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PubMedDate not supplied

Serum concentrations of interferon gamma, interleukin-6 and neopterin in patients with infectious mononucleosis and other Epstein-Barr virus-related lymphoproliferative diseases.

Serum levels of interferon gamma, interleukin-6 and neopterin were determined in 15 patients with different forms of Epstein-Barr virus-associated diseases: acute self-limiting infectious mononucleosis, chronic active infectious mononucleosis and X-linked lymphoproliferative syndrome. In patients with acute type of infection, neopterin, interferon gamma and interleukin-6 were elevated in nearly all patients. In contrast, the situation was less clear-cut in the other EBV-associated diseases; particularly interleukin-6 was undetectable in most cases. The results suggest that concomitant measurement of these diverse immune activation markers may provide interesting insights into the interactions between the virus and the host, and may also lead to therapeutic consequences.

Acute Disease↗

PubMed1981

[Thrombocytopenic purpura in infectious mononucleosis (author's transl)].

A patient with infectious mononucleosis (IM) and thrombocytopenic purpura is reported. Clinical symptoms were not suggestive and diagnosis was based on the presence of lymphomonocytic cells in peripheral blood and serologic study. Bone marrow aspirate showed characteristic features of an immunologic thrombopenia, though antiplatelet antibodies were not found. Literature on this subject is revised and pathogenic and therapeutic problems are discussed.

Autoantibodies↗

PubMed1978

EBNA antibodies are more useful than complement fixing antibodies in monitoring infectious mononucleosis patients.

Thirty-six patients with infectious mononucleosis (IM) were followed prospectively for both anti-Epstein-Barr virus nuclear antigen (EBNA) and complement-fixing antibodies using the soluble EBV antigen (CF/S). Discrepancies in time between the two reactivities were found, due to the differences in sensitivity of the tests. It is suggested that, in clinical virology laboratories, EBNA and not CF/S tests be used.

Adolescent↗

PubMed2004

Significant liver injury with dual positive IgM antibody to Epstein-Barr virus and cytomegalovirus as a puzzling initial manifestation of infectious mononucleosis.

A 35-year-old man was admitted because of significant hepatic dysfunction with mild splenomegaly and intra-abdominal lymphadenopathy of unknown cause. Infectious mononucleosis was suggested by subsequently detected high fever, pharyngotonsillitis and cervical lymphadenopathy, but IgM to Epstein-Barr virus (EBV) and cytomegalovirus (CMV) showed dual positivity. A definite diagnosis of EBV-induced infectious mononucleosis was established 3 months later on the basis of seroconversion to Epstein-Barr nuclear antigen (EBNA)-IgG positivity and reduced CMV-IgM titer with persistently negative CMV-IgG. This case highlights the initial diagnostic difficulties of EBV-induced infectious mononucleosis particularly in older patients, due to concomitant abnormal humoral immunity and unusual initial manifestations such as significant liver injury and extensive intra-abdominal lymphadenopathy.

Adult↗

PubMed1998

Genital ulceration as a presenting manifestation of infectious mononucleosis.

This article describes a case of infectious mononucleosis (IM) in a 16-year-old female adolescent who presented with fever, sore throat, cervical lymphadenopathy and genital ulcerations. Initially, this patient was thought to have herpes simplex viral infection secondary to the characteristic multiple genital ulcers. Seven cases (including this case) have reported an association between Epstein-Barr virus (EBV) infection and genital ulcerations. IM as a cause of genital ulcerations should be included in the differential diagnosis.

Adolescent↗

PubMed1976

Infectious mononucleosis. Death due to agranulocytosis and pneumonia.

Infectious mononucleosis (IM) is usually considered a benign disease. Agranulocytosis developed in a young college student 14 days after the onset of IM. Fulminant staphylococcal pneumonia and bilateral pulmonary infarcts resulted, and the patient died 4 1/2 hours after admission to a hospital. Agranulocytosis secondary to IM may be more prevalent than previously thought. A review of the literature indicated that infection developed in 57.9% of the patients with IM and extreme neutropenia and 45.4% of the infected patients died.

Acute Disease↗

PubMed1977

Cytogenetic study of 10 cases of infectious mononucleosis.

Cytogenetic analysis of 10 cases of infectious mononucleosis has revealed increased damage in the form of chromosome breakage and aberrations typical of viral infection, but in addition a few cells were consistently found to harbour a deleted number 22, similar tsponse to the mitogen phytohaemagglutinin is suggested. This inhibitor appears to have a reversible action on the patient's own lymphocytes but no inhibitory effect on control lymphocytes.

Adolescent↗

PubMed1981

Association of infectious mononucleosis with nephrotic syndrome.

A patient had infectious mononucleosis (IM) associated with transient nephrotic syndrome (NS). A kidney biopsy sample studied by light and electron microscopy demonstrated minimal glomerular lesions. Immunofluorescent studies revealed mainly granular mesangial deposits of IgM, and to a lesser extent, deposits of IgG and of C4 and C3. No Epstein-Barr virus-related antigen could be detected in the kidney. This, and three other cases reported in the literature, suggest a causal relationship between IM and NS.

Adolescent↗

PubMed1978

[Incidence and specificity of circulating immune complexes in infectious mononucleosis (proceedings)].

Occurrence of immune complexes in infectious mononucleosis has been investigated by the 125I Clq binding assay. Increased serum Clq-binding activity was found in 87% of the 23 patients studied during the acute stage of the disease. The serum Clq-binding material detected has properties identical to those of immune complexes. IgG antibodies dissociated from the complexes at acid pH and F (ab)'2 fragments obtained after treatment by pepsin appeared to be directed against the viral capsid antigen of Epstein-Barr virus.

Antibodies, Viral↗

PubMed1983

Rubella-specific IgM reactivity in sera from cases of infectious mononucleosis.

Eight sera from 125 cases of infectious mononucleosis (IM) were reactive for rubella-specific IgM in an M-antibody capture radioimmunoassay. The reactivity of individual sera varied depending upon the source of the rubella antigen used in the assay. One serum gave strongly positive results with some rubella haemagglutinating antigens but negative results with others and may have contained an IgM antibody which was capable of distinguishing between strains of rubella virus. If the diagnosis of rubella is based solely on detection in solid-phase immunoassay of rubella-specific IgM, IM should be excluded.

Adult↗

PubMed1995

[Infectious mononucleosis and the risk of splenic rupture].

Infectious mononucleosis is a common and benign disease, affecting mainly teenagers and young adults. Patients with IM are often generally advised to restrain from physical exertion for a period of 6 months. We report one case of splenic rupture in a patient with IM which required emergency laparotomy and splenectomy and one case of splenic rupture which was managed with conservative treatment. We have retrospectively examined the 37 cases of IM admitted during the period 1990-1994 and found that liver function tests return to normal within eight weeks. We therefore advise that patients with IM and no abdominal discomfort should limit their physical activity during eight weeks of convalescence. Patients with IM and abdominal pain should be further examined, using imaging procedures.

Adolescent↗

PubMed1976

Tonsillectomy and infectious mononucleosis--a possible relationship.

A review of 1,192 student medical records shows a prior history of tonsillectomy in 41 percent of a control group and 22 percent of an infectious mononucleosis group--a significant difference (p less than 0.01). Nine hundred eighty-nine Stanford University students (421 females, 568 males) who visited Cowell Student Health Center between April and September, 1973, comprise the control group. Two hundred three students with positive monospot tests and clinical mononucleosis diagnosed between June, 1968, and May, 1973, comprise the experimental group. The lower incidence of tonsillectomy in the infectious mononucleosis group implies that the tonsillar lymphoid tissue serves as a reservoir and possible replicating milieu for the Epstein-Barr virus. Prior tonsillectomy may reduce the possibility of contracting infectious mononucleosis.

Adolescent↗

PubMed2004

[Dynamics of changes in magnesium (Mg) serum levels in patients suffering from infectious mononucleosis].

The aim of the study was to assess the dynamics of changes in magnesium (Mg) serum levels in the acute, symptomatic period of infectious mononucleosis and during the convalescence period, when clinical symptoms were no longer present. 50 subjects were included, among them 26 patients (14 women and 12 men) at the age of 16 to 27 years in the acute, symptomatic stage of the disease. The diagnosis of infectious mononucleosis was based on the clinical, hematological, biochemical and serologic criteria. Mg concentration was measured 3 times: on the 1st day and in the 2nd week of hospitalization, and also in the convalescence period--3 weeks after the regression of clinical symptoms. The control group consisted of 24 healthy individuals (5 men and 5 women) at the age of 17 to 26 years. Mg concentration was measured once in this group. All measurements of Mg serum concentration were performed using the method of atomic absorption spectrophotometry (AAS) at the wavelength of 285.2 nm. We observed significantly higher Mg serum concentrations in patients with acute, symptomatic infectious mononucleosis than in healthy individuals. During the convalescence period Mg serum concentrations were lower but still statistically higher than in the control group.

Acute Disease↗

PubMed1996

Interferon and tumor necrosis factor production by peripheral blood leukocytes of patients with infectious mononucleosis.

Blood samples from 29 patients with infectious mononucleosis (IM) in phases of acute disease and convalescence were obtained. Interferon alpha (IFN-alpha) and tumor necrosis factor alpha (TNF-alpha) activity was detected in sera of patients both in: acute and convalescence phase, however when IFN titers were higher in the acute than convalescence phase, TNF titers were the highest in convalescence. In the whole blood assay Newcastle disease virus (NDV), phytohemagglutinin (PHA) and concanavalin A (ConA) and lipopolysaccharide (LPS) were used as cytokine inducers. A significant decrease in IFN titer induced in vitro with NDV, PHA and ConA was observed in blood leukocytes of patients in the acute IM phase. In convalescence the ability of blood leukocyte of IM patients to produce IFN returned to normal, comparable with control. However, blood leukocytes of IM patients in the acute phase produced more TNF in response to LPS than in convalescence. The role of the observed overproduction of TNF in the course of IM similar to that in HIV infection should be elucidated.

Acute Disease↗

PubMed1985

Evaluation of ten commercial heterophile antibody tests for infectious mononucleosis.

Ten rapid slide agglutination tests for infectious mononucleosis were evaluated. The quality of the technical information included with the kits was found to differ considerably, as did the composition of the tests and the principles of test specificity. Furthermore, large variation was found in the shelf life and price of the different kits. Thirty-nine serum samples were selected according to titre in the Paul-Bunnell-Davidsohn differential absorption test, largely from the low titre area, since this is where most diagnostic problems can be expected. The sera were tested blindly using the ten rapid slide agglutination tests. Considerable differences were found in specificity and sensitivity. When compared with the results obtained from PBD, the tests could be divided into two groups. The first group consisted of three kits, all of which gave false negative, but no false positive results. The remaining seven tests gave false negative and false positive results, but were more sensitive than the tests in the first group. The large variation in the results obtained when using the different kits under controlled conditions indicates that such tests may give even less satisfactory results in practice.

Antibodies, Heterophile↗

PubMed1988

Monoclonal antibodies Ki-B3 and Leu-M1 discriminate giant cells of infectious mononucleosis and of Hodgkin's disease.

In infectious mononucleosis (IM), the involved lymphatic tissue may contain large blasts which are generally referred to as Hodgkin cell-like cells when mononuclear and as Sternberg-Reed cell-like cells when multinuclear. The resemblance of these reactive cells to true Hodgkin and Sternberg-Reed cells constitutes a major differential diagnostic problem. In this paper, we report a study of 20 cases of Hodgkin's disease (HD); five of nodular sclerosis and 15 of mixed cellularity type) and of 20 clinically and serologically confirmed cases of IM with the aim of developing immunohistologic criteria for their reliable differentiation. Routinely processed paraffin sections were subjected to the immunoperoxidase reaction using the monoclonal antibodies Leu-M1 (anti-CD15) and Ki-B3. The subcellular distribution of the immunoreactivity to Ki-B3 was controlled at the electron microscopic level. In all cases of HD, many Hodgkin and Sternberg-Reed cells were found to be positive for Leu-M1, whereas the same cells were invariably negative for Ki-B3. By contrast, cells similar to Hodgkin and Sternberg-Reed cells in IM were consistently negative for Leu-M1. The majority of these cells reacted positively for Ki-B3. The results imply that immunohistochemical application of these two antibodies facilitates a clear-cut discrimination of true Hodgkin and Sternberg-Reed cells from similar cells of IM.

Adolescent↗

PubMed1989

Characterization of the T cell-mediated cellular cytotoxicity during acute infectious mononucleosis.

Primary infection with EBV during acute infectious mononucleosis (IM) is associated with a cytotoxic response against allogeneic target cells. C depletion with anti-CD3 (OKT3) and anti-CD8 (OKT8) mAb decreased the allogeneic cytolysis of two EBV-infected lymphoblastoid cell lines (LCL) by 96% and 89%, respectively. Complement depletion with the NK cell-specific mAb Leu-11b and NKH-1a resulted in only a slight decrease (less than 35%) in the lysis of these LCL. mAb inhibition studies with OKT3 and OKT8 inhibited the allogeneic lysis of two LCL by 87% and 82%, respectively. The alloreactive cytotoxic response was strongly inhibited by mAb specific for MHC class I determinants (W6/32, 65% inhibition and BBM.1, 58% inhibition). Acute IM lymphocytes lysed the allogeneic EBV-negative cell lines HSB2 (45%) and HTLV-1 T cell lines (16%). NK cell-depleted lymphocytes from an acute IM patient demonstrated preferential lysis of K562 transfected with human HLA-A2 (73%) compared with the K562 transfected control (20%). Cold target competition studies with allogeneic and autologous target and competitor LCL demonstrated no significant competitive inhibition between allogeneic and autologous cells. We interpret these results as evidence that 1) the acute IM-alloreactive cytotoxic response is mediated primarily by CTL; 2) these alloreactive CTL lyse allogeneic target cells irrespective of EBV antigenic expression; 3) MHC class I expression is sufficient for allogeneic recognition and lysis of target cells; 4) distinct effector CTL populations mediate lysis of autologous and allogeneic target cells; and 5) during acute IM, EBV infection results in the induction of both virus-specific and alloreactive CTL populations.

Acute Disease↗

PubMed1995

The management of splenic rupture in infectious mononucleosis.

Non-operative management of splenic trauma is now well established; however, the role of conservative management in spontaneous splenic rupture is undetermined. The leading cause of spontaneous splenic rupture is infectious mononucleosis. We report on the management of four patients with spontaneous rupture, in association with infectious mononucleosis. Three patients eventually required splenectomy, and one was successfully managed non-operatively. The comparative risks of operative and non-operative management are discussed. We believe that when splenic rupture complicates infectious mononucleosis, early splenectomy is the most appropriate management.

Adult↗