Departamento de Infectología, Hospital de Pediatría "Dr. Silvestre Frenk Freund", Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS).
Unidad de Investigación en Virología y Cáncer, Hospital Infantil de México "Federico Gómez".
Bol Med Hosp Infant Mex. 2024;81(5):272-279. doi: 10.24875/BMHIM.24000027.
Epstein-Barr virus (EBV) infection, with a global prevalence exceeding 95%, typically manifests in children as infectious mononucleosis. However, clinical practice frequently encounters diverse atypical presentations characterized by multisystem involvement, often resulting in an unfavorable clinical course. Our objective is to describe the clinical manifestations and results of EBV infection in a tertiary pediatric hospital in Mexico.
An observational, transversal, retrospective, and descriptive study that included a systematic review of medical records (2012-2022) of patients under 18 years of age with detectable EBV particles in peripheral blood.
The study included 26 patients with a median age of 5 years and a male predominance of 53.8%. Predominant symptoms were fever (85%) and lymphadenopathy (35%). Sixty-five percent had severe and atypical manifestations, including pneumonia and hepatic, hematologic-oncologic, and autoimmune diseases. Anemia, thrombocytopenia and leukopenia were common, with lymphocytosis in 19% of cases. The median EBV viral load was 2816 copies/mL (range: 555-355,500 copies/mL). Four deaths related to EBV infection were reported. Viral load in these cases also varied widely from 594 to 121,000 copies/mL. Supportive care was administered to 85% of patients, while others received antiviral treatment, steroids, and rituximab.
Atypical manifestations were common, especially in children with multisystem involvement. EBV should be considered as a potential contributor to a diverse spectrum of clinical presentations, emphasizing the need for comprehensive evaluation and awareness in clinical diagnosis.
EB 病毒（EBV）感染在全球的流行率超过 95%，通常在儿童中表现为传染性单核细胞增多症。然而，临床实践中经常遇到多种不典型表现，其特征为多系统受累，常导致不良的临床病程。我们的目的是描述墨西哥一家三级儿科医院中 EBV 感染的临床表现和结果。
这是一项观察性、横断面、回顾性和描述性研究，包括对 2012 年至 2022 年期间外周血中可检测到 EBV 颗粒的 18 岁以下患者的病历进行系统回顾。
该研究纳入了 26 例患者，中位年龄为 5 岁，男性占 53.8%。主要症状为发热（85%）和淋巴结病（35%）。65%的患者表现为严重和不典型的症状，包括肺炎以及肝、血液肿瘤学和自身免疫性疾病。贫血、血小板减少和白细胞减少较为常见，19%的病例存在淋巴细胞增多。中位 EBV 病毒载量为 2816 拷贝/ml（范围：555-355500 拷贝/ml）。报告了 4 例与 EBV 感染相关的死亡病例。这些病例的病毒载量也差异很大，从 594 到 121000 拷贝/ml 不等。85%的患者接受了支持性治疗，而其他患者接受了抗病毒治疗、类固醇和利妥昔单抗。
不典型表现较为常见，特别是在多系统受累的儿童中。EBV 可能是多种临床表现的潜在原因，这强调了在临床诊断中需要全面评估和认识。
