The impact of acute CMV coinfection on the course of EBV hepatitis in children

Aim of the study:
Hepatitis occurs in 50-90% of patients hospitalized with primary Epstein-Barr virus (EBV) infection. Dual serological positivity for EBV and cytomegalovirus (CMV) may occur. Our retrospective study aimed to compare the clinical course of hepatitis between children with EBV monoinfection (Group 1) and those with EBV and CMV dual positivity (Group 2).

Material and methods:
In total, 244 patients were recruited. Eighty (32.79%) of them belonged to Group 2. The diagnosis of EBV and CMV infection was confirmed by positive viral capsid antigen (VCA) antibody testing and serum CMV IgM antibodies.

Results:
Clinical symptoms suggesting cholestasis occurred significantly more often in Group 2: nausea or vomiting in 35 (43.21%) vs. 45 (27.44%) in Group 1, p = 0.010 (OR = 2.01 [95% CI: 1.15-3.51]); abdominal pain in 37 (45.67%) vs. 52 (31.71%), p = 0.042 (OR = 1.81 [95% CI: 1.05-3.13]); dark urine in 12 (14.81%) vs. 8 (4.88%), p = 0.006 (OR = 3.39 [95% CI: 1.33-8.67]). The alanine aminotransferase (ALT) activity was higher in Group 2 during the first week of the disease, although the difference was not statistically significant p = 0.083). Aspartate aminotransferase (AST) activity was significantly higher in Group 2 only in the first week of the disease (p = 0.023). Abnormal abdominal ultrasound results occurred more often in Group 2: 100% of patients vs. 66.46% in Group 1 (p = 0.045).

Conclusions:
In Group 2, we observed more pronounced clinical symptoms of hepatitis and more frequently abnormal ultrasound images of the liver and bile ducts.