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At least 397 records · Page 22Linked to original sources
PubMed1987

Spontaneous splenic rupture in infectious mononucleosis.

Spontaneous splenic rupture is a rare but life-threatening complication of infectious mononucleosis. Patients typically present with acute abdominal pain most marked in the left lower abdomen. Occasionally the pain is referred to the left shoulder and preceded by "flu-like" symptoms. Palor, orthostasis, and tachycardia can also be observed. Because abdominal pain and tachycardia are unusual in uncomplicated cases of infectious mononucleosis, the possibility of spontaneous splenic hematoma or rupture must be considered. The case presented here typifies the clinical manifestations of this entity and illustrates appropriate management.

Adult↗
PubMed1978

Adolescent infectious mononucleosis with psychosis.

This report describes an adolescent with an acute catatonic schizophrenic illness associated with infectious mononucleosis. The literature and clinical evidence supporting a diagnosis of infectious mononucleosis encephalopathy are reviewed. Diagnostic questions in such cases are discussed from a clinical psychiatric perspective. Therapeutic and developmental issues in managing adolescent psychosis of uncertain etiology are explored.

Acute Disease↗
PubMedDate not supplied

Infectious mononucleosis presenting as upper airway obstruction.

Upper airway obstruction though a common complication of infectious mononucleosis is rarely considered in differential diagnosis of stridor. We report a three-year-old child who had upper airway obstruction due to infectious mononucleosis, managed conservatively with oxygen, intravenous fluids and steroids.

Adenoids↗
PubMed1983

Acquired hypogammaglobulinemia following infectious mononucleosis.

The case of a 17-year-old male who developed hypogammaglobulinemia following infectious mononucleosis is presented. The family history revealed that a male sibling had died some years earlier with encephalitis also following infectious mononucleosis. Laboratory investigations revealed adequate numbers of T and B cells and normal proportions of helper and suppressor T lymphocytes but poor in vitro responses to mitogens and an absence of hypersensitivity to skin test antigens. Serial serological examinations for Epstein-Barr virus antibodies indicated a primary immune response to this virus in a hypogammaglobulinemic individual. The patient probably represents a case of the X-linked lymphoproliferative syndrome. The unique feature of the present case is the demonstration of Epstein-Barr virus-specific T-cell memory. The significance of this finding and the variable expression of this syndrome in two members of the same family are discussed.

Adolescent↗
PubMedDate not supplied

Spontaneous splenic rupture in infectious mononucleosis: a review.

Spontaneous rupture of the spleen is a rare complication of infectious mononucleosis (IM) occurring in 0.1-0.5 percent of patients with proven IM [1]. Although splenectomy has been advocated as the definitive therapy in the past, numerous recent reports have documented favorable outcomes with non-operative management. A review of the literature suggests that non-operative management can be successful if appropriate criteria, such as hemodynamic stability and transfusion requirements are applied in patient selection. We report the case of a 36 year old man with infectious mononucleosis who had a spontaneous splenic rupture and who was successfully managed by splenectomy. Based on review of the literature, an approach to management of a spontaneously ruptured spleen secondary to IM is suggested.

Adult↗
PubMed1979

Lymphocyte transformation induced by autologous cells. VIII. Impaired autologous mixed lymphocyte reactivity in patients with acute infectious mononucleosis.

The autologous mixed lymphocyte reaction (MLR) is severely impaired in patients with acute infectious mononucleosis. Reactivity returned during the course of convalescence. The allogeneic MLR was not impaired in these patients. B cells from patients with infectious mononucleosis do not stimulate autologous T-cell proliferation, and this observation appears to explain the cellular basis of the impaired autologous MLR in infection. Two explanations for the B-cell defect were considered: (a) the influence of serum factors on B-cell function and (b) the effect of Epstein-Barr virus infection.

Adolescent↗
PubMed1978

Renal disease in infectious mononucleosis.

Evidence of mild renal involvement is present in approximately 16% of patients with infectious mononucleosis as gauged by abnormalities in urinary sediment. Serious renal involvement including renal failure is very rare, our incidence was only 1.6%. There are only six cases reported in the literature during the last 25 years. The mechanism of renal involvement is probably multifactorial and includes both a direct viral cytopathic effect with other factors including hemolysis, hyperuricemia, and nephrotoxic drugs playing an important role. Interstital nephritis is the most common histologic abnormality. Chronic renal failure has been reported in only one case of infectious mononucleosis.

Adult↗
PubMed1976

Circulating immune complexes and complement sequence activation in infectious mononucleosis.

The role of immune complex formation was investigated in a patient with infectious mononucleosis complicated by an urticarial rash. Circulating cryoprotein immune complexes were identified during the urticarial phase of the illness, and disappeared during recovery. These complexes were composed of immunoglobulins G (IgG), M (IgM) and A (IgA), complement components C3, C4 and C5, Epstein-Barr (EB) virus capsid antibody and particles resembling EB virus. The IgG subtypes identified in the immune complexes were the complement fixing IgG-1, IgG-2 and IgG-3. The C3 activator of the properdin complex was detected in serum obtained during that acute phase but not after recovery. Thus, the transient appearance of circulating complement-fixing immune complexes was associated in this patient with activation of both classic and alternate complement pathways. The findings suggest that these complexes may be involved in the rash associated with infectious mononucleosis.

Adult↗
PubMed1996

[Lemierre's post-tonsillitis sepsis with meningitis and intravascular consumption coagulopathy as complication of infectious mononucleosis with pansinusitis].

HISTORY AND CLINICAL FINDINGS: 24 days after the onset of infectious mononucleosis, clinically and serologically confirmed, an otherwise healthy 18-year-old schoolboy developed a fulminant septicaemia with acute meningitis and loss of consciousness, consumptive coagulopathy and acute renal failure. INVESTIGATIONS: Computed tomography demonstrated pansinusitis. Lumbar puncture produced purulent cerebrospinal fluid with 11,500 cells/microliters, predominantly granulocytes, protein 205 mg/dl, glucose 19 mg/dl, indicating bacterial meningitis. The suspected diagnosis of posttonsillitis septicaemia (Lemierre's syndrome) was confirmed by repeated demonstration of fusiform gram-negative bacteria in anaerobic blood cultures, identified as Fusobacterium necrophorum. Anaerobic CSF culture grew Prevotella bivia of the Bacteroidaceae family. TREATMENT AND COURSE: Both the consumptive coagulopathy and the renal failure were successfully treated and the patient's condition stabilized. The sinuses were surgically drained under high doses of piperacillin/sulbactam and chloramphenicol. Despite the sensitivity of the cultured bacteria to the administered antibiotics the septic temperature continued, but disappeared within 4 days of metronidazole having been added. After 5 weeks of antibiotic treatment, three of them in an intensive care unit, the patient was discharged in good general condition. CONCLUSION: This case illustrates that severe septicaemia caused by rare bacteria may follow an attack of infectious mononucleosis which had taken an uncomplicated course.

Acute Kidney Injury↗
PubMed1980

Infectious mononucleosis complicated by severe Mycoplasma pneumoniae infection.

A 14-year-old girl with infectious mononucleosis and secondary immunosuppression had severe dyspnea and cough, spiking fever, rales, and diffuse bilateral pulmonary infiltrates. The pulmonary disease progressed rapidly, necessitating empiric trials of antimicrobial agents. Mycoplasma pneumoniae was isolated from a lung biopsy specimen, transtracheal aspirate, and expectorated sputum, but the relatively long period required to isolate the organism delayed the microbiologic diagnosis. Serologic study of acute and convalescent serum samples confirmed the M pneumoniae infection. Clinical improvement was gradual, and the immunosuppression was transient. The patient's illness appeared to represent microbial synergism, with severe M pneumoniae infection complicating transient immunosuppression induced by infectious mononucleosis.

Adolescent↗
PubMed1975

Thrombocytopenic purpura in infectious mononucleosis-- A rare complication?

We have presented an illustrative case of thrombocytopenic purpura complicating infectious mononucleosis. Steroid therapy appeared to be beneficial although spontaneous recovery cannot be excluded. The use of the Paul-Bunnell heterophil agglutination test is recommended for patients having idiopathic thrombocytopenic purpura to rule out subclinical infectious mononucleosis. It is suggested that this syndrome be treated with the expectancy of long-term remissions. Steroids appear to be of benefit. Platelet recovery is usually complete in less than 60 days. Splenectomy should not be considered until at least two months have passed. Chronic thrombocytopenia is an unlikely complication.

Adolescent↗
PubMedDate not supplied

Infectious mononucleosis fifty years after the discovery of the Paul-Bunnell test.

The Paul-Bunnell test, now 50 years old, is still of fundamental importance in the diagnosis of infectious mononucleosis, even though various immunologic methods have been developed in clinical practice to identify constituents of the Epstein-Barr virus (EBV). The demonstration of sheep red cell agglutinins in infectious mononucleosis (Paul-Bunnell) was in fact the first observation of the presence of heterophil antibodies in this viral disease which was later shown to evoke a polyclonal antibody response to a wide spectrum of autoantigens as well. The selective tropism of EBV for B lymphocytes and the reactivity of T lymphocytes to these infected B lymphocytes are the pathophysiological elements characteristic of infectious mononucleosis, and are the reason for this massive antibody response.

Antibodies, Heterophile↗
PubMed1983

The MLC response of patients with infectious mononucleosis to Epstein-Barr virus-transformed cells.

Lymphocytes of 6 patients with infectious mononucleosis were found to be capable of responding in mixed lymphocyte culture (MLC) to Epstein-Barr virus (EBV)--transformed lymphoblastoid cell lines and Raji cells, whereas their response to PWM-induced blasts and non-T cells was significantly depressed. This means that despite the suppression of cellular reactivity, observed in infectious mononucleosis, the specific response to EBV-infected cells remains unaffected.

Antigens, Viral↗
PubMed1990

Autoantibodies against triosephosphate isomerase. A possible clue to pathogenesis of hemolytic anemia in infectious mononucleosis.

In sera from patients with acute EBV, infection and the clinical symptoms of infectious mononucleosis antibodies of the Ig class M were found that are directed against two cellular proteins. The molecular mass of these proteins was determined to be 29 (p29) and 26 kD (p26), respectively, in SDS-PAGE. P29 was identified as part of the glycolytic enzyme triosephosphate isomerase (TPI) by comparison of the NH2-terminal amino acid sequences. A purified antibody against TPI induces a 51Cr release from human erythrocytes. Possibly, anti-TPI causes hemolysis, which is an infrequent but serious symptom of infectious mononucleosis.

Amino Acid Sequence↗
PubMed1981

Angioimmunoblastic lymphadenopathy after infectious mononucleosis.

Angioimmunoblastic lymphadenopathy occurred in a 46-year-old man 16 months after an episode of infectious mononucleosis induced by Epstein-Barr (EB) virus. The features of infectious mononucleosis included fever, pharyngitis, lymph gland enlargement, hepatosplenomegaly, hyperbasophilic mononuclear cells, and IgM antibodies to EB virus, although heterophile antibodies were not detected. The illness was severe and prolonged and included an asymptomatic measles virus infection. Over a year later massive enlargement of the lymph nodes led to a biopsy, which showed a diffuse infiltration with lymphoid cells and a proliferation of arborising small vessels typical of angioimmunoblastic lymphadenopathy. In spite of corticosteroids, levamisole, chlorambucil, and radiotherapy, no remission occurred, and serious infections led to death 18 months after the onset. Viral infections with EB virus and measles virus associated with pre-existing or subsequent immunological changes probably resulted in the appearance of angioimmunoblastic lymphadenopathy.

Humans↗
PubMed2004

Dexamethasone for the treatment of sore throat in children with suspected infectious mononucleosis: a randomized, double-blind, placebo-controlled, clinical trial.

OBJECTIVE: To evaluate the efficacy of a single oral dose of dexamethasone for pain relief in acute exudative pharyngitis associated with infectious mononucleosis. METHODS: We conducted a randomized, double-blind, placebo-controlled pediatric emergency department-based clinical trial. Patients aged between 8 and 18 years with a sore throat from clinically suspected infectious mononucleosis were eligible. Patients were randomized to receive either an oral dose of 0.3 mg/kg (maximum, 15 mg) of dexamethasone or a placebo. Patients completed a diary of symptoms and rated their pain on a visual analog scale from 0 to 100 mm at 0 hours, 12 hours, 24 hours, 48 hours, 72 hours, and on day 7. An improvement of 20 mm from baseline on the visual analog scale was evaluated as the primary end point. RESULTS: Twenty patients were recruited in each group; mean +/- SD age was 13.5 +/- 2.8 years. In comparison with the placebo group, a significantly greater proportion of patients given dexamethasone achieved pain relief within the first 12 hours (12/20 vs 5/19; P =.03). On further follow-up, the proportions achieving pain relief were similar between groups: 11 of 20 vs 6 of 20 at 24 hours (P =.10); 11 of 20 vs 11 of 20 at 48 hours (P>.99); 15 of 20 vs 15 of 19 at 72 hours (P =.93); and 18 of 19 vs 19 of 20 at day 7 (P>.99), with dexamethasone vs placebo, respectively. CONCLUSIONS: The short-lived relief of pain in acute exudative pharyngitis in children with suspected infectious mononucleosis may suggest that a single oral dose of dexamethasone may not be sufficient and that additional doses may be necessary for ensuring lasting relief.

Adolescent↗
PubMed1997

Recovery from infectious mononucleosis after altitude training in an elite middle distance runner.

OBJECTIVES: This investigation was designed to monitor altitude acclimatisation in an elite cohort of distance runners and follow the subsequent recovery from infectious mononucleosis which developed in one of these athletes. METHODS: Twenty six national standard distance runners performed treadmill tests 24 days before they travelled to an altitude camp (1500 to 2000 m). One of these athletes was diagnosed as suffering from infectious mononucleosis 14 days after return to sea level. A physician prescribed an individualised training programme which was designed to maximise recovery from the condition, which was monitored on days 16 and 147 after altitude training. RESULTS AND CONCLUSIONS: The data suggest that the athlete was in a state of over-reaching during the altitude sojourn. After return to sea level, the early stages of infectious mononucleosis resulted in a marked impairment in physiological response to endurance exercise, which improved over time. Longitudinal physiological monitoring in conjunction with a carefully prescribed training programme made recovery from this condition possible.

Altitude↗