In this study, we evaluated the data of 52
patients, who had positive EBV-VCA-IgM
results. Thirteen cases (25%) were equal or
younger than two years of age, while 39 cases
(75%) were older.
Seasonal features
Twenty-one cases (40.4%) in spring, 14 cases
(26.9%) in summer, six cases (11.5%) in autumn,
11 cases (21.2%) in winter had applied to the
hospital. Mean hospital admission time of the
patients after initial complaints was 5.2±5.3
(2-30) days. All patients were hospitalized for
differential diagnosis and symptomatic therapy.
Clinical findings
According to anamnesis, the initial complaints
of the disease were fever and upper airway
symptoms such as cough, rhinitis, etc. in all of
the cases. The major clinical findings were determined
as lymphadenopathy, tonsillopharyngitis
and fever at the admission. Lymphadenopathy
in 49 cases (94.2%), tonsillopharyngitis in 46
cases (88.5%) and fever in 44 cases (84.6%) were
found. Moreover, while the classical triad consisting
of fever, lymphadenopathy and tonsillopharyngitis was defined in 41 cases (78.8%),
atypical findings as peroral enanthema in 26
cases (50.0%), hepatomegaly in 31 cases (59.6%),
splenomegaly in 40 cases (76.9%), skin rash in
seven cases (13.5%) and eyelid edema without
nephrologic disorders in seven cases (13.5%)
were determined.
In all of the cases, body temperature had
altered between 38 and 39 °C. In the cases with
tonsillopharyngitis, the sore throat was accompanied
by marked tonsillar enlargement and
exudates. Lymphadenopathy was generalized
but had manifested in the regions of anterior
cervical and submandibular nodes.
Twenty-two cases (23.1%) had received
antibiotherapy without throat cultures before
admission time. The antibiotics were given to
the patient by the peripheral practitioners. These
antibiotics were penicillins (8 cases), cephalosporins
(3 cases) and macrolids (1 case). Skin
rashes were maculopapular and were defined in
seven cases who had received penicillins.
The atypical findings such as ascites, arthritis
and severe abdominal pain-like acute abdomen
were defined in five cases (10.1%). Ascites which
was minimal and transudative was determined
in three cases. The cases with ascites had suffered
from hepatitis and gastrointestinal disturbances. Each of the atypical findings such as
arthritis and severe abdominal pain had been
observed in separate cases. Reactive arthritis
had involved a single joint (right ankle). An
acute abdomen-like clinic with severe abdominal
pain had occurred due to mesentery lymphadenitis.
At the admission-time none of the
cases with atypical features had fever. They had
generalized microlymphadenopathy and tonsillopharyngitis.
According to the clinical findings, although
there was no significant difference between age
groups (p>0.05), there was significant difference
between admission time groups (p<0.05)
(Table 1). The classical triad and the findings
such as fever, tonsillopharyngitis were more
often in the group who applied to the hospital in
the first five days than the other group.
Click Here to Zoom |
Table 1: The clinical findings according to age and admission time groups |
Laboratory findings
The laboratory parameter values were as
follows: The WBC count; 10998±3272 (5280-
18200)/mm3, the absolute lymphocyte count;
6539±2802 (1710-13838)/mm3, absolute neutrophil
count; 4458±1482 (1458-7830)/mm3, Plt
count 275413±98199 (163000-591000)/mm3, Hb
level 11.7±0.5 (10.6-12.6) gr/dl.
The most frequent laboratory finding lymphocytosis
determined in 47 (90.4%) cases was
accompanied by atypical lymphocytes and
monocytosis. Lymphocyte count was normal in
five cases. While one case (1.9%) had neutrophilia and four cases (7.7%) had neutropenia, neutrophil
counts were normal in 47 cases (90.4%).
Moreover, in blood spread, the mean values of
percentage rates of atypical lymphocytes and
monocytes were found as 7±3 (5-14) and 5±2
(4-15), respectively.
The acute phase reactants; mean ESR and
CRP levels were determined as 23±10 (10-50)
mm/hr and 16±14 (6-65) mg/L, respectively.
High ESR and high CRP levels were defined in
13 cases (25%) and 25 cases (48.1%), respectively.
No cases had any bacterial infection, also microbiological
cultures (throat, blood and urine)
were sterile.
The serum liver transaminases were found
mildly or moderately elevated in 14 cases
(26.9%). Mean ALT and AST levels were determined
as 64±58 (11-225) U/L and 48±33 (18-168)
U/L, respectively. In addition, mean ALP level
was 354±104 (158 –562) U/L.
Among laboratory findings, only the percentage
of atypical lymphocytes were higher in the
group “admission time > 5 days" than the other
group (p<0.0001), (Table 2). Otherwise, according
to the laboratory findings, there was no significant
difference between age groups, (p>0.05),
(Table 2).
Click Here to Zoom |
Table 2: The laboratory findings according to age and admission time groups |
The serological tests, such as EBV-VCA-IgM,
anti-CMV-IgM, and Monospot latex test had
been done for diagnosis and differential diagnosis.
Interestingly, anti-CMV-IgM was positive in six cases (11.5%) together with EBV-VCA-IgM
(+). In these cases, CMV-DNA-PCR tests were
negative.
Monospot latex tests were found to be positive
in 19 cases (36,5%). The mean age of the
cases with positive Monospot latex tests were
8±3 (4-13) years. The admission times were
≤5 days in 12 cases (63.2%) and >5 days in
seven cases (36.8%). According to the results of
Monospot latex tests, while there was a significant
difference between age groups (p=0.004), no
significant difference was determined between
admission time groups.
Complications and therapy
The complications such as artritis, ascites, hepatitis
and mesentery lymphadenitis were observed
in some patients. However, there were neither
any complications nor severe progress or death
seen in all of the cases. We applied symptomatic
therapy for all of the cases. No case received
antiviral therapy.
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