MORPHOLOGICAL JUSTIFICATION OF IMMUNOREHABILITATION THERAPY OF CHRONIC NASOPHARYNGITIS ASSOCIATED WITH EBV
Authors: Koshel I. V. , Leta O. I. , Bahrii M. M. 
Published: October 2022

Adenotomy, the most widespread surgery in children, which does not solve the problem of symptoms in 19-26% patients. The main reasons are related diseases of nasopharynx, therefore, the indications for surgical intervention must be considered after evaluating the efficacy of conservative treatment. The relevant conservative treatment of CNP associated with EBV infection must include adequate immunorehabilitation effect on nasopharynx epitheliocytes, since the interaction of local immune response and cells infected with Epstein-Barr virus can lead to the control of virus infection.

Objective of research: to establish the specific features of morphological changes in respiratory epithelium of pharyngeal tonsil in patients with chronic nasopharyngitis associated with EBV.

Materials and methods. There was carried out the research of surgical material obtained as a result of endoscopic surgical intervention including the removal of hypertrophic part of pharyngeal tonsil in 15 patients diagnosed with chronic nasopharyngitis associated with EBV. The diagnosis was made on the ground of a typical clinical picture and determination of immunoglobulin M, G classes to Epstein-Barr virus in the blood.

Results. It has been shown that intraepithelial lymphocytic and histiocytic infiltration can be determined morphologically and the edema of loose connective tissue, full blood vessels of the microcirculatory channel can be determined subepithelially which is the morphological sign of the chronic inflammation process.

The identified structural reconstruction of epithelium reflects the development of virus-induced degenerative processes, namely, koilocytosis and spongiosis. The virus-induced changes in epithelium in the form of koilocytosis can be observed both in covering epithelia and in metaplastic epithelium, which demonstrates the persistence of viral infection in chronic inflammation.

It has been found that on the background of chronic inflammation the cystic formations in the thickness of the lymphoid tissue are forming and the amphophilic masses of mucus can be visualized on the surface of epitheliocytes with hypersecretory changes, as well as similar mucous masses can be identified in the lumen of cysts of lymphoid tissue. The changes in epithelium in the form of koilocytosis can be seen in the epithelial crypts and cysts as well as indicating that the persistence of infection is viral.

Conclusions:

In CNP associated with EBV, the morphological changes of respiratory epithelium of nasopharynx are indications of both non-specific inflammatory processes (hyperplasia, metaplasia of epithelium, hypersecretory changes in cells, intraepithelial inflammatory cell infiltration), and specific for viral infections processes (koilocytosis, spongiosis, lymphocytes with wide cytoplasm).

Structural changes are indications of the development of degenerative virus-induced processes (koilocytosis, spongiosis) combined with reactive changes in epithelial cells (hyperplasia, hypersecretion) that happen both in the surface epithelium and in the crypts with cyst formations.

There can be seen phenomena of significant hypersecretory activities of epithelium including the accumulation of mucus on the surface of cells as well as in the lumen of crypts and cysts.