Indicators of the functional state of the liver in infectious mononucleosis in adults


Infectious mononucleosis (IM) caused by the Epstein-Barr virus (EBV) ranks sixth in terms of assessing the magnitude of economic damage from infectious diseases without tuberculosis and HIV in the Russian Federation. The polymorphism of clinical manifestations, the absence of specific prevention, and the lifelong persistence of the virus in the body determine the socio-economic significance of EBV-IM. Liver damage in EBV-IM is caused by both the direct action of the virus and the activation of autoimmune processes. Taking into account the involvement of the liver in the pathological process, it becomes important to use modern non-invasive methods for assessing the state of the liver parenchyma in EBV-IM.

The aim of the study – assessment of biochemical markers of the functional state of the liver in adult patients with EBV-IM, taking into account the results of liver fibroelastometry.

Material and methods. 49 patients aged 18–34 years were under observation. All patients underwent general and biochemical blood analysis, in addition – ultrasound of the abdominal cavity and liver fibroelastometry on the device “FibroScan 502”.

The results obtained in the course of the conducted studies were processed using methods of variational statistics using Excell computer programs. Intensive and extensive indicators, average values (Msr±m), median (Me), Pearson correlation coefficient (r±m) were calculated. The revealed differences were considered statistically significant at p<0.05.

Results. Examination of patients revealed changes in almost all key biochemical parameters of blood serum measured in routine practice in patients with EBV-IM. The range of liver parenchyma density in the observed patients according to fibroelastometry was from 3.7 to 17.3 kPa. The average value of the sample is 6.33±0.33 kPa. In half of the cases, the density of liver tissue (57.1±7.1%) corresponded to F0 according to the gradations of the METAVIR scale, and the detection rate of F2 and F3 in total was 20.5±5.8%.

Correlation analysis revealed different degrees of severity and directionality of the relationship between the assessed key variables of clinical and biochemical parameters of blood serum and liver fibroelastometry.

A direct strong correlation was determined between the level of erythrocytes and hemoglobin, the level of SGPT and SGOT (r=0.857±0.04, t=21.4, p>0.001; r=0.884±0.03, t=29.5, p>0.001, respectively). The correlation of average strength was between the change in liver elasticity and the content of lymphocytes and SGOT (r=0.301±0.013, t=23.15, p>0.05; r=0.301±0.013, t=6.71, p>0.05 ), and the inverse correlation of average strength was between platelets and the content of SGOT, the level of alkaline phosphatase and SGPT (r=-0.462±0.11, t=4.2, p>0.001; r=-0.604± 0.09, t=6.7, p>0.001, respectively).

Fibroelastometry in this study did not reveal significant or unexpected findings and changes in liver density. Taking into account the correlations between the indicators of biochemical blood analysis and liver density, the revealed changes can be considered as functional reversible processes according to the type of acute hepatitis of low or moderate activity.

Conclusion. The results of observation of patients in this study showed that with a moderate course of EBV-IM, almost all routinely determined clinical and biochemical parameters in blood serum change. In this regard, it is necessary to continue the study of the role of EBV in liver pathology using a non-invasive method for assessing the state of liver parenchyma in EBV-MI.

Keywords:infectious mononucleosis; Epstein–Barr virus mononucleosis; fibroelastometry; liver; adults

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

Contribution. The authors contributed equally to this article.

For citation: Mikhneva S.A., Maximov S.L., Safiullina N.Kh., Martynov Yu.V., Popova T.I., Kukhtevich E.V., Grishina Yu.Yu. Indicators of the functional state of the liver in infectious mononucleosis in adults. Infektsionnye bolezni: novosti, mneniya, obuchenie [Infectious Diseases: News, Opinions, Training]. 2022; 11 (1): 49–56. DOI:


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Yushchuk Nikolay Dmitrievich
Academician of the Russian Academy of Sciences, Professor, head of the Infectious Diseases and Epidemiology Department, President of the Moscow State University of Medicine and Dentistry named after A.I. Evdokimov, Board member of the National Scientific Infectiologists? Society.
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