Role of Ebstein Barr virus in children with tonsillar hypertrophy

Abstract

Aim: The aim of this clinical prospective study is to evaluate the relationship between Epstein Barr virüs EBV and asymmetric and symmetric tonsillar hypertrophy in children between 3 14 years old Material and Method: Tonsil size of forty two children were evaluated a orophayrngeal inspection preoperatively Tonsils were grouped according to Brodsky L scala classification Grade 1 4 Childrens are separated into two groups including the ones that have grade 1 2 and grade 3 4 tonsil size 1 difference between two tonsils was accepted as tonsillar asymmetry Viral capsid antigen IgG VCA IgG viral capsid antigen IgM VCA IgM early antigen and EBV nuclear antigen EBNA levels were measured in serum preoperatively EBV latent membrane protein 1 and EBNA 2 levels were determined with immunohistochemical studies after paraffin sectioning Chi square and Fisher rsquo;s exact tests were used to compare groups The study was approved by the ethics commite KA0992 Results: The 20 of the cases were boy and 22 were girl The mean age was 7 12 plusmn;2 07 There were no significant difference between groups among age and gender distribution Thirty two children 76 2 were sero positive for VCA IgG Among 62 5 of them EBNA IgG was also positive VCA IgG was significanlty higher in children with tonsillar hypertrophy grade 3 4 and EBNA was significantly higher in children with tonsillar hypertrophy grade 1 2 All tonsil spacements are evaluated as chronic tonsillit that shows lymphoid hyperplasia 35 7 of EBV is found by immunohistochemical staining This ratio is determined as 28 6 for latent membran protein 1 and 19 for EBNA The relationship between EBV and degree of tonsillar hypertrophy was found to be statistically insignificant p gt;0 05 Asymetric tonsillar hypertrophy were seen among 16 7 of the children The relationship between EBV and asymetric tonsillar hypertrophy was also found to be statistically insignificant p gt;0 05 Conclusions: We found statistical correlation between the grade of tonsillar hypertrophy and viral load in serum This study points out the reservoir of EBV in tonsil tissue Turk Arch Ped 2013; 48: 30 4

Keywords

• Asymmetric tonsil, Epstein Barr virus, recurrent tonsillitis, tonsillar hypertrophy

Çocuklarda tonsiller hipertrofi olgularında Epstein Barr virüsünün rolü

Abstract

Amaç: Bu klinik ileriye dönük çalışma ile tonsillektomi gerekçesi bulunan 3 14 yaş arası çocuklarda simetrik ve asimetrik tonsiller hipertrofi ile Epstein Barr virüsü EBV arasındaki ilişkinin araştırılması amaçlandı.

Gereç ve Yöntem: Çalışmaya alınan 42 olguda tonsil büyüklüğü ameliyat öncesinde orofaringeal görüntüsü ile değerlendirildi Derecelendirme için Brodsky L skalası evre 1 4 kullanıldı Olgular tonsil büyüklüğü evre 1 2 olanlar ve tonsil büyüklüğü evre 3 4 olanlar olarak iki gruba ayrıldı tonsiller arasında 1 fark asimetrik hipertrofi kabul edildi Ameliyat öncesi alınan kan örneklerinde viral kapsid antijen IgG VCA IgG viral kapsid antijen IgM VCA IgM ldquo;early antijen rdquo; ve EBV nükleer antijen EBNA düzeyleri ölçüldü Tonsillektomi maddelerinde EBV için immünohistokimyasal yöntem ile EBV virüsü latent membran protein 1 ve EBNA 2 düzeyleri belirlendi Çalışmada elde edilen verilerin karşılaştırılmasında ki kare test ve Fisher rsquo;s exact test kullanıldı Çalışma için etik kurul onayı alındı.

Bulgular: Olguların 20 rsquo;si erkek 22 rsquo;si kız olup yaş ortalaması 7 12 plusmn;2 07 idi Gruplar arasında yaş ve cinsiyet açısından anlamlı fark yoktu Otuz iki olguda 76 2 serum VCA IgG pozitif bulundu Bunların 62 5 rsquo;inde aynı zamanda EBNA IgG de pozitifti Evre 3 ve 4 tonsiller hipertrofi olgularında VCA IgG ve EBNA pozitifliği evre 1 2 olgulardan anlamlı olarak yüksek saptandı p lt;0 05 Doku örneklerinin tümü lenfoid hiperplazi gösteren kronik tonsillit olarak değerlendirildi İmmünohistokimyal yöntemiyle 35 7 oranında EBV pozitifliği gösterildi Latent membran protein 1 için bu oran 28 6 ve EBNA için 19 saptandı Dokudaki EBV pozitifliği ile tonsiller hipertrofinin derecesi arasında ise anlamlı ilişki bulunamadı p gt;0 05 Olguların 16 7 rsquo;sinde asimetrik tonsiller hipertrofi saptandı Asimetrik tonsiller hipertrofi ile EBV arasında da anlamlı ilişki saptanmadı.

Çıkarımlar: Bulgularımız tonsiller hipertrofinin derecesi ile EBV enfeksiyonu arasında anlamlı bir ilişki olduğunu tonsillerin EBV için kaynak olduğunu gösterdi.

Keywords

• Asimetrik tonsil
• Epstein Barr virüs
• tekrarlayan tonsillit
• tonsiller hipertrofi

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