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Introduction. To determine the tactics of management of chronic lymphoproliferative syndrome in young children, a comprehensive examination is necessary. Herpesvirus infection (HVI) plays an important role in the etiology of hypertrophy of lymphoid formations of the pharynx.Purpose. To evaluate the results of preoperative diagnosis of chronic lymphoproliferative syndrome in children in early childhood.Materials and methods. In 96 patients aged 1 to 3 years 11 months with lymphoproliferative syndrome more than 3–6 months, endoscopy, otomicroscopy, impedance, ultrasound examination of abdominal organs, cervical and submandibular lymph nodes, serological and molecular genetic analyses of markers of EBV, CMV, HCV-6 in the blood; PCR in pharyngeal tonsil scrapings were performed.Results and discussion. The clinical picture in children with chronic lymphoproliferative syndrome of younger age was dominated by complaints of difficulty in nasal breathing, snoring in 42% of children, recurrent otitis in 58%, manifestations of asthenovegetative and intoxication syndromes and frequent acute respiratory viral infections in 70% of patients. A high degree of infection of children of the younger age group was revealed – HCV-6 in 87%, CMV in 63% of children, 46% – EBV. And high activity of the infectious process in 31% of patients for all three GVI, more often for EBV in 27%. A combination of two or three GVI was detected in 83% of patients. During instrumental examination, a high degree of hypertrophy of the nasopharyngeal tonsils (adenoid vegetations of 2–3 degrees – 67% and 3 degrees – 18%, combined with hypertrophy of the palatine tonsils in 27% of cases), an increase in neck lymph nodes of more than 16mm, including lymph node packs in 28% of younger children and reactive hepatosplenomegaly in 17.7% of patients.Conclusion. To determine the tactics of management of chronic lymphoproliferative syndrome in young children, it is important to assess the severity of lymphoproliferative syndrome according to the clinical picture and instrumental research methods (nasopharyngeal endoscopy, ultrasound examination of neck and abdominal lymph nodes) in combination with laboratory data and characteristics of the stage of activity of the infectious process of herpesvirus etiology.

The aim of study was to assess the diagnostic value of ultrasound diagnostics of chronic lymphoproliferative syndrome in the young children. 88 children aged 2–3 years with pathology of the lymphadenoid ring of the pharynx, accompanied by regional cervical lymphadenitis, needing surgery were examined. Endoscopy of the nasopharynx, otomicroscopy, impedance, ultrasound examination of cervical and submandibular lymph nodes, abdominal organs, complete blood count with a manual differential, ELISA to determine specific IgM, IgG to cytomegalovirus (CMV) antigens, to human herpes virus type 6 (HCV-6) antigens, to nuclear, viral capsid and early antigens complex Epstein – Barr virus (EBV), PCR in scrapes from the oropharyngeal mucosa and blood were performed. The patients were divided into two groups: group I with pronounced lymphadenopathy (lymph nodes conglomerates 31×13 mm in size or multiple) (n = 32), group II with moderate lymphadenopathy (single symmetrical painless lymph nodes less than 16 mm in size) (n =  56). In the group I, the following were statistically significant more frequent: snore and sleep apnea (Fisher's exact test, p < 0,001, odds ratio (OR) 13,00, 95% confidence interval (CI) 4,439–38,07); manifestations of asthenic vegetative and intoxication syndromes (p < 0,001, OR 7,80, CI 2,248–27,06); ultrasound signs of hepatic splenic syndrome (p < 0,001, OR 34,71, CI 7,185–167,7); serological markers of contamination and active stages EBV infection (p < 0,001, OR 16,71, CI 4,673–55,27); markers of mixt EBV + CMV + HHV-6 infections (p < 0,001, OR 16,20, CI 3,327–78,87), compared to the group II. Regional cervical lymphadenitis with lymph nodes diameter more than 16 mm on ultrasound was a sign of pronounced chronic lymphoproliferative syndrome in the young children, in which half were found to have markers of the EBV infection active stage. The development of pronounced cervical lymphadenitis is associated with hepatic splenic syndrome, usually caused by the herpesvirus infections reactivation.

To assess the nasopharyngeal microbiota role in the development of chronic lymphoproliferative syndrome of ENT organs in young children, 40 children aged 2–3 years were examined. Cytological and cultural bacteriological studies of nasopharyngeal smears were carried out. Serological and molecular genetic analyzes of markers of herpesvirus infections (Epstein–Barr virus (EBV), cytomegalovirus (CMV), and human herpes virus type 6 (HHV-6)) in the blood, polymerase chain reaction (PCR), and immunofluorescence reaction (RIF) were performed with generic antiherpetic sera of the same name in scrapings of the pharyngeal tonsil. In the rhinocytogram, 57,14% of children had poor gram-positive cocci, characteristic of the normal state of the mucosa. In nasopharyngeal smears, the growth of microorganisms of opportunistic and saprophytic microbiota was not detected in a diagnostically significant amount in 19,44% of children; isolated growth of normal aerobic and/or facultative anaerobic microbiota was observed with the same frequency. Opportunistic microbiota was detected in 61,11% of cases, including associations of saprophytic microbiota and opportunistic microorganisms were detected in 27,78% of children. Most often, Staphylococcus aureus 54,55% was detected in children; known respiratory pathogens were found less frequently: Streptococcus pneumoniae 31,82%, Haemophilus influenzae 13,64%, Moraxella catarrhalis 13,64%. In the majority of patients, 77,27%, one type of pathobiont was identified. 100% infection with herpesvirus infections was established, including EBV 66,67%, CMV 56,41%, HHV-6 61,54%. Mixed infections dominated 69,23%, EBV infection prevailed among mono infections. The active stage of herpesvirus infection was established in 56,41% of children, of which 77,27% were mono infections, and 22,73% were mixed infections, among which 80% were EBV + HHV-6. Most frequently, there were detected the signs of active EBV infection 46,15%, HHV-6 reactivation was detected in 20,51% of cases, active CMV persistence was much less common 7,69%. The active stage of herpesvirus infections was confirmed by the study of brush-smears of the nasopharyngeal mucosa with immunofluorescence test and PCR. In general, the traditional semi-quantitative studies of cultures of bacterial colonies from samples of the pharyngeal tonsil biotope did not reveal a unified causative agent (pathogen) of chronic lymphoproliferative syndrome of ENT organs in young children.

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