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Abstract：
BACKGROUND: Infectious mononucleosis (IM) is a common viral infection that typically causes fever, pharyngitis, and lymphadenopathy in young patients. The Epstein-Barr virus (EBV) is the most common cause of IM, followed by cytomegalovirus (CMV). Given that serological testing is associated with limitations regarding its accuracy, availability, and time to receive results, clinical differentiation based on symptoms, signs, and basic tests would be useful. We evaluated whether clinical findings could be used to differentiate EBV-IM from CMV-IM.
METHODS: In this single-center retrospective case-control study, we evaluated >14-year-old patients with serologically confirmed EBV-IM or CMV-IM during 2006-2017. We compared the patients\' symptoms, physical findings, blood counts, and serum biomarkers to create three regression models: model 1 (symptoms and signs), model 2 (model 1 plus sonographic hepatosplenomegaly and blood counts), and model 3 (model 2 plus hepatobiliary biomarkers).
RESULTS: Among the 122 patients (72.6%) with EBV-IM and 46 patients (27.4%) with CMV-IM, the median age was 25 years and 82 patients (48.8%) were male. The median age was 10 years older in the CMV-IM group (p < 0.001) and the median interval from onset to visit was 5 days longer in the CMV-IM group (p < 0.001). Logistic regression revealed that EBV-IM was predicted by younger age, short onset-to-visit interval, lymphadenopathy, tonsillar white coat, hepatosplenomegaly, atypical lymphocytosis, and elevations of lactate dehydrogenase and gamma-glutamyl transferase. All regression models had areas under the curve of >0.9.
CONCLUSIONS: History and physical findings, especially when used with atypical lymphocytosis and sonographic hepatosplenomegaly, can help physicians differentiate EBV-IM from CMV-IM.
METHODS: In this single-center retrospective case-control study, we evaluated >14-year-old patients with serologically confirmed EBV-IM or CMV-IM during 2006-2017. We compared the patients\' symptoms, physical findings, blood counts, and serum biomarkers to create three regression models: model 1 (symptoms and signs), model 2 (model 1 plus sonographic hepatosplenomegaly and blood counts), and model 3 (model 2 plus hepatobiliary biomarkers).
RESULTS: Among the 122 patients (72.6%) with EBV-IM and 46 patients (27.4%) with CMV-IM, the median age was 25 years and 82 patients (48.8%) were male. The median age was 10 years older in the CMV-IM group (p < 0.001) and the median interval from onset to visit was 5 days longer in the CMV-IM group (p < 0.001). Logistic regression revealed that EBV-IM was predicted by younger age, short onset-to-visit interval, lymphadenopathy, tonsillar white coat, hepatosplenomegaly, atypical lymphocytosis, and elevations of lactate dehydrogenase and gamma-glutamyl transferase. All regression models had areas under the curve of >0.9.
CONCLUSIONS: History and physical findings, especially when used with atypical lymphocytosis and sonographic hepatosplenomegaly, can help physicians differentiate EBV-IM from CMV-IM.
摘要：
背景：传染性单核细胞增多症（IM）是一种常见的病毒感染，通常会导致发烧，咽炎,年轻患者的淋巴结病。爱泼斯坦-巴尔病毒（EBV）是IM的最常见原因，其次是巨细胞病毒（CMV）。鉴于血清学检测与准确性方面的局限性有关，可用性,以及收到结果的时间，根据症状进行临床鉴别，标志,和基本测试将是有用的。我们评估了临床发现是否可用于区分EBV-IM和CMV-IM。
方法：在这项单中心回顾性病例对照研究中，我们在2006-2017年期间评估了血清学证实为EBV-IM或CMV-IM的>14岁患者.我们比较了病人的症状,物理发现，血细胞计数,和血清生物标志物来创建三个回归模型：模型1(症状和体征)，模型2（模型1加超声肝脾肿大和血细胞计数），和模型3（模型2加肝胆生物标志物）。
结果：在122例（72.6%）EBV-IM患者和46例（27.4%）CMV-IM患者中，中位年龄为25岁,82例患者(48.8%)为男性.CMV-IM组的中位年龄大于10岁（p<0.001），CMV-IM组的发病到就诊的中位间隔延长了5天（p<0.001）。Logistic回归显示EBV-IM的预测年龄较小，发病时间间隔短，淋巴结病，扁桃体白色外套,肝脾肿大,非典型淋巴细胞增多症,乳酸脱氢酶和γ-谷氨酰转移酶的升高。所有回归模型的曲线下面积>0.9。
结论：历史和身体发现，特别是当使用非典型淋巴细胞增多症和超声肝脾肿大时，可以帮助医生区分EBV-IM和CMV-IM。
方法：在这项单中心回顾性病例对照研究中，我们在2006-2017年期间评估了血清学证实为EBV-IM或CMV-IM的>14岁患者.我们比较了病人的症状,物理发现，血细胞计数,和血清生物标志物来创建三个回归模型：模型1(症状和体征)，模型2（模型1加超声肝脾肿大和血细胞计数），和模型3（模型2加肝胆生物标志物）。
结果：在122例（72.6%）EBV-IM患者和46例（27.4%）CMV-IM患者中，中位年龄为25岁,82例患者(48.8%)为男性.CMV-IM组的中位年龄大于10岁（p<0.001），CMV-IM组的发病到就诊的中位间隔延长了5天（p<0.001）。Logistic回归显示EBV-IM的预测年龄较小，发病时间间隔短，淋巴结病，扁桃体白色外套,肝脾肿大,非典型淋巴细胞增多症,乳酸脱氢酶和γ-谷氨酰转移酶的升高。所有回归模型的曲线下面积>0.9。
结论：历史和身体发现，特别是当使用非典型淋巴细胞增多症和超声肝脾肿大时，可以帮助医生区分EBV-IM和CMV-IM。
