Coinfection with EBV/CMV and other respiratory agents in children with suspected infectious mononucleosis

The occurrence of multipathogen infections was 68.9%, 81.3% and 63.6% in the children with primary EBV, CMV or EBV/CMV, respectively, which was significantly higher than that in the past-infected group or the uninfected group (p < 0.001). Of the multipathogen-infected patients, the incidence of C. pneumoniae in children with primary infection was as high as 50%, significantly higher than in the other groups (p < 0.001). In the patients with multipathogen infection and EBV/CMV primary infection, fever, rash, lymphadenopathy, hepatomegaly, splenomegaly, atypical lymphocytes and abnormal liver function were more frequent and the length of hospital stay and duration of fever were longer than in other patients.Our study suggests that there is a high incidence of multipathogen infections in children admitted with EBV/CMV primary infection and that the distribution of these pathogens is not random.Epstein-Barr virus (EBV) and Cytomegalovirus (CMV), members of the herpesvirus family, are common viruses that cause infectious mononucleosis (IM) characterized by fever, pharyngitis and lymphadenopathy. EBV/CMV infects at least 90% of the world's population and can persist in a latent form after primary infection. Reactivation can occur years later, particularly under conditions of immunosuppression [1,2]. The primary infection may occur shortly after the disappearance of maternal antibodies during infancy [3]. In childhood, EBV is the most common cause of IM, but primary CMV infection will cause up to 7% of cases of mononucleosis syndrome and will manifest symptoms almost indistinguishable from those of EBV-induced mononucleosis [4].It is well known that EBV and CMV are common opportunistic infection agents in the immunocompromised, including human immunodeficiency virus-infected individuals, and are a major source of serious viral complications in organ transplant recipients [5]. Children are also a susceptible population at high risk of CMV/EBV infection. During growth and de