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PubMed1979

Epstein-Barr virus-specific serum immunoglobulin A as an acute-phase antibody in infectious mononucleosis.

Immunoglobulin A (IgA) antibodies to Epstein-Barr virus viral capsid antigen were assayed serially in 19 patients with infectious mononucleosis and in 38 controls. Seventy-four percent of infectious mononucleosis patients demonstrated IgA antibody, whereas this was found in 13% of controls. This antibody appeared early in infectious mononucleosis and was virtually gone 10 weeks after onset. Comparison of IgA antibody kinetics was made with IgG and IgM antibodies to viral capsid antigen, heterophile antibody, and antibody to Epstein-Barr virus early antigen and nuclear antigen. Failure to demonstrate IgA antibody was associated with severe illness, prolonged illness, delay in IgG and anti-Epstein-Barr virus nuclear antigen antibody, and low or absent heterophile and anti-early antigen antibody. Assay of IgA antibody to viral capsid antigen is a potentially useful adjunct in the serodiagnosis of infectious mononucleosis or recent Epstein-Barr virus infection, as are the other antibodies tested, but in this study IgM viral capsid antigen antibody was the only acute-phase antibody present in all patients.

Acute Disease↗

PubMed2004

The nosology of sub-acute and chronic fatigue syndromes that follow infectious mononucleosis.

BACKGROUND: A previous principal components analysis of symptoms occurring after infectious mononucleosis suggested that a discrete fatigue syndrome occurs, which is independent of psychiatric disorder. This work has not been replicated and no latent class analysis of subjects has been published. METHOD: We prospectively examined a cohort of 150 American primary care patients 2 and 6 months after the onset of corroborated infectious mononucleosis. A subset of 50 subjects was studied 4 years after onset. We performed principal components analyses of both psychological and somatic symptoms and latent class analyses of subjects. RESULTS: Principal components analyses consistently delineated two fatigue factors at 2 and 6 months and one fatigue factor at 4 years. These factors were separate from a mixed anxiety and depressive factor. A four-class solution for the latent class analyses consisted of most subjects with few symptoms, a few with many symptoms, a group with predominantly mood symptoms and some subjects with fatigue symptoms. CONCLUSIONS: The symptoms of the principal factors with fatigue were similar to those previously described. Both the factors and classes were independent of an equally delineated mood factor and class. These results support the existence of two discrete chronic fatigue syndromes after infectious mononucleosis, one of which is still demonstrable 4 years after onset.

Acute Disease↗

PubMed1984

Decrease in generation of reactive oxygen species by neutrophils from patients with infectious mononucleosis: role of suppressor T lymphocytes.

We assessed the generation of reactive oxygen species (ROS: O2-, H2O2, OH . , chemiluminescence) by neutrophils and monocytes from six patients with infectious mononucleosis, ten patients with other viral diseases, and ten normal controls. Neutrophils from infectious mononucleosis patients showed markedly decreased generation of all reactive oxygen species, compared with the two control groups; this abnormality persisted for four to eight weeks after disease onset. Monocytes from these patients generated normal levels of ROS. Normal neutrophils incubated with T lymphocytes from infectious mononucleosis patients generated significantly less of each ROS than did those incubated with T cells from either control group. T cell-mediated suppression of ROS generation required both OKT4+ cells from infectious mononucleosis patients and OKT8+ cells from either patients or normals. We conclude that the generation of reaction oxygen species in neutrophils is suppressed in patients with infectious mononucleosis, at least in part, by interacting subsets of T lymphocytes.

Adolescent↗

PubMedDate not supplied

Cytology and immunocytology of infectious mononucleosis in fine needle aspirates of lymph nodes.

Two cases of infectious mononucleosis with atypical clinical presentations were initially diagnosed by fine needle aspiration (FNA) of lymph nodes and subsequently confirmed by serologic studies. The cytologic features that allowed recognition included a high percentage of cells with relatively abundant cytoplasm that stained pale to deep blue using a Giemsa-type stain. Many of the cells had plasmacytoid features. The cells ranged in size from small lymphocytes to large immunoblastic forms. Other features included mitotic figures and occasional binucleated forms. Immunologic studies showed a mixture of B and T cells, with many of the cells having a cytotoxic/suppressor phenotype. The features seem to be relatively characteristic and distinct from those of malignant processes that could be aspirated in lymph nodes. Recognition of infectious mononucleosis by FNA in these cases allowed for confirmation by serologic studies, thereby avoiding the need for an excisional biopsy. These cases show that FNA of lymph nodes may shed light on the nature of the process underlying the lymphadenopathy in selected cases of clinically atypical infectious mononucleosis.

Adolescent↗

PubMedDate not supplied

[Serological studies of antibodies to Epstein-Barr virus in infectious mononucleosis].

This is the first study in this country of sera from patients with infectious mononucleosis and other infectious diseases (control group) for determination of complement-fixing antibody to the soluble (S) antigen and of fluorescent antibody to the virus capsid antigen (VCA) of Epstein-Barr virus. It was established that the CFT and the immunofluorescence test could be used for diagnosis of infectious mononucleosis only on a limited scale because of the lack of complement-fixing antibody in patients early in the convalescent period and because of the presence of complement-fixing and fluorescent antibody in a high per cent of patients of the control group.

Adolescent↗

PubMed1978

Hypoglossal nerve palsy in infectious mononucleosis.

Involvement of the central nervous system is a rare complication of infectious mononucleosis. Isolated cranial nerve palsy is the least reported neurologic complication. We report a second case of hypoglossal nerve palsy associated with infectious mononucleosis, and review 20 other reported cases of cranial nerve palsies. Any cranial nerve may be involved. The onset of the palsy usually follows the diagnosis and clinical presentation of infectious mononucleosis. The prognosis for a complete recovery is excellent, although recovery may be protracted. The use of steroids does not appear to be etiologic, nor beneficial or deleterious in treatment.

Adolescent↗

PubMed1990

[Conservative treatment in spontaneous splenic rupture due to infectious mononucleosis].

Spontaneous rupture of the spleen secondary to infectious mononucleosis frequently proves to be an urgent surgical decision: splenectomy during a exploratory laparotomy. Few cases have been described where diagnosis was made by means of an abdominal ultrasound and those followed-up and treated conservatively, are most exceptional. A case of rupture of spleen during a course of an infectious mononucleosis, confirmed by abdominal ultrasounds and treated conservatively, with good evolution, is presented.

Adolescent↗

PubMed2003

Infectious mononucleosis patients temporarily recognize a unique, cross-reactive epitope of Epstein-Barr virus nuclear antigen-1.

The spectrum of antibodies against Epstein-Barr virus nuclear antigen-1 (EBNA-1) in patients with a recent history of infectious mononucleosis and nonaffected EBV-positive individuals has been characterized by epitope mapping. Sera were evaluated for antibodies to all unique maximally overlapping octapeptides of EBNA-1. Both normal controls and patients with infectious mononucleosis produce IgG antibodies that recognize the glycine-alanine-rich portion of EBNA-1, as previously described. All EBNA-1 IgG-positive infectious mononucleosis patients tested, however, consistently produce IgG specific for an additional epitope (aa 398-412 PPPGRRPFFHPVGEA) near the middle of the EBNA-1 protein. This region was not found to be antigenic in healthy EBV-seropositive individuals. This region does, however, cross-react with the sequence PPPGMRPP from the common lupus spliceosomal autoantigen Sm B' in several infectious mononucleosis patient sera. Patients with recent clinical infectious mononucleosis temporarily recognize a unique cross-reactive epitope of EBNA-1 not bound by antibodies from non-infectious mononucleosis EBV-positive sera or those with a distant history of IM.

Amino Acid Sequence↗

PubMed1975

Reactions of murine myeloma cells with infectious mononucleosis sera.

Reactions of murine myeloma cells with infectious mononucleosis sera were studied by means of cytolysis in agarose gel. Of 75 sera tested, 30 lysed IgM myeloma cells, MOPC-104E. The antibodies responsible for the lysis of the myeloma cells were shown to be different from Paul-Bunnell antibodies and other antibodies found in infectious mononucleosis sera. Three types of antibodies acting upon the myeloma cells were identified serologically on the basis of absorption experiments with bovine erythrocytes, theta-positive murine lymphoma cells and guinea pig kidney cells. Antibodies of the first group could be absorbed with none of these antigens, antibodies of the second group could be absorbed only with lymphoma cells, and antibodies of the third group could be absorbed with any of these three antigens. Evidence was presented that the antibodies under study combine with antigenic cell membrane components of a subpopulation of IgM-producing murine B cells.

Absorption↗

PubMed1984

Acute renal failure and infectious mononucleosis.

Renal failure is a rare complication of infectious mononucleosis, and is usually due to acute interstitial nephritis. Outcome has been variable with spontaneous recovery, death, and chronic renal failure being described. Only two patients have been reported as requiring dialysis. In some cases the aetiology of the interstitial nephritis has been open to doubt and may have been drug-induced. The case of a patient with acute renal failure associated with infectious mononucleosis and in whom interstitial nephritis appears to have been totally related to the underlying disease is described. There was an excellent response to treatment with high doses of methyl prednisolone given intravenously.

Acute Kidney Injury↗

PubMed2002

Epstein-Barr viral load assessment in immunocompetent patients with fulminant infectious mononucleosis.

We describe 2 immunocompetent adolescents with fulminant infectious mononucleosis and virus-associated hemophagocytosis. A new quantitative polymerase chain reaction revealed high serum Epstein-Barr virus DNA levels in these patients. One patient died with an increasing viral load not responding to corticosteroids followed by antiviral and intensified immunomodulatory treatment. The other patient received corticosteroids and acyclovir at diagnosis; her rapid recovery was heralded by a steep decline of viral load. We propose monitoring the clinical course of fulminant infectious mononucleosis in immunocompetent patients by Epstein-Barr virus DNA quantification and prompt corticosteroid and antiviral therapy when viral load is high.

Acyclovir↗

PubMedDate not supplied

Infectious mononucleosis in the athlete. Diagnosis, complications, and management.

Although almost always a benign, self-limiting disease, infectious mononucleosis accounts for considerable symptomatic illness in the young athlete and can, on occasion, be truly life-threatening. Recognition of the syndrome "glandular fever," vis-a-vis infectious mononucleosis--fever, pharyngitis, lymphadenopathy, and splenomegaly, with characteristic changes in the peripheral blood leukocytes--dates back over a half a century. However, seroepidemiologic studies have only recently established its viral causation and epidemiology. This acute infection by the Epstein-Barr virus is unique pathophysiologically--an acute, self-limiting, lymphoproliferative disorder with autoimmune features--and may well be the cause or one of the causes of several malignant neoplasms, Burkitt's lymphoma, and nasopharyngeal carcinoma. This review (1) describes infectious mononucleosis, pathophysiologically, clinically, and epidemiologically; and outlines its most frequent and serious complications; (2) discusses how to reliably diagnose infectious mononucleosis and evaluate the heterophile-negative case; and (3) addresses management, especially the thorny issues of the use of corticosteroids and restriction from athletic training and participation.

Adrenal Cortex Hormones↗

PubMed1996

[Contribution of cytology and lymphocyte phenotyping in the biological diagnosis in infectious mononucleosis due to Epstein-Barr virus].

Because infectious mononucleosis is characterized by a T cell proliferation reacting with EBV-infected lymphocytes, we studied the changes in the blood cell counts and in the immunophenotype of the lymphocytes during this infection. The laboratory findings were similar for the different age groups, except in children less than 5 years old in whom we found a significantly less intense CD8+ S6F1+ response. According to this study, virus-specific serodiagnostic tests rarely show evidence of an acute primary EBV infection if the peripheral blood analysis fails to reveal significant changes in the leucocyte counts and in the T lymphocyte profiles. The study of this hematologic picture is a useful tool for the confirmation of infectious mononucleosis; moreover, it could greatly help when diagnostic problems occur.

Adolescent↗

PubMed1976

Evaluation of tests for infectious mononucleosis through proficiency testing.

Two standard tests for infectious mononucleosis (the Davidsohn differential and the ox cell hemolysin test) and ten slide tests; Monotest (Wampole), Monospot (Ortho), IM Kit (Micro. Res. Corp.) Monosticon (Organon), Diagluto IM (Beckman), Monosticon Dri-Dot (Organon), Bacto-Hetrol (Difco), Mono-Diff (Wampole), Monophile (Bio-Diagnostic Systems) and Rythrotox (BMC) were evaluated as they were used in 50 laboratories within the State of Utah and by two referee laboratories outside the state. The state proficiency testing program for infectious mononucleosis was modified so that the desired evaluation survey data could be obtained. Sensitivity, specificity, reproducibility (within and between shipments) and percent agreement with target results were determined for each test; factors which might have affected the test results were evaluated to determine which were correlated with good performance.

Costs and Cost Analysis↗

PubMed1983

Acute cerebellar ataxia and hearing loss as initial symptoms of infectious mononucleosis.

A 16-year-old boy had symptoms and signs of cerebellar ataxia and hearing loss. He had no systemic manifestations of infectious mononucleosis and no lymphocytosis. Results of a test for infectious mononucleosis were positive and there was a fourfold rise of serum antibody titer to Epstein-Barr virus capsid antigen. The patient recovered from ataxia but the hearing loss persisted. We reviewed the English literature and 15 cases of cerebellar ataxia associated with infectious mononucleosis were collected. In four of these cases, cerebellar ataxia was the sole manifestation of infectious mononucleosis but no patient had a hearing loss. All patients recovered from ataxia.

Acute Disease↗

PubMed1981

Malignant B-cell lymphoma following and associated with infectious mononucleosis. A comparison of two cases.

The present report describes two young males with clinically diagnosed infectious mononucleosis (IM) who subsequently were diagnosed as having malignant B-cell lymphoma (i.e., immunoblastic sarcoma of B-cells). Despite these apparent similarities, there were fundamental differences between the two cases. The first patient, who lymphoma was diagnosed 9 months after IM, was one of a well-described kindred with the X-linked lymphoproliferative syndrome (XLP) in which affected young males lack the ability to mount an effective immune response to primary infection with the Epstein-Barr virus (EBV) (i.e., infectious mononucleosis), and subsequently develop fatal lymphoproliferative disorders of the B-cell type. This was in contrast to a second patient, also a young male, who did not have the X-linked lymphoproliferative syndrome, who did develop specific antibodies to the Epstein-Barr virus and whose malignant lymphoma was closely associated in time (i.e., 5 weeks) with the clinical diagnosis of infectious mononucleosis. The comparative immunologic and virologic features are discussed as well as the importance of careful clinicopathologic correlation in young adults and children developing malignant lymphoma both following and in association with infectious mononucleosis.

Adolescent↗

PubMed1996

Infectious mononucleosis presenting with dacryoadenitis.

BACKGROUND: A case of severe, bilateral, acute dacryoadenitis in a rarely reported association with infectious mononucleosis is described. METHODS: A 16-year-old girl had acute, bilateral, lacrimal gland enlargement demonstrated with computed tomographic scanning of the orbits. Clinical findings and laboratory investigations confirmed the diagnosis of infectious mononucleosis. Treatment with systemic steroids was initiated. RESULTS: There was rapid resolution of the clinical findings with systemic steroids. CONCLUSION: Dacryoadenitis is an uncommon presentation of infectious mononucleosis and may overshadow the other manifestations of this disease. The diagnosis of infectious mononucleosis should be considered in patients with acute dacryoadenitis. Systemic steroids play an important role in rapidly resolving the dacryoadenitis.

Acute Disease↗

PubMedDate not supplied

Upper airway obstruction in infectious mononucleosis.

Life-threatening upper respiratory obstruction is an unusual complication of infectious mononucleosis. Although the majority of fatalities result from progressive bulbar paralysis or the Guillain-Barré syndrome, airway impairment primarily occurs as a result of pharyngeal lymphoid hyperplasia and associated faucial arch edema. Recent experience in a young child with infectious mononucleosis who exhibited progressive hypersomnolence, sleep apnea, and stridor during sleep is presented. In addition, a retrospective analysis of 72 cases of respiratory complications of infectious mononucleosis provides guidelines for specific airway management. Mild upper respiratory obstruction with persistent fever, severe odynophagia, and malaise is treated with parenteral corticosteroids. Immediate tonsillectomy using a halothane and oxygen induction technique is recommended for severe airway occlusion. Tracheotomy is currently reserved for those patients with progressive alveolar hypoventilation, hypercarbia, atelectasis, and bulbar paralysis. In general, tonsillectomy is well-tolerated, eliminating airway obstruction, improving swallowing function, and rapidly resolving pharyngeal discomfort.

Adrenal Cortex Hormones↗