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Determination of Antiviral Activity
Published in Adorjan Aszalos, Modern Analysis of Antibiotics, 2020
The Epstein-Barr (EB) virus is known to be associated with infectious mononucleosis, Burkitt’s lymphoma, and nasopharyngeal carcinoma. Infectious mononucleosis is a chronic disease, particularly of young people, which is insidious in onset and characterized by fever, sore throat, enlarged lymph nodes and spleen, and a striking rise in circulating mononuclear cells. The disease has become associated with deaths occurring in immunodeficient patients [93]. To date there is no means of controlling infectious mononucleosis. No animal model is available for in vivo study of EB virus-inhibitory compounds, although serological evidence indicates several simian species may be naturally infected [94,95].
Diagnostic Approach to Fulminant Hepatitis in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
The Epstein–Barr virus (EBV), also called human herpesvirus-4 (HHV-4), belongs to the herpesvirus family and is one of the most common human viruses. It causes infectious mononucleosis, which results in fever, sore throat, enlarged lymph nodes in the neck, vomiting, and fatigue. Symptoms of mild hepatitis and cholestasis occur in approximately 90% of infected individuals [20]. It is often spread through contact with saliva and rarely through semen or blood. In a study of ALF patients enrolled into the US ALFSG, 0.21% of the participants were found to have EBV-related ALF, reflecting the rare occurrence of ALF in EBV [20]. These cases of ALF, however, were associated with a high fatality rate. Although clinically significant hepatic damage usually occurs in immunosuppressed patients, acute severe hepatitis in young, immunocompetent patients has been reported [21]. The diagnosis is made by the presence of positive EBV viral capsid antigen (VCA) IgM with or without positive EBV VCA IgG antibody titers or serum measurements of EBV DNA through PCR [20]. Compared with other viruses, ALF caused by EBV typically presents with a cholestatic enzyme pattern, with variable serum aminotransferase levels and jaundice [22]. Patients may or may not have the classical symptoms of infectious mononucleosis at presentation. The small number of EBV-related ALF cases makes potential ALF risk factors difficult to identify (Table 23.2).
Epstein–Barr virus and the nervous system
Published in Avindra Nath, Joseph R. Berger, Clinical Neurovirology, 2020
Alexandros C. Tselis, Kumar Rajamani, Pratik Bhattacharya
Epstein–Barr virus is the cause of infectious mononucleosis, an acute febrile illness characterized by fever, fatigue, sore throat, cervical lymphadenopathy, hepatosplenomegaly, and occasionally a rash. The illness usually lasts no more than a few weeks and is followed by complete recovery. It is of variable severity, and fatalities are rare. Many of the fatalities in the normal host are caused by the neurological manifestations of the infection. Occasionally, there is a disproportionate involvement of certain organs in the disease, such as the liver, leading to hepatitis, or the brain, leading to encephalitis. Splenomegaly may occur, and rupture of the spleen can lead to fatal hemorrhage.
Multiple coinfections and Guillain Barré syndrome following outdoor travel to the American Northeast
Published in Baylor University Medical Center Proceedings, 2023
William Farrington, Farzam Farahani, Kevin Garrett Tayon, Jaclyn Rudzinski, Mark Feldman, Kartavya Sharma
The patient’s positive IgM and IgG to viral capsid antigen along with positive qualitative EBV PCR can be seen in both primary infection and reactivation of latent EBV.6 Absence of IgG antibodies to Epstein-Barr nuclear antigen (EBNA), which are produced after 6 to 12 weeks of primary infection, may be useful to indicate acute vs recent/remote infection, but even these can be false-negative in 5% to 10% of cases that fail to produce EBNA IgG.6 Very high titers of EBV DNA on quantitative PCR could also indicate active over latent infection, although there are no clear thresholds in the literature guiding use of titers outside of the setting of hematologic malignancies or preexisting immunodeficiency.7 In our patient, there were no specific signs or symptoms of infectious mononucleosis like sore throat, lymphadenopathy, splenomegaly, or atypical lymphocytosis.8 Along with no recent history of potential EBV exposures, this greatly reduced our suspicion for primary infection. Further testing with IgG-EBNA or quantitative PCR was therefore not pursued. Of note, primary EBV infection has been found to be associated with GBS in up to 10% of cases.9 However, it is not clear if reactivation presents the same risk as primary infection in causing GBS. We found only one reported case of EBV reactivation preceding GBS in an immunocompromised patient.10
Molecular point-of-care testing in the community pharmacy setting: current status and future prospects
Published in Expert Review of Molecular Diagnostics, 2022
Michael Klepser, Renee R. Koski
Test-and-Monitor services include those that utilize laboratory data to monitor for an undiagnosed condition to determine when or if treatment is warranted or to monitor the safe and effective use of medications in the treatment of a previously diagnosed condition. Examples of the first scenario would be an infectious mononucleosis or viral conjunctivitis screening program. Although no treatment for infectious mononucleosis currently exists, knowledge of this condition can allow the patient to follow appropriate recovery guidelines and precautions to prevent the spread of the pathogen to uninfected individuals. Additionally, knowledge of the cause of a previously uncharacterized illness can bring peace of mind to patients. With respect to monitoring the safe and effective use of medications in the treatment of a previously diagnosed condition, pharmacists can use POCT to evaluate the response to a medication and modify therapy as appropriate. Examples of this type of service would be monitoring blood glucose or HgBA1C for an individual with diabetes, cholesterol levels in patients on treatment for dyslipidemias, or clotting times for patients on anticoagulants and adjusting medications or doses to achieve optimal outcomes. Similarly, serum chemistry analyzers could be used by pharmacists to support medication therapy management (MTM) programs by monitoring renal and hepatic function and serum electrolyte levels to ensure safe use of medications.
Autoimmune hemolytic anemia: causes and consequences
Published in Expert Review of Clinical Immunology, 2022
AIHA may follow several infections, particularly Parvovirus B19, in up to 20% of cases, hepatotropic virus infections, including HCV, HBV, and HAV, and more rarely HIV [3]. In particular, HCV-related AIHA was mainly sustained by cold agglutinins (CAS) and had a mortality rate as high as 56% in a large study [50]. The risk of AIHA in HCV patients consistently increased from 2.8- to 11.6-fold in cases treated with interferon [51]. Additionally, AIHA may develop in up to 3% of patients with infectious mononucleosis, within 1–2 weeks of onset, and more frequently as a CAS [3]. Regarding bacteria, CAS may follow Mycoplasma pneumoniae infection [52], as well as tuberculosis, and usually recovers after anti-tuberculosis treatment [53]. More rare associations include AIHA complicating brucellosis or undulant fever, and the above mentioned PCH classically preceded by syphilis and virus infections [3].