Hodgkin’s Lymphoma associated Epstein-Barr Virus (EBV) infectionSIDDHESH U. SAPREROLL NUMBER- 17M.SC. VIROLOGY – PART INATIONAL INSTITUTE OF VIROLOGY (NIV), PUNE

Epstein Barr Virus/

HHV-4

Tegument Family: Herpesviridae

Subfamily: Gammaherpesviri

naeGenus:

Lymphocryptovirus

Nucleic acid: Linear, double stranded DNA

(184 kbp)

Enveloped, Spherical or pleomorphic

Icosahedral symmetry

Modes of transmission:1. Exposure to infected body secretions

2. Respiratory tract and mucous membranes

3. Parenteral exposure (transfusion) rare

Structure and infectious cycle(EBV):

viral envelope glycoprotein gp350/220

cellular receptor for the C3d complement component CR2 (CD 21)

gp25, gp42 & gp85

B-lymphocyte (APC)

EBV is an etiological agent for:

1. Infectious mononucleosis 2. Hodgkin’s lymphoma (after

Dr.Thomas Hodgkin) 3. Burkitt’s lymphoma 4. AIDS-related lymphoma 5. Post-transplant

lymphoproliferative disease (PTLD) 6. Nasopharyngeal carcinoma Let’s explore Hodgkin’s lymphoma

now……………………!

Hodgkin’s lymphoma

Lymphoid tissue is present throughout the body HD can start practically anywhere inside the body (most often starts in the lymph nodes in the upper part of the body)

Sites: in the neck, in the chest or under the arm Most often spreads through the lymph nodes in a

stepwise fashion from lymph node to lymph node In the late stage (rare), it invades the blood stream and

spreads throughout the body (liver, lungs, and bone marrow)

Types of Hodgkin’s disease (appearance under microscope) Classical HD (95% case in the world) Reed-Sternberg cells (abnormal type

of B lymphocyte, much larger than normal lymphocytes,)

Classical HD has 4 subtypes

Mixed cellularity

HD Lymphocyte

rich HD Nodular sclerosis

HD

Lymphocyte depleted

HD

People who have had infectious mononucleosis (mono),an infection caused by the Epstein-Barr virus (EBV), have an increased risk of Hodgkin disease.

Signs and symptoms of HD:

Lumps under the skin Cough, trouble breathing, chest pain General (non-specific) symptoms/ B

symptoms: Fever without an infection Drenching night sweats Weight loss of the body (unintentional,

more than 10% of the body weight in about 6 months)

Treatment of HD:

Radiation therapy (involved site/ involved field ) PBSCT, BMT Chemotherapy for HD:o Adriamycin (doxorubicin)o Bleomycino Vinblastineo Dacarbazine (DITC)o Generally ABVD and BEACOPP regimens are usedo mAb therapy (Brentuximab vedotin, Rituximab)

Factors that show the presence of EBV infection in B lymphocytes

fluorescent situ hybridisation technique to detect EBV DNA (EBER1 & EBER 2) sequences (latent infection in situ) ( GOLD Std. for Clinical

samples) Also express high levels of (EBNA), (LMP) LMP (CD23 & CD40) IL-10 production , upregulation of ICAM, Lymphocyte Function associated

Antigen (LFA), downregulation of CD99 Protects B cells from cell death by upregulation of several anti-apoptotic

genes including bcl-2, mcl-1 and A-20

Treatment of Epstein Barr Virus infections

no vaccine protected by close physical contact, food, or personal items,

like toothbrushes, with people who have EBV infection

To summarise:

Epstein Barr virus is associated with about 37% of the cases of all lymphomas- including the Hodgkin’s disease

Early EBV infection associated with immunocompromised status or transplantation/ transfusions can increase the risk of EBV infections causing lymphoma

In about 90% of the cases which are infected with EBV, it remains latent throughout the life cycle of the subject and doesn’t lead to malignancies

Hodgkin’s lymphoma is curable even in the late state of malignancy

THANKS!!!

QUESTIONS?????