Complications of Infectious Mononucleosis in Children

Epstein-Barr virus (EBV) is a double-stranded DNA virus from the herpes virus family.It is common all over the world.Although approximately 90%-95% of adults are EBV seropositive, most infections are subclinical and silent.The infection spreads via close contact.EBV is the most common cause of infectious mononucleosis (IM).Primary IM is usually asymptomatic in children, but sometimes tonsillopharyngitis, cervical lymphadenopathy, fever, headache, nausea, vomiting, loss of appetite, and otitis media can be seen.Lymphadenopathy is symmetrical and is more common in the posterior cervical chain than in the front chain.Tonsils may be white or gray-green with an exudate.Also, they may be necrotic, accompanied by palatal petechiae.Periorbital, palpebral edema, and maculopapular or morbilliform rashes are the skin findings that can be seen.Further, 90% of the patients have mild hepatitis and associated nausea, vomiting, and anorexia.Splenomegaly is seen in 50% of patients, but jaundice and hepatomegaly are rare (1).Intrauterine infection is rare, as less than 5% of pregnant women are susceptible to the virus.Cases with congenital anomalies, such as biliary atresia, congenital heart disease, hypotonia, micrognathia, cataracts, and thrombocytopenia, have been reported rarely (2). ABSTRACTInfectious mononucleosis (IM) is detected more in preschool and infant children, with differences in clinical features.This study aimed to analyze and compare the demographic, clinical, and laboratory characteristics and complications of IM in Turkey and other nonindustrial countries.The study was performed to retrospectively analyze the etiology of fever and lymphadenopathy in Keçiören Training and Research Hospital Pediatric Clinic between 2014 and 2018.Twenty-six patients clinically suspected of having IM and positive for Epstein-Barr virus (EBV) viral capsid antigen immunoglobulin M (IgM) antibody were included in the study.The files of 26 (13%) patients diagnosed with IM were analyzed for EBV viral capsid antigen (VCA) IgM antibody.Twelve (46%) of the patients were male, and 14 (54%) were female; 21 (80.7%) were aged less than 3 years, and the average age was 26 months.The age of onset peaked between 0-12 months (34.6%) and 25-36 months (30.7%).Fever, lymphadenopathy, and hepatosplenomegaly were observed in all patients (n = 26).The fever lasted for an average of 5 days.Tonsillopharyngitis (80%), skin rash (69%), conjunctivitis (65%), anemia (12%), leukocytosis (54%), and high liver function (65%) were the most common laboratory findings.The average hospital stay was 7.5 days.Patients with prolonged fever, lymphadenopathy, and hepatomegaly were more prominent, and patients with elevated liver enzymes stayed longer in the hospital.This study showed that exposure to EBV at an early age in Turkey, like other nonindustrial countries, developed into IM; therefore, the incidence rates of hepatosplenomegaly, lymphadenopathy, and hospitalization were high.It aimed to emphasize the importance of preventing exposure at a growing age because it also led to the development of chronic diseases in advanced ages.