Splenic rupture or infarction associated with Epstein-Barr virus infectious mononucleosis: a systematic literature review

Knowledge mapping of childhood infectious mononucleosis: a bibliometric analysis for the twenty-first century

BACKGROUND

The incidence of infectious mononucleosis (IM) has increased in recent years, particularly in the pediatric population, and there are currently no specific drugs available, posing a threat to the lives and health of children worldwide. Although some results have been published, there is a lack of systematic review and summarization of current research.

METHODS

Based on screening criteria, literature on IM in children from 2000 to 2023 was retrieved from the Web of Science Core Collection. The included literature's indicators (country, institution, journal, author, keywords, and references) were analyzed and visualized using Citespace, VOSviewer software, and the Bibliometrix program package.

RESULTS

A total of 538 eligible publications were included in this study. The number of publications has been on an upward trend during this century, with great potential for future growth. The countries with the most publications are the USA and China, and Capital Medical University is the most contributing institution. Hjalgrim, Henrik and Cohen, Jeffrey, I are among the field's most influential authors and co-cited authors. Among the major journals, the JOURNAL OF MEDICAL VIROLOGY had the highest output and the JOURNAL OF INFECTIOUS DISEASES was the most frequently cited. The reference with the highest outbreak intensity was Ramagopalan, SV, LANCET NEUROLOGY, 2010. Through in-depth analysis of the keywords, we conclude that the characteristics of diagnosis and assessment of IM, the association of IM with other diseases, and interventions for IM are the current hot topics of research in the field and that the pathogenesis of IM due to EBV is a cutting-edge topic in the field. This study also analyzes the reasons for geographical research differences and proposes a new "increasing quantity-improving quality-integrating" cooperation model.

CONCLUSION

This study's hotspots and frontiers reflect the current status and trends in pediatric IM, and these findings provide important insights to guide future research and optimize therapeutic strategies. In the future, there is a need to strengthen international collaboration and cooperation, conduct RCTs with large sample sizes, and promote the development of new drugs in mechanism research.

[Atraumatic splenic rupture in Legionella pneumonia]

A 48-year-old male patient was admitted to hospital with Legionella pneumonia. He developed a splenic rupture 1 day after admission, which was surgically treated. Retrospectively, the splenomegaly could already be seen by sonography on admission. An alternative etiology of the splenic rupture was excluded. The case highlights the importance of early detection of splenomegaly in patients with legionellosis. Through an early interdisciplinary presentation this life-threatening complication can be recognized in a timely manner and safely treated.

Infectious mononucleosis: new concepts in clinical presentation, epidemiology, and host response

PURPOSE OF REVIEW

Infectious mononucleosis (IM) is an infectious disease that presents clinically in only a small percentage of individuals despite almost universal infection with the causative agent. Here, we review the latest concepts in the clinical presentation, epidemiology, and host response of this disease.

RECENT FINDINGS

Several recently published papers/reviews describe IM as a condition caused by one of several etiologic agents including, cytomegalovirus (HHV-5), Roseola virus (HHV-6) and Toxoplasmosis amongst others; this review focuses on IM as solely caused by the human herpes virus 4 (HHV-4). Since the initial discovery of the virus in the 1960s and its subsequent discovery as the primary etiologic agent for IM it has been associated with several human cancers and autoimmune disorders. Recent published findings show a correlation between HHV-4 and the autoimmune disorder, multiple sclerosis (MS), suggesting earlier IM could possibly act as a causative factor. Considering the important links being made with IM to so many cancers and autoimmune disorders it is surprising that a standard investigative procedure has yet to be determined for this disease. A standard approach to the investigation of IM would ensure more cases are diagnosed, particularly atypical cases, this would benefit epidemiological studies, and more immediately help practitioners distinguish viral from bacterial throat infections, enabling them to treat accordingly.

SUMMARY

The understanding of the latest concepts in clinical presentation, epidemiology and host response to IM would benefit greatly from the introduction of a standard procedure for its investigation and diagnosis.

A case report of successful splenic artery embolization for atraumatic splenic rupture secondary to Epstein Barr virus infection in a haemodynamically unstable patient

Splenic rupture in haemodynamically unstable patients has traditionally been managed with splenectomy. This case report discusses the successful management of atraumatic splenic rupture, a rare but life-threatening complication of Epstein-Barr virus (EBV) infection, in a hemodynamically unstable patient. The patient, diagnosed with infectious mononucleosis (IM) secondary to EBV, presented with severe abdominal pain and a syncopal episode. Imaging revealed an American Association for the Surgery of Trauma (AAST) grade III splenic injury, which was subsequently upgraded to a grade IV injury on repeat imaging. The patient's condition deteriorated even with initial resuscitation, leading to splenic angioembolization. The procedure was successful and the patient was discharged after 5 days. This case highlights the efficacy of splenic artery embolization (SAE) in haemodynamically unstable patients with atraumatic splenic rupture, particularly in centers with interventional radiology resources, offering an alternative to splenectomy and its associated complications.

An unexpected finding between the EBV and splenic rupture

EBV is a gammaherpesvirus that infects a large fraction of the human population. Many people infected with the virus remain asymptomatic. The most common clinical manifestation of EBV is linked to infectious mononucleosis (IM). IM usually resolves over a period of weeks or months without sequelae. However, splenic rupture is another rare complication of IM. Splenic rupture of this case occur without any traumatic cause.