Peculiarities of Liver Affection in Children with Infectious Mononucleosis
Introduction. Today, there is a tendency of infectious mononucleosis (IM) morbidity to spread. Aim of research is to identify clinical features of liver affection in children with infectious mononucleosis. Materials and methods. Case histories of 42 children aged from 4 to 15 years old with a diagnosis of chronic hepatitis were analyzed. The activity of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), levels of bilirubin, alkaline phosphatase (ALP), gamma-glutamyl (GGT)), markers of viral hepatitis were determined. There were performed ultrasound investigation and enzyme immunoassay (IEA) with determination of blood markers of Epstein — Barr virus (EBV) (IgM VCA, IgG EA, IgG VCA, avidity) and cytomegalovirus (CMV) (IgM, IgG, avidity); EBV-DNA, CMV-DNA were defined by polymerase chain reaction. Depending on the etiology of the disease patients were divided into 3 groups: group 1 — patients with IM of EBV-etiology (17 patients); group 2 — patients with MI of CMV etiology (16 patients); group 3 — mixed IM of EBV + CMV etiology (9 patients). Received digital data were processed by methods of statistical analysis in application «Statistica‑6». Results. In 85.7 % of cases MI had usual course and moderate severity (enlargement of the lymph nodes was noted in 98.6 % of patients, tonsillitis throat — in 54.7 %, hepatomegaly — in 71.4 %, splenomegaly — in 38.1 %). The most common hemogram changes in MI are leukocytosis (64.2 %) and atypical mononuclear cells (73.5 %) 15 children (35.7 %) had enhanced transaminase level. Icteric hepatitis was observed in five patients. Blood level of atypical mononuclear cells over 20 % was observed in 43.3 % of cases. Ultrasound investigation showed diffuse increase in liver echoicity in 36.6 % of patients. Conclusions. Hepatitis with MI was observed in more than half of patients, its development and severity correlated with etiological features of the disease (mixed infection EBV + CMV, rs = 0.60 ± 0.07); age (rs = 0.40 ± 0.07), sex (rs = 0.80 ± 0.07). 2. Hepatitis with MI background is characterized by significant prevalence of anicteric forms of moderate and transitory increase of transaminases, accompanied by splenomegaly and abnormal levels of mononuclear cells in blood over 20 %.
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