DETECTION OF EBV 3C GENE OF THE EBV
EBV DNA was detected in 76 cases of infectious mononucleosis to identify the type of EBV by PCR for the EBNA3C gene, 55.3% (42/76) belonged to the female gender and 44.7% (34/76) to the male gender. The cases came from the cities of Belém with rates of 76.3% (58/76), Ananindeua with 22.4% (17/76) and Marituba with 1.3% (1/76).
As to the clinical picture, a multiplicity of signs and symptoms were noticed, such as: fever in 65.8% (50/76), cervical lymphadenomegaly in 60.5% (46/76), pharyngitis (15/76) in 19.7 %, arthralgia in 17.0% (13/76), headache in 9.2% (7/76) of the patients. With fever days, 22% (11/50) reported their permanence for up to 5 days, 16% (8/50) for 10 days, 20% (10/50) for 15 days, 16% (8/50) for 20 days, 16% (8/50) for more than 20 days, and 10% (5/50) had no information in the epidemiological record.
The EBV1 infection was observed in 71.1% (54/76); the most frequent age group was> 14 years old, with 66.7% (36/54) of the individuals, since the age range was of 23 years, the number of women was higher 61.1% (33/54) was higher than in men with 38.9% (21/54).
As for the origin of the individuals with EBV genotype 1, the frequencies were: city of Belém with rates of 76.0% (41/54), Ananindeua with 22.2% (12/54) and 1.8% (1/54) of Marituba.
The symptoms/clinical signs observed in infection by EBV1 were cervical lymphadenopathy in 64.8% (35/54), fever in 63% (34/54), headache and arthralgia in 20.3% (11/54), and exanthema in 18.5% (10/54) (Fig. 1).
In EBV2 infection, 17.1% (13/76) cases were observed, where the most frequent symptom was fever in 76.9% (10/13), the individuals were distributed in only two ranges, being > 14 years old, slightly higher, with 53.8% (7/13) individuals, compared to 6 to 14 years old, in 46.2% (6/13) individuals; the average age was 24 years, with the males being more frequent 76.9% (10/13) than females 23.1% (3/13).
Co-infection with EBV1 and EBV2 is more frequent in children and cervical lymphadenopathy in 66.7 (6/9) and 55.6% (5/9), respectively. The most frequent age group was > 14 years, with 44.4% (4/9) of the individuals, since the age group of 2 to 5 years presented 22.2% (2/9) individuals and 6 to 14 years 33.3% (3/9) individuals, an average age of 21 years, the number of women of 66.7% (6/9) was higher than that of men with 33.3% (3/9).
In the assessment of hepatic function, alterations to AST in EBV1 infection were confirmed in 14,8% (8/54) with results above the reference values (5-40 U/L) and 7.7% (1/13) for EBV2. It is worth mentioning that the reference values are the same in the three age groups (Fig 2). When analyzing the mean values by age group, the range of >14 years was outside the normality limits with more frequency of alterations, thus presenting statistical difference (p-value < 0.05).
Fig 2. Evaluation of ALS of individuals with EBV 1, EBV 2 and EBV 1 and 2 infection.
Values above the reference values (2-41 U/L) were also observed for ALT (Fig 3). The mean value was outside the limits of normality in the age groups of 6 to 14 years and >14 years, presenting a statistical difference (p-value < 0.05) by the Wilcoxon test.
Fig 3. Evaluation of AST of individuals with EBV 1, EBV 2 and EBV 1 and 2 infection.
For the evaluation of GGT, some altered results were observed, but no changes were found in the age group of 2 to 5 years, given the reference values: (5 - 55 U/L), changes in the age group from 6 to 14 years were all values above normal, given the same reference range of the previous age group, and in the range of >14 years the greatest number of alterations were perceived, above or below, given reference values: (12 - 43 U/L) (Fig 4).The mean value was outside the limits of normality in the age group of > 14 years, and the mean values presented a statistical difference (p-value <0.05) by the Wilcoxon test.
Fig 4. Evaluation of GGT activity in individuals with EBV 1, EBV 2 and EBV 1 and 2 infection.