ArticleBMC infectious diseases2026
Epstein-barr virus super-infection is associated with increased severity of hemorrhagic fever with renal syndrome.
Article in BMC infectious diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Not yet cited in PubMed.
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Corrections and comments
- Erratum issued
Authors and funding
10 authors.
Funding
Abstract
backgroundThis study aimed to characterize the clinical impact of Epstein-Barr virus (EBV) super-infection in patients with Hemorrhagic Fever with Renal Syndrome (HFRS).
methodsA cohort of 126 confirmed HFRS patients were enrolled and stratified into EBV (n = 62) and Non-EBV (n = 64) groups based on PCR detection of the EBV IR1 gene. Clinical manifestations and serial laboratory parameters assessing multi-organ function were compared.
resultHFRS patients super-infected with EBV exhibited a significantly higher frequency of neurological and gastrointestinal symptoms, including dizziness (50.0% vs. 26.6%), anorexia (95.2% vs. 82.8%), and diarrhea (50.0% vs. 15.6%). Laboratory findings revealed more severe multi-organ dysfunction in the EBV group, evidenced by significantly elevated markers of hepatic injury (γ-GGT, LDH), renal impairment (BUN, β2-MG, uric acid; decreased eGFR), cardiac stress (BNP), and thyroid suppression (T4, FT3). Additionally, the EBV group demonstrated heightened hematologic stress, with lower platelet counts and higher red cell distribution width. Immunological profiling showed a paradoxical state of intense cellular immune activation (elevated WBC, lymphocytes, neutrophils) coupled with suppressed systemic inflammatory markers (lower CRP and ESR).
conclusionsEBV super-infection is associated with increased HFRS severity, exacerbating multi-organ dysfunction and inducing a distinct dysregulated immune response. CLINICAL TRIAL: Not applicable.
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