Department of Infectious Diseases, Children's Hospital of Soochow University, Suzhou, Jiangsu, China.
Pediatric Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, Jiangsu, China.
J Med Virol. 2021 Aug;93(8):5048-5057. doi: 10.1002/jmv.26941. Epub 2021 Mar 25.
Epstein-Barr virus (EBV) is a globally prevalent herpesvirus associated with multiple diseases. This study aimed to determine the characteristics of primary EBV infection disease spectrum and reactivation in children, in Suzhou, China. All children admitted to the Children's Hospital of Soochow University between May 2018 and September 2020 with suspected EBV-associated disease and subjected to the indirect immunofluorescence assay for EBV-specific antibodies and plasma EBV-DNA assays were included. Of the 3567 children, 2782 (78.0%) tested positive for EBV. The positive rates of viral capsid antigen (VCA)-IgM, VCA-IgG, early antigen (EA)-IgG, nuclear antigen (EBNA)-IgG, and plasma EBV-DNA were 12.1%, 74.6%, 37.9%, 35.6%, and 31.1%, respectively. The lowest VCA-IgG and EBNA-IgG seropositivity rates occurred at ages between 8 and 36 months, then increased gradually in the older age groups. The EBV-IgM seropositivity rate was the highest in those aged 36 to <72 months. Primary EBV infection was more common in children aged 36 to <72 months. In past infections, reactivation mainly occurred in 8 to <36 months. The most common disease caused by primary EBV infection was infectious mononucleosis (56.1%), followed by a respiratory infection (17.0%). Respiratory infection (30.0%), EBV infection (29.2%), and hemophagocytic lymphohistiocytosis (HLH) (15.8%) were the commonest diseases caused by EBV reactivation. EBV reactivation was a risk factor for HLH (adjusted odds ratio, 16.4; 95% confidence interval, 7.9-34.0). Among reactivated patients, the viral load of HLH was higher than that of EBV infection and respiratory infection (p < .01). This is a retrospective large sample study that explored the characteristics of primary EBV infection disease spectrum and reactivation in children.
爱泼斯坦-巴尔病毒（EBV）是一种在全球范围内普遍存在的疱疹病毒，与多种疾病有关。本研究旨在确定中国苏州儿童中原发性 EBV 感染疾病谱和再激活的特征。所有 2018 年 5 月至 2020 年 9 月期间因疑似 EBV 相关疾病而入住苏州大学附属儿童医院并接受 EBV 特异性抗体间接免疫荧光检测和血浆 EBV-DNA 检测的儿童均纳入本研究。在 3567 名儿童中，2782 名（78.0%）EBV 检测阳性。病毒衣壳抗原（VCA）-IgM、VCA-IgG、早期抗原（EA）-IgG、核抗原（EBNA）-IgG 和血浆 EBV-DNA 的阳性率分别为 12.1%、74.6%、37.9%、35.6%和 31.1%。VCA-IgG 和 EBNA-IgG 血清阳性率最低的年龄在 8 至 36 个月之间，然后在年龄较大的组中逐渐增加。EBV-IgM 血清阳性率在 36 至<72 个月的年龄组中最高。原发性 EBV 感染在 36 至<72 个月的儿童中更为常见。在既往感染中，再激活主要发生在 8 至<36 个月。原发性 EBV 感染最常见的疾病是传染性单核细胞增多症（56.1%），其次是呼吸道感染（17.0%）。呼吸道感染（30.0%）、EBV 感染（29.2%）和噬血细胞性淋巴组织细胞增生症（HLH）（15.8%）是 EBV 再激活最常见的疾病。EBV 再激活是 HLH 的危险因素（调整优势比，16.4；95%置信区间，7.9-34.0）。在再激活患者中，HLH 的病毒载量高于 EBV 感染和呼吸道感染（p<0.01）。这是一项回顾性大样本研究，旨在探讨儿童中原发性 EBV 感染疾病谱和再激活的特征。
