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EBV connection to adenotonsillar hypertrophy

Ieva Grīnberga

Mentor: Dr. Jānis Sokolovs

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EBV also known as the human herpes virus 4, is a member of the herpes

virus family

Prevalent in as much as 90% of the worlds population

The Epstein–Barr virus was named after Michael Anthony Epstein and

Yvonne Barr

Yvonne Barr was a virologist born on 11 March 1932, died at the age of

83 last February

Graduated from University of London in 1966 with a Ph.D.

In 1964 published a study on the existance of the EBV in Lancet

Epstein- Barr virus

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Extreme fatigue

Fever

Sore throat

Head and body aches

Swollen lymph nodes in the neck and armpits

Swollen liver or spleen or both

Rash

Symptoms

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Viral capsid antigen (VCA) Anti-VCA IgM appears early in EBV infection

and usually disappears within 4 to 6 weeks. Anti-VCA IgG appears in the

acute phase of EBV infection, peaks at 2 to 4 weeks after onset, declines

slightly then persists for the rest of a person’s life.

Early antigen (EA)

Anti-EA IgG appears in the acute phase of illness and generally falls to

undetectable levels after 3 to 6 months. In many people, detection of

antibody to EA is a sign of active infection. However, 20% of healthy

people may have antibodies against EA for years.

Laboratory testing [1]

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EBV nuclear antigen (EBNA)

Antibody to EBNA, determined by the standard immunofluorescent test,

is not seen in the acute phase of EBV infection but slowly appears 2 to 4

months after onset of symptoms and persists for the rest of a person’s

life. Other EBNA enzyme immunoassays may report false positive

results.

Laboratory testing [2]

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Susceptibility to infection

People are considered susceptible to EBV infection if they do not have

antibodies to the VCA.

Primary (new or recent) infection

People are considered to have a primary EBV infection if they have anti-

VCA IgM but do not have antibody to EBNA. Other results that strongly

suggest a primary infection are a high or rising level of anti-VCA IgG and

no antibody to EBNA after at least 4 weeks of illness. Resolution of the

illness may occur before the diagnostic antibody levels appear. In rare

cases, people with active EBV infections may not have detectable EBV-

specific antibodies.

Result interpretation [1]

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Past infection

The presence of antibodies to both VCA and EBNA suggests past

infection (from several months to years earlier). Since over 90% of adults

have been infected with EBV, most adults will show antibodies to EBV

from infection years earlier. High or elevated antibody levels may be

present for years and are not diagnostic of recent infection.

Result interpretation [2]

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Suseptable of

EBV infection

(seronegative)

Primary EBV

infekction early

stage (<2

months)

Primary EBV

infection or

reactivation

Past infection

EBV VCA IgM – + + –

EBV VCA IgG – – + +

EBNA-1 IgG – – – +

Anti-EA IgG – + –/+ –

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Voice changes: As a result of swollen tissue near the vocal chords, the

voice may be altered slightly.

Difficulty swallowing: The enlarged tissue of the tonsils can become

obstructive and make swallowing certain foods difficult.

Loss of appetite: When swallowing food is difficult or painful, many

children eat less and lose their appetite.

Halitosis: Due to infections of the tonsils, bad breath often affects children

with tonsil hypertrophy.

Tonsillar hypertrophy

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Obstructive sleep apnea: In severe cases of tonsil hypertrophy, sleep

apnea, a condition indicated by pauses in breathing during sleep, can

occur. This is due to blocked airways. Sleep apnea is a serious condition

that can potentially cause pulmonary hypertension and hypertrophy of the

right side of the heart.

Frequent ear infections: The enlarged tonsils can block the Eustachian

tubes and impede drainage. This can result in fluid build up behind the

eardrum and ear infections.

Chronic Sinusitis: Hypertrophic tonsils and surrounding tissue can

prevent proper drainage from the sinus cavities. The mucous becomes

trapped and infections can develop. Symptoms such as congestion,

pressure and fatigue are common with sinusitis.

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Mouth breathing: As a result of blocked nasal airways, children with

adenoid hypertrophy are often forced to breath through their mouths. If

mouth breathing occurs for a prolonged period of time, orthodontic issues

can arise.

Runny nose: Because mucous cannot drain properly through the back of

the nasal cavity, mucous and secretions exit through the nostrils.

Snoring and sleep apnea: The blocked airways caused by the enlarged

adenoid tissue can interfere with breathing during sleep.

Snoring: Hypertrophic tonsils can obstruct the airways making breathing

during sleep more difficult.

Adenoid hypertrophy

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Chronic sinusitis: When enlarged adenoids block the nasal passages, the

sinus cavities cannot drain properly. The buildup of mucous leads to

inflammation of the lining and often infections.

Eustachian tube dysfunction: When enlarged adenoids prevent proper

drainage from the Eustachian tubes, fluid collects behind the eardrum.

Adenoid hypertrophy

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Adenotonsillar hypertrophy

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The exact cause of tonsil hypertrophy is not always clear, but the

enlargement is typically related to tonsillitis or infection of the tonsils and

surrounding tissue.

Because of the nature of EBV, there have been many discussions about

the connection between adenotonsillar hypertrophy and EBV

Adenotonsillar hypertrophy

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The aim of this study is to determine the connection between

adenotonsillar hypertrophy and EBV

104 patients were included in this study

Laboratory and objective clinical data was analyzed

Materials and methods

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Results

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Tonsillar hypertrophy

EBV serological markers I–II group III–IV group p value

VCA IgGPositive 19 (51,4%) 18 (48,6%)

0.639Negative 3 (37,5%) 5 (62,5%)

EBNA-1 Positive 6 (85,7%) 1 (14,3%)

0.266Negative 12 (42,9%) 16 (57,1%)

VCA IgG un EBNA-1

IgG + / EBNA + 6 (85,7%) 1 (14,3%)

IgG + / EBNA – 11 (47,8%) 12 (52,2%)

IgG – / EBNA – 1 (20,0%) 4 (80,0%)

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Most commonly diagnosed symptom of EBV infection was throat

hyperaemia

Tonsillar hypertrophy was prevalent in 44,2% of the cases, adenoids

were prevalent in 11,5% cases

The most common tonsillar hypertrophy grade was III

Patients with VCA IgG and EBNA-1 positive serology had mostly grade I-

II tonsillar hypertrophy

Patients with VCA IgG and EBNA-1 negative serology had mostly grade

III- IV tonsillar hypertrophy

Average age of children with adenoids was 7

Conclusions

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Thank you for attention!