SARS-CoV-2 Infection Is Associated With an Increased Risk of Hospital-Treated Infectious Mononucleosis due to EBV:...

Area of Science:

• Immunology
• Infectious Diseases
• Epidemiology

Background:

• Persistent immune dysregulation following SARS-CoV-2 infection is hypothesized to increase susceptibility to other infections.
• Epstein-Barr virus infectious mononucleosis (EBV-IM) is a common viral illness.
• The potential link between SARS-CoV-2 and subsequent EBV-IM has not been extensively studied.

Purpose of the Study:

• To investigate the association between SARS-CoV-2 infection and the subsequent diagnosis of EBV-IM.
• To determine if the severity of COVID-19 influences the risk of developing EBV-IM.

Main Methods:

• A population-based cohort study in Sweden (January 2020 - November 2022) included 9,978,860 participants aged 3-100 without prior EBV-IM diagnosis.
• Participants were categorized into: no COVID-19, SARS-CoV-2 positive PCR test only (less severe), and hospitalized COVID-19 (more severe).
• Cox regression analysis was used to estimate hazard ratios (HR) for EBV-IM, adjusting for demographic and clinical factors.

Main Results:

• The incidence rate of EBV-IM per 100,000 person-years was 4.6 (no COVID-19), 7.8 (PCR positive only), and 10.5 (hospitalized COVID-19).
• Adjusted HR for EBV-IM was 1.61 (95% CI 1.39-1.88) for SARS-CoV-2 PCR positive individuals and 5.71 (95% CI 3.33-9.79) for hospitalized COVID-19 patients, compared to those without COVID-19.
• A significant association was observed between SARS-CoV-2 infection and increased risk of EBV-IM, even in less severe cases.

Conclusions:

• SARS-CoV-2 infection is associated with a significantly increased risk of subsequent EBV-IM diagnosis.
• This association persists even with less severe acute SARS-CoV-2 infection, indicating potential immune perturbation.
• The findings suggest that COVID-19 may trigger delayed sequelae, such as EBV-IM, highlighting the broader impact on immune function.