Infectious Mononucleosis in Children

We reviewed the clinical findings of infectious mononucleosis and performed Epstein-Barr virus (EBV) serologic antibody tests in infectious mononucleosis and healthy group. One groupwas 18 cases of children, diagnosed as infectious mononucleosis who had been admitted to the department of Pediatrics, Asan Medical Center for two years and eight months, from November, 1989 to June, 1992. Another group was 20 cases of healthy 5-year old children. @ES The results wereas follows: 1) The age distributions of 18 patients with infectious mononucleosis were as follows: nine patients were less than 5 year old and nine patients (50%)were older than 5 year old. 2) The hematologic findings revealed increased atypicallymphocytes in sixteen patients (88%), leukopenia in one patient (6%), thrombocytopenia in one patient (6%). In addition, we observed transient hepatitis in eight patients (44%) and jaundice in one patient (6%). 3) Hemophagocytic sydrome wasdeveloped in one patient who expired due to meningitis. 4) The heterophil antibody tests werepositive in two cases (11%) out of eighteen infectious mononucleosis patients. 5) EBV serologic antibody tests for IgM antibody to EBV-viral capsid antigen (VCA) in 18 patients were all positive, which implies primary infection. 6) EBV serologic antibody tests for IgG antibody to EBV-VCA and antibody to Epstein-Barr nuclear antigen (EBNA) in helathy 5-year old children were negative in 3 cases (15%) out of 20 cases each other, which suggests primary infection might occur afer five years of age. 7) Recently, more cases of clinically typical infectious mononucleosis are detected and the onset of EBV primary infection is becoming late in Korea, which is thought to be due to economic developments and improvements of environmental hygine. And we recommend EBV serologic antibody test for the confirmative diagnostic test of infectious mononucleosis.

Prevalence of Epstein-Barr Virus(EBV) Antibody in Korean Children

Recently, cases with typical clinical manifestations of infectious mononucleosis are increasing in Korea. So, to evaluate the recent epidemiology of EBV infection in Korea, we performed EBV serologic antibody tests for IgG antibody to EBV-viral capsid antigen (VCA) and antibody to EBV-associated nuclear antigen (EBNA) among the 108 healthy Korean infants and children whose ages were from newborn to 15 years old. And the results were as follows; 1) The positive rates of anti-VCA IgG 100% in newborn, 90% in 2 to 6 months, 20% in 7 to 12 months, 60% in 1 to 2 years, 77.3% in 3 to 4 years, 88.5% in 5 to 6 years, 90% in 7 to 9 years, and 100% in 10 to 15 years of age, respectively. 2) The anti-VCA IgG titers ranged from 1:20 to 1:1280. 3) The positive rates of anti-EBNA were 100% in newborn, 60% in 2 6 months, 10% in 7 to 12 months, 60% in 1 to 2 years, 68.2% in 3 to 4 years, 84.5% in 5 to 6 years, 70% in 7 to 9 years, and 100% in 10 to 15 years of age, respectively. 4) The anti-EBNA titers ranged from 1:2 to 1:128. According to these data, the age of primary infection of EBV has increased compared to the previous data in Korean children.

A clinical study on aseptic meningitis combined with polio-like paralysis

We clinically reviewed four patients who were suffering from aseptic meningitis combined with polio-like paralysis and performed radiological. neurological and virological studies on them. Three patients were admitted to the department of Pediatrics. Asan Medical Center from March to August 1990, and one patient was admitted to the department of Pediatrics. Kangnam General Hospital. The results were as follows; 1) During the period of study, 18 patients (10.1%)out of 178 aseptic meningitis patients also suffered from hand, foot and mouth disease, and three patients (1.69%) out of 178 patients also suffered from polio-like paralysis. 2) The age of the patients who also suffered from polio-like paralysis were eight months, 22 months, 23 months and four years old respectively. Three patients were male and one patient was female. 3) Paralysis developed three to five days after aseptic meningitis infection. 4) In two cases, Magnetic Resonance Imaging (MR) showed two small cavitary lesions that means anterior horn cell necrosis in concordant with residual paralysis. Axial T1-weighted image showed decreased signal intensity and axial T2-weighted image showed increased signal intensity. In another case 20 days after onset of illness MR was performed, the transverse myelitis showed mild swelling of cornus medullaris. Follow up MR in 2 months revealed atropic change in lower thoracic spinal cord. 5) The electromyography and nerve conduction velocity test revealed acute polyradiculoneuropathy. 6) Serologic virus study were carried out in three cases for Coxsackievirus A16 and Enterovirus 71. The Enterovirus 71 antibody titer were 1:128 in two cases and 1:64 in one case. The Coxsackievirus A16 antibody titer were less than 1:4. This study showed that the causative agents for polio-like paralysis during this period seemed to be the Enterovirus 71 infection.