The Role of Epstein-Barr Virus in Adenoid and Tonsil Enlargement in Nigerian Children
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Keywords
Adenotonsillar hypertrophy, paediatric lymphoid tissue, ENT viral assessment, EBV seropositivity, adenoid hypertrophy assessment
Abstract
Background: Epstein–Barr Virus (EBV) is a lymphotropic virus that persists in lymphoid tissues such as the adenoids and tonsils and has been associated with several head and neck diseases. Because adenotonsillar enlargement is common in children, this study investigated whether EBV contributes to hypertrophy of these tissues.
Methodology: A comparative cross-sectional study was conducted at the University of Abuja Teaching Hospital involving 90 age and sex-matched children, 45 test and 45 control. Adenoid size was assessed radiologically using the Fujioka Adenoid-Nasopharyngeal Ratio (ANR), tonsil size was graded with the Brodsky system, and EBV status was determined using Chemiluminescence Immunoassay. Postoperative tissue volumes were also measured.
Results: Ninety children (test: 45; control: 45) participated; groups were age- and sex-matched (p = 0.480). Mean ages were 51.7±5.4 months (test) and 66.5±5.6 months (control). Mean Brodsky grade was 2.80±0.99, and mean ANR was 0.72±0.21.
EBV IgG prevalence for the test group was 91.1% and 8.9% were EBV negative prevalence, and 82% with 17% for control respectively. There was also a significant difference between the mean values of the EBV IgG titers in the test and control groups using the T-test analysis. T= 12.956, p= <0.001. The Odds ratio was 2.6.Only two (2) patients in the test group tested positive for EBV IgM and IgG. There was a positive correlation between EBV status and tonsil volume p=0.0320, r =0.320 and Brodsky grade r= 0.338 p= 0.023. However, the adenoid volume and ANR showed a weaker correlation with the EBV status of the test patients p= 0.466, r= 0.113
Conclusion: These findings suggest that EBV may be associated with the development and progression of tonsillar hypertrophy, and to a lesser extent adenoidal enlargement.
References
2. Crowcroft NS, Vyse A, Brown DWG, Strachan DP. Epidemiology of Epstein-Barr virus infection in pre-adolescent children: application of a new salivary method in Edinburgh, Scotland. Journal of Epidemiology and Community Health. 1998 Feb 1;52(2):101–104.
3. Bornkamm GW, Hammerschmidt W. Molecular virology of Epstein-Barr virus Vol. 356, Philosophical Transactions of the Royal Society B: Biological Sciences. Royal Society; 2001. p. 437–459.
4. Jamiyan T, Nakazato Y, Kuroda H, Kojima M, Imai Y. Characteristic Histological Findings of Asymptomatic EBV-associated Lymphoproliferative Disorders in Tonsils. Journal of Clinical and Experimental Hematopathology. 2018;58(3):122–127.
5. Seishima N, Kondo S, Wakisaka N, Kobayashi E, Imoto T, Moriyama-Kita M, et al. EBV infection is prevalent in the adenoid and palatine tonsils in adults. Journal of Medical Virology. 2017 Jun 1;89(6):1088–1095.
6. Hess RD. Routine Epstein-Barr Virus Diagnostics from the Laboratory Perspective: Still Challenging after 35 Years. Journal of Clinical Microbiology 2004 Aug;42(8):3381.
7. Gulley ML, Tang W. Laboratory Assays for Epstein-Barr Virus-Related Disease. Journal of Molecular Diagnostics. 2008;10(4):279.
8. Al-Salam S, Dhaheri S Al, Awwad A, Daoud S, Shams A, Ashari M Al. Prevalence of epstein-barr virus in tonsils and adenoids of united arab emirates nationals. International Journal of Pediatric Otorhinolaryngology. 2011;75(9):1160–1166.
9.Arambula A, Brown JR, Neff L. Anatomy and physiology of the palatine tonsils, adenoids, and lingual tonsils. World Journal of Otorhinolaryngology - Head Neck Surgery. 2021 July 1;7(3):155
10. Fossum CC, Chintakuntlawar A V., Price DL, Garcia JJ. Characterization of the oropharynx: anatomy, histology, immunology, squamous cell carcinoma and surgical resection. Histopathology. 2017 Jun 1;70(7):1021–1029.
11. Varkki S, Varghese A. Adenoid Hypertrophy. In: Case Based Reviews in Pediatric Pulmonology Jaypee Brothers Medical Publishers (P) Ltd.; 2018. p. 30–30.
12. Talebian S, Sharifzadeh G, Vakili I, Golboie SH. Comparison of adenoid size in lateral radiographic, pathologic, and endoscopic measurements. Electronic Physician Journal. 2018 Jun 20; 10(6):6935–6941
13. Samdi, Emmanuel M, Kirfi AM. Adenotonsilar surgeries in Kaduna, Nigeria. Annals of Indian Academic Otorhinolaryngology- Head Neck Surgery. 2017;1(1):6.
14. Adedeji TO, Amusa YB, Aremu AA. Correlation between adenoidal nasopharyngeal ratio and symptoms of enlarged adenoids in children with adenoidal hypertrophy. African Journal of Paediatric Surgery. 2016 Jan 1 ;13(1):14–19.
15. Papadopoulos N, Liverezas A, Antonakopoulos N, Karathanasis A, Apostolopoulos G. Airway Obstruction in a Young Adult with Infectious Mononucleosis by Epstein-Barr Virus. Infectious Diseases in Clinical Practice. 2008 Jan;16(1):79.
16. Fujioka M, Young LW, Girdany BR. Radiographic evaluation of adenoidal size in children: Adenoidal-nasopharyngeal ratio. American Journal of Roentgenology. 1979;133(3):401–404
17. Brodsky L, Koch RJ. Anatomic Correlates of Normal and Diseased Adenoids in Children. Laryngoscope. 1992 Nov 1 :102(11):1268–
18. John. K. Douglas,William.T Wcislo. An inexpensive and portable microvolumeter for rapid evaluation of biological samples. International Journal of Life Science Methods. August 2010; 49:566-
19. Titus S.Ibekwe, Godwin Obasikene, Ekeng Offiong. Tonsillectomy: Vasoconstrictive hydrolytic cold dissection method. African Journal of Peadiatric Surgery. April 2013; 10(2): 150-
20. Tagliacarne SC, Valsecchi C, Castellazzi AM, Licari A, Klersy C, Montagna L, et al. Impact of passive smoke and/or atopy on adenoid immunoglobulin production in children. Immunology Letters. 2015 Jun 1 165(2):70–77.
21. Endo, L. H., Sakano, E., Camargo, L. A., Ferreira, D. R., Pinto, G. A., & Vassallo, J. The EBV action in tonsils and adenoids. International Congress Series, 2003 ;1257(C): 263–267. 153
22. Chinawa JM, Onuorah Akpeh J, Chinawa AT. Clinical profile and pattern of adenoid hypertrophy among children attending a private hospital in Enugu, South East Nigeria. Pan African Medical Journal. 2016 Apr 4;21(1). .
23. Adegbiji WA, Kayode Aremu S, Nwawolo CC, Asoegwu CN. Current trends of adenotonsilar hypertrophy presentation in a developing country, Nigeria. International Journal of Otorhinolaryngology- Head Neck Surgery 2017:3(3):501–505
24. Günel C, Kirdar S, Ömürlü IK, Ağdaş F. Detection of the Epstein-Barr virus, Human Bocavirus and novel KI and KU polyomaviruses in adenotonsilar tissues. International Journal of Pediatric Otorhinolaryngology. 2015 Mar 1;79(3):423
25. Lu X, Zhang J, Xiao S. Correlation between Brodsky Tonsil Scale and Tonsil Volume in Adult Patients. Biomed Research International. 2018;2018.
26. Al-Salam S, Dhaheri S Al, Awwad A, Daoud S, Shams A, Ashari M Al. Prevalence of Epstein–Barr virus in tonsils and adenoids of United Arab Emirates nationals. International Journal of Pediatric Otorhinolaryngology. 2011;75(9):1160.
27. Olusanya O, Okpere E, Ezimokhai M. the importance of social class in voluntary fertility control in developing countries. West African Journal of Medicine 1985; 4:205-207
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