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Clinical features of Epstein-Barr Virus-associated Infectious Mononucleosis According to Age Group in Children

Article information

Kosin Med J. 2018;33(3):347-357
Publication date (electronic) : 2018 January 19
doi : https://doi.org/10.7180/kmj.2018.33.3.347
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 2017 August 04; 2017 October 23; Accepted 2017 November 07.

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.

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.

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.

Age and Sex Distribution

Frequency of signs and symptoms associated with infectious mononucleosis according to age group

Laboratory findings by patient age group

Frequency of abnormal laboratory findings among 68 pediatric patients with Epstein-Barr virus-associated infectious mononucleosis

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Article information Continued

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

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