Journal of Clinical Virology - Volume 82 - Supplement 1 - September 2016

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Abstracts / Journal of Clinical Virology 82S (2016) S1–S142 S139
Abstract no: 193
Presentation at ESCV 2016: Poster 240
Acute exudative tonsillopharyngitis;
Epstein-Barr virus, Herpesvirus and Adenovirus
B. Elmas ∗, M. Koroglu , H.A. Terzi , F.G. Aslan ,
E. Menekse , M. Kosecik , M. Altindis
1 Sakarya University, Training and Research
Hospital, Department of Pediatrics, Sakarya, Turkey
2 Sakarya University, Training and Research
Hospital, Department of Medical Microbiology,
Sakarya, Turkey
Background: Exudative tonsillopharyngitis (ExTP) is a com-
mon illness that requires a careful clinical assessment in order
to identify underlying etiology and to avoid morbidity and mor-
tality. As a clinical symptom include fever, lymphadenopathy,
trismus, dysphagia, pooling of saliva, pharyngeal congestion, ery-
thematous uvula, soft palate erythema, and bilaterally enlarged
tonsils covered with white exudates. Tonsillar exudate culture
confirmed group A streptococcal (GAS) tonsillitis. Differential
diagnosis includes Epstein-Barr virus (EBV), adenovirus, Fusobac-
teria, Arcanobacterium hemolyticum, Corynebacterium diphtheriae,
C. ulcerans, Francisella tularensis, Yersinia enterocolitica, and Neis-
seria gonorrhoea. Epstein-Barr virus, the most common cause of
pseudomembranous tonsillitis, causes tonsillitis with or without
infectious mononucleosis. The tonsils can be severely enlarged
which are covered with an extensive necrotic, greyish-white mem-
branous exudate. In this study, we aimed to analyse the presence
of EBV, Adenovirus and Herpesvirus type- 1(HSV-1) in ExTP.
Material and method: Molecular diagnosis was performed for
EBV, Adeno and HSV 1 detection with swab samples from tonsil-
lar membranous exudate of 51 paediatric patients with Exudative
tonsillopharyngitis after GAS ruled out (21 men and 30 women,
ages between 2 and 16 years) and at the same time, monospot test
was performed. DNA extraction from swap samples was carried out
from tonsillar membranous exudate, using the Magnesia® Extrac-
tion Kit by using the Nucleic Acid Extraction robot (Magnesia®
2448)(Anatolia Geneworks). Bosphore® EBV DNA, ADENO and HSV
type 1 Quantification Kits were used for EBV DNA, ADENO and HSV
type 1 PCR by Montania® 4896 RT PCR platform (Anatolia).
Results: The frequency of positive EBV DNA cases in the ton-
sillar membranous exudate in swap samples were 21.5% (11/51).
Monospot test was only one of the positive cases in EBV DNA pos-
itive. On the side a case of adenovirus, the HSV-1 was detected in
two cases.
Conclusions: A meticulous clinical examination would differ-
entiate between the 2 most common causes; Streptococcus and
EBV. Adeno and HSV were determined as less causative agents.
Streptococcal tonsillitis can be successfully treated with suitable
antibiotics. Acyclovir, ganciclovir, and foscarnet have been shown
to inhibit EBV DNA polymerase enzyme.
Abstract no: 216
Presentation at ESCV 2016: Poster 241
Epilepsy patients show reactivation of the HHV6
infection
S. Chapenko ∗, S. Rasa , N. Suna , E. Kashuba ,
Z. Zazerska , M. Lazdane , G. Karelis ,
M. Murovska
1 A. Kirchenstein institute of microbiology and
virology, Riga Stradins university, Latvia
2 Riga Eastern clinical Hospital, Latvia
3 MTC, Karolinska Institute, Sweden
Background: The human herpes virus 6 (HHV6) is ubiquitous,
lymphotropic, immunomodulating, and potentially pathogenic for
the neural system beta-herpes virus. HHV6 is associated with such
diseases, as multiple sclerosis, mesial temporal lobe epilepsy, and
myalgic encephalomyelitis/chronic fatigue syndrome. HHV6 family
consists of two different viruses, A and B.
Materials and methods: 53 patients with clinically diagnosed
epilepsy and 104 age and gender matched apparently healthy indi-
viduals were enrolled in this study. A patient cohort consisted
of 66% of females and 34% of males; the mean age was 49 ± 17
years. Presence of HHV-6 viral DNA was analysed, using nested
PCR; viral loads was determined by Real-time PCR; HHV-6 variant-
specificity was analysed, using restriction endonuclease analysis;
U89/90 mRNA presence was detected by RT-PCR; the early (p41)
and late (gB) antigens expression was studied by immunofluores-
cent analysis; levels of TNF-alpha, and presence of HHV-6 specific
IgG class antibodies in peripheral blood were examined by ELISA.
The GraphPad Prism software (version 6.0) was used for statistical
analysis.
Results: The rate of HHV-6 seroprevalence (presence of HHV-6
specific IgG class antibodies in the blood plasma) was similar for the
epilepsy patients and healthy individuals (42 out of 53, or 79.2% and
76 out of 104, or 73.1%, respectively). Noteworthy, the HHV-6 DNA
in peripheral blood was detected with the significantly higher fre-
quency in patients, compared with the healthy persons (13 out of
53, or 24.5% and 10 out of 104, or 9.6%, respectively, p = 0.017). Out
of 13 patients, 11 were carrying HHV6B, and only 2 were infected
with HHV6A. In all healthy individuals the HHV6B was detected.
Furthermore, the significantly higher HHV-6 load (>10 copies/106
cells) was detected in patients compared with the healthy indi-
viduals (median values were 1574.0 and 131.85 copies/106 cells,
respectively). The U89/90mRNAwas found in 10 out of 13 patients.
The mononuclear cells of the peripheral blood showed the p41 sig-
nal in 54.5% of patients, and 45.5% of patients were positive for gB
antigens.
The TNF-alpha levels were significantly higher in plasma of
patients with an active viral infection (40.09 ± 11.13 pg/ml), in
comparison with latently infected patients (18.81 ±2.52 pg/ml,
p = 0.014) and with non-infected individuals (7.71 ±3.07 pg/ml,
p = 0.0001).
Conclusions: The significantly high frequency of HHV6 pres-
ence, the high viral load, expression of the early and late viral
antigens, and high levels of pro-inflammatory TNF-alpha allow us
to propose that HHV6 infection plays an important role in the devel-
opment of epilepsy.