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Open Access Research article

Relationship between Non-Hodgkin’s lymphoma and blood levels of Epstein-Barr Virus in children in north-western Tanzania: a case control study

Rogatus Kabyemera1*, Nestory Masalu2, Peter Rambau3, Erasmus Kamugisha4, Benson Kidenya4, Anita De Rossi5, Maria Raffaella Petrara5 and Damas Mwizamuholya1

Author affiliations

1 Department of Pediatrics and Child Health, Bugando Medical Centre, P.O. Box 1370, , Mwanza, Tanzania

2 Department of Oncology, Bugando Medical Centre, P.O. Box 1370, , Mwanza, Tanzania

3 Department of Pathology, Catholic University of Health and Allied Sciences – Bugando, P.O. Box 1464, , Mwanza, Tanzania

4 Department of Biochemistry and Molecular Biology, Catholic University of Health and Allied Sciences – Bugando, P.O. Box 1464, , Mwanza, Tanzania

5 Department of Surgery, Oncology and Gastroenterology, Section of Oncology and Immunology, University of Padova, Unit of Viral Oncology, IOV-IRCCS, Via Gattamelata 64, 35128, Padova, Italy

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Citation and License

BMC Pediatrics 2013, 13:4  doi:10.1186/1471-2431-13-4

Published: 7 January 2013

Abstract

Background

Non-Hodgkin’s Lymphomas (NHL) are common in African children, with endemic Burkitt’s lymphoma (BL) being the most common subtype. While the role of Epstein-Barr Virus (EBV) in endemic BL is known, no data are available about clinical presentations of NHL subtypes and their relationship to Human Immunodeficiency Virus (HIV) infection and Epstein Barr Virus (EBV) load in peripheral blood of children in north-western, Tanzania.

Methods

A matched case control study of NHL subtypes was performed in children under 15 years of age and their respective controls admitted to Bugando Medical Centre, Sengerema and Shirati district designated hospitals in north-western, Tanzania, between September 2010 and April 2011. Peripheral blood samples were collected on Whatman 903 filter papers and EBV DNA levels were estimated by multiplex real-time PCR. Clinical and laboratory data were collected using a structured data collection tool and analysed using chi-square, Fisher and Wilcoxon rank sum tests where appropriate. The association between NHL and detection of EBV in peripheral blood was assessed using conditional logistic regression model and presented as odds ratios (OR) and 95% confidence intervals (CI).

Results

A total of 35 NHL cases and 70 controls matched for age and sex were enrolled. Of NHLs, 32 had BL with equal distribution between jaw and abdominal tumour, 2 had large B cell lymphoma (DLBCL) and 1 had NHL-not otherwise specified (NHL-NOS). Central nervous system (CNS) presentation occurred only in 1 BL patient; 19 NHLs had stage I and II of disease. Only 1 NHL was found to be HIV-seropositive. Twenty-one of 35 (60%) NHL and 21 of 70 (30%) controls had detectable EBV in peripheral blood (OR = 4.77, 95% CI 1.71 – 13.33, p = 0.003). In addition, levels of EBV in blood were significantly higher in NHL cases than in controls (p = 0.024).

Conclusions

BL is the most common childhood NHL subtype in north-western Tanzania. NHLs are not associated with HIV infection, but are strongly associated with EBV load in peripheral blood. The findings suggest that high levels of EBV in blood might have diagnostic and prognostic relevance in African children.

Keywords:
Non-Hodgkin’s Lymphoma; Children; HIV; EBV