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Herpes group virus infections, which are very common in humans, are mostly benign, paucisymptomatic or even asymptomatic in immunocompetent subjects. The latent persistence of these viruses after contamination exposes the patient to a risk of reactivation throughout life, particularly during an episode of immunosuppression. These viruses cause hepatitis that can be severe in the absence of rapid therapeutic management. The diagnosis, suggested by a bundle of often non-specific clinical and biological arguments, is confirmed by serological virological and molecular biology tests in immunocompromised patients. Antiviral treatment is sometimes necessary in severe forms or at risk of progression. Vaccination strategies are currently being developed for some of them. [ABSTRACT FROM AUTHOR]

Introduction. Lymphoepithelioma-like carcinoma (LELC) of the uterine cervix is a rare type of squamous cell carcinoma (SSC). It differs from the usual SSC of the cervix in its morphology and clinical behavior and shows a better prognosis than the more common SSC of the cervix. It is considered that LELC is associated with Epstein–Barr virus (EBV) infection in Asian and with human papilloma virus (HPV) or no infection in Caucasian patients. The aim of the study was to confirm whether or not LELC is more common in Caucasian patients with EBV/HPV infection or whether there is no correlation to the previous viral exposure. Material and methods. A retrospective research has been done on 775 female patients for a period of 8 years, who have been operated for cervical cancer in the Onco-gynecological Department of UMHAT “Doctor Georgi Stranski”-Pleven, Bulgaria. A group of 16 women with LELC has been identified by clinical data. Morphologically, 13 of them have been examined by routine histological and immunohistochemical tests, for assessment of the viral status, with monoclonal antibodies against EBV/HPV by DAKO protocol. Results. Two of the women have been proven to have EBV, tree-HPV infection and two – both viruses. In the other six cases no viral infections have been identified. Conclusion. Our results show a stronger correlation between LELC in Caucasian women and a previous HPV infection or no viral infection, rather than association with EBV infection.

Introduction. Lymphoepithelioma-like carcinoma (LELC) of the uterine cervix is a rare type of squamous cell carcinoma (SSC). It differs from the usual SSC of the cervix in its morphology and clinical behavior and shows a better prognosis than the more common SSC of the cervix. It is considered that LELC is associated with Epstein–Barr virus (EBV) infection in Asian and with human papilloma virus (HPV) or no infection in Caucasian patients. The aim of the study was to confirm whether or not LELC is more common in Caucasian patients with EBV/HPV infection or whether there is no correlation to the previous viral exposure. Material and methods. A retrospective research has been done on 775 female patients for a period of 8 years, who have been operated for cervical cancer in the Onco-gynecological Department of UMHAT “Doctor Georgi Stranski”-Pleven, Bulgaria. A group of 16 women with LELC has been identified by clinical data. Morphologically, 13 of them have been examined by routine histological and immunohistochemical tests, for assessment of the viral status, with monoclonal antibodies against EBV/HPV by DAKO protocol. Results. Two of the women have been proven to have EBV, tree-HPV infection and two – both viruses. In the other six cases no viral infections have been identified. Conclusion. Our results show a stronger correlation between LELC in Caucasian women and a previous HPV infection or no viral infection, rather than association with EBV infection.

Résumé: L'Epstein-Barr virus (EBV) est responsable d'une infection chronique latente, le plus souvent contractée dans la petite enfance. Cette infection est dans la majorité des cas contrôlée par le système immunitaire, mais peut être responsable d'un syndrome d'activation macrophagique (SAM) et/ou de cancers, principalement sous forme de lymphoproliférations. Environ 95 % des patients de plus de 18 ans sont immunisés et une primo-infection symptomatique sous forme d'une mononucléose infectieuse reste possible à tout âge. Celle-ci peut se compliquer d'un SAM, potentiellement mortel, qui doit être cherché systématiquement dans ce contexte. Chez l'homme jeune sous thiopurines, la primo-infection peut aussi évoluer vers une lymphoprolifération précoce. C'est pourquoi une sérologie EBV doit être effectuée avant toute mise sous immunosuppresseurs. En l'absence d'immunisation, le traitement par thiopurines doit être évité s'il existe des alternatives thérapeutiques. Le risque de lymphome est également augmenté chez les patients immunisés et sous thiopurines au long cours. Ce sur-risque persiste tant que le traitement est maintenu, et disparaît à son arrêt. Ainsi, une charge virale EBV doit être demandée devant toute asthénie, adénopathie, et/ou fièvre inexpliquée sous immunosuppresseurs et devant tout lymphome. Il a récemment été suggéré que les anti-TNF augmenteraient également le risque de lymphomes, sans que la responsabilité de l'EBV puisse être établie. Quelques cas de lymphomes de Hodgkin ont été décrits chez des patients traités par méthotrexate, la majorité étant liée à une infection EBV. Les données, issues des autres spécialités médicales, concernant l'utilisation de l'ustékinumab, sont rassurantes et n'ont pas montré de risques particuliers en lien avec l'EBV. Nous manquons de recul sur le védolizumab et les anti-JAK pour conclure. Enfin, des études récentes ont montré que la charge virale EBV était augmentée sur les biopsies coliques de patients ayant une maladie réfractaire. Ces données qui sont issues de travaux de recherche demandent confirmation avant sa réalisation en pratique courante et ce, d'autant plus qu'à l'heure actuelle, nous ne savons pas si l'EBV est une cause ou une conséquence de la maladie réfractaire. During the management of inflammatory bowel disease, status of Epstein-Barr virus (EBV) must be investigated. In the majority of cases, an equilibrium is established between EBV and the immune system. But sometimes, EBV can cause tumor, and hemophagocytic lymphohistiocytosis. More than 95% of patients 18 year-olds and older have already been infected by the virus. A symptomatic primary infection, characterized by an infectious mononucleosis, remains possible at any age. A hemophagocytic lymphohistiocytosis can complicate a primary infection, be fatal, and must be looked for each time. Young men treated with thiopurin for a primary infection can also develop an early lymphoma. It is therefore necessary to practice a serology prior to starting thiopurin. When patient is negative for EBV, another treatment must be considered. Risk of lymphoma is increased during thiopurin therapy, even if the patient is positive for EBV. This risk is continuous and justifies an EBV viral load in case of unexplained fatigue, adenopathy, fever and/or lymphoma. On another note, anti-TNFs could also increase the risk of lymphoma, without the possibility to determine the proportion attributable to EBV. Several cases of Hodgkin's lymphoma have been reported in patients treated with methotrexate, associated to EBV infection in most cases. Data about ustekinumab, issued from other medical specialities, are reassuring and did not find any link with EBV. There is no data about vedolizumab and anti-JAKs because of lack of hindsight. Lastly, EBV viral load could be increased in colonic samples of refractory disease, and could be associated with risk of colectomy, but these data are issued from experimental studies. Confirmation is needed and it is not known which is the chicken and the egg. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Epstein-Barr virus (EBV) is a ubiquitous virus that infects more than 90% of the world's population, and is implicated in lymphoma pathogenesis. However, in Zambia during the diagnosis of these lymphomas, the association of the virus with the lymphomas is not established. Since most patients with lymphomas have poor prognosis, the identification of the virus within the lymphoma lesion will allow for more targeted therapy. The aim of this study was to provide evidence of the presence of the EBV in lymphomas diagnosed at the University Teaching Hospital (UTH) in Lusaka, Zambia. METHODS: One hundred and fifty archival formalin-fixed paraffin embedded suspected lymphoma tissues stored over a 4-year period in the Histopathology Laboratory at the UTH in Lusaka, Zambia, were analysed. Histological methods were used to identify the lymphomas, and the virus was detected using Polymerase Chain Reaction. Subtyping of the virus was achieved through DNA sequencing of the EBNA-2 region of the viral genome. Chi square or fisher's exact test was used to evaluate the association between EBV status, type of lymphoma and gender. RESULTS: The majority of the lymphomas identified were of the non-Hodgkin's lymphoma (NHL) (80%) followed by Hodgkin's lymphoma (HL) (20%). EBV was detected in 51.8% of the cases, 54.5% of which were associated with NHL cases, while 40.9% associated with HL cases. The predominant subtype of the virus in both types of lymphomas was subtype 1. One of the lymphoma cases harboured both subtype 1 and 2 of the virus. CONCLUSION: This study showed that EBV is closely associated with lymphomas. Therefore, providing evidence of the presence of the virus in lymphoma tissues will aid in targeted therapy. To our knowledge this is the first time such data has been generated in Zambia.

Résumé: L'évaluation et la prise en charge des maladies du foie sont essentielles pour améliorer la survie des patients d'hématologie, notamment après greffe de cellules hématopoïétiques allogéniques. Donner un avis de consultant hépato-gastroentérologue est, en général, compliqué lorsque le patient a un cancer en cours de traitement, et qu'il développe un ictère, une prise de poids, une ascite, de la fièvre, des douleurs de l'hypochondre droit, et des tests hépatiques anormaux. Les avancées dans le domaine de la biologie moléculaire diagnostique et de l'imagerie ont rendu les démarches diagnostiques plus simples, et la biopsie hépatique n'est maintenant indiquée que dans de rares situations. Les algorithmes diagnostiques et thérapeutiques sont plus clairs pour orienter le clinicien et débuter rapidement un traitement. L'hématologie est une spécialité en pleine expansion et de nombreux médicaments arrivent sur le marché sans que leur sécurité hépatique soit parfaitement cernée. L'objectif de cette revue est de fournir au lecteur les clés pour être un praticien averti dans le domaine des maladies du foie des patients d'hématologie. The evaluation and management of liver diseases is essential to improve the survival of hematology patients, especially after transplantation of allogeneic hematopoietic cells. The consulting hepatologist may never see a more complex patient than a patient with cancer who develops jaundice, fluid retention, fever, liver pain, and abnormal serum liver tests – and in contrast to the situation where patients have a single diagnosis, there may be multiple causes of liver dysfunction in such a patient. However, medical progress in liver imaging and molecular methods of viral diagnosis have made evaluations more straight-forward, such that liver biopsy can be confined to the most puzzling cases. Diagnostic and therapeutic algorithms are clearer in guiding the clinician and starting treatment quickly, but one long-term goal should be to prevent liver injury in the first place. Hematology is a growing specialty and many drugs are coming to the market without their liver safety being fully understood. The purpose of this review is to provide the reader with the keys to be a knowledgeable practitioner in the field of liver disease in hematology patients. [ABSTRACT FROM AUTHOR]

Several studies have shown an association between Epstein-Barr virus (EBV) infection and some human cancers such as a subgroup of gastric carcinomas. The oncogenic potential of EBV has been widely explored but the exact processes conducting carcinogenesis are not yet fully understood. EBV-encoded viral proteins are known to deregulate the DNA damage response (DDR) signaling pathways. DDR inactivation leads to genomic instability and promote cellular transformation to generate malignant cells. In a recently published article in Nature Medicine, a molecular characterization of tumor tissue and circulating tumor DNA (cDNA) from non-selected patients with metastatic gastric cancer treated with pembrolizumab was conducted. This work showed that a strong correlation between PD-L1 positivity, EBV(+) and MSI-H could be established in the studied cohort. These results suggest that EBV(+) gastric cancer might, similarly to MSI-H tumors, be a target of high-potential for getting a clinical benefit of immunotherapy. Together, these data suggest that EBV status might thus serve as a clinical biomarker to identify patients with gastric cancer who would benefit from immunotherapy. Beyond their clinical interest, these works also pave the way for additional fundamental researches that will allow better characterizing the underlying molecular mechanisms. [ABSTRACT FROM AUTHOR]

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Henoch-Schönlein purpura (HSP) is the most common form of childhood vasculitis. Various viral and bacterial infections, drugs, vaccines, food allergy and even insect bites have been considered as triggering factors in pathogenesis of HSP. Epstein-Barr virus (EBV) infection, which is associated with HSP, have been rarely reported. Herein we present HSP patient possibly caused by EBV infection. A 8-year old boy was admitted to our department with fever, rashes on legs and arms and intermittant mild abdominal pain. Multiple purpuric rashes were on his extremities, abdomen and buttock. Laboratory investigations revealed that monospot test was positive, EBV seriology tests; Anti-EA-D Ig G: 3+, Anti-VCA gp125 Ig G: 3+, Anti-VCA p19 Ig M: 2+, Anti EBNA-1 Ig M: negative, Anti EBNA-1 Ig M: negative, Anti EBNA-1 Ig G: negative. The patient was interpreted as the primary active acute EBV infection. A skin biopsy showed leucocytoclastic vasculitis. The other viral and bacterial investigations were negative. The patient was diagnosed as HSP vasculitis according to EULAR criteria and treated with intravenous hydration and ibuprofen. He was discharged after 15 days with normal laboratory findings and physical examination. We think that EBV infection may be stimulant factor for autoimmune reactions and may cause HSP vasculitis. Hence, it may be usefull to investigate the EBV infection in etiology of HSP cases.

INTRODUCTION: gastric cancer is one of the major causes of cancer related deaths, but data from sub-Saharan Africa are very scanty. The cancer genome atlas (TCGA) initiative confirmed Epstein-Barr virus (EBV) related cancer as a distinct subtype, and we set out to look for serological evidence of its role in a sub-Saharan African patient group. METHODS: we used stored serum samples obtained from a gastric cancer case-control study conducted between 2010 and 2012 in Lusaka, Zambia. A total of 147 patients were included with 51 gastric adenocarcinoma cases and 96 age and sex matched controls. The presence of antibodies to EBV nuclear antigen-1 (EBNA-1) and early antigen (EA) was determined using commercially available ELISA kits. Data were analysed in STATA Stata Corp, College Station TX. RESULTS: over 90% of all the samples analysed were positive for antibodies to EBNA-1. The presence of antibodies to EBV EA was significantly higher in gastric cancer cases than in controls, (OR 4.38; 95% CI 1.53-13.06, P=0.0027), with an attributable risk of 23%. HIV infection was also associated with EBV EA seroprevalence (OR 10.97; 95% CI 2.26 -13.06, P=0.001) but not EBNA-1 (OR 0.81; 95% CI 0.10 -38.75, P=0.596). There was no association of EBV infection with age below 45 years, Helicobacter pylori infection, intestinal metaplasia, gastric atrophy or inflammation. CONCLUSION: we therefore conclude that EBV exposure is common among Zambian adults and that EBV EA seropositivity is associated with gastric cancer and HIV infection, but not premalignant lesions.

Résumé Introduction Le lymphome de Burkitt (LB) représente une cause exceptionnelle d’insuffisance rénale aiguë (IRA). Les follicules lymphoïdes secondaires à l’infection rénale à l’Epstein-Barr virus (EBV) pourraient être l’origine du clone tumoral. À travers une observation, les auteurs discutent la pathogénie, les arguments diagnostiques et l’évolution de cette affection rarissime. Observation Il s’agit d’un patient âgé de 4 ans, avec un antécédent récent d’ostéomyélite aiguë de la cuisse droite. Le patient présente, au décours de cette infection, une IRA sans arguments en faveur d’une glomérulonéphrite post-infectieuse. L’échographie montre des reins augmentés de taille sans dilatation des cavités excrétrices. La biopsie rénale note une infiltration interstitielle diffuse en nappe de cellules lymphoïdes atypiques de taille moyenne. Les cellules tumorales expriment les anticorps anti-CD20, CD10, Bcl6, Ki67 et sont négatives aux anticorps anti-Bcl2 et anti-CD3. La recherche d’une infection à l’EBV est positive. L’évolution est spontanément mortelle quelques jours après le diagnostic. Discussion/conclusion Le LB du rein est une affection rarissime, représentant moins de 1 % des tumeurs rénales,et est associé de façon quasi constante à une infection à l’EBV. Le diagnostic est histologique sur biopsie rénale et les critères de Malbrain permettent d’affirmer le caractère primitif du lymphome. Il s’agit d’une urgence diagnostique et thérapeutique. L’évolution spontanée est mortelle. Introduction Burkitt's lymphoma (BL) is an exceptional cause of acute renal failure (ARF). The origin of the tumor clone may be lymphoid follicles secondary to renal Epstein-Barr virus (EBV) infection. With the presentation of this clinical case, the pathogenesis, diagnostic criteria and evolution of this extremely rare affection will be discussed. Observation A 4-year-old patient with a recent history of acute osteomyelitis of the right thigh presented an ARF without indications of post-infectious glomerulonephritis. Ultrasound showed enlarged kidneys without dilation of the excretory cavities. Diffuse interstitial infiltration of atypical lymphoid cells of medium size were noted upon renal biopsy. The tumor cells expressed antibodies against CD20, CD10, Bcl6, and Ki67 but not against Bcl2 or CD3. The search for an EBV infection was positive. A few days after diagnosis, the evolution was spontaneously fatal. Discussion/conclusion BL of the kidney is a rare condition that accounts for less than 1 % of kidney tumors, associated almost invariably with EBV infection. The diagnosis is confirmed histologically by renal biopsy and the criteria of Malbrain affirms the primitive character of the lymphoma. BL of the kidney is a diagnostic and therapeutic emergency and may be fatal. [ABSTRACT FROM AUTHOR]

L'ulcère aigu de la vulve ou ulcère de Lipschütz porte le nom de l'auteur qui l'a décrit initialement en 1913. Cette entité rare et probablement sous-diagnostiquée survient chez l'adolescente ou la jeune fille le plus souvent vierge au décours d'une affection fébrile. L'étiologie est inconnue, elle serait la conséquence d'une réaction immunologique exagérée à un agent infectieux tel que l'Epstein-Barr virus. Il s'agit d'une ulcération vulvaire aphtoïde unique ou multiple, hyperalgique, creusante et nécrotique d'évolution aigue, non sexuellement transmissible. La guérison spontanée survient en deux semaines parfois au prix de mutilations. C'est un diagnostic d'exclusion à retenir après avoir écarté les infections sexuellement transmissibles (IST), les causes auto-immunes, les traumatismes et autres étiologies des ulcérations génitales aigues. La prise en charge thérapeutique est symptomatique à base d'antalgiques, d'anesthésiques et de corticoïdes locaux, ou d'antibiotiques. Les cas sévères avec douleur et dysurie importantes peuvent nécessiter une hospitalisation et un sondage urinaire.

Résumé: Le Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), défini initialement comme une toxidermie grave, est considéré aujourd’hui comme un syndrome induit par des médicaments pouvant mettre en jeu le pronostic vital par la survenue de manifestations viscérales sévères. Il est caractérisé par un long délai d’apparition entre la prise médicamenteuse et le début des manifestations, et par une évolution prolongée souvent par poussées même après l’arrêt du médicament causal. Sa physiopathologie reste incomplètement comprise et fait intervenir des réactivations des virus herpès (HHV-6, HHV-7, EBV, CMV) et une forte réponse immune dirigée contre ces virus. Les médicaments pourraient intervenir à la fois sur le contrôle épigénétique pour favoriser la réactivation virale et sur une réponse immune lymphocytaire T (LT) antivirale en interagissant avec le récepteur du complexe majeur d’histocompatibilité chez des individus prédisposés génétiquement. [ABSTRACT FROM AUTHOR]

Résumé: Le virus d’Epstein-Barr virus (EBV) est un virus oncogène ubiquitaire avec une séroprévalence de plus de 90 %. À l’âge de 5 ans, la moitié des enfants a déjà rencontré cet herpesvirus. Il présente le plus haut pouvoir transformant chez l’homme, et induit une réponse immunitaire cellulaire majeure au moment de la primo-infection. Il est responsable de différentes lymphoproliférations B, essentiellement (lymphome de l’immunodéprimé, Hodgkin, Burkitt) et épithélioproliférations (carcinome nasopharyngé, carcinome gastrique). Les cellules infectées par le virus sont en phase de latence 0, I, II ou III ou en cycle réplicatif (ou lytique) selon l’étape naturelle de l’infection ou selon la pathologie associée. Le diagnostic virologique d’une pathologie EBV-induite se fait sur tissu par immunohistochimie ou par hybridation in situ (recherche des ARN non codants les EBERs). Il est possible également de quantifier l’ADN de l’EBV par PCR en temps réel (charge virale EBV) dans le sang périphérique (sang total), la moelle ou d’autres fluides biologiques, voire dans des tumeurs. La charge virale EBV est en particulier utilisée dans le suivi longitudinal des greffes de moelle ou d’organe afin de dépister plus précocement une Iymphoproiiferation et de proposer ainsi un traitement anticipé. [Copyright &y& Elsevier]

Summary: Introduction: Almost all organs can be involved in the infection by Epstein–Barr virus and consequently, the beginning symptoms of infectious mononucleosis may be different. Materials and methods: We report a case of infection by Epstein–Barr virus in a 17-year-old girl whose primary manifestation was an initially monolateral and subsequently bilateral dacryoadenitis. Results: The incidence of acute dacryoadenitis by Epstein–Barr virus is valued around one case per million people per year, but it is probably underestimated: it is due to infiltration of the lacrimal gland by activated lymphocytes. Discussion: An acute dacryoadenitis, especially when it affects a young adult and when bilateral, should guide the diagnostic and haematochemical and serological investigations towards a systemic disease such as infectious mononucleosis. It is almost always responsive to a systemic corticosteroid therapy, but in some cases it can progress towards a dacryocystitis and exceptionally towards the Sjögren syndrome. Appropriate and timely treatment will be able to reduce any subsequent complications. [Copyright &y& Elsevier]

Abstract: Objective: The objective of this study was to compare epidemiological, clinical, and biological data of Epstein-Barr virus (EBV) and cytomegalovirus (CMV) primary infections in immunocompetent adults, admitted in the infectious disease department of the Reims Teaching Hospital between 2000 and 2005. Patients and methods: Inclusion criteria were the presence of anti-VCA IgM antibodies or the presence of CMV specific IgM antibodies and the absence of any other positive serology. Differences in reported percentage were compared with a Khi2 test or Fischer''s exact test, when appropriate. Continuous variables were compared with the Mann-Whitney Test. Results: There were no significant changes over the years in the numbers of EBV (n =32) and CMV (n =20) primary infections. The patient''s mean age was 22.7years (14–48years) in EBV primary infections and 38.6years (13–66years) in CMV primary infections (P <0.01). The clinical variables significantly associated with primary EBV infection were sore throat and cervical lymphadenopathy (P <0.01). Arthromyalgia and respiratory manifestations were less frequent in EBV primary infection (P <0.01). The biological variables significantly associated with EBV primary infection were a marked alanine aminotransferase elevation and a marked lymphocytosis with atypical lymphocytes (P <0.001). Thrombopenia was less frequently associated with EBV primary infection (P <0.001). Conclusion: Clinical and biological presentations of EBV and CMV primary infections were similar. The simultaneous serologic diagnosis of these two infections remains necessary to provide a specific diagnosis, for the most efficient patient care. [Copyright &y& Elsevier]

Summary: Acute inflammatory polyradiculoneuropathy, or Guillain-Barré syndrome (GBS), is characterized by peripheral nerve demyelination, which leads to rapidly progressive weakness, loss of sensation, and loss of deep tendon reflexes. It is a prototype of postinfectious autoimmune disease, whose pathophysiology is well described in the forms provoked by certain bacteria (molecular mimicry with Campylobacter jejuni), but remains unclear for the forms related to other organisms (cytomegalovirus, Epstein-Barr virus and other herpes group viruses, Mycoplasma pneumoniae). Glomerular lesions can be associated with the neurological symptoms and have also been described after various infections, independently of any signs of polyradiculoneuropathy. We report the observation of a 12-year-old girl who presented with Guillain-Barré syndrome with facial diplegia, ataxia, and intracranial hypertension following Epstein-Barr virus (EBV) primary infection. During the course of the neurological disease, membranous glomerulonephritis (MGN) was diagnosed. The neurological impairment was regressive within 6 months after intravenous immunoglobulin treatment followed by intravenous then oral corticosteroid administration. Viremia remained high more than 6 months after the onset of symptoms. Glomerulopathy progressed independently and finally required immunosuppressant medication with cyclosporine. EBV might be the factor that triggered the autoimmune disorders, as previously reported for systemic lupus erythematosus and multiple sclerosis in children. To the best of our knowledge, this association of 3 conditions (GBS, MGN, and EBV primary infection) has never been reported in the literature. [ABSTRACT FROM AUTHOR]

Résumé: Objectifs: Le risque de lymphome est accru dans la polyarthrite rhumatoïde (PR), contrairement à la spondylarthrite ankylosante (SA). Le rôle de l’EBV dans la survenue des lymphomes au cours de la PR reste discuté. Méthode: Nous avons étudié de manière prospective l’évolution de la charge virale EBV (CvEBV) de patients atteints de PR ou de SA traités par anti-TNFα, ainsi que le lien avec l’activité de la maladie. Résultats: Les 46 patients atteints de PR (femmes : 82,6 %), étaient âgées de 52,7±11,3 ans. La CvEBV a été contrôlée à 9,72±5,7 mois. Elle est devenue positive chez cinq patients et a augmenté chez un autre (quatre sous etanercept, un sous adalimumab, un sous infliximab). Elle est devenue négative chez six patients (cinq patients sous adalimumab, un sous étanercept). Le DAS 28 est passé de 4,78±1,1 à l’inclusion à 2,94±1,24. Les 27 patients atteints de SA (hommes : 81,5 %) étaient âgés de 45,1±12,7 ans. La CvEBV a été contrôlée à 12,9±10,6 mois. Elle est devenue positive chez deux patients (7,4 %) (un sous infliximab, un sous adalimumab), indétectable chez un patient sous adalimumab. Sous traitement, le BASDAI est passé de 55,1±16,2 à 17,8±18,6. Une CvEBV positive est plus fréquente dans la PR que dans la SA (p =0,039). Aucun cas de lymphome n’a été recensé. Conclusion: L’introduction d’un traitement anti-TNFα n’influence pas la CvEBV de patients traités pour une PR ou une SA. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The Roche LightCycler® 480 (LC480) system was evaluated for quantitative molecular diagnosis of opportunistic viral infections caused by human cytomegalovirus (CMV), Epstein-Barr virus (EBV), human herpesvirus 6 (HHV-6), and BK virus (BKV), in comparison with “in-house” real-time PCR assays. Patients and methods: A total of 253 whole blood specimens obtained from transplant recipients were tested. Results: Both the “in-house” and the LC480 methods were highly correlated (Spearman correlation coefficient Rho≥0.85; p <0.0001) with an excellent overall qualitative agreement (90.5 %) and no significant quantitative difference between both techniques for the four viruses tested. The accuracy of the LC480 protocols were confirmed further by the results obtained with the 44 samples from the Quality Control for Molecular Diagnosis (QCMD) 2008 proficiency panel. Conclusion: The LC480 system constitutes a suitable and versatile real-time PCR platform in a routine laboratory setting for the diagnosis and monitoring of opportunistic viral infections in transplant recipients, by measuring HCMV, EBV, HHV-6, and BKV loads in whole blood samples. [Copyright &y& Elsevier]

Abstract: We report a case of Epstein Barr virus-associated large B cell lymphoproliferative disorder, with an abdominal cutaneous localization, in an adult treated for 10 years with immunosuppressive agents for a dermatomyositis. This is the third case of immunosuppressive induced lymphoproliferative disorder localized to skin in a patient with dermatomyositis. Diagnosis was unexpectedly obtained by the histologic examination of surgical samples of skin necrosis possibly induced by edetate calcium disodium subcutaneous injections in calcinosis cutis. [Copyright &y& Elsevier]

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Summary: We report the cases of two young immunocompetent children with bronchopneumonia associating disabling, spastic cough and severe hypoxemia. In both patients, a primary Epstein-Barr Virus (EBV) infection had been suggested based on EBV presence in nasal secretions and a positive serology with anti-VCA immunoglobulin M. Nevertheless, the diagnosis was not confirmed. We discuss the problems confirming EBV responsibility in acute respiratory infections and the pitfalls of diagnostic tests. [Copyright &y& Elsevier]

Résumé: Il existe de multiples relations entre le virus d''Epstein-Barr (EBV) et la polyarthrite rhumatoïde (PR): les malades atteints de PR ont des titres d''anticorps dirigés contre les antigènes d''EBV plus élevés par rapport à des sujets sains; la PR est caractérisée par un défaut de contrôle cellulaire de l''infection par EBV; des similitudes antigéniques entre EBV et des composants du soi ont été observées (séquences glycine–alanine d''EBNA-1 et protéines de la synoviale; glycoprotéine gp110 et épitope partagé); des réponses cellulaires dirigées contre des protéines du cycle réplicatif et contre gp110 ont été observées au niveau du liquide articulaire de PR; EBV (ses antigènes ou son génome) a été mis en évidence au niveau de la synoviale de PR par hybridation in situ ou PCR, avec un rendement variable; la charge virale en EBV des cellules mononucléées du sang circulant est élevée dans la PR comparativement aux témoins; EBNA-1 est susceptible de subir une citrullination et des anticorps antipeptides citrullinés peuvent être induits par EBV; des lymphomes compliquent la PR et certains sont associés à EBV. Ainsi, les liens EBV–PR sont nombreux et complexes, mais la relation de causalité directe n''a pas été formellement établie. Le virus d''Epstein-Barr pourrait agir indirectement dans le schéma physiopathologique de la PR, par l''intermédiaire du mauvais contrôle de l''infection et d''une exposition chronique à ses antigènes, sources de réaction inflammatoire chronique. L''effet des nouvelles thérapeutiques de la PR (biothérapies) sur la cohabitation EBV-hôte nécessite d''être analysé. [Copyright &y& Elsevier]

Abstract: Purpose: To determine the level and prognostic significance of c-kit expression in the two age groups of North African nasopharyngeal carcinomas. Patients and methods: A retrospective study of 99 NPC specimens from Tunisian patients was investigated by immunohistochemistry. Immunohistochemical data were correlated with Epstein-Barr virus LMP1 expression and pathological, clinical and survival parameters. Results: c-kit was detected in 79% of the cases for patients under 30 years of age (juvenile form) but in only 56% of specimens in patients over 30 years (P =0.039) and was significantly over-expressed for patients with lymph node involvement (P =0.015). LMP1 score was 5.78 (±1.84) for c-kit negative tumors compared to 8,23 (±2.39) for c-kit positive tumors (P =0.002). Multivariate analysis including age, lymph nodes involvement and LMP1 expression as co-variables, showed that only age (P =0.027) and LMP1 expression (P =0.005) were significantly correlated to the c-kit expression. Conclusion: c-kit is highly expressed in the juvenile form of North African nasopharyngeal carcinomas. There is a significant association between LMP1 and c-kit expression. The contrasted levels of C-kit expression in the two age groups strengthen the hypothesis that these clinical forms result from distinct oncogenic mechanisms. [Copyright &y& Elsevier]

Copyright of IBS, Immuno-analyse & Biologie Specialisee is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of IBS, Immuno-analyse & Biologie Specialisee is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Purpose: The cause of Sjögren''s syndrome is unclear. Several studies suggested the role of Epstein-Barr virus (EBV) in the pathogenesis of this syndrome, but this always remains a subject of numerous controversies. The purpose of this study was to evaluate the prevalence of EBV in Sjögren''s syndrome in Tunisia. Methods: A series of 31 paraffin-embedded biopsies of salivary glands from patients with Sjögren''s syndrome were studied in comparison with 19 control glands. EBV was investigated by PCR, EBERs in situ hybridization and by immunohistochemistry for the detection of LMP1, EBNA2 and ZEBRA. Results: EBV DNA was detected by PCR in 3 of 22 PCR β-globin positive Sjögren''s syndrome cases (13.6%) and in 2 of 17 PCR β-globin positive control glands (11.7%); in situ hybridization positivity was noted in rare lymphocytes in the 3 EBV positive cases of Sjögren''s syndrome, but not in control glands; immunohistochemical study was negative in all cases. Conclusion: EBV infection does not appear to play a significant role in the pathogenesis of Sjögren''s syndrome in Tunisia. [Copyright &y& Elsevier]

Copyright of EMC-Hematologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Nasopharyngeal carcinomas (NPC) are very different from other head and neck cancers because of their specific multifactorial etiology and their geographic distribution. Epstein-Barr Virus (EBV) is implicated in oncogenesis of NPC in association with genetic alterations such as inactivation of the p16/Ink4, p19/ARF, RASSF1 or Blu genes. Tumoral tissues include a very abundant characteristic lymphoid infiltrate. Inflammatory cytokines are produced by both malignant and infiltrating cells. There is no efficient immune response against the tumor. On the opposite, infiltrating lymphocytes might play a role in tumor development. Serological methods and detection of circulating viral DNA are expected to become useful for early detection of relapse and on a longer term for primary screening. NPC are often diagnosed at a late stage because patients may remain asymptomatic for a long time. Computed tomography (CT scan) and magnetic resonance imaging (MRI) are complementary for the initial evaluation. Positron emission tomography (PET) is efficient for the evaluation of treatment efficiency and detection of relapses. Treatment is based on radiotherapy and chemotherapy. Their optimal use needs to be evaluated by phase III trials but positive results have been obtained by concomitant association of radiotherapy and chemotherapy. Targeted therapies are beeing studied with strategies based on disruption of viral latency, use of replicative adenoviruses or anti-tumor vaccination. [Copyright &y& Elsevier]

Nasopharyngeal carcinoma (NPC) represents an interesting model in the field of head and neck cancers. This cancer is rare in occidental countries (<1/100,000) and relatively moderate to highly frequent in the Mediterranean area and south-east Asia. This disease is linked to Epstein-Barr virus with a latent infection starting in the oropharyngeal epithelium and involving not only both epithelial tumor cells but also B lymphocytes. This viral infection represents the early phase of carcinogenesis where Latent Membrane Protein-1 has an important role via the terminal part of the BARF-1 gene. There are also various chromosomal alterations reported in NPC concerning the regions of chromosomes 3p, 9p, 11q, 13q, 14q et 16q detected essentially in areas of suppressors genes. Allelic and antigenic specificities of class II and II HLA seems to be associated to an increased risk of NPC different according to the incidence areas. Anti-EBV serology is suggestive of for NPC with an elevated level of IgA EA (early antigen) and VCA (viral capsid antigen). Cyfra 21 represents a promising serum marker for NPC with a 80% sensitivity. Radiotherapy remains the base of loco-regional treatment with a more frequent and systematic use of systemic chemotherapy (primary or concomitant) for high-risk-patients (T3-4 and N2-3 disease). [Copyright &y& Elsevier]

Copyright of Revue Francaise des Laboratoires is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Central nervous system leiomyosarcomas are extremely rare, however, they became more frequent among immunodeficient patients, either in a patients infected with human immunodeficiency virus (HIV), or after organ transplantation. The data of the literature indicate that the infection by Epstein-Barr virus (EBV) plays a causal role in the development of these tumours but its precise role in the oncogenesis remains unresolved. We report a new case of EBV associated leiomyosarcoma of the left cavernous sinus occurring after renal transplantation. The epidemiological, clinical, pathological and therapeutic characteristics of these tumours are discussed. [Copyright &y& Elsevier]

Copyright of IBS, Immuno-analyse & Biologie Specialisee is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Systemic lupus erythematosus (SLE) is a complex multifactorial autoimmune disease depending on both intrinsic and environmental factors. Among the latter, the Epstein-Barr Virus (EBV) has long been suggested as one of the responsible factors for the onset and activity of lupus disease. It is a herpes virus with a very specific tropism for B lymphocytes and therefore closely linked to the immune system. EBV infection almost always precedes the onset of lupus disease and in vitro data and animal models suggest that anti-EBV response may favor the development of autoantibodies and lupus disease in some subjects. Also, there are abnormalities in humoral and cellular responses to EBV and lupus patients have impaired control of EBV, with higher blood viral loads. Interstingly, this virus seems to be able to promote disease activity, by promoting the survival of autoreactive B lymphocytes and the production of interferon-α, which are two pivotal mechanisms in the pathophysiology of lupus disease., (Copyright © 2022 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.)

A 75-year-old woman is hospitalised for sepsis. The diagnosis of cholecystitis is made and an antibiotic therapy is debuted. The clinical worsening leads to realise an urgent cholecystectomy. A sepsis like shock persisted. The antibiotherapy was changed and a second abdominal look made. A severe lactic acidosis persisted since the cholecystectomy despite a continuous hemofiltration. The diagnosis of type B lactic acidosis secondary to malignancy was suspected. An osteomedullar biopsy revelled B-cell lymphoma EBV induced. [ABSTRACT FROM AUTHOR]

Résumé: Dans une démarche qui vise à uniformiser la prise en charge des malades faisant l’objet d’une allogreffe de cellules souches hématopoïétiques, la société française de greffe de moelle et de thérapie cellulaire (SFGM-TC) a organisé les troisièmes ateliers d’harmonisation des pratiques en octobre 2012 à Lille. Le but de ces ateliers était de trouver un terrain d’entente entre les centres qui le souhaitent dans les domaines où la littérature ne fournit pas de réponses incontestables et consensuelles. Dans cet atelier nous abordons la conduite à tenir lorsque le donneur a une sérologie IgM positive témoignant d’une infection récente au cytomégalovirus, au virus d’Epstein-Barr, ou en faveur d’une toxoplasmose ou d’une syphilis active. [ABSTRACT FROM AUTHOR]

Abstract: Abdominal pain is uncommon in patient with Epstein-Barr infection and is usually attributed to an enlargement of the liver or spleen. We report on an 8-year-old girl with a pseudoperitonitis due to a mesenteric lymphadenitis associated with Epstein-Barr infection. Outcome was favourable without surgery. We review the different causes of abdominal pain occurring during Epstein-Barr infection. [Copyright &y& Elsevier]

A 3 year-old immunocompetent boy presented with severe obstructive respiratory failure with pneumothorax accompanying a primary Epstein-Barr virus infection. Because of the patient’s severe hypoxemia, he required mechanical ventilation for 6 days. The clinical course with corticosteroids was favourable and the patient was discharged from the intensive care unit without sequelae. Severe pneumonitis with EBV is rare, particularly in children. We describe the clinical course and laboratory test results of this atypical pediatric patient. [Copyright &y& Elsevier]

Introduction: An original case of DRESS syndrome is reported herein with a particular cutaneous presentation and etiology., Observation: A 52-year-old man developed a febrile pustular rash after being treated with methotrexate and celecoxib for inflammatory rheumatism and with amoxicillin-clavulanic acid over the previous 2 days. Eighty percent of his body surface was covered with pustular infiltrated plaques. On the following days, the patient developed persistent fever, with polyadenopathy, hepatic cytolysis, eosinophilia, interstitial lung disease and cardiac involvement. Cutaneous biopsy was consistent with a drug eruption. Epstein Barr Virus PCR was positive. A diagnosis of DRESS syndrome was made with a RegiSCAR score above 5. Systemic corticosteroids were given, resulting in cessation of the fever and complete recovery with regard to dermatosis, laboratory abnormalities and cardiac function., Discussion: The present case is original, with a febrile pustular eruption mimicking acute generalized exanthematous pustulosis and cardiac anomalies with electrical changes and impairment of ventricular function. Epstein Barr Virus may have played a role in the presentation. No previous cases of DRESS syndrome caused by methotrexate have been described. Amoxicillin was probably not involved in the present case of DRESS syndrome as it was taken for only two days, but its role as a co-factor in association with the EBV viral reactivation should not be ruled out., Conclusion: We report an original case of DRESS syndrome in terms of pustular cutaneous presentation and cardiac impairment. EBV reactivation associated with amoxicillin may be suspected., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)