Olkhovska V. Diagnostic and prognostic value of clinical, laboratory and immunological parameters of children with streptococcal tonsillitis and infected with herpes virus type 6.

Українська версія

Thesis for the degree of Doctor of Philosophy (PhD)

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  • 228 - Педіатрія


Specialized Academic Board

ДФ 64.609.046

The Kharkiv Medical Academy of Postgraduate Education


The aim of the study is to improve diagnosis of herpes virus type 6 infection in children with streptococcal tonsillitis, and predict the course of the tonsillitis based on identifying the features of clinical manifestations, laboratory parameters, factors of specific and non-specific protection. The dissertation provides a theoretical basis and presents new solutions to the current problem of pediatrics, which is to determine the features of streptococcal tonsillitis in children with concomitant human herpes virus type 6 infection (HHV-6), as well as to develop a scientifically based approach to early diagnosis of HHV-6 infection in children with streptococcal tonsillitis, and predicting the course of streptococcal tonsillitis in these patients. A comprehensive clinical and laboratory examination of 120 children aged three to fifteen years with streptococcal tonsillitis, which were divided into two groups. The first group consisted of 48 children with streptococcal tonsillitis on the background of HHV-6 infection; the second - 72 children with streptococcal tonsillitis as a mono-infection. The control group consisted of 20 healthy children, similar in age and sex. Criteria for inclusion of patients in the study were: age from three to fifteen years, moderate streptococcal tonsillitis, signed informed consent of parents or guardians to participate in the study. Criteria for exclusion of children were: congenital or acquired immunodeficiency, use of immunomodulatory or steroid drugs during the last month, the presence of autoimmune diseases, blood diseases, the presence of chronic comorbidities that could affect the results of the study. Simultaneously with the generally accepted laboratory tests, special studies were performed: determination of blood lymphocyte population levels (CD3 +, CD4 +, CD8 +, CD16 +, CD 22+, CD 25 + lymphocytes); serum IgA, IgM, IgG levels; phagocytic activity of neutrophils (FAN) according to the nitrosine tetrazolium reduction test (NRT test), and also determined the autonomic reactivity (according to cardiointervalography - CIG). The studies were performed in the acute period (second to third day from the onset of the disease) and in the period of early convalescence of streptococcal tonsillitis (eighth to tenth day of the disease). It was determined that in children with concomitant HHV-6 infection at the collection of anamnesis probably more often there are indications of past diseases (frequent respiratory infections, bronchitis, t> 2.0). In terms of age, streptococcal tonsillitis was more common in school-age children (81.66 %). Although the number of tonsillitis was lower in summer than in other periods, we did not find a significant seasonal dependence of the frequency of tonsillitis registration depending on the season (p ˃ 0.05). Provoking factors for the development of the disease were mainly previous hypothermia (42.5 %) and close contact with the patient in the family or among friends (17.5 %). The percentage of unexplained causes of the disease was high (40.0 %). It was determined that the clinical symptoms of tonsillitis and the duration of pathological changes depended on the presence of background HHV-6 infection. Among patients with co-infection, we observed a high incidence of adverse tonsillitis, t > 2.0. Subfebrile temperature reaction (18 - 15.0%) was more often registered in patients with concomitant HHV-6 infection, while febrile figures (47 - 39.16%), t≥2.0 prevailed in children of the second group. In general, in children with concomitant HHV-6 infection, the temperature response figures were significantly lower than in children with mono-infection (37.85 ± 0.27ºC vs. 38.89 ± 0.41ºC, respectively, p < 0.05). Difficulty in nasal breathing was significantly more common in most patients of the first group (29 - 24.17 %), while in patients without concomitant HHV-6 this symptom was registered only in 10 cases (8.33 %), t ≥ 2.0 . Generalized lymphadenopathy was significantly more often observed in patients with tonsillitis with concomitant HHV-6 infection - 27 (22.5 %) cases against 9 (7.5 %) in the second group; including an increase in cervical lymph nodes – 46 (38.33 %) against 16 (13.33 %), respectively, t ≥ 2.0. Patients in the first group were more likely to have a short systolic murmur at the apex of the heart, arrhythmia was detected - 29 (24.16 %) vs. 10 (8.33 %), respectively, in groups t ≥ 2.0. In 33 (27.5 %) patients showed an increase in liver size, which was significantly more common in patients with mixed infection - 25 (20.83 %) vs. 8 (6.66 %) in groups, t ≥ 2.0. In 28 (23.33 %) cases, the appearance of skin rash was observed, which was more typical of patients of the first group - 22 (18.33 %) against 6 (5.0 %), respectively, in the groups, t ≥ 2.0.


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