Epstein-Barr Virus Infection in Kenyan Children with Tonsillar Enlargement DOI: https://dx.doi.org/10.4314/ajhs.v38i3.11

Abstract

Background: Enlarged tonsils and adenoids are common in children, but excessive growth can obstruct the airways. The tonsil, as a secondary lymphoid organ, harbours various pathogens, including Epstein-Barr virus (EBV), a widespread human herpesvirus that establishes lifelong latency in B cells, often commencing in the tonsils. Tonsil size typically decreases with age, with younger children having larger tonsils. However, the influence of EBV on tonsillar hypertrophy in malaria-endemic regions remains unclear.

Materials and methods: In this cross-sectional study, data were collected from 102 children aged between one and 14 years undergoing routine tonsillectomy. Finger-prick blood was collected before tonsillectomy, while tonsil tissue was collected during the surgery and transported on ice for analysis. Clinical and demographic data were recorded. EBV loads in tonsils and Plasmodium falciparum (pf) parasitemia were determined by quantitative polymerase chain reaction (qPCR). Based on the EBV status, Children were categorised into two groups and the demographic as well as clinical parameters were compared between the groups.

Results: EBV was detected in 58.1% of the participants, while 17.6% tested positive for malaria infection by qPCR. Adenotonsillar hypertrophy accounted for 44.1% of tonsillectomy cases. EBV-positive children had significantly lower haemoglobin levels as compared to EBV-negative individuals (p=0.04). Tonsil size showed a positive correlation with age (p = 0.037) and was significantly larger in malaria-negative children compared to malaria-positive (p<0.001).

Conclusion and Recommendation: The higher proportion of malaria-negative children who were EBV positive suggests a possible relationship between repeated malaria infections and EBV detection. Lower haemoglobin levels observed among EBV-positive children suggest that EBV infection may influence haemoglobin levels. Further research is needed to better understand these relationships.