans ; Infectious Mononucleosis ; Inflammation ; Korea ; Lymphatic Diseases ; Prognosis

Burkitt Lymphoma ; pathology ; virology ; Epstein-Barr Virus Infections ; pathology ; Hematologic Diseases ; pathology ; Histiocytic Necrotizing Lymphadenitis ; pathology ; Hodgkin Disease ; pathology ; Humans ; Lymphoma ; classification ; pathology

An 11-year-old girl was diagnosed with encephalitis due to Epstein-Barr virus(EBV). She was admitted to our hospital due to convulsion and decreased consciousness after several days of fever, sore throat and headache. Cerebrospinal fluid analysis showed lymphocyte-dominant pleocytosis and markedly elevated levels of protein. Magnetic resonance imaging(MRI) finding was normal, except for marked leptomeningeal enhancement. Even though she had signs and symptoms of infectious mononucleosis, EBV infection could not be considered as the underlying cause of the encephalitis until IgM for the viral capsid antigen of EBV had been detected in her blood. After treatment with acyclovir, a high dose of methylprednisolone and intravenous immunoglobulin, the neurological symptoms improved rapidly. She has not suffered from any neurological complications in the four months since being discharged. EBV infection should be considered as the main etiology in cases of childhood encephalitis, although there is no evidence of infectious mononucleosis existed.
Acyclovir ; Capsid ; Child ; Consciousness ; Encephalitis ; Epstein-Barr Virus Infections ; Fever ; Headache ; Herpesvirus 4, Human ; Humans ; Immunoglobulin M ; Immunoglobulins ; Infectious Mononucleosis ; Leukocytosis ; Magnetic Resonance Spectroscopy ; Methylprednisolone ; Pharyngitis ; Seizures

PURPOSE: Few studies have been conducted on the recent status of infectious mononucleosis (IM) in Korean children. The aim of this study was to evaluate the recent trend in the clinical manifestations of Epstein-Barr virus (EBV)-associated IM as well as the clinical differences according to age. METHODS: A retrospective study was performed on 81 children hospitalized with EBV-associated IM who fulfilled the serological criteria for the diagnosis of EBV infection (viral capsid antigen immunoglobulin M positive). The patients were divided into 3 age groups: <5 years, 5 to 9 years, and > or =10 years. We evaluated the recent trend in clinical manifestations and the differences in clinical and laboratory findings among the 3 age groups. RESULTS: Thirty (37%) children were under 5 years of age, 38 (46.9%) were 5 to 9 years of age, and 13 (16%) were 10 years of age or older. The differences in the symptoms and signs among the 3 age groups were not statistically significant, except for headache. The mean duration of fever was 7.7 days (range, 0 to 18 days). A comparison of liver enzyme elevation among the age groups showed an association with advancing age (26.6%, 63.1%, and 76.9%, respectively, P=0.04) CONCLUSION: This study showed that EBV-associated IM in Korean children continues to occur mostly in children under 10 years of age. In children with EBV-associated IM, the incidence of headache and liver enzyme elevation, the duration of fever, and the proportion of females to males were all positively associated with advancing age.
Capsid ; Child ; Epstein-Barr Virus Infections ; Female ; Fever ; Headache ; Herpesvirus 4, Human ; Humans ; Immunoglobulin M ; Incidence ; Infectious Mononucleosis ; Korea ; Liver ; Male ; Retrospective Studies