Jaundice in relation to immune activation during Epstein-Barr virus-induced infectious mononucleosis

Páez-Guillán, Emilio-Manuel; Franco, J. Campos; Alende, Rosario; Lázare-Iglesias, Héctor; Beceiro, Carmen; González‐Quintela, Arturo

doi:10.1016/j.amjms.2022.12.004

Cited by 5 publications

(2 citation statements)

References 30 publications

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“…The main cause is believed to be that most children with infectious diseases in this group are infected with EBV (40.5%, 30/74). Acute EBV infection typically manifests as non-jaundice hepatitis, and jaundice is rare ( 19 ).…”

Section: Discussionmentioning

confidence: 99%

The etiology and differential diagnosis of “autoimmune hepatitis-like liver disease” in children: a single-center retrospective study

Ma,

Liu,

et al. 2024

Front. Pediatr.

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BackgroundChildren with autoimmune hepatitis (AIH) often present with symptoms similar to those of other liver diseases. This study consists of a comparison between the clinical and histological characteristics of AIH and those of other four AIH-like liver diseases [i.e., drug-induced liver injury (DILI), gene deficiency, infectious liver disease and other etiology of liver disease], as well as an evaluation of the AIH scoring system's diagnostic performance.MethodsAll children with AIH-like liver disease at our center from January 2013 to December 2022 were included. The clinical and histological characteristics of the AIH group were retrospectively analyzed and compared with those of the other four groups.ResultsA total of 208 children were included and divided into AIH group (18 patients), DILI group (38 patients), gene deficiency group (44 patients), infectious liver disease group (74 patients), and other etiology group (34 patients). The antinuclear antibodies (ANA) ≥ 1:320 rate was significantly higher in the AIH compared to the other four groups after multiple testing correction (p < 0.0125), while patients with positive antibodies to liver-kidney microsomal-1 (anti-LKM1, n = 3) and smooth muscle antibodies (SMA, n = 2) were only observed in the AIH group. The positive rates of antibodies to liver cytosol type1 (anti-LC1) and Ro52 were higher than those in the other four groups. The serum immunoglobulin G (IgG) and globulin levels, as well as the proportions of portal lymphoplasmacytic infiltration, lobular hepatitis with more than moderate interface hepatitis, and lobular hepatitis with lymphoplasmacytic infiltration, were significantly higher in the AIH group than in the other four groups after multiple testing correction (p < 0.0125). The cirrhosis rate in the AIH group was higher than that in the DILI and infectious liver disease groups (p < 0.0125). Both the simplified (AUC > 0.73) and the revised systems (AUC > 0.93) for AIH have good diagnostic performance, with the latter being superior (p < 0.05).ConclusionPositive autoantibodies (ANA ≥ 1:320 or anti-LKM1 positive, or accompanied by SMA, anti-LC1 or Ro-52 positive) and elevated serum IgG or globulin levels contribute to early recognition of AIH. The presence of lobular hepatitis with more than moderate interface hepatitis and lymphoplasmacytic infiltration contribute to the diagnosis of AIH.

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Section: Discussionmentioning

confidence: 99%

The etiology and differential diagnosis of “autoimmune hepatitis-like liver disease” in children: a single-center retrospective study

Ma,

Liu,

et al. 2024

Front. Pediatr.

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“…We reviewed the clinical records of adult patients (aged 15 years and older) with infectious mononucleosis who were admitted to the University Hospital of Santiago de Compostela (Spain) between 1995 and 2018, as reported elsewhere. 18,19 The hospital is the reference center for an area including approximately 400,000 inhabitants. The main reasons for hospital admission were severe signs of a systemic inflammatory response, difficulty with oral intake, and complications.…”

Section: Methodsmentioning

confidence: 99%

Hematological abnormalities beyond lymphocytosis during infectious mononucleosis: Epstein-Barr virus-induced thrombocytopenia

Quintela

Paez-Guillan

Franco

et al. 2023

Mediterr J Hematol Infect Dis

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Background and aim: Thrombocytopenia in the course of Epstein-Barr virus mononucleosis is well-known; however, no recent series have investigated its frequency, associated factors, and evolution. The present study aimed to investigate platelet count characteristics in adult patients with infectious mononucleosis. Methods: We reviewed the clinical records of 400 patients admitted to the hospital with infectious mononucleosis (52.0% male; median age, 19 years [range, 15-87 years]), with a focus on blood platelet counts, thrombocytopenia prevalence, and outcomes. Results: Thrombocytopenia (platelet count ≤150 x109/L) was present in 119 (29.7%) patients. Thirty-two (8.0%) patients showed platelet counts lower than 100 x109/L. Thrombocytopenia was severe (platelets <50 x109/L) in 6 (1.5%) patients. Thrombocytopenia was associated with lower frequency of typical mononucleosis symptoms such as sore throat and lymphadenopathy, lower frequency of positive heterophil antibodies, higher serum bilirubin concentration and prothrombin time, lower blood leukocyte and lymphocyte count, lower concentration of serum immunoglobulin G and immunoglobulin A concentrations, and larger spleen size. Thrombocytopenia normalized quickly during follow-up. Only 2 cases required specific therapy. Platelet counts significantly increased during follow-up even in cases without baseline thrombocytopenia. There were no significant hemorrhagic complications. Conclusions: Transient thrombocytopenia is common during infectious mononucleosis in adult patients. Patients with thrombocytopenia have distinct clinical and biologic features. Thrombocytopenia during infectious mononucleosis is typically mild. Cases of severe thrombocytopenia are rare and were not associated with hemorrhagic complications in this series.

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Are corticosteroids safe in adolescent and adult patients with infectious mononucleosis? A retrospective cohort study

Páez-Guillán,

Campos-Franco,

Alende

et al. 2023

Enfermedades Infecciosas y Microbiología Clínica

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Jaundice in relation to immune activation during Epstein-Barr virus-induced infectious mononucleosis

Cited by 5 publications

References 30 publications

The etiology and differential diagnosis of “autoimmune hepatitis-like liver disease” in children: a single-center retrospective study

The etiology and differential diagnosis of “autoimmune hepatitis-like liver disease” in children: a single-center retrospective study

Hematological abnormalities beyond lymphocytosis during infectious mononucleosis: Epstein-Barr virus-induced thrombocytopenia

Are corticosteroids safe in adolescent and adult patients with infectious mononucleosis? A retrospective cohort study

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