The Influence of Primary Cytomegalovirus or Epstein-Barr Virus Infection on the Course of Idiopathic Thrombocytopenic Purpura

Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 878)


Idiopathic thrombocytopenic purpura (ITP) in children is usually triggered by a viral infections such as cytomegalovirus (CMV) or Epstein-Barr virus (EBV) infection. The aim of this study was to assess the frequency of CMV and EBV infections in children with first relapse of ITP, and the influence of these infections on the course and response to treatment of ITP. Sixty patients (30 boys and 30 girls) with ITP were enrolled into the study. We found that the age at the onset of ITP was from 1 month to 17 years (mean 7.0 ± 5.7 years), the platelet number was from 1 to 79 × 109/L (mean 18.1 ± 19.0 × 109/L) at the time of diagnosis and it increased from 17 to 395 × 109/L (mean 134.4 ± 81.2 × 109/L) (p < 0.05) after the first course of therapy. Forty seven patients required pharmacological treatment, the duration of the treatment was from 2 to 25 days (mean 6.1 ± 4.1 days). Relapses were observed in 27 (45 %) of the patients. Active CMV infection was found in 19 patients (31.7 %), EBV infection in 5 patients (8.3 %), and both infections concomitantly in 1 patient (1.7 %). The group of patients with CMV or EBV infection (n = 25) did not differ from the patients free of infection (n = 35) in regard to the age, number of platelets at onset, duration of treatment, number of platelets after treatment, number of relapses, and the interval between the onset and first relapse. In conclusion, active CMV or EBV infection is common in children with ITP. These infections do not seem to have an appreciable bearing on the clinical course and the response to treatment on children with ITP.


Children Cytomegalovirus Ebstein-Barr virus Idiopathic thrombocytopenic purpura Infection 


Conflicts of Interest

The authors declare no conflicts of interest in relation to this article.


  1. Adamowicz-Salach A, Chybicka A, Sawicz-Birkowska K (eds) (2008) Pediatric oncology and hematology. Wydawnictwo Lekarskie PZWL, Warsaw, pp 873–878Google Scholar
  2. Banks TA, Rouse BT (1992) Herpesviruses-immune escape artists? Clin Infect Dis 14:933–941CrossRefPubMedGoogle Scholar
  3. Blanchette VS, Carcao M (2003) Childhood acute immune thrombocytopenic purpura: 20 years later. Semin Thromb Hemost 29(6):605–617CrossRefPubMedGoogle Scholar
  4. Blanchette V, Imbach P, Andrew M, Adams M, McMillan J, Wang E, Milner R, Ali K, Barnard D, Bernstein M et al (1994) Randomised trial of intravenous immunoglobulin G, intravenous anti-D, and oral prednisone in childhood acute immune thrombocytopenic purpura. Lancet 344(8924):703–707CrossRefPubMedGoogle Scholar
  5. Brodkiewicz A, Peregud-Pogorzelski J, Szychot E, Badowicz B, Pakulski C, Marciniak H (2009) Fatal outcome of spontaneous cerebral and intraventricular hemorrhage in a child with idiopathic thrombocytopenic purpura (ITP)-case report. Ann Acad Med Stetin 55(1):11–13PubMedGoogle Scholar
  6. Cines DB, Bussel JB, Liebman HA, Luning Prak ET (2009) The ITP syndrome: pathogenic and clinical diversity. Blood 113(26):6511–6521PubMedCentralCrossRefPubMedGoogle Scholar
  7. DiMaggio D, Anderson A, Bussel JB (2009) Cytomegalovirus can make immune thrombocytopenic purpura refractory. Br J Haematol 146(1):104–112CrossRefPubMedGoogle Scholar
  8. Likic R, Kuzmanic D (2004) Severe thrombocytopenia as a complication of acute Epstein-Barr virus infection. Wien Klin Wochenschr 116(1–2):47–50CrossRefPubMedGoogle Scholar
  9. Mitura-Lesiak M, Filiks-Litwin B, Małek U, Kowalczyk JR (2004) Clinical course, diagnostic and therapeutic management of immune thrombocytopenic purpura in children. Med Wieku Rozwoj 8:1004–1101PubMedGoogle Scholar
  10. Miyahara M, Shimamoto Y, Yamada H, Shibata K, Matsuzaki M, Ono K (1997) Cytomegalovirus-associated myelodysplasia and thrombocytopenia in an immunocompetent adult. Ann Hematol 74:99–101CrossRefPubMedGoogle Scholar
  11. Rand ML, Wright J (1998) Virus-associated idiopathic thrombocytopenic purpura. Transfus Sci 19(3):253–259CrossRefPubMedGoogle Scholar
  12. Rice GPA, Schrier RD, Oldstone MBA (1984) Cytomegalovirus infects human lymphocytes and monocytes: virus expression is restricted to immediate early gene products. Proc Natl Acad Sci U S A 81:6134–6138PubMedCentralCrossRefPubMedGoogle Scholar
  13. Rodeghiero F (2008) First-line therapies for immune thrombocytopenic purpura: re-evaluating the need to treat. Eur J Haematol Vol 80 ( Suppl 69 ):19–26Google Scholar
  14. Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold DM, Bussel JB, Cines DB, Chong BH, Cooper N, Godeau B, Lechner K, Mazzucconi MG, McMillan R, Sanz MA, Imbach P, Blanchette V, Kühne T, Ruggeri M, George JN (2009) Standarization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood 113(11):2386–2393CrossRefPubMedGoogle Scholar
  15. Shad AT, Gonzalez CE, Sandler SG (2005) Treatment of immune thrombocytopenic purpura in children: current concepts. Paediatr Drugs 7(5):325–336CrossRefPubMedGoogle Scholar
  16. Sheng YZ, Tang LF, Zou CC, Yan ZJ, Zhao ZY (2008) Cytomegalovirus-associated idiopathic thrombocytopenic purpura in Chinese children. Scand J Infect Dis 40(11–12):922–927CrossRefGoogle Scholar
  17. Takahashi T, Hamasaka N, Harada S, Sugawara N, Yoshimoto M (2008) Methylprednisolone pulse therapy for severe immune thrombocytopenia associated with infectious mononucleosis. Am J Hematol 82(5):416–417CrossRefGoogle Scholar
  18. Tarantino MD, Goldsmith G (1998) Treatment of acute immune thrombocytopenic purpura. Semin Hematol 35(1 Suppl 1):28–35PubMedGoogle Scholar
  19. Tavil B, Unal S, Aytaç-Elmas S, Yetgin S (2008) Weekly long-term intravenous immunoglobulin for refractory parvovirus B19 and Epstein-Barr virus-induced immune thrombocytopenic purpura. Turk J Pediatr 50(1):74–77PubMedGoogle Scholar
  20. Walter RB, Hong TC, Bachli EB (2004) Life-threatening thrombocytopenia associated with acute Epstein- Barr virus infection in an older adult. Ann Hematol 81:672–675Google Scholar
  21. Watts RG (2004) Idiopathic thrombocytopenic purpura: a 10-year natural history study at the childrens hospital of Alabama. Clin Pediatr (Phila) 43(8):691–702CrossRefGoogle Scholar
  22. Wu Z, Zhou J, Wei X, Wang X, Li Y, Peng B, Niu T (2013) The role of Epstein-Barr virus (EBV) and cytomegalovirus (CMV) in immune thrombocytopenia. Hematology 18(5):295–999CrossRefPubMedGoogle Scholar

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© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Department of Pediatrics, Hematology and OncologyMedical University of WarsawWarsawPoland
  2. 2.Department of Laboratory Diagnostics and Clinical Immunology of Developmental AgeMedical University of WarsawWarsawPoland

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