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.

A Case of Diphtheria and Infectious Mononucleosis Co-Infection in a Partially Vaccinated Boy

We report the case of an eight-year-old partially immunized boy who presented with presumed bacterial tonsillitis. He was initially prescribed amoxicillin-clavulanic acid which resulted in the development of an erythematous maculopapular over the face which spread to the trunk and extremities including palms and soles and resolved over the next three days. He was diagnosed to have diphtheria and infectious mononucleosis (IMN) co-infection. He made an uneventful recovery and an extensive review of the literature showed that the incidence of diphtheria and IMN co-infection is a relatively rare clinical entity. We wish to highlight the possibility of such co-infections which often mimic one another.

Diphtheria

Diphtheria is a potentially fatal infection mostly caused by toxigenic Corynebacterium diphtheriae strains and occasionally by toxigenic C. ulcerans and C. pseudotuberculosis strains. Diphtheria is generally an acute respiratory infection, characterized by the formation of a pseudomembrane in the throat, but cutaneous infections are possible. Systemic effects, such as myocarditis and neuropathy, which are associated with increased fatality risk, are due to diphtheria toxin, an exotoxin produced by the pathogen that inhibits protein synthesis and causes cell death. Clinical diagnosis is confirmed by the isolation and identification of the causative Corynebacterium spp., usually by bacterial culture followed by enzymatic and toxin detection tests. Diphtheria can be treated with the timely administration of diphtheria antitoxin and antimicrobial therapy. Although effective vaccines are available, this disease has the potential to re-emerge in countries where the recommended vaccination programmes are not sustained, and increasing proportions of adults are becoming susceptible to diphtheria. Thousands of diphtheria cases are still reported annually from several countries in Asia and Africa, along with many outbreaks. Changes in the epidemiology of diphtheria have been reported worldwide. The prevalence of toxigenic Corynebacterium spp. highlights the need for proper clinical and epidemiological investigations to quickly identify and treat affected individuals, along with public health measures to prevent and contain the spread of this disease.

Detection and virulence potential of a phospholipase D-negative Corynebacterium ulcerans from a concurrent diphtheria and infectious mononucleosis case

Diphtheria by Corynebacterium ulcerans is increasingly occurring in children, adolescents and adults. In addition to diphtheria toxin (DT), phospholipase D (PLD) is considered a virulence factor of C. ulcerans. In the present study, a first case of concurrent diphtheria by a PLD-negative C. ulcerans and infectious mononucleosis (IM) was verified. Clinical and microbiological profiles and binding properties to human Fibrinogen (Fbg), Fibronectin (Fn) and type I collagen (col I) biotinylated proteins and virulence to Caenorhabditis elegans were investigated for C. ulcerans strain 2590 (clinical isolate) and two control strains, including PLD-positive BR-AD22 wild type and PLD-negative ELHA-1 PLD mutant strains. MALDI-TOF assays and a multiplex PCR of genes coding for potentially toxigenic corynebacteria identified strain 2590 as non-DT producing. Interestingly, strain 2590 did not express PLD activity in the CAMP test although the presence of the pld gene was verified. PLD-negative 2590 and a PLD-positive 210932 strains showed similar affinity to Fbg, Fn and type I collagen. C. elegans were able to escape from C. ulcerans strains, independent of PLD and DT production. Higher mortality of nematodes was verified for PLD-negative strains. Additional studies concerning multifactorial virulence potential of C. ulcerans, including environmental conditions remain necessary.

The re-emergency and persistence of vaccine preventable diseases

The introduction of vaccination worldwide dramatically reduced the incidence of pathogenic bacterial and viral diseases. Despite the highly successful vaccination strategies, the number of cases among vaccine preventable diseases has increased in the last decade and several of those diseases are still endemic in different countries. Here we discuss some epidemiological aspects and possible arguments that may explain why ancient diseases such as, measles, polio, pertussis, diphtheria and tuberculosis are still with us.

Diphtheria outbreak in Maranhão, Brazil: microbiological, clinical and epidemiological aspects

We describe microbiological, clinical and epidemiological aspects of a diphtheria outbreak that occurred in Maranhão, Brazil. The majority of the 27 confirmed cases occurred in partially (n = 16) or completely (n = 10) immunized children (n = 26). Clinical signs and characteristic symptoms of diphtheria such as cervical lymphadenopathy and pseudomembrane formation were absent in 48% and 7% of the cases, respectively. Complications such as paralysis of lower limbs were observed. Three cases resulted in death, two of them in completely immunized children. Microbiological analysis identified the isolates as Corynebacterium diphtheriae biovar intermedius with a predominant PFGE type. Most of them were toxigenic and some showed a decrease in penicillin G susceptibility. In conclusion, diphtheria remains endemic in Brazil. Health professionals need to be aware of the possibility of atypical cases of C. diphtheriae infection, including pharyngitis without pseudomembrane formation.