The Influence of Primary Cytomegalovirus or Epstein-Barr Virus Infection on the Course of Idiopathic Thrombocytopenic Purpura

Abstract

Idiopathic thrombocytopenic purpura (ITP) in children is usually triggered by a viral infections such as cytomegalovirus (CMV) or Epstein-Barr virus (EBV) infection. The aim of this study was to assess the frequency of CMV and EBV infections in children with first relapse of ITP, and the influence of these infections on the course and response to treatment of ITP. Sixty patients (30 boys and 30 girls) with ITP were enrolled into the study. We found that the age at the onset of ITP was from 1 month to 17 years (mean 7.0 ± 5.7 years), the platelet number was from 1 to 79 x 10(9)/L (mean 18.1 ± 19.0 x 10(9)/L) at the time of diagnosis and it increased from 17 to 395 x 10(9)/L (mean 134.4 ± 81.2 x 10(9)/L)(p < 0.05) after the first course of therapy. Forty seven patients required pharmacological treatment, the duration of the treatment was from 2 to 25 days (mean 6.1 ± 4.1 days). Relapses were observed in 27 (45%) of the patients. Active CMV infection was found in 19 patients (31.7%), EBV infection in 5 patients (8.3%), and both infections concomitantly in 1 patient (1.7%). The group of patients with CMV or EBV infection(n = 25) did not differ from the patients free of infection (n = 35) in regard to the age, number of platelets at onset, duration of treatment, number of platelets after treatment, number of relapses, and the interval between the onset and first relapse. In conclusion, active CMV or EBV infection is common in children with ITP. These infections do not seem to have an appreciable bearing on the clinical course and the response to treatment on children with ITP.

Cytomegalovirus Has No Impact on Immune Thrombocytopenia Bleeding Scale or Prognostic Outcomes in Egyptian Pediatric Immune Thrombocytopenia

“…Smalisz-Skrzypczyk et al also found no significant impact of CMV positivity on the clinical course or response to therapy. 17 Wu et al found no statistically significant difference between CMV positivity and platelet count. 32 Similarly, Elalfy et al did not find that CMV had any impact on the clinical severity of the disease but they suggested that the virus might play a role in duration of initial response to immunomodulation.…”

“…A similar observation was also noted by Nishio et al 31 DiMaggio et al and Smalisz-Skrzypczyk et al reported that clinical manifestations of CMV infection in immunocompetent cases is often asymptomatic and usually noticed retrospectively. 15,17 On the other hand, Jin et al suggested that ITP patients may display CMV-like symptoms at the time of thrombocytopenia diagnosis when CMV infects megakaryocytes and causes direct cytotoxicity, whereas the symptoms may be displayed a few weeks before the diagnosis of thrombocytopenia when a CMVrelated secondary ITP is caused by an immunological reaction after a recent CMV infection. 13 Moreover, our results found that CMV did not have any impact on the clinical severity of the disease, outcomes of refractory cases or the response to treatment (►Tables 3-5).…”

“…16 CMV-thrombocytopenia is reported to be less responsive to standard therapies for ITP and may require antiviral therapies. 17 Cytomegalovirus, unlike other viral agents, may continue to trigger immune-modulation with chronicity if it is not cleared. 18 CMV modulates cellular immune response not only by affecting the production capacity of infected cells (leukocytes, hematopoietic, and stromal bone marrow cells) but also by altering the function of the stromal cells by promoting the secretion of host and viral cytokines acting upon these cells.…”

Analysis of clinical effects and mechanism of recombinant human interleukin-11 with glucocorticoids for treatment of idiopathic thrombocytopenic purpura

“…This protein is involved in the pathophysiological process of a variety of diseases such as cancer. Increased B cell activating factor causes decreased levels of platelet autoantibodies, which accelerates the blood platelet defect; iv) bone marrow megakaryocyte abnormity (11). Decreased amount of megakaryocytes affects normal platelet production, which is a major cause of several diseases; and v) Th1/Th2 dysfunction (12).…”

Effect of Blood Transfusion on Platelet-Related Antibodies in ITP Patients

“…Incremental B cytokines lead to decreasing levels of platelet autoantibodies and accelerate thrombocytopenia. (IV) Abnormal expression of Bone marrow megakaryocyte [8]. The reduction of megakaryocytes affects the production of normal platelets.…”