We investigated clinical characteristics of real-time PCR proven EBV viremia patients who were not serologically diagnosed but clinically suspected, and compared it to serologically proven EBV infected patients.

The study population consisted of 45 patients, who were suspected acute EBV infection at Wonju Christian Hospital Department of Pediatrics, Yonsei University Wonju College of Medicine from Jan. 2004 to Dec. 2006. real-time PCR of cell free serum was performed to prove EBV viremia. Then we chose 102.5 copies/µg DNA as a suitable cutoff level for EBV associated diseases.

There are 4 patients diagnosed as EBV infection by serologically and 15 patients diagnosed as EBV viremia by real-time PCR quantitative measurement. The most common presenting symptoms and signs of EBV viremia was fever in 11 cases (73%). Atypical lymphocytosis was found in 4 cases (27%). Increased AST, ALT levels were observed in 13 cases (87%), 12 cases (80%), respectively. We could diagnose 5 cases of EBV viremia younger than one year of age. They revealed clinical symptoms which could be found in EBV infection. The serologically diagnosed patients had hepatomegaly and splenomegaly in 3 cases (75%). All serologically confirmed patients have leukocytosis above 20,000/mm³, among them 2 cases (50%) had higher percentage (>15%) of atypical lymphocytes. The AST/ALT level above 50 IU/L were demonstrated in all cases.

Serologically unproven real-time PCR EBV viremia patients revealed similar clinical findings with that of serologically proven EBV infected patients. So, it is meaningful to perform EBV real-time PCR for the diagnosis of EBV infection especially for the cases younger than 1 year of age.