Differential Diagnostic Aspects of Epstein-Barr Virus Infectious Mononucleosis in Children from the Standpoint of the Duration of the Infection

DOI: 10.22138/2500-0918-2017-14-2-171-181

M. V. Antonova, Je. A. Kashuba, T. G. Drozdova, O. A. Ljubimceva,

L. V. Hanipova, N. V. Ogoshkova, Ju. S. Chehova

Tyumen State Medical University, Tyumen, Russian Federation

Abstract. There is increased incidence of Epstein-Barr virus infection currently worldwide, including in Russia. Special attention of scientists attracts the problem of long-term persistence of the virus with the development of a chronic process. Purpose is to determine the possibility of differential diagnosis of primary Epstein-Barr virus infection and reactivation, occurring with clinical manifestations of infectious mononucleosis. Materials and methods. The study was included 152 children with clinical manifestations of infectious mononucleosis and activity Epstein-Barr virus infection. A comprehensive study was included dynamic clinical observation, analysis of the results of laboratory studies (General blood analysis, General urine analysis, biochemical blood analysis), calculation of the leukocyte index of intoxication, serological examination of the blood by ELISA. Results. Clinical picture of the reactivation of Epstein-Barr virus is characterized by an easier course, which was manifested in lesser severity and duration of main symptoms, such as tonsillitis, adenoiditis, lymphadenopathy, and hepatosplenomegaly. As the hematology «markers» of the reactivation identified a high ESR, neutrophilia, relative small number of atypical mononuclear cells (5%), high LII and normal biochemical parameters, reflecting the functional state of the liver. Correlation analysis of clinical symptom with haematological and serological indices showed appearance of a large number of clinical symptoms and the index of positivity of antibodies of different classes for reactivation Epstein-Barr virus. Conclusion. Clinical supervision for children with reactivation of Epstein-Barr virus should be longer, including the periodic fences General and biochemical blood tests, a dynamic study of ELISA and quantitative PCR of blood.

Keywords: infectious mononucleosis, primary Epstein-Barr virus infection, reactivation of Epstein-Barr virus infections, children, persistence

Received 31.05.2017

For citation:
Dolgikh V.T., Pjanova L.G., Likholobov V.A., Lavrenov A.V., Rudakov N.V., Chesnokova M.G., Sedanova A.V., Rusakov V.V., Korpachova O.V. Antibacterial and antimycotic properties of granularcarbon sorbents. Vestn. Ural. Med. Akad. Nauki = Jour. Ural Med. Acad. Science. 2017, no. 2, pp. 171–181. DOI: 10.22138/2500-0918-2017-14-2-171-181 (In Russ.)

REFERENCES
1. Sharipova E.V., Babachenko I.V. The herpes virus infection and infectious mononucleosis (review of literature). Journal of Infectology = Zhurnal infektologii. 2013, no. 2, 5-12 (in Russ.)
2. Isakov V. A., Arhipova E. I., Isakov D. V. Herpesviral infections in human (2nd edition, revised and enlarged): Guidelines for physicians. Saint Petersburg: SpecLit, 2013. 670 pp. (in Russ.)
3. L'vov N.D., Dudkina E.A. Key issues in the diagnosis of Epstein-Barr virus infection. Infectious diseases: news, opinions, training = Infekcionnye bolezni: novosti, mnenija, obuchenie. 2013, no. 3, pp. 24-32. (in Russ.)
4. Zhmilevskaja S.A. Epstein-Barr virus infectious mononucleosis: clinical and dynamic features of the various variants of infection. Saratov scientific medical journal = Saratovskij nauchno-medicinskij zhurnal. 2010, no. 3(6), pp. 570-574 (in Russ.)
5. Antonova M.V., Ljubimceva O.A., Kashuba Je.A., Drozdova T.G., Bertram L.I., Molokova O.M., Mjasunova E.Ju. The clinical picture of infectious mononucleosis Epstein-Barr virus etiology in the age aspect. Academic journal of Western Siberia = Akademicheskij zhurnal zapadnoj Sibiri. 2014, no. 5(54), pp. 65-66 (in Russ.)
6. Bertram L.I., Kashuba Je.A., Drozdova T.G., Lobacevich V.Ju., Peretjagin A.N. The role of Allergy in the formation of cutaneous manifestations in certain infectious diseases in children. Medical science and education in the Urals = Medicinskaja nauka i obrazovanie Urala. 2006, no. 7(4), pp. 47-49 (in Russ.)
7. Simovan'jan Je.N. Chronic infection of Epstein-Barr virus in children: modern aspects of diagnosis and treatment. Consilsum Medicum. 2006, no. 2(8), pp. 2-8 (in Russ.)
8. Figueira-Silva C. M., Pereira F. E. L. Prevalence of Epstein-Barr virus antibodies in healthy children and adolescents in Vitoria, State of Espirito Santo, Brazil. Revista da Sociedade Brasileira de Medicina Tropical. 2004, no. 37(5), pp. 409-412.
9. Masakhwe C. et al. Frequency of Epstein-Barr Virus in Patients Presenting with Acute Febrile Illness in Kenya. PloS one. 2016, no. 11(5), e0155308. doi.org/10.1371/journal.pone.0155308
10. Bertram L.I., Kashuba Je.A., Drozdova T.G., Ogoshkova N.V., Gerasimenko S.M., Knjazeva E.F., Ljubimceva O.A., Cheremnyh L.G., Lobacevich V.Ju., Kecherukova L.M., Smirnjagina R.N. The immunopathogenesis of the main clinical manifestations in cases involving mononucleotide syndrome. Medical science and education in the Urals = Medicinskaja nauka i obrazovanie Urala, 2006, no. 7(2), pp. 23-28 (in Russ.)
11. Goleva O.V., Murina E.A., Osipova Z.A. Serological markers of reactivation of Epstein–Barr in children with viral encephalitis. Journal of Infectology = Zhurnal infektologii, 2015, no. 1(7), pp. 70-74 (in Russ.)
12. Bolis V. et al. Atypical manifestations of Epstein–Barr virus in children: a diagnostic challenge. Jornal de pediatria. 2016, no. 92(2), pp. 113-121. doi.org/10.1016/j.jped.2015.06.007
13. Kalinina N.M., Drygina L.B., Gorejko T.V. Current views on the immunopathogenesis of the infection caused by the virus Epstein-Barr. Infection and immunity = Infekcija i immunitet, 2011, no. 2, pp. 121-130 (in Russ.).
14. Kramarev S.A., Vygovskaja O.V. Experience in the use of the drug flakozid with Epstein-Barr virus infection in children. Modern Pediatrics = Sovremennaja pediatrija, 2011, no. 5(39), pp. 1-6 (in Russ.)
15. Malashenkova I.K. et al. Clinical forms of chronic Epstein-Barr virus infection: diagnosis and treatment]. Doctor = Lechashhij vrach. 2003, no. 9, pp. 32-38 (in Russ.)
16. Kal'f-Kalif Ja.Ja. About the leukocytic index of intoxication and its practical significance. Medical business = Vrachebnoe delo 1941, no. 1, pp. 31-40 (in Russ.)
17. Il'in V.P. Correlation analysis of quantitative data in biomedical research. Bulletin of Eastern-Siberian scientific centre of Siberian branch of the Russian Academy of medical Sciences = Bjulleten' Vostochno-Sibirskogo nauchnogo centra Sibirskogo otdelenija Rossijskoj akademii medicinskih nauk. 2013, no. 4(92), pp. 125-130 (in Russ.)
18. Timchenko V.N. et al. Clinical and laboratory criteria of severity and treatment principles of acute infectious mononucleosis Epstein-Barr virus etiology in children. Pediatrician = Pediatr. 2015, no. 4(6), pp. 147-153 (in Russ.)
19. Blohina E.B. The role of latent infection caused by the Epstein—Barr in the development of lymphoproliferative disorders. Questions of Hematology, Oncology and immunopathology in Pediatrics = Voprosy gematologii, onkologii i immunopatologii v pediatrii. 2003, no. 3, pp. 65-70 (in Russ.)
20. Vygovskaja O.V. et al. Infectious mononucleosis Epstein-Barr virus etiology in children: issues of etiology, pathogenesis, immunogenesis, treatment. Practitioner = Praktikujushhij lekar'. 2012, no. 4, pp. 29-34 (in Russ.)
21. Svincova T.A. et al. The value of indicators of the immune response in patients with EBV infectious mononucleosis in predicting the course and efficacy of antiviral and immunocorrective therapy. Epidemiology and infectious diseases = Jepidemiologija i infekcionnye bolezni. 2013, no. 1, pp. 7-14 (in Russ.)
22. Letaeva O.V., Filimonkova N.N., Chigvinceva E.A. The identified pathogenetic features of lichen planus and treatment optimization. Vestn. Ural. Med. Akad. Nauki = Jour. Ural Med. Acad. Science. 2009, no. 3(26), pp. 41-43 (in Russ.)
23. Smirnov A.V., Chuelov S.B., Rossina A.L. The current understanding of hepatitis caused by herpes viruses. Children's infections = Detskie infekcii. 2008, no. 3(7), pp. 3-16 (in Russ.)
24. Epstein-Barr virus hepatitis associated with icterus — a case report. P. Canovic, O. Gajovic., Z. Todorovic, Z. Mijailovic. Med. Pregl. 2006, vol. 59, pp. 179-182.
25. Dryganova M.B., Martynova G.P., Kurtasova L.M. Infectious mononucleosis caused by Epstein-Barr children: clinical and immunological parallels. Siberian medical review = Sibirskoe medicinskoe obozrenie. 2010, no. 3(63), pp. 16-28 (in Russ.)
26. Crum N. F. Epstein Barr virus hepatitis: case series and review. Southern medical journal. 2006, vol. 99, no. 5, pp. 544-548.
27. Simovan'jan Je.N. Epstein-Barr virus infection in children: current approaches to diagnosis and treatment. Doctor = Lechashhij vrach. 2007 no. 7 pp. 36-41 (in Russ.)
28. Nagoev B.S., Kambachkova Z.A. The state of cellular immunity in patients with herpesvirus infections. Bulletin of new medical technologies = Vestnik novyh medicinskih tehnologij. 2011, no. 3(18), pp. 325-327 (in Russ.)
29. Pirogova Z.I., Rjabchuk F.N. Clinical and laboratory characteristics of persistent forms of herpes-viral infections in children. Doctor = Lechashhij vrach. 2011, no. 8, pp. 62-65 (in Russ.)
30. Shano V.P., Kucher E.A. The syndrome of endogenous intoxication. Acute and urgent conditions in medical practice = Ostrye i neotlozhnye sostojanija v praktike vracha. 2011, no. 1(25), pp. 35-41 (in Russ.)

Authors
Mariya V. Antonova
Postgraduate of the Department of Infectious Diseases with a course of Childhood Infections
antonovamariav@mail.ru

Eduard A. Kashuba
Dr. Sci. (Med.), Professor, Head of the Department of Infectious Diseases with a course of Childhood Infections
kashuba.ed@gmail.com

Tat'yana G. Drozdova
Cand. Sci. (Med.), Associate Professor at the Department of Infectious Diseases with a course of Childhood Infections
drozdova.t.g.@mail.ru

Oksana A. Lyubimtseva
Cand. Sci. (Med.), Associate Professor at the Department of Infectious Diseases with a course of Childhood Infections
loa_1975@mail.ru

Lyudmila V. Khanipova
Cand. Sci. (Med.), Associate Professor at the Department of Infectious Diseases with a course of Childhood Infections
ludainf03@rambler.ru

Natal'ya V. Ogoshkova
Cand. Sci. (Med.), Associate Professor at the Department of Infectious Diseases with a course of Childhood Infections
onw13051978@mail.ru

Yuliya S. Chekhova
Lecturer at the Department of Infectious Diseases with a course of Childhood Infections
doktor-ch@bk.ru

Tyumen State Medical University
Str. Odesskaya, 54, Tyumen, 625025, Russian Federation

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