Abstract
-
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.
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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.
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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
Fig. 2.Annual number of EBV-associated infectious mononucleosis cases.
Fig. 3.Monthly distribution of EBV-associated IM cases in a hospital in Korea.
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 |
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) |
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Citations
Citations to this article as recorded by
- 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
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