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Правильний передоперацшний д1агноз, виб1р п1дходящо1 мрурпчно1 техшки, врахування шфшь-тративно1 природи к1сти, штраоперацшна профша-ктика для зменшення розливу та заднш х1рург1чний доступ для лшування мають виршальне значення для запобтання рецидиву.
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Ivanova Loryna, (ORCID ID 0000-0002-6946-698X)
PhD, Professor of Department of Pediatrics and Children Infectious Diseases of Bukovinian State Medical
University, Teatralna Sq., 2, Chernivtsi, Ukraine, 58002
Horbatiuk Inna, (ORCID ID 0000-0002-7985-3190) PhD, Associate Professor of Department of Pediatrics and Children Infectious Diseases of Bukovinian
State Medical University Teatralna Sq., 2, Chernivtsi, Ukraine, 58002
Huk L.I., Sichkar I.B.,
Doctor of the Department of the Regional Children's Clinical Hospital, Chernivtsi, Ruska Str., 207A
Pyzhyk M.A., Hrytsyuk M. O., Kerebko D. V., Buganyuk I.I. Students of Bukovinian State Medical University Teatralna Sq., 2, Chernivtsi, Ukraine, 58002
DOI: 10.24412/2520-6990-2022-34157-29-31 EPSTEIN-BARR VIRAL HEPATITIS IN CHILDREN (CLINICAL CASE)
Abstract.
The increasing incidence of Epstein-Barr virus (EBV) infections among children is a very urgent problem in pediatrics. EBV is one of the most common viruses worldwide, affecting 80-95% of the population. The causative agent itself is herpesvirus type 4. The genome of the virus is represented by DNA, which codes for more than 100 proteins.
Keywords: children, Epstein-Barr virus, viral hepatitis
Introduction. The virus is present in the saliva of infected people, through which it is transmitted to other people. The primary replication of the virus occurs in the epithelial cells of the oropharynx, which are simultaneously destroyed with the release of a large number of viruses, which subsequently enter the B-lympho-cytes of the lymphoid tissue of the pharynx. Massive replication of the virus leads to viremia, pronounced proliferation of B- and T-lymphocytes is noted in various organs, such as lymph nodes, spleen, liver, bone marrow, and causes the development of characteristic clinical manifestations of the disease [1-4].
As you know, in developing countries, in socially disadvantaged families, the majority of children are infected before the age of 3, and almost the entire population - before adulthood. Unlike the previous ones, in socially developed countries, EBV infection can occur later. According to literature data, it is known that in 85-99% of cases the primary infection is asymptomatic, and only in 1-15% it manifests itself in some way [5-8].Young children, as a rule, have an asymptomatic
course, the main manifestations of the disease occur in adolescence. It is believed that the older the child, the more difficult, longer and with a more extensive clinical picture the disease is transmitted. After the initial infection, pathogens persist for a long time, often for life, in the body and have the ability to reactivate, especially in the presence of immunosuppression (colds, hypothermia, malnutrition, stress, taking some medicines). Elimination of the virus from the blood occurs on average 1-2 months after the onset of the disease. However, in 10% of patients, the virus periodically appears in the blood after suffering infectious mononucle-osis for several months, sometimes several years [910].
The possibility of lifelong persistence of EBV in the body, despite the effectiveness of the immune response during primary infection, is due to the properties of the virus to avoid the action of some immune mechanisms. The virus promotes the production of proteins with the properties of cytokines and cytokine receptors,
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which modulate the immune response and promote the persistence of the virus in the body [11].
In children, frequent manifestations of Epstein-Barr virus infection are fever, sore throat, lymphade-nopathy, hepatosplenomegaly, exanthema; less often -these are dyspeptic symptoms and abdominal pain. Acute viral hepatitis with EBV infection occurs quite rarely, which is manifested by a multiple increase in the level of transaminases (50-80% of cases), jaundice (in 5% of patients), leukocytosis and lymphocytosis. The basis of liver damage with EBV damage is lymphocytic infiltration and proliferation of Kupffer cells with the subsequent development of intrahepatic cholestasis, but without structural damage and necrosis [12-14].
The purpose of the work: to investigate the peculiarities of the course of hepatitis, which arose as a result of the first detected Epstein-Barr virus infection in adolescence
Material and methods. The observation of the 16-year-old patient was carried out on the basis of the regional communal non-profit enterprise "Regional Children's Clinical Hospital" in Chernivtsi. A range of laboratory (general blood analysis, urine, biochemical analysis and acute phase blood parameters, coagulo-gram, polymerase chain reaction (PCR) to detect infectious hepatitis A, B, C); instrumental (ultrasound diagnostics, electrocardiography, echocardiography), as well as consultations of narrow specialists
Results. M., a 16-year-old girl, was hospitalized in the infectious department on the 3rd day after the onset of the disease with complaints of nausea, vomiting, an increase in body temperature to 38.3°C, yellowing of the skin, pain in muscles and joints. From the anamnesis of the disease, it is known that the disease began with an increase in body temperature to 39.2 C, nausea, vomiting. She took ampicillin, groprinosine, and paracetamol on her own. On the 3rd day, the patient turned to the family doctor, who referred her to the Regional Children's Clinical Hospital in Chernivtsi. It is known from the medical history that the patient was not in contact with the sick.
Objective examination, the child's condition is of medium severity, due to the intoxication syndrome. Body temperature - 37.5°C, heart rate - 90 bpm, respiratory rate - 18/min, oxygen saturation - 97%. The skin is clean, with a yellowish tint, subicteric sclera is noted, the tongue is covered with a white coating. Diuresis is preserved. The abdomen is soft, the liver and spleen are slightly enlarged, painless. On the basis of an objective examination and data from additional examination methods: biochemical blood analysis - an increase in the level of total bilirubin - 45.9 mmol/l, direct bilirubin - 13.6 mmol/l, indirect bilirubin - 32.3 mmol/l, ALT - 210 units/l, AST - 90 units/l; general blood test - increase in the number of leukocytes - 20.7 G/l; general analysis of urine - light yellow, cloudy; ultrasound data - signs of reactive changes in the liver parenchyma, splenomegaly. A preliminary diagnosis was established: Hepatitis of unknown etiology.
The next day, in order to make a final diagnosis, the patient was subjected to a number of other tests: 1) PCR (qualitative determination) of blood plasma to de-
tect HAV of the hepatitis A virus - the result was negative; 2) Determination of HBsAg - not detected; 3) Total HBcorAg antibodies - not detected; 4) Total HCV antibodies - not detected; 4) Virological examination for the detection of hepatitis "A" and hepatitis "E" - the result is negative. The general condition of the patient remained of medium severity, due to manifestations of hepatosplenomegaly, cytolytic and manifestations of moderate jaundice syndromes.
During the examination, the patient is active, contact, periodically there is an increase in body temperature. Hemodynamics and microcirculation are not disturbed. The skin is pale pink with a jaundiced tint, the sclera are subicteric. Above the lungs, breathing is vesicular, heart sounds are rhythmic, loud. The abdomen is soft, not painful on palpation. Stool and urination are normal. On the basis of complaints, objective and laboratory research data, a clinical diagnosis was established: Acute hepatitis? Epstein-Barr virus infection. Infectious mononucleosis.
To confirm the diagnosis, the patient was immediately prescribed the following tests - 1) detection of Ig M to the Epstein-Barr virus -19.2 (positive); 2) detection of Epstein-Barr capsid antigen - 2.53 (positive).
On the basis of complaints, anamnesis data, objective examination, obtained results of laboratory and instrumental research methods, the final clinical diagnosis was established: Epstein-Barr virus infection. Infectious mononucleosis, moderate course, acute form. Exicosis of the II century. by isotonic type. Other specified viral hepatitis.
The patient received detoxification therapy during the entire course of treatment, dufalac during the first 7 days, anti-inflammatory and antibacterial therapy from the 4th to the 9th day, and hepatoprotectors from the 7th day. Against the background of the treatment, an improvement in the girl's general condition and clinical and laboratory indicators was observed. As a result of clinical recovery, the child was discharged home under the supervision of a family doctor on the 14th day.
Conclusions. Acute viral hepatitis caused by the Epstein-Barr virus is a relatively rare pathology that any pediatrician may encounter. In the case described above, EVV infection had an unusual onset: abdominal pain, nausea with vomiting, myalgia and arthralgia, jaundice. All this requires conducting rather difficult diagnostics with viral hepatitis of other etiology, acute cholecystitis, mechanical jaundice, leptospirosis. The disease, as a rule, has a benign course, ending in full recovery with further chronic asymptomatic carriage of the Epstein-Barr virus.
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