Clinical characteristics and effectiveness of antiviral agents in hospitalized children with infectious mononucleosis in China: A multicenter retrospective study

Abstract

Importance The clinical characteristics of infectious mononucleosis (IM) in Chinese children have not been evaluated in multicenter studies, and the effectiveness of antiviral treatment are controversial. Objective To investigate the clinical characteristics of Chinese children with IM and current status of antiviral therapy for affected patients. Methods Hospitalized patients with IM were enrolled between 2018 and 2020 in five children’s hospitals in China. The clinical characteristics were compared among four age groups: <3 years, 3–<6 years, 6–<10 years, and ≥10 years. The clinical characteristics of IM and effectiveness of antiviral therapy were compared among patients receiving acyclovir (ACV), ganciclovir (GCV), and no antiviral therapy (i.e., non‐antiviral group). Results In total, 499 patients were analyzed; most patients were 3–<6 years of age. The most common symptoms and signs included fever (100%), lymphadenopathy (98.6%), pharyngitis (86.4%), eyelid edema (76.8%), and snoring (72.9%). There were significant differences in rash, hepatomegaly, and liver dysfunction among the four age groups. Patients aged < 3 years had a lower incidence of liver dysfunction and a higher incidence of rash. Among the 499 patients, 50.1% were treated with GCV, 26.3% were treated with ACV, and 23.6% received no antiviral therapy. Compared with the non‐antiviral group, patients in the ACV and GCV groups had longer durations of fever (P < 0.001). There were no significant differences in the incidences of complications among the three treatment groups. Interpretation The incidence of IM in Chinese children peaked at 3–<6 years of age. Clinical features of IM varied according to age. Patients receiving antiviral therapy exhibited more serious clinical manifestations than did patients without antiviral therapy. The effectiveness of antiviral therapy for IM requires further analysis.

Epidemiological characteristics and disease burden of infectious mononucleosis in hospitalized children in China: A nationwide retrospective study

“…In terms of the at-risk age of onset, our results showed that children hospitalized for IM were mainly 4–6 years old in China, which was similar to the data analyzed by the single-center study of hospitalized IM children ( Gao et al., 2011 ; Hu et al., 2021 ). In China and other developing countries of Asia and Africa, most primary EBV infections occur in children, especially preschoolers, who make up a large portion of IM patients ( Dunmire et al., 2015 ; Shi et al., 2022 ).…”

“…Hu et al. analyzed the epidemiological characteristics of children hospitalized for IM in Beijing, China, and indicated that the male to female ratio was 1.6:1 ( Hu et al., 2021 ). Keun Hyung Son et al.…”

“…This retrospective study collected basic medical information from the FUTURE database for all children hospitalized with IM based on ICD-10 codes as selection criteria. The clinical manifestations and laboratory tests of these 24,120 children met the proposed diagnostic criteria for IM ( Subspecialty Group of Infectious Diseases and Children, 2016 ; Xie et al., 2018 ), and the complications were defined as reported previously ( Fernbach and Starling, 1972 ; Jenson, 2000 ; Hu et al., 2021 ). When the aspartate aminotransferase (AST) or alanine aminotransferase (ALT) is elevated two or more times the upper limit of reference, without other causes of elevated AST or ALT, it can be diagnosed that the existence of IM is complicated by hepatic dysfunction.…”

“…Laboratory examination shows an increase in peripheral blood lymphocytes and atypical lymphocytes ( Fernbach and Starling, 1972 ; Naughton et al., 2021 ). In children, the typical clinical manifestations of IM are the classic triad consisting of fever, pharyngitis, and lymphadenopathy, sometimes accompanied by edema of eyelids, hepatosplenomegaly, liver dysfunction ( Gao et al., 2011 ; Hu et al., 2021 ). Adult IM patients may present with a sore throat, lymphadenopathy, and fatigue ( Gao et al., 2011 ; Dunmire et al., 2015 ).…”

“…Data from a prospective study at the University of Minnesota showed that 74% of college students aged 18–22 who were experiencing EBV infection were considered IM patients ( Dunmire et al., 2015 ). However, as a developing country, a high incidence of IM in China was found in the preschoolers, among which children aged 4–6 years reach the peak ( Hu et al., 2021 ).…”