title: Cardiac complications and immunophenotypic profile of infectious mononucleosis syndrome in children.
abstract: OBJECTIVE
  To investigate cardiac complications in infectious mononucleosis patients and to associate them with biochemical and immunological parameters, as well as with spleen ultrasound findings.
  
  
  METHODS
  Cross-sectional study with follow-up.
  
  
  METHODS
  Tertiary care pediatric unit, in the city of Thessaloniki, Greece.
  
  
  METHODS
  Twenty-five children  (15 boys, aged 1-11.6 years) suffering from infectious mononucleosis were studied during the acute phase and after 3-6 months. Cardiac evaluation comprised of electrocardiogram, echocardiogram, and measurement of creatine phosphokinase, creatine phosphokinase cardiac isoenzyme, and troponin levels. Biochemical and immunological tests included serum transaminases, serum amylase, CD3+/CD8+ T-lymphocytes subpopulation and CD4+/CD8+ T-lymphocytes ratio.
  
  
  RESULTS
  During acute phase, all children had splenomegaly and normal serum amylase values. 17 patients had elevated serum transaminases. Percentages of CD3+/CD8+ T-lymphocytes subpopulation were elevated and CD4+/CD8+ ratio was decreased in all patients. Echocardiography revealed mild pericardial effusion in 13 patients (10/21 with Epstein-Barr infection, 3/4 with cytomegalovirus infection), but none presented  with myocarditis. Four out of these 13 patients also had markedly elevated liver enzymes, 10/13 had significant splenomegaly and 12/13 presented very low CD4+/CD8+ T-lymphocytes ratio. Pericardial effusion demonstrated a statistically significant association solely with very low CD4+/CD8+ T-lymphocytes ratio (<0.5). Repetition of laboratory tests 3-6 months post-discharge detected persistent mild pericardial effusion in five patients, along with decreased CD4+/CD8+ ratio in 1/5.
  
  
  CONCLUSIONS
  In infectious mononucleosis syndrome, asymptomatic pericardial effusion could be associated with very low CD4+/CD8+ ratio (<0.5). Further studies would extend and confirm such an association.
authors: Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece. kelipap@gmail.com
authors: Kyriaki
authors: K
authors: Papadopoulou-Legbelou
authors: Efimia
authors: E
authors: Papadopoulou-Alataki
authors: Alexandra
authors: A
authors: Fleva
authors: Sofia
authors: S
authors: Spanou
authors: Aikaterini
authors: A
authors: Pavlitou
authors: George
authors: G
authors: Varlamis
mesh_terms: D016516:CD4-CD8 Ratio; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000276:immunology / Q000821:virology*; D006801:Humans; D016130:Immunophenotyping; D007223:Infant; D007244:Infectious Mononucleosis / Q000150:complications* / Q000276:immunology; D008297:Male; D010490:Pericardial Effusion / Q000821:virology