During a 5 year period, 33 children (22 males) were diagnosed to have infectious mononucleosis (M:F::2:1; age 9 mo-15 y). The common clinical features observed were fever (100%), lymphadenopathy (84%) hepatosplenomegaly (81%), tonsillar enlargement (45%), neck swelling (30%), upper respiratory symptoms (21%), epitrochlear node enlargement (20%), vomiting and diarrhea (1%). Ten children had complications; upper airway obstruction and hemophagocytic lymphohistocytosis occurred in four each and septic shock in two. EBV associated infectious mononucleosis in hospitalized children was found to affect mainly preschool children and had a favorable prognosis.

Key Words: Children, EBV, Infectious mononucleosis.

During the six year study period, 33 children were diagnosed to have IM out of a total 46,873 (0.07%) hospitalized children. Most of the cases were between 1 and 5 years old (22) (age range 9 months-15 years). The common clinical features and laboratory features observed are shown in Table I. Children who had fever > 14 days had a high risk of development of complications in our series ( Fisher’s exact, P<0.05). The EBV VCA IgM titers ranged from 12 to 158 µ/mL. Children with high titers of VCA IgM (>100) had complications like septic shock. Complications were noted in ten (30%) patients; upper airway obstruction and hemophagocytic lymphohisto-cytosis (HLH) in four (12%) each and septic shock in two (6%). Though 15 (45%) of these 33 cases had received amoxicillin before diagnosis, none developed any rash. Children with upper airway obstruction were treated with corticosteroid therapy (prednisolone 1mg/kg/day for 1 week). Children with HLH were treated as per HLH 2004 protocol [1].

TABLE I	Clinical and Laboratory Features of 33 Children with Infectious Mononucleosis

Our study reveals that EBV associated IM is more common in preschool male children similar to the earlier observation by Tsai, et al. [2]. The youngest age of presentation in our series was 9 months as against one year described previously [3,4). The involvement of epitrochlear lymph nodes was noted in 6 (20%) patients and this clinical feature has not been described in earlier studies. Significant atypical lymphocytosis (atypical lymphocyte >10%) seen in our series is similar to previously reports [2, 5]. Airway obstruction has been reported in 3.5% of all patients with infectious mononucleosis whereas it was present in only four (6%) of our patients [6]. Strikingly, a higher value of anti EBV IgM titre (>100 µ/mL) was observed in our series in children with complications. Female gender has been earlier reported as one of the risk factors for development of complications, which was not seen in this study. There was no mortality in our series.

We conclude that EBV associated IM is more common in preschool children. Amoxicillin induced rash may not always occur in children with EBV infection. These children need to be monitored for severe complications like upper airway obstruction, HLH and septic shock.

1. Henter JI, Horne A, Arico M, Egeler RM, Filipovich AH, Imashuku S, et al. HLH- 2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer 2007; 48:124-31.

2. Tsai MH, Hsu CY, Yen MH, Yan DC, Chiu CH, Huang YC, et al. Epstein-Barr virus-associated infectious mononucleosis and risk factor analysis for complications in hospitalized children. J Microbiol Immunol Infect. 2005;38: 255-61.

3. Biggar RJ, Henle G, Böcker J, Lennette ET, Fleisher G, Henle W. Primary Epstein-Barr virus infections in African infants. II. Clinical and serological observations during seroconversion. Int J Cancer. 1978;22:244-50.

4. Henke CE, Kurland LT, Elveback LR. Infectious mononucleosis in Rochester, Minnesota, 1950 through 1969. Am J Epidemiol. 1973;98:483-90.

5. Krabbe S, Hesse J, Uldall P. Primary Epstein-Barr virus infection in early childhood. Arch Dis Child. 1981;56: 49-52.