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Epstein-Barr virus infection in children with liver transplantation
Norrapat Onpoaree1, Nattinee Leelakanok2, Anapat Sanpavat3
1Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
Insights
Epstein-Barr virus (EBV) infection is common in children, sometimes causing serious issues like cancer. This review explores EBV in healthy children and liver transplant recipients, offering detection and management strategies.
Area of Science:
- Pediatrics
- Infectious Diseases
- Virology
Background:
- Epstein-Barr virus (EBV) is a widespread childhood infection.
- While often asymptomatic, EBV can lead to severe complications like malignancies and multiple sclerosis.
- Immunocompromised children, especially liver transplant recipients, face diverse EBV presentations, including post-transplant lymphoproliferative disorder (PTLD).
Purpose of the Study:
- To review the pathogenesis and clinical manifestations of EBV in healthy children.
- To investigate EBV in pediatric liver transplant recipients.
- To provide an early detection and management algorithm for EBV in children.
Main Methods:
- Literature review focusing on EBV pathogenesis and clinical outcomes.
- Analysis of EBV presentations in healthy vs. immunocompromised pediatric populations.
- Development of a practical algorithm for EBV detection and management.
Main Results:
- EBV infection presents variably in children, from asymptomatic cases to severe conditions.
- Liver transplant recipients are at risk for PTLD, a potentially life-threatening EBV complication.
- Early detection and prompt management are critical for improving outcomes.
Conclusions:
- Understanding EBV's diverse manifestations is key for pediatricians.
- A structured approach aids in the early identification and treatment of EBV-related issues.
- The proposed algorithm can enhance clinical suspicion and guide management decisions.
Abstract:
Epstein-Barr virus (EBV) infection commonly occurs in children, particularly in developing countries. Most children infected with EBV are asymptomatic, though some develop significant complications, including EBV-associated malignancies, hemophagocytic lymphohistiocytosis, and multiple sclerosis. In immunocompromised children, including those with liver transplantation, EBV infection manifests with a diverse spectrum of presentations, varying from asymptomatic to post-transplant lymphoproliferative disorder, which can evolve into lymphoma. Therefore, close monitoring, early detection, and prompt management are crucial. This review aimed to investigate the pathogenesis and manifestations of EBV in healthy children and those who underwent liver transplantation. The proposed algorithm for early EBV detection and management, along with case studies, is provided to help pediatricians increase their index of suspicion.
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