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Published on: March 30, 2018
High Epstein-Barr Virus DNA Load in T Cells Predicts Hemophagocytic Lymphohistiocytosis
Xiaohui Fang1, Shanshan Xu2, Kang Cai2
1Department of Infectious Diseases, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
Background:
To evaluate the risk of hemophagocytic lymphohistiocytosis (HLH) linked to Epstein-Barr virus (EBV) infection in different lymphocyte subtypes during infectious mononucleosis (IM).
Methods:
Patients with IM and patients with EBV-HLH were included within the Children's Critical EBV Infection cohort for a nested case-control study. Lymphocytes were isolated into T, B, and natural killer cells using magnetic bead sorting, followed by individual polymerase chain reaction testing. Receiver operating characteristic curve analysis identified subtype-specific cutoffs for EBV-HLH prediction. Kaplan-Meier and Cox regression analyses assessed viral load-HLH risk associations.
Results:
Patients with EBV-HLH exhibited significantly higher T-cell viral loads than patients with IM (median, 5.1 × 104 vs 6.0 × 102 copies/106 cells). A T-cell viral load >1.5 × 104 copies/106 cells was linked with higher incidences of viral sepsis, renal dysfunction, hepatic dysfunction, coagulation dysfunction, and cardiovascular dysfunction (odds ratios, 10.0, 4.7, 6.5, 15.7, and 6.5). This elevated T-cell viral load was a strong predictor for distinguishing EBV-HLH (AUC 0.815) and increased the risk of developing EBV-HLH (hazard ratio 4.7).
Conclusions:
High EBV DNA load in T cells can serve as a potential predictor for the development of EBV-HLH.
