Association of virus infected-T cell in severe hepatitis caused by primary Epstein-Barr virus infection.
BACKGROUND
Infectious mononucleosis owing to primary Epstein-Barr virus (EBV) infection sometimes causes hepatitis, which is usually self-limiting with mildly elevated transaminases, but can rarely develop into severe hepatitis with jaundice.


OBJECTIVE
To clarify the pathogenesis of severe hepatitis by primary EBV infection.


METHODS
We experienced four cases of severe hepatitis with jaundice caused by primary EBV infection. These cases were analyzed virologically and histologically, and compared with infectious mononucleosis patients without jaundice.


CONCLUSIONS
Using real-time PCR, more EBV-DNA was detected in peripheral blood from patients with severe hepatitis, as compared to those without jaundice. Furthermore, CD3+, CD4+ or CD8+ cells contained more EBV DNA than did other cell populations, indicating that in severe hepatitis, T cells harbor most of the EBV. By contrast, mainly B cells were infected in infectious mononucleosis patients without jaundice. The liver was biopsied in three of the four cases. An in situ hybridization study showed that EBV infected lymphocytes, not hepatocytes. In addition, in one patient, it was confirmed that the infected lymphocytes were CD8+ T cells. These results suggest that a large EBV burden and T cell infection may play major roles in the mechanism of severe hepatitis caused by primary EB virus infection.
Hara
Shinya
S
Department of Pediatrics, Toyota Memorial Hospital, Toyota, Japan.
Hoshino
Yo
Y
Naitou
Takehito
T
Nagano
Kenichi
K
Iwai
Masakatsu
M
Suzuki
Kazuyuki
K
Yamamoto
Kazuhide
K
Nagasaka
Tetsuro
T
Morishima
Tsuneo
T
Kimura
Hiroshi
H
D000293:Adolescent; D000328:Adult; D001402:B-Lymphocytes / Q000821:virology; D002675:Child, Preschool; D004279:DNA, Viral / Q000097:blood; D020031:Epstein-Barr Virus Infections / Q000473:pathology / Q000821:virology*; D005260:Female; D006525:Hepatitis, Viral, Human / Q000473:pathology* / Q000821:virology*; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D017403:In Situ Hybridization; D007565:Jaundice; D008099:Liver / Q000473:pathology / Q000821:virology; D016131:Lymphocyte Subsets / Q000821:virology; D008297:Male; D016133:Polymerase Chain Reaction; D013601:T-Lymphocytes / Q000821:virology*
D004279:DNA, Viral