Canović Predrag, Gajović Olgica, Todorović Zoran, Mijailović Zeljko
Medicinski fakultet, Klinicko-bolnicki centar Kragujevac.
Med Pregl. 2006 Mar-Apr;59(3-4):179-82. doi: 10.2298/mpns0604179c.
Primary Epstein-Barr virus infection (EBVI) in children is usually asymptomatic with seroconversion. If primary infection occurs in adolescents or in adulthood, the most common manifestation is acute infectious mononucleosis. The diagnosis of acute infectious mononucleosis is made by virus and serologic tests. The most important evidence of primary EBV infection includes IgM class antibodies detected by using EBV virus-capsid-antigen (EBV VCA) which appears at the beginning of illness and usually lasts 1 to 2 months. Paul Bunnell Davidson test, although non-specific, is still in use today in diagnosis of infectious mononucleosis and for detection of heterophile antibodies.
Acute hepatitis with icterus is a rare clinical manifestation in primary EBV infection. However, sometimes it is the only manifestation of the disease. This is a case report of a patient with EBV hepatitis and icterus associated with long-lasting fever without pharyngitis and lymphadenopathy, which are characteristics of infectious mononucleosis. The etiologic diagnosis was confirmed by positive Paul Bunnell Davidson test and by detection of specific antibodies (class IgM) to EBV VCA in patient's serum.
The pathogenetic mechanism which causes destruction of hepatic cells and provokes cholestasis during EBV infection, has not been cleared yet. It is supposed that EBV has no direct cytocide effects on hepatic cells, yet destruction of these cells is caused by toxic action of free radicals through lipid peroxidation. Patients with infectious mononucleosis have autoantibodies directed against enzyme superoxide-dismutase which neutralizes enzyme's antioxidant action. As a result of this action, free radicals accumulate in hepatic cells and cause their damage.
Icteric forms of EBV infection are rare. In differential diagnosis of icterus caused by infectious agents, one should not forget EBV.
儿童原发性爱泼斯坦-巴尔病毒感染（EBVI）通常无症状并伴有血清转化。如果原发性感染发生在青少年或成人期，最常见的表现是急性传染性单核细胞增多症。急性传染性单核细胞增多症的诊断通过病毒学和血清学检测进行。原发性EBV感染的最重要证据包括使用EBV病毒衣壳抗原（EBV VCA）检测到的IgM类抗体，该抗体在疾病开始时出现，通常持续1至2个月。保罗·邦内尔·戴维森试验虽然不具有特异性，但至今仍用于诊断传染性单核细胞增多症和检测嗜异性抗体。
伴有黄疸的急性肝炎是原发性EBV感染中罕见的临床表现。然而，有时它是该疾病的唯一表现。这是一例EBV肝炎合并黄疸的病例报告，患者伴有持续发热，无咽炎和淋巴结病，而这些是传染性单核细胞增多症的特征。通过阳性的保罗·邦内尔·戴维森试验以及在患者血清中检测到针对EBV VCA的特异性抗体（IgM类），确诊了病因。
EBV感染期间导致肝细胞破坏并引发胆汁淤积的发病机制尚未明确。据推测，EBV对肝细胞没有直接的细胞杀伤作用，然而这些细胞的破坏是由自由基通过脂质过氧化的毒性作用引起的。传染性单核细胞增多症患者具有针对超氧化物歧化酶的自身抗体，该抗体中和了酶的抗氧化作用。由于这种作用，自由基在肝细胞中积累并导致其损伤。
EBV感染的黄疸型罕见。在由感染因子引起的黄疸的鉴别诊断中，不应忘记EBV。
