Letter to the Editor
Atypical manifestations of Epstein-Barr virus: red alert for primary immunodeficiencies
Manifestações atípicas do vírus de Epstein-Barr: alerta vermelho para imunodeficiências primárias
Gesmar R.S. Segundo
Universidade Federal de Uberlândia (UFU), Departamento de Pediatria, Uberlândia, MG, Brazil
Read
3158
Timeswas read the article
1358
Total PDF
1800
Total HTML
Share statistics
array:26 [ "pii" => "S0021755716300675" "issn" => "00217557" "doi" => "10.1016/j.jped.2016.05.002" "estado" => "S300" "fechaPublicacion" => "2016-09-01" "aid" => "407" "copyright" => "Sociedade Brasileira de Pediatria" "copyrightAnyo" => "2016" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "J Pediatr (Rio J). 2016;92:539-40" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1230 "formatos" => array:3 [ "EPUB" => 105 "HTML" => 805 "PDF" => 320 ] ] "Traduccion" => array:1 [ "pt" => array:19 [ "pii" => "S2255553616300660" "issn" => "22555536" "doi" => "10.1016/j.jpedp.2016.06.005" "estado" => "S300" "fechaPublicacion" => "2016-09-01" "aid" => "407" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "J Pediatr (Rio J). 2016;92:539-40" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1222 "formatos" => array:3 [ "EPUB" => 85 "HTML" => 828 "PDF" => 309 ] ] "pt" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta ao Editor</span>" "titulo" => "Atypical manifestations of Epstein‐Barr virus: red alert for primary immunodeficiencies" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "539" "paginaFinal" => "540" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Manifestações atípicas do vírus de Epstein‐Barr: alerta vermelho para imunodeficiências primárias" ] ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Gesmar R.S. Segundo" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Gesmar R.S." "apellidos" => "Segundo" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0021755716300675" "doi" => "10.1016/j.jped.2016.05.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755716300675?idApp=UINPBA000049" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2255553616300660?idApp=UINPBA000049" "url" => "/22555536/0000009200000005/v1_201609200029/S2255553616300660/v1_201609200029/pt/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S0021755716300687" "issn" => "00217557" "doi" => "10.1016/j.jped.2016.06.002" "estado" => "S300" "fechaPublicacion" => "2016-09-01" "aid" => "408" "copyright" => "Sociedade Brasileira de Pediatria" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "J Pediatr (Rio J). 2016;92:540-1" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 926 "formatos" => array:3 [ "EPUB" => 79 "HTML" => 538 "PDF" => 309 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Authors’ reply: Atypical manifestations of Epstein–Barr virus: red alert for primary immunodeficiencies" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "540" "paginaFinal" => "541" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Resposta dos autores: manifestações atípicas do vírus de Epstein-Barr: alerta vermelho para imunodeficiências primárias" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Vasileios Bolis, Christos Karadedos, Ioannis Chiotis, Nikolaos Chaliasos, Sophia Tsabouri" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Vasileios" "apellidos" => "Bolis" ] 1 => array:2 [ "nombre" => "Christos" "apellidos" => "Karadedos" ] 2 => array:2 [ "nombre" => "Ioannis" "apellidos" => "Chiotis" ] 3 => array:2 [ "nombre" => "Nikolaos" "apellidos" => "Chaliasos" ] 4 => array:2 [ "nombre" => "Sophia" "apellidos" => "Tsabouri" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2255553616300672" "doi" => "10.1016/j.jpedp.2016.06.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2255553616300672?idApp=UINPBA000049" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755716300687?idApp=UINPBA000049" "url" => "/00217557/0000009200000005/v1_201609220038/S0021755716300687/v1_201609220038/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S0021755716300638" "issn" => "00217557" "doi" => "10.1016/j.jped.2016.01.011" "estado" => "S300" "fechaPublicacion" => "2016-09-01" "aid" => "404" "copyright" => "Sociedade Brasileira de Pediatria" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "J Pediatr (Rio J). 2016;92:532-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1091 "formatos" => array:3 [ "EPUB" => 113 "HTML" => 575 "PDF" => 403 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Serum TSH levels are associated with cardiovascular risk factors in overweight and obese adolescents" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "532" "paginaFinal" => "538" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Níveis de TSH sérica associados a fatores de risco cardiovascular em adolescentes acima do peso e obesos" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Luciana Lopes de Souza, Erika Paniago Guedes, Patrícia Fátima dos Santos Teixeira, Rodrigo Oliveira Moreira, Amelio Fernando Godoy-Matos, Mario Vaisman" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Luciana Lopes de" "apellidos" => "Souza" ] 1 => array:2 [ "nombre" => "Erika Paniago" "apellidos" => "Guedes" ] 2 => array:2 [ "nombre" => "Patrícia Fátima dos Santos" "apellidos" => "Teixeira" ] 3 => array:2 [ "nombre" => "Rodrigo Oliveira" "apellidos" => "Moreira" ] 4 => array:2 [ "nombre" => "Amelio Fernando" "apellidos" => "Godoy-Matos" ] 5 => array:2 [ "nombre" => "Mario" "apellidos" => "Vaisman" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2255553616300751" "doi" => "10.1016/j.jpedp.2016.06.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2255553616300751?idApp=UINPBA000049" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755716300638?idApp=UINPBA000049" "url" => "/00217557/0000009200000005/v1_201609220038/S0021755716300638/v1_201609220038/en/main.assets" ] "asociados" => array:2 [ 0 => array:20 [ "pii" => "S0021755716000024" "issn" => "00217557" "doi" => "10.1016/j.jped.2015.06.007" "estado" => "S300" "fechaPublicacion" => "2016-03-01" "aid" => "332" "copyright" => "Sociedade Brasileira de Pediatria" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "ssu" "cita" => "J Pediatr (Rio J). 2016;92:113-21" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2201 "formatos" => array:3 [ "EPUB" => 99 "HTML" => 1684 "PDF" => 418 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>" "titulo" => "Atypical manifestations of Epstein–Barr virus in children: a diagnostic challenge" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "113" "paginaFinal" => "121" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Manifestações atípicas do vírus de Epstein–Barr em crianças: um desafio diagnóstico" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Vasileios Bolis, Christos Karadedos, Ioannis Chiotis, Nikolaos Chaliasos, Sophia Tsabouri" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Vasileios" "apellidos" => "Bolis" ] 1 => array:2 [ "nombre" => "Christos" "apellidos" => "Karadedos" ] 2 => array:2 [ "nombre" => "Ioannis" "apellidos" => "Chiotis" ] 3 => array:2 [ "nombre" => "Nikolaos" "apellidos" => "Chaliasos" ] 4 => array:2 [ "nombre" => "Sophia" "apellidos" => "Tsabouri" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2255553616000112" "doi" => "10.1016/j.jpedp.2016.01.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2255553616000112?idApp=UINPBA000049" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755716000024?idApp=UINPBA000049" "url" => "/00217557/0000009200000002/v1_201603250033/S0021755716000024/v1_201603250033/en/main.assets" ] 1 => array:20 [ "pii" => "S0021755716300687" "issn" => "00217557" "doi" => "10.1016/j.jped.2016.06.002" "estado" => "S300" "fechaPublicacion" => "2016-09-01" "aid" => "408" "copyright" => "Sociedade Brasileira de Pediatria" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "J Pediatr (Rio J). 2016;92:540-1" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 926 "formatos" => array:3 [ "EPUB" => 79 "HTML" => 538 "PDF" => 309 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Authors’ reply: Atypical manifestations of Epstein–Barr virus: red alert for primary immunodeficiencies" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "540" "paginaFinal" => "541" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Resposta dos autores: manifestações atípicas do vírus de Epstein-Barr: alerta vermelho para imunodeficiências primárias" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Vasileios Bolis, Christos Karadedos, Ioannis Chiotis, Nikolaos Chaliasos, Sophia Tsabouri" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Vasileios" "apellidos" => "Bolis" ] 1 => array:2 [ "nombre" => "Christos" "apellidos" => "Karadedos" ] 2 => array:2 [ "nombre" => "Ioannis" "apellidos" => "Chiotis" ] 3 => array:2 [ "nombre" => "Nikolaos" "apellidos" => "Chaliasos" ] 4 => array:2 [ "nombre" => "Sophia" "apellidos" => "Tsabouri" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2255553616300672" "doi" => "10.1016/j.jpedp.2016.06.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2255553616300672?idApp=UINPBA000049" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755716300687?idApp=UINPBA000049" "url" => "/00217557/0000009200000005/v1_201609220038/S0021755716300687/v1_201609220038/en/main.assets" ] ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Atypical manifestations of Epstein-Barr virus: red alert for primary immunodeficiencies" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "539" "paginaFinal" => "540" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Gesmar R.S. Segundo" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Gesmar R.S." "apellidos" => "Segundo" "email" => array:1 [ 0 => "gesmar@famed.ufu.br" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Universidade Federal de Uberlândia (UFU), Departamento de Pediatria, Uberlândia, MG, Brazil" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Manifestações atípicas do vírus de Epstein-Barr: alerta vermelho para imunodeficiências primárias" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">Jornal de Pediatria</span> has published an elegant review paper entitled “Atypical manifestations of Epstein-Barr virus in children: a diagnostic challenge”.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> The authors performed a literature review including the last 30 years of publications on atypical manifestations associated with an Epstein-Barr virus (EBV) infection. However, I would like to complement their review by providing a particularly important point of view related to atypical EBV infections.</p><p id="par0010" class="elsevierStylePara elsevierViewall">EBV is a gamma-1 herpes virus restricted to primate hosts, characterized by its persistence in the B-lymphoid system, and its capacity to stimulate B-cells growth by coordinating the expression of latent cycle genes.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Most EBV-infected individuals are asymptomatic or present infectious mononucleosis syndrome with a benign course, especially teenagers and young adults.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,3</span></a> In its normal course, EBV infects B-cells and the immune system controls the virus using a complex mechanism that involves NK, iNKT, CD4, and CD8 cells. Genetic alterations leading to functional NK or T-cell impairment may lead to a failure in the EBV control mechanisms.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Primary immunodeficiencies (PIDs) are a group of different diseases that cause alterations in the development and/or function of the immune system, leading to an increased susceptibility to infections and, in some cases, increased incidence of autoimmune diseases and malignancies. Most PID cases are genetic diseases that follow simple Mendelian patterns of inheritance, while a few others are considered as complex disorders.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4,5</span></a> The advance in the genetic approaches in the last years has increased the pace at which causative genes for PIDs are being discovered.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Recently, Palendira and Rickson, in a educational and simple method, divided PID patients into groups to explain the susceptibility to EBV infections: (1) PIDs that are selectively susceptible to EBV; (2) PIDs with broader virus susceptibility, but frequent EBV disease; (3) PIDs generally susceptible to viral and nonviral infections; and (4) PIDs with an inherent susceptibility to lymphoma.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Group 1 includes the X-linked lymphoproliferative diseases type 1, caused by SH2D1A gene mutations, and type 2, associated with XIAP gene mutations. In both diseases, patients could present severe infectious mononucleosis; and acute disease could result in a cytokine storm that causes macrophage activation and hemophagocytic lymphohistiocytosis (HLH).<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,4</span></a> In another review, authors added three different PIDs to this group, including mutations in the genes PRF1 (perforin deficiency, autosomal recessive (AR)), STXBP2 (munc18-2 deficiency, AR), and UNC13D (munc13-4 deficiency, AR), which are also associated with HLH and the development of chronic and severe EBV disease.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Group 2 contains PIDs caused by mutations in genes CD27 (CD27 deficiency, AR), MAGT1 (XMEN syndrome, X-linked), ITK (ITK deficiency, AR), CORO1A (coronin-1A deficiency, AR), FCGR3 (CD16 deficiency, AR), and MCM4 (MCM4 deficiency, AR).<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> The diseases in this group showed an increased susceptibility not only to EBV, but also to other herpes virus family and, in some cases, to HPV.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Group 3 has complex PIDs with different predispositions to several microorganisms, including EBV infections. The PIDs included in this group are result of mutations in genes PIK3CD (Activated PI3-kinase delta syndrome, autosomal dominant (AD)), STK4 (MST1 deficiency, AR), ZAP70 (Zap-70 deficiency, AR), CTPS1 (CTPS1 deficiency, AR), CARD11 (CARD11 deficiency, AR), LRBA (LRBA deficiency, AR), GATA2 (mono MAC syndrome or GATA2 deficiency, AD), LYST (Chediak-Higashi syndrome, AR), and hypomorphic mutations in ARTEMIS and DNA ligase IV, both associated with Omenn syndrome.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,4,6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The PIDs in group 4 present different degrees of immune system deficiency, which are also associated with increased cancer incidence and the involvement of EBV in some of these tumors, especially lymphomas. This group includes PIDs with mutations in genes WAS (Wiskott–Aldrich syndrome, X-linked), ATM (Ataxia telangiectasia syndrome, AR), and TNFRSF6 (ALPS-FAS, AD and AR).<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,4,6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The message for all pediatricians is to consider EBV as a causative agent in clinical pictures similar to those described by Bolis et al. In addition to the immune system impairment associated with treatment for several diseases, we must also consider these situations as a red alert for primary immunodeficiencies in pediatric patients. Recognizing PIDs may be essential to achieve a better management for patients with atypical EBV infections.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0050" class="elsevierStylePara elsevierViewall">C.H.I.L.D.R.E.N. initiative for primary immunodeficiency research of the <span class="elsevierStyleGrantSponsor" id="gs1">Jeffrey Modell Foundation</span>; Postdoctoral Fellow abroad through Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – CAPES (Higher Education Personnel Improvement Coordination).</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The author declares no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Segundo GR. Atypical manifestations of Epstein-Barr virus: red alert for primary immunodeficiencies. J Pediatr (Rio J). 2016;92:539–40.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Atypical manifestations of Epstein-Barr virus in children: a diagnostic challenge" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "V. Bolis" 1 => "C. Karadedos" 2 => "I. Chiotis" 3 => "N. Chaliasos" 4 => "S. Tsabouri" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Pediatr (Rio J)" "fecha" => "2016" "volumen" => "92" "paginaInicial" => "113" "paginaFinal" => "121" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary immunodeficiencies and the control of Epstein-Barr virus infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "U. Palendira" 1 => "A.B. Rickinson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/nyas.12937" "Revista" => array:6 [ "tituloSerie" => "Ann NY Acad Sci" "fecha" => "2015" "volumen" => "1356" "paginaInicial" => "22" "paginaFinal" => "44" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26415106" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0045" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "EBV-specific immune response: early research and personal reminiscences" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.J. Moss" 1 => "V.P. Lutzky" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/978-3-319-22822-8_3" "Revista" => array:6 [ "tituloSerie" => "Curr Top Microbiol Immunol" "fecha" => "2015" "volumen" => "390" "paginaInicial" => "23" "paginaFinal" => "42" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26424642" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary immunodeficiency diseases: an update on the classification from the International Union of Immunological Societies Expert Committee for Primary Immunodeficiency 2015" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Picard" 1 => "W. Al-Herz" 2 => "A. Bousfiha" 3 => "J.L. Casanova" 4 => "T. Chatila" 5 => "M.E. Conley" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10875-015-0201-1" "Revista" => array:6 [ "tituloSerie" => "J Clin Immunol" "fecha" => "2015" "volumen" => "35" "paginaInicial" => "696" "paginaFinal" => "726" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26482257" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary immunodeficiencies and inflammatory disease: a growing genetic intersection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "N. Fodil" 1 => "D. Langlais" 2 => "P. Gros" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.it.2015.12.006" "Revista" => array:6 [ "tituloSerie" => "Trends Immunol" "fecha" => "2016" "volumen" => "37" "paginaInicial" => "126" "paginaFinal" => "140" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26791050" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary immunodeficiencies associated with EBV disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.I. Cohen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/978-3-319-22822-8_10" "Revista" => array:6 [ "tituloSerie" => "Curr Top Microbiol Immunol" "fecha" => "2015" "volumen" => "390" "paginaInicial" => "241" "paginaFinal" => "265" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26424649" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00217557/0000009200000005/v1_201609220038/S0021755716300675/v1_201609220038/en/main.assets" "Apartado" => array:4 [ "identificador" => "18984" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/00217557/0000009200000005/v1_201609220038/S0021755716300675/v1_201609220038/en/main.pdf?idApp=UINPBA000049&text.app=https://jped.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755716300675?idApp=UINPBA000049" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 2 | 5 |
| 2024 October | 19 | 32 | 51 |
| 2024 September | 20 | 45 | 65 |
| 2024 August | 32 | 32 | 64 |
| 2024 July | 38 | 35 | 73 |
| 2024 June | 25 | 17 | 42 |
| 2024 May | 18 | 12 | 30 |
| 2024 April | 28 | 21 | 49 |
| 2024 March | 21 | 20 | 41 |
| 2024 February | 19 | 28 | 47 |
| 2024 January | 18 | 32 | 50 |
| 2023 December | 13 | 21 | 34 |
| 2023 November | 23 | 38 | 61 |
| 2023 October | 25 | 31 | 56 |
| 2023 September | 21 | 34 | 55 |
| 2023 August | 22 | 22 | 44 |
| 2023 July | 20 | 19 | 39 |
| 2023 June | 16 | 9 | 25 |
| 2023 May | 23 | 17 | 40 |
| 2023 April | 14 | 12 | 26 |
| 2023 March | 26 | 15 | 41 |
| 2023 February | 16 | 16 | 32 |
| 2023 January | 22 | 20 | 42 |
| 2022 December | 24 | 20 | 44 |
| 2022 November | 24 | 19 | 43 |
| 2022 October | 38 | 27 | 65 |
| 2022 September | 17 | 23 | 40 |
| 2022 August | 25 | 28 | 53 |
| 2022 July | 23 | 32 | 55 |
| 2022 June | 22 | 23 | 45 |
| 2022 May | 23 | 22 | 45 |
| 2022 April | 36 | 32 | 68 |
| 2022 March | 29 | 40 | 69 |
| 2022 February | 18 | 16 | 34 |
| 2022 January | 13 | 14 | 27 |
| 2021 December | 23 | 14 | 37 |
| 2021 November | 8 | 16 | 24 |
| 2021 October | 8 | 24 | 32 |
| 2021 September | 9 | 8 | 17 |
| 2021 August | 6 | 8 | 14 |
| 2021 July | 4 | 1 | 5 |
| 2021 June | 2 | 12 | 14 |
| 2021 May | 20 | 13 | 33 |
| 2021 April | 23 | 16 | 39 |
| 2021 March | 11 | 10 | 21 |
| 2021 February | 12 | 7 | 19 |
| 2021 January | 5 | 9 | 14 |
| 2020 December | 15 | 9 | 24 |
| 2020 November | 9 | 9 | 18 |
| 2020 October | 4 | 6 | 10 |
| 2020 September | 15 | 14 | 29 |
| 2020 August | 7 | 8 | 15 |
| 2020 July | 4 | 5 | 9 |
| 2020 June | 6 | 5 | 11 |
| 2020 May | 14 | 2 | 16 |
| 2020 April | 9 | 10 | 19 |
| 2020 March | 5 | 4 | 9 |
| 2020 February | 11 | 7 | 18 |
| 2020 January | 18 | 16 | 34 |
| 2019 December | 6 | 7 | 13 |
| 2019 November | 4 | 2 | 6 |
| 2019 October | 9 | 10 | 19 |
| 2019 September | 15 | 8 | 23 |
| 2019 August | 16 | 11 | 27 |
| 2019 July | 15 | 9 | 24 |
| 2019 June | 9 | 8 | 17 |
| 2019 May | 13 | 12 | 25 |
| 2019 April | 17 | 9 | 26 |
| 2019 March | 13 | 5 | 18 |
| 2019 February | 11 | 8 | 19 |
| 2019 January | 13 | 5 | 18 |
| 2018 December | 18 | 11 | 29 |
| 2018 November | 26 | 3 | 29 |
| 2018 October | 142 | 24 | 166 |
| 2018 September | 63 | 8 | 71 |
| 2018 August | 38 | 10 | 48 |
| 2018 July | 17 | 4 | 21 |
| 2018 June | 12 | 5 | 17 |
| 2018 May | 37 | 4 | 41 |
| 2018 April | 21 | 1 | 22 |
| 2018 March | 10 | 4 | 14 |
| 2018 February | 6 | 1 | 7 |
| 2018 January | 10 | 3 | 13 |
| 2017 December | 9 | 1 | 10 |
| 2017 November | 9 | 1 | 10 |
| 2017 October | 15 | 2 | 17 |
| 2017 September | 8 | 1 | 9 |
| 2017 August | 8 | 3 | 11 |
| 2017 July | 14 | 2 | 16 |
| 2017 June | 7 | 1 | 8 |
| 2017 May | 10 | 2 | 12 |
| 2017 April | 14 | 3 | 17 |
| 2017 March | 10 | 5 | 15 |
| 2017 February | 6 | 2 | 8 |
| 2017 January | 14 | 6 | 20 |
| 2016 December | 16 | 12 | 28 |
| 2016 November | 26 | 26 | 52 |
| 2016 October | 27 | 30 | 57 |
| 2016 September | 19 | 14 | 33 |
| 2016 August | 6 | 2 | 8 |
| 2016 July | 19 | 14 | 33 |
Show all
