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

Abstract

a b s t r a c tIntroduction: Infectious mononucleosis (IM) is a common viral infection that typically causes fever, pharyngitis, and lymphadenopathy in young patients. The Epstein-Barr virus (EBV) is the most common cause of IM, followed by cytomegalovirus (CMV). Given that serological testing is associated with limitations regarding its accuracy, availability, and time to receive results, clinical differentiation based on symptoms, signs, and basic tests would be useful. We evaluated whether clinical findings could be used to differentiate EBV-IM from CMV-IM. Methods: In this single-center retrospective case-control study, we evaluated >14-year-old patients with serologically confirmed EBV-IM or CMV-IM during 2006e2017. We compared the patients' symptoms, physical findings, blood counts, and serum biomarkers to create three regression models: model 1 (symptoms and signs), model 2 (model 1 plus sonographic hepatosplenomegaly and blood counts), and model 3 (model 2 plus hepatobiliary biomarkers). Results: Among the 122 patients (72.6%) with EBV-IM and 46 patients (27.4%) with CMV-IM, the median age was 25 years and 82 patients (48.8%) were male. The median age was 10 years older in the CMV-IM group (p < 0.001) and the median interval from onset to visit was 5 days longer in the CMV-IM group (p < 0.001). Logistic regression revealed that EBV-IM was predicted by younger age, short onset-to-visit interval, lymphadenopathy, tonsillar white coat, hepatosplenomegaly, atypical lymphocytosis, and elevations of lactate dehydrogenase and gamma-glutamyl transferase. All regression models had areas under the curve of >0.9. Conclusion: History and physical findings, especially when used with atypical lymphocytosis and sonographic hepatosplenomegaly, can help physicians differentiate EBV-IM from CMV-IM.

Cytomegalovirus and Epstein–Barr Virus Associations with Neurological Diseases and the Need for Vaccine Development

“…Cytomegalovirus (CMV) infection is usually acquired during the early years of life and, in immunocompetent individuals, it is usually subclinical. In immunocompetent adults, CMV infection is most commonly associated with abnormal liver function test results, malaise and fever [9] and it is the second leading cause of infectious mononucleosis behind EBV [10]. CMV infection or reactivation is responsible for significant morbidity and mortality in the immunocompromised [11], solid organ transplant recipients [12] and critically ill immunocompetent patients [13].…”

Sex difference in clinical presentation of patients with infectious mononucleosis caused by Epstein-Barr virus

“…As a post-hoc analysis of our previous study on clinical differentiation of EBV-IM and IM caused by cytomegalovirus [6], we evaluated the medical records of immunocompetent patients with serologically confirmed EBV-IM from the Toho University Medical Center Omori Hospital, an institution with 948 beds located in the southern part of Tokyo, Japan. The ethics committee of Toho University Medical Center Omori Hospital approved the study's retrospective protocol (M17295) and the waiver of individual informed consent subject to public announcement of the research because of the retrospective and noninvasive study design.…”

“…We did not evaluate hepatosplenomegaly detected by physical examination because hepatosplenomegaly as a physical finding was not evaluated in all patients. For logistic regression analysis, we categorized or defined cut-off values of some numeric variables based on previous studies in the following manner: Fever was defined as a body temperature of !38.0 C [6], leukocytosis as a leukocyte count of >11,000/mm 3 [7], and thrombocytopenia as a platelet count of <150,000/mm 3 [8]. We also separated patients in two age-related categories: 30 years old and >30 years old [3].…”

The role of children and adults as a reservoir of pathogens during the seasonal rise in the incidence of upper respiratory tract infections

“…Сопоставление результатов лабораторного исследования с наличием отдельных катаральных симптомов показало, что для выделения ВЭБ как единственного возбудителя характерно наличие гиперемии ротоглотки. Это соотносится с результатами других исследований [1][2][3]14]. Преимущественное отсутствие при инфекционном мононуклеозе насморка и кашля определяет его более медленное распространение по сравнению с другими ИВДП [1].…”

“…Особенностями инфекционного мононуклеоза, вызванного вирусом Эпштейна-Барр (ВЭБ), являются наличие широкого спектра клинических проявлений, в том числе катаральных, длительное течение первичной инфекции с последующим переходом к латентной персистенции вируса [1][2][3][4]. Наиболее высокие показатели заболеваемости инфекционным мононуклеозом отмечаются среди детей дошкольного возраста и подростков [5,6].…”