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PubMed1987

Hematologic parameters and leukocyte histogram patterns in infectious mononucleosis.

Blood samples from 60 patients with serologically positive infectious mononucleosis were analyzed on the Coulter S-Plus IV. Hemoglobins and platelet counts were essentially normal, and leukocyte counts were elevated in less than half the cases. Reactive lymphocytes were present on blood smears from all patients. The S-Plus IV automated three-part leukocyte differentials showed significantly lower numbers of lymphocytes and more mononuclears and granulocytes than manual microscopic differentials. On the leukocyte histograms, lymphocyte peaks were consistently wider than normal and asymmetrical. The instrument generated R2 flags on 43 of 60 (72%) of the samples. Using a combination of "R" flags, mononuclear backlighting, and "H" flags, the Coulter S-Plus IV identified 59 of 60 infectious mononucleosis samples as requiring further review.

Adolescent↗
PubMed2004

Heterophile antibody positive infectious mononucleosis.

OBJECTIVE: The present study has been carried out to analyse the trend of heterophile antibody positive infectious mononucleosis cases. METHODS: A total of 1741 cases of clinically suspected infectious mononucleosis from various age groups were investigated during the period January, 1986 to December, 2000 and were analysed for infectious mononucleosis (IM) specific heterophile antibody by Paul-Bunnel-Davidsohn (PBD) test. Forty seven heterophile antibody negative samples were also tested simultaneously for the presence of the IgG antibody to viral capsid antigen (VCA) and Epstein Barr nuclear antigen (EBNA) to detect the exposure to Epstein Barr Virus (EBV) infection. RESULTS: The overall percentage of EBV specific heterophile (Paul-Bunnel) antibody positivity was found to be 11.1% (194/1741). The average Paul-Bunnel antibody positivity between 1986 to 1990 was 20.5% which declined drastically to 5.7% during 1991-2000. Males comprised of 55.2% of the serologically proven IM cases. Of the 47 heterophile antibody negative cases, 38 (80.9%) and 33 (70.2%) were found to be positive for anti-VCA IgG and anti-EBNA IgG antibodies respectively. Paul Bunnel antibody positivity was found to be higher in >14 year age group patients than those below 14 years. CONCLUSION: These findings suggest that the EBV infection still continues to be endemic in this part of the country, however, a declining trend in IM cases was observed during the last decade.

Adolescent↗
PubMed1995

BLT-esterase in infectious mononucleosis.

Peripheral blood lymphocytes of three patients suffering from infectious mononucleosis due to Epstein-Barr virus (EBV) infection were analysed for BLT-esterase expression in peripheral blood lymphocytes by a well established cytochemical staining method. During the acute phase of disease with presence of clinical symptoms a very high level of up to 90% BLT-esterase-expressing lymphocytes were detected. The increased percentage of lymphocytes expressing BLT-esterase coincided with the time of greatest symptoms and the peak elevation of hepatocellular enzymes. The still moderately elevated level only gradually decreased to normal during the further recovery period of 2 months during which the patients described episodes of weakness. Peripheral blood lymphocyte phenotype analysis revealed a marked CD8 lymphocytosis, a CD4/CD8 ratio of about 0.2, low number of CD19+ B cells, and a high level of DR+ CD3+ lymphocytes. Reduction of BLT esterase expression during the recovery period coincided with reduction of CD8+ DR+ lymphocytes. By a combination of BLT-esterase staining with immunocytochemical phenotype analysis, 95% of CD8+ lymphocytes were found to be BLT-esterase-positive. BLT-esterase might be involved in the immunodefence against EBV in infectious mononucleosis by inducing apoptosis in EBV-transformed B cells.

Adolescent↗
PubMed1977

Cell mediated immunity during infectious mononucleosis to Epstein-Barr virus associated antigens.

Twenty-three patients with recent infectious mononucleosis were studied for cell-mediated immunity to Epstein-Barr virus (EBV)-associated antigens. By means of a virion-containing antigen preparation, (P3J), leukocyte migration inhibition was demonstrated in 6 of 13 patients with acute infectious mononucleosis (IM) and in 6 of 10 patients studied during the convalescent period. Inhibition with a soluble antigen (S) preparation was seen in only a few patients at all stages of the illness. Lymphocyte blast transformation on exposure to P3J occurred in 4 of 9 patients with acute IM; no other study group reacted. Control donors lacking anti-EBV antibodies did not demonstrate migration inhibition or blast transformation with either P3J or S. Control donors with evidence of previous EBV infection did demonstrate migration inhibition with P3J (8 of 12) and S (3 of 10). These studies indicated that cell-mediate immunity to EBV-associated antigens could be detected by either leukocyte migration inhibition or lymphocyte blast transformation, but neither assay is diagnostic of infectious mononucleosis.

Acute Disease↗
PubMed2004

Serological diagnosis of infectious mononucleosis by chemiluminescent immunoassay using capsid antigen p18 of Epstein-Barr virus.

BACKGROUND: Infectious mononucleosis is the common clinical manifestation of primary Epstein-Barr virus (EBV) infection in young children. We evaluated a chemiluminescent immunoassay method for the determination of serum anti-viral capsid antigen IgM antibody and its clinical value in the diagnosis of infectious mononucleosis. METHODS: Concentrations of the antibody in serum samples from 187 children measured by chemiluminescent immunoassay were compared with those measured by ELISA. RESULTS: Assessment of technologic quality (methodology) in diagnostic tests demonstrated that sensitivity of CLIA was 0.64 U/ml and the functional sensitivity was <0.9 U/ml. The within-assay and the between-assay imprecisions of different concentrations were all <5%. Recoveries were all in 93-107%. The linear regression equation between expected values and measured values was y=0.0967+1.0093x, correlation coefficient was 0.9996 (p<0.0001). The ROC curve showed that the sensitivity and specificity of the CLIA both were >90%. The area under the curve was 0.992, which was significantly higher than that of ELISA (p<0.05). CONCLUSION: The CLIA was the excellent method for EBV-VCA IgM measurement at present and can improve the clinical diagnosis of infectious mononucleosis.

Adolescent↗
PubMed2004

[Serum copper and zinc level in patients suffering from infectious mononucleosis and after the regression of clinical symptoms].

UNLABELLED: The aim of this work was to assess the serum copper (Cu) and zinc (Zn) level and ratio Cu/Zn in the acute, symptomatic period of infectious mononucleosis and during the convalescence period, when no clinical symptoms were present. MATERIAL AND METHODS: We examined 50 persons, including 26 patients (14 women and 12 men) in the age of 16 to 27 years, examined in the acute, symptomatic period of the disease. The diagnosis of infectious mononucleosis was based on the clinical, haematological, biochemical and serologic criteria. Cu and Zn concentration was measured 3 times: on the 1st day and the 2nd week of hospitalisation, and also after the regression of clinical symptoms. The control group consisted of 24 healthy individuals (13 men and 11 women) in the age of 17 to 26 years. Cu and Zn concentration was measured once in this group. All measurements of Cu and Zn serum concentration were done using the method of atomic absorption spectrophotometry (AAS) with AAS-3 spectrophotometer of Carl Zeiss-Jena production, at the wavelength for Cu--324.8, Zn--213.9 nm. We observed the Cu and Zn serum concentration and ratio Cu/Zn in patients with acute, symptomatic infectious mononucleosis and also after the regression of clinical symptoms to be statistically higher that the results from the healthy individuals. CONCLUSION: The statistical significant elevated serum Cu and Zn concentration observed during the course of infectious mononucleosis and after clinical symptoms regression in comparison to healthy persons expressed the perturbation of trace elements homeostasis. If copper to zinc ratio reflects myeloproliferative diseases activity, the practical value for infectious mononucleosis monitoring is the same as copper and zinc serum level measurement.

Adolescent↗
PubMed1969

A comparison of the Monospot with the Paul-Bunnell test in infectious mononucleosis and other diseases.

The Monospot is a spot test designed for the diagnosis of infectious mononucleosis and its efficacy has been compared with that of the standard Paul-Bunnell test. Three out of 210 (1.4%) sera from normal persons and persons suffering from diseases other than infectious mononucleosis gave ;false' positive results when compared with the Paul-Bunnell test. Using 38 sera from patients with strong clinical and haematological evidence of infectious mononucleosis no false negative results were found with the Monospot test. The sera of 37 patients gave positive results with the Paul-Bunnell test: the one negative result was positive using serum taken a few days later.

Animals↗
PubMed1981

Cold-induced urticaria in infectious mononucleosis.

Cold-induced urticaria in a patient suffering from infectious mononucleosis is described. This condition was associated with the presence of cryoglobulins in the serum. To our knowledge this is the first description of cold-induced urticaria associated with infectious mononucleosis.

Adult↗
PubMed1976

How frequent is bacterial superinfection of the pharynx in infectious mononucleosis? Observations on incidence, recognition, and management with antibiotics.

Throat cultures from 133 patients with infectious mononucleosis were compared with cultures from 2,881 patients who were seen during the same period because of pharyngitis. Less than 3 per cent of the cultures from each group contained Group A beta hemolytic streptococci. The inflamed pharynx and necrotic tonsils of infectious mononucleosis are seldom subject to bacterial superinfection, either initially or during the course of the illness. There is no indication for routine use of antibiotics when infectious mononucleosis is diagnosed. Should, however, a throat culture indicate presence of a bacterial pathogen, any appropriate antibiotic except ampicillin may be used without increasing the incidence of skin rash.

Anti-Bacterial Agents↗
PubMed1988

Infectious mononucleosis in hospitalized patients over forty years of age.

Clinical and laboratory features of 17 patients over 40 years of age (mean age: 55 years) admitted with infectious mononucleosis were compared with those of 17 adolescents (mean age: 13 years) hospitalized with this illness. Elderly patients with infectious mononucleosis were found to run a longer febrile course (13 vs. 7 days, p less than 0.01) and to have a lower peak total white blood cell count (6,600/mm3 vs. 11,000/mm3, p less than 0.001) and a lower incidence of splenomegaly (50% vs. 76%, p less than 0.05), lymphadenopathy (25% vs. 94%, p less than 0.001), and pharyngitis (25% vs. 47%, p less than 0.05), compared with young patients with infectious mononucleosis. Patients in both groups had a high prevalence of abnormal liver function tests. It is concluded that infectious mononucleosis in patients over 40 years of age is not as uncommon as previously reported, and that clinical and laboratory features differ between young and older patients suffering from this disease.

Adolescent↗
PubMed1978

The efficiency and cost effectiveness of diagnostic tests for infectious mononucleosis.

The problem of diagnosis and appropriate treatment of patients presenting with pharyngitis is a common occurrence in family practice. The study of these patients includes laboratory tests to differentiate between infectious mononucleosis and other bacterial and viral infections. This study reviews the diagnosis of infectious mononucleosis in two large ambulatory populations, where different approaches were used. In one approach, all laboratory tests were concurrent, while in the other, serology was performed only after satisfaction of hematologic criteria for infectious mononucleosis. In the latter case, sequential use of laboratory tests resulted in a significant improvement in cost effectiveness. In both approaches, no appreciable gain was obtained from heterophil titers. Since the heterophil titer in confirmed cases of infectious mononucleosis does not correlate with prognosis or severity of the disease, this procedure can be replaced by the Monospot/"monoscreen" test alone.

Adolescent↗
PubMed1967

Infectious mononucleosis.

A short review of past and recent works pertinent to the etiology and pathogenesis of infectious mononucleosis is presented. Epidemiological studies have led to the elaboration of hypotheses concerning the etiology, the length of the incubation period and the mode of transmission of the disease. An unusual type of infectious mononucleosis of rickettsial origin has been reported by Japanese workers. Studies of accidental and experimental transmission suggest that more than one agent may give rise to the same disease. Isolation attempts in tissue cultures have been unrewarding except for the uncovering of possible agents by interference and immunofluorescence.The atypical lymphocyte is the site of increased RNA and DNA synthesis. It does not seem to be involved in antibody synthesis. The heterophile agglutinins and other mononucleosis-associated antibodies apparently account for only part of the excess 19S antibody material found in mononucleosis sera. The origin and function of these antibodies and of the atypical lymphocyte are the subject of speculation.The final elucidation of the pathogenesis of the disease and the confirmation of the reviewed hypotheses are all dependent on the eventual discovery of the elusive etiological agent(s) of infectious mononucleosis.

Adult↗
PubMed1979

Incidence of infectious mononucleosis at the Universities of California and Hawaii.

The observed rates of heterophil-positive infectious mononucleosis at the University of California at Davis and the University of Hawaii at Manoa were 1,212 and 37 per 100,000 students per academic year, respectively. The data collected suggest that the extraordinarily low incidence at the University of Hawaii may be due to the following factors: (1) underutilization of the student health service by students with infectious mononucleosis; (2) low proportion of Epstein-Barr virus-seronegative students; (3) high proportion of Asian students who appear to be less likely to develop heterophil-positive infectious mononucleosis; and (4) possible low efficiency in the transmission of primary Epstein-Barr virus infections.

Adolescent↗
PubMed1982

Two-dimensional analysis of human lymphocyte proteins. III. Preliminary report on a marker for the early detection and diagnosis of infectious mononucleosis.

Two-dimensional gel electrophoretic patterns of human peripheral blood leukocytes from 12 patients with infectious mononucleosis were prepared by use of the ISO-DALT system. Before the two-dimensional separation, the leukocytes were purified by Ficoll-Paque gradient centrifugation and labeled overnight with [35S]methionine. Quantitative increases in two proteins were detected in the patterns of infected leukocytes from the patients as compared with controls. Fluorescence-activated cell sorting of leukocytes from normal human peripheral blood before subsequent two-dimensional gel analysis revealed that the dramatic increase in one of these proteins (Inmono:2) could be due to shifts in the population ratios of lymphocytes, monocytes, and granulocytes (Willard et al., manuscript in preparation). In contrast, the appearance of the infected leukocytes of a second protein, Inmono:1, could not be accounted for by cell-population shifts. Increased amounts of these two proteins have been found in every patient studied who had clinically detectable infectious mononucleosis. In addition, a patient who displayed symptoms of infectious mononucleosis but who did not have a positive result in the MONOSPOT Test (Ortho) until three weeks after our analysis also demonstrated increased relative amounts of these proteins in his leukocyte pattern.

Adolescent↗
PubMed1973

Social class and infectious mononucleosis.

The socio-economic status of 80 patients with infectious mononucleosis was compared with the socio-economic distribution of the general population in the same area of south-west London. An excess incidence of infectious mononucleosis was observed among subjects from upper socio-economic groups. A possible relationship between this observation and the epidemiology of the Epstein-Barr virus is discussed.

Health Surveys↗
PubMed1978

Rupture of the spleen in infectious mononucleosis: a critical review.

Spontaneous rupture of the spleen in infectious mononucleosis is a well-known clinical phenomenon. However, when strict criteria concerning the presence or absence of trauma and the diagnosis of infectious mononucleosis are applied to the 107 cases in the world literature, only 18 true spontaneous ruptures are found. In these, the survival rate was 100%. In addition to pain referral to the left shoulder (Kehr's sign), right shoulder and scapular pain from diaphragmatic irritation, caused by free intraperitoneal blood, can be a valuable sign in determining splenic rupture. Because the spleen remains susceptible to rupture even after recovery based on all clinical, hematologic, and serological criteria, it is recommended that full normal activities not be resumed for two to three months by the nonathlete and for six months by the athlete.

Adolescent↗
PubMed2004

A randomised controlled trial of a psycho-educational intervention to aid recovery in infectious mononucleosis.

OBJECTIVES: Glandular fever is associated with an approximate fivefold increase in fatigue at 6 months. Reduced levels of fitness and illness beliefs may be important predictors of fatigue following glandular fever. We therefore developed a brief psycho-educational intervention aimed at improving recovery from infectious mononucleosis, and piloted a randomised controlled trial to evaluate the intervention. METHODS: We performed a randomised-controlled trial in primary health care in Southeast London and Kent. Sixty-nine patients aged between 16 and 45 years who were diagnosed, serologically and clinically, with acute infectious mononucleosis between December 1999 and December 2000 were randomised. The control group received a standardised fact-sheet about infectious mononucleosis, which gave no advice on rehabilitation. Patients who were randomised to the intervention received an individual treatment session, two follow-up telephone calls, and an information booklet. Fatigue score 6 months after the onset of infectious mononucleosis was the main outcome measure. RESULTS: Sixty-nine out of 139 patients referred were recruited and randomised. Eighty-seven percent of those recruited completed the Fatigue Questionnaire at 6 months. The intervention was acceptable to all who received it. There were fewer fatigue cases in the intervention group than the control group at 6 months follow-up (odds ratio 0.31, 95% confidence interval 0.09-0.91). CONCLUSIONS: A brief intervention at the diagnosis of infectious mononucleosis is acceptable, and may help prevent the development of chronic fatigue. Definitive randomised controlled trials are required to test the intervention.

Adolescent↗