Differential diagnosis of Epstein-Barr viral mononucleosis and mononucleosis-like syndrome in HIV infection in adults at the prehospital stage

Abstract

The complexity of the prehospital differential diagnosis of Epstein-Barr viral mononucleosis and mononucleosis-like syndrome in HIV infection in adults is due to the polymorphism of clinical symptoms.

The aim - analysis of early clinical symptoms of Epstein-Barr viral mononucleosis and mononucleosis-like syndrome of HIV infection in adults at the prehospital stage.

Material and methods. The analysis included a sample of 1020 case histories of patients admitted to the 6 Infectious Diseases Department of the Infectious Diseases Clinical Hospital N 2 in Moscow for the period 2009-2017. From the selected case histories, 2 groups were formed: 1 - 36 case histories of patients with a diagnosis of IM confirmed in the laboratory in the hospital, 2 - 39 case histories of patients with newly diagnosed HIV infection who were admitted with a directional diagnosis of IM. The results obtained in the course of the conducted studies were processed using the methods of variation statistics.

Results. The results obtained allow us to state that the discrepancies in the clinical diagnosis both in the case of hyper- and hypodiagnostics occurred against the background of ARVI, adenovirus infection, tonsillitis, fever of unclear etiology. Overdiagnosis of IM was associated with the presence of symptoms and syndromes of respiratory tract infections when patients were admitted to the hospital. In the 4th place in the structure of clarified diagnoses (5.6% of cases), HIV infection was detected for the first time. Predictors have been identified to assess the likelihood of IM or HIV infection. The combination of a febrile syndrome of less than 15 days with hospitalization up to 14 days of illness with isolated peripheral lymph node lymphadenopathy, purulent tonsillitis and splenomegaly with a 97% probability suggests that the patient has IM. Generalized lymphadenopathy, combined with fever for more than 15 days, and the predominantly catarrhal nature of tonsillitis suggest a 75% probability of HIV infection.

Conclusion. A large range of targeted diagnoses in patients with HIV infection, first identified in the hospital, once again emphasizes the need for HIV testing not only in patients at risk, but also in patients with an unusual clinical course of infectious pathology.

Keywords:Epstein-Barr virus, infectious mononucleosis, HIV infection, early diagnosis

Funding. The study was not sponsored.

Conflict of interest. The authors declare that there is no conflict of interest.

Contribution. The authors contributed equally to this article.

For citation: Mikhneva S.A., Kukhtevich E.V., Grishina Yu.Yu., Popova T.I., Martynov Yu.V. Differential diagnosis of Epstein-Barr viral mononucleosis and mononucleosis-like syndrome in HIV infection in adults at the prehospital stage. Infektsionnye bolezni: novosti, mneniya, obuchenie [Infectious Diseases: News, Opinions, Training]. 2021; 10 (1): 39-45. DOI: https://doi.org/10.33029/2305-3496-2021-10-1-39-45 (in Russian)

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CHIEF EDITOR
Aleksandr V. Gorelov
Academician of the Russian Academy of Sciences, MD, Head of Infection Diseases and Epidemiology Department of the Scientific and Educational Institute of Clinical Medicine named after N.A. Semashko ofRussian University of Medicine, Ministry of Health of the Russian Federation, Professor of the Department of Childhood Diseases, Clinical Institute of Children's Health named after N.F. Filatov, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, Deputy Director for Research, Central Research Institute of Epidemiology, Rospotrebnadzor (Moscow, Russian Federation)

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