Features of diagnostics of the hepatobiliary system diffuse lesions in children with herpes viral infection caused by Epstein-Barr virus (both isolated and in the form of mixed herpesvirus infection)

Abstract

Purpose: to improve the treatment quality and prognosis of herpesvirus infection in children caused by the Epstein-Barr virus (both isolated and in the form of mixed herpesvirus infection) based on the study of clinical, biochemical and immunological parameters of the hepatobiliary system.

Materials and methods: We examined 95 children aged 3 to 7 years with herpesvirus infection, who were divided into three groups (the I group – children with acute Epstein-Barr infection, the II group – children with Epstein-Barr infection in combination with cytomegalovirus infection, the ІІІ group – children with Epstein-Barr infection and herpesvirus infection type 6). Age-matched healthy control group consisted of 20 children. The diagnosis was verified using a polymerase chain reaction. Biochemical studies included determination of total protein and its fractions, total bilirubin and its fractions, alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase, thymol index. All patients underwent echosonography of the liver. The level of cytokines (IL-1β, IL-4) and antiviral protection parameters – the content of natural killers (CD16+), T-helper (CD4 +) and/or cytotoxic lymphocytes (CD8 +) were evaluated.

Results. In all examined children the disease started acutely from general intoxication syndrome, lesion of the nasopharynx and oropharynx, which were more pronounced in the children of the 1st and 2nd examined groups. Manifestations of the viral exanthema and enanthema were more commonly and pronounced in children of the III group. Most children (61.8 %) with Epstein-Barr infection in combination with herpesvirus infection type 6 had disturbances in the central nervous system. The lesions of lymphoid tissue occurred in 73 (76.7 %) children and were more prevalent in the 1st and 2nd surveyed groups. The constant symptom of the disease was hepatomegaly. Splenomegaly was observed in 82 (86.7 %) patients.

We have noted an increase in the levels of aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase in the examined children. These changes were more pronounced in children of the 2nd group. Herewith, cytolysis of hepatocytes in most cases among children of all examined groups was not accompanied by hyperbilirubinemia. The jaundice of the skin and mucous membranes occurred only in 18.5% of all examined patients, who were diagnosed with moderate hyperbilirubinemia (60.0 ± 4.6 μmol/l).

Proteinogram parameters in the examined patients in the acute period were characterized by a decrease in albumin content, an increase in the content of α1-, α2- and γ-globulins and a decrease in the albumin / globulin ratio. These indicators were significantly changed in the 2nd surveyed group. The majority of examined patients had coagulogram indices on average matched to the age norm. One third of patients showed moderately elevated fibrinogen levels.

Immune disorders, that accompany the herpesvirus infection, are characterized by an imbalance of proinflammatory and anti-inflammatory cytokines.

Indicators of portal hemodynamics in patients of the I group in the acute period of the disease were characterized by moderate changes such as a decrease in hepatic artery and portal vein blood flow without viscoelasticity and peripheral vascular resistance violations. In the II group the decrease in the diameter of the common hepatic artery and the increase in the diameter of the portal vein, the decrease in the vessels blood flow with a decrease in their viscoelasticity and peripheral vascular resistance was noted. In the III group of patients the hepatic artery and portal vein hemodynamic changes, which had a compensatory character, were identified.

Conclusions: Taking into account the revealed clinical changes, it can be noted that lesions of the nasopharynx, more pronounced manifestations of intoxication and hepatolienal syndromes prevailed in infants with herpesvirus infection. Proinflammatory cytokines overactivity in patients with Epstein-Barr viral infection in combination with cytomegalovirus infection causes a longer intoxication period, pronounced liver enlargement, elevation of transaminases and inhibition of liver albumin synthesis. It could be reasonable to prescribe vasoactive therapy for patients with Epstein-Barr virus infection in combination with cytomegalovirus infection both in the acute and reconvalescence period of the disease followed by structural-functional and hemodynamic state of the liver monitoring at the stages of medical rehabilitation.