Epstein-Barr virus infection in children with AIDS

Abstract

ResumoObjetivo: A associação das infecções por HIV e vírus EpsteinBarr tem sido relatada em diversos estudos, especialmente em crianças que apresentam pneumonia intersticial linfóide. Analisouse a incidência da infecção pelo vírus Epstein-Barr em crianças com AIDS, naquelas com AIDS com e sem pneumonia intersticial linfóide, comparando-se com crianças não infectadas pelo HIV.Métodos AbstractObjective: The association of the HIV and Epstein-Barr virus infections has been reported in several studies, specially in children that present lymphocytic interstitial pneumonitis. The analysis of the incidence of Epstein-Barr virus infection was performed in children with AIDS, in those with AIDS with and without lymphocytic interstitial pneumonitis, comparing to children without HIV infection.Methods: A cross-sectional study was performed with 60 children with AIDS and 54 children not infected by HIV, matched by sex and age, in the Hospital Infantil Joana de Gusmão in Florianópolis city, Santa Catarina State, Brazil, between June 1994 and June 1995. The selection of the cases followed the order of the consultation. The detection of antibodies against Epstein-Barr capsid antigen was performed by standard indirect immunofluorescence techniques and ELISA, and antibodies against nuclear antigen only by ELISA. The stage of the infection was defined according to serologic responses.Results: Lymphadenopathy occurred in 59 cases (98.3%), hepatomegaly in 51 (85.0%), splenomegaly in 46 (76.7%), recurrent bronchopneumonia in 41 (68.3%). Lymphocytic interstitial pneumonitis was observed in 21 cases (35.0%), 90.5% of which showed positive serologic reactions to EBV. The geometric mean of the IgG against capsid antigen titers was 1:439.5 in the cases group and 1:42.8 in the controls. The IgM against capsid antigen by indirect immunofluorescence techniques was positive in 16 (26.7%) of the 60 cases and only in one of the 53 controls (1.9%) (p=0.0002). The primary Epstein-Barr virus infection was evidenced with greater frequency in the children with AIDS (p<0.0001), as well as the reactivated infection (p=0.0745).Conclusions: The incidence of primary and reactivated EpsteinBarr virus infection was more frequent in the patients with AIDS. The primary and reactivated Epstein-Barr virus infection was observed in almost all of the patients with diagnosis of lymphocytic interstitial pneumonitis (90.5%).J. pediatr. (Rio J.). 1998; 74(2):125-134 IntroduçãoAs similaridades clínicas decorrentes da infecção pelo vírus da imunodeficiência humana (HIV) e pelo vírus Epstein-Barr (EBV), especialmente relacionadas às manifestações envolvendo o sistema linfático, além de semelhanças no comprometimento do sistema imunológico,

O virus Epstein-Barr no tecido pulmonar de crianças com pneumonia intersticial e aids

“…(Blanche et al, 1994). Discussão Atualmente, considera-se que o complexo HLP/PIL esteja presente em 17% a 80 % das crianças com AIDS e com doença pulmonar (Joshi et al, 1985;Rubstein et al,1986;Marolda et al,1991;Neshein et al, 1994;Moran et al,1994;Ikeogu et al, 1997;Carvalho et al, 1998;Swigris et al, 2002;Graham, 2005;Toro et al, 2006;Zar, 2008).…”

“…O complexo HLP/PIL é descrito com relativa freqüência em pacientes pediátricos infectados pelo HIV-1 (Grieco e Chinoy-Acharya, 1985;Carvalho, et al, 1998;Toro et al, 2006). Representa uma resposta inespecífica a múltiplos estímulos.…”

“…Rubstein et al, 1986, Barbera et al, 1992, Moran et al, 1994, Kaan et al, 1997, Carvalho et al, 1998, Brodie et al,1999, Bekker et al, 2006 Katz et al (1992). analisaram em um estudo de caso controle, 10 crianças infectadas pelo HIV e com síndrome linfoproliferativa pulmonar.…”

“…demonstraram em modelo experimental o crescimento do EBV no pulmão. Dessa maneira, presume-se que a co-infecção dos HIV e EBV nos macrófagos pulmonares potencialize a replicação do HIV nos linfócitos B infectados pelo EBV e, em alguns casos, pode ser o estímulo antigênico necessário para precipitar as alterações patológicas da PIL(Montagnier et al, 1984;Lane et al, 1985) Carvalho et al (1998). avaliaram crianças brasileiras com AIDS e verificaram que elas desenvolveram infecção pelo EBV aos 24 meses de idade ou menos, e com uma freqüência mais elevada do que a do grupo controle.…”