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Splenic rupture or infarction associated with Epstein-Barr virus infectious mononucleosis: a systematic literature
Johannes M A Toti1, Beatrice Gatti2, Isabella Hunjan2
1Department of Surgery and Transplantation, University Hospital Zurich Zurich, Switzerland.
Background:
Epstein-Barr virus (EBV), also known as human herpesvirus 4, is one of the most common pathogenic viruses in humans. EBV mononucleosis always involves the spleen and as such it predisposes to splenic rupture, often without a trauma, and splenic infarction. Nowadays the goal of management is to preserve the spleen, thereby eliminating the risk of post-splenectomy infections.
Methods:
To characterise these complications and their management, we performed a systematic review (PROSPERO CRD42022370268) following PRISMA guidelines in three databases: Excerpta Medica, the United States National Library of Medicine, and Web of Science. Articles listed in Google Scholar were also considered. Eligible articles were those describing splenic rupture or infarction in subjects with Epstein-Barr virus mononucleosis.
Results:
In the literature, we found 171 articles published since 1970, documenting 186 cases with splenic rupture and 29 with infarction. Both conditions predominantly occurred in males, 60% and 70% respectively. Splenic rupture was preceded by a trauma in 17 (9.1%) cases. Approximately 80% (n = 139) of cases occurred within three weeks of the onset of mononucleosis symptoms. A correlation was found between the World Society of Emergency Surgery splenic rupture score, which was retrospectively calculated, and surgical management: splenectomy in 84% (n = 44) of cases with a severe score and in 58% (n = 70) of cases with a moderate or minor score (p = 0.001). The mortality rate of splenic rupture was 4.8% (n = 9). In splenic infarction, an underlying haematological condition was observed in 21% (n = 6) of cases. The treatment of splenic infarction was always conservative without any fatal outcomes.
Conclusions:
Similarly to traumatic splenic rupture, splenic preservation is increasingly common in the management of mononucleosis-associated cases as well. This complication is still occasionally fatal. Splenic infarction often occurs in subjects with a pre-existing haematological condition.
Insights
Epstein-Barr virus (EBV) mononucleosis can cause spleen rupture or infarction. Management increasingly focuses on spleen preservation, though rupture remains occasionally fatal, while infarction is treatable conservatively.
Area of Science:
- Infectious Diseases
- Gastroenterology and Hepatology
- Surgical Pathology
Background:
- Epstein-Barr virus (EBV), or human herpesvirus 4, is a common pathogen.
- EBV mononucleosis frequently involves the spleen, increasing risks of rupture and infarction.
- Current management aims to preserve the spleen, avoiding post-splenectomy infections.
Approach:
- A systematic review of PRISMA guidelines was conducted across major databases.
- Searched Excerpta Medica, PubMed, Web of Science, and Google Scholar for relevant articles.
- Included studies detailing splenic rupture or infarction in EBV mononucleosis patients.
Key Points:
- 171 articles documented 186 splenic ruptures and 29 infarctions, predominantly in males.
- Most ruptures (80%) occurred within three weeks of symptom onset; trauma preceded only 9.1% of cases.
- Higher World Society of Emergency Surgery splenic rupture scores correlated with increased splenectomy rates (p=0.001); rupture mortality was 4.8%.
Conclusions:
- Splenic preservation is becoming standard for EBV-associated splenic events, mirroring trauma management.
- Splenic infarction is linked to underlying hematological conditions and treated conservatively without fatalities.
- Despite advances, EBV-associated splenic rupture remains a potentially fatal complication.
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