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

Abstract

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: https://doi.org/10.33029/2305-3496-2022-11-2-49-56

References

1. On the state of sanitary and epidemiological welfare of the population in the Russian Federation in 2020: State Report. Moscow: Federal Service for the Oversight of Consumer Protection and Welfare, 2021: 121–3. (in Russian)

2. Mikhneva S.A., Grishina Yu.Yu., Kukhtevich E.V., Martynov Yu.V. Infectious mononucleosis: a spatio-temporal manifestation of the epidemic process. Infektsionnye bolezni: novosti, mneniya, obuchenie [Infectious Diseases: News, Opinions, Training]. 2017; (5): 61–4. (in Russian)

3. Human Herpesviruses: Biology, Therapy, and Immunoprophylaxis. Edited by A. Arvin, G. Campadelli-Fiume, et al. Cambridge: Cambridge University Press, 2007; 1432: 986 p.

4. Shestakova I.V., Yushchuk N.D. Modern approaches to the treatment of Epstein–Barr virus infection in adults. Lechashchiy vrach [Attending Physician]. 2011; (2): 98–103. (in Russian)

5. Drozdova N.F., Fazylov V.X. Infectious mononucleosis due to Epstein-Barr: clinical and pathogenetic aspects (literature review). Vestnik sovremennoy klinicheskoy meditsiny [Bulletin of Contemporary Clinical Medicine]. 2018; 11 (3): 59–65. (in Russian)

6. Shestakova I.V., Yushchuk N.D. Plan-summary of the seminar on the topic «Infectious mononucleosis caused by the Epstein-Barr virus» within the framework of the basic course of the residency training program in the specialty «Infectious diseases» (taking into account federal state requirements for the structure of the basic professional educational program of postgraduate professional education of the III generation). Infektsionnye bolezni: novosti, mneniya, obuchenie [Infectious Diseases: News, Opinions, Training]. 2013; (3): 85–96. (in Russian)

7. Khmilevskaya S.A., Zaytseva I.A., Mikhaylova E.V. Changes in the functional state of the liver in Epstein-Barr viral mononucleosis in children. Saratovskiy nauchno-meditsinskiy zhurnal [Saratov Journal of Medical Scientific Research]. 2009; 5 (4): 572–8. (in Russian)

8. Baranova I.P., Kurmaeva D.Yu. Clinical and laboratory characteristics of hepatitis in infectious mononucleosis. Izvestiya vysshikh uchebnykh zavedeniy. Povolzhskiy region. Meditsinskie nauki [Proceedings of Higher Educational Institutions. Volga Region. Medical Sciences]. 2012; 2 (22): 26–32. (in Russian)

9. Permyakova A.V., L’vova I.I., Deryusheva A.Yu. About age-related features of infectious mononucleosis. Permskiy meditsinskiy zhurnal [Permian Medical Journal]. 2017; XXXIV (5): 63–8. (in Russian)

10. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. In: J. Bennett, R. Dolin, M. Blaser. Elsevier, 2015. Ch. 138. 3904 p.

11. Educational and methodical manual. Clinical pathophysiology of the liver. Irkutsk: IGMU, 2014: 41 p. (in Russian)

12. Wang Y., Li J., Ren Y.Y., Zhao H. The levels of liver enzymes and atypical lymphocytes are higher in youth patients with infectious mononucleosis than in preschool children. Clin Mol Hepatol. 2013; 19 (4): 382–8. DOI: https://doi.org/10.3350/cmh.2013.19.4.382 PMID: 24459643; PMCID: PMC3894438.

13. Shchekotova A.P., Nevzorova M.S., Ermakova O.A. Modern methods of laboratory diagnostics of liver fibrosis. Vestnik nauki i obrazovaniya [Bulletin of Science and Education]. 2018; 17 (pt 2): 54–9. (in Russian)

14. Borsukov A.V., Demin I.Yu., Venidiktova D.Yu., et al. Recommendations 2017 on the standardized method of elastography of shear waves of parenchymal internal organs (the SSMU vulture, Protocol No. 1 CMS dated 26.10.2017). Smolensk: Publishing house of the Saratov State Medical University, 2015: 116 p. (in Russian)

15. Han X., Xu P., Xu H. Red cell distribution width is a predictor of patients with liver cell damage by EBV infectious mononucleosis in children in Southeast China. Clin Lab. 2020; 66 (11). DOI: https://doi.org/10.7754/Clin.Lab.2020.191233 PMID: 33180435.

16.Avdeeva M.G., Namitokov H.A. Polyansky A.V., et al. Features of the current course of infectious mononucleosis in adults. Infektsionnye bolezni [Infectious Diseases]. 2009; 7 (2): 22–5. (in Russian)

17. Antonova M.V., Lyubimtseva O.A., Kashuba E.A., et al. Clinical picture of infectious Epstein-Barr mononucleosis of viral etiology in the age aspect. Akademicheskiy zhurnal Zapadnoy Sibiri [West Siberia Academic Journal]. 2014; 10 (5): 65–7. (in Russian)

18. L’vov N.D., Dudukina E.A. Key issues of diagnosis of Epstein–Barr viral infection. Infektsionnye bolezni: novosti, mneniya, obuchenie [Infectious Diseases: News, Opinions, Training]. 2013; (3): 24–32. (in Russian)

19. Solomoy T.V., Semenenko T.A., Ivanova M.Yu. The role of Epstein-Barr viral infection and hepatitis ViS in liver pathology. Voprosy virusologii [Problems of Virology]. 2019; 64 (5): 215–20. (in Russian)

20. Shaapuni A.R., Mkhitaryan A.L. The nature of hepatitis in infectious mononucleosis in patients of different ages with typical and erased manifestations of the disease. Aktual’naya infektologiya [Current Infectology]. 2013; 1 (1): 25–8. (in Rus- sian)

21. Zhang L., Zhou P., Meng Z., Pang C., Gong L., Zhang Q., et al. Infectious mononucleosis and hepatic function. Exp Ther Med. 2018; 15: 2901–9. PMID: 29456696; PMCID: PMC5795407.

22. Forsberg M., Galan M., Kra J. Infectious mononucleosis causing acute liver failure and hemolytic anemia in a patient with underlying hereditary hemochromatosis. Case Rep Oncol. 2020; 13 (3): 1232–8. DOI: https://doi.org/10.1159/000509742 PMID: 33173490.

23. Solomoy T.V., Semenenko T.A. Viral hepatitis B, C and infectious mononucleosis: epidemiological similarities and differences. Voprosy virusologii [Problems of Virology]. 2020; 65 (1): 27–34. (in Russian)

24. Dvoryakovskaya G.M., Ivleva S.A., Darmanyan A.S., et al. Noninvasive ultrasound evaluation of liver and spleen parenchyma in children with infectious mononucleosis. Epidemiologiya i infektsionnye bolezni [Epidemiology and Infectious Diseases]. 2013; (1): 14–8. (in Russian)

CHIEF EDITOR
CHIEF EDITOR
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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