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’Predictors of hospitalization in children with infectious mononucleosis

Year 2020, Volume: 53 Issue: 2, 113 - 119, 31.08.2020
https://doi.org/10.20492/aeahtd.597416

Abstract

Background: Infectious mononucleosis (IM), characterized by fever, lymphadenopathy and pharyngitis, is a common infectious disease caused by Epstein-Barr virus (EBV). In this study, we performed a retrospective analysis of the clinical findings, laboratory data and management of children with IM due to EBV to find out the predictors of hospitalizations. 

Methods:We retrospectively reviewed the medical records of patients under the age of 18 years who were diagnosed with IM between October 31, 2017 and October 31, 2018 at Muğla Sıtkı Koçman University Medical Faculty Hospital. The study population was categorized into three groups according to the age; the 0-4 years, 5-10 years, and above 10 years. Complaints, physical examination findings, laboratory data, complications and treatment strategies of the patients were compared in these groups. Factors associated with hospitalizations and predictors of hospitalization were also investigated.

Results: This study included 158 patients. The mean age of the patients was 88.9 ± 53.5 months and 93 (58.9%) were male. The most common complaint was fever (57.6%), and the most common physical examination finding was hepatomegaly (73.4%). No significant difference was found between the age groups in most of the clinical and laboratory findings. The antibiotic treatment was administered in 44% of the patients and 34.8% of the patients were required hospitalization. Patients who needed hospitalization were more symptomatic, had more physical examination findings and had higher acute phase reactants. For variables were found to be significant predictors of hospitalization: presence of fever, palatal petechiae, or exudative tonsillitis and higher levels of C-reactive protein at presentation.

Conclusions: More than one third of the children with IM required hospitalization. Presence of fever, palatal petechiae, or exudative tonsillitis and higher levels of C-reactive protein at presentation were ssociated with  higher  rates of  hospitalizations.

 

Key words: Infectious mononucleosis, children, clinical features


References

  • 1.Odumade OA, Hogquist KA, Balfour HH Jr. Progress and problems in understanding and managing primary Epstein-Barr virus infections. Clin Microbiol Rev. 2011;24(1):193.
  • 2. Evans AS, Niederman JC, Cenabre LC, West B, Richards VA. A prospective evaluation of heterophile and Epstein-Barr virus-specific IgM antibody tests in clinical and subclinical infectious mononucleosis: Specificity and sensitivity of the tests and persistence of antibody. J Infect Dis 1975; 132:546.
  • 3.Dunmire SK, Hogquist KA, Balfour HH. Curr Top Microbiol Immunol. 2015;390(Pt 1): 211-40.
  • 4. Rea TD, Russo JE, Katon W, Ashley RL, Buchwald DS. Prospective study of the natural history of infectious mononucleosis caused by Epstein-Barr virus. J Am Board Fam Practice 2001, 14:234–242.
  • 5. Yoda K, Sata T, Kurata T, Aramaki H. Oropharyngotonsillitis associated with nonprimary Epstein-Barr virus infection. Arch Otolaryngol Head Neck Surg 2000; 126:185.
  • 6. Hoagland RJ, Henson HM. Splenic rupture in infectious mononucleosis. Ann Intern Med 1957; 46: 1184–1191.
  • 7. Evans A, Niederman J. Epstein-Barr virus. In: Viral Infections of Human Epidemiology and Control, Evans A (Ed), Plenum Publishing, New York 1989. p.265
  • 8.Fidan i, Yüksel S, İmir T. The İnvestigation of Epstein-Barr virus antibadiesin different age groups. İnfeksiyon Dergisi (Turkish Journal of İnfection) 2005; 19 (4): 453-456
  • 9.Ozkan A, Kilic S. S, Kalkan A, Ozden M, Demirdag K, Ozdarendeli A. Seropositivity of Epstein-Barr virus in Eastern Anatolian Region of Turkey. Asian Pac. J. Allergy Immunol. 2003;21(1):49–53.).
  • 10.Hocqueloux L, Causse X, Valery A, et al. The high burden of hospitalization for primary EBV infection: a 6 year prospective survey in a French hospital. Clin Microbiol Infect. 2015 Nov;21(11):1041.
  • 11.Horwitz CA, Henle W, Henle G, et al. Clinical and laboratory evaluation of infants and children with Epstein-Barr virus-induced infectious mononucleosis: report of 32 patients (aged 10-48 months). Blood 1981; 57:933.
  • 12. Luzuriaga K, Sullivan JL. Infectious mononucleosis. N Engl J Med 2010; 362:1993.
  • 13. Jiao F, Yan X, Yan X, Chen Y, Liu K. Clinical analysis of 102 cases of Epstein-Barr virus infections in Chinese children. Georgian Med News. 2014 May;(230):35-8.
  • 14. Kanegane H, Kanegane C, Yachie A, Miyawaki T, Tosato G. Infectious mononucleosis as a disease of early childhood in Japan caused by primary Epstein-Barr virus infection. Acta PaediatrJpn 1997; 39: 166-171
  • 15. Cengiz AB, Cultu-Kantaroğlu O, Seçmeer G, Ceyhan M, Kara A, Gürgey A. Infectious mononucleosis in Turkish children. Turk J Pediatr. 2010; 52(3):245-54.
  • 16.Johannsen EC, Schooley RT, Kaye KM. Epstein-Barr virus (infectious mononucleosis). In: Mandell GL, Bennett JE, Dolin R (eds). Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases (6th ed) Vol. 2. Philadelphia: Elsevier Churchill Livingstone; 2005: 1801-1820
  • 17.Son KH, Shin MY. Clinical features of Epstein–Barr virus-associated infectious mononucleosis in hospitalized Korean children. Korean J Pediatr. 2011; 54(10):409-13.
  • 18. Cheng CC, Chang LY, Shao PL, et al. Clinical manifestations and quantitative analysis of virus load in Taiwanese children with Epstein-Barr virus-associated infectious mononucleosis. J Microbiol Immunol Infect 2007; 40: 216-221.
  • 19. Chan CW, Chiang AK, Chan KH, Lau AS. Epstein-Barr virus-associated infectious mononucleosis in Chinese children. Pediatr Infect Dis J 2003; 22: 974-978.
  • 20. Balfour HH, Holman CJ, Hokanson KM, et al. A prospective clinical study of Epstein-Barr virus and host interactions during acute infectious mononucleosis. J Infec Dis 2005, 192:1505–1512.
  • 21. Gao LW, Xie ZD, Liu YY, Wang Y, Shen KL. Epidemiologic and clinical characteristics of infectious mononucleosis associated with Epstein-Barr virus infection in children in Beijing, China. World J Pediatr 2011, 7:45–49
  • 22. Topp SK, Rosenfeldt V, Vestergaard H, Christiansen CB, Von Linstow ML. Clinical characteristics and laboratory findings in Danish children hospitalized with primary Epstein-Barr virus infection. Infect Dis (Lond) 2015; 47:908.
  • 23.Tamir D, Benderly A, Levy J, Ben-Porath E, Vonsover A. Infectious mononucleosis and Epstein-Barr virus in child- hood. Pediatrics 1974;53:330–5.
  • 24. Moon WY, Oh SH, Ko TS, et al. Infectious mononucleosis in children. J Korean Pediatr Soc 1994;37:822- 31.
  • 25. Çağlar M, Balcı YI, Polat A, Cevahir N, Çölgeçen Ş. Enfeksiyöz mononükleoz tanısı alan hastaların değerlendirilmesi. Pam Tıp Derg 2014;7(3):210-213
  • 26.Eroğlu Y, Hiçsönmez G. Hacettepe Üniversitesi çocuk hastanesinde anemi görülme sıklığı ve nedenleri. Çocuk Sağlığı ve Hastalıkları Dergisi 1994;37:267-71.
  • 27.Medović R, Igrutinović Z, Radojević-Marjanović R, et al. Clinical and laboratory differences betveen Epstein-Barr and cytomegalovirus infectious mononucleosis in children. Srp Arh Celok Lek. 2016 Jan-Feb;144(1-2):56-62.
  • 28.Saldaña NG, Colín VA, Ruiz GP, Olguín HJ. Clinical and laboratory characteristics of infectious mononucleosis by Epstein-Barr virus in Mexican children. BMC Res Notes 2012;5:361.
  • 29.Brigden ML, Au S, Thompson S, Brigden S, Doyle P, Tsaparas Y. Infectious mononucleosis in an outpatient population: diagnostic utility of 2 automated hematology analyzers and the sensitivity and specificity of Hoagland's criteria in heterophile-positive patients. Arch Pathol Lab Med 1999; 123:875.
  • 30.Sumaya CV, Ench Y. Epstein-Barr virus infectious mononucleosis in children. I. Clinical and general laboratory findings. Pediatrics 1985; 75: 1003-1010.
  • 31. Axelrod P, Finestone AJ. Infectious mononucleosis in older adults. Am Fam Physician 1990; 42:1599.
  • 32. Crum NF. Epstein Barr virus hepatitis: case series and review. South Med J 2006;99:544-7
  • 33. Vine LJ, Shepherd K, Hunter JG, Madden R, Thornton C, Ellis V, et al. Characteristics of Epstein-Barr virus hepatitis among patients with jaundice or acute hepatitis. Aliment Pharmacol Ther 2012; 36:16-21
  • 34.Wang Y, Li J, Ren YY, Zhao H. The levels of liver enzymes and atipical lymhocytes are higer in youthpatients with infectious mononucleosis than preschool children. Clin Mol Hepatol. 2013; 19(4):382-8.
  • 35. Tynell E, Aurelius E, Brandell A, et al. Acyclovir and prednisolone treatment of acute infectious mononucleosis: a multicenter, double-blind, placebo-controlled study. J Infect Dis 1996; 174:324.
  • 36.Brandfonbrener A, Epstein A, Wu S, Phair J. Corticosteroid therapy in Epstein-Barr virus infection. Effect on lymphocyte class, subset, and response to early antigen. Arch Intern Med 1986; 146:337.
  • 37. Glynn FJ, Mackle T, Kinsella, J. Upper airway obstruction in infectious mononu- cleosis, Eur. J. Emerg. Med. 2007; 14 (1): 41–42.
  • 38.Thompson SK, Doerr TD, Hengerer AS. Infectious mononucleosis and corticosteroids: management practices and outcomes. Arch Otolaryngol Head Neck Surg. 2005 Oct;131(10):900-4.
Year 2020, Volume: 53 Issue: 2, 113 - 119, 31.08.2020
https://doi.org/10.20492/aeahtd.597416

Abstract

References

  • 1.Odumade OA, Hogquist KA, Balfour HH Jr. Progress and problems in understanding and managing primary Epstein-Barr virus infections. Clin Microbiol Rev. 2011;24(1):193.
  • 2. Evans AS, Niederman JC, Cenabre LC, West B, Richards VA. A prospective evaluation of heterophile and Epstein-Barr virus-specific IgM antibody tests in clinical and subclinical infectious mononucleosis: Specificity and sensitivity of the tests and persistence of antibody. J Infect Dis 1975; 132:546.
  • 3.Dunmire SK, Hogquist KA, Balfour HH. Curr Top Microbiol Immunol. 2015;390(Pt 1): 211-40.
  • 4. Rea TD, Russo JE, Katon W, Ashley RL, Buchwald DS. Prospective study of the natural history of infectious mononucleosis caused by Epstein-Barr virus. J Am Board Fam Practice 2001, 14:234–242.
  • 5. Yoda K, Sata T, Kurata T, Aramaki H. Oropharyngotonsillitis associated with nonprimary Epstein-Barr virus infection. Arch Otolaryngol Head Neck Surg 2000; 126:185.
  • 6. Hoagland RJ, Henson HM. Splenic rupture in infectious mononucleosis. Ann Intern Med 1957; 46: 1184–1191.
  • 7. Evans A, Niederman J. Epstein-Barr virus. In: Viral Infections of Human Epidemiology and Control, Evans A (Ed), Plenum Publishing, New York 1989. p.265
  • 8.Fidan i, Yüksel S, İmir T. The İnvestigation of Epstein-Barr virus antibadiesin different age groups. İnfeksiyon Dergisi (Turkish Journal of İnfection) 2005; 19 (4): 453-456
  • 9.Ozkan A, Kilic S. S, Kalkan A, Ozden M, Demirdag K, Ozdarendeli A. Seropositivity of Epstein-Barr virus in Eastern Anatolian Region of Turkey. Asian Pac. J. Allergy Immunol. 2003;21(1):49–53.).
  • 10.Hocqueloux L, Causse X, Valery A, et al. The high burden of hospitalization for primary EBV infection: a 6 year prospective survey in a French hospital. Clin Microbiol Infect. 2015 Nov;21(11):1041.
  • 11.Horwitz CA, Henle W, Henle G, et al. Clinical and laboratory evaluation of infants and children with Epstein-Barr virus-induced infectious mononucleosis: report of 32 patients (aged 10-48 months). Blood 1981; 57:933.
  • 12. Luzuriaga K, Sullivan JL. Infectious mononucleosis. N Engl J Med 2010; 362:1993.
  • 13. Jiao F, Yan X, Yan X, Chen Y, Liu K. Clinical analysis of 102 cases of Epstein-Barr virus infections in Chinese children. Georgian Med News. 2014 May;(230):35-8.
  • 14. Kanegane H, Kanegane C, Yachie A, Miyawaki T, Tosato G. Infectious mononucleosis as a disease of early childhood in Japan caused by primary Epstein-Barr virus infection. Acta PaediatrJpn 1997; 39: 166-171
  • 15. Cengiz AB, Cultu-Kantaroğlu O, Seçmeer G, Ceyhan M, Kara A, Gürgey A. Infectious mononucleosis in Turkish children. Turk J Pediatr. 2010; 52(3):245-54.
  • 16.Johannsen EC, Schooley RT, Kaye KM. Epstein-Barr virus (infectious mononucleosis). In: Mandell GL, Bennett JE, Dolin R (eds). Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases (6th ed) Vol. 2. Philadelphia: Elsevier Churchill Livingstone; 2005: 1801-1820
  • 17.Son KH, Shin MY. Clinical features of Epstein–Barr virus-associated infectious mononucleosis in hospitalized Korean children. Korean J Pediatr. 2011; 54(10):409-13.
  • 18. Cheng CC, Chang LY, Shao PL, et al. Clinical manifestations and quantitative analysis of virus load in Taiwanese children with Epstein-Barr virus-associated infectious mononucleosis. J Microbiol Immunol Infect 2007; 40: 216-221.
  • 19. Chan CW, Chiang AK, Chan KH, Lau AS. Epstein-Barr virus-associated infectious mononucleosis in Chinese children. Pediatr Infect Dis J 2003; 22: 974-978.
  • 20. Balfour HH, Holman CJ, Hokanson KM, et al. A prospective clinical study of Epstein-Barr virus and host interactions during acute infectious mononucleosis. J Infec Dis 2005, 192:1505–1512.
  • 21. Gao LW, Xie ZD, Liu YY, Wang Y, Shen KL. Epidemiologic and clinical characteristics of infectious mononucleosis associated with Epstein-Barr virus infection in children in Beijing, China. World J Pediatr 2011, 7:45–49
  • 22. Topp SK, Rosenfeldt V, Vestergaard H, Christiansen CB, Von Linstow ML. Clinical characteristics and laboratory findings in Danish children hospitalized with primary Epstein-Barr virus infection. Infect Dis (Lond) 2015; 47:908.
  • 23.Tamir D, Benderly A, Levy J, Ben-Porath E, Vonsover A. Infectious mononucleosis and Epstein-Barr virus in child- hood. Pediatrics 1974;53:330–5.
  • 24. Moon WY, Oh SH, Ko TS, et al. Infectious mononucleosis in children. J Korean Pediatr Soc 1994;37:822- 31.
  • 25. Çağlar M, Balcı YI, Polat A, Cevahir N, Çölgeçen Ş. Enfeksiyöz mononükleoz tanısı alan hastaların değerlendirilmesi. Pam Tıp Derg 2014;7(3):210-213
  • 26.Eroğlu Y, Hiçsönmez G. Hacettepe Üniversitesi çocuk hastanesinde anemi görülme sıklığı ve nedenleri. Çocuk Sağlığı ve Hastalıkları Dergisi 1994;37:267-71.
  • 27.Medović R, Igrutinović Z, Radojević-Marjanović R, et al. Clinical and laboratory differences betveen Epstein-Barr and cytomegalovirus infectious mononucleosis in children. Srp Arh Celok Lek. 2016 Jan-Feb;144(1-2):56-62.
  • 28.Saldaña NG, Colín VA, Ruiz GP, Olguín HJ. Clinical and laboratory characteristics of infectious mononucleosis by Epstein-Barr virus in Mexican children. BMC Res Notes 2012;5:361.
  • 29.Brigden ML, Au S, Thompson S, Brigden S, Doyle P, Tsaparas Y. Infectious mononucleosis in an outpatient population: diagnostic utility of 2 automated hematology analyzers and the sensitivity and specificity of Hoagland's criteria in heterophile-positive patients. Arch Pathol Lab Med 1999; 123:875.
  • 30.Sumaya CV, Ench Y. Epstein-Barr virus infectious mononucleosis in children. I. Clinical and general laboratory findings. Pediatrics 1985; 75: 1003-1010.
  • 31. Axelrod P, Finestone AJ. Infectious mononucleosis in older adults. Am Fam Physician 1990; 42:1599.
  • 32. Crum NF. Epstein Barr virus hepatitis: case series and review. South Med J 2006;99:544-7
  • 33. Vine LJ, Shepherd K, Hunter JG, Madden R, Thornton C, Ellis V, et al. Characteristics of Epstein-Barr virus hepatitis among patients with jaundice or acute hepatitis. Aliment Pharmacol Ther 2012; 36:16-21
  • 34.Wang Y, Li J, Ren YY, Zhao H. The levels of liver enzymes and atipical lymhocytes are higer in youthpatients with infectious mononucleosis than preschool children. Clin Mol Hepatol. 2013; 19(4):382-8.
  • 35. Tynell E, Aurelius E, Brandell A, et al. Acyclovir and prednisolone treatment of acute infectious mononucleosis: a multicenter, double-blind, placebo-controlled study. J Infect Dis 1996; 174:324.
  • 36.Brandfonbrener A, Epstein A, Wu S, Phair J. Corticosteroid therapy in Epstein-Barr virus infection. Effect on lymphocyte class, subset, and response to early antigen. Arch Intern Med 1986; 146:337.
  • 37. Glynn FJ, Mackle T, Kinsella, J. Upper airway obstruction in infectious mononu- cleosis, Eur. J. Emerg. Med. 2007; 14 (1): 41–42.
  • 38.Thompson SK, Doerr TD, Hengerer AS. Infectious mononucleosis and corticosteroids: management practices and outcomes. Arch Otolaryngol Head Neck Surg. 2005 Oct;131(10):900-4.
There are 38 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Original research article
Authors

Yaşar Topal 0000-0002-7059-4823

Hatice Topal This is me 0000-0003-3226-0205

Betül Battaloğlu İnanç 0000-0001-7478-5451

Publication Date August 31, 2020
Submission Date July 26, 2019
Published in Issue Year 2020 Volume: 53 Issue: 2

Cite

AMA Topal Y, Topal H, Battaloğlu İnanç B. ’Predictors of hospitalization in children with infectious mononucleosis. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi. August 2020;53(2):113-119. doi:10.20492/aeahtd.597416