Clinical features of primary Epstein-Barr virus infection in inpatients younger than 3 years old

Abstract

Objective To investigate the clinical characteristics of primary Epstein-Barr virus (EBV) infection in children younger than 3 years old, and to achieve deeper understanding of this disease. Methods Five hundred and ninety-seven children younger than 3 years old who had serology evidence for primary EBV infection from January 2008 to December 2015 admitted in Beijing Children′s Hospital, Capital Medical University, were studied retrospectively. Results Among 597 patients, 83 patients (13.9%) were younger than 1 year old and the other 514 patients (86.1%) were within the range of 1-3 years old.The symptoms included fever(92.8%, 554/597 cases), cervical lymphnode enlargement(67.3%, 402/597 cases), hepatomegaly(59.8%, 357/597 cases), liver damage (44.6%, 266/597 cases), splenomegaly(32.7%, 195/597 cases), eyelid edema(29.0%, 173/597 cases), pneumonia(27.0%, 161/597 cases), and rash (26.5%, 158/597 cases). Diagnosis of infectious mononucleosis (IM) was made in 370 patients (62.0%). Forty patients (6.7%) suffered from hemophagocytic syndrome.Duration between onset and hemo-phagocytic syndrome was (15.3±9.5) days.Six patients (1.0%) complicated with cholestatic hepatitis, 6 patients (1.0%) with purulent lymphadenitis, 4 patients (0.7%) with Kawasaki disease, and 11 patients (1.8%) with encephalitis or meningitis.Compared with infants younger than 1 year old, the incidence of eyelid edema, nasal congestion and tonsil secretions were more common in toddlers ranging from 1-3 years old (all P 0.05). Eighty-seven cases (30.5%) of 285 patients using cephalosporin antibiotics had rash, only 71 cases (22.8%) of 312 patients did not use antibiotics with rash, there was a statistical significance in the incidence (P<0.05) . Conclusions Fever, cervical lymph node enlargement and hepatomegaly are the most common clinical manifestations in primary EBV infection in children younger than 3 years old.Toddlers ranging from 1-3 years old are more likely to have with typical IM symptom and elevated ALT than infants; meanwhile, rash, pneumonia and myocardial damage are more common in infants.Cephalosporin should be used with caution in children younger than 3 years old with primary EBV infection. Key words: Epstein-Barr virus; Primary Epstein-Barr virus infection; Child