Characteristics of primary Epstein–Barr virus infection disease spectrum and its reactivation in children, in Suzhou, China

Abstract

Epstein–Barr virus (EBV) is a globally prevalent herpesvirus associated with multiple diseases. This study aimed to determine the characteristics of primary EBV infection disease spectrum and reactivation in children, in Suzhou, China. All children admitted to the Children's Hospital of Soochow University between May 2018 and September 2020 with suspected EBV‐associated disease and subjected to the indirect immunofluorescence assay for EBV‐specific antibodies and plasma EBV‐DNA assays were included. Of the 3567 children, 2782 (78.0%) tested positive for EBV. The positive rates of viral capsid antigen (VCA)‐IgM, VCA‐IgG, early antigen (EA)‐IgG, nuclear antigen (EBNA)‐IgG, and plasma EBV‐DNA were 12.1%, 74.6%, 37.9%, 35.6%, and 31.1%, respectively. The lowest VCA‐IgG and EBNA‐IgG seropositivity rates occurred at ages between 8 and 36 months, then increased gradually in the older age groups. The EBV‐IgM seropositivity rate was the highest in those aged 36 to <72 months. Primary EBV infection was more common in children aged 36 to <72 months. In past infections, reactivation mainly occurred in 8 to <36 months. The most common disease caused by primary EBV infection was infectious mononucleosis (56.1%), followed by a respiratory infection (17.0%). Respiratory infection (30.0%), EBV infection (29.2%), and hemophagocytic lymphohistiocytosis (HLH) (15.8%) were the commonest diseases caused by EBV reactivation. EBV reactivation was a risk factor for HLH (adjusted odds ratio, 16.4; 95% confidence interval, 7.9–34.0). Among reactivated patients, the viral load of HLH was higher than that of EBV infection and respiratory infection (p < .01). This is a retrospective large sample study that explored the characteristics of primary EBV infection disease spectrum and reactivation in children.

A combined antibody and DNA assay for EBV infection in children

“…The current infection rate in this study was 15.7%. When comparing the current infection rates of each age group, we found that the preschool age group had the highest current infection rate, which was consistent with the results of most domestic studies (12,13). This suggests that the preschool age group experienced a high incidence of EBV infection.…”

Seroprevalence of Epstein–Barr virus infection in children during the COVID-19 pandemic in Zhejiang, China

“…EBV infection in France has decreased during the last 15 years, and the seronegative rates increased from nearly 50% during 2001–2005 to >60% during the 2011–2015 period in patients aged <10 years old ( 26 ). A previous study in other regions of China found that the positive rates of EBV infection reached 78.0% in children aged 0–16 years ( 27 ). Similarly, a retrospective study showed that the prevalence of EBV infection in North and South China was 80.78% and 79.38% in children aged 0–10 years, respectively ( 28 ).…”

“…Pattern D and pattern E represented past EBV infection, accounting for 44.21%. However, other investigations showed that the positivity rate of VCA-IgG was 74.6% in children aged 0–16 years in Suzhou ( 27 ), 77.8% in Guangzhou and 77.4% in Beijing ( 28 ). Similarly, the positivity rate of EBNA-IgG in our study was lower than that in Guangzhou (75.53%) and Beijing (76.26%).…”

Diversity of adenosine deaminase in children with EBV-related diseases

“…The diagnostic criteria for EBV-IM are as follows [ 12 ]: (1) the presence of at least three of the following clinical manifestations: fever, tonsillopharyngitis, cervical lymphadenopathy, hepatomegaly, and splenomegaly; (2) immunoglobin (Ig) M and IgG to EBV viral capsid antigen (VCA-IgM)-positive and IgG to nuclear antigen (EBNA)-negative or VCA-IgM-negative and VCA-IgG-positive (low affinity); and (3) other infections, such as cytomegalovirus and human immunodeficiency virus, were ruled out. In this study, atypical EBV infection was defined as the onset of fever or elevated atypical lymphocytes in the peripheral blood without target organ damage [ 13 ].…”

“…(2) immunoglobin (Ig) M and IgG to EBV viral capsid antigen (VCA-IgM)-positive and IgG to nuclear antigen (EBNA)-negative or VCA-IgM-negative and VCA-IgGpositive (low affinity); and (3) other infections, such as cytomegalovirus and human immunodeficiency virus, were ruled out. In this study, atypical EBV infection was defined as the onset of fever or elevated atypical lymphocytes in the peripheral blood without target organ damage [13].…”