Seroprevalence of herpes simplex virus types 1 and 2, Epstein-Barr virus, and cytomegalovirus in children with acute lymphoblastic leukemia in Egypt

OBJECTIVE: Viral infection, especially caused by herpes viruses, is now recognized as an important cause of morbidity and mortality in immunocompromised cancer patients. This study aimed at studying seroprevalence of 3 herpes viruses Herpes simplex virus types 1 and 2 (HSV 1 and 2), Epstein-Barr virus (EBV), and cytomegalovirus (CMV) in children with acute lymphoblastic leukemia (ALL).

METHODS: We conducted this study on 68 newly diagnosed pediatric patients with ALL presented to the Pediatric Oncology Service of National Cancer Institute, Cairo University, Egypt from November 2001 to June 2003. We used enzyme-linked immunosorbent assay in detecting HSV 1 and 2, CMV, EBV antibodies of both types immunoglobulin (Ig) M and IgG detection of DNA for both CMV and EBV by polymerase chain reaction was carried out.

RESULTS: High seroprevalence of HSV-1 and 2, CMV and EBV IgG antibodies in both leukemic children and their control was observed (69%, 100%, 83%) and (80%, 100%, 95%). Significantly higher percentage of HSV-1 and 2 IgM or reactivated infection was found among leukemic children 17/68 (25%) compared with normal control 0%. Analysis showed that prevalence of HSV 1 and 2 IgG increased from 18/33 (54%) in children <5 years to 11/13 (77%) in children >10 years, and reactivation of HSV-1 and 2 increased with increasing age from 1/33 (3%) in children <5 years to 4/13 (30%) in children >10 year. This was in contrast to seroprevalence of CMV and EBV IgG which were 100% and 83% in children <5 years. No difference in seroprevalence was found among both gender, and no difference was found in leukemic patients with granulocytopenia.

CONCLUSION: The data show a higher exposure to HSV-1 and 2 both primary infections and reactivation among ALL children. Therefore, acyclovir prophylaxis could be highly effective for seropositive leukemic patients who are undergoing induction chemotherapy.