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Abstract
Background
Infectious mononucleosis (IM) is typically caused by Epstein-Barr virus (EBV), but can also be caused by drugs and other pathogens, such as cytomegalovirus (CMV) and hepatitis B virus. It shows a wide range of clinical and laboratory characteristics, which are presumed to be dependent on the patient age during the primary infection. This report describes the clinical features of hospitalized adults who developed EBV- or CMV-induced IM.
Methods
The medical records of adult patients, diagnosed as EBV- or CMV-induced IM at the Hallym Medical Center and Dankook University Hospital, between January 1999 and July 2004, were retrospectively reviewed.
Results
The analysis included 23 patients, consisting of 16 with EBV-induced IM and 7 with CMV-induced IM. Many of these patients were hospitalized under the impressions of either acute pharyngitis, acute hepatitis, fever of unknown origin or a malignant lymphoma. The vast majority of patients initially demonstrated lymphocytosis, with atypical lymphocytes. While patients younger than 20 years of age, usually presented with the classic triad of symptoms; IM-fever, pharyngitis and lymphadenopathy; those over the age of 20 often presented without pharyngitis or lymphadenopathy. There were no significant differences in the laboratory findings between EBV- and CMI-induced IM. Compared with patients with EBV-induced IM, however, those with CMV-induced IM were more likely to have abdominal pain (12.5% vs. 57%, P=0.04) and nausea or vomiting (25% vs. 75%, P=0.07), but less likely to have pharyngitis (69% vs. 14%, P=0.03) and cervical lymphadenopathy (75% vs. 14%, P=0.01).
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REFERENCES
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Table 1.
Initial impression on admission in 23 adult patients with infectious mononucleosis
| Initial impression∗ | Patients (N) |
|---|---|
| Acute pharyngitis | 10 (43%) |
| Acute hepatitis | 7 (30%) |
| Fever of unknown origin | 6 (26%) |
| Infectious mononucleosis | 6 (26%) |
| Tonsillitis | 4 (17%) |
| Tuberculosis lymphadenitis | 3 (13%) |
| Malignant lymphoma | 3 (13%) |
| Typhoid fever | 1 (4%) |
| Malaria | 1 (4%) |
| Acute gastroenteritis | 1 (4%) |
Table 2.
Demographic and clinical features on admission in adults with infectious mononucleosis
| Characteristics | Total (N=23) | EBV-induced IM (N=16) | CMV-induced IM (N=7) | P-value∗ |
|---|---|---|---|---|
| Age (years) | ||||
| Median (range) | 22 (18～56) | 21 (18～56) | 23 (18～39) | |
| Mean±SD | 28±12.9 | 29±15 | 25±7 | 0.42 |
| Sex | ||||
| Male: Female | 11: 12 | 8: 8 | 3: 4 | 1.0 |
| Symptoms (%) | ||||
| Fever (＞38.5°C) | 21 (91%) | 14 (87.5%) | 6 (100%) | 0.33 |
| Headache | 12 (52%) | 7 (44%) | 5 (71%) | 0.37 |
| Sore throat | 15 (65%) | 13 (81%) | 2 (28.5%) | 0.03 |
| Myalgia | 14 (61%) | 11 (69%) | 3 (43%) | 0.37 |
| Nausea or Vomiting | 9 (39%) | 4 (25%) | 5 (71%) | 0.07 |
| Abdominal pain | 6 (26%) | 2 (12.5%) | 4 (57%) | 0.04 |
| Cough or Sputum | 8 (35%) | 5 (31%) | 3 (43%) | 0.66 |
| Signs (%) | ||||
| Pharyngitis | 12 (52%) | 11 (69%) | 1 (14%) | 0.03 |
| PTH | 7 (30%) | 6 (37.5%) | 1 (14%) | 0.37 |
| Lymphadenopathy | 17 (74%) | 14 (87.5%) | 3 (43%) | 0.04 |
| Only cervical | 13 (56.5%) | 12 (75%) | 1 (14%) | 0.01 |
| Generalized | 5 (22%) | 3 (19%) | 2 (28.5%) | 0.62 |
| Splenomegaly | 10 (43%) | 8 (50%) | 2 (28.5%) | 0.40 |
| Hepatomegaly | 7 (30%) | 5 (31%) | 2 (28.5%) | 1.0 |
| Skin rash | 2 (9%) | 3 (12.5%) | 0 (0%) | 1.0 |
| Jaundice | 1 (4%) | 1 (6%) | 0 (0%) | 1.0 |
| Use of Antibiotics (%) | 10 (43%) | 10 (62.5%) | 0 (0%) | 0.01 |
| Admission duration (days) | 7.5±3.4 | 7.6±3.0 | 7.0±4.4 | 0.72 |
Table 3.
Laboratory values of adult patients with infectious mononucleosis
| Laboratory values (mean±SD) | Total (N=23) | EBV-induced IM (N=16) | CMV-induced IM (N=7) | P-value∗ |
|---|---|---|---|---|
| Hemoglobin (g/dL) | 12.9±1.3 | 12.7±1.1 | 13.5±1.6 | 0.27 |
| White blood count (cell/mm3) | 11092±7689 | 10093±5252 | 13375±11794 | 0.50 |
| Neutrophil (%) | 33.1±8.4 | 33.6±8.4 | 31.9±9.1 | 0.69 |
| Monocytes (%) | 7.1±2.6 | 6.9±2.3 | 7.4±3.2 | 0.74 |
| Lymphocytes (%) | 57.9±10.0 | 57.9±10.4 | 57.9±10.2 | 0.99 |
| Platelets (103 cells/mm3) | 176±87 | 173±94 | 186±73 | 0.70 |
| Atypical lymphocytes (%) | 23.9±12.5 | 23.3±13.1 | 25.3±11.8 | 0.73 |
| Total bilirubin (mg/dL) | 0.74±0.79 | 0.84±0.94 | 0.51±0.12 | 0.18 |
| AST (IU/L) | 213±187 | 176±158 | 297±233 | 0.16 |
| ALT (IU/L) | 295±287 | 268±238 | 357±392 | 0.51 |
| Alkaline phosphatase (IU/L) | 412±297 | 373±275 | 501±348 | 0.35 |
| LDH (IU/L) | 904±335 | 854±288 | 1020±424 | 0.28 |
| ESR (mm/hour) | 20.9±16.8 | 23.0±16.6 | 16.4±18.4 | 0.51 |
| CRP (mg/L) | 10.7±8.3 | 10.3.±8.7 | 11.5±8.2 | 0.78 |
∗ P-values were calculated from the comparison of patients with EBV-induced IM and patients with CMV-induced IM. Abbreviations: ALT, alanine aminotransferase; AST, aspartate aminotransferase; CMV, cytomegalovirus; CRP, C-reactive protein; EBV, Epstein-Barr virus; ESR, erythrocyte sedimentation rate; IM, infectious mononucleosis; LDH, lactate dehydrogenase; SD, standard deviation.
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