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A possible role for Epstein-Barr virus in the pathogenesis of pleural effusion

¹ Dept of Microbiology, ² Unit Molecular Diagnostics, ³ Dept of Pathology and ⁴ Dept of Pulmonology and Heart Lung Center Utrecht, Diakonessenhuis Utrecht, The Netherlands.

CORRESPONDENCE: S. F. T. Thijsen, Diakonessenhuis, Dept of Microbiology, Bosboomstraat 1, 3582 KE Utrecht, The Netherlands. Fax: 31 302566695. E-mail: sthijsen{at}diakhuis.nl

Keywords: Epstein-Barr virus, pleural effusion

Received: November 15, 2004
Accepted May 22, 2005

A high percentage of pleural effusions remain unexplained despite an intensive diagnostic workup. Epstein-Barr virus (EBV) infections occur worldwide and affect the majority of the population. The present study investigated the prevalence and clinical relevance of EBV in pleural effusions.

A prospective study was performed in which 60 consecutive patients with pleural effusion were enrolled. Real-time quantitative EBV-PCR was performed on pleural fluid and serum. Pleural fluid was further evaluated using standard biochemical, cytological and microbiological procedures. Demographic data, medical history and medication were recorded.

A total of 24 (40%), from 60 pleural fluids tested, were positive in the EBV-PCR. Median EBV-DNA levels for positive samples was 454 genome equivalents (geq)·mL^–1 (range 36–163,446 geq·mL^–1). A total of 20 (59%) out of 34 unexplained pleural effusions were EBV-PCR positive. Serological analysis of all patients with a positive PCR revealed a previous infection. Patients with a positive EBV-PCR on pleural fluid were more likely to have a positive EBV-PCR on serum than patients with a negative PCR on pleural fluid.

Epstein-Barr virus reactivation in pleural fluid is a frequent event and the absence of an alternative diagnosis to explain the nature of the effusion in the majority of cases suggests an aetiological role for Epstein-Barr virus in the development of pleural effusion.

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