Infectious Mononucleosis Group Research Articles

The diagnostic value of peripheral blood lymphocyte testing in children with infectious mononucleosis

ObjectiveTo investigate the diagnostic value of peripheral blood lymphocyte testing in children with infectious mononucleosis (IM).MethodsA total of 135 children with IM as the IM group and 100 healthy volunteers as the healthy group were included in this retrospective study. Peripheral blood lymphocyte subsets marked as CD3+, CD4+, CD8+, CD16 + CD56+, and CD19 + in the peripheral blood were quantified using flow cytometry. Statistical analysis was performed using the chi-square test, Kruskal-Wallis test, AUROC curve, and Kappa consistency test to assess the diagnostic value of these markers in IM.ResultsThe AUROC curve for CD8 + cells and for CD4+/CD8 + ratios both achieved a value of 1 with the sensitivity and specificity of 100% (P<0.001). The Kappa coefficients were 1 for CD8+, CD4+/CD8 + ratios and the combined EBV analysis, indicating a 100% consistency with the clinical diagnosis. Significant differences were also observed in the CD3+, CD4+, CD16 + CD56+, and CD19 + lymphocyte subsets between the IM group and the healthy group (P<0.05).ConclusionThe evaluation of CD8 + and CD4+/CD8 + ratios in peripheral blood lymphocytes represents a significant advancement in the diagnosis of IM. Peripheral blood lymphocyte testing offers a reliable, sensitive, and specific diagnostic tool to enhance the clinical management of children with IM.

Metabolomic differences between exanthematous drug eruption and infectious mononucleosis.

Exanthematous drug eruption and infectious mononucleosis (IM) are both exanthematous diseases. Current research on exanthematous drug eruption and IM mainly targets identifying these disorders, the resulting differences at the metabolism level have not yet been systematically analyzed. A total of 30 cases of exanthematous drug eruption and IM, 10 patients without exanthema and 10 healthy volunteers were enrolled, 3mL of fasting venous blood was collected, the serum metabolite content was detected by gas chromatography-mass spectrometry metabolomics. A total of 165 metabolites were identified, exhibiting significant differences in plasma metabolic trends between exanthematous drug eruption and IM, and pinpointed 28 potential biomarkers. Notable changes were seen in the metabolic activities of the pentose phosphate pathway (PPP), tricarboxylic acid cycle (TCA-cycle), and galactose metabolism, characterized by increased levels of gluconate, gluconolactone, glucose, galactaric acid, and mannose, along with decreased amounts of pyruvic acid, succinic acid, malic acid, and glycerol, indicating an impairment in the exanthematous drug eruption group's capacity to endure oxidative stress and regulate energy metabolism. In contrast to its medication without rash counterpart, the exanthematous drug eruption group's plasma displayed distinct metabolic routes, predominantly in the processing of arginine and proline, along with the TCA. This resulted in a marked reduction in urea levels and a rise in pyruvate, citrate, and ornithine, indicating hypoxic stress as the primary cause of these rashes. In contrast to the healthy control group, the IM group showed 26 potential biomarkers, marked by increased levels of ketoglutaric acid, malic acid, pyruvic acid, and oxoglutaric acid, and reduced amounts of glutamine, galacturonic acid, arachidonic acid, trimethylphosphonic acid ester, gluconolactone, and indole acetic acid. Mainly, the metabolic pathways included the TCA, breaking down alanine, aspartate and glutamate metabolism, and the processing of D-glutamine and D-glutamate metabolism, underscoring the body's crucial role in generating energy and inflammatory agents through the citric acid cycle. The comparison of serum metabolomic features of exanthematous drug eruptions and IM outlines a unique pattern closely related to the differences in the pathogenesis of these two exanthematous diseases.

Comparative Clinical Characteristics of Cytomegalovirus and Epstein-Barr Virus Mononucleosis in Immunocompetent Hosts: Experience from a Tropical Setting.

Epstein-Barr Virus (EBV) and Cytomegalovirus (CMV) are herpesviruses that cause different clinical syndromes depending on the host's immune status. EBV is known for causing infectious mononucleosis (IMN), which presents with fever, pharyngitis, cervical lymphadenopathy, and atypical lymphocytes. CMV can also cause a mononucleosis syndrome with similar symptoms but is less frequently reported. Comparative studies on IMN and CMV mononucleosis from India are rare. This study aimed to elucidate the clinical characteristics of IMN and CMV mononucleosis in a South Indian tertiary care center, emphasizing the differences in their presentations. A retrospective analysis using Electronic Medical Records (EMR) from a tertiary care hospital at Thiruvananthapuram, Kerala, was conducted, including patients diagnosed with IMN or CMV mononucleosis based on clinical and serological tests during 2017 to 2023. Immunocompromised patients were excluded. The study compared demographic, clinical, and laboratory characteristics between the two groups. Out of 136 IMN cases and 17 CMV mononucleosis cases, the CMV group had a significantly higher median age (34.0 years) compared to the IMN group (20.0 years). The CMV group experienced a longer duration of fever (median 14.0 days) compared to the IMN group (5.0 days). Sore throat, cervical lymphadenopathy, and tonsil enlargement were significantly less common in CMV cases. The study concludes that CMV mononucleosis is more likely in older adults with prolonged fever and an absence of sore throat, tonsillitis, or cervical lymphadenopathy.

The Role of Notch Signaling Pathway in Adult Patients with Epstein-Barr Virus-induced Infectious Mononucleosis

To investigate the changes of Notch signaling molecules and Th22 cells in adult patients with infectious mononucleosis (IM), and assess the regulatory function of Notch signaling inhibition to Th22 cells. Forty-two IM patients and twenty-one healthy controls were enrolled in this study. Their peripheral blood was collected, from which plasma and peripheral blood mononuclear cells (PBMCs) were isolated. Plasma interleukin (IL)-17 and IL-22 were measured by enzyme-linked immunosorbent assay. The percentages of CD3+ CD4+ IL-17+ Th17 cells and CD3+ CD4+ IL-22+ Th22 cells were investigated by flow cytometry. The mRNA relative levels corresponding to Th17 transcription factor retinoic acid related orphan receptor γt (RORγt), Th22 transcription factor aryl hydrocarbon receptor (AhR), and Notch signaling pathway molecules (including Notch receptors, Notch ligands, Notch downstream molecules) were semi-quantified by real-time PCR. CD4+ T cells were purified and stimulated with γ-secretase inhibitor (GSI). Cellular proliferation, Th17 and Th22 percentage, IL-17 and IL-22 secretion, transcription factor mRNA were measured in response to GSI stimulation. The relative expression levels of Notch1 and Notch2 mRNA in PBMCs of IM group were 13.58±3.18 and 4.73±1.16, respectively, which were significantly higher than 1.09±0.12 and 1.07±0.15 in PBMCs of control group (both P < 0.001). However, there were no significant differences in relative expression levels of Notch3 and Notch4 mRNA between IM group and control group (P >0.05). The relative expression levels of Notch ligands (including DLL1 and Jagged1 ) mRNA and Notch downstream molecules (including Hes1, Hes5, and Hey1 ) were increased in IM group compared with control group (all P < 0.001). In IM group, the Th17 and Th22 percentage were 5.03%±1.15% and 4.48%±1.29%, respectively, which were both higher than 4.36%±0.82% and 3.83%±0.55% in control group (both P < 0.05). In IM group, the IL-17 and IL-22 level were (301.1±53.82) and (101.2±16.45) pg/ml, respectively, which were both higher than (237.2±72.18) and (84.75±11.83) pg/ml in control group (both P < 0.001). In IM group, the relative expression levels of RORγt and AhR mRNA were 1.25±0.22 and 1.21±0.12, respectively, which were both higher than 0.99±0.15 and 1.04±0.11 in control group (both P < 0.001). There were no remarkable differences in CD4+ T cell proliferation, Th17 percentage, IL-17 secretion, and relative expression level of RORγt mRNA between cells with GSI stimulation and without GSI stimulation (P >0.05). GSI stimulation reduced Th22 percentage, IL-22 secretion, and relative expression level of AhR mRNA compared with non-stimulation (all P < 0.05). Notch signaling pathway regulates IL-22 secretion by CD4+ T cells via AhR in IM patients. Notch-AhR-Th22 pathway may take part in the pathogenesis of IM.

The Impact of Infectious Mononucleosis History on the Risk of Developing Lymphoma and Nasopharyngeal Carcinoma: A Retrospective Large-Scale Cohort Study Using National Health Insurance Data in South Korea.

This study aimed to assess the long-term risks associated with a history of infectious mononucleosis (IM), primarily caused by the Epstein-Barr virus (EBV). Specifically analyzing the potential increase in developing nasopharyngeal cancer (NPC) and lymphoma in patients with a history of IM and exploring the prevalence of other EBV-associated conditions. The Korean National Health Insurance Service (NHIS) database was utilized for a retrospective analysis, covering data from 2002 to 2021. A total of 25,582 IM patients and controls were included, with 1:1 propensity score matching. The study monitored outcomes, including lymphoma, NPC, gastric cancer, multiple sclerosis, and all-cause mortality. Patients with a history of IM demonstrated a significantly higher incidence of lymphoma (hazard ratio [HR], 5.320; 95% confidence interval [CI], 3.208 to 8.820; p < 0.001) and NPC (HR, 7.116; 95% CI, 1.617 to 31.314; p=0.009) during the follow-up period compared with the control group. Additionally, the IM group showed an increased rate of all-cause mortality (HR, 2.225; 95% CI, 1.858 to 2.663; p < 0.001). This study suggests that individuals with a history of IM have an elevated risk of developing lymphoma and NPC in South Korea, emphasizing the importance of vigilant follow-up and monitoring. The results advocate for heightened awareness and potential national monitoring policies to address the long-term health implications of EBV infection and to implement preventive measures.

Clinical, laboratory and virological aspects in infectious mononucleosis of EBV- and HHV-6 etiology in children

Purpose: To characterize clinical and laboratory features of infectious mononucleosis (IM) of EBV and HHV-6 etiology among children. Material and methods. A single-center prospective study was performed at Pediatric Research and Clinical Center for Infectious Diseases in 2021 — 2022, which included 84 patients with IM EBV (n = 40), HHV-6 (n = 11), EBV + HHV-6 (n = 33). Methods of laboratory diagnostics were clinical, biochemical blood tests, qualitative and quantitative PCR of blood (whole blood, plasma) to herpesvirus 4—6 types. Results. Patients with EBV IM were significantly older than children with HHV-6 IM and EBV + + HHV-6 IM (р ≤ 0,004). The main complaint of patients was fever (median 39,0°С, Q1—Q3 38,5—39,3°С). Nasal stuffiness (93%), tonsillitis (86%), peripheral cervical lymphadenopathy (100%) dominated among clinical manifestations in all groups. Splenomegaly was noted more rarely than hepatomegaly in children. There were no significant differences in the level of leukocytes among patients (р &gt; 0,05). Increased values of lymphocytes, atypical mononuclear cells, hepatic cytolysis syndrome were characteristic of EBV-monoinfection (р ≤ 0,007). On the contrary, level of neutrophils was significantly higher in the HHV-6 IM group. Genotype HHV-6B was detected in 100% of cases. Assay of EBV viral load showed following: this indicator in plasma (р = 0,0008) and whole blood (р = 0,028) in EBV patients was significantly higher than among EBV + HHV-6 IM. A direct moderate correlation was found between viral loads in different human fluids (r = 0,413, р &lt; 0,05). Conclusions. The results emphasize the importance of clinical and etiological diagnosis, including HHV-6 determination, for the well-timed registration of children with IM and their coverage with regular medical check-up.

Manganese and the cGAS-STING Pathway in Infectious Mononucleosis Caused by Epstein-Barr Virus Infection.

To study the clinical significance of manganese (Mn) in the serum of children with infectious mononucleosis (IM) caused by Epstein-Barr virus (EBV) infection, we analyzed the correlation between Mn and the cyclic GMP-AMP synthase (cGAS)-stimulator of interferon genes (STING) pathway and explored the immune pathogenesis of EBV infection. Children diagnosed with IM comprised the IM group, and healthy children during the same period were selected as the normal control group. Real-time reverse transcription-polymerase chain reaction was used to detect the mRNA expression levels of cGAS, STING, Tank-binding kinase 1 (TBK1), interferon regulatory factor 3 (IRF3), and related inflammatory factors, and Mn in serum was detected by inductively coupled plasma mass spectrometry. Interferon (IFN)-α and IFN-β expression levels in serum were detected by enzyme-linked immunosorbent assay, and the correlation between Mn levels and clinical manifestations and laboratory tests was analyzed. Mn levels and the expression levels of cGAS, STING, and related inflammatory factors were significantly higher in children with IM than in healthy children. Furthermore, Mn levels in children with IM were positively correlated with the expression levels of cGAS and related inflammatory factors. Thus, Mn, cGAS, STING, and inflammatory cytokines may be involved in the immune mechanism of IM caused by EBV infection.

The pathophysiologic significance of lymphocyte subset determination in children with infectious mononucleosis, mycoplasma pneumonia and Henoch–Schönlein purpura

ObjectiveThis study aimed to explore lymphocyte subset determinations as an aid to understanding the pathophysiology of infectious mononucleosis (IM), pneumonia due to mycoplasma infection (P-MI) and Henoch–Schönlein purpura in children.MethodsThe peripheral blood lymphocyte subsets of 45 children with IM, 20 children with P-MI, and 31 children with Henoch–Schönlein purpura (HSP), who were treated in the pediatrics department of our hospital from April 2019 to February 2020, were determined by flow cytometry, and the number and percentage of lymphocyte subsets with CD3+, CD3 + CD4+, CD3 + CD8+, CD3 + CD4+/CD3 + CD8+, CD3–CD16 + CD56+, and CD3–CD19 + cells were observed, and the results were compared and analyzed.Results(1) The percentages of CD3+, CD3 + CD8 + lymphocyte subsets in children in IM group were significantly higher than those in children with P-MI and HSP, and the percentages of CD3-CD19 + lymphocyte subsets in children in IM group were significantly lower than those in children with P-MI and HSP. The percentages of CD3 + CD4 + lymphocyte subsets in children in the three groups were the lowest in children with IM, and the highest in children with P-MI.The differences in the percentages of CD3+, CD3 + CD4+, CD + CD8+, and CD3-CD19 + lymphocyte subsets among the IM, P-MI, and HSP groups were statistically significant (P < 0.01). (2) The results of CD3 + CD4+/CD3 + CD8 + in the three groups were the lowest in children with IM and the highest in children with P-MI. There was a significant difference among the three groups (P < 0.01); The ages of the children with IM and P-MI were lower than that of the children with HSP (p < 0.01), while there was no difference in the ages of the children with IM and P-MI (p > 0.05). (3) The difference in the percentage of CD3–CD16 + CD56 + lymphocyte subsets among the three groups was not statistically significant (P > 0.05).ConclusionThe determination of peripheral blood lymphocyte subsets is of significance for understanding the pathophysiology of IM, mycoplasma pneumonia, and HSP in children.

Detection Value of EB Virus DNA, IL-2, and IL-6 Level in Peripheral Blood of Children with Infectious Mononucleosis

To investigative the detection value of EB virus DNA (EBV-DNA), interleukin-2 (IL-2), and interleukin-6 (IL-6) level in peripheral blood of children with infectious mononucleosis (IM). A total of 59 children clinically confirmed with IM in Anhui Provincial Children's Hospital from January 2018 to September 2020 were enrolled as IM group, while other 30 healthy children undergoing physical examination during the same period were enrolled as healthy group. The level of EBV-DNA load, IL-2, and IL-6 were compared between the two groups, and their diagnostic values for IM children were explored. According to the median level of EBV-DNA load, positive children were divided into high viral load group and low viral load group. The hepatomegaly and splenomegaly, and levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), IL-2, and IL-6 were compared between the two groups. The relationship between EBV-DNA load and IL-2, IL-6 levels were explored. The positive rate of EBV-DNA was 67.80% in IM group, which was significantly higher than 10.00% in healthy group (P<0.001), and the levels of serum IL-2 and IL-6 were also significantly higher than healthy group (P<0.001). The results of ROC curve analysis showed that AUC of IL-2 combined with IL-6 and EBV-DNA load was 0.948, which was significantly greater than that of IL-2, IL-6, and EBV-DNA load alone (0.847, 0.728, 0.789) (P<0.001). The cut-off value of IL-2 and IL-6 was 15.545 pg/ml and 56.560 pg/ml, respectively. Both the proportions of cases with moderate to severe hepatomegaly and splenomegaly in high viral load group were significantly higher than those in low viral load group (P<0.01, P<0.05). The levels of ALT, AST, and IL-2 in high viral load group were significantly higher than those in low viral load group (P<0.001), as well as IL-6 (P<0.01). In high and low viral load groups, EBV-DNA load was positively correlated with IL-2 and IL-6 (in high viral load group, rIL-2=0.598, rIL-6=0.416; in low viral load group, rIL-2=0.621, rIL-6=0.527, P<0.001). The detection of EBV-DNA load combined with IL-2 and IL-6 can improve the diagnostic accuracy of IM, and EBV-DNA load, IL-2 and IL-6 levels are related to the disease progression.

Adenosine deaminase as a marker for the severity of infectious mononucleosis secondary to EBV in children

BackgroundInfectious mononucleosis, a common disease in children and young adults, is often accompanied by elevated transaminase levels and rarely, liver failure. This study aimed to determine whether adenosine deaminase is a marker of severity in children with infectious mononucleosis, especially those with elevated alanine transaminase levels.MethodsThis case-control study was conducted at the Children’s Hospital of Soochow University. A total of 104 children with infectious mononucleosis and 50 controls with other acute infections and fever, tonsillitis, or lymphadenitis, were enrolled in the study. Among the 104 children with infectious mononucleosis, 54 had normal alanine transaminase levels and 50 had elevated alanine transaminase levels. The children’s clinical and laboratory data were analyzed to assess the diagnostic value of adenosine deaminase in the three groups.ResultsThe adenosine deaminase level in the infectious mononucleosis group was significantly higher than that in the control group (P < 0.001). The adenosine deaminase levels were highly correlated with lymphocyte count, CD3+CD8+ T cells (%), CD4+/CD8+ ratio, and CD3−CD19+ (%) (r > 0.7, P < 0.01). The sensitivity and specificity of adenosine deaminase in predicting children with infectious mononucleosis were 97.1% and 94.0%, respectively. Furthermore, multivariate regression analysis revealed that adenosine deaminase level was a risk factor for elevated alanine transaminase in children with infectious mononucleosis.ConclusionsAdenosine deaminase may be a marker of the severity of infectious mononucleosis in children, and a predictor of elevated alanine transaminase in children with infectious mononucleosis.

The application of quantitative analysis of EBV DNA loads in plasma and peripheral blood mononuclear cells in Epstein-Barr Virus infection-related diseases in children

Objective: To explore the correlation of EBV DNA load in two different types of plasma and peripheral blood mononuclear cells (PBMCs) in children with Epstein-Barr Virus (EBV) infection diseases. Methods: A retrospective evaluated was performed on EBV DNA quantification in plasma and PBMCs by qPCR between April, 2019 and December, 2020. The samples were collected from children of 456 cases with EBV infection and 2 306 healthy cases. In EBV infection group, boys were 253 and girls were 203, aged from 8 days to months to 16 years. In healthy group, boys were 1 267 and girls were 1 039, aged from 8 days to 16 years. Results: Infectious mononucleosis (IM) was the most common disease associated with EBV infection 73.68%(336/456). The detection rate of plasma and PBMCs in EBV infection group was 91.89% (419/456)and 99.34% (453/456)respectively, and was 100%(456/456) in plasma or PBMCs. The detection rate of plasma and PBMCs in healthy group was 1.13%(26/2 306) and 30.01%(715/2 306), respectively. Levels of EBV DNA in plasma and PBMCs in EBV infection group [IM, acute infections, pneumonia, post-transplantation lymphoproliferative disorder (PTLD), hemophagocytic lymphohistiocytosis, tonsillitis and lymphadenitis] was significantly higher than those in healthy group (In plasma, Z=-47.18,-34.41,-33.40,-31.71,-24.38,-20.86 and -20.59,respectively; In PBMCs, Z=-33.17,-16.45,-11.33,-9.45,-5.57,-5.16 and -5.45, respectively; P<0.05). In IM group, EBV DNA load in plasma and PBMCs in remission stage was significantly lower than those in infection stage (Z=-11.45, -8.53;P<0.05). In PTLD group, there was significant difference in EBV DNA load in plasma between infection and remission stage (Z=-4.13, P<0.05), while there was no significant difference in EBV DNA load in PBMCs (Z=-0.817, P>0.05). Conclusions: EBV infection was mainly caused by IM. Combined detection of plasma and PBMCs in EBV DNA is valuable for improving diagnosis ability of EBV infection-related diseases, and the load of EBV DNA could be used as a marker.

The clinical value of high fluorescent lymphocytes and smudge cells in the diagnosis of infectious mononucleosis.

BackgroundThe diagnostic value of high fluorescent lymphocytes (HFLC) and smudge cells in diseases like sepsis has been confirmed. In this study, we explore the diagnostic value of HFLC and smudge cells for infectious mononucleosis (IM).MethodsSixty‐two IM patients, 67 healthy controls, 84 patients with upper respiratory tract virus infection, and 35 patients with malignant lymphoid diseases were enrolled. The complete blood counts and leukocyte differential counts are tested, and the smudge cells were manually counted.ResultsThe value of HFLC% and smudge cells of the IM group were significantly higher than those of healthy controls and disease controls (p < 0.05), and the HFLC% value of IM patients was positively correlated with the number of reactive lymphocytes (r = 0.265). When the cutoff value of HFLC% was 0.4%, and the diagnostic value of IM was high (AUC = 0.995). When the smudge cells >2/100 nucleated cells, it can show better (AUC = 1.000). When the cutoff value of the HFLC% was 1.2%, it can effectively distinguish IM patients from upper respiratory tract virus infection patients (AUC = 0.934); when smudge cells >16/100 nucleated cells, it also has high differential diagnosis value (AUC = 0.913). In addition, the AUC of the combination HFLC% and smudge cells for the differential diagnosis can be increased to 0.968. The performance value of single HFLC% (AUC = 0.942) for distinguishing IM from malignant lymphoid diseases was better than smudge cells and combine index with the cutoff value of 0.4%.ConclusionHFLC% and smudge cells can be used as effective indicators in the early diagnosis and differential diagnosis of IM.

Primary Epstein-Barr Virus Infection in Healthy Children in Saudi Arabia: A Single Hospital-Based Study.

Primary Epstein-Barr virus (EBV) infection presents typically with features of infectious mononucleosis (IM) but it may present with atypical symptoms. We aim to evaluate the epidemiological, clinical and laboratory characteristics of primary EBV infection in children in western Saudi Arabia. A retrospective analysis of the electronic data of all children who were admitted to the hospital and were tested for EBV-viral capsid antigen (VCA) IgM in the period from 1 January 2018 to 31 December 2019. All data of the children with positive EBV-VCA IgM were collected. Patients were divided into two groups; IM and the non-typical presentations groups. Fort-two patients had positive EBV-VCA IgM; 71% had IM and 29% had non-typical presentations. IM was more common in early childhood (46.7%). The non-typical presentations were more in infants below 1 year (50%). Adolescents were less affected (6.7% and 16.7%, respectively). Time to diagnose EBV in the non-typical presentations group was longer than IM group; [3.4 (3.2-4.6) vs. 4.7 (4.1-5.5), p = 0.039]. The total leucocytes count was higher in the IM syndrome group compared to the non-typical presentation group [11 (10.3-17.7) vs. 5.5 (4.5-6.4), p < 0.0001]. Primary EBV infection in healthy children in Saudi Arabia occurs more frequently in the younger age groups. IM syndrome occurs more frequently in early childhood. The non-typical presentation occurs more frequently in infants. While adolescents are less commonly affected by primary EBV.

Diagnostic Value of Combined Detection of HLA-G and IL-6 in Children with Infectious Mononucleosis

To investigate the diagnostic value of combined detection of HLA-G and IL-6 in children with infectious mononucleosis (IM). Eighty-three children suffered from infectious mononucleosis hospitalized in Wuhan Children's Hospital（Wuhan Maternal and Child Healthcare Hospital） from January 2014 to June 2017 were selected as the IM group, 83 healthy children in the same period were selected as the as control group. Enzyme-linked in munosorbent assay (ELISA) was used to detect and compare the changes of HLA-G and IL-6 levels between 2 groups. The positive rate of HLA-G and IL-6 were calculated and compared. The correlation of plasma HLA-G with IL-6 in IM group was analyzed, the MOC curve was drawn, and the diagnostic efficiencies of plasma HLA-G and IL-60 alone as well as 2 combined detection were compared. The plasma level of HLA-G and IL-6 in IM group was significantly higher than that in control group, and the difference between the 2 groups was were statistically significant (P<0.01). In untreated children with infectious mononucleosis, the positive rate of plasma HLA-G detection was 90.36% (75/83) and the positive rate of IL-6 detection was 87.95% (73/83) without a significant difference between 2 groups (P>0.05). There was a positive correlation between the plasma HLA-G and IL-6 levels in the observation group (r=0.196, (P<0.05). The analysis of ROC curve diagnostic effectiveness showed that the diagnostic sensitivity of IL-6 was 68.90%, the specificity was 71.50%, and the area under the ROC curve was 0.703. The diagnostic sensitivity of the plasma HLA-G was 74.20%, the specificity was 77.50%, and the area under the ROC curve was 0.761. The combined diagnostic sensitivity and specificity of 2 methods was 89.50% and 85.70% respectively, and the area under the ROC curve was 0.906. The combination of HLA-G and IL-6 for detect infectious mononucleosis resulted in a high sensitivity and accuracy, which is helpful to define the progress of the patient's condition, and worth for clinical application.

Relationship between the clinical manifestations and the changes of atypical lymphocyte and lymphocyte subsets in children with infectious mononucleosis

Objective To investigate atypical lymphocyte and lymphocyte subsets in children with infectious mononucleosis(IM)and its relationship with the clinical symptoms by retrospective method. Methods Two hundred and six children were diagnosed as infectious mononucleosis. Atypical types, lymphocyte subsets, and clinical symptoms and their relationship were evaluated and analyzed. Results In the IM children increased, decreased, increased and NK cells decreased. The control group was(64.23±6.26)%,(32.96±8.68)%,(20.25±7.45)%,(14.68±5.4)%,the IM group was(84.13±14.64)%,(18.45±5.14)%,(54.46±16.82)%,(4.65±1.50)%, the difference was statistically significant(P<0.001).92.9%patients had more 10%atypical lymphocytes. The children with more than 20%atypical lymphocytes had higher v8 and NK cells decreased,(58.78±16.67)%, (3.28±1.57)%. The difference with the atypical cells more than 10%less than 20%and the group less than 10%has statistically sighnificant which were(54.53±15.12)%,(4.55±1.64)%,(50.25±14.23)%,(5.13±1.84)%(P<0.001). The serious type of IM children had higher ratio of increased and decreased NK cells and had statistically significant compared with the light group, which were(57.78±15.45)%,(3.18±1.61)%,(51.09±12.26)%, (4.68±1.82)%,(20.25±7.45)%,(14.68±5.46)%(P<0.001). Conclusion The infectious mononucleosis can cause abnormal immune functions. The ratio of atypical lymphocytes, and NK cells numbers can be viewed as a monitoring index of the disease. Key words: Infectious mononucleosis; Lymphocyte subsets

English

To investigate the different expressions of protein spectra in sera from children with infectious mononucleosis (IM) at acute stage and recovery stage in order to screen out potential protein biomarkers for children IM, the fingerprints of serum protein were obtained from the healthy (controls), acute upper respiratory infection (AURI), acute IM and recovery IM children using surface enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF-MS) and gold chip technique. Data were analyzed by Biomarker Wizard 3.1 and diagnostic models were established by Biomarker Patterns System 5.0. Within the mass to charge (m/z) ratios, there were six protein peaks (five were down-expressed and one over-expressed) showing significant differences between the acute IM group and the control group (P 0.05). The established diagnostic model based on significative peak test, the specificity and the sensitivity of IM. All the analytical results suggested that the protein at 6421.5 (M/Z value) may be the serum biomarker for IM; the protein bank showed that the protein at 6421.5 is a new protein; the diagnostic models based on this peak could accurately distinguish acute IM from normal children, the recovery IM children. SELI-TOF-MS technology is an effective tool to search for disease-related proteins. Key words: Infectious mononucleosis (IM), proteomics, biomarker, artificial neural network.

The change of T-lymphocyte subgroup in children with infectious mononucleosis

Objective To investigate the change of T-lymphocyte subgroup in children with infectious mononucleosis (IM).Methods Sixty young children with IM caused by Epstein-Barr virus (EBV) were recruited for this study in Jiaxing First Hospital from Jan 2005 to Dec 2010.Thirty-six normal children were chosen as control group.Both of the two groups were detected blood test,blood smear,T-lymphocyte subgroup ( including CD3,CD4,CD8,CD4/CD8 ),liver and kidney function test,IgM antibodies of EBV,cytomegalovirus,adenovirus,and hepatitis virus.Results Compared with the control group (53.58％ ± 5.97％,31.22％±8.72％ ),the ratio of CD3 (81.55％ ±9.04％ ) and CD8(58.13％ ± 13.35％ ) were significantly higher in IM group( P ＜0.05 ).And the ratio of CD4 ( 18.19％ ± 7.61％ ) and CD4/CD8 (0.37 ± 0.33) were significantly lower in IM group,compared with the control group (36.98％ ± 5.32％,1.98 ± 0.41 )(P ＜ 0.05 ).While the leukocyte count,the ratio of abnormal leukomonocyte,and alanine transaminase had no correlation with the decrease of CD4/CD8 ( P ＞ 0.05 ).Conclusion Children with IM caused by EBV have bad immunocompetence,and we can treat them with immunotherapy early. Key words: infectious mononucleosis; T-lymphocyte subgroup; CD4/CD8 ; Children

Glutamate dehydrogenase activity in lymphocytes of B-cell chronic lymphocytic leukaemia patients

Objectives: To investigate the pattern of glutamate dehydrogenase (GLDH) activity, GLUD1 and GLUD2 expressions in peripheral blood mononuclear cells (PBMC) of untreated B-chronic lymphocytic leukemia (B-CLL) in healthy individuals (HI) and patients with infectious mononucleosis (IM). Design and methods: GLDH activity was determined in a supernatant obtained from pelleted PBMC. GLUD1 and GLUD2 mRNA expression was determined using a quantitative real-time polymerase chain reaction. CD19 + B cells from PBMC were purified by using positive selection. Results: The highest GLDH activity was found in PBMC of the B-CLL group followed by the HI group and IM group. The PBMC GLDH activity was higher in 60% of the B-CLL patients according to the established reference interval for our HI (2.17–5.70 μkat/g protein). The greater GLDH activity was also found in the CD19 + cell preparation of the B-CLL patients (two of the three) but not in HI ( n = 3). The median value of GLUD1 expression was highest in the IM group ( n = 11), followed by the HI ( n = 14) and B-CLL groups ( n = 59) (median 4.69/3.78, P < 0.005 and 4.69/2.91, P < 0.0005, respectively). GLUD2 expression was not significantly different between groups. Conclusions: The increased GLDH activity is specific for the PBMC of B-CLL patients. The GLUD1 but not the GLUD2 gene expression pattern is different between the PBMC of IM and B-CLL patients.

Diagnosis of infectious mononucleosis by combined detection of atypical lymphocytes and transaminase

In order to explore the value of combined detection of atypical lymphocytes (ATL) and transaminase (alanine aminotransferase, ALT; asparate aminotransferase, AST) in the diagnosis of infectious mononucleosis (IM), The data of blood routine and liver function were collected from 54 IM patients, 34 acute hepatitis (AH) patients, 44 upper respiratory infection (URI) patients in Union Hospital during March 2002 to March 2005. Same data were also collected from 40 healthy children as normal control. These data were analyzed retrospectively. Both proportion of atypical lymphocytes and enzyme activity of transaminase were elevated simultaneously (ALT > 40 IU/L, AST > 45 IU/L) in 57.4% (31/54) IM patients. There was significant difference (P < 0.01) between IM group and the other groups. Combined detection of atypical lymphocytes and transaminase can be regarded as a diagnostic marker of infectious mononucleosis.