Clinical characteristics and laboratory findings in Danish children hospitalized with primary Epstein-Barr virus infection

Abstract

Background: Epstein-Barr virus (EBV) positive infectious mononucleosis (IM) is a common disease in adolescents. However, IM is often considered a rare disease in early childhood. We aimed to describe the classical presentation of adolescent EBV-associated IM compared to EBV infection at younger age. Methods: All immunocompetent children hospitalized at Hvidovre University Hospital, Copenhagen between 2002 and 2013, who presented with clinical features that prompted a laboratory test for EBV, and who tested positive by presence of EBV-specific antibodies, heterophile antibodies or a positive EBV PCR were included (n = 95). Results: Children aged 1–2 years were the age group most commonly hospitalized with acute EBV infection (27% of the cohort), followed by teenagers aged 14–15 years (23%). Fever, cervical lymphadenopathy, tonsillitis and fatigue were the most common physical findings overall. Dividing the children into three age groups (0–4 years, 5–10 years and 11–15 years) revealed that the oldest age groups significantly more often suffered from headache, tonsillitis, sore throat, abdominal pain and nausea. Young children typically presented with a runny nose, fever, fatigue and cervical adenitis. Compared with children under 5, children aged 5–15 years more often showed lymphocytosis (84% vs 62%), elevated alanine aminotransferase (77% vs 33%) and lactate dehydrogenase (79% vs 44%). Conclusion: EBV infection is common in young children, and children less than 3 years of age constitute the largest group of hospitalizations for acute EBV infection. EBV-associated IM should be suspected in febrile children of all ages with tonsillitis, lymphadenopathy, lymphocytosis and elevated liver enzymes.

Keywords::

• Children
• Epstein-Barr virus
• symptoms
• age
• mononucleosis

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. No funding was received for the study.