Diagnosis Of Infectious Mononucleosis By CD4, CD8

Objective:Infectious mononucleosis (infectious mononucleosis, IM) is an acute infectious diseases caused by Epstein-Barr (EB) virus. The clinical presentation is characterized by fever, angina and lymphadenopathy, while the cellular immune function has also changed significantly. In this paper, we analyzed the diagnosis and differential diagnosis of IM by CD4 and CD8, based on the study of part of the children admitted to our hospital, diagnosed respectively with IM,infectious mononucleosis syndrome, atypical EB virus infections, or upper respiratory tract infections (not by EB virus).Methods:86 of the children admitted to our paediatric ward from March 2008 to January 2010 were selected randomly, among which there are 27 diagnosed with IM,20 with infectious mononucleosis syndrome,16 with virus atypical EB infections, and upper respiratory tract infections in 23 cases. Clinical datas of the 86 children were collected for our study, including the duration of the diseases, clinical symptoms and signs, peripheral blood test, the proportion of atypical lymphocytes, liver function test, liver and spleen ultrasound,heterophile antibody test,EBV-CA-IgM,EBV-CA-IgG,EBV-NA-IgG,CD4,CD8.The differents between IM and infectious mononucleosis syndrome in clinical presentations were observed. And we also observed the changes of T lymphocyte subsets including CD4 and CD8 of these children diagnosed with IM, infectious mononucleosis syndrome, atypical EB virus infections, or upper respiratory tract infections.Results:Compared with upper respiratory tract infections, the other three kinds of diseases have lower CD4 and higher CD8 varying degrees, therefore CD4/CD8 ratio decreased significantly (P<0.05), especially in IM. There are statistically significant differences between IM and other three kinds of diseases in CD4 and CD8, while there are no statistical significance between infectious mononucleosis syndrome and atypical EB virus infections in CD4 and CD8.CD4/CD8 ratio has more value of clinical applications than CD4 and CD8, because of the more obvious differences among these diseases.Children diagnosed with IM,CD4 reduced,CD8 increased,and CD4/ CD8 ratio decreased, comparing to the other three diseases, so CD4 and CD8, especially CD4/CD8 ratio, are of diagnosis and differential diagnosis significance for IM. Because of the same source of infection, the changes of CD4 and CD8 of Atypical EB virus infection and IM are similar, but IM are more markedly. Though have different sources of infection, IM and infectious mononucleosis syndrome have the same clinical presentations and the similar changes of CD4 and CD8, suggesting that both of the diseases have the same pathogenesis. Infectious mononucleosis syndrome has less obviously changes of CD4 and CD8 than IM, so we can say that immune dysfunction in EB virus caused IM are more visible, and the clinical presentation of IM are more typical.Conclusion:1 T lymphocyte subsets are markedly abnormal in children with IM, CD4 reduced, CD8 rised, and CD4/CD8 ratio decreased, so CD4 and CD8 are of auxiliary diagnostic meaning.2 The changes of CD4 and CD8 of Infectious mononucleosis syndrome and atypical EB virus infection, are similar with IM, although the changes of the two diseases are less significantly than IM, also can assist identification.