Herpesvirus and Adenotonsillar Hypertrophy in Chinese Children: An Epidemiological and Clinical Analysis

To investigate the possible association between adenotonsillar hypertrophy (ATH) and herpesviral infections in children, and to examine correlations between specific viral detection and clinical characteristics.

We enrolled 43 children aged 3-14 years with ATH (mean age 76.56 ± 25.65 months; 31 boys). Paired tonsil and adenoid specimens were collected during non-acute infection periods, defined as the absence of fever (body temperature < 37.3°C), purulent tonsillar exudate, or new-onset respiratory symptoms within 2 weeks before surgery. Eight human herpesviruses (HHVs) were detected by qualitative real-time polymerase chain reaction (qPCR), and associations with demographic, clinical, and polysomnographic variables were explored.

The overall HHV detection rate was 97.7% (42/43). Epstein-Barr virus (EBV), HHV-6, and HHV-7 were the most prevalent in both tissues, with detection rates of 44.2%, 74.4%-79.0%, and 65.1%-67.5%, respectively. EBV DNA positivity in both tissue types was associated with older age, longer disease duration, and a lower arousal index (AI) (all p < 0.05). HHV-6 DNA positivity in tonsils was correlated with longer disease duration (p = 0.006), whereas HHV-7 DNA positivity in adenoids was associated with larger adenoid size (p = 0.012). No significant differences were identified between monoviral and multiviral groups.

EBV, HHV-6, and HHV-7 are highly prevalent in pediatric ATH tissues and associate with select clinical parameters, yet viral positivity did not correlate with disease severity. These findings do not support routine viral screening or changes in clinical management for ATH. The role of herpesviruses in ATH pathogenesis warrants further investigation through controlled, longitudinal studies.