title: A possible role for Epstein-Barr virus in the pathogenesis of pleural effusion.
abstract: A high percentage of pleural effusions remain unexplained despite an intensive diagnostic workup. Epstein-Barr virus (EBV) infections occur worldwide and affect the majority of the population. The present study investigated the prevalence and clinical relevance of EBV in pleural effusions. A prospective study was performed in which 60 consecutive patients with pleural effusion were enrolled. Real-time quantitative EBV-PCR was performed on pleural fluid and serum. Pleural fluid was further evaluated using standard biochemical, cytological and microbiological procedures. Demographic data, medical history and medication were recorded. A total of 24 (40%), from 60 pleural fluids tested, were positive in the EBV-PCR. Median EBV-DNA levels for positive samples was 454 genome equivalents (geq).mL-1 (range 36-163,446 geq.mL-1). A total of 20 (59%) out of 34 unexplained pleural effusions were EBV-PCR positive. Serological analysis of all patients with a positive PCR revealed a previous infection. Patients with a positive EBV-PCR on pleural fluid were more likely to have a positive EBV-PCR on serum than patients with a negative PCR on pleural fluid. Epstein-Barr virus reactivation in pleural fluid is a frequent event and the absence of an alternative diagnosis to explain the nature of the effusion in the majority of cases suggests an aetiological role for Epstein-Barr virus in the development of pleural effusion.
authors.affiliation: Dept of Microbiology, Bosboomstraat 1, 3582 KE Utrecht, The Netherlands. sthijsen@diakhuis.nl
authors.forename: S F T
authors.initials: SF
authors.lastname: Thijsen
authors.forename: R
authors.initials: R
authors.lastname: Luderer
authors.forename: J M H
authors.initials: JM
authors.lastname: van Gorp
authors.forename: S J G
authors.initials: SJ
authors.lastname: Oudejans
authors.forename: A W J
authors.initials: AW
authors.lastname: Bossink
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D020031:Epstein-Barr Virus Infections / Q000150:complications / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010996:Pleural Effusion / Q000821:virology*; D015995:Prevalence; D011446:Prospective Studies