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Lee, Chung, Park, Seo, Kim, Yeom, Park, Lim, Woo, and Youn: Clinical features of Epstein-Barr Virus-associated Infectious Mononucleosis According to Age Group in Children
Original Article

Kosin Medical Journal 2018;33(3):347-357.

Published online: 19 January 2018

DOI: https://doi.org/10.7180/kmj.2018.33.3.347

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

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 4 August 201723 October 2017       Accepted 7 November 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.

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.

Keywords: Epstein-Barr Virus Infection, Infectious Mononucleosis, Pediatrics

REFERENCES

1.Higgins CD., Swerdlow AJ., Macsween KF., Harrison N., Williams H., McAulay K, et al. A study of risk factors for acquisition of Epstein-Barr virus and its subtypes. J Infect Dis. 2007. 195:474–82.
crossref
2.Luzuriaga K., Sullivan JL. Infectious mononucleosis. N Engl J Med. 2010. 362:1993–2000.
crossref
3.Bolis V., Karadedos C., Chiotis I., Chaliasos N., Tsabouri S. Atypical manifestations of Epstein-Barr virus in children: a diagnostic challenge. J Pediatr (Rio J). 2016. 92:113–21.
crossref
4.Murata T., Sato Y., Kimura H. Modes of infection and oncogenesis by the Epstein-Barr virus. Rev Med Virol. 2014. 24:242–53.
crossref
5.Moon WY., Oh SH., Ko TS., Park YS., Moon HN., Hong CY, et al. Infectious mononucleosis in children. J Korean Pediatr Soc. 1994. 37:822–31.
6.Choi JS., Kim TH., Park HY., Lim SC. Clinical analysis of infectious mononucleosis. Korean J Otolaryngol-Head Neck Surg. 1997. 40:914–21.
7.Oh SH., Lee YA., Moon WY., Ko TS., Park YS., Moon HN, et al. Prevalence of Epstein-Barr virus (EBV) antibody in Korean children. J Korean Pediatr Soc. 1994. 37:804–11.
8.Son KH., Shin MY. Clinical features of Epstein-Barr virus-associated infectious mononucleosis in hospitalized Korean children. Korean J Pediatr. 2011. 54:409–13.
crossref
9.González Saldaña N., Monroy Colín VA., Piña Ruiz G., Juárez Olguín H. Clinical and laboratory characteristics of infectious mononucleosis by Epstein-Barr virus in Mexican children. BMC Res Notes. 2012. 5:361.
crossref
10.Topp SK., Rosenfeldt V., Vestergaard H., Christiansen CB., Von Linstow ML. Clinical characteristics and laboratory findings in Danish children hospitalized with primary Epstein-Barr virus infection. Infect Dis (Lond). 2015. 47:908–14.
crossref
11.Wang Y., Li J., Ren YY., Zhao H. The levels of liver enzymes and atypical lymphocytes are higher in youth patients with infectious mononucleosis than in preschool children. Clin Mol Heptol. 2013. 19:382–8.
crossref
12.Xiong G., Zhang B., Huang MY., Zhou H., Chen LZ., Feng QS, et al. Epstein-Barr virus (EBV) in-fection in Chinese children: a retrospective study of age-specific prevalence. PLoS One. 2014. 9:e99857.
crossref
13.Dowd JB., Palermo T., Brite J., McDade TW., Aiello A. Seroprevalence of Epstein-Barr virus infection in U.S. children ages 6-19, 2003-2010. PLoS One. 2013. 8:e64921.
crossref
14.Gao LW., Xie ZD., Liu YY., Wang Y., Shen KL. Epidemiologic and clinical characteristics of infectious mononucleosis associated with Epstein-Barr virus infection in children in Beijing, China. World J Pediatr. 2011. 7:45–9.
crossref
15.Odame J., Robinson J., Khodai-Booran N., Yeung S., Mazzulli T., Stephens D, et al. Correlates of illness severity in infectious mononucleosis. Can J Infect Dis Med Microbiol. 2014. 25:277–80.
crossref
16.Ventura KC., Hudnall SD. Hematologic differences in heterophile-positive and heterophile- negative infectious mononucleosis. Am J Hematol. 2004. 76:315–8.
17.Balfour HH Jr., Dunmire SK., Hogquist KA. Infectious mononucleosis. Clin Transl Immunology. 2015. 4:e33.
crossref
18.Balfour HH Jr., Odumade OA., Schmeling DO., Mullan BD., Ed JA., Knight JA, et al. Behavioral, virologic, and immunologic factors associated with acquisition and severity of primary Epstein-Barr virus infection in university students. J Infect Dis. 2013. 207:80–8.
crossref

Fig. 1.
Age distributions of 68 pediatric patients with infectious mononucleosis caused by Epstein-Barr virus infection
kmj-33-347f1.tif
Fig. 2.
Annual number of EBV-associated infectious mononucleosis cases.
kmj-33-347f2.tif
Fig. 3.
Monthly distribution of EBV-associated IM cases in a hospital in Korea.
kmj-33-347f3.tif
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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