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Viral etiology of obscure splenomegaly in Egyptian children
A A Hassan1, N Mokhtar, S Isaac
1Pediatric Department, Cairo University.
Insights
Cytomegalovirus (CMV) infection is a likely cause of mild splenomegaly in Egyptian children, indicated by significantly higher IgM antibody prevalence. Epstein-Barr virus and Herpes type 1 virus showed no significant association with splenomegaly.
Area of Science:
- Virology
- Pediatrics
- Immunology
Background:
- Splenomegaly in children can have various causes, necessitating etiological investigations.
- Herpesviruses, including Cytomegalovirus (CMV), Epstein-Barr virus (EBV), and Herpes type 1 virus, are common human pathogens.
- Understanding the viral contribution to pediatric splenomegaly is crucial for diagnosis and management.
Purpose of the Study:
- To investigate the potential role of CMV, EBV, and Herpes type 1 virus in causing mild splenomegaly in Egyptian children.
- To compare the prevalence of antibodies against these herpesviruses in children with splenomegaly versus healthy controls.
Main Methods:
- Serological screening for IgM and IgG antibodies against CMV, EBV, and Herpes type 1 virus in 57 Egyptian children with mild splenomegaly and 57 healthy controls.
- Comprehensive clinical and laboratory workup to exclude other causes of splenomegaly.
- Histological and immunohistochemical examination of splenic aspirates for CMV antigens in a subset of patients.
Main Results:
- A statistically significant higher prevalence of IgM antibodies to CMV was observed in children with splenomegaly (63%) compared to controls (19.4%) (P < 0.001).
- No significant difference in IgG antibodies to CMV was found between patients and controls.
- Antibody prevalence for EBV and Herpes type 1 virus did not show a significant association with splenomegaly in this cohort.
Conclusions:
- Primary or reactivated CMV infection is a potential cause of mild splenomegaly in Egyptian children.
- EBV and Herpes type 1 virus infections are unlikely to be primary drivers of mild splenomegaly in this pediatric population.
- Further research may elucidate the specific mechanisms of CMV-induced splenomegaly in children.
Abstract:
Fifty seven Egyptian children aged 1.5 to 9.5 years with mild splenomegaly (less than 3 cm below the costal margin) were screened for antibodies against the three common viruses of the Herpes group: Cytomegalovirus (CMV), Epstein-Barr (EB) and Herpes type 1 virus. A group of 57 healthy children were studied similarly. All patients were subjected to a comprehensive laboratory and clinical work up to exclude any hematological, metabolic or malignant etiology for the splenomegaly. Splenic aspirates from five cases were examined histologically and by immunohistochemistry for the antigens of CMV. Only primary or reactivation of CMV might be considered a cause of splenomegaly, as there was a statistically significant increase in the prevalence of IgM antibodies to CMV in the patients compared to normal controls (63% of patients and 19.4% of controls had IgM antibodies, P less than 0.001; 68.3% of patients and 54% of controls had IgG antibodies, P is insignificant). An almost equal proportion of children with and without splenomegaly had antibodies to EB-Viral Capsid Antigen (EBVCA) both IgG and IgM. (28% of cases and 33% of controls had IgM antibodies; 26% of patients and 21% of controls had IgG antibodies). A role of Epstein-Barr viral infection could not be ruled out in these patients. There was a higher prevalence of antibodies to Herpes type 1 virus in asymptomatic controls than in children with splenomegaly. (10% of patients and 43% of controls had IgM antibodies, 10.6% of patients and 38% of controls had IgG antibodies).
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