EBV-DNA load: A predictor of immune and hepatic dysfunction in pediatric infectious mononucleosis

Epstein-Barr virus (EBV)-induced infectious mononucleosis (IM) is a prevalent pediatric condition with diverse clinical manifestations. This study aimed to investigate the relationship between EBV-DNA load, lymphocyte subsets, serum biomarkers, and hepatic dysfunction in pediatric IM. A retrospective analysis was conducted on 318 pediatric IM patients admitted between January 2022 and July 2024. Blood samples collected during the patients' initial visits were subjected to comprehensive testing. Patients were stratified into three groups based on EBV-DNA load: low (<10⁴ copies/mL), medium (10⁴-10⁶ copies/mL), and high (>10⁶ copies/mL). Clinical features, lymphocyte subsets, serum biomarkers, and liver function parameters were analyzed. Compared to the low-load group, the high-load group demonstrated significantly elevated alanine aminotransferase (ALT), aspartate aminotransferase (AST), and CD8+ T cell counts, along with reduced platelet (PLT) levels, prealbumin (PA), CD4+ T cells, and CD4+/CD8+ ratios (P < 0.05). The high-load group also exhibited longer hospital stays. Receiver operating characteristic (ROC) curve analysis revealed that ALT, AST, and the CD4+/CD8+ ratio were strong predictors of high EBV-DNA load. In pediatric IM, higher EBV-DNA loads are associated with more severe hepatic injury and immune dysfunction. These findings highlight the critical role of early stratified management based on EBV-DNA load to prevent complications.