Clinical And Laboratory Features Analysis Of Infectious Mononucleosis In Hospitalized Children

Objective: To delineate the clinical manifestations and laboratory features indifferent age groups and to define the epidemiological characters of hospitalizedchildren with infectious mononucleosis (IM).Methods：We reviewed data on268children patients admitted to Shanghaisixth people’s hospital with IM from January2009to December2013. Clinical andlaboratory features were evaluated according to the demographic features of thepatients among four age groups:≤1year,≤3years,≤6years and＞6years. Clinicalfeatures include fever, tonsillopharyngitis, cervical adenopathy, hepatomegaly,splenomegaly and complications; Laboratory findings include complete blood count(CBC), liver transaminase, myocardial enzyme, CD4+and CD8+T cells subsets, andchest X-ray; EBV viral infection was identified by specific antibody detection. Thecurative effects of anti-virus and supportive treatment as well as the prognosis of IMwere also evaluated.Results：Data from268hospitalized patients (159males and109females),ranged in age from32days to14years, mean age years were4.0±2.7, reviewed inthis study. The children of toddler age and preschool-age were main groups of IM,accounted for39.6%,32.1%respectively. The fever, lymphnoditis, hepatomegaly,tonsillitis, splenomegaly and rsah were the most important clinical manifestations ofIM. the mean duration of fever was(6.9±4.5)days. There were significant difference clinical features among the four groups, The incidences of hyperpyrexia, lymphnoditis,tonsillopharygitis, splenomegaly and palpebral edema were higher in older patients, Incontrast, The incidences of rash were higher in younger patients. leukocytosis(WBC>10×109/L) was found in56.3%of the patients, and abnormal total WBC wasmore common in infants than in older children. There was no significant differenceabout the ratio of lymphocytes among the four groups, abnormal lymphocytespercentage rose in the4groups, and monocyte proportion became lower with ageincrement. Thrombocytopenia and Granulocytopenia were noted in1.9%and39.2%of the268patients respectively, with no difference among the four groups. Anemiawas seen in11.6%of the patients, and was more commen in younger groups.Abnormal liver function and myocardial damage were detected in22.8%and11.9%of patients, which were more common in younger groups.25.7%has pneumonia. In251cases of the268patients, the seroprevalence of VCA-IgM, VCA-IgG, EA-IgG,EBNA-IgM to EBV were34.3%,17.5%,20.7%,21.5%respectively. All of thepatients were treated with supportive therapy and antiviral medication. Most of thepatients were benign and self limited, intravenous immunoglobulin andcorticosteroids were administered to1patient with hemophagocytic syndrome (HPS),with satisfactory results.Conclusions：IM in children exhibits an age associated distribution,(i.e., thefirst incidence peak is in the preschool period and the second is in toddler), however,as demonstrated in our present review, the low aging tendency into infants should alsobe pay more attention. The main clinical manifestations of IM in children were fever,tonsillopharyngitis, cervical adenopathy, hepatomegaly, or splenomegaly.Pneumonia was the most common complication. while abnormal lymphocytesincreased,neutrocytopenia happened at the same time.some cases might suffer fromanemia and thrombopenia,and it was easy to cause cellular immune dysfunction andthe damage of liver and myocardium.The detection of EBV antibody was stillvaluable for diagnosing EBV infections The main clinic treatentments weresupportive therapy and antiviral medication. Most of the patients were benign and selflimited. The prognosis was favorable.