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Airway obstruction in children with infectious mononucleosis
1Department of Otolaryngology, Head and Neck Surgery, Medical College of Virginia/Virginia Commonwealth University and Children's Hospital, Richmond, 23298-0416, USA.
Insights
Epstein-Barr Virus (EBV) infection can cause severe upper airway obstruction in children. Prompt recognition and management by otolaryngologists are crucial for patient outcomes.
Area of Science:
- Otolaryngology
- Pediatric Infectious Diseases
- Respiratory Medicine
Background:
- Epstein-Barr Virus (EBV) infection, commonly known as infectious mononucleosis, typically presents with mild symptoms.
- While EBV is often associated with adolescents, its occurrence in younger children is increasingly recognized.
- Upper airway obstruction is a recognized, albeit less common, complication of EBV infection.
Observation:
- A review of 36 pediatric admissions for infectious mononucleosis over 12 years identified 11 cases requiring consultation for airway obstruction.
- Airway compromise varied in severity, necessitating diverse management strategies.
- A rare case involved a four-year-old experiencing near-total upper airway obstruction due to extensive pharyngeal and transglottic inflammation.
Findings:
- Pediatric infectious mononucleosis can lead to significant upper airway obstruction.
- Management approaches ranged from conservative observation and stenting to invasive interventions like intubation and surgery.
- The severity of obstruction was directly related to the degree of inflammatory edema.
Implications:
- Otolaryngologists must be vigilant for potential airway compromise in pediatric EBV infections.
- Timely and appropriate airway management is critical for preventing severe complications.
- Awareness of EBV's potential for severe respiratory distress in children is essential for pediatric healthcare providers.
Abstract:
Epstein-Barr Virus (EBV) infection generally has a benign clinical course. Upper airway obstruction is a known complication requiring the otolaryngologist's attention. EBV is usually associated with adolescence but has been increasingly documented in younger children. We review 36 pediatric admissions for infectious mononucleosis over a 12-year period at our institution, 11 of which required consultation for airway obstruction. Airway management was based on clinical severity and ranged from monitored observation, with or without nasopharyngeal stenting, to prolonged intubation or emergent tonsilloadenoidectomy. A rare case of a four-year-old with near total upper airway obstruction secondary to panpharyngeal and transglottic inflammatory edema prompted this review and is reported. The otolaryngologist must recognize the potential severity of EBV-related airway compromise and be prepared to manage it.