Epstein-Barr Virus Versus Novel Coronavirus-Induced Hemophagocytic Lymphohistocytosis: The Uncharted Waters

Amir, Rawan; Kichloo, Asim; Singh, Jagmeet P.; Bhanot, Ravinder; Aljadah, Michael; Kumar, Akshay; Albosta, Michael; Solanki, Shantanu

doi:10.1177/2324709620950107

Cited by 5 publications

(4 citation statements)

References 10 publications

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“…In this paper, we compared the clinical features of EBVinfected and non-infected children and found differences in the first symptoms, karyotype, immunophenotyping, clinical risk, secondary infection during chemotherapy, and lymphocyte subsets, suggesting that EBV infection is associated with these clinical features. More than half of primary EBV infections occur in children under 5 years old, such children present only with respiratory infections or infectious mononucleosis, and EBV infection is associated with hepatosplenomegaly in children (18,19). The results of this paper showed that the highest percentage of first symptoms were hepatosplenic lymph node enlargement in infected patients compared to non-EBV infected children, which further supports the conclusion that EBV infection can cause hepatosplenomegaly and is consistent with the characteristics of this virus.…”

Section: Discussionsupporting

confidence: 83%

Clinical features and prognosis of acute lymphoblastic leukemia in children with Epstein-Barr virus infection

Deng¹,

Xu²,

Yuan³

2022

Transl Pediatr

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Background: Acute lymphoblastic leukemia (ALL) is one of the most common malignant diseases of the hematopoietic system in children. Although the etiology of ALL is unknown, it has been reported that it may be associated with Epstein-Barr virus (EBV) infection. The aim of this study was to analyze the impact of EBV infection on the clinical features and prognosis of childhood ALL.Methods: A total of 162 children with ALL admitted to Heilongjiang Provincial Hospital from January 2018 to December 2020 were selected for this stud, and were divided into 2 groups, infected group and noninfected group, according to whether they had EBV infection. Differences in clinical characteristics between the 2 groups were analyzed by χ 2 or t-test. The impact of EBV infection on the prognosis of children was analyzed by Kaplan-Meier survival and Cox regression analysis. Results:The 2 groups were statistically significantly different (P<0.05) according to comparison of characteristics such as first symptoms, karyotype, immunophenotyping, clinical risk, whether secondary infection occurred during chemotherapy, and lymphocyte subsets. Logistic regression results suggested that first symptoms, karyotype, immunophenotyping, clinical risk, the presence of secondary infection during chemotherapy, and lymphocyte subsets were independently associated with EBV infection in children with ALL (P<0.05). The complete remission rate at 46 days after chemotherapy, event-free survival (EFS), overall survival (OS), and survival rate were lower in the infected group than non-infected group, and the complete remission recurrence rate was higher than non-infected group (P<0.05). The EBV DNA levels were statistically lower in the good prognosis group (1.07±0.25×10 3 copies/L) than poor prognosis group (8.86±1.14 ×10 3 copies/L) (P<0.01). The area under the curve (AUC) for EBV to predict prognosis in children with ALL was 0.921, sensitivity and sensitivity were 86.57%, 80.16%.Conclusions: Infection with EBV is associated with first symptoms, karyotype, immunophenotyping, clinical risk, secondary infection during chemotherapy, and lymphocyte subpopulation index levels in children with ALL, and children with EBV infection have a reduced clinical remission rate and poor prognosis. Therefore, the detection of EBV DNA is clinically important for assessing the prognosis of their disease.

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Section: Discussionsupporting

confidence: 83%

Clinical features and prognosis of acute lymphoblastic leukemia in children with Epstein-Barr virus infection

Deng¹,

Xu²,

Yuan³

2022

Transl Pediatr

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“…As the number of cases of this virus increases, so do the number of complications exposed. Chronic B-lymphocyte depletion ultimately puts patients at higher risk for infections other than SARS-CoV-2 [ 14 ]. EBV reactivation was closely related to the prognosis of patients with COVID-19, which may exacerbate COVID-19 pneumonia.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and outcomes of critically ill patients with acute COVID-19 with Epstein-Barr virus reactivation

Xie

Cao

et al. 2021

BMC Infect Dis

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Background Our goal is to further elucidate the clinical condition and prognosis of patients with severe acute COVID-19 with EBV reactivation. Method This is a retrospective single-center study of COVID-19 patients admitted to the intensive care unit of Wuhan No. 3 Hospital (January 31 to March 27, 2020). According to whether Epstein-Barr virus reactivation was detected, the patients were divided into an EBV group and a Non-EBV group. Baseline data were collected including epidemiological, larithmics, clinical and imaging characteristics, and laboratory examination data. Results Of the 128 patients with COVID-19, 17 (13.3%) were infected with Epstein-Barr virus reactivation. In the symptoms,the rate of tachypnoea in the EBV group was apparently higher than that in the Non-EBV group. In lab tests, the lymphocyte and albumin of EBV group decreased more significantly than Non-EBV group, and the D-dimer and serum calcium of EBV group was higher than Non-EBV group. Regarding the infection index, CRP of EBV group was apparently above the Non-EBV group, and no significant difference was found in procalcitonin of the two groups. The incidence of respiratory failure, ARDS, and hypoproteinaemia of EBV group had more incidence than Non-EBV group. The 28-day and 14-day mortality rates of EBV group was significantly higher than that of Non-EBV group. Conclusions In the COVID-19 patients, patients with EBV reactivation had higher 28-day and 14-day mortality rates and received more immuno-supportive treatment than patients of Non-EBV group.

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“…serum ferritin) in our patient triggered an initiation of a modified, etoposide-free treatment protocol with dexamethasone and rituximab. Although rituximab is generally accepted for treatment of EBV-HLH, its safety in active COVID-19 has not been established, with only one (non-transplant) case report published to date [ 18 ]. Mehta et al speculated that whilst rituximab might be risky at the beginning of SARS-CoV-2 infection by interfering with development of protective antibodies and viral clearance as recently showed by Avouvac et al [ 19 ], it might prove beneficial later (when seropositive) by reducing COVID-19-associated (HLH-like) hyper-inflammation [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Use of rituximab in SARS-CoV-2-positive renal transplant recipient with EBV reactivation and probable haemophagocytic lymphohistiocytosis

et al. 2022

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We present a case of a rapid clinical recovery in a critically ill kidney transplant recipient with SARS-CoV-2 positivity, Epstein–Barr virus (EBV) reactivation and probable secondary hemophagocytic lymphohistiocytosis (HLH) treated with etoposide-free regimen, based on dexamethasone and a single dose of rituximab. Although rituximab is often a part of EBV-HLH treatment strategy, its use in simultaneous Coronavirus 2019 disease (COVID-19) and solid-organ transplantation has not been reported yet. We review the current evidence for the potential of SARS-CoV-2 to trigger EBV reactivation, leading to a severe clinical illness. Finally, we compare the clinical features of hyper-inflammatory response typical for severe COVID-19 and classical secondary HLH and discuss the benefits of therapeutic B-cell depletion in both conditions.

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Epstein-Barr Virus Versus Novel Coronavirus-Induced Hemophagocytic Lymphohistocytosis: The Uncharted Waters

Cited by 5 publications

References 10 publications

Clinical features and prognosis of acute lymphoblastic leukemia in children with Epstein-Barr virus infection

Clinical features and prognosis of acute lymphoblastic leukemia in children with Epstein-Barr virus infection

Clinical characteristics and outcomes of critically ill patients with acute COVID-19 with Epstein-Barr virus reactivation

Use of rituximab in SARS-CoV-2-positive renal transplant recipient with EBV reactivation and probable haemophagocytic lymphohistiocytosis

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