Biochemical studies on hepatic involvement in infectious mononucleosis

Baron, Dror; Bell, Joyce L.; Dunnet, W. N.

doi:10.1136/jcp.18.2.209

Cited by 14 publications

(6 citation statements)

References 18 publications

(7 reference statements)

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“…The studies included a total number of 3,924 patients. Five studies evaluated only adult population [4][5][6][7][8] ; ten studies were on paediatric population (defined as under 18 years) [9][10][11][12][13][14][15][16][17][18] ; ten studies included both adult and children [19][20][21][22][23][24][25][26][27][28] ; eight studies did not report on the participants' age [29][30][31][32][33][34][35][36] .…”

Section: Resultsmentioning

confidence: 99%

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The utility of liver function tests and abdominal ultrasound in infectious mononucleosis -- A systematic review

Tan¹,

Wilkinson

Edafe

2022

Preprint

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Introduction: A large proportion of patients with infectious mononucleosis (IM) have abnormal liver function tests (LFT) at presentation. There is no guideline regarding the management and follow-up of these patients. Some patients also have abdominal ultrasound due to deranged LFT, the need for this practice is unclear. The aim of this systematic review was to evaluate the evidence base on LFT assessment in IM, time to resolution of derangement, and the role of abdominal ultrasound. Methods: A systematic search of PubMed, EMBASE and the Cochrane library was done. Two authors independently screened records for eligibility using pre-defined criteria. We included both adult and paediatric populations. Quality assessment of included studies was done. Results: A total of 3924 patients were included from 32 studies. A combination of typical clinical features, heterophile antibodies and EBV-specific antibodies were used to ascertain diagnosis. The following proportion of patients had abnormal LFTs: AST (57%); ALT (62%); ALP (65%); Bilirubin (16%); GGT (41%). Reported median (i.q.r.) time to resolution of LFT was 8 (6–12) weeks. Maximum time to resolution was >6 months. Clinical hepatomegaly and splenomegaly were found in 35% and 44% of patients respectively. Enlarged liver and spleen on ultrasound were seen in 16/29 (55%) and 38/38 (100%) of patients respectively. There were no reports of decompensated liver disease. Conclusion: Derangement in LFTs can persist over six months from initial presentation in IM. However, this is self-limiting. The evidence suggests serial liver function assessments and ultrasound abdomen are not required in immunocompetent patients with subclinical derangement in LFTs.

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Section: Resultsmentioning

confidence: 99%

“…Zhang et al found reduce levels of total bilirubin in patients with IM compared to healthy control. Two studies included albumin within their testing and reported reduced albumin levels in 21/114 (18.4%) patients 27,35 .…”

Section: Main Outcomesmentioning

confidence: 99%

The utility of liver function tests and abdominal ultrasound in infectious mononucleosis -- A systematic review

Tan¹,

Wilkinson

Edafe

2022

Preprint

View full text Add to dashboard Cite

show abstract

“…The studies included a total number of 3924 patients. Five studies evaluated only adult population 4–8 ; 10 studies were on paediatric population (defined as under 18 years) 9–18 ; 10 studies included both adult and children 19–28 ; 8 studies did not report on the participants' age 29–36 …”

Section: Resultsmentioning

confidence: 99%

“…10 studies were on paediatric population (defined as under 18 years) [9][10][11][12][13][14][15][16][17][18] ; 10 studies included both adult and children [19][20][21][22][23][24][25][26][27][28] ; 8 studies did not report on the participants' age. [29][30][31][32][33][34][35][36] 3.1 | Diagnosis of IM albumin within their testing and reported reduced albumin levels in 21 of 114 (18.4%) patients. 27,35 Data on resolution of abnormal LFT was largely incompletely reported (Table 3).…”

Section: Resultsmentioning

confidence: 99%

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The utility of liver function tests and abdominal ultrasound in infectious mononucleosis—A systematic review

Tan

Wilkinson

Edafe

2022

Clinical Otolaryngology

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Introduction A large proportion of patients with infectious mononucleosis (IM) have abnormal liver function tests (LFT) at presentation. There is no guideline regarding the management and follow‐up of these patients. Some patients also have abdominal ultrasound (US) due to deranged LFT, the need for this practice is unclear. The aim of this systematic review was to evaluate the evidence base on LFT assessment in IM, time to resolution of derangement, and the role of abdominal US. Methods A systematic search of PubMed, EMBASE and the Cochrane library was done. Two authors independently screened records for eligibility using pre‐defined criteria. We included both adult and paediatric populations. Quality assessment of included studies was done. Results A total of 3924 patients were included from 32 studies, of which LFT values were reported on 2779 patients. A combination of typical clinical features, heterophile antibodies and Epstein–Barr virus‐specific antibodies were used to ascertain diagnosis. The following proportion of patients had abnormal LFT: aspartate transaminase (57%); alanine transaminase (62%); alkaline phosphatase (65%); bilirubin (16%); gamma‐glutamyltransferase (41%). Reported median (interquartile range) time to resolution of LFT was 8 (6–12) weeks (n = 438). Maximum time to resolution was >6 months. Clinical hepatomegaly and splenomegaly were found in 35% and 44% of patients, respectively. Enlarged liver and spleen on US were seen in 16 of 29 and 38 of 38 of patients, respectively. There were no reports of decompensated liver disease. Conclusion Current evidence questions the need for routine assessment of LFT in immunocompetent patients presenting with IM; serial LFT assessments following initial abnormalities are not required in immunocompetent patients with subclinical derangement of LFT; routine US abdomen in IM to evaluate for derangement of LFT is not required.

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Hyperuricemia in Infectious Mononucleosis

Cowdrey¹

1966

JAMA

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Biochemical studies on hepatic involvement in infectious mononucleosis

Abstract: No patient has developed chronic hepatitis.

Cited by 14 publications

References 18 publications

The utility of liver function tests and abdominal ultrasound in infectious mononucleosis -- A systematic review

The utility of liver function tests and abdominal ultrasound in infectious mononucleosis -- A systematic review

The utility of liver function tests and abdominal ultrasound in infectious mononucleosis—A systematic review

Hyperuricemia in Infectious Mononucleosis

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