Question About Fevers and the Epstein Bar Virus?
Question by Bubba: Question about Fevers and the Epstein bar Virus?
Hello im 18 and i have been diagnosed with autoimmune hepatitus and have had a liver transplant in 2002 and in 2003 i was diagnosed with Epstein Bar Virus (EBV) and the doctors are almost clueless still up to this day on how to treat it or control it.. I have been in the hospital for going on 9 days (went in for fever 102.4 and with a liver transplant they say to allways rush in ) and they have drawn cultures and everything else they could possibly think of and nothing but the ebv comes back possitive … I have ran a fever everynight since i came in and all they can do is give me tylenol ….. also the only known treatment i can find that possibly works is called microimmunetherapy and its generated somewere in germany and i cant find out any information on it Thanks to all replys they are GREATLY Appreciated!!!!
Forgot to mention i already have post transplant lymphatic disorder
Best answer:
Answer by mirror
There is research that indicates EBV increases risk of LPD and others that it does not.
The fact that you have positive tests to EBV may be significant indicating a new infection or it may indicate you were exposed before the transplant and are reactive.
The liver itself may have been exposed to EBV before you got the transplant.
1. At present, the major concern regarding EBV infection is that it may later develop into lymphoproliferative disease (LPD), which is a malignant condition (cancer). However, the virus also may be responsible for chronic fatigue in transplant and healthy patients, and occasionally it can cause hepatitis and damage the liver.
The major risk factor that seemed to increase the chance of getting EBV was having treatment for rejection with immunosuppressive antibodies, such as OKT3 and ATGAM. Also, the younger groups seem to have the highest risk. Finally, there seems to be more EBV infection in children treated with tacrolimus (Prograf) compared to cyclosporine; however, most patients who were treated with tacrolimus had a higher dosage than is currently in use. This may explain the higher incidence of EBV infection.
It is unclear whether prophylactic treatment with anti-viral drugs, such as ganciclovir and acyclovir, decreases the risks of getting an EBV infection or not.
http://www.classkids.org/library/classqa/ebv.htm
2. Conclusions—These data indicate that tonsillar enlargement in paediatric liver transplant patients does not necessarily imply a diagnosis of PTLD. Furthermore, the presence of increased numbers of EBV infected cells in tonsils from liver transplant recipients by itself does not indicate an increased risk of developing PTLD.
ttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1187079
3. Latent EBV in the transplanted liver-
EBV-associated post-transplant lymphoproliferative disease (PTLD) develops in ~1% of renal transplant recipients, and evidence of EBV-encoded small RNA (EBER) expression is found in the majority of the constituent affected cells [4,5]. In situ hybridization (ISH) for EBERs probably is the most sensitive method for detecting EBV infection in tissues, and remains the gold standard with which to confirm that a histopathologic lesion is EBV-related [4,6]. EBER 1 and EBER 2 are small nuclear RNAs that are expressed in large numbers (up to 107 copies/cell) in cells with latent infections, thus providing an abundant target for ISH [7].
http://ndt.oxfordjournals.org/cgi/content/full/18/12/2638
4. Here is lytic induced threapy, but for PTLD present rather than just EBV positive and fever. (Chapel Hill NC, rather than Germany)
Lytic Induction Therapy for Epstein-Barr Virus-Positive B-Cell Lymphomas
Wen-hai Feng,1 Gregory Hong,1 Henri-Jacques Delecluse,2 and Shannon C. Kenney1*
Department of Medicine, Department of Microbiology, and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599,1 Division of Cancer Studies, Department of Pathology, University of Birmingham, Birmingham B15 2TT, United Kingdom2
Received 27 June 2003/ Accepted 20 October 2003
http://jvi.asm.org/cgi/content/full/78/4/1893
5. Immune gobulin therapy in general.
http://216.109.125.130/search/cache?ei=UTF-8&p=micro+immune+therapy+EBV&y=Search&fr=moz2&u=www.primaryimmune.org/pubs/book_diag/IDF%2520Diagnostic%2520and%2520Clinical%2520Care%2520Guidelines%2520-%2520Final.pdf&w=micro+micros+immune+therapy+ebv&d=IcEXnfH_QeCi&icp=1&.intl=us
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This all is background but the fact remains: EBV positive can mean you were exposed to EBV, your new liver was exposed to it, or you have an acute case. Even if you have an acute case, only 1% appears to induce lymphoma, in which case treatment is an issue.
It is most probably that at the moment the absolute treatment that is indicated is tylenol for the fever from what you have said.
I put the above references for you to learn more on your own, to communicate(asking and hearing) what the doctors say. If you question anything at any point of anything:
get a second opinion.
From what you state here good communication with your doctors is your next step.
It sounds to me like they are ruling out more serious things and the EBV positive is like patients in the tropics who get a lab work up and the only thing that shows positive is typhoid ( which has such a high false positive it has very little help to offer alone) come into the hospital stating they have typhoid fever.
The US Army has a doctrine for infantry: shoot, move and communicate.
For your situation it is: communicate, self educate, and consult second opinion
By the time you read this, your doctors may have results to tell you that changes the focus from EBV therapy because at the moment, that really seems like grasping something as crucial that is not.
Speak with your doctors directly: express your concerns, get their answers, and keep asking questions until you are satisfied excellent communication has taken place and you understand perfectly if EBV is important to treat if you have that.
It does not appear extraordinary therapy for EBV is indicated from what you say even if it is the cause of the fever.
If you are not satisfied with any of the above: get a second opinion.