Epstein-Barr virus and JC virus Reactivation in Dermatological Patients Receiving Immunosuppressive Therapy
Creators
- 1. Department of Dermatology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
- 2. Department of Medical Microbiology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
- 3. Department of Medical Microbiology, Gulhane Institute of Health Sciences, University of Health Sciences, Ankara, Turkey.
- 4. Department of Family Medicine, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
- 5. Department of Medical Microbiology, Gulhane Medical Faculty, University of Health Sciences, Ankara, Turkey.
- 6. Department of Infectious Diseases and Clinical Microbiology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
Description
Abstract
Immunosuppressive medications are the mainstay treatment of many severe cutaneous diseases. The objective of this study was to investigate the reactivation of certain viral agents (Epstein-Barr virus, human cytomegalovirus, BK virus, JC virus, B19 virus, and herpes simplex virus) in dermatology patients who underwent immunosuppressive treatment. The study included 57 patients and they were divided into three groups based on the treatments; patients not receiving any immunosuppressive therapy (control group), patients treated with phototherapy only (phototherapy group), and patients treated with systemic immunosuppressive agents (systemic immunosuppressive therapy group). Saliva, blood, and urine samples were collected from all patients, and these samples were analyzed for the presence of virus-specific DNA by TaqMan-based real-time polymerase chain reaction. In the overall study population, the positivity rate for any viral reactivation in at least one of the investigated specimens was 31.6% (18/57). The frequencies of viral reactivation in the control, phototherapy, and systemic immunosuppressive treatment groups were 9.5% (2/21), 18.8% (3/16), and 65.0% (13/20), respectively. The viral reactivation rate in patients receiving systemic immunosuppressive treatments was significantly higher than in the other two groups (p=0.00022 and p=0.00544), but there was no statistically significant difference between the phototherapy and control groups. EBV (15 patients, 26.3%) and JC virus (7 patients, 12.3%) were the most frequently detected viruses. Viral reactivation is a potential risk for dermatology patients receiving immunosuppressive treatments and it can be considered as a parameter of disease control and management. Our study results also reveal that the safety profile of phototherapy is not different from the control group in terms of viral reactivation.
Özet
İmmünosüpressif ilaçlar, birçok ciddi dermatolojik hastalıkta temel tedavi yaklaşımıdır. Bu çalışmanın amacı, immünosüpressif tedavi alan dermatoloji hastalarında belirli viral etkenlerin (Epstein-Barr virus, insan sitomegalovirus, BK virus, JC virus, B19 virus ve herpes simpleks virus) reaktivasyonunun araştırılmasıdır. Çalışma grubu 57 hastayı içeriyordu ve hastalar uygulanan tedaviler baz alınarak üç gruba ayrıldı; herhangi bir immünosüpressif tedavi almayan hastalar (kontrol grubu), sadece fototerapi uygulanan hastalar (fototerapi grubu) ve sistemik immünosüpressif ilaçlarla tedavi edilen hastalar (sistemik immünosüpressif tedavi grubu). Tüm hastalardan tükürük, kan ve idrar örnekleri toplandı ve bu örnekler TaqMan tabanlı gerçek zamanlı polimeraz zincir reaksiyonu ile ilgili virüs spesifik DNA'ların varlığı yönünden incelendi. Çalışma popülasyonu genelinde incelenen örneklerinden en az birinde herhangi bir viral reaktivasyon için pozitiflik saptanma oranı %31.6 (18/57) idi. Kontrol, fototerapi ve sistemik immünosüpressif tedavi gruplarında viral reaktivasyon sıklığı ise sırasıyla %9.5 (2/21), %18.8 (3/16) ve %65.0 (13/20) olarak bulundu. Sistemik immünosüpressif tedavi alan hastalarda viral reaktivasyon oranı diğer iki gruba göre anlamlı derecede yüksekti (p=0.00022 ve p=0.00544), ancak fototerapi ve kontrol grupları arasında istatistiksel olarak anlamlı farklılık yoktu. EBV (15 hasta, %26.3) ve JC virus (7 hasta, %12.3) en sık saptanan virüslerdi. Viral reaktivasyon, immünosüpressif tedavi alan dermatoloji hastaları için potansiyel bir risktir ve bu nedenle hastalık kontrolü ve yönetiminin bir parametresi olarak kabul edilebilir. Çalışma sonuçlarımız ayrıca, fototerapinin güvenlik profilinin, viral reaktivasyon açısından, kontrol grubundan farklı olmadığını ortaya koymaktadır.
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