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[Infectious mononucleosis]
OBJECTIVE: To present updated aspects of the Infectious Mononucleosis caused by the Epstein-Barr Virus. MATERIALS AND METHODS: Research of bibliographic references through the Medline and direct research of selected papers. RESULTS: A concise approach to some aspects related to the epidemiology of the virus, namely the two types that are presently known,EBVtypeAandEBVtype B, and some differences that they present. It was possible to establish a relationship between what one sees in the clinical picture and the immunological changes that occur at the same time. The author also describes the physiopathology, clinical features, complications and other syndromes associated to the EBV. As far as the laboratory workup is concerned, it is important to have a complete blood count as the first step, followed by the quantitative exam of the heterophile antibodies and antibodies antiEBV analysis. CONCLUSION: The pathologies related to the EBV are important, and certainly fascinating from the immunological point of view. Among these, the Infectious Mononucleosis caused by the EBV has shown some interesting clinical and laboratorial aspects.
[Infectious mononucleosis.].
OBJECTIVE: To present updated aspects of the Infectious Mononucleosis caused by the Epstein-Barr Virus. MATERIALS AND METHODS: Research of bibliographic references through the Medline and direct research of selected papers. RESULTS: A concise approach to some aspects related to the epidemiology of the virus, namely the two types that are presently known,EBVtypeAandEBVtype B, and some differences that they present. It was possible to establish a relationship between what one sees in the clinical picture and the immunological changes that occur at the same time. The author also describes the physiopathology, clinical features, complications and other syndromes associated to the EBV. As far as the laboratory workup is concerned, it is important to have a complete blood count as the first step, followed by the quantitative exam of the heterophile antibodies and antibodies antiEBV analysis. CONCLUSION: The pathologies related to the EBV are important, and certainly fascinating from the immunological point of view. Among these, the Infectious Mononucleosis caused by the EBV has shown some interesting clinical and laboratorial aspects.
[THE INDIRECT AND DIRECT DEMONSTRATION OF MONONUCLEOSIS ANTIBODIES AS A SEROLOGICAL DIAGNOSTIC AID IN INFECTIOUS MONONUCLEOSIS].
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Bone marrow findings in infectious mononucleosis and mononucleosis-like diseases in the older adult.
The bone marrow findings in 5 older adults with infectious mononucleosis or mononucleosis-like illnesses are presented. These individuals were initially considered to have lympho-proliferative disorders which often have similar constitutional signs and symptoms. All had atypical lymphocytosis of the peripheral blood. In addition, there were also abnormalities in the bone marrow. The most common findings included focal collection of lymphocytes and the presence of granulomas. The granulomas were small without caseous necrosis and giant cells were infrequent. This is in contrast to the idea that the bone marrow is normal in infectious mononucleosis and gives support to performing core biopsies as the aspirate smears in these individuals did not demonstrate the focal lymphocytosis or granulomas. Whereas, infectious mononucleosis and mononucleosis-like illness may be uncommon in the older individual, they certainly are not rare and it is important to differentiate these benign disorders from the more serious lymphoproliferative diseases. Heterophil test and/or Epstein Barr titers are important confirmatory tests.
Paroxysmal nocturnal hemoglobinuria associated with infectious mononucleosis.
A previously healthy 16-yr-old girl was found to have pancytopenia, low reticulocyte count, a cellular bone marrow, and a negative Coombs test, all coincident with clinical and laboratory evidence of infectious mononucleosis. Symptoms and signs of infectious mononucleosis subsided, but pancytopenia and hemolytic anemia persisted. Sucrose hemolysis and acid hemolysis tests supported a diagnosis of paroxysmal nocturnal hemoglobinuria (PNH). After 18 mo, the platelet count is normal, but leukopenia and hemolytic anemia continue. The development of PNH in this patient suggests it may have resulted from an effect of infectious mononucleosis.
Patients treated in hospital for infectious mononucleosis and risk of cancer.
The risk of cancer was evaluated in a cohort of 1,234 patients with severe infectious mononucleosis between 1954 and 1983. The diagnosis of mononucleosis was confirmed by reviewing patient records. The observed numbers of cancer cases up to 1988 were obtained through record linkage from the Finnish Cancer Registry, which is nationwide and population-based. There were 11 cases of cancer in the cohort, as against 17.4 expected on the basis of the 24,288 person-years at risk and of incidence rates specific for age, sex and period in the area. This gives a standardized incidence ratio of 0.6 (95% confidence interval 0.3-1.1). There was only 1 lymphoma case. No malignancies were diagnosed during the first 5 years after infectious mononucleosis. The results indicate that infectious mononucleosis with severe symptoms does not imply an increased risk of cancer.
Treatment of severe infectious mononucleosis with famciclovir.
We report a patient with severe acute infectious mononucleosis who was successfully treated with famciclovir. A 15-year-old male was admitted with a 6-week history of fever, malaise, generalized lymphadenopathy, and hepatosplenomegaly, the patient was acutely ill with a temperature of 39.0 degrees C. Oropharingeal examination revealed enlarged tonsils partially obstructing the airways. EBV serology obtained during admission showed a positive Monospot test, virus capsid antigen IgM, 1:320, Epstein-Barr nuclear and early antigen, negative. After 72 hours of treatment with famciclovir (500 mg t.i.d.), the patient was afebrile with important regression of the lymphadenopathy, enlarged tonsils and hepatosplenomegaly. Because acute infectious mononucleosis may be associated with extensive and prolonged disease, the potential therapeutic role of famciclovir in the treatment of severe forms of the disease deserves further studies.
Serological studies in infectious mononucleosis.
Serological investigations performed on 27 patients with illnesses resembling infectious mononucleosis showed a significant increase in high antibody titres (more than 1:40) to EB virus in 11 of the 12 who developed heterophile antibodies. Two of these patients, however, had a significant increase in antibody titre to cytomegalovirus and rubella virus, respectively. Of 15 patients who failed to develop heterophile antibodies, one had a high antibody titre to EB virus, the others generally having undetectable or low antibody titres. The insidious onset of the illness in many patients together with the fact that EB virus antibodies rose to high titres rapidly reduced the value of this investigation diagnostically.EB virus antibody was still present in the sera of five patients who had had well-authenticated heterophile-antibody-positive infectious mononucleosis some four to seven years previously. Twenty-seven out of 70 (39%) healthy nurses had antibody at a level of more than 1:10 to EB virus. The presence of EB virus antibody in different population groups appears to be related to such factors as age and socioeconomic status.
Application of low-avidity immunoglobulin G studies to diagnosis of Epstein-Barr virus infectious mononucleosis.
Single serum samples from 121 patients suffering from clinical infectious mononucleosis were tested by an indirect immunofluorescence assay for avidity of Epstein-Barr virus (EBV) capsid antigen immunoglobulin G (IgG), involving a wash step with phosphate-buffered saline-8 M urea. Ninety-four samples showed serological markers of recent EBV infection (presence of viral-capsid antigen-specific IgM [87 cases] and/or presence of IgG in the absence of EBV nuclear antigen antibodies [85 cases]). The remaining 27 cases had serological evidence of prior infection (presence of viral-capsid IgG and EBV nuclear antibodies and absence of IgM). In the avidity assay, 89 samples from patients with recent infection showed low-avidity IgG and 25 samples from patients with prior infection had high-avidity IgG. The avidity assay showed a sensitivity that was at least equal to those of classical serological procedures for diagnosing EBV infectious mononucleosis. Further studies are necessary, however, to establish the specificity of the assay and the duration of low-avidity antibodies.
[Analysis of viral capsid anti-antigen antibodies of the Epstein Barr virus in infectious mononucleosis. Comparative evaluation of a fluorescence method with classic methods].
708 sera were tested by a FA method for the detection of antibodies anti-viral capsid antigen in Epstein-Barr virus disorders to establish its effective value in infectious mononucleosis diagnosis. The arise of IgG class's antibody was not significative between recent infectious mononucleosis's patients and controls. Preliminary study of a test to research IgM anti-viral capsid antigen confirmed its value in infectious mononucleosis's diagnosis, but only in early stages of infection. At least, after evaluation of the results obtained by FA test for IgG-anti-viral capsid antigen in 200 blood donors the authors suggest the utilization of this method as screening in these people to avoid infectious mononucleosis transmission by blood transfusion in newborn children or in immunosuppressed patients.
Management of blunt splenic injury in patients with concurrent infectious mononucleosis.
Selective nonoperative management is appropriate for most blunt splenic injuries in adults and children, but the efficacy of this approach is unknown when injury occurs in patients with concurrent infectious mononucleosis. We have reviewed our experience during the past 23 years with the selective nonoperative management of blunt splenic injury in these patients. Medical record review identified nine patients with blunt splenic injury and infectious mononucleosis from 1978 to 2001, representing 3.3 per cent of our total trauma population with blunt splenic injury treated during that interval. Two patients underwent immediate splenectomy because of hemodynamic instability. Seven patients were admitted with the intent to treat nonoperatively. Five patients were successfully managed nonoperatively. Two patients failed nonoperative management and underwent splenectomy, one because of hemodynamic instability and one because of an infected splenic hematoma. Concurrent infectious mononucleosis does not preclude the successful nonoperative management of blunt splenic injury. This small subset of patients may be managed nonoperatively using the same criteria as for patients whose splenic injuries are not complicated by infectious mononucleosis.
Spontaneous rupture of the spleen detected on CT as the initial manifestation of infectious mononucleosis.
Spontaneous splenic rupture after infectious mononucleosis (IM) is a rare, potentially fatal complication of IM, occurring in 0.1-0.5% of patients with proven IM. It usually occurs several weeks after the onset of symptoms, but may, rarely, be the initial manifestation of the disease. The patient is usually examined as an emergency due to severe abdominal pain and a falling hematocrit. The radiologist should be aware of the pathologic conditions involving the spleen which may lead to its spontaneous rupture.
Infectious mononucleosis in the community hospital.
The clinical records from three community hospitals of 161 patients with a diagnosis of infectious mononucleosis were reviewed. Epidemiological, clinical, and laboratory findings were compared with previous studies of selected populations and age groups as well as with those from referral centers. The purpose of this study was to obtain information on infectious mononucleosis as it presents to primary care physicians in the community setting. Infectious mononucleosis can pose diagnostic difficulties, demonstrated by the variety of admission diagnoses made by physicians prior to the laboratory confirmation of the illness. Although often a benign and self-limited illness, hospitalization was often required for minor and rare major complications. Ampicillin-related rash did not occur so frequently as previously reported. The use of steroids in treatment of complications was felt to be appropriate. With few exceptions, epidemiological, clinical, and laboratory findings generally agreed with previous studies.
Erythema nodosum associated with infectious mononucleosis.
Erythema nodosum is an immunoallergic epiphenomenon appearing during the course of various conditions; it has been exceptionally observed in association with infectious mononucleosis. A 9-year-old girl with clinical manifestations of infectious mononucleosis developed cutaneous nodules of erythema nodosum over the shins, which cleared after 12 days. Diagnosis was based on the presence of atypical mononuclear cells, detection of antibodies against Epstein-Barr virus, and positive ox red blood cell hemolysis. Coincidence of both diseases is not surprising because infectious mononucleosis may exhibit diverse immunologic reactions. On the other hand, commonest etiologies were excluded in this case.
Quantitative evaluation of Epstein-Barr-virus-infected mononuclear peripheral blood leukocytes in infectious mononucleosis.
We devised a quantitative assay for Epstein-Barr-virus-infected mononuclear leukocytes (virocytes) to determine their prevalence in the blood of patients with acute-phase and convalescent-phase infectious mononucleosis and in healthy Epstein-Barr-virus-seropositive controls. Mononuclear peripheral blood leukocyte suspensions were tested for virus-determined cytoproliferative activity by cocultivation with human cord-cell indicator cultures. The highest levels of virocytes among circulating mononuclear leukocytes were found in the early acute phase of infectious mononucleosis (up to 0.05 per cent). Virocytemia decreased to levels comparable with those of healthy controls (less than 0.00001 per cent) by the third month after onset of infectious mononucleosis. These findings provide a quantitative profile of the course of the infection at cellular level and support existing evidence of the efficiency of immune control mechanisms in limiting Epstein-Barr-virus infection during the course of infectious mononucleosis.
Spontaneous splenic rupture in infectious mononucleosis.
Spontaneous splenic rupture is a rare but life-threatening complication of infectious mononucleosis. Abdominal pain and tachycardia are unusual in uncomplicated infectious mononucleosis and should alert a doctor to the possibility of spontaneous splenic rupture.
Microbiology of tonsillar surfaces in infectious mononucleosis.
OBJECTIVE: To compare the cultures of tonsillar surface aerobic and anaerobic bacterial flora taken during the acute phase of infectious mononucleosis with the repeated cultures taken 2 months later. PATIENTS: Fourteen patients with pharyngotonsillitis associated with infectious mononucleosis. RESULTS: A total of 121 bacterial isolates (ie, 84 anaerobes and 37 facultatives and aerobes) were isolated in the acute stage, and 75 isolates (ie, 42 anaerobes and 33 aerobes) were recovered 2 months later. The reduction in the number of organisms in the second specimen was mostly due to the decrease in the recovery of Prevotella intermedia (13 in the first culture, compared with four in the second) and Fusobacterium nucleatum (12 vs four, respectively). CONCLUSIONS: The study illustrates that the surfaces of tonsils of patients with infectious mononucleosis contain more species of anaerobic organisms during the illness than following it. The potential role of these organisms in the inflammation process warrants further study.