Background

The impact of Epstein–Barr virus (EBV) infection on the clinical outcomes of children and adolescents with inflammatory bowel disease (IBD) is not well known. The aim of the study is to evaluate the seroprevalence, seroconversion rate and complications associated with EBV infection in a cohort of paediatric IBD (PIBD) patients at a tertiary care hospital.

Methods

A descriptive study was performed collecting demographic, clinical and treatment data from medical records as well as EBV serological status of paediatric IBD patients from 2012 to 2018. In seronegative patients, seroconversion rate was evaluated. Complications associated with primary EBV infection were described. Since September 2016, EBV serology was included into the initial work-up for PIBD patients. For those patients who did not have EBV study at IBD onset, it was performed during follow-up.

Results

A total of 307 patients with PIBD were diagnosed between 2012 and 2018. EBV status was available for 131 patients (43%). Of those, 57% had Crohn’s Disease, 41% Ulcerative Colitis, and 2% IBD unclassified (66% males; median age at IBD diagnosis: 13.2 years (IQR: 0.8–17.8)). In 102 patients serological EBV status was determined at IBD onset; while in 17 patients it was performed during the follow-up. Overall, EBV seroprevalence was 67%, and no differences were observed regarding age (over or under 10 years-old). EBV seroprevalence was higher in females than in males (80% vs. 60.5%, p = 0.02). Regarding IBD treatment, 84% had received immunosuppressive treatment [thiopurines (32%), anti-TNF (9%) and combined treatment (59%)], without differences in the seroprevalence rate according to the treatment modality. Forty-three patients were seronegative, and 12 of them had a second determination during follow-up. Overall, 5 patients showed seroconversion (42%) after a mean follow-up of 24 months (IQR: 22–26). All these patients had received treatment with thiopurines: 2 patients presented symptomatic mononucleosis with neutropenia, requiring hospital admission and withdrawal of immunosuppressive treatment and 3 patients had asymptomatic primary infection.

Conclusion

EBV seroprevalence in our paediatric IBD cohort is similar as previously described in the literature. EBV status study in patients with IBD, especially prior to initiation of thiopurines, may be useful to plan subsequent follow-up since a non-negligible percentage of them could present with complicactions of primary EBV infection under immunosuppressive treatment.

中文翻译：

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P763爱泼斯坦-巴尔病毒在小儿炎性肠病患者中的血清学状况

背景

爱泼斯坦-巴尔病毒（EBV）感染对炎性肠病（IBD）的儿童和青少年的临床结果的影响尚不清楚。这项研究的目的是评估三级医院的一组小儿IBD（PIBD）患者的血清阳性率，血清转化率和与EBV感染相关的并发症。

方法

进行描述性研究，收集2012年至2018年儿童IBD患者的病历，人口统计，临床和治疗数据以及EBV血清学状况。评估血清阴性患者的血清转化率。描述了与原发性EBV感染相关的并发症。自2016年9月以来，EBV血清学被纳入PIBD患者的初始检查中。对于那些在IBD发作时未进行EBV研究的患者，在随访期间进行。

结果

在2012年至2018年之间，共诊断出307例PIBD患者。131例患者中有EBV状态（43％）。其中，57％患有克罗恩病，41％溃疡性结肠炎和2％未分类的IBD（66％男性； IBD诊断的中位年龄为13.2岁（IQR：0.8-17.8））。在IBD发作时确定了102名患者的血清EBV状态；在17例患者中进行了随访。总体而言，EBV血清阳性率为67％，年龄（大于或小于10岁）没有差异。女性的EBV血清阳性率高于男性（80％比60.5％，p = 0.02）。关于IBD治疗，有84％的患者接受了免疫抑制治疗[硫嘌呤（32％），抗TNF（9％）和联合治疗（59％）]，根据治疗方式不同，血清阳性率没有差异。43例血清阴性，他们中的12位在随访期间有了第二个决定。总体而言，平均随访24个月后，有5例患者出现了血清转化（42％）（IQR：22–26）。所有这些患者均接受了硫嘌呤治疗：2例出现有症状的单核细胞增多症伴中性粒细胞减少，需要入院并撤回免疫抑制治疗，3例出现无症状的原发性感染。

结论

小儿IBD队列中的EBV血清阳性率与文献中先前描述的相似。在IBD患者中进行EBV状态研究，尤其是在开始硫嘌呤之前，可能有助于计划后续随访，因为在免疫抑制治疗中，只有极低百分比的患者可能伴有原发性EBV感染的并发症。