Department of Infectious Diseases and Child Neurology, Karol Marcinkowski University of Medical Sciences, Poznań, Poland.
Student Research Circle at the Department of Infectious Diseases and Child Neurology, Karol Marcinkowski University of Medical Sciences, Poznań, Poland.
Int J Clin Pract. 2019 Sep;73(9):1-6. doi: 10.1111/ijcp.13386. Epub 2019 Jul 29.
Acute acalculous cholecystitis (AAC), an inflammatory process of the gallbladder (GB) in the absence of gallstones, typically occurs in seriously ill patients. AAC can complicate primary Epstein-Barr virus (EBV) infection, but it is an atypical clinical presentation.
The aim of our study was to analyse AAC occurrence in children with primary symptomatic EBV infection who had been admitted to the hospital.
We retrospectively evaluated the medical documentation of 181 children with EBV infection who were diagnosed based on the presence of viral capsid antigen IgM antibodies. All EBV-positive patients underwent transabdominal ultrasonography of the liver in the supine and right anterior oblique positions. Fifteen children who presented with AAC symptoms, including abdominal pain and a positive Murphy's sign, were analysed as a subsample and re-evaluated after 2-3 months.
The incidence of AAC in children hospitalised with infectious mononucleosis (IM) was estimated at 8.3%. Analysis of the laboratory results confirmed that the C-reactive protein (CRP) concentration was the only parameter which was higher in children who presented with AAC symptoms. The mean number of leucocytes and monocytes and liver enzyme activities were not significantly higher. The radiological findings of AAC were evident: increased GB wall thickness, non-shadowing echogenic sludge and pericholecystic fluid collection.
AAC during primary EBV infection appears to be a more common pathology than previously suspected. Its relatively mild nature and the lack of laboratory abnormalities mean that ultrasonographic examination is required for diagnosis. This might explain why the prevalence in children is underestimated.
急性非结石性胆囊炎（AAC）是一种在无胆石症的情况下发生的胆囊（GB）炎症过程，通常发生在重病患者中。AAC 可并发原发性 EBV 感染，但临床表现不典型。
本研究旨在分析因原发性有症状 EBV 感染住院的儿童中 AAC 的发生情况。
我们回顾性评估了 181 名 EBV 感染儿童的病历资料，这些儿童的诊断依据是存在病毒衣壳抗原 IgM 抗体。所有 EBV 阳性患者均接受仰卧位和右前斜位的肝腹部超声检查。15 名出现 AAC 症状（包括腹痛和墨菲氏征阳性）的儿童作为亚组进行分析，并在 2-3 个月后重新评估。
在因传染性单核细胞增多症（IM）住院的儿童中，AAC 的发病率估计为 8.3%。实验室结果分析证实，仅 C 反应蛋白（CRP）浓度是出现 AAC 症状儿童的唯一更高参数。白细胞和单核细胞的平均数量以及肝酶活性均无明显升高。AAC 的放射学表现明显：GB 壁增厚、无阴影回声性胆泥和胆囊周围积液。
在原发性 EBV 感染期间，AAC 似乎比以前怀疑的更为常见。其相对较轻的性质和缺乏实验室异常意味着需要进行超声检查以进行诊断。这可能解释了为什么儿童的患病率被低估。
