Role of Ebstein Barr virus in children with tonsillar hypertrophy

Öz

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

Anahtar Kelimeler

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

Çocuklarda tonsiller hipertrofi olgularında Epstein Barr virüsünün rolü

Öz

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.

Anahtar Kelimeler

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

Kaynakça

1. Dias EP, Rocha ML, Carvalho MO, Amorim LM. Detection of Epstein-Barr virus in recurrent tonsillitis. Braz J Otorhinolaryngol 2009; 75: 30-4.
2. Endo LH, Ferreira D, Montenegro MCS, et al. Detection of EpsteinBarr virus in tonsillar tissue of children and the relationship with recurrent tonsillitis. Int J Pediatr Otorhinolaryngol 2001; 58: 9-15.
3. Nadal D, Blasius M, Niggli FK, Meier G, Berger C. Epstein-Barr virus (EBV) DNA levels in palatine tonsils and autologous serum from EBV carriers. J Med Virol 2002; 67: 54-8.
4. Chagas CA, Endo LH, Santos WLC, et al. Is there a relationship between the detection of human herpesvirus 8 and Epstein-Barr virus in Waldeyer’s ring tissue? Int J Pediatr Otorhinolaryngol 2002; 70: 1923-7.
5. Sahin F, Gerceker D, Karasartova D, Ozsan TM. Detection of herpes simplex virus type 1 in addition to Epstein-Barr virus in tonsils using a new multiplex polymerase chain reaction assay. Diagn Microbiol Infect Dis 2007; 57: 47-51.
6. Lawrense SY, Rickinson AB. Epstein-Barr: 40 years on. Nat Rev Cancer 2004; 4: 757-68.
7. Ulff-Mİller CJ, Nielsen NM, Rostgaard K, Hjalgrim H, Frisch M. EpsteinBarr virus-associated infectious mononucleosis and risk of systemic lupus erythematosus. Rheumatology (Oxford) 2010; 49: 1706-12.
8. Levin LI, Munger KL, O’Reilly EJ, Falk KI, Ascherio A. Primary infection with the Epstein-Barr virus and risk of multiple sclerosis. Ann Neurol 2010; 67: 824-30.

9. Brodsky L. Modern assessment of tonsils and adenoids. Pediatr Clinic N Am 1989; 36: 1551-69.
10. Morris MC, Edmunds WJ, Hesketh LM, et al. Sero-epidemiological patterns of Epstein-Barr and Herpes simplex (HSV-1 and HSV-2) viruses in England and Wales. J Med Virol 2002; 67: 522-7.
11. Dogan B, Rota S, Gurbuzler L, et al. The correlation between EBV viral load in the palatine tonsils of patients with recurrent tonsillitis and concurrent serum titers of VCA-IgG. Eur Arch Otorhinolaryngol 2010; 267: 143Endo LH, Vassallo J, Sakano E, Brousset P. Detection of Epstein-Barr virus and subsets of lymphoid cells in adenoid tissue of children under 2 years of age. Int J Pediatr Otorhinolaryngol 2002; 66: 223-6.
12. Koseoglu RD, Filiz N, Aladag I, Güven M, Eyibilen A. Kronik tekrarlayıcı tonsillit-adenotonsiller hipertrofide Epstein-Barr virus ve herpes simpleks virüs tip 1 analizi. Ankara Üniversitesi Tıp Fakültesi Mecmuası 2007; 604: 156-62.
13. Hug M, Dorner M, Fröhlich FZ, et al. Pediatric Epstein-Barr virus carriers with or without tonsillar enlargement may substantially contribute to spreading of the virus. J Infect Dis 2010; 202: 1192-9.
14. Al-Salam S, Dhaheri SA, Awwad A, Daoud S, Shams A, Ashari MA. Prevalence of Epstein-Barr virus in tonsils and adenoids of United Arab Emirates nationals. Int J Pediatr Otorhinolaryngol 2011; 75: 1160-6.
15. Cinar F. Significance of asymptomatic tonsil asymmetry. Otolaryngol Head Neck Surg 2004; 131: 101-3. van Lierop AC, Prescott CA, Fagan JJ, Sinclair-Smith CC. Is diagnostic tonsillectomy indicated in all children with asymmetrically enlarged tonsils? S Afr Med J 2007; 975: 367-70.
16. Harley EH. Asymmetric tonsil size in children. Arch Otolaryngol Head Neck Surg 2002; 128: 767-9.
17. Howard NS, Brietzke SE. Pediatric tonsil size: objective vs subjective measurements correlated to overnight polysomnogram. Otolaryngol Head Neck Surg 2009; 140: 675-81.