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Original Article
Clinical features of Epstein-Barr Virus-associated Infectious Mononucleosis According to Age Group in Children
Soram Lee1, Ju-Young Chung2, Jung Je Park3, Ji-Hyun Seo1, Jae Young Kim4, Jung Sook Yeom1, Eun-Sil Park1, Jae-Young Lim1, Hyang-Ok Woo1, Hee-Shang Youn1
Kosin Medical Journal 2018;33(3):347-357.
DOI: https://doi.org/10.7180/kmj.2018.33.3.347
Published online: January 19, 2018

1Department of Pediatrics, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science, Jinju, Korea

2Department of Pediatrics, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea

3Department of Otolaryngology, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science, Jinju, Korea

4Department of Pediatrics, Gyeongsang National University Hospiratal, Changwon, Korea

Corresponding Author: Ji-Hyun Seo, Department of Pediatrics, Gyeongsang National University School of Medicine, 79, Gangnam-ro, Jinju-Si, Gyeongsangnam-do 52727, Korea Tel: +82-55-750-8731 Fax: +82-55-752-9339 E-mail: seozee@gnu.ac.kr
• Received: August 4, 2017   • Revised: October 23, 2017   • Accepted: November 7, 2017

Copyright © 2018 Kosin University School of Medicine Proceedings

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Objectives
    Few studies of pediatric Epstein-Barr virus (EBV)-associated infectious mononucleosis (IM) have been conducted in Korea. We evaluated the clinical features of children with IM to define differences according to age.
  • Methods
    We conducted retrospective chart reviews of 68 children aged 0 to 15 years who were diagnosed by EBV-associated IM with EBV-Viral Capsid Antigen(VCA) IgM at laboratory test and were admitted between 2010 and 2014. The children were classified into four age groups: aged 0–3, 4–6, 7–9, and 10–15 years.
  • Results
    The age distribution of patients was as follows: 19 (27.9%) 0–3, 25 (36.8%) 4–6, 13 (19.1%) 7–9, and 11 (16.2%) 10–15. Fever was the most common presentation regardless of age. It was more common in the 0–3 group than the 4–6 group (P = 0.018). Pharyngitis was more common in the 7–9 group than the 0–3 group (P = 0.048), and myalgia was more common in the 10–15 group than the 0–3 group (P = 0.007). Pharyngitis was accompanied by lymphadenopathy, protracted fever, and rash. In the 0–3 age group, the prevalence of rash was higher while the percentage of atypical lymphocytes was lower, but there was no statistical support for this tendency. There were no differences in the frequency of hepatosplenomegaly or laboratory findings between age groups.
  • Conclusions
    IM is not uncommon in young children and its clinical presentation varies with age. Therefore, IM should be suspected in young febrile children with pharyngitis and rash despite low percentages of atypical lymphocytes.
  • Keywords: Epstein-Barr Virus Infection; Infectious Mononucleosis; Pediatrics
Fig. 1.
Age distributions of 68 pediatric patients with infectious mononucleosis caused by Epstein-Barr virus infection
kmj-33-347f1.jpg
Fig. 2.
Annual number of EBV-associated infectious mononucleosis cases.
kmj-33-347f2.jpg
Fig. 3.
Monthly distribution of EBV-associated IM cases in a hospital in Korea.
kmj-33-347f3.jpg
Table 1.
Age and Sex Distribution
Age (y) No. of cases Total(%)
Female (%) Male (%)
0-3 10(52.6) 9(47.4) 19(27.9)
4-6 8(32.0) 17(68.0) 25(36.8)
7-9 6(46.2) 7(53.8) 13(19.1)
10-15 3(27.3) 8(72.7) 11(16.2)
Total 27(39.7) 41(60.3) 68(100.0)
Table 2.
Frequency of signs and symptoms associated with infectious mononucleosis according to age group
0-3 y (n=19) 4-6 y (n=25) 7-9 y (n=13) 10-15 y (n=11) Total (n=68) P-value
Fever* 19 (100) 16 (64.0) 12 (92.3) 9 (81.8) 56 (82.4) 0.011
Lymphadenopathy† 7 (36.8) 16 (64.0) 11 (84.6) 9 (81.8) 43 (63.2) 0.017
Pharyngitis 4 (21.1) 9 (36.0) 9 (69.2) 7 (63.6) 29 (42.6) 0.018
Rashes 8 (42.1) 3 (12.0) 3 (23.1) 1 (9.1) 15 (22.1) 0.072
Myalgia 0 (0) 1 (4.0) 1 (7.7) 4 (36.4) 6 (8.8) 0.003
Hepatomegaly 3 (15.8) 4 (16.0) 7 (53.8) 1 (9.1) 15 (22.1) 0.019
Splenomegaly 3 (15.8) 5 (20.0) 7 (53.8) 2 (18.2) 17 (25.0) 0.064

Values are presented as number(%).

Table 3.
Laboratory findings by patient age group
0-3 y 4-6 y 7-9 y 10-15 y Total (±S.D.) P-value
WBC (/μL) 13,754 13,217 10,083 9,204 12,119±6,338 0.029
Lym (%) 45.8 54.3 51.9 55.6 51.7±19.8 0.474
Atypical lym (%) 5.2 13.2 14.9 12.4 11.2±17.3 0.361
Hb (g/dL) 12.1 11.9 12.3 13.3 12.3±1.0 0.001
Plt (×103/μL) 266 222 215 234 244±95.9 0.474
T. bil (mg/dL) 0.5 0.5 0.6 0.5 0.5±0.5 0.966
AST (IU/L) 66.4 76.6 110.9 73.2 79.8±83.1 0.499
ALT (IU/L) 105.8 83.9 121.5 73.1 95.4±161.7 0.867
LDH (IU/L) 365.8 421.4 518.3 376.9 417.2±176.4 0.088
CRP (mg/L) 17.7 16.7 14.2 10.8 15.5±20.4 0.818
Table 4.
Frequency of abnormal laboratory findings among 68 pediatric patients with Epstein-Barr virus-associated infectious mononucleosis
0-3 y 4-6 y 7-9 y 10-15 y Total
Leukopenia* 0 1 (4.0) 1 (7.6) 0 (0) 2 (2.9)
Leukocytosis† 3 (15.8) 1 (4.0) 0 (0) 0 (0) 4 (5.9)
Thrombocytopenia 2 (10.5) 3 (12.0) 3 (23.1) 3 (27.3) 11 (16.2)
Elevated AST or ALT 8 (42.1%) 13 (52.0) 8 (61.5) 5 (45.5) 34 (50.0)
Elevated T.bil 1 (5.2) 1 (4.0) 1 (7.6) 1 (9.1) 4 (5.9)
Elevated LDH 4 (21.1) 8 (32.0) 6 (46.2) 1 (9.1) 19 (27.9)

Values are presented as number(%). *Leukopenia is defined as less than 3,000/mm3 of WBC counts †Leukocytosis is defined as more than of 20,000/mm3 WBC counts

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    • The Nature and Clinical Significance of Atypical Mononuclear Cells in Infectious Mononucleosis Caused by the Epstein-Barr Virus in Children
      Olga S Fedyanina, Anna E Filippova, Olga I Demina, Olga A Zhuliabina, Dmitry S Tikhomirov, Alexander V Filatov, Tatiana A Chebotareva, Sofya A Kuznetsova
      The Journal of Infectious Diseases.2021; 223(10): 1699.     CrossRef

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      Clinical features of Epstein-Barr Virus-associated Infectious Mononucleosis According to Age Group in Children
      Kosin Med J. 2018;33(3):347-357.   Published online January 19, 2018
      DOI: https://doi.org/10.7180/kmj.2018.33.3.347
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