Comprehensive insights into pediatric infectious mononucleosis: a retrospective study

The objectives of this study were to identify clinical and laboratory markers of infectious mononucleosis (IM) in children, investigate the risk factors for liver damage and prolonged hospitalization, and enhance Epstein-Barr virus (EBV) diagnostic precision.

This retrospective study analyzed 288 pediatric IM cases hospitalized from January 2023 to December 2024. Clinical features, laboratory parameters, and EBV-DNA loads were evaluated using statistical analyses to identify predictors of disease severity and outcomes.

Among the 288 children (median age: 5 years; 48.3% male), fever, cervical lymphadenopathy, creatine kinase (CK), IgM, and CD4/CD8 ratios were significantly associated with high EBV-DNA load. Liver damage (35.1% of cases) correlated with age, splenomegaly, alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyltransferase (GGT), lactate dehydrogenase (LDH), ferritin, and immune markers (p < 0.05). Prolonged hospitalization was associated with hepatomegaly, ALT, AST, GGT, LDH, and ferritin levels (p < 0.05). Multivariate analysis identified fever as a predictor of high EBV-DNA load; while age, LDH, and ferritin were independent risk factors for liver damage. Hepatomegaly was a key predictor of extended hospitalization (p < 0.05).

IM predominantly affected children aged 3-7 years in Hangzhou. Fever predicted high EBV-DNA load, while elevated LDH, ferritin, and hepatomegaly signaled increased risks of liver damage and prolonged hospitalization, informing more precise management strategies.