| ObjectiveTo understand the prevalence of Epstein-Barr virus in children in Chongqing and the clinical characteristics of infectious mononucleosis (IM) through retrospective case analysis of infectious mononucleosis and to provide epidemical data for the prevention and treatment of EBV infection.MethodsAll results of anti-VCA-IgM and anti-VCA-IgG to Epstein-Barr virus detected by ELISA in Chongqing Children's Hospital from January to December in 2009 were collected. The data was counted using statistical analysis of Chi-Square Test by gender, age group and months. The clinical data of 306 cases of infectious mononucleosis diagnosed in 2009 was also analyzed retrospectively.Results1. The total infection rate of Epstein-Barr virus for children under 18 years old was 35.27% in Chongqing in 2009 and the recent infection rate was 12.66%.2. The accumulation infection rate gradually increased with ages, and nearly half of children had been infected by Epstein-Barr virus in pre-school age group. The period from 3 to 5 years old was the peak age of infection. There may be seasonal differences of EBV infection in Chongqing in 2009 (P < 0.05). There was no gender differences in the distribution of the cumulative and the recent infection rates. The accumulation rate among 0-3 months, 3-6 months, 6-12 months, 1-2 years, 3-5 years, 6-12 years old 13-18 years old was 27.70%, 10.48%, 14.13%, 27.69%, 44.61%, 51.99% and 57.34%, respectively. And the recent infection rate was 1.15%, 1.25%, 2.52%, 12.55%, 22.21%, 18.55% and 20.3%, respectively. The recent infection rates in March, September and October were higher than those of others in 2009, and the difference was statistically significant (P <0.05). Except the 1-2 years group (P <0.05), there was no difference in other age groups about the cumulative and the recent infection rate by gender (P> 0.05).3. The total 306 cases diagnosed as infectious mononucleosis were preschool children based, and cases between 3-6 years old were 158/306(51.63 %).The main clinical manifestations were fever (276/306, 90.20%), enlarged lymph nodes (271/306, 88.56%), pharyngitis (268/306, 87.58%), hepatosplenomegaly (161/306,52.61%), hepatomegaly (221/306, 72.22%),splenomegaly(163/306,53.27%),eyelid edema(130/306, 42.48%), nasal obstruction (104/306, 33.99%). Some symptoms had age difference: pharyngitis was more common in older groups (≥7 years) and nasal obstruction was more common in little age groups (<7 years) (P <0.05). There were many complications and multiple systems damage associated with infectious mononucleosis. The following were more common complications: liver damage (16.34%), pneumonia (10.45%), bronchitis (10.13%), myocarditis (8.17%). Severe complication Epstein-Barr virus associated hemophagocytic lymphohistiocytosis syndrome was 3/306 (0.98%). The count of WBC in peripheral blood increased (more than 10×109/L) in 81.37% of the patients with lymphocyte predominance. The patients with the atypical lymphocyte >10% were 37.91%. The abnormal of ALT and AST were found in 53.24% and 52.22% of patients respectively,and severe liver damage was more common in older age groups(≥7 years) (P<0.05). Heterophile antibody (HA) was positive in 97 cases (58.08%) and cases positive for HA were 20/42 (47.65%) under 3 years old and 77/128 (60.16%) aged more than 3 years old, but there was no significant difference to be found (χ~2=2.02,P=0.15).Conclusion1. The infection rate with EB virus for people under the age of 18 years old was 35.27% overall in Chongqing in 2009. The accumulation rate among 3-6 months, 6-12 months, 1-2 years, 3-5 years, 6-12 years old and 13-18 years old was 27.70%, 10.48%, 14.13%, 27.69%, 44.61%, 51.99% and 57.34%, respectively. Nearly half of children had been infected by Epstein-Barr virus in pre-school age group, the peak period of infection was 3-5 years old.2. There was no gender difference of cumulative and recent EB virus infection rate in Chongqing in 2009, the infection rate in March and September-October were higher than those of others.3. Infectious mononucleosis usually occurs to preschool children. Fever, lymphadenopathy, pharyngitis ,hepatosplenomegaly were the main clinical manifestations. Nasal obstruction and eyelid edema are also important clinical features and they varied in different age groups. Severe hepatic damage often happened to old age groups. The disease can affect multiple organs and systems, but most had good prognosis. Children with Epstein-Barr virus associated hemophagocytic lymphohistiocytosis may have poor prognosis. |
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