The Clinical Characteristics Of 223 Suspected Epstein-barr Virus Infections In Adults

Objective:To explore the clinical characteristics of adult suspected EBV infection and to analyze the differences of clinical characteristics on EBV-DNA positive and negative patients,which will help to identify clinically early EBV infection-related diseases,screen high-risk patients and provide a basis for early diagnosis and treatment of the disease.Methods:Patients with suspected EBV infection in adults who were treated in the Department of Infectious Diseases,First Hospital of Shanxi Medical University from January 2018 to January 2019 were collected.The EBV antibody results,EBV-DNA results,clinical manifestations,and laboratory tests were analyzed.The EBV-infected patients were divided into EBV-DNA-positive and EBV-DNA-negative groups based on EBV-DNA results.The age,gender,clinical symptoms（fever,rash,angina,lymphadenopathy,hepatosplenomegaly）,laboratory tests（test results of EBV antibodies,liver function（ALT,AST,TBIL）,white blood cell count,erythrocyte sedimentation）,discharge diagnosis between EBV-DNA-positive and EBV-DNA-negative groups were analyzed.Results:Of the 223 adults with suspected EBV infection,144 were male and 79 were female,ratio was 1.82:1.Aged 18-83 years,and the average age was（45.82±17.24）years.Among 223 adults with suspected EBV infection,200（89.7%）cases were fever,128（57.4%）cases of splenomegaly,55（24.7%）cases were pharyngitis,42（18.8%）cases were hepatomegaly,39（17.5%）cases were lymphadenopathy and 23（10.3%）cases were rash.There were 217 patients who tested positive for EBV antibodies,with a total antibody positive rate of 97.3%,of which the male positive rate was 97.9%（141/144）and the female positive rate was 96.2%（76/79）.There was no significant difference in the positive rate between genders（χ²=0.572,P=0.608）.The positive rate of young people（18-65 years）was 98.4%（187/190）,and the positive rate of middle-aged people（≥66years）was 90.9%（30/33）.There was a statistically significant difference between different age groups（χ²=6.060,P=0.043）.Of the 223 adult patients suspected of EBV infection,6 were EBV antibody-negative patients,including 3 males and 3 females.The ratio of male to female was 1:1.Aged 21-72 years,mean age（54.33±20.27）years,6（100%）cases were fever,3（50%）cases of splenomegaly,2（23.3%）cases were pharyngitis,and 1（16.7%）cases were rash,1（16.7%）case of lymphadenopathy,and 0（0.0%）case of liver enlargement.A total of 9 EBV antibody response patterns were detected in 223 patients with suspected EBV infection.The highest detection positive rate of EBVCA-IgG and EBNA-IgG was 77.6%,followed by EBVCA-IgG,EBNA-IgG,and EBVCA-IgM positive（6.3%）,EBVCA-IgG,EBNA-IgG and EBEA-IgM positive（5.4%）,only EBNA-IgG positive（2.7%）,all EBV antibodies were negative（2.7%）,and only EBVCA-IgG positive（2.2%）,all EBV antibodies were positive（1.8%）,only EBVCA-IgM positive（0.9%）,EBNA-IgG and EBEA-IgM positive（0.4%）.The 223 adult patients with suspected EBV infection were divided into EBV antibody positive group and negative group according to the test results of EBV antibody.The EBV-DNA positive rate in the EBV antibody positive group was 13.4%,and the EBV-DNA positive rate in the EBV antibody negative group was 0.0%.There was no statistically significant difference between the two groups（P=1.000）.Among the 223 patients who tested positive for EBV antibodies,there were 29EBV-DNA positive,and the EBV-DNA positive rate was 13.0%.EBV-DNA viral load of1×10³-1.781×10⁷ copies/ml,viral load M(P₂₅,P₇₅):5.709×10³（2.024×10³,2.877×10⁴）copies/ml.There were no significant differences in age,clinical symptoms（fever,rash,hepatomegaly,splenomegaly）,EBV antibodies,and laboratory tests（ALT,AST,TBIL,ESR）between the EBV-DNA positive group and the EBV-DNA negative group（P>0.05）.gender,clinical symptoms（lymph node enlargement,angina）,and white blood cell count in the EBV-DNA positive group were statistically different from those in the EBV-DNA negative group（P<0.05）.In the EBV-DNA positive group,22（30.6%）cases of EBV infectious accounted for the highest proportion,followed by 13（18.1%）cases of upper respiratory tract infection.The EBV-DNA positive group included 4（5.6%）cases of infectious mononucleosis,3（4.2%）cases of chronic active EBV infection,1（1.4%）case of NK/T-cell lymphoma,1（1.4%）case of diffuse large B-cell lymphoma,and 1（1.4%）case of liver cancer.In the EBV-DNA negative group,85（25.4%）patients with abnormal liver function accounted for the highest proportion,followed by 62（18.5%）cases of infectious fever,38（16.0%）cases of upper respiratory tract infection,1（0.4%）case of rectal cancer and 1（0.4%）case of lymphoma.Conclusion:The clinical manifestations of suspected EBV infection in adults are mostly fever,splenomegaly,followed by symptoms such as lymphadenopathy,angina,and can be diagnosed as other viral infections.The clinical symptoms of many diseases are similar to those of EBV infection,and clinicians need to give more vigilance and diagnose in a timely manner.Adult EBV infection has a complex and diverse serological response,most of which are latent infections.Clinical diagnosis of EBV infection requires the combination of EBV antibody test results and EBV-DNA test results to determine whether EBV infection is present in order to avoid missed diagnosis.EBV-DNA positive patients have more severe inflammation.In addition to fever,they are more likely to show symptoms such as lymphadenopathy and angina.EBV infection are more likely to be associated with malignant lymphoproliferative diseases.