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Separation of Immune Cell Subpopulations in Peripheral Blood Samples from Children with Infectious Mononucleosis
Published on: September 7, 2022
Retrospective Review of Children Hospitalized for Epstein-Barr Virus-Related Infectious Mononucleosis
Shufeng Tian1, Jinjun Zheng1, Zhe Zhou2,3
1Department of Infectious Diseases, Shenzhen Children's Hospital, Shenzhen 518038, China.
Insights
Epstein-Barr virus (EBV)-related infectious mononucleosis (IM) in children can have prolonged fever and liver issues. Specific lab markers predict these, and antiviral therapy may not be beneficial in uncomplicated cases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Virology
Background:
- Epstein-Barr virus (EBV) causes infectious mononucleosis (IM), a common childhood illness.
- Understanding EBV-IM clinical features, complications, and treatment is crucial for pediatric care.
Purpose of the Study:
- To investigate clinical characteristics, complications, and treatment outcomes of EBV-IM in children.
- To identify risk factors for prolonged fever and abnormal liver function in pediatric EBV-IM.
Main Methods:
- Retrospective analysis of 2660 children with confirmed EBV-IM.
- Data collection on demographics, clinical signs, lab results, complications, and outcomes.
- Logistic regression to identify risk factors for prolonged fever and liver dysfunction.
Main Results:
- Elevated ferritin and atypical lymphocytes predicted prolonged fever; elevated LDH and lower CD4% predicted liver dysfunction.
- Complications occurred in 24.46% of patients without co-infections; bronchitis was most common.
- Antiviral therapy, especially with corticosteroids or IVIG, prolonged fever and hospital stay.
Conclusions:
- Ferritin, atypical lymphocyte percentage, LDH, and CD4% are key predictors for prolonged fever or liver issues in EBV-IM.
- Antiviral therapy may not benefit uncomplicated EBV-IM cases.
- Tailored treatment strategies are needed to improve outcomes in pediatric EBV-IM.
Objectives:
Our objective was to investigate the clinical characteristics, complications, and treatment outcomes of Epstein-Barr virus (EBV)-related infectious mononucleosis (IM) in children and to identify risk factors associated with prolonged fever and abnormal liver function.
Methods:
This retrospective study included 3006 children admitted to Shenzhen Children's Hospital from May 2009 to April 2024 with suspected EBV-related IM. After excluding cases without etiological evidence and those with underlying diseases, 2660 cases were analyzed. Data on demographics, clinical manifestations, laboratory findings, complications, and treatment outcomes were collected. Logistic regression was used to identify risk factors for prolonged fever and abnormal liver function.
Results:
Among the 2660 confirmed cases, patients ranged from 8 months to 17 years of age, with a median age of 4 years and a male-to-female ratio of 1.46:1. Co-infections were identified in 369 (13.9%) patients, predominantly with Group A Streptococcus. Complications occurred in 560 (24.46%) of the 2289 patients without co-infections, with bronchitis being the most common (42.68%). Elevated ferritin and atypical lymphocyte percentage were associated with prolonged fever (p < 0.001), while elevated lactate dehydrogenase (LDH) and a lower CD4% predicted abnormal liver function (p < 0.001). Antiviral therapy did not shorten fever duration or hospital stay but prolonged both when combined with corticosteroids or intravenous immunoglobulin (IVIG) (p < 0.001).
Conclusions:
Specific laboratory markers such as ferritin, atypical lymphocyte percentage, LDH, and CD4% are important predictors of prolonged fever or liver dysfunction in EBV-IM. Our findings suggest that antiviral therapy may not be beneficial in uncomplicated cases and highlight the need for tailored treatment strategies to optimize patient outcomes.
