Low uric acid level increases the risk of infectious mononucleosis and this effect is more pronounced in women

Abstract

Abstract. Infectious mononucleosis (IM) due to Epstein-Barr virus infection is common. Uric acid (UA) is an important endogenous antioxidant. To the best of our knowledge, the association between UA and IM has not been comprehensively investigated to date. The aim of the present study was to investigate this association in Chinese patients. A total of 95 patients (47 men and 48 women) with IM were recruited, along with 95 healthy controls. Clinical data were classified by patient sex. Receiver operating characteristic (ROC) curve analysis was adopted to determine the cut-off values of UA for IM diagnosis and prediction. Crude and adjusted odds ratios (ORs) of UA for IM were analyzed by binary logistic regression. The UA levels were significantly lower in IM patients compared with those in controls. In addition, UA levels in men were significantly higher compared with those in women. The ROC curve demonstrated good diagnostic and predictive values of UA for IM in both sexes. The UA cut-off values were 326.00 and 243.50 µmol/l for diagnosing IM in men and women, respectively, with a diagnostic accuracy of 76.596 and 80.208%, respectively. Binary logistic regression analysis revealed a significant risk of IM in the low UA quartiles in both sexes. Following adjustments, the ORs even increased. Women with low UA levels appeared to be more susceptible to IM. For example, the crude ORs in quartile 1 were 24.000 and 52.500 for men and women, respectively, and the respective adjusted ORs were 31.437 and 301.746 (all P<0.01). To the best of our knowledge, the present study is the first to demonstrate the inverse association between UA and IM, suggesting a progressive decrease of antioxidant reserve in IM. Moreover, low UA was suggestive of IM, particularly in women. IntroductionInfectious mononucleosis (IM) is an important clinical entity that is associated with Epstein-Barr virus (EBV) infection (1,2). This clinical manifestation was first described in 1889, but the term IM was coined in 1920, when it was discovered that a number of patients with glandular fever had similar blood films (3). In 1968, the then newly discovered EBV was identified as the cause of IM (4). The currently estimated incidence of IM is at ~500 cases per 100,000 persons annually. IM diagnosis is often established with the classical clinical triad of pharyngitis, fever and lymphadenopathy. Serological testing for the identification of EBV antibodies is required for a definitive diagnosis (1,2). The treatment of patients with IM is mainly supportive. Corticosteroids are considered as the standard treatment for severe complications associated with IM (1,2).Uric acid (UA) is a purine degradation metabolite. A high serum level of UA is considered harmful. Hyperuricemia is considered to be closely associated with a number of metabolic disorders (5-7). For example, it was previously demonstrated that UA and metabolic syndrome were closely associated, and young women with hyperuricemia were at the highest risk of developing metabolic syndrome (5). Our rece...

Serum Uric Acid Concentrations and Risk of Adverse Outcomes in Patients With COVID-19

“…However, few studies on associations between serum uric acid concentrations and infections have been previously reported. Hypouricemia is a poor prognostic indicator in patients with intra-abdominal sepsis (36) or radiating pneumonitis (37). Another study showed that hypouricemic patients with SARS had poorer outcomes, especially in terms of respiratory failure (10).…”

“…Moreover, uric acid crystals can be sensed by Clec12A, a regulator of type-I interferon responses, which is a pivotal defensive mechanism against viral infection ( 33 ). Uric acid strongly enhances T-cell immune responses to viruses ( 34 ), and low uric acid concentrations increase the risk of infection with viruses, such as Epstein–Barr virus ( 35 ). However, few studies on associations between serum uric acid concentrations and infections have been previously reported.…”

Antioxidant and inflammatory biomarkers in herpes zoster

“…Zhang et al 32 found that low UA levels were predictive of infectious | 3927 mononucleosis, particularly in women. More recently, Hu et al 33 indicated that UA levels were decreased and negatively associated with COVID-19 severity.…”

“…Previous studies have shown that decreased UA levels exist in many viral pathogens such as influenza virus, hepatitis virus, respiratory viruses, and Epstein–Barr virus‐associated viral diseases. Zhang et al 32 found that low UA levels were predictive of infectious mononucleosis, particularly in women. More recently, Hu et al 33 indicated that UA levels were decreased and negatively associated with COVID‐19 severity.…”