Splenic morphometric characteristics in infectious mononucleosis (ultrasonic study)

Cover Page

Cite item

Abstract

The spleen is a secondary immune and the largest organ of the reticuloendothelial system, actively involved during infectious mononucleosis. Clinically, assessing a degree of organ involvement in the pathological process seems unlikely. As a rule, only palpation and percussion are used to determine the size of the spleen, which represents a late and subjective sign of potential splenomegaly. Ultrasound examination provides ample opportunities to estimate the spleen size during infectious mononucleosis. Our study was aimed at identifying morphometric and Doppler ultrasound changes in the spleen in patients with infectious mononucleosis. Materials and methods. There were enrolled 24 patients with infectious mononucleosis to be compared with 30 healthy medical institute students in control group. All participants underwent splenic ultrasound examination. Spleen echotexture and contour clarity together with measuring linear dimensions: length, width, and thickness were analyzed. Splenic artery and vein velocity parameters were measured at the gates of the spleen. Elastographic window for fibroelastometry was positioned within the window for standard grayscale examination. Measurements were performed at 5 or more points of the spleen parenchyma at least 4—5 mm away from the capsular zone and the zone of large vessels. Based on the morphometric measurements obtained, the mass, spleen mass coefficient (SMC), as well as the spleen mass/body height ratio and spleen mass/body surface area ratio were calculated. Results. We found that patients with infectious mononucleosis had the length, thickness and weight of the spleen significantly greater than those observed in control group. However, the mass of the spleen varies widely and justified to calculate the CMS as an objective criterion to assess the size of the spleen. It was revealed that infectious mononucleosis may proceed in one of the three variants of the splenic response: decreased size, CMR < 1.5; normal size, CMR ranged from 1.5 to 4; splenomegaly, CMR > 4. Splenomegaly is associated with increased organ stiffness, peak blood flow velocity and pressure in v. lienalis, as well as periportal lymphadenopathy. Identified changes are characteristics of young patients. Conclusion. Ultrasound examination of the spleen is of high diagnostic value for patients with infectious mononucleosis allowing highly accurate assessment state of the immune organs in the acute disease period. At the preclinical stage, gradation of splenomegaly is possible depending on its intensity, assessed hemodynamics and organ stiffness.

About the authors

S. A. Perepelitsa

Imannuel Kant Baltic Federal University; V.A. Negovsky Research Institute of General Reanimatology, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology

Author for correspondence.
Email: sveta_perepeliza@mail.ru
ORCID iD: 0000-0002-4535-9805

Svetlana A. Perepelitsa - PhD, MD (Medicine), Professor of the Department of Surgery, Imannuel Kant Baltic Federal University; Leading Researcher, Laboratory of Cell Pathology in Critical Conditions, V.A. Negovsky Research Institute of General Reanimatology, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology.

236041, Kaliningrad, A. Nevskiy str., 14.

Phone: +7 (401) 246-15-30

Russian Federation

L. A. Perminova

Imannuel Kant Baltic Federal University

Email: perminova72@mail.ru

PhD (Medicine), Associate Professor, Department of Therapy, Imannuel Kant Baltic Federal University.

Kaliningrad.

Russian Federation

I. A. Stepanyan

Imannuel Kant Baltic Federal University; Infectional Hospital of the Kaliningrad Region

Email: lublumedicinu@mail.ru

PhD Student, Assistant, Department of Fundamental Medicine, Imannuel Kant Baltic Federal University; Doctor of Ultrasound Diagnostics, Infectional Hospital of the Kaliningrad Region.

Kaliningrad.

Russian Federation

E. V. Zakhar

Infectional Hospital of the Kaliningrad Region

Email: nf-bol@infomed39.ru

Infectious Disease Doctor, 1st Infectious Department, Infectional Hospital of the Kaliningrad Region.

Kaliningrad.

Russian Federation

References

  1. Бондаренко А.Л., Савиных М.В., Савиных Н.А., Калужских Т.И., Хлебникова Н.В., Малкова Л.В., Рябова Н.В. Возрастные отличия инфекционного мононуклеоза Эпштейна—Барр вирусной этиологии // Журнал инфектологии. 2018. Т. 10, № 1. С. 36-41. doi: 10.22625/2072-6732-2018-10-1-36-41
  2. Возгомент О.В., Пыков М.И., Зайцева Н.В. Новые подходы к ультразвуковой оценке размеров селезенки у детей // Ультразвуковая и функциональная диагностика. 2013. № 6. С. 56-62.
  3. Касымова Е.Б., Башкина О.А., Галимзянов Х.М. Ключевые вопросы диагностики и лечения инфекционного мононуклеоза // Астраханский медицинский журнал. 2016. Т. 11, № 3. С. 38-44.
  4. Михнева С.А., Гришина Ю.Ю., Кухтевич Е.В., Мартынов Ю.В. Инфекционный мононуклеоз: характеристика проявлений эпидемического процесса // Инфекционные болезни: новости, мнение, обучение. 2017. № 5. С. 61-64. doi: 10.24411/2305-3496-2017-00086
  5. Перепелица С.А., Алексеева С.В., Возгомент О.В. Ранние ультразвуковые признаки спленомегалии у новорожденных // Общая реаниматология. 2019. Т. 15, № 4. С. 58-66. doi: 10.15360/1813-9779-2019-4-58-66
  6. Соломай Т.В. Динамика заболеваемости и территориальное распределение инфекционного мононуклеоза // Здравоохранение Российской Федерации. 2019. Т. 63, № 4. С. 186-192.
  7. Шайхуллина Л.Р., Валишин Д.А., Хунафина Д.Х., Хасанова Г.М., Галиева А.Т., Кутлугужина Ф.Г., Ишмухаметова А.Р. Клиническое течение инфекционного мононуклеоза в Республике Башкортостан // Международный академический вестник. 2016. Т. 15, № 3. С. 20-22.
  8. Alaoui C.R., Rami M., Khatalla K., Elmadi A., Bouabdellah Y. Spontaneous rupture of the spleen in a child. Pan. Afr. Med. J., 2019, vol. 32: 184. doi: 10.11604/pamj.2019.32.184.4260
  9. Balfour H.H., Dunmire S.K., Hogquist K.A. Infectious mononucleosis. Clin. Transl Immunology, 2015, vol. 4, no. 2: e33. doi: 10.1038/cti.2015.1
  10. Balfour H.H., Odumade O.A., Schmeling D.O., Mullan B.D., Ed J.A., Knight J.A., Vezina H.E., Thomas W., Hogquist K.A. Behavioral, virologic, and immunologic factors associated with acquisition and severity of primary Epstein-Barr virus infection in university students. J. Infect. Dis., 2013, no. 207, pp. 80-88. doi: 10.1093/infdis/jis646
  11. Barnwell J., Deol P.S. Atraumatic splenic rupture secondary to Epstein-Barr virus infection. BMJ Case Rep., 2017: bcr2016218405. doi: 10.1136/bcr-2016-218405
  12. Bartlett A., Williams R., Hilton M. Splenic rupture in infectious mononucleosis: a systematic review of published case reports. Injury, 2016, vol. 47, no. 3, pp. 531-538. doi: 10.1016/j.injury.2015.10.071
  13. Cohen J.I. Epstein-Barr virus vaccines. Clin. Transl. Immunology, 2015, vol. 4, no. 1: e32. doi: 10.1038/cti.2014.27
  14. Dunmire S.K., Hogquist K.A., Balfour H.H. Infectious Mononucleosis. Curr. Top. Microbiol. Immunol., 2015, no. 390, pp. 211240. doi: 10.1007/978-3-319-22822-8_9
  15. Dunmire S.K., Verghese P.S., Balfour H.H. Jr. Primary Epstein-Barr virus infection. J. Clin. Virol., 2018, no. 102, pp. 84-92. doi: 10.1016/j.jcv.2018.03.001
  16. Ebell M.H. Epstein-Barr virus infectious mononucleosis. Am. Fam. Physician, 2004, vol. 70, no. 7, pp. 1279-1287.
  17. Farukhi S.N., Fox J.C. The role of ultrasound in the management and diagnosis of infectious mononucleosis. Crit. Ultrasound. J., 2014, vol. 6, no. 1: 4. doi: 10.1186/2036-7902-6-4
  18. Fourcade G., Germi R., Guerber F., Lupo J., Baccard M., Seigneurin A., Semenova T., Morand P., Epaulard O. Evolution of EBV seroprevalence and primary infection age in a French hospital and a city laboratory network, 2000-2016. PLoS One, 2017, vol. 12, no. 4: e0175574. doi: 10.1371/journal.pone.0175574.
  19. Heo D.H., Baek D.Y., Oh S.M., Hwang J.H., Lee C.S., Hwang J.H. Splenic infarction associated with acute infectious mononucleosis due to Epstein-Barr virus infection. Med. Virol., 2017, vol. 89, no. 2, pp. 332-336. doi: 10.1002/jmv.24618
  20. Hocqueloux L., Causse X., Valery A., Jandali J.-C., Maitre O., Soin C., Buret J., Ouane F., Niang M., Mille C., Prazuck T., Guinard J., Guigon A. The high burden of hospitalizations for primary EBV infection: a 6-year prospective survey in a French hospital. Clin. Microbiol. Infect., 2015, vol. 21, no. 11: 1041.e1-7. doi: 10.1016/j.cmi.2015.07.015
  21. Izranov V., Palvanova U., Gordova V., Perepelitsa S., Morozov S. Ultrasound criteria of splenomegaly. The Radiologist, 2019, vol. 1, no. 1002, pp. 3—6.
  22. Lennon P., Crotty M., Fenton J.E. Infectious mononucleosis. BMJ, 2015, 350: h1825. doi: 10.1136/bmj.h1825
  23. Li Y., George A., Arnaout S., Wang J.P., Abraham G.M. Splenic infarction: an under-recognized complication of infectious mononucleosis? Open Forum Infect. Dis., 2018, vol. 5, no. 3: ofy041. doi: 10.1093/ofid/ofy041
  24. Machado C., Salgado J.M., Monjardino L. The unexpected finding of a splenic infarction in a patient with infectious mononucleosis due to Epstein-Barr virus. BMJ Case Rep., 2015, 2015: bcr2015212428. doi: 10.1136/bcr-2015-212428
  25. Naviglio S., Abate M.V., Chinello M., Ventura A. Splenic infarction in acute infectious mononucleosis. J. Emerg. Med., 2016, vol. 50 (1): e11-3. doi: 10.1016/j.jemermed.2015.09.019
  26. Pelizzo G., Guazzotti M., Klersy C., Nakib G., Costanzo F., Andreatta E., Bassotti G., Calcaterra V. Spleen size evaluation in children: time to define splenomegaly for pediatric surgeons and pediatricians. PLoS One, 2018, vol. 13 (8): e0202741. doi: 10.1371/journal.pone.0202741
  27. Sergent S.R., Johnson S.M., Ashurst J., Johnston G. Epstein-Barr virus-associated atraumatic spleen laceration presenting with neck and shoulder pain. Am. J. Case. Rep., 2015, no. 16, pp. 774-777. doi: 10.12659/ajcr.893919
  28. Suzuki Y., Kakisaka K., Kuroda H., Sasaki T., Takikawa Y. Splenic infarction associated with acute infectious mononucleosis. Korean. J. Intern. Med., 2018, vol. 33, no. 2, pp. 451—452. doi: 10.3904/kjim.2016.394
  29. Rostgaard K., Balfour H.H., Jarrett R., Erikstrup C., Pedersen O., Ullum H., Nielsen L.P., Voldstedlund M., Hjalgrim H. Primary Epstein-Barr virus infection with and without infectious mononucleosis. PLoS One, 2019, vol. 14 (12): e0226436. doi: 10.1371/journal.pone.0226436
  30. Rotbain E.C., Hansen D.L., de Muckadell O.S., Wibrand F., Meldgaard Lund A., Frederiksen H. Splenomegaly — diagnostic validity, work-up, and underlying causes. PLoS One, 2017, vol. 12 (11): e0186674. doi: 10.1371/journal.pone.0186674
  31. Wemel A.C., Mayet A., Bellier S., Bigaillon C., Rapp C., Ficko C. Severe infectious mononucleosis in immunocompetent adults. Med. Mal. Infect., 2017, vol. 47, no. 8, pp. 540—545. doi: 10.1016/j.medmal.2017.09.009

Supplementary files

There are no supplementary files to display.


Copyright (c) 2020 Perepelitsa S.A., Perminova L.A., Stepanyan I.A., Zakhar E.V.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies