Power and Triplex Doppler ultrasound as a method of early diagnosis of infection with Epstein Barr virus and cytomegalovirus in children

Purpose: Besides hepatitis with viruses A, B, C, D, E which have the tropism for liver, more frequently involved in lymphopoiesis organs damage, appear to be infections with Epstein Barr virus and cytomegalovirus, members of the herpesvirus family, with a prevalence in adolescents from 50 to 80%. In Epstein Barr virus infection, symptoms vary from nothing up to fever, superficial and deep lymphadenopathy, moderate hepatitis and pharyngitis. Cytomegalovirus infection persists long after the initial infection with reactivation, may develop the symptoms of infectious mononucleosis.

Material and methods: The prospective study included 400 symptomatic patients with fever, respiratory associated with dyspeptic syndrome and lymphadenopathy. Exclusion criteria were chronic carriers of the virus. All patients performed both abdominal ultrasound, and lymph nodes (superficial or deep chains). Doppler ultrasonography was performed abdominal fasting, using a multifrequency transducers, depending on the size and depth abdomen and neck area to explore. Biological investigations were monitored: inflammatory, hepatocytolisis and cholestasis syndromes, blood picture and followed specific antibodies to CMV, EBV.

Results: The incidence of cases studied were 32% EBV and 12% CMV. We obtained following quantitative and qualitative ultrasound aspects: morphological and structural changing: mild hepatomegaly with heterogeneous structure and splenomegaly. In Doppler ultrasound we found increased velocity in the portal vein than 30 cm/s at all positive patients. Doppler ultrasound allowed us to identify two main types of lymphadenopathy vascularity: one which has a single vascular pole thins associated with chronic inflammatory and two with a vascular pole doubled in diameter and thickness of two or more branches around it, common acute lymphadenopathy (sensitivity 70%, specificity 85%, p < 0.01).

Conclusion: Doppler ultrasound in infections with CMV and EBV, allowing the establishment of early diagnostic indicators, may specify lymphadenopathy with hepatomegaly and splenomegaly. The most significant Doppler changing in infections mononucleosis are: increased velocity in the portal vein and hepatic arterial flow.