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Gozal D. Obstructive sleep apnea and respiratory viruses in children: A secret alliance uncovered. Pediatr Pulmonol 2024; 59:1523-1524. [PMID: 38501318 DOI: 10.1002/ppul.26985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 03/13/2024] [Indexed: 03/20/2024]
Affiliation(s)
- David Gozal
- Office of the Dean, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, USA
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Gayoso-Liviac MG, Nino G, Montgomery AS, Hong X, Wang X, Gutierrez MJ. Infants hospitalized with lower respiratory tract infections during the first two years of life have increased risk of pediatric obstructive sleep apnea. Pediatr Pulmonol 2024; 59:679-687. [PMID: 38153215 PMCID: PMC10901459 DOI: 10.1002/ppul.26810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 11/29/2023] [Accepted: 12/02/2023] [Indexed: 12/29/2023]
Abstract
RATIONALE Lower respiratory tract infections (LRTI) during the first 2 years of life increase the risk of pediatric obstructive sleep apnea (OSA), but whether this risk varies by LRTI severity is unknown. METHODS We analyzed data from 2962 children, aged 0-5 years, with early-life LRTI requiring hospitalization (severe LRTI, n = 235), treated as outpatients (mild LRTI, n = 394) and without LRTI (reference group, n = 2333) enrolled in the Boston Birth Cohort. Kaplan-Meier survival estimates and Cox proportional hazards models adjusted by pertinent covariables were used to evaluate the risk of pediatric OSA. RESULTS Compared to children without LRTI, those with mild LRTI were at a higher risk of having OSA (hazard ratio [HR] 1.44, 95% confidence interval [CI]: 1.01-2.05), and those with severe LRTI were at the highest risk (HR 2.06, 95% CI: 1.41-3.02), independently of relevant covariables (including maternal age, race, gestational age, and type of delivery). Additional risk factors linked to a higher risk of OSA included prematurity (HR 1.34, 95% CI 1.01-1.77) and maternal obesity (HR 1.82, 95% CI 1.32-2.52). The time elapsed between LRTI and OSA diagnosis was similar in mild and severe LRTI cases, with medians of 23 and 25.5 months, respectively (p = .803). CONCLUSION Infants with severe early-life LRTI have a higher risk of developing OSA, and surveillance strategies to identify OSA need to be particularly focused on this group. OSA monitoring should continue throughout the preschool years as it may develop months or years after the initial LRTI hospitalization.
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Affiliation(s)
- Mirtha G Gayoso-Liviac
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington DC, USA
| | - Gustavo Nino
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington DC, USA
| | - Agnes S Montgomery
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington DC, USA
| | - Xiumei Hong
- Department of Population, Family and Reproductive Health, Center on the Early Life Origins of Disease, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Center on the Early Life Origins of Disease, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Maria J Gutierrez
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Kong L, Jean-Louis F, Lamont DL. Successful Antiviral Treatment for Chronic Adenoiditis Caused by Herpes Virus in a Pediatric Patient: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e942418. [PMID: 38366584 PMCID: PMC10883657 DOI: 10.12659/ajcr.942418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 01/09/2024] [Accepted: 01/01/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND The adenoids are lymphatic tissue located in the nasopharynx and play a role in upper-airway immunity. Inflammation of the adenoids is called adenoiditis, which can cause a variety of symptoms. This is a common condition and is due to acute viral or bacterial infection. Most patients experience mild symptoms of upper-respiratory tract infection with a self-limiting course. CASE REPORT A 5-year-old female patient was brought into the clinic by her parents with concerns regarding hearing and sleep. Clinical assessment was consistent with persistent otitis media with effusion and sleep-disordered breathing. She was scheduled for surgery, including nasendoscopy, adenoidectomy, and bilateral grommet insertion. During surgery, direct visualization of the postnasal space showed complete obstruction by hypertrophic, inflamed adenoids covered in a thick, white film. A biopsy was taken, which detected herpes virus cytopathic effect. A diagnostic workup excluded a neoplastic process and other bacterial or fungal infections. A trial of oral antiviral medication was successful and follow-up nasendoscopy showed resolution of adenoid hypertrophy. CONCLUSIONS Direct visualization of the postnasal space, with a transoral mirror or 120-degree endoscope, prior to adenoidectomy can aid diagnosis. Adenoiditis may be caused by a wide range of organisms, including herpes virus. Active mucopurulent discharge should raise concern for infection by bacteria, fungi, or virus. Previous research on viral infection of the adenoids have been in asymptomatic patients with presumed latent infection and undergoing elective adenoidectomy. To our knowledge, this is the first paper to report on successful treatment with antiviral medication alone.
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Affiliation(s)
- Leon Kong
- Department of Otolaryngology, Waikato Hospital, Hamilton, New Zealand
| | | | - Duncan L. Lamont
- Department of Anatomical Pathology and Cytology, Waikato Hospital, Hamilton, New Zealand
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de Lima TM, Martins RB, Miura CS, Souza MVO, Cassiano MHA, Rodrigues TS, Veras FP, Sousa JDF, Gomes R, de Almeida GM, Melo SR, da Silva GC, Dias M, Capato CF, Silva ML, Luiz VEDDB, Carenzi LR, Zamboni DS, Jorge DMDM, Cunha FDQ, Tamashiro E, Anselmo-Lima WT, Valera FCP, Arruda E. Tonsils are major sites of persistence of SARS-CoV-2 in children. Microbiol Spectr 2023; 11:e0134723. [PMID: 37737615 PMCID: PMC10581087 DOI: 10.1128/spectrum.01347-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/01/2023] [Indexed: 09/23/2023] Open
Abstract
In the present study, we show that SARS-CoV-2 can infect palatine tonsils, adenoids, and secretions in children without symptoms of COVID-19, with no history of recent upper airway infection. We studied 48 children undergoing tonsillectomy due to snoring/OSA or recurrent tonsillitis between October 2020 and September 2021. Nasal cytobrushes, nasal washes, and tonsillar tissue fragments obtained at surgery were tested by RT-qPCR, immunohistochemistry (IHC), flow cytometry, and neutralization assay. We detected the presence of SARS-CoV-2 in at least one specimen tested in 27% of patients. IHC revealed the presence of the viral nucleoprotein in epithelial surface and in lymphoid cells in both extrafollicular and follicular regions, in adenoids and palatine tonsils. Also, IHC for the SARS-CoV-2 non-structural protein NSP-16 indicated the presence of viral replication in 53.8% of the SARS-CoV-2-infected tissues. Flow cytometry showed that CD20+ B lymphocytes were the most infected phenotypes, followed by CD4+ lymphocytes and CD123 dendritic cells, CD8+ T lymphocytes, and CD14+ macrophages. Additionally, IF indicated that infected tonsillar tissues had increased expression of ACE2 and TMPRSS2. NGS sequencing demonstrated the presence of different SARS-CoV-2 variants in tonsils from different tissues. SARS-CoV-2 antigen detection was not restricted to tonsils but was also detected in nasal cells from the olfactory region. Palatine tonsils and adenoids are sites of prolonged RNA presence by SARS-CoV-2 in children, even without COVID-19 symptoms. IMPORTANCE This study shows that SRS-CoV-2 of different lineages can infect tonsils and adenoids in one quarter of children undergoing tonsillectomy. These findings bring advancement to the area of SARS-CoV-2 pathogenesis, by showing that tonsils may be sites of prolonged infection, even without evidence of recent COVID-19 symptoms. SARS-CoV-2 infection of B and T lymphocytes, macrophages, and dendritic cells may interfere with the mounting of immune responses in these secondary lymphoid organs. Moreover, the shedding of SARS-CoV-2 RNA in respiratory secretions from silently infected children raises concern about possible diagnostic confusion in the presence of symptoms of acute respiratory infections caused by other etiologies.
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Affiliation(s)
- Thais Melquiades de Lima
- Department of Cellular and Molecular Biology and Pathogenic Bioagents, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Ronaldo Bragança Martins
- Department of Cellular and Molecular Biology and Pathogenic Bioagents, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
- Department of Clinical, Toxicological and Bromatological Analysis, University of São Paulo School of Pharmaceutical Sciences, Ribeirão Preto, São Paulo, Brazil
| | - Carolina Sponchiado Miura
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Maria Vitória Oliveira Souza
- Department of Cellular and Molecular Biology and Pathogenic Bioagents, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Murilo Henrique Anzolini Cassiano
- Department of Cellular and Molecular Biology and Pathogenic Bioagents, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Tamara Silva Rodrigues
- Department of Biochemistry and Immunology, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Flávio Protásio Veras
- Department of BioMolecular Sciences, University of São Paulo School of Pharmaceutical Sciences, Ribeirão Preto, São Paulo, Brazil
| | - Josane de Freitas Sousa
- Department of Cellular and Molecular Biology and Pathogenic Bioagents, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Rogério Gomes
- Department of Cellular and Molecular Biology and Pathogenic Bioagents, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Glaucia Maria de Almeida
- Department of Biochemistry and Immunology, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Stella Rezende Melo
- Department of Cellular and Molecular Biology and Pathogenic Bioagents, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Gabriela Condé da Silva
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Matheus Dias
- Department of Cellular and Molecular Biology and Pathogenic Bioagents, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Carlos Fabiano Capato
- Department of Cellular and Molecular Biology and Pathogenic Bioagents, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Maria Lúcia Silva
- Department of Cellular and Molecular Biology and Pathogenic Bioagents, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Veridiana Ester Dias de Barros Luiz
- Department of Cellular and Molecular Biology and Pathogenic Bioagents, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Lucas Rodrigues Carenzi
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Dario Simões Zamboni
- Department of Cellular and Molecular Biology and Pathogenic Bioagents, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
- Department of Biochemistry and Immunology, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Daniel Macedo de Melo Jorge
- Department of Cellular and Molecular Biology and Pathogenic Bioagents, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Fernando de Queiroz Cunha
- Department of Pharmacology, University of Sao Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Edwin Tamashiro
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Wilma Terezinha Anselmo-Lima
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Fabiana Cardoso Pereira Valera
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
| | - Eurico Arruda
- Department of Cellular and Molecular Biology and Pathogenic Bioagents, University of São Paulo School of Medicine, Ribeirão Preto, São Paulo, Brazil
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5
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Ahmad Z, Krüger K, Lautermann J, Lippert B, Tenenbaum T, Tigges M, Tisch M. Adenoid hypertrophy-diagnosis and treatment: the new S2k guideline. HNO 2023; 71:67-72. [PMID: 37491540 PMCID: PMC10409824 DOI: 10.1007/s00106-023-01299-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/27/2023]
Abstract
Hyperplasia of the pharyngeal tonsils is to be considered pathologic when nasopharyngeal symptoms of mechanical obstruction and/or chronic inflammation occur. Chronic Eustachian tube dysfunction can result in various middle ear diseases such as conductive hearing loss, cholesteatoma, and recurrent acute otitis media. During examination, attention should be paid to the presence of adenoid facies (long face syndrome), with a permanently open mouth and visible tip of the tongue. In the case of severe symptoms and/or failure of conservative treatment, adenoidectomy is usually performed on an outpatient basis. Conventional curettage remains the established standard treatment in Germany. Histologic evaluation is indicated for clinical evidence of mucopolysaccharidoses. Due to the risk of hemorrhage, the preoperative bleeding questionnaire, which is obligatory before every pediatric surgery, is referred to. Recurrence of adenoids is possible despite correct adenoidectomy. Before discharge home, otorhinolaryngologic inspection of the nasopharynx for secondary bleeding should be performed and anesthesiologic clearance obtained.
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Affiliation(s)
- Z Ahmad
- Department of Otolaryngology-Head and Neck Surgery, Bundeswehr Hospital of Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany.
| | - K Krüger
- Institute of General Medicine, Berlin Charité Hospital, Berlin, Germany
| | - J Lautermann
- Department of Otolaryngology-Head and Neck Surgery, Plastic Surgery, Martha-Maria Halle-Dölau Hospital, Halle-Dölau, Germany
| | - B Lippert
- Department of Otolaryngology-Head and Neck Surgery, Plastic Surgery, SLK-Kliniken Heilbronn GmbH am Gesundbrunnen, Heilbronn, Germany
| | - T Tenenbaum
- Department of Paediatric and Adolescent Medicine, Sana Klinikum Lichtenberg, Berlin, Germany
| | - M Tigges
- Department of Otolaryngology, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - M Tisch
- Department of Otolaryngology-Head and Neck Surgery, Bundeswehr Hospital of Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany
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6
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Samara P, Athanasopoulos M, Athanasopoulos I. Unveiling the Enigmatic Adenoids and Tonsils: Exploring Immunology, Physiology, Microbiome Dynamics, and the Transformative Power of Surgery. Microorganisms 2023; 11:1624. [PMID: 37512798 PMCID: PMC10383913 DOI: 10.3390/microorganisms11071624] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/18/2023] [Accepted: 06/20/2023] [Indexed: 07/30/2023] Open
Abstract
Within the intricate realm of the mucosal immune system resides a captivating duo: the adenoids (or pharyngeal tonsils) and the tonsils (including palatine, tubal, and lingual variations), which harmoniously form the Waldeyer's ring. As they are strategically positioned at the crossroads of the respiratory and gastrointestinal systems, these exceptional structures fulfill a vital purpose. They function as formidable "gatekeepers" by screening microorganisms-both bacteria and viruses-with the mission to vanquish local pathogens via antibody production. However, under specific circumstances, their function can take an unsettling turn, inadvertently transforming them into reservoirs for pathogen incubation. In this review, we embark on a fascinating journey to illuminate the distinctive role of these entities, focusing on the local immune system inside their tissues. We delve into their behavior during inflammation processes, meticulously scrutinize the indications for surgical intervention, and investigate the metamorphosis of their microbiota in healthy and diseased states. We explore the alterations that occur prior to and following procedures like adenoidectomy, tonsillectomy, or their combined counterparts, particularly in pediatric patients. By comprehending a wealth of data, we may unlock the key to the enhanced management of patients with otorhinolaryngological disorders. Empowered with this knowledge, we can embrace improved therapeutic approaches and targeted interventions/surgeries guided by evidence-based guidelines and indications.
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Affiliation(s)
- Pinelopi Samara
- Children's Oncology Unit "Marianna V. Vardinoyannis-ELPIDA", Aghia Sophia Children's Hospital, 11527 Athens, Greece
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7
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Ahmad Z, Krüger K, Lautermann J, Lippert B, Tenenbaum T, Tigges M, Tisch M. [Adenoids-diagnosis and treatment: the new German S2k guideline]. HNO 2023; 71:285-293. [PMID: 37071194 PMCID: PMC10125940 DOI: 10.1007/s00106-023-01298-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 04/19/2023]
Abstract
Hyperplasia of the pharyngeal tonsils is to be considered pathologic when nasopharyngeal symptoms of mechanical obstruction and/or chronic inflammation occur. Chronic Eustachian tube dysfunction can result in various middle ear diseases such as conductive hearing loss, cholesteatoma, and recurrent acute otitis media. During examination, attention should be paid to the presence of adenoid facies (long face syndrome), with a permanently open mouth and visible tip of the tongue. In the case of severe symptoms and/or failure of conservative treatment, adenoidectomy is usually performed on an outpatient basis. Conventional curettage remains the established standard treatment in Germany. Histologic evaluation is indicated for clinical evidence of mucopolysaccharidoses. Due to the risk of hemorrhage, the preoperative bleeding questionnaire, which is obligatory before every pediatric surgery, is referred to. Recurrence of adenoids is possible despite correct adenoidectomy. Before discharge home, otorhinolaryngologic inspection of the nasopharynx for secondary bleeding should be performed and anesthesiologic clearance obtained.
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Affiliation(s)
- Z Ahmad
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland.
| | - K Krüger
- Institut für Allgemeinmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - J Lautermann
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Plastische Operationen, Krankenhaus Martha-Maria Halle-Dölau, Halle-Dölau, Deutschland
| | - B Lippert
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Plastische Operationen, SLK-Kliniken Heilbronn GmbH - Standort Gesundbrunnen, Heilbronn, Deutschland
| | - T Tenenbaum
- Klinik für Kinder- und Jugendmedizin, Sana Klinikum Lichtenberg, Berlin, Deutschland
| | - M Tigges
- Hals-Nasen-Ohrenklinik, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland
| | - M Tisch
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
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Is There an Association between Viral Infections and Risk for Pediatric Obstructive Sleep Apnea? A Systematic Review. CHILDREN 2023; 10:children10030487. [PMID: 36980046 PMCID: PMC10047345 DOI: 10.3390/children10030487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
(1) Background: Obstructive sleep apnea (OSA) affects approximately 1% to 5% of children. To date, the main pathophysiological factor is adenotonsillar tissue hypertrophy. As many respiratory viruses can persist in secondary lymphoepithelial organs after upper airway infection, the objective of this systematic review was to investigate the link between history of viral infections and the risk of pediatric OSA. (2) Methods: Corresponding references were searched electronically (PubMed [MEDLINE], Cochrane Library and Scopus) until 21 November 2022. Prospective or retrospective cohorts, evaluating the children suffering from OSA with history of viral infections and comparing them with children with no history of viral infections written in English, were included. Four independent reviewers selected studies, extracted data, and evaluated the risk of bias using ROBINS-I. (3) Results: Of 1027 potentially eligible articles, four studies (one retrospective, two prospective cohorts and one case-control) were included. (4) Conclusions: Exposure to lower airway infections may precede the diagnosis of pediatric OSA suggesting that respiratory viruses may play a mechanical role in the development of pediatric OSA. Further research is required to improve our understanding of the role of viral infections. Registration: PROSPERO CRD awaiting.
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Santiago-Olivares C, Martínez-Alvarado E, Rivera-Toledo E. Persistence of RNA Viruses in the Respiratory Tract: An Overview. Viral Immunol 2023; 36:3-12. [PMID: 36367976 DOI: 10.1089/vim.2022.0135] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Respiratory RNA viruses are a major cause of acute lower respiratory tract infections and contribute substantially to hospitalization among infants, elderly, and immunocompromised. Complete viral clearance from acute infections is not always achieved, leading to persistence. Certain chronic respiratory diseases like asthma and chronic obstructive pulmonary disease have been associated with persistent infection by human respiratory syncytial virus and human rhinovirus, but it is still not clear whether RNA viruses really establish long-term infections as it has been recognized for DNA viruses as human bocavirus and adenoviruses. Herein, we summarize evidence of RNA virus persistence in the human respiratory tract, as well as in some animal models, to highlight how long-term infections might be related to development and/or maintenance of chronic respiratory symptoms.
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Affiliation(s)
- Carlos Santiago-Olivares
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Eber Martínez-Alvarado
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Evelyn Rivera-Toledo
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
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Ivaska LE, Silvoniemi A, Mikola E, Puhakka T, Waris M, Vuorinen T, Jartti T. Herpesvirus infections in adenoids in patients with chronic adenotonsillar disease. J Med Virol 2022; 94:4470-4477. [PMID: 35488185 PMCID: PMC9545566 DOI: 10.1002/jmv.27818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/18/2022] [Accepted: 04/26/2022] [Indexed: 12/02/2022]
Abstract
Adenoids and tonsils have gained interest as a new in vivo model to study local immune functions and virus reservoirs. Especially herpesviruses are interesting because their prevalence and persistence in local lymphoid tissue are incompletely known. Our aim was to study herpesvirus and common respiratory virus infections in nonacutely ill adenotonsillar surgery patients. Adenoid and/or palatine tonsil tissue and nasopharyngeal aspirate (NPA) samples were collected from elective adenoidectomy (n = 45) and adenotonsillectomy (n = 44) patients (median age: 5, range: 1–20). Real‐time polymerase chain reaction was used to detect 22 distinct viruses from collected samples. The overall prevalence of herpesviruses was 89% and respiratory viruses 94%. Human herpesviruses 6 (HHV6), 7 (HHV7), and Epstein–Barr virus (EBV) were found, respectively, in adenoids (33%, 26%, 25%), tonsils (45%, 52%, 23%), and NPA (46%, 38%, 25%). Copy numbers of the HHV6 and HHV7 genome were significantly higher in tonsils than in adenoids. Patients with intra‐adenoid HHV6 were younger than those without. Detection rates of EBV and HHV7 showed agreement between corresponding sample types. This study shows that adenoid and tonsil tissues commonly harbor human herpes‐ and respiratory viruses, and it shows the differences in virus findings between sample types.
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Affiliation(s)
- Lotta E Ivaska
- Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital and University of Turku, Turku, Finland
| | - Antti Silvoniemi
- Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital and University of Turku, Turku, Finland
| | - Emilia Mikola
- Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital and University of Turku, Turku, Finland.,Department of Otorhinolaryngology, Satakunta Central Hospital, Pori, Finland
| | - Tuomo Puhakka
- Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital and University of Turku, Turku, Finland
| | - Matti Waris
- Institute of Biomedicine, University of Turku, Turku, Finland.,Clinical Microbiology, Turku University Hospital, Turku, Finland
| | - Tytti Vuorinen
- Institute of Biomedicine, University of Turku, Turku, Finland.,Clinical Microbiology, Turku University Hospital, Turku, Finland
| | - Tuomas Jartti
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland.,PEDEGO Research Unit, Medical Research Center, University of Oulu, Oulu, Finland.,Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
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Kim HK, Kim H, Lee MK, Choi WH, Jang Y, Shin JS, Park JY, Bae DH, Hyun SI, Kim KH, Han HW, Lim B, Choi G, Kim M, Chang Lim Y, Yoo J. Generation of human tonsil epithelial organoids as an ex vivo model for SARS-CoV-2 infection. Biomaterials 2022; 283:121460. [PMID: 35286852 PMCID: PMC8901203 DOI: 10.1016/j.biomaterials.2022.121460] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 12/14/2022]
Abstract
The palatine tonsils (hereinafter referred to as "tonsils") serve as a reservoir for viral infections and play roles in the immune system's first line of defense. The aims of this study were to establish tonsil epithelial cell-derived organoids and examine their feasibility as an ex vivo model for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The tonsil organoids successfully recapitulated the key characteristics of the tonsil epithelium, including cellular composition, histologic properties, and biomarker distribution. Notably, the basal layer cells of the organoids express molecules essential for SARS-CoV-2 entry, such as angiotensin-converting enzyme 2 (ACE2), transmembrane serine protease 2 (TMPRSS2) and furin, being susceptible to the viral infection. Changes in the gene expression profile in tonsil organoids revealed that 395 genes associated with oncostatin M signaling and lipid metabolism were highly upregulated within 72 h after SARS-CoV-2 infection. Notably, remdesivir suppressed the viral RNA copy number in organoid culture supernatants and intracellular viral protein levels in a dose-dependent manner. Here, we suggest that tonsil epithelial organoids could provide a preclinical and translational research platform for investigating SARS-CoV-2 infectivity and transmissibility or for evaluating antiviral candidates.
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Affiliation(s)
- Han Kyung Kim
- Department of Microbiology, CHA University School of Medicine, Seongnam, Republic of Korea; CHA Organoid Research Center, CHA University, Seongnam, Republic of Korea; R&D Institute, Organoidsciences Ltd., Seongnam, Republic of Korea
| | - Hyeryeon Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, The Research Institute, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Myoung Kyu Lee
- Infectious Diseases Therapeutic Research Center, Korea Research Institute of Chemical Technology (KRICT), Daejeon, Republic of Korea
| | - Woo Hee Choi
- Department of Microbiology, CHA University School of Medicine, Seongnam, Republic of Korea; CHA Organoid Research Center, CHA University, Seongnam, Republic of Korea
| | - Yejin Jang
- Infectious Diseases Therapeutic Research Center, Korea Research Institute of Chemical Technology (KRICT), Daejeon, Republic of Korea
| | - Jin Soo Shin
- Infectious Diseases Therapeutic Research Center, Korea Research Institute of Chemical Technology (KRICT), Daejeon, Republic of Korea
| | - Jun-Yeol Park
- Department of Microbiology, CHA University School of Medicine, Seongnam, Republic of Korea; CHA Organoid Research Center, CHA University, Seongnam, Republic of Korea
| | - Dong Hyuck Bae
- Department of Microbiology, CHA University School of Medicine, Seongnam, Republic of Korea; CHA Organoid Research Center, CHA University, Seongnam, Republic of Korea
| | - Seong-In Hyun
- Department of Microbiology, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Kang Hyun Kim
- Department of Biomedical Informatics, CHA University School of Medicine, CHA University, Seongnam, Republic of Korea
| | - Hyun Wook Han
- Department of Biomedical Informatics, CHA University School of Medicine, CHA University, Seongnam, Republic of Korea
| | - Byungho Lim
- Data Convergence Drug Research Center, KRICT, Daejeon, Republic of Korea
| | - Gildon Choi
- Data Convergence Drug Research Center, KRICT, Daejeon, Republic of Korea; Department of Medicinal Chemistry and Pharmacology, University of Science and Technology (UST), Daejeon, Republic of Korea
| | - Meehyein Kim
- Infectious Diseases Therapeutic Research Center, Korea Research Institute of Chemical Technology (KRICT), Daejeon, Republic of Korea; Graduate School of New Drug Discovery and Development, Chungnam National University, Daejeon, Republic of Korea.
| | - Young Chang Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, The Research Institute, Konkuk University School of Medicine, Seoul, Republic of Korea.
| | - Jongman Yoo
- Department of Microbiology, CHA University School of Medicine, Seongnam, Republic of Korea; CHA Organoid Research Center, CHA University, Seongnam, Republic of Korea; R&D Institute, Organoidsciences Ltd., Seongnam, Republic of Korea.
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12
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Gutierrez MJ, Nino G, Landeo-Gutierrez JS, Weiss MR, Preciado DA, Hong X, Wang X. Lower respiratory tract infections in early life are associated with obstructive sleep apnea diagnosis during childhood in a large birth cohort. Sleep 2021; 44:zsab198. [PMID: 34522958 PMCID: PMC8664572 DOI: 10.1093/sleep/zsab198] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/26/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Several birth cohorts have defined the pivotal role of early lower respiratory tract infections (LRTI) in the inception of pediatric respiratory conditions. However, the association between early LRTI and the development of obstructive sleep apnea (OSA) in children has not been established. METHODS To investigate whether early LRTIs increase the risk of pediatric OSA, we analyzed clinical data in children followed during the first 5 years in the Boston Birth Cohort (n = 3114). Kaplan-Meier survival estimates and Cox proportional hazards models adjusted by pertinent covariates were used to evaluate the risk of OSA by the age of 5 years between children with LRTI during the first 2 years of life in comparison to those without LRTI during this period. RESULTS Early life LRTI increased the risk of pediatric OSA independently of other pertinent covariates and risk factors (hazard ratio, 1.53; 95% CI, 1.15 to 2.05). Importantly, the association between LRTI and pediatric OSA was limited to LRTIs occurring during the first 2 years of life. Complementarily to this finding, we observed that children who had severe respiratory syncytial virus bronchiolitis during infancy had two times higher odds of OSA at 5 years in comparison with children without this exposure (odds ratio, 2.09; 95% CI, 1.12 to 3.88). CONCLUSIONS Children with severe LRTIs in early life have significantly increased risk of developing OSA during the first 5 years of life. Our results offer a new paradigm for investigating novel mechanisms and interventions targeting the early pathogenesis of OSA in the pediatric population.
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Affiliation(s)
- Maria J Gutierrez
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gustavo Nino
- Division of Pediatric Pulmonary and Sleep Medicine, Children’s National Medical Center, George Washington University, Washington, DC, USA
| | - Jeremy S Landeo-Gutierrez
- Division of Pediatric Pulmonary and Sleep Medicine, Children’s National Medical Center, George Washington University, Washington, DC, USA
| | - Miriam R Weiss
- Division of Pediatric Pulmonary and Sleep Medicine, Children’s National Medical Center, George Washington University, Washington, DC, USA
| | - Diego A Preciado
- Division of Pediatric Otorhinolaryngology, Children’s National Hospital, George Washington University, Washington, DC, USA
| | - Xiumei Hong
- Center on Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Xiaobin Wang
- Center on Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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13
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Cielo CM, Tapia IE. More than just a wheeze: bronchiolitis and obstructive sleep apnea in children. Sleep 2021; 44:6370221. [PMID: 34522966 DOI: 10.1093/sleep/zsab227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Christopher M Cielo
- Division of Pulmonary & Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ignacio E Tapia
- Division of Pulmonary & Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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14
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The investigation of bacterial adhesion of palatine tonsils epithelial cells in patient with infectious mononucleosis. EUREKA: HEALTH SCIENCES 2021. [DOI: 10.21303/2504-5679.2021.001835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Aim. To evaluate the features of pharynx tonsils mucous membrane colonization by pathogenic and opportunistic microorganisms by using the pharynx palatine tonsils epithelium electron microscopic examination of the patients with infectious mononucleosis and acute streptococcal tonsillitis.
Materials and methods. Two patients – patient P., 12 years old with a confirmed diagnosis of infectious mononucleosis and patient A., 8 years old with confirmed acute streptococcal tonsillitis. The patients were taken a bacteriological examination of the mucus and epithelium scraping from the surface of the pharyngeal tonsils. Tissue samples were examined in the electron microscopy laboratory of the Lviv National University.
Results and discussion. 36 tonsils epithelial tissue micro preparations of patient A. and 41 micro preparations of patient P. were studied. Streptococcus pyogenes, Str. pneumoniae, Str. viridans, Сandida albicans, as well as non-pathogenic bacteria: Diphtheroides sp., Neisseria sp., Corynebacterium spp. were identified as result of the patient P. bacteriological examination of mucus from the surface of the pharyngeal tonsils. Staph. aureus, Str. viridans, Str. pneumoniae were identified during a bacteriological examination of patient A. Eosinophils with a two-segmented nucleus, specific granularity, phagocytosed spherical bacteria in the cytoplasm were detected during the histological examination of the materials taken from the surface of the patient’s tonsils with acute tonsillitis. Research showed that bacteria were accumulated not only in the structure of extracellular detritus. Numerous bacteria accumulations were also found in the cytoplasm of the epithelial cells in the patient with infectious mononucleosis. The cell's shape looked like a bunch of grapes.
Conclusions. The electron microscopic examination showed differences in the coccal flora localization: the extracellular localization of bacteria in the patient with acute bacterial tonsillitis and intraepithelial presence of the bacteria in the patient with tonsillitis during infectious mononucleosis were found.
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15
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Silvoniemi A, Mikola E, Ivaska L, Jeskanen M, Löyttyniemi E, Puhakka T, Vuorinen T, Jartti T. Intratonsillar detection of 27 distinct viruses: A cross-sectional study. J Med Virol 2020; 92:3830-3838. [PMID: 32603480 PMCID: PMC7689766 DOI: 10.1002/jmv.26245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 06/26/2020] [Indexed: 12/11/2022]
Abstract
Palatine tonsils have been observed to harbor several distinct respiratory and herpesviruses in separate studies. In this study, the presence of these viruses in palatine tonsils was comprehensively studied in both children and adults. A cross-sectional analysis of 181 patients (median age 22 years; range, 2.6-66) operated for a benign tonsillar disease was conducted. Real-time polymerase chain reaction was performed to detect 27 distinct viruses in all: eight human herpesviruses, 16 respiratory viruses, parvo B19, and polyoma BK/JC viruses. Clinical characteristics of the patients and underlying conditions were evaluated. In total, 92% of patients had virus detected in tonsils (Epstein-Barr virus 72%, human herpesvirus 7, and 6B 54% and 16%, respectively, enterovirus 18%, parvovirus B19 7% and the rest <4%). No herpes simplex virus 2, varicella zoster virus, polyoma JC virus, parainfluenza-, metapneumo-, or coronaviruses were found. Enterovirus was more common in children and was frequently observed in the presence of HHV6B. None of the viruses showed a positive association to the tonsillar disease. Respiratory symptoms were not associated with the prevalence of viruses. This study comprehensively reports a cross-sectional view of intratonsillar virus infections in elective tonsillectomy patients in a wide age range cohort. Tonsils are a major virus reservoir for distinct herpes and respiratory viruses without a positive association with tonsillar disease or respiratory symptoms.
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Affiliation(s)
- Antti Silvoniemi
- Department of Otorhinolaryngology – Head and Neck SurgeryTurku University Hospital and University of TurkuTurkuFinland
| | - Emilia Mikola
- Department of Otorhinolaryngology – Head and Neck SurgeryTurku University Hospital and University of TurkuTurkuFinland
| | - Lotta Ivaska
- Department of Otorhinolaryngology – Head and Neck SurgeryTurku University Hospital and University of TurkuTurkuFinland
| | - Marja Jeskanen
- Department of Clinical Microbiology, Turku University Hospital and Institute of BiomedicineUniversity of TurkuTurkuFinland
| | | | - Tuomo Puhakka
- Department of Otorhinolaryngology – Head and Neck SurgeryTurku University Hospital and University of TurkuTurkuFinland
| | - Tytti Vuorinen
- Department of Clinical Microbiology, Turku University Hospital and Institute of BiomedicineUniversity of TurkuTurkuFinland
| | - Tuomas Jartti
- Department of Pediatrics and Adolescent MedicineTurku University Hospital and University of TurkuTurkuFinland
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16
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Nicodemo J, Hamersley E, Baker P, Reed S. Benign adenoidal hypertrophy caused by adenovirus presenting as a nasopharyngeal mass concerning for malignancy. Int J Pediatr Otorhinolaryngol 2020; 138:110300. [PMID: 32823205 DOI: 10.1016/j.ijporl.2020.110300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/04/2020] [Accepted: 08/04/2020] [Indexed: 11/17/2022]
Abstract
Benign adenoidal hypertrophy is the most common cause of nasopharyngeal obstruction. However, depending on size and location, masses may cause nasopharyngeal obstruction. We present our experiences with a ten-year-old female who presented with what appeared to be a large nasopharyngeal mass that was initially favored to be malignant and was ultimately found to be adenoid hypertrophy related to acute infection with adenovirus.
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Affiliation(s)
- J Nicodemo
- Department of Hematology/Oncology, Nationwide Children's Hospital, Columbus, OH, USA.
| | - E Hamersley
- Department of Otolaryngology - Head & Neck Surgery, Nationwide Children's Hospital and Wexner Medical Center at Ohio State University, Columbus, OH, USA; Navy Medicine Professional Development Center, USA
| | - P Baker
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - S Reed
- Department of Hematology/Oncology, Nationwide Children's Hospital, Columbus, OH, USA
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17
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Proenca-Modena JL, de Souza Cardoso R, Criado MF, Milanez GP, de Souza WM, Parise PL, Bertol JW, de Jesus BLS, Prates MCM, Silva ML, Buzatto GP, Demarco RC, Valera FCP, Tamashiro E, Anselmo-Lima WT, Arruda E. Human adenovirus replication and persistence in hypertrophic adenoids and palatine tonsils in children. J Med Virol 2019; 91:1250-1262. [PMID: 30815882 PMCID: PMC7166372 DOI: 10.1002/jmv.25441] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 12/31/2022]
Abstract
The role of human adenovirus (HAdV) infection in different acute diseases, such as febrile exudative tonsillitis, conjunctivitis, and pharyngoconjunctival fever is well established. However, the relationships, if any, of HAdV persistence and reactivation in the development of the chronic adenotonsillar disease is not fully understood. The present paper reports a 3-year cross-sectional hospital-based study aimed at detecting and quantifying HAdV DNA and mRNA of the HAdV hexon gene in adenoid and palatine tonsil tissues and nasopharyngeal secretions (NPS) from patients with adenotonsillar hypertrophy or recurrent adenotonsillitis. HAdV C, B, and E were detectable in nearly 50% of the patients, with no association with the severity of airway obstruction, nor with the presence of recurrent tonsillitis, sleep apnea or otitis media with effusion (OME). Despite the higher rates of respiratory viral coinfections in patients with HAdV, the presence of other viruses, including DNA and RNA viruses, had no association with HAdV replication or shedding in secretions. Higher HAdV loads in adenoids showed a significant positive correlation with the presence of sleep apnea and the absence of OME. Although this study indicates that a significant proportion (~85%) of individuals with chronic adenotonsillar diseases have persistent nonproductive HAdV infection, including those by HAdV C, B, and E, epithelial and subepithelial cells in tonsils seem to be critical for HAdV C production and shedding in NPS in some patients, since viral antigen was detected in these regions by immunohistochemistry in four patients, all of which were also positive for HAdV mRNA detection.
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Affiliation(s)
- José Luiz Proenca-Modena
- Department of Genetics, Evolution, Microbiology and Immunology, Institute of Biology, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Ricardo de Souza Cardoso
- Department of Cell Biology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Miriã Ferreira Criado
- Department of Cell Biology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.,Department of Cell Biology, Virology Research Center, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Guilherme Paier Milanez
- Department of Genetics, Evolution, Microbiology and Immunology, Institute of Biology, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - William Marciel de Souza
- Department of Cell Biology, Virology Research Center, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Pierina Lorencini Parise
- Department of Genetics, Evolution, Microbiology and Immunology, Institute of Biology, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Jéssica Wildgrube Bertol
- Department of Genetics, Evolution, Microbiology and Immunology, Institute of Biology, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Bruna Lais Santos de Jesus
- Department of Cell Biology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Maria Lúcia Silva
- Department of Cell Biology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.,Department of Cell Biology, Virology Research Center, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Guilherme Pietrucci Buzatto
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Ricardo Cassiano Demarco
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Fabiana Cardoso Pereira Valera
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Edwin Tamashiro
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Wilma Terezinha Anselmo-Lima
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Eurico Arruda
- Department of Cell Biology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.,Department of Cell Biology, Virology Research Center, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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18
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Arslan H, Çandar T, Vural Ö. Increased anti- EBV VCA IgG antibody levels are associated with need for surgery in patients developing upper respiratory tract complications. Int J Pediatr Otorhinolaryngol 2018; 111:84-88. [PMID: 29958621 DOI: 10.1016/j.ijporl.2018.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 05/26/2018] [Accepted: 05/28/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The immune reaction developing against Ebstein-Barr virus (EBV) infection may be one of the major determinants of severe adenoid hypertrophy (AH) and chronic otitis media with effusion (COME) needing surgery. In this study, we aimed to investigate the relationship between these antibodies and the need for surgery due to complications such as severe AH and COME. METHODS Sixty consecutive patients <15 years old who were admitted to our outpatient clinics between January 2014 and December 2015 with severe AH ± COME and underwent adenoidectomy ± ventilation tube insertion and 129 control patients who had a history of EBV infection at least three months before the inclusion to the study without current symptoms of upper airway obstruction and middle ear disease were included in this study. Two groups of patients and a control group were studied: a) children who underwent adenoidectomy alone with no middle ear disease (group 1), b) children with COME and AH who underwent adenoidectomy and tympanostomy with ventilation tube insertion (group 2), and c) control group without adenoid hypertrophy or otitis media with effusion. RESULTS Patients who needed surgery (Group 1 and 2) had significantly higher levels of anti-EBV VCA IgG antibodies than control patients (19.8 ± 16.4 vs. 1.7 ± 0.8 S/CO, p < 0.001). Anti-EBV VCA IgM levels did not differ between groups. Group 2 patients had also higher levels of Anti-EBV VCA IgG antibodies than group 1 patients (35.8 ± 16.7 vs. 11.8 ± 8.5 S/CO, p < 0.001). ROC curve analysis resulted in a cut-off point of 2.92 S/CO level for anti-EBV VCA IgG antibodies for need for surgery in EBV infected patients with 97% sensitivity and 98% specificity. CONCLUSION Markedly increased serum anti-EBV VCA IgG antibodies in children who developed upper respiratory tract complications such as severe AH and COME may show the significant role of enhanced immune system reaction in the pathogenesis of these complications due to EBV infection.
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Affiliation(s)
- Hande Arslan
- Department of Otorhinolaryngology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
| | - Tuba Çandar
- Department of Biochemistry, Ufuk University Faculty of Medicine, Ankara, Turkey.
| | - Özge Vural
- Department of Pediatric Hematology, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey.
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