Hepatitis due to Epstein–Barr virus and cytomegalovirus: clinical features and outcomes

Leonardsson, Hilmar; Hreinsson, Jóhann P.; Löve, Arthur; Bjõrnsson, Einar

doi:10.1080/00365521.2017.1319972

Cited by 28 publications

(27 citation statements)

References 36 publications

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“…Similar to our results, some previous studies of hepatobiliary markers in EBV-IM and CMV-IM cases have revealed significantly higher hepatobiliary biomarkers in EBV-IM patients [10,13]. However, other recent studies have indicated that the differences were not significant [2,22,23]. Our logistic regression analyses revealed that mild-to-moderate elevation of GGT and LDH were independent predictors of EBV-IM, and this finding may be useful when evaluating hepatobiliary biomarkers in IM patients.…”

Section: Discussionsupporting

confidence: 90%

Clinical differentiation of infectious mononucleosis that is caused by Epstein-Barr virus or cytomegalovirus: A single-center case-control study in Japan

Ishii

Sasaki

Maeda

et al. 2019

Journal of Infection and Chemotherapy

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a b s t r a c tIntroduction: Infectious mononucleosis (IM) is a common viral infection that typically causes fever, pharyngitis, and lymphadenopathy in young patients. The Epstein-Barr virus (EBV) is the most common cause of IM, followed by cytomegalovirus (CMV). Given that serological testing is associated with limitations regarding its accuracy, availability, and time to receive results, clinical differentiation based on symptoms, signs, and basic tests would be useful. We evaluated whether clinical findings could be used to differentiate EBV-IM from CMV-IM. Methods: In this single-center retrospective case-control study, we evaluated >14-year-old patients with serologically confirmed EBV-IM or CMV-IM during 2006e2017. We compared the patients' symptoms, physical findings, blood counts, and serum biomarkers to create three regression models: model 1 (symptoms and signs), model 2 (model 1 plus sonographic hepatosplenomegaly and blood counts), and model 3 (model 2 plus hepatobiliary biomarkers). Results: Among the 122 patients (72.6%) with EBV-IM and 46 patients (27.4%) with CMV-IM, the median age was 25 years and 82 patients (48.8%) were male. The median age was 10 years older in the CMV-IM group (p < 0.001) and the median interval from onset to visit was 5 days longer in the CMV-IM group (p < 0.001). Logistic regression revealed that EBV-IM was predicted by younger age, short onset-to-visit interval, lymphadenopathy, tonsillar white coat, hepatosplenomegaly, atypical lymphocytosis, and elevations of lactate dehydrogenase and gamma-glutamyl transferase. All regression models had areas under the curve of >0.9. Conclusion: History and physical findings, especially when used with atypical lymphocytosis and sonographic hepatosplenomegaly, can help physicians differentiate EBV-IM from CMV-IM.

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Section: Discussionsupporting

confidence: 90%

Clinical differentiation of infectious mononucleosis that is caused by Epstein-Barr virus or cytomegalovirus: A single-center case-control study in Japan

Ishii

Sasaki

Maeda

et al. 2019

Journal of Infection and Chemotherapy

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“…We did not observe massive hepatocellular necrosis in proximity to CMV‐positive cells, even in Group 1 patients with disseminated CMV disease. Extensive hepatocellular necrosis has been described in rare cases of CMV hepatitis in immunocompetent individuals . Our patients lacked any semblance of robust immunity, and yet there was no evidence that CMV hepatitis caused extensive necrosis or contributed to liver failure.…”

Section: Discussionmentioning

confidence: 63%

“…Some CMV‐infected patients will develop CMV disease in organs throughout the body, causing significant morbidity and mortality from damage to the lungs, gastrointestinal tract and bone marrow, particularly in more severely immune suppressed patients . CMV liver disease and enterocolitis can also be seen in apparently healthy individuals, presenting with elevated serum aminotransferase enzymes, jaundice and diarrhoea . The outcome of CMV liver disease in the absence of obvious immune suppression is generally favourable, but cases of more severe liver injury have been reported .…”

Section: Introductionmentioning

confidence: 99%

“…CMV liver disease and enterocolitis can also be seen in apparently healthy individuals, presenting with elevated serum aminotransferase enzymes, jaundice and diarrhoea . The outcome of CMV liver disease in the absence of obvious immune suppression is generally favourable, but cases of more severe liver injury have been reported . However, even in severely immunosuppressed patients who have undergone allogeneic marrow transplantation, the extent and clinical severity of CMV hepatitis appears to have far less impact than acute hepatitis caused by other herpesviruses (herpes simplex and varicella zoster virus) …”

Section: Introductionmentioning

confidence: 99%

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Cytomegalovirus hepatitis after bone marrow transplantation: An autopsy study with clinical, histologic and laboratory correlates

McDonald

Sarmiento

Rees-Lui

et al. 2019

Journal of Viral Hepatitis

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Mortality from cytomegalovirus disease after marrow transplantation can be reduced by treatment with antiviral drugs based on the detection of viremia and organ involvement. We examined autopsy liver specimens to determine the frequency, extent and outcome of cytomegalovirus hepatitis and whether cytomegalovirus hepatitis occurred in the absence of cytomegalovirus disease elsewhere. Autopsy specimens from 50 transplant patients were evaluated for cytomegalovirus‐infected cells, in five groups of 10, according to extent of CMV during life and at autopsy. Liver sections were examined by routine light microscopy, immunohistochemistry and in situ DNA hybridization. Clinical and laboratory data collected during the last 30 days of life were analysed as markers of liver cytomegalovirus infection. Cytomegalovirus‐infected cells were detected in the livers of 10/10 patients with cytomegalovirus infection during life and widespread cytomegalovirus at autopsy; in 3/20 livers from patients with cytomegalovirus infection during life but negative liver cultures at autopsy; and in 1/10 livers from cytomegalovirus‐seropositive patients who had been without other evidence of cytomegalovirus infection. Histology detected a lower density of cytomegalovirus‐bearing cells per unit area of liver, compared to immunohistochemistry and in situ hybridization. No cytomegalovirus‐infected cells were detected in livers from cytomegalovirus‐seronegative controls. No distinctive clinical or laboratory findings correlated with liver cytomegalovirus detection. CMV liver disease is common in allografted patients with disseminated CMV but may rarely be isolated to the liver, best demonstrated with IHC and ISH. Massive hepatic necrosis from CMV was not seen in any autopsy liver in this study.

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“…were detected in both groups, with additional detection of Parvibaculum lavamentivorans and Human Herpesvirus 5 in one group. There are some hints that Human Herpesvirus 5 might play a role in the carcinogenesis of liver cancer, among them presence of CMV DNA in tumor tissue and an increased seroprevalence in liver cancer patients 43 as well as frequent hepatitis in Human Herpesvirus 5 infection underscoring hepatotropism of Human Herpesvirus 5 44 . The other identified taxa have not yet been implied in liver cancer carcinogenesis.…”

Section: Discussionmentioning

confidence: 99%

An atlas of the tissue and blood metagenome in cancer reveals novel links between bacteria, viruses and cancer

Borchmann

2019

Preprint

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Hepatitis due to Epstein–Barr virus and cytomegalovirus: clinical features and outcomes

Abstract: A high proportion of patients with acute CMV and EBV developed hepatitis and jaundice, most of those patients have good prognosis. Patients with CMV hepatitis were more often immunosuppressed, required hospitalization or were pregnant in comparison with patients with EBV hepatitis.

Cited by 28 publications

References 36 publications

Clinical differentiation of infectious mononucleosis that is caused by Epstein-Barr virus or cytomegalovirus: A single-center case-control study in Japan

Clinical differentiation of infectious mononucleosis that is caused by Epstein-Barr virus or cytomegalovirus: A single-center case-control study in Japan

Cytomegalovirus hepatitis after bone marrow transplantation: An autopsy study with clinical, histologic and laboratory correlates

An atlas of the tissue and blood metagenome in cancer reveals novel links between bacteria, viruses and cancer

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