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"Child`s Health" 4 (64) 2015

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Syntropia in children with ebv-infection

Authors: L. A. Khodak, V. I. Brailko - Kharkiv Medical Academy of Postgraduate Education, Ukraine

Categories: Pediatrics/Neonatology

Sections: Specialist manual

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Introduction.

Epstein-Barr virus infection (EBV), a family of herpesviruses (HHV-4, γ-herpesvirus) is a widespread disease among people of young age. For a long time EBV was associated only with infectious mononucleosis (IM), which was considered a primary infection. At present its role in the pathology of the nervous, hepato-biliary, cardiovascular systems and onko-hematologic diseases has been proven.
The virus being neurotropic, isolated lesions of the nervous system (meningoencephalitis) or syntropia can be observed when two or three organs are involved in the pathological process caused by one pathogen.
In the past 10 years EBV meningoencephalitis was diagnosed in 47 children in children's infectious diseases hospital. Of these, 15 children showed syntropia. 12 children having IM with liver disease developed meningoencephalitis. In 3 children the medical case of IM was not mentioned, but hepatitis C with prevalence of the syndrome of cytolysis in combination with meningoencephalitis was apparent. 4 children had acute EBV infection, 11 patients had chronic active form.


Materials and methods.

The paper presents a clinical observation of acute EBV infection in a girl of 16 years old with manifested combined lesion of lymphoid reticular system (hepatitis) and nervous system (meningoencephalitis).

Diagnosis of EBV infection is based on clinical and laboratory data: indicators of clinical blood analysis and biochemical tests of the liver, the ELISA blood test to detect antibodies of early and late phase, PCR examination of CSF, MRI of the brain, and ultrasound examination of the abdominal cavity.


Results and discussion.

A patient P. (No. history 8561) of 16 years old was admitted to the Regional children's infectious diseases hospital of Kharkov in the tenth day of disease with complaints of increased body temperature up to 38C, headache, single vomiting, and sore throat when swallowing. On admission her condition was regarded as moderately severe due to the moderate symptoms of intoxication; redness in the throat, and questionable meningeal symptoms were also noted. On the second day of hospitalization the child's condition deteriorated – she developed generalized dynamically repeated clonic-tonic convulsions, visual hallucinations, general excitement. The neurological status: consciousness – sopor, eye slits – S<D, the smoothing of the left nasolabial fold. The child was transferred to a ventilator, which was conducted during 3 days. The clinical analysis of blood: leukocytosis – 20. 6*109/l, lymphomonocytosis (lymphocytes – 64 %, monocytes – 12%). Virocytes were absent in the clinical analysis of blood. The study of cerebrospinal fluid showed serous meningitis (cytosis – 225*106/l (lymphocytes – 80%, neutrophils – 20%); protein – 0. 48 g/l; glucose – 2.8 mmol/l; chlorides – 128 mmol/l). According to MRI of the brain – diffuse swelling of the cortical divisions was mild. The membranes were densified. The catarrhal swelling of the mucous membranes of the paranasal sinuses was observed. Conclusion: meningoencephalitis. ELISA identified markers of acute phase to EBV (VCA Ig M – 1.8; EA Ig G to 2.7). PCR of CSF detected EBV DNA. Damage of the nervous system was combined with involvement of liver in the pathological process. According to the ultrasound of the abdominal organs the liver was enlarged to 4 cm below the costal margin. Echogenicity was increased to 12 gradation (N = 6–7 cm). Syndrome of cytolysis was noted: ALT 142 U/l (N – up to 27 U/l), AST 63.2 U/l (N – up to 29 U/l), bilirubin was normal. Markers for viral hepatitis were negative. Specific antiviral therapy included 500mg of acyclovir 3 times a day intravenously in drips for 7 days with subsequent transition to oral intake up to 3 weeks. On the background of therapy the child's condition improved: body temperature steadfastly normalized, indicators of clinical blood analysis normalized, sanitation of the CSF was observed. At the time of patient discharge a slight increase in transaminases remained, which required regular medical check-up by a gastroenterologist.
The absence of late phase markers (EBV Na IgG) made it possible to diagnose acute EBV infection, meningoencephalitis, hepatitis, severe course.


Conclusions.

1. EBV infection can occur in both acute and chronic form, predominantly chronic active.

2. Acute primary EBV infection is characterized by the identification of serum markers for early phase – EBV VCA IgM, EBV EA IgG in the absence of markers of late phase – EBV Na IgG. The presence of EBV Na IgG is as essential for chronic active EBV infection as detection of the markers of the acute phase.

3. Damage of the nervous system (meningoencephalitis) in EBV– infection may be isolated or concurrent with infectious mononucleosis or hepatitis (syntropia).

4. Lesions of the liver in EBV– infection are characterized by hepatitis with the prevalence of the syndrome of cytolysis; anicteric forms of the disease are more common.

5. Functional changes of the liver and nervous system may persist for a long term, which requires follow-up care for patients.


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