Clinical and laboratory differences between Epstein-Barr and cytomegalovirus infectious mononucleosis in children

Abstract

In children with CMV abdominal pain, eyelid swelling, skin rash, fatigue and thrombocytopenia were more common. In children with EBV values of transaminases declined significantly faster.

Clinical differentiation of infectious mononucleosis that is caused by Epstein-Barr virus or cytomegalovirus: A single-center case-control study in Japan

“…Fever was defined as a body temperature of !38.0 C. Hepatosplenomegaly was identified based on ultrasound-based confirmation of hepatomegaly and/or splenomegaly. Leukocytosis was defined as a leukocyte count of >10,000/mm 3 [2] and thrombocytopenia was defined as a platelet count of <150,000/mm 3 [2]. For the analyses, some continuous variables were categorized: age ( 30 years, 31e40 years, and >40 years) [5], atypical lymphocytes ( 10%, 11e30%, and >30%) [5,12], ALT ( 40 IU/L, 41e200 IU/L, and >200 IU/L) [2,12], LDH ( 250 IU/L, 251e500 IU/L, and >500 IU/L), ALP ( 350 IU/L, 351e500 IU/L, and >500 IU/L), and GGT ( 50 IU/L, 51e300 IU/L, and >300 IU/L).…”

“…Leukocytosis was defined as a leukocyte count of >10,000/mm 3 [2] and thrombocytopenia was defined as a platelet count of <150,000/mm 3 [2]. For the analyses, some continuous variables were categorized: age ( 30 years, 31e40 years, and >40 years) [5], atypical lymphocytes ( 10%, 11e30%, and >30%) [5,12], ALT ( 40 IU/L, 41e200 IU/L, and >200 IU/L) [2,12], LDH ( 250 IU/L, 251e500 IU/L, and >500 IU/L), ALP ( 350 IU/L, 351e500 IU/L, and >500 IU/L), and GGT ( 50 IU/L, 51e300 IU/L, and >300 IU/L). The cut-off values for age, leukocytosis, thrombocytopenia, atypical lymphocytosis, and ALT level were selected based on previous relevant studies and the distribution of our data.…”

“…The cut-off values for age, leukocytosis, thrombocytopenia, atypical lymphocytosis, and ALT level were selected based on previous relevant studies and the distribution of our data. We used original categories for LDH, ALP, and GGT levels based on previous studies and the distribution of our data [2,12,13].…”

“…Infectious mononucleosis (IM) is a common self-limiting viral infection that typically affects juvenile patients and presents with a classical triad: fever, pharyngitis, and lymphadenopathy [1]. Most cases of IM are caused by Epstein-Barr virus (EBV) and the second most common causative agent is cytomegalovirus (CMV), which causes 5e16% of cases [1,2]. Other conditions that must be considered in the differential diagnosis include toxoplasmosis, human herpes virus-6 (HHV-6) infection, human herpes virus-7 (HHV-7) infection, adenovirus infection, rubella, herpes simplex virus (HSV) infection, influenza/parainfluenza virus infection, rhinovirus infection, coronavirus infection, and acute human immunodeficiency virus (HIV) infection [1,3].…”

“…Thus, it would be helpful for primary care physicians to differentiate between EBV-IM and CMV-IM based on symptoms, clinical signs, and readily available laboratory data, such as complete blood counts (CBC). However, we are only aware of a few studies that have directly compared the clinical characteristics of EBV-IM and CMV-IM [2,10], and those studies were limited by their small size and the absence of multivariate analyses. Therefore, the present study aimed to determine whether clinical findings could be used to differentiate between EBV-IM and CMV-IM before serological confirmation could be obtained.…”