Эпштейна — Барра вирус — ведущая причина гипертрофии глоточной миндалины у детей

Abstract

The leading cause of tonsil hypertrophy in children is viruses, often in combination with bacterial flora. The purpose — to evaluate the role of the main viral-bacterial pathogens in pharyngeal tonsil hypertrophy (PTH) and adenoiditis in children. Material and methods. We observed 463 children with PTH and chronic adenoiditis. The patients were divided into groups depending on the PTH degree: 108 children with grade 1–2 adenoids, 355 children with PTH grade 3. EBV DNA, CMV and HHV-6 were determined in a smear from removed tissue of the pharyngeal tonsil or in a swab from the nasopharynx using the PCR method, and a bacteriological examination of a smear from the throat and nose was performed. The sIgA proteinase activity of the isolated S. aureus strains was determined. The content of sIgA in the patients’ saliva was determined. Statistical processing of data was carried out using Statistica 8.0 software. Results. DNA of herpes viruses in swabs from the nasopharynx was detected in 70.8% (328/463) of the examined: in 36.1% (39/108) of patients with grade 1–2 PTH and 81.4% (289/355) of grade 3, p < 0.001. Epstein-Barr virus was isolated most often – in 53% (174/328). The results of a bacteriological study of 151 patients with PTH demonstrated the predominance of S. aureus (71.5%, 108/151) and S. pyogenes (55.6%, 84/151), p = 0.005 in nasopharyngeal swabs. 58.3% (63/108) of S. aureus strains had sIgA proteinase activity. In 45.3% (49/108) of cases, the isolation of such staphylococci was combined with the detection of EBV DNA. The level of sIgA in the saliva of patients with grade 3 tonsil hypertrophy (Me 43; IQR 34.4–76.6) was statistically significantly lower than the level of sIgA in the saliva of patients with grade 1–2 hypertrophy of the tonsils (Me 63.8; IQR 44.2–98,6), p = 0.023 and healthy children. Conclusions. Infection of the nasopharynx with EBV can be considered a leading risk factor for the development of tonsil hypertrophy and adenoiditis in children. This must be taken into account when monitoring such patients.