| Objective:To analyze the clinical data of adult patients with infectious mononucleosis(IM)under different infection states,summarize the clinical characteristics of IM patients under different infection states,strengthen the understanding of EBV infection,and provide reference for clinical diagnosis and treatment of patients with EBV infection.Methods:136 adult patients diagnosed as IM in the inpatient medical record system of the First Hospital of Jilin University from January 2011 to December 2021 were included in this study.The patients were divided into primary infection group and reactivation group according to the results of EBV etiological detection.The basic information,clinical manifestations,laboratory examination,imaging examination,treatment and follow-up were compared and analyzed between the two groups.Independent sample t test,non-parametric rank-sum test,Chi-square test were used for statistical analysis.Results:1.EBV etiological detection and grouping results:136 patients were divided into primary infection group(86 cases)and reactivation group(50 cases)according to five EBV antibodies and nucleic acid results.36 cases in the primary infection group showed EBNA-Ig G negative,VCA-Ig G and VCA-Ig M positive;42 cases showed EBNA-Ig G,VCA-Ig G negative,VCA-Ig M positive;8 cases showed EBNA-Ig G,VCA-Ig G and VCA-Ig M positive with low EBNA-Ig G titer.Reactivation group showed EBNA-Ig G positive(high titer),VCA-Ig M positive or EBV-DNA positive.EBV nucleic acid detection was completed in 76 patients,of which 71(93.42%)were positive,The viral load of the primary infection group was mainly 10~4-10~6copies/ml,and that of the reactivation group was 10~3-10~5copies/ml.There were 42 cases in the primary infection group completed EBV nucleic acid detection,and the viral load was9.45×10~4(3.2×10~4,4.37×10~5)copies/ml.There were 29 cases in the reactivation group completed nucleic acid detection and viral load was 1.15×10~4(3.29×10~3,8.36×10~4)copies/ml,the viral load in the primary infection group was higher than that in the reactivation group,and the difference was statistically significant(P=0.000<0.05).2.General clinical features:there were 86 patients in the primary infection group,including 44 males and 42 females,with a male to female ratio of 1.05:1.There were50 patients in the reactivation group,including 28 males and 22 females,with a male to female ratio of 1.27:1.There was no significant difference in gender between the two groups(P=0.586>0.05).Patients in the primary infection group ranged in age from 18 to 57 years old,and average age was 20(19,23)years old.Patients in the reactivation group ranged in age from 18 to 72 years old,and the average age was 33(25,51)years old.Patients in the reactivation group were older than those in the primary infection group,the difference was statistically significant(P=0.000<0.05).In the primary infection group,82 cases(95.35%)were 18 to 30 years old,and 4cases(4.65%)were over 30 years old.In the reactivation group,18 patients(36%)were 18 to 30 years old and 32 patients(64%)were over 30 years old.The main treatment departments of the two groups were infection department,hepatobiliary and pancreatic medicine department,hematology department and respiratory department.The primary infection group had the highest incidence in winter,the reactivation group had the higher incidence in spring and autumn.There were 14 patients with underlying disease in the primary infection group and 25 patients in the reactivation group.The percentile of course in the primary infection group was 10(7,14)days,and that in the reactivation group was 14(7,20)days.The course of course in the reactivation group was higher than that in the primary infection group,and the difference was statistically significant(P=0.047<0.05).3.Clinical manifestations:The most common clinical manifestations of the two groups were fever,angina and lymphadenopathy.The proportion of the typical triad in the primary infection group(72.09%)was significantly higher than that in the reactivation group(28%),and the difference was statistically significant(P<0.05).In addition,the other main clinical manifestations of the two groups included splenomegaly,respiratory symptoms,hepatomegaly,fatigue,rash,etc.The primary infection group was more likely to have angina,lymphadenopathy,hepatosplenomegaly than the reactivation group,and the differences were statistically significant(P<0.05).4.Laboratory examination:The main laboratory findings of the two groups were the increase of the proportion of lymphocytes,atypical lymphocytes and liver transaminase,and some patients were accompanied by the increase of ESR and CRP.The total white blood cell count,lymphocyte proportion,ALT,AST,γ-GT,ALP,TBIL,DBIL,TBA and LDH in the primary infection group were significantly higher than those in the reactivation group,and the differences were statistically significant(P<0.05),The CRP in the reactivation group was higher than that in the primary infection group,and the differences was statistically significant(P<0.05).5.The results of bone puncture:In the primary infection group,26 patients completed bone marrow aspiration,including 10 patients with reduced granuloid system,11 patients with reduced red system,1 patient with reduced megakaryon system,no simultaneous reduction of all three systems,atypical lymphocytes was found in 11 cases.In the reactivation group,26 patients completed bone marrow aspiration,including 7 patients with reduced granuloid system,6 patients with reduced red system,3 patients with reduced megakaryon system,no simultaneous reduction of all three systems,atypical lymphocytes was found in 11 cases.6.Multisystem involvement performance:There were 79 cases(91.86%)with liver injury in the primary infection group(including 63 cases with transaminase elevation greater than 3 times of the normal value and 1 case with cholestatic hepatitis).36 cases with respiratory complications(18 cases of upper respiratory tract infection,2 cases of bronchitis,16 cases of pneumonia).3 cases with circulatory system involvement(1 case of myocardial injury,1 case of pericardial effusion,1 case of arrhythmia).2 cases with hematological involvement(1 case of thrombocytopenic purpura and 1 case of hemophagocytic syndrome).1 case with viral encephalitis;1case with urinary system infection.In the reactivation group,there were 30 cases(60%)with liver injury and 32 cases with respiratory complications(10 cases of upper respiratory tract infection,2 cases of bronchitis,and 20 cases of pneumonia).7.Treatment and follow-up results:The patients in both groups were given antiviral drugs or traditional Chinese medicine preparations during hospitalization.Six patients in the primary infection group were treated with glucocorticoids,and 1patient was treated with gamma globulin.Patients in both groups were improved and discharged after active treatment.63 of 136 patients were followed up by telephone,The duration of follow-up was 1-11 years,with a median of 8 years.9 patients in the primary infection group were followed up,and 2 patients had IM-like symptoms after discharge.24 patients in the reactivation group were followed up,and 2 patients had IM-like symptoms after discharge.Up to the follow-up date,no patient had CAEBV or lymphoma.Conclusions:1.Patients clinically diagnosed as IM may have primary infection or reactivation of EBV infection,which should be combined with EBV etiological detection results for comprehensive determination.2.The clinical symptoms of primary infection and reactivation after EBV infection are similar,but the primary infection of EBV is younger than that of reactivation patients,and the clinical symptoms and laboratory test results of primary infection patients are more typical than those of reactivation patients.3.Most patients with primary infection and reactivation of EBV have good prognosis,while a small number of patients have recurrent disease.Long-term follow-up is of great significance. |
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