Epstein Barr virus and Cytomegalovirus reactivation in patients with chronic laryngotracheitis

Abstract

Objective: Determine the prevalence of reactivation of Ebstein Barr virus (EBV) and Cytomegalovirus (CMV) in patients with chronic laryngotracheitis (CLTR). Methods:A retrospective case series of 507 patients presenting with a chief complaint of hoarseness, sore throat, difficulty swallowing, or cough for greater than six weeks was performed. Patients were included if stroboscopic exam showed laryngeal/tracheal inflammation and serology for EBV and CMV was done. SPSS was used to analyze prevalence of elevated IgG to EBV Nuclear Antigen (EBNA), EBV Viral Capsid Antigen (EB VCA), EBV Early Antigen (EBV EA) and CMV IgG in whole study sample, each symptom group and symptom duration category (1-3 months, 4-6 months, and >6 months).Results: 193 (38%) patients were EBV EA seropositive with mean titer of 1.81 while 157 (33%) had elevated CMV IgG (mean = 6.1). 48% of patients with cough had significantly elevated EBV EA IgG while 35% showed elevated CMV Immunoglobulins. Among difficulty swallowing and sore throat groups, 34% and 46% were highly seropositive to EBV EA compared to 30% and 15% with elevated CMV IgG. 50 % of the patients in the 4-6 month duration of illness group had elevated EBV EA IgG compared to 42% and 38% in 1-3 months and > 6 months duration respectively. Conclusion:The prevalence of EBV and CMV reactivation in immunocompetent patients with CLTR is significant, may be more common in the patient with symptoms of intermediate duration, and may indicate reactivation of EBV and CMV as a cofactor in CLTR.