Adolesan Çağındaki Çocuklarda Otoimmün Tiroiditte Parvovirus B19’un Rolü

Abstract

Amaç: Bu çalışmanın amacı adolesan çağındaki otoimmün tiroidit patogenezinde Parvovirus B19'un (PV-B19) tetikleyici rolünü belirlemektir.

Materyal ve Metot: Çalışmaya son 6 ayda Hashimoto tiroiditi tanısı konulan 10-18 yaş arası 35 hasta dahil edildi. Kontrol grubu olarak PV-B19 ile ilişkili akut hastalığı olmayan, fizik muayenesinde guatr olmayan, ailede tiroid hastalığı öyküsü olmayan ve tiroid fonksiyon testleri normal olan 35 sağlıklı gönüllü alındı. Katılımcılardan alınan serum örnekleri PV-B19 IgM ve IgG antikorları ve PV-B19 DNA için test edildi. İstatistiksel analiz SPSS programı kullanılarak yapıldı.

Bulgular: Dört (%11,4) hasta ve 5 (%14,3) kontrolde PV-B19 IgM antikorları pozitif iken, 13 (%37,1) hasta ve 6 (%17,1) kontrolde PV-B19 IgG antikorları mevcuttu. PV-B19 DNA'sı hastaların %11,4'ünde (n:4) ve kontrollerin %14,3'ünde (n:5) saptandı. Antikor ve polimeraz zincir reksiyonu pozitifliği açısından hasta ve kontrol grupları arasında anlamlı fark yoktu. Lojistik regresyon analizinde PV-B19 IgG pozitifliği üzerine serbest tiroksin düzeyi (p:0,021), antitiroid peroksidaz antikor düzeyi (p:0,005) ve istmus kalınlığı (p:0,021) etkili bulundu.

Sonuç: Geçirilmiş PV-B19 enfeksiyonları, Hashimoto tiroiditi patogenezinde tetikleyicilerden biri olabilir.

Keywords

• adolesan
• Hashimoto hastalığı
• otoimmün hastalık
• parvovirus B19

The Role of Parvovirus-B19 in Autoimmune Thyroiditis in Adolescent Children

Abstract

Objective: This study aims to determine the triggering role of parvovirus B19 (PV-B19) in the pathogenesis of autoimmune thyroiditis in adolescence.

Materials and Methods: Thirty-five patients aged 10-18 years who were diagnosed with Hashimoto's thyroiditis in the last 6 months were included in the study. As the control group, 35 healthy volunteers without PV-B19 associated acute disease, no goiter in physical examination, no family history of thyroid disease, and normal thyroid function tests were recruited. Serum samples were tested for PV-B19 IgM and IgG antibodies and PV-B19 DNA. Statistical analysis was performed using the SPSS.

Results: PV-B19 IgM antibodies were positive in 4 (11.4%) patients and 5 (14.3%) controls whereas PV-B19 IgG antibodies were present in 13 (37.1%) patients and 6 (17.1%) controls. PV-B19 DNA was detectable in 11.4% of patients (n:4) and 14.3% of controls (n:5). There was no significant difference between the patient and control groups in terms of antibody and polymerase chain reaction positivity. In logistic regression analysis, free thyroxine level (p:0.021), anti-thyroid peroxidase antibody level (p:0.005), and isthmus thickness (p:0.021) were found to be effective on PV-B19 IgG positivity.

Conclusion: Previous PV-B19 infections may be one of the triggers in the pathogenesis of Hashimoto’s thyroiditis. 

Keywords

• adolescent
• autoimmune diseases
• Hashimoto disease
• parvovirus B19

References

1. Mori K, Yoshida K, Ishii K, et al. Experimental autoimmune thyroiditis in human parvovirus B19 transgenic mice. Autoimmunity. 2011;44(6):483-489. doi:10.3109/08916934.2010.547891
2. LaFranchi S. Thyroiditis. In: Kliegman RM, Stanton BF, St.Geme III JW, Behrman RE, Schor NF, ed. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, USA:WB Saunders; 2015:1903-1905.
3. Zdraveska N, Kocova M. Hashimoto thyroiditis in childhood – review of the epidemiology, genetic susceptibility and clinical aspects of the disease. Maced J Med Sci. 2012;5(3):336-345. doi:10.3889/MJMS.1857-5773.2012.0247
4. Cappa M, Bizzarri C, Crea F. Autoimmune thyroid diseases in children. J Thyroid Res. 2010;2011:675703. doi:10.4061/2011/675703
5. Heegaard ED, Brown KE. Human parvovirus B19. Clin Microbiol Rev. 2002;15(3):485-505. doi:10.1128/CMR.15.3.485-505.2002
6. Koch WC. Parvovirus B19. In: Kliegman RM, Stanton BF, St.Geme III JW, Behrman RE, Schor NF, ed. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, USA: WB Saunders; 2015:1094-1097.
7. Broliden K, Tolfvenstam T, Norbeck O. Clinical aspects of parvovirus B19 infection. J Intern Med. 2006;260(4):285-304. doi:10.1111/j.1365-2796.2006.01697.x
8. Lunardi C, Tinazzi E, Bason C, Dolcino M, Corrocher R, Pucetti A. Human parvovirus B19 infection and autoimmunity. Autoimmun Rev. 2008;8(2):116-120. doi:10.1016/j.autrev.2008.07.005

9. Vejlgaard TB, Nielsen OB. Subacute thyroiditis in Parvovirus B19 infection. Ugeskr Laeger. 1994;156(41):6039-6040
10. Krassas GE, Tziomalos K, Pontikides N, Lewy H, Laron Z. Seasonality of month of birth of patients with Graves' and Hashimoto's diseases differ from that in the general population. Eur J Endocrinol. 2007;156(6):631-636. doi:10.1530/EJE-07-0015
11. Desailloud R, Hober D. Viruses and thyroiditis: An update. Virol J. 2009;6:5. doi:10.1186/1743-422X-6-5
12. Seishima M, Shibuya Y, Suzuki S. Hyperthyroidism associated with human parvovirus B19 infection. Clin Exp Dermatol. 2009;34(7):e439-e440. doi:10.1111/j.1365-2230.2009.03470.x
13. Mori K, Munakata Y, Saito T, et al. Intrathyroidal persistence of human parvovirus B19 DNA in a patient with Hashimoto's thyroiditis. J Infect. 2007;55(2):e29-e31. doi:10.1016/j.jinf.2007.05.173
14. Lehmann HW, Lutterbüse N, Plentz A, et al. Association of parvovirus B19 infection and Hashimoto's thyroiditis in children. Viral Immunol. 2008;21(3):379-383. doi:10.1089/vim.2008.0001
15. Heidari Z, Jami M. Parvovirus B19 infection is associated with autoimmune thyroid disease in adults. Int J Endocrinol Metab. 2021;19(4):e115592. doi:10.5812/ijem.115592
16. Wang J, Zhang W, Liu H, et al. Parvovirus B19 infection associated with Hashimoto's thyroiditis in adults. J Infect. 2010;60(5):360-370. doi:10.1016/j.jinf.2010.02.006
17. Gravelsina S, Nora-Krukle Z, Svirskis S, Cunskis E, Murovska M. Presence of B19V in patients with thyroid gland disorders. Medicina (Kaunas). 2019;55(12):774. doi:10.3390/medicina55120774
18. Tozzoli R, Barzilai O, Ram M, et al. Infections and autoimmune thyroid diseases: parallel detection of antibodies against pathogens with proteomic technology. Autoimmun Rev. 2008;8(2):112-115. doi:10.1016/j.autrev.2008.07.013