Клинико-этиологические аспекты лимфопролиферативного синдрома у детей 2–3 лет

Abstract

The objective of the study was to assess the clinical signs and symptoms of the pathology of lymphadenoid pharyngeal ring lymphoid structures in 2–3-year-old children and to define the etiological role of herpesviral infection. The study covered 47 children with lymphoproliferative syndrome who needed surgical intervention. The examinations performed included endoscopy, otomicroscopy, impedancemetry, ultrasound of abdomen, cervical and submandibular lymph nodes, enzyme-linked immunosorbent assay to determine specific anti-CMV IgM, IgG, human herpesvirus type 6 (HHV-6), nuclear, viral capsid and early antigen complex of Epstein-Barr virus (EBV), polymerase chain reaction in oropharyngeal mucosa scrapes. The patients were divided into two groups: group I with severe lymphoproliferative syndrome (n = 25), group II with moderate lymphoproliferative syndrome (n = 22). In comparison with group I, the following symptoms were statistically significantly more frequent in group II: nasal breathing obstruction (Fisher’s exact test, p < 0.05), snore and night apnea (p < 0.01; odds ratio (OR) = 6.044, 95% confidence interval (CI) 1.665÷21.94); manifestations of asthenic vegetative and intoxication syndromes (p < 0.01; OR=8.061, CI 1.888÷34.42); ultrasound signs of hepatosplenic syndrome (p < 0.05; OR = 9.882, CI 1.122÷87.03). Only the group I children had indications for tonsillotomy (p < 0.001; OR = 41.67, CI 2.277÷762.5). The frequency of detection of mixed EBV + CMV + HHV-6 markers in group I is higher than in group II (p < 0.05). EBV markers and EBV infection active stages were more frequently detected in group I children, than in group II (p < 0.01, OR = 6.786, CI 1.880÷24.50; p < 0.02, OR=5.846, CI 1.373÷24.90, respectively). HHV-6 genome was detected in blood in group I in 12% of cases. The integrity of the immunological changes detected in lymphoproliferative syndrome in children may contribute to the persistence of herpesviruses in the body and the recurrent course of the disease.