Abstract
BackgroundNumerous studies have shown that Epstein-Barr virus (EBV) and cytomegalovirus (CMV) can infect immunocompetent patients simultaneously with other agents. Nonetheless, multiple infections with other agents in EBV/CMV-infected children have received little attention. We conducted a retrospective study of children with suspected infectious mononucleosis. Peripheral blood samples were analyzed by indirect immunofluorescence to detect EBV, CMV and other respiratory agents including respiratory syncytial virus; adenovirus; influenza virus types A and B; parainfluenza virus types 1, 2 and 3; Chlamydia pneumoniae and Mycoplasma pneumoniae. A medical history was collected for each child.ResultsThe occurrence of multipathogen infections was 68.9%, 81.3% and 63.6% in the children with primary EBV, CMV or EBV/CMV, respectively, which was significantly higher than that in the past-infected group or the uninfected group (p < 0.001). Of the multipathogen-infected patients, the incidence of C. pneumoniae in children with primary infection was as high as 50%, significantly higher than in the other groups (p < 0.001). In the patients with multipathogen infection and EBV/CMV primary infection, fever, rash, lymphadenopathy, hepatomegaly, splenomegaly, atypical lymphocytes and abnormal liver function were more frequent and the length of hospital stay and duration of fever were longer than in other patients.ConclusionOur study suggests that there is a high incidence of multipathogen infections in children admitted with EBV/CMV primary infection and that the distribution of these pathogens is not random.
Highlights
Epstein-Barr virus (EBV) and Cytomegalovirus (CMV), members of the herpesvirus family, are common viruses that cause infectious mononucleosis (IM) characterized by fever, pharyngitis and lymphadenopathy
Numerous studies have shown that EBV/ CMV can infect immunocompetent patients simultaneously with other agents including respiratory syncytial virus (RSV), Chlamydia pneumoniae (CP), human herpesvirus 6, measles virus and others[7,10,11,12,13,14], and it has been reported that EBV/CMV-infected children with no detected immune deficiency can suffer from mixed infections with other agents[12,14]
There were no differences between these three groups in their main laboratory results, except that the percentage of patients with > 10% atypical lymphocytes was higher in the primary- and pastinfected groups than in the uninfected group and the frequency of C-reactive protein (CRP) > 10 mg/L was significantly lower in the primary-infection group
Summary
Epstein-Barr virus (EBV) and Cytomegalovirus (CMV), members of the herpesvirus family, are common viruses that cause infectious mononucleosis (IM) characterized by fever, pharyngitis and lymphadenopathy. EBV is the most common cause of IM, but primary CMV infection will cause up to 7% of cases of mononucleosis syndrome. Because CMV and EBV have so much in common, coinfection with these two viruses occurs occasionally in children [7,8,9]. Multiple infections of EBV/CMV and other agents have received little attention. Numerous studies have shown that Epstein-Barr virus (EBV) and cytomegalovirus (CMV) can infect immunocompetent patients simultaneously with other agents. Multiple infections with other agents in EBV/CMV-infected children have received little attention.
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