Impact of Epstein–Barr virus infection in patients with inflammatory bowel disease

Abstract

A high prevalence of Epstein–Barr virus (EBV) infection in patients with inflammatory bowel disease (IBD) has been reported in many case reports and studies; thus, the association between EBV and IBD has gained increasing attention. Patients with IBD are at an increased risk of opportunistic EBV infection owing to the common use of immunomodulators. EBV infection in IBD patients can cause various complications, including superimposed viral colitis, which is associated with chronicity, exacerbation, and poor prognosis of refractory IBD, and can induce progression to lymphoproliferative disorders, such as EBV-positive mucocutaneous ulcer (EBVMCU), lymphomatoid granulomatosis (LYG), hemophagocytic lymphohistiocytosis (HLH) and diffuse large B-cell lymphoma (DLBCL). It has been suggested to screen for EBV before initiating immunosuppressive therapy and monitor the status of EBV infection in patients with IBD, especially those who are EBV-seronegative and have a risk of primary EBV infection. Clinicians should also be careful of misdiagnosing IBD and EBV-associated lymphoproliferative diseases due to similarities in both clinical symptoms and endoscopic manifestations. Withdrawal of immunosuppressants has been shown to be an effective strategy to achieve remission of disease at the time of EBV diagnosis, but antiviral therapy remains controversial. The present review aims to describe the characteristics of the complications caused by EBV infection and generalize the recent research progress on and challenges caused by EBV infection in IBD patients. The literature for writing this review was collected from ‘PubMed’ research engine. The keywords ‘inflammatory bowel disease and Epstein–Barr virus’ or ‘ulcerative colitis and Epstein–Barr virus’ or ‘Crohn’s disease and Epstein–Barr virus’ were used to collect the literature and relevant papers were collected to help writing this review.

Protective role of flavonoids quercetin and silymarin in the viral-associated inflammatory bowel disease: an updated review

“…As another member of the herpesvirus family, Epstein–Barr virus (EBV) has infected most of the world’s population (90%), in a form of latent lifelong infection, as an asymptomatic disease in childhood and as infectious mononucleosis (IM) in adulthood, a self-limiting disease (Jefremow and Neurath 2020 ; Zhang et al 2022 ). In a systematic review and meta-analysis, using 11 metagenomic studies, the EBV plus CMV was determined as a significant cause of IBD (Marongiu et al 2022 ).…”

“…T cells, B cells and NK cells infections also occur, impairing cellular immunity. Additionally, the spread of infection into enterocytes causes epithelial or mucosal tissue damage (Zhang et al 2022 ). The misdiagnosis may occur due to the similarity of IBD and EBV-associated lymphoproliferative disorders (LPDs) (Patton et al 2018 ; Zhou et al 2019 ).…”

Identification of CD8 T-cell dysfunction associated with symptoms in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and Long COVID and treatment with a nebulized antioxidant/anti-pathogen agent in a retrospective case series

“…Patients treated with anti-TNF have also been reported to develop shingles (symptomatic VZV reactivation), requiring treatment, and have been found to have EBV and CMV by PCR in the stool ( Kim and Solomon, 2010 ; Santella et al, 2022 ). In fact, other T-cell mediated autoimmune diseases, such as inflammatory bowel disease has been associated with reactivation of herpes viruses, as EBV has been found in the mucosal lining of the gut in some of these patients ( Zhang et al, 2022 ; Wang et al, 2022 ). Dysregulated immune responses to EBV have also been strongly linked to the immunopathogenesis of multiple sclerosis, as well as finding evidence of EBV in the brain ( Pender et al, 2017 , 2018 ).…”

Novel plasma microRNA expression features in diagnostic use for Epstein-Barr virus-associated febrile diseases

“…Circulating miRNAs are widely distributed throughout the body, interacting with tissues and organs [ 40 ]. Bioinformatics studies have demonstrated that the target gene hsa-miR-320d is involved in the pathogenesis of inflammatory bowel disease [ 41 ], with elevated concentrations observed in the blood under inflammation-prone conditions [ 42 ]. Furthermore, this miRNA may be specific to systemic inflammatory disorders, including knee osteoarthritis [ 43 ].…”