Primary EBV infection and hypersensitivity to mosquito bites: a case report

Primary cutaneous anaplastic large-cell lymphoma with DUSP22-IRF4 rearrangement following insect bites

Primary cutaneous anaplastic large‐cell lymphoma (pC‐ALCL) is distinguished from systemic anaplastic large‐cell lymphoma (S‐ALCL) with cutaneous involvement. Although pC‐ALCL is a unique entity with different genetics, clinical characteristics, and prognosis, its causes are unknown. Herein, we report the case of a Chinese woman with a 4‐month history of a gradually enlarged ulcerative mass in her right forearm following an unidentified insect bite. Biopsy revealed an extensive infiltrate with patches of large anaplastic lymphoid cells. These cells were immunohistochemically positive for CD45, CD30, and TIA‐1 and negative for CD2, CD3, CD4, CD5, CD20, CD7, CD8, and ALK‐1. DUSP22‐IRF4 rearrangement was detected; on the other hand, TP63 rearrangement was not observed by fluorescence in situ hybridization (FISH). No Epstein‐Barr virus‐encoded small RNAs (EBERs) were detected by ISH. Rearrangement of monoclonal TCR gene was found using BIOMED‐2 polymerase chain reaction. No abnormality was found on the subsequent positron emission tomography‐computed tomography (PET‐CT) scan. After five cycles of cyclophosphamide + doxorubicin + vincristine + prednisolone (CHOP) chemotherapy, the patient achieved complete remission. This is the first report of a unique pC‐ALCL with DUSP22‐IRF4 rearrangement following an insect bite other than S‐ALCL involving the skin.

Hypersensitivity to mosquito bites: A versatile Epstein-Barr virus disease with allergy, inflammation, and malignancy

Hypersensitivity to mosquito bites (HMB) is a rare disease characterized by transient intense skin reaction and systemic inflammation. Clinical presentation of HMB resembles other mosquito allergic responses, and it can also be difficult to clinically distinguish HMB from other severe allergic reactions. However, a distinctive pathophysiology underlies HMB. HMB belongs to a category of Epstein-Barr virus (EBV)-associated natural killer (NK) cell lymphoproliferative disorders (LPD). Hence, HMB may progress to systemic diseases, such as hemophagocytic lymphohistiocytosis, chronic active EBV disease, and EBV-associated malignancies. A triad of elevated serum IgE, NK lymphocytosis, and detection of EBV DNA in peripheral blood is commonly observed, and identification of EBV-infected NK cells usually facilitates the diagnosis. However, the effective treatment is limited, and its precise etiology remains unknown. Local CD4+ T cell proliferation triggered by mosquito bites appears to help induce EBV reactivation and EBV-infected NK-cell proliferation. These immunological interactions may explain the transient HMB signs and symptoms and the disease progression toward malignant LPD. Further research to elucidate the mechanism of HMB is warranted for better diagnosis and treatment of HMB and other forms of EBV-associated LPD.

Immunoinformatic and systems biology approaches to predict and validate peptide vaccines against Epstein-Barr virus (EBV)

Epstein-Barr virus (EBV), also known as human herpesvirus 4 (HHV-4), is a member of the Herpesviridae family and causes infectious mononucleosis, Burkitt's lymphoma, and nasopharyngeal carcinoma. Even in the United States of America, the situation is alarming, as EBV affects 95% of the young population between 35 and 40 years of age. In this study, both linear and conformational B-cell epitopes as well as cytotoxic T-lymphocyte (CTL) epitopes were predicted by using the ElliPro and NetCTL.1.2 webservers for EBV proteins (GH, GL, GB, GN, GM, GP42 and GP350). Molecular modelling tools were used to predict the 3D coordinates of peptides, and these peptides were then docked against the MHC molecules to obtain peptide-MHC complexes. Studies of their post-docking interactions helped to select potential candidates for the development of peptide vaccines. Our results predicted a total of 58 T-cell epitopes of EBV;  where the most potential were selected based on their TAP, MHC binding and C-terminal Cleavage score. The top most peptides were subjected to MD simulation and stability analysis. Validation of our predicted epitopes using a 0.45 µM concentration was carried out by using a systems biology approach. Our results suggest a panel of epitopes that could be used to immunize populations to protect against multiple diseases caused by EBV.

A review on Respiratory allergy caused by insects

Hypersensitivity or allergy encompasses a wide range of immunological reactions that generally have adverse consequences involving one or many organ systems of the body. Allergens are usually glycoprotein or chemically complex low molecular weight substances. The common allergens include pollen, fungal spores, house dust mite and house dust, animal danders, drugs, foods, insect emanations, and detritus, etc. Information on the role of insects in respiratory allergy is increasing in the literature. There are about 30 million living species of insects. These insects can broadly be classified as stinging insects, biting insects and non-stinging and non-biting insects. All materials form insets namely wings, scales, saliva; dried feces and venom can cause allergic diseases, such as rhinitis, conjunctivitis, asthma and urticaria. There are wide varieties of insects such as moths, butterflies, bees, wasps, hornets, yellow jackets, flies, beetles, cockroaches, and mosquitoes. Exposure to emanations and detritus of these insects may lead to several allergies in some genetically predisposed individuals. Therefore, it is of interest to review allergies caused by various insect's stings and bites and their adverse effect on the human body.