FEATURES OF ACUTE PURULENT LYMPHADENITIS OF THE MAXILLOFACIAL REGION AND NECK IN CHILDREN AGAINST THE BACKGROUND OF INFECTION WITH THE EPSTEIN-BARR VIRUS, THE DIAGNOSTIC ROLE OF THE ONCOMARKER LMP-1

Agapova Margarita Aleksandrovna, Kharitonov Dmitry Yuryevich, Filin Andrey Anatolyevich, Samoylenko Tatiana Valeryevna

The aim of the study. To assess and describe the clinical and laboratory characteristics, morphological features of acute purulent lymphadenitis of the maxillofacial region and neck against the background of Epstein-Barr virus infection in children. Material and Methods. We analyzed 30 cases of acute purulent lymphadenitis of the maxillofacial region and neck in children from 3 to 7 years old against the background of Epstein-Barr virus infection, which was confirmed by laboratory. 9 people were diagnosed with an acute Epstein-Barr virus infection, 21 people had an exacerbation of a chronic infection. All patients underwent a comprehensive examination, including measurement of body temperature, general and biochemical blood tests, immunogram, ultrasound examination of the abdominal cavity. Bacteriological seeding, morphological examination and immunohistochemistry for latent membrane protein-1 were performed on the surgical material. Result. The ratio of boys to girls was 3:1. The dominant localization of inflammation of the lymph node was the upper lateral part of the neck (n=20). In 24 cases, lymphadenitis was preceded by a viral infection clinic, among them one child with infectious mononucleosis. Body temperature during treatment was mostly subfebrile (n=18). According to the general blood test during hospitalization, the following were detected: leukocytosis (n=23), increased ESR (n=23), anemia (n=8), thrombocytosis (n=16). According to the biochemical study of blood, an increase in the level of SGOT (n=13), SGPT (n=5) was established. Ultrasound examination of the abdominal cavity revealed hepatomegaly (n=5), splenomegaly (n=3), mesodenitis (n=1), diffuse liver changes (n=1). According to the results of bacteriological seeding from the surgical wound, half of the sampling did not give seeding, in other cases gram-positive cocci were isolated. Histological examination revealed the following morphological features: follicular (n=21), parafollicular (n=7) and paracortical (n=7) hyperplasia; sinus histiocytosis (n=5), plethoric vessels with severe endothelial edema (n=15), hemorrhages (n=8), necrosis (n=8). An immunohistochemical study of the oncomarker LMP-1 was performed in 30 lymph nodes obtained during surgery. The virus was identified in lymphocytes localized perifollicularly in 18 cases (60%). Conclusion. Taking into account the data obtained, the examination, treatment tactics and dispensary observation of patients should be carried out in the context of oncological alertness.

Keywords:lymphadenitis in children, lymphadenitis on the background of EBV, LMP-1, tumor marker for lymphadenitis