Human Herpes Viruses Are Associated with Classic Fever of Unknown Origin (FUO) in Beijing Patients

Zhou, Weimin; Tan, Xinyi; Li, Yamin; Tan, Wenjie

doi:10.1371/journal.pone.0101619

Cited by 19 publications

(11 citation statements)

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“…Clinical manifestation of fever of unknown origin (FUO) was closely associated with EBV infections [ 16 , 17 ], Lymphadenopathy and elevated serum liver enzymes were also linked to EBV infections, especially in adolescents [ 18 – 20 ]. In our study, the highest frequency of acute EBV infections occurred in 30 years old or younger patients and lymphadenopathy was found to be associated with VCA-IgM antibody in these younger patients, indicating that acute EBV infection should be considered and serological tests may be performed to confirm when such patients visit doctors.…”

Section: Discussionmentioning

confidence: 99%

Anti-Epstein–Barr virus antibodies in Beijing during 2013–2017: What we have found in the different patients

Cui

Yan

et al. 2018

PLoS ONE

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BackgroundEpstein–Barr virus (EBV) is associated with nasopharyngeal carcinoma (NPC) which is prevalent in South China, and its association with systemic lupus erythematosus (SLE) or other autoimmune diseases has not been studied in the mainland of China. The EBV serological tests have been performed on patients with various diseases or manifestations for years at our institution and their values need to be evaluated.MethodsFor routine medical purposes, anti-EB viral capsid antigen (VCA) IgG, IgA and IgM antibodies, anti-EBV diffuse early antigen (EA-D) IgA antibodies, and anti-EBV nuclear antigen-1(EBNA-1) IgG antibodies were tested with commercial enzyme-linked immunosorbent assay (ELISA) in patients visiting Peking Union Medical College Hospital between 2013 and 2017. The test results were analyzed in this retrospective study.ResultsThere were a total of 11122 serum samples available to be tested in the study. As indicators of past EBV infection, the prevalence of VCA-IgG/EBNA1-IgG were 66.6%/58.5%, 84.3%/78.8%, 92.9%/87.0% and 98.5%/95.4% in patients aged under 5 years, 6–10 years, 11–20 years and 21–30 years old, respectively, and these values maintained at this highest rate as age increased further. The prevalence of VCA-IgM, as a parameter of acute EBV infection, was 14.6%, 10.2%, 10.4%, 6.3% and 3.1% in patients aged under 5 years, 6–10 years,11–20 years, 21–30 years, 31–40 years old, respectively, and decreased to 2%~3% in older patients. Patients with elevated serum liver enzymes were more likely to have a higher prevalence of EA/D IgA antibody (P < 0.01) and young patients (≤30 years) with lymphadenopathy were more likely to have higher prevalence of VCA-IgM antibody (P < 0.01). The prevalence of VCA-IgA and EAD-IgA were 87.0% and 59.2% in NPC patients, respectively, and both were significantly higher (P < 0.001) than that in non-NPC patients. The prevalence of VCA-IgA was 45.4% and 25.6% in SLE patients and patients with other autoimmune diseases, respectively, which were significantly (P < 0.001) and mildly (P = 0.039) higher than their controls. In pediatric SLE patients between 6 and10 years old, the prevalence of VCA-IgG, VCA-IgA and EBNA1-IgG was 100%, 59.5% and 100%, respectively, all being significantly higher than the age (6-10y) related controls (P< 0.01). In the 705 cerebral spinal fluid (CSF) specimens, VCA-IgG, VCA-IgM, VCA-IgA and EAD-IgA were found to be positive in 12.1%, 0.15%, 0.25% and 0.25%, respectively. There were 157 paired specimens (CSF and serum were collected simultaneously) and VCA-IgG was identified as positive in 12.7% of the CSF and 100% of the serum specimens.ConclusionsAround 98% of Chinese patients were infected with EBV before 30 years of age and the highest rate of acute EBV infection were observed in patients under 5 years old. EBV infection was found to be associated with elevated serum liver enzymes, NPC and SLE. Acute anti-EBV antibody was valued for young patients with lymphadenopathy but limited value for CNS neuropathy.

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Section: Discussionmentioning

confidence: 99%

Anti-Epstein–Barr virus antibodies in Beijing during 2013–2017: What we have found in the different patients

Cui

Yan

et al. 2018

PLoS ONE

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“…Obviously, the patient had clinical and biological manifestations related to an acute infection that could be attributable to CMV infection which could be also responsible for liver failure [Orlikowski et al, 2011;Hersch and Oh, 2014;Miyaji et al, 2014;Zhou et al, 2014]. Examination results of positive serum anti-CMV IgM and negative anti-CMV IgG during the period of hospitalization and the subsequent clearance of serum anti-CMV IgM and appearance of anti-CMV IgG 3 months later supported this etiological diagnosis.…”

Section: Discussionmentioning

confidence: 94%

“…Examination results of positive serum anti‐CMV IgM and negative anti‐CMV IgG during the period of hospitalization and the subsequent clearance of serum anti‐CMV IgM and appearance of anti‐CMV IgG 3 months later supported this etiological diagnosis. When the patient was admitted to our hospital, his fever had been cured for 2 weeks, and it was supposed that serum CMV DNA detection could hardly be detected [Hersch and Oh, ; Zhou et al, ]. So detection of the serum CMV DNA was not performed.…”

Section: Discussionmentioning

confidence: 99%

Guillain–Barré syndrome following acute co‐super‐infection of hepatitis E virus and cytomegalovirus in a chronic hepatitis B virus carrier

Lei

Tian

Luo

et al. 2016

Journal of Medical Virology

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Guillain-Barré syndrome (GBS) is a rare neurological complication of hepatitis B. GBS presence in acute hepatitis E virus (HEV) and cytomegalovirus (CMV) infection is also sporadically reported. Here, a rare case of GBS in a chronic Hepatitis B virus carrier co-infected with HEV and CMV was reported. Based on the analysis on the progress of the manifestations and virus serological detection results, it could be concluded that GBS might mostly likely result from super-infection of HEV and CMV. This case report is clinically important in that it provides a good example of differential diagnosis and appropriate treatment on such a rare but life-threatening case. J. Med. Virol. 89:368-372, 2017. © 2016 Wiley Periodicals, Inc.

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“…As shown in the earlier results, the etiology spectrum of FUO is composed of common diseases, which is similar to most previous studies on FUO, such as infections, neoplasms, CTDs, miscellaneous disorders, and undiagnosed illnesses. 1 , 4 – 10 Accordingly, it is difficult to establish the diagnosis in the initial evaluation due to two main reasons: most cases lack typical clinical characters in the initial stage or even throughout the course of diseases or some important detail was ignored by the physicians at the initial visit. In our study, five cases of miliary tuberculosis had received chest X-ray during the 2 weeks before admission, but no abnormal results had been found, and the CT scan displayed the imaging features of miliary tuberculosis in the patients after hospitalization.…”

Section: Discussionmentioning

confidence: 99%

Comparison of classical diagnostic criteria and Chinese revised diagnostic criteria for fever of unknown origin in Chinese patients

Huang

Shi

et al. 2016

TCRM

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BackgroundFever of unknown origin (FUO) has always been a challenging problem for physicians since it was first reported half a century ago. This study aimed to investigate the clinical features of FUO and to compare the clinical significance of the classical diagnostic criteria and the Chinese revised diagnostic criteria of FUO.MethodsWe retrospectively collected a series of 140 patients admitted to our hospital between September 2011 and June 2013 because of prolonged febrile illnesses (lasting at least 2 weeks, temperature ≥38.5°C) without diagnosis and categorized them into two groups according to the Chinese revised diagnostic criteria (group A) and classical diagnostic criteria (group B) for FUO. The A group included patients presenting with fever persisting between 2 and 3 weeks with the diagnosis remaining uncertain after three outpatient visits or at least 3 days of hospital investigation. The B group included patients presenting with fever persisting for more than 3 weeks with no established diagnosis after 1 week of hospital investigation. The general conditions, etiologies, definite diagnosis times, and diagnostic methods of the two groups were compared.ResultsThere were no significant differences in the general conditions, etiologies, definite diagnosis times, and diagnostic methods between the Chinese revised diagnostic criteria and classical diagnostic criteria.ConclusionBoth the examined FUO diagnostic criteria are suitable for clinical practice in this region.

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Human Herpes Viruses Are Associated with Classic Fever of Unknown Origin (FUO) in Beijing Patients

Cited by 19 publications

References 14 publications

Anti-Epstein–Barr virus antibodies in Beijing during 2013–2017: What we have found in the different patients

Anti-Epstein–Barr virus antibodies in Beijing during 2013–2017: What we have found in the different patients

Guillain–Barré syndrome following acute co‐super‐infection of hepatitis E virus and cytomegalovirus in a chronic hepatitis B virus carrier

Comparison of classical diagnostic criteria and Chinese revised diagnostic criteria for fever of unknown origin in Chinese patients

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