Changes Of Neutrophils In Children With Infectious Mononucleosis And Its Influencing Factors

Background and purposeInfectious Mononucleosis(IM)is a kind of acute lymphoproliferative disease of mononucleose-macrophage system caused by primary EBV infection.The Absolute Neutrophil Count(ANC)decreased in 50%～80%of patients in the first few weeks of IM course.The age of onset of IM is different in different regions,studies on neutropenia in IM are mostly carried out in adolescents and adults in western developed countries,while in China,most studies on neutropenia in children with IM are morbidity statistics,and the dynamic change of neutrophil count in the course of IM was rarely analyzed.Based on the current situation,we analyzed the changes of neutrophil count in children with IM to help understand the occurrence time and outcome of neutropenia,and analyzed the risk factors of neutropenia in children with IM,with a view to providing reference for reasonable clinical monitoring of blood routine and application of antiviral drugs.Research object and methodThe clinical data of 196 children with Epstein-Barr virus infectious mononucleosis who were hospitalized in the Department of Pediatrics of the Second Affiliated Hospital of Dalian Medical University from January 2017 to October 2022 were retrospectively analyzed.The patients were divided into IM-ANC reduced group(100 cases)and IM-ANC normal group(96 cases)according to whether there was a decrease in acute neutrophils count(ANC<1.5×10~9/L)during the course of disease.To describe the dynamic changes of neutrophil counts in children with IM,and analyze the relationship between IM with neutropenia and clinical symptoms,laboratory tests,and ganciclovir therapy.Results1.The incidence of neutropenia in IM children was 51.0%.Mild to moderate neutropenia began at mean day 10(7,12)in the course of IM and decreased to its lowest level at the third week.Neutrophil counts returned to normal in 85%of children with IM within 1～2 weeks,and 9 patients developed more severe neutropenia again on day15 to 28 of the course of the disease after the neutrophilic count returned to normal.2.The mean age of the children in the IM-ANC reduction group was higher than that in the normal IM-ANC group,and the incidence of neutropenia was higher in school-age children,with statistical significance(P<0.05).The patients in the IM-ANC reduction group had a later course of disease at admission,a higher incidence of splenomegaly and a longer total heat course,and the differences were statistically significant(P<0.05).3.Compared with the normal IM-ANC group,the positive proportion of Ig M antibody of Mycoplasma pneumoniae and ALT level in the IM-ANC reduced group were higher,and the lymphocyte count,neutrophil count and monocyte count in the first routine blood routine after admission were lower,the differences were statistically significant(P<0.05).4.B lymphocyte count,NK cell count,helper T lymphocyte count and cytotoxic T lymphocyte count in the IM-ANC reduced group were lower than those in the IM-ANC normal group,and the differences were statistically significant(P<0.05),there was no significant difference in the levels of humoral immunity Ig G,Ig M and Ig A between the two groups(P>0.05).5.Splenomegaly,the positive proportion of Ig M antibody of Mycoplasma pneumoniae and neutrophil count on admission were independent risk factors for neutropenia in IM children.The results of receiver operating characteristic curve show that the optimal threshold value of neutrophil count on admission to predict neutropenia in children with IM was 3.015×10~9/L(P<0.001),the area under curve(AUC)value was 0.761,the sensitivity was 0.760,and the specificity was 0.656.6.There was no correlation between the occurrence of neutropenia and ganciclovir therapy in children with IM(P>0.05).Conclusion1.Up to 51%of the children with IM had a transient mild to moderate neutropenia beginning on the mean 10th day of the course of the disease,and it decreased to a minimum at the 3rd week.Close monitoring of neutrophil counts was required for the first 4 weeks of the course of IM.2.More attention should be given to the occurrence of neutropenia in school-age children with IM,especially those with splenomegaly,the positive proportion of Ig M antibody of Mycoplasma pneumoniae and neutrophil count lower than 3.015×10~9/L upon admission.3.Antiviral therapy with ganciclovir does not increase the risk of neutropenia in children with IM,and it is safe and effective for children with IM who have complications or in the early stages of the disease.