Clinical characteristics and laboratory examination of Epstein-Barr virus infection and infectious mononucleosis in Chengde

doi:10.3969/j.issn.1004-583X.2023.06.008

Abstract

Abstract:

Objective To explore the clinical characteristics of children with Epstein-Barr virus (EBV) infection and infectious mononucleosis (IM). Methods A total of 72 children with EBV infection and IM infection admitted to Chengde Central Hospital from January 2021 to July 2022 were retrospectively analyzed. They were divided into EBV infection group ( n =37) and IM group ( n =35), and the clinical data of the two groups were compared.Resultss (1) General data: there were no significant differences in gender, age and peak temperature between the two groups ( P >0.05). Compared with that in IM group, the fever time in EBV infection group was significantly shorter ( P <0.05). (2) Initial symptom: fever was the initial symptom in both groups, and there was no significant difference in the incidence of initial symptom between the two groups ( P >0.05). (3) Clinical manifestations: there was no significant difference in the incidence of lymph node enlargement, rash and angina between the two groups ( P >0.05). Compared with that in the IM group, the EBV infection group had a significantly lower incidence of sore throat, eyelid edema, hepatomegaly, splenomegaly, and fever ( P <0.05). (4) Laboratory tests: a total of 20 patients in the two groups received laboratory testing of herpes simplex virus, cytomegalovirus, rubella virus, Mycoplasma pneumoniae, and adenovirus. Rubella virus was detected in all children who received serum virology test, and 17/20 (85%) children were detected with cytomegalovirus infection. There were no significant differences in the percentage of lymphocytes, and monocytes, as well as alanine aminotransferase and aspartate aminotransferase levels between the two groups ( P >0.05). Compared with those in the IM group, the white blood cell count in the EBV infection group was significantly higher, the percentage of abnormal lymphocyte and lactate dehydrogenase were significantly lower ( P <0.05). A total of 19 children in the IM group received immunological tests, and 14/19 (73.7%) had elevated serum immunoglobulin E levels. Nine patients in the EBV group received immunological tests, and 8/9 (88.9%) had elevated serum immunoglobulin E levels. There was no significant difference in the incidence of a higher-than-normal range of immunoglobulin E between the two groups ( P =0.630). (5) Complications: compared with IM group, the incidence of respiratory tract infection in EBV infection group was significantly lower ( P <0.05). There was no significant difference in the incidence of complications of other systems (blood system, liver, kidney, myocardium, digestive tract) ( P >0.05).Conclusion The clinical features of EBV infection differ from those of IM in children. Clinical manifestations like sore throat, eyelid edema, hepatomegaly, splenomegaly, fever, and laboratory tests of white blood cell count, lactate dehydrogenase, and percentage of lymphocytes should be well concerned in children.

Key words: herperirus rype 4, infectious mononucleosis, child, clinical manifestations

CLC Number:

R725.5

Xiao Meng, Cheng Tingting, Ma Qiange, Feng Xiaoying, Li Lihua, Li Tao. Clinical characteristics and laboratory examination of Epstein-Barr virus infection and infectious mononucleosis in Chengde[J]. Clinical Focus, 2023, 38(6): 526-531.

Add to citation manager EndNote|Ris|BibTeX

URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2023.06.008

https://huicui.hebmu.edu.cn/EN/Y2023/V38/I6/526

Figures/Tables 6

Tab.1 Comparison of general data between the two groups

组别	例数	性别[例(%)]		年龄[例(%)]			热峰(℃)	发热时间(天)
组别	例数	男	女	<3岁	3~7岁	>7岁	热峰(℃)	发热时间(天)
EBV感染组	37	22(59.5)	15(40.5)	19(51.4)	9(24.3)	9(24.3)	38.80(37.90,39.50)	5.00(2.50,7.00)
IM组	35	23(65.7)	12(34.3)	15(42.9)	15(42.9)	5(14.3)	39.00(38.60,39.50)	7.00(5.00,8.00)
统计值		χ²=0.300		χ²=3.060			$Z$ =-1.437	$Z$ =-2.511
$P$ 值		0.584		0.217			0.151	0.012

Tab.1 Comparison of general data between the two groups

组别	例数	性别[例(%)]		年龄[例(%)]			热峰(℃)	发热时间(天)
组别	例数	男	女	<3岁	3~7岁	>7岁	热峰(℃)	发热时间(天)
EBV感染组	37	22(59.5)	15(40.5)	19(51.4)	9(24.3)	9(24.3)	38.80(37.90,39.50)	5.00(2.50,7.00)
IM组	35	23(65.7)	12(34.3)	15(42.9)	15(42.9)	5(14.3)	39.00(38.60,39.50)	7.00(5.00,8.00)
统计值		χ²=0.300		χ²=3.060			$Z$ =-1.437	$Z$ =-2.511
$P$ 值		0.584		0.217			0.151	0.012

Fig.1 Incidence of initial symptom in the two groups

Tab.2 Comparison of the initial symptom between the two groups [cases(%)]

组别	例数	发热	眼睑浮肿	鼻塞	颈部肿物	咽痛	鼻出血	肝功能异常
EBV感染组	37	19(51.4)	3(8.1)	3(8.1)	3(8.1)	5(13.5)	1(2.7)	3(8.1)
IM组	35	23(65.7)	7(20.0)	2(5.7)	1(2.9)	2(5.7)	0	0
χ²值		1.527	1.249	0.000	0.209	0.516	0.000	1.279
$P$ 值		0.217	0.264	1.000	0.647	0.472	1.000	0.258

Tab.2 Comparison of the initial symptom between the two groups [cases(%)]

组别	例数	发热	眼睑浮肿	鼻塞	颈部肿物	咽痛	鼻出血	肝功能异常
EBV感染组	37	19(51.4)	3(8.1)	3(8.1)	3(8.1)	5(13.5)	1(2.7)	3(8.1)
IM组	35	23(65.7)	7(20.0)	2(5.7)	1(2.9)	2(5.7)	0	0
χ²值		1.527	1.249	0.000	0.209	0.516	0.000	1.279
$P$ 值		0.217	0.264	1.000	0.647	0.472	1.000	0.258

Tab.3 Comparison of the clinical manifestations between the two groups [cases(%)]

组别	例数	咽痛	眼睑水肿	肝脏肿大	脾脏肿大	发热	淋巴结肿大	皮疹	咽峡炎
EBV感染组	37	20(54.1)	3(8.1)	1(2.7)	16(43.2)	29(78.4)	34(91.9)	5(13.5)	28(75.7)
IM组	35	27(77.1)	27(77.1)	17(48.6)	24(68.6)	34(97.1)	34(97.1)	3(8.6)	29(82.9)
χ²值		4.230	35.267	20.182	4.673	4.202	0.209	0.085	0.562
$P$ 值		0.040	0.000	0.000	0.031	0.040	0.647	0.770	0.453

Tab.3 Comparison of the clinical manifestations between the two groups [cases(%)]

组别	例数	咽痛	眼睑水肿	肝脏肿大	脾脏肿大	发热	淋巴结肿大	皮疹	咽峡炎
EBV感染组	37	20(54.1)	3(8.1)	1(2.7)	16(43.2)	29(78.4)	34(91.9)	5(13.5)	28(75.7)
IM组	35	27(77.1)	27(77.1)	17(48.6)	24(68.6)	34(97.1)	34(97.1)	3(8.6)	29(82.9)
χ²值		4.230	35.267	20.182	4.673	4.202	0.209	0.085	0.562
$P$ 值		0.040	0.000	0.000	0.031	0.040	0.647	0.770	0.453

Tab.4 Comparison of serologic examination between the two groups

组别	例数	白细胞计数 (×10⁹/L)	乳酸脱氢酶 (IU/L)	异型淋巴细胞百分比 (%)	淋巴细胞百分比 (%)	单核细胞百分比 (%)	ALT (IU/L)	AST (IU/L)
EBV感染组	37	14.29±6.40	375.24±108.86	4.00(3.00,7.5)	67.60(62.15,74.05)	7.90(6.25,9.80)	35.00(19.00,123.00)	40.00(31.50,86.00)
IM组	35	11.34±3.61	457.66±125.46	14.00(11.00,20.00)	70.20(58.80,76.10)	7.90(6.61,11.20)	48.00(29.20,111.00)	51.00(32.00,77.00)
统计值		$t$ =-2.391	$t$ =-2.982	$Z$ =-6.838	$Z$ =-0.462	$Z$ =-0.840	$Z$ =-0.766	$Z$ =-0.496
$P$ 值		0.020	0.000	0.000	0.644	0.401	0.444	0.620

Tab.4 Comparison of serologic examination between the two groups

组别	例数	白细胞计数 (×10⁹/L)	乳酸脱氢酶 (IU/L)	异型淋巴细胞百分比 (%)	淋巴细胞百分比 (%)	单核细胞百分比 (%)	ALT (IU/L)	AST (IU/L)
EBV感染组	37	14.29±6.40	375.24±108.86	4.00(3.00,7.5)	67.60(62.15,74.05)	7.90(6.25,9.80)	35.00(19.00,123.00)	40.00(31.50,86.00)
IM组	35	11.34±3.61	457.66±125.46	14.00(11.00,20.00)	70.20(58.80,76.10)	7.90(6.61,11.20)	48.00(29.20,111.00)	51.00(32.00,77.00)
统计值		$t$ =-2.391	$t$ =-2.982	$Z$ =-6.838	$Z$ =-0.462	$Z$ =-0.840	$Z$ =-0.766	$Z$ =-0.496
$P$ 值		0.020	0.000	0.000	0.644	0.401	0.444	0.620

Tab.5 Comparison of complication between the two groups [cases (%)]

组别	例数	血液系统	肝功能损害	呼吸道	肾炎	心肌损害	消化道
EBV感染组	37	5(13.5)	9(24.3)	7(18.9)	0	0	3(8.1)
IM组	35	1(2.9)	10(28.6)	13(37.1)	1(2.9)	0	2(5.7)
χ²值		-	0.167	7.472	-	-	-
$P$ 值		0.202^*	0.683	0.006	0.486^*	-	1.000

Tab.5 Comparison of complication between the two groups [cases (%)]

组别	例数	血液系统	肝功能损害	呼吸道	肾炎	心肌损害	消化道
EBV感染组	37	5(13.5)	9(24.3)	7(18.9)	0	0	3(8.1)
IM组	35	1(2.9)	10(28.6)	13(37.1)	1(2.9)	0	2(5.7)
χ²值		-	0.167	7.472	-	-	-
$P$ 值		0.202^*	0.683	0.006	0.486^*	-	1.000

References 30

[1]	温彩娟, 师永红. EB病毒与淋巴瘤关系的研究进展[J]. 临床与实验病理学杂志, 2021, 37(12):1472-1475.
[2]	沈丽贤, 李学, 陈乐欢, 等. 儿童EB病毒相关性噬血细胞综合征死亡1例分析并文献复习[J]. 罕少疾病杂志, 2021, 28(6):1-3.
[3]	Shi J, Ma W, Li W. Epidemiologic features of children with Epstein-Barr virus associated diseases in Hangzhou, China[J]. J Med Virol, 2020, 92(8):1277-1282. doi: 10.1002/jmv.25633 pmid: 31750545
[4]	Kuri A, Jacobs BM, Vickaryous N, et al. Epidemiology of Epstein-Barr virus infection and infectious mononucleosis in the United Kingdom[J]. BMC Public Health, 2020, 20(1):912. doi: 10.1186/s12889-020-09049-x pmid: 32532296
[5]	徐海芹, 冯征远, 徐晓艳, 等. EB病毒阳性的不同类型淋巴瘤组织中EBNA1多态性研究[J]. 中国病理生理杂志, 2021, 37(11):2057-2061.
[6]	陶佳, 陈福雄, 陈德辉, 等. 儿童EB病毒感染及传染性单核细胞增多症临床特点和实验室检查分析[J]. 中国实用儿科杂志, 2013, 28(3):200-203.
[7]	中华医学会儿科学分会感染学组, 全国儿童EB病毒感染协作组. 儿童EB病毒感染相关疾病的诊断和治疗原则专家共识[J]. 中华儿科杂志, 2021, 59(11):905-911.
[8]	Medovic R, Igrutinovic Z, Radojevic-Marjanovic R, et al. Clinical and laboratory differences between Epstein-Barr and cytomegalovirus infectious mononucleosis in children[J]. Srp Arh Celok Lek, 2016, 144(1-2):56-62. doi: 10.2298/SARH1602056M URL
[9]	翟谨, 徐俊, 何萍, 等. 儿童Epstein-Barr病毒合并肺炎支原体感染的临床特点[J]. 临床荟萃, 2020, 35(2):174-176.
[10]	董荣荣, 迟昆, 吴箫, 等. 儿童噬血细胞性淋巴组织细胞增多症的临床特点、诊断及治疗(附6例分析)[J]. 山东医药, 2021, 61(30):49-52.
[11]	徐嘉良, 郑润辉, 罗晓丹, 等. 伴噬血细胞综合征EB病毒阳性T细胞淋巴瘤患者临床特征及疗效分析[J]. 白血病·淋巴瘤, 2021, 30(11):658-664.
[12]	戴莎莎, 周凯. 重组人干扰素α1b辅助治疗传染性单核细胞增多症疗效的前瞻性随机对照研究[J]. 中国当代儿科杂志, 2020, 22(9):953-957.
[13]	Gonzalez SN, Monroy CV, Pina RG, et al. Clinical and laboratory characteristics of infectious mononucleosis by Epstein-Barr virus in Mexican children[J]. BMC Res Notes, 2012, 5:361. doi: 10.1186/1756-0500-5-361 pmid: 22818256
[14]	宋建刚, 庞随军, 李元霞. 不同年龄段儿童传染性单核细胞增多症实验室检查分析[J]. 中国国境卫生检疫杂志, 2021, 44(06):431-433.
[15]	Wu Y, Ma S, Zhang L, et al. Clinical manifestations and laboratory results of 61 children with infectious mononucleosis[J]. J Int Med Res, 2020, 48(10):1220724102.
[16]	房丽云, 王洁英, 吕梅, 等. NLR、MLR与儿童传染性单核细胞增多症的相关性研究[J]. 中国妇幼健康研究, 2021, 32(11):1672-1675.
[17]	袁丽萍, 王金坤, 范晓晨. 儿童传染性单核细胞增多症的临床特征和流行病学分析[J]. 中国临床研究, 2021, 34(8):1031-1034.
[18]	Gao LW, Xie ZD, Liu YY, et al. Epidemiologic and clinical characteristics of infectious mononucleosis associated with Epstein-Barr virus infection in children in Beijing, China[J]. World J Pediatr, 2011, 7(1):45-49. doi: 10.1007/s12519-011-0244-1 pmid: 21191775
[19]	沈军, 曹凌峰, 施鹏, 等. 原发性EB病毒感染患儿的临床和实验室检查特征分析[J]. 中华传染病杂志, 2020, 38(5):279-282.
[20]	王晓莉, 于洁, 徐酉华, 等. 传染性单核细胞增多症及其相关疾病临床特点分析[J]. 中国实用儿科杂志, 2006(9):696-698.
[21]	刘姜艳, 孙军, 茆康卫, 等. 儿童传染性单核细胞增多症免疫功能变化与肝功能损害相关性研究[J]. 中国医药导报, 2022, 19(3):91-94.
[22]	陈天明, 苗亦青, 耿竹馨, 等. 原发性EB病毒感染3岁以下儿童住院病例的临床特征[J]. 中华实用儿科临床杂志, 2016, 31(22):1700-1704.
[23]	Fedyanina OS, Filippova AE, Demina OI, et al. The Nature and Clinical Significance of Atypical Mononuclear Cells in Infectious Mononucleosis Caused by the Epstein-Barr Virus in Children[J]. J Infect Dis, 2021, 223(10):1699-1706. doi: 10.1093/infdis/jiaa601 pmid: 32959062
[24]	顾晓红. EB病毒感染后儿童呼吸系统临床特征分析[D]. 吉林大学, 2022.
[25]	桑艳峰, 孟林, 冯会颖, 等. EB病毒感染相关肺炎患儿的临床特征分析[J]. 中华医院感染学杂志, 2020, 30(9):1407-1411.
[26]	胡岩岩, 潘家华, 周浩泉. 儿童传染性单核细胞增多症临床及实验室检查特点分析[J]. 中华全科医学, 2021, 19(9):1510-1513.
[27]	王晓娟, 贾莉, 刘俊莹, 等. 甲泼尼龙琥珀酸钠联合免疫球蛋白治疗小儿重症传染性单核细胞增多症的临床研究[J]. 中国医院用药评价与分析, 2021, 21(12):1441-1444.
[28]	刘四喜. 静脉注射用免疫球蛋白在儿童血液/肿瘤性疾病中应用的儿科专家共识[J]. 中国当代儿科杂志, 2021, 23(4):319-327.
[29]	王曼丽, 汤继宏, 赵东敬, 等. EB病毒侵犯幼儿小脑1例报告并文献复习[J]. 中国妇幼健康研究, 2021, 32(10):1537-1540.
[30]	Jenson HB. Acute complications of Epstein-Barr virus infectious mononucleosis[J]. Curr Opin Pediatr, 2000, 12(3):263-268. doi: 10.1097/00008480-200006000-00016 pmid: 10836164