Clinical Report: A Nomogram Utilizing Standard Blood Parameters to Assess the Risk of Extended Fever in Pediatric Patients with Primary Epstein-Barr Virus Infection

Overview

This study developed a nomogram using routine blood parameters to predict prolonged fever in children with acute primary Epstein-Barr virus (EBV) infection. The nomogram demonstrated an area under the curve (AUC) of 0.728.

Background

Epstein-Barr virus (EBV) infection is common in children and can lead to prolonged fever, which increases distress for patients and families. Identifying children at risk for extended fever is crucial for managing expectations and guiding clinical observation. Current predictive tools are limited.

Data Highlights

Key Findings

• Prolonged fever occurred in 27.4% of the cohort.
• Antiviral therapy was administered to all patients with prolonged fever (100%).
• White blood cell count (WBC), neutrophil count (NEU), platelet count (PLT), and atypical lymphocyte proportion (AL) were identified as optimal predictors.
• The nomogram achieved an AUC of 0.728 (95% CI: 0.689–0.768).
• Calibration and decision curve analysis confirmed the nomogram's clinical utility.

Clinical Implications

The developed nomogram provides a tool for risk stratification of children with primary EBV infection.

Conclusion

The nomogram based on routine blood parameters offers a method for predicting prolonged fever in pediatric EBV infections.

Related Resources & Content

1. Frontiers in Pediatrics, 2026 -- Diagnostic value of combined flow cytometry-based detection of peripheral blood lymphocyte subsets and cytokines for pediatric infectious mononucleosis
2. Infection, 2020 -- Approaches to Treating Pediatric Patients with Fever and Neutropenia: Findings from a Survey of 51 Pediatric Oncology Centers in Germany, Austria, and Switzerland
3. Frontiers in Pediatrics, 2026 -- Alanine aminotransferase elevation in hospitalized children with infectious mononucleosis: independent associations with Epstein–Barr virus DNA load, age, and sex
4. Frontiers in Pediatrics, 2026 -- Serum beta-2 microglobulin as a diagnostic biomarker for pediatric Epstein–Barr virus infections: a retrospective study
5. CDC -- About Infectious Mononucleosis (Mono) | EBV and Mono
6. BMC Pediatrics, 2026 -- IL-10, IL-17A, and IFN-γ as clinical early-warning indicators for severe Epstein-Barr virus-associated infectious mononucleosis in children
7. Frontiers, 2026 -- Predicting prolonged fever in immunocompetent children with primary EBV infection: A nomogram based on routine blood parameters
8. About Infectious Mononucleosis (Mono) | EBV and Mono | CDC
9. IL-10, IL-17A, and IFN-γ as clinical early-warning indicators for severe Epstein-Barr virus-associated infectious mononucleosis in children | BMC Pediatrics | Springer Nature Link
10. Frontiers | Predicting prolonged fever in immunocompetent children with primary EBV infection: A nomogram based on routine blood parameters