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PubMed1976

Clinical and laboratory evaluation of elderly patients with heterophil-antibody positive infectious mononucleosis. Report of seven patients, ages 40 to 78.

Clinical, hematologic, biochemical and serologic data are recorded in seven patients aged 40 to 78 years with heterophil-antibody positive infectious mononucleosis (HA+IM). Clinical observations included fever of 22 to 30 days' duration (five of seven patients), sore throat (six of seven patients), myalgia (five of seven patients) and prominent lymph adenopathy (two of seven patients). Initial blood smears revealed significant numbers of atypical lymphocytes in only five of seven patients; however, or serial testing, in the remaining two patients Downey cells developed to a degree seen in most young adult patients with infectious mononucleosis. Comparison of liver function data from these and younger patients suggests that abnormalities tend to be more marked in those in the older than in those in the younger age range. Serologic tests confirmed primary Epstein-Barr virus (EBV) infections in all seven patients based on detection of IgM antibodies to EB viral capsid antigen in specimens obtained early, but not late, in the course of the infection, transitory antibody responses to the D (diffuse) component of the EMB-induced early antigen complex, and the initial absence and later development of antibodies to the EBV-associated nuclear antigen. Thus, the serologic data did not differ from those seen in younger patients. These results show that infectious mononucleosis should be included in the differential diagnosis of fever, sore throat and myalgia with or without significant cervical adenopathy in elderly persons.

Adolescent↗

PubMed1978

[BCG vaccination, cancer and infectious mononucleosis. A retrospective study of hospitalized patients].

A retrospective study (1966--1976) of patients hospitalized for cancer was carried out to determine a possible relationship with BCG vaccination, with a control group matched for age and sex and a similar study concerning infectious mononucleosis. Among 105 patients with cancer, 54 (51.42%) had been previously vaccinated with BCG, 56 (53.33%) in the control group, and 22 (33.84%) among the 65 patients with infectious mononucleosis (p less than 0.05, x2). The mean age on admission for cancer or infectious mononucleosis among vaccinees is significantly older than among non-vaccinees, suggesting a transient protection afforded by vaccination. These results need to be confirmed by a prospective study with Epstein-Barr virus serology.

Age Factors↗

PubMed1977

Infectious mononucleosis and fatal myocarditis.

Mycocarditis is an uncommon manifestation and, very rarely, a lethal complication of infectious mononucleosis. A 14-year-old girl initially had exudative pharyngitis and splenomegaly and developed refractory ventricular fibrillation. The diagnosis of infectious mononucleosis was confirmed by both a strongly positive heterophil antibody test and a high titer of Epstein-Barr virus. Pathologic studies demonstrated extensive histiocytic and lypmhocytic infiltration of the myocardium.

Adolescent↗

PubMed1983

Immunochemical studies of infectious mononucleosis--XI. comparison of heterophile antibody inhibitors from the erythrocyte membranes of four mammalian species.

Immunochemical comparisons were made of the reactivity of membrane glycoproteins from horse, bovine, sheep and goat erythrocytes with heterophile antibodies of infectious mononucleosis. The four receptors were tested as competitive inhibitors of a sandwich-type solid-phase radioimmunoassay and of agglutination of glycoprotein-latex reagents by infectious mononucleosis serum. The results of this study showed that the bovine glycoprotein had a superior reactivity with this heterophile antibody system and sheep erythrocyte glycoprotein was the least reactive. The latter had negligible ability to displace 125I-bovine glycoprotein and was a very poor inhibitor of the agglutination of a bovine glycoprotein-latex reagent by infectious mononucleosis serum. Horse and goat glycoproteins were more efficient inhibitors than sheep glycoprotein but less active than the preparation from bovine red cells. All of the inhibitory activity of sheep, horse and goat glycoproteins, and a major portion of that of the bovine glycoprotein was destroyed by neuraminidase treatment. We have termed this receptor--shared by all four species--the Paul-Bunnell receptor, since by definition Paul-Bunnell antibody is a sheep erythrocyte agglutinin which is also reactive with horse, bovine and goat erythrocytes. The neuraminidase (and alkaline borohydride) resistant receptor of bovine glycoprotein has been designated the Bo receptor because it is not common to the other three species.

Agglutination Tests↗

PubMed1991

Intravenous gammaglobulin treatment for immune thrombocytopenia associated with infectious mononucleosis.

Severe thrombocytopenia is an uncommon (incidence less than 1%) but serious complication of infectious mononucleosis. Corticosteroids have been used for therapy with variable responses reported. Five consecutive patients with infectious mononucleosis-related severe thrombocytopenia were treated with intravenous gammaglobulin (IVIG) at a dose of 400 mg/kg/day for 2-5 days. All patients appear to have had an immunologic or consumptive etiology for their thrombocytopenia as determined by increased marrow megakaryocytes. All patients were initially treated with oral prednisone 1 mg/kg/day. Due to the relatively slow response to prednisone (platelet count less than 20,000/microliters on the 8th to 13th hospital day) or increased bleeding symptoms, IVIG was initiated. Four of the five patients rapidly developed significant increases in their platelet counts (range 44,000/microliters to 97,000/microliters). Two of these responses were sustained and two relapses occurred (while on continued steroid therapy) which again responded to booster doses of IVIG at similar doses. IVIG has been previously shown to be effective in treating patients with idiopathic thrombocytopenia purpura. Historically, patients with infectious mononucleosis-related severe thrombocytopenia often are refractory to corticosteroid therapy and our limited experience suggests that IVIG may also be effective in infectious mononucleosis-related severe thrombocytopenia.

Adolescent↗

PubMed1997

The 30-bp deletion variant of Epstein-Barr virus-encoded latent membrane protein-1 prevails in acute infectious mononucleosis.

To assess the frequency of malignancy-associated 30-bp deletion variants of the latent membrane protein 1 (LMP-1) in benign conditions, a comparative sequence analysis was done using samples from 20 American children with acute infectious mononucleosis and 16 Swiss children with chronic tonsillar hyperplasia. The 30-bp deletion variant (LMP-1-del) was present in 66% of patients (12/20 with infectious mononucleosis and 12/16 with tonsillar hyperplasia). Two additional patients had a 3-bp deletion and an inframe insertion of 18 nucleotides, respectively. All but 1 isolate had numerous nonsilent point mutations. These data identify a hypervariable region within the C-terminus of LMP-1, in a domain required for maximal stimulation of NF-kappaB activity. These data demonstrate that LMP-1-del variants are frequent in acute infectious mononucleosis and tonsillar hyperplasia and identical to those observed in Epstein-Barr virus-associated AIDS-related lymphoma.

Acute Disease↗

PubMedDate not supplied

CT diagnosis of a clinically unsuspected acute appendicitis complicating infectious mononucleosis.

Acute appendicitis is a rare complication of infectious mononucleosis (IM). We describe a patient with IM and splenic rupture with a computerized tomography (CT) diagnosis of acute appendicitis during the acute phase of the infectious disease. Diagnostic imaging features of acute appendicitis were found on an abdominal CT performed for the evaluation of postoperative fever. Histologic examination confirmed the CT diagnosis of the clinically unsuspected acute appendicitis. Our case is unique both for the rarity of this complication and the lack of clinical symptoms.

Acute Disease↗

PubMed1981

Beta 2-microglobulin serum levels in infectious mononucleosis in childhood.

A material of fifteen children aged 10 months to 15 years with infectious mononucleosis (IM) was investigated. The diagnosis was established by demonstration of Epstein-Barr virus (EBV) specific IgM antibodies. The serum concentrations of beta 2-microglobulin (beta 2-m) were significantly increased (p less than 0.01) in the first sample after onset of disease, compared to control groups of children with other infectious diseases and children without diseases. The serum concentration of beta 2-m decreased towards normal range within 3 weeks- 3 months. During the same period, IgM antibodies of EBV decreased to unmeasurable levels, and the IgG titers were almost constant. Serum beta -2m may be a parameter of value in the diagnosis of infectious mononucleosis in childhood, replacing tests for heterophile antibodies (Emni test and Paul-Bunnell test) which are often negative in children suffering from a primary EBV infection, or it may be used for assessment of disease activity.

Adolescent↗

PubMed1993

[Dynamics of the Paul Bunnel-Davidsohn test during infectious mononucleosis].

The study was aimed at establishment whether dependence exists between severity of clinical course of infectious mononucleosis and the level of heterophilic antibodies in the PBD test. Antibody titers were measured three times during illness in 34 persons with infectious mononucleosis, divided into two groups: I--patients with moderate course of the disease and II--patients with moderate-severe course. In five persons out of 34 tested negative PBD test result was obtained, although these patients exhibited symptoms on mononucleosis confirmed by other laboratory methods. Positive result of the PBD test was occurring more frequently and mean titer of heterophilic antibodies was higher in patients with moderate clinical course than in persons with moderate-serious course of the disease. Decrease of PBD test titer was observed between first and third determination in both groups of patients.

Adolescent↗

PubMed1982

Periodic EEG complexes in infectious mononucleosis encephalitis.

The presence of periodic EEG complexes in patients with an acute viral encephalitis is generally held to suggest that infection is due to herpes simplex. We now report a patient with clinical and laboratory findings of infectious mononucleosis, and neurologic involvement manifested by lymphocyte meningitis, coma, seizures, aphasia, hemiparesis and hemianopsia. Serial EEGs showed periodic, predominantly left-sided slow wave complexes occurring every 4 to 5 seconds, which disappeared with clinical resolution of the illness. In view of our findings and the similar findings reported previously by others in another case of infectious mononucleosis encephalitis, an EEG showing periodic complexes in the clinical setting of acute viral encephalitis should not be considered pathognomonic of herpes encephalitis, and infectious mononucleosis should be included in the differential diagnosis.

Adolescent↗

PubMed2003

Down-regulation of pan-T-cell antigens, particularly CD7, in acute infectious mononucleosis.

Multiparameter flow cytometric analysis was performed on the peripheral blood samples from 25 patients with acute infectious mononucleosis. Phenotypic results were matched with those for patients without viral symptomatology. Samples from all patients with infectious mononucleosis exhibited an activated (HLA-DR+, CD38+) CD8+ cytotoxic-suppressor T-cell population with aberrant down-regulation of CD7, and samples from 2 (8%) of 25 patients also showed down-regulation of CD5. The CD8+ cells also were slightly larger than normal T cells by forward scatter characteristics. None of the control samples showed down-regulation of either antigen. Aberrant pan-T-cell antigenic expression is a criterion in the immunophenotypic diagnosis of T-cell lymphoproliferative disorders. Acute Epstein-Barr virus infection should be considered in the differential diagnosis when down-regulation of CD7 is present, especially in conjunction with an activated CD8+ T-cell population.

Acute Disease↗

PubMed1991

[Serologic diagnosis of infectious mononucleosis in children].

In 116 children admitted to hospital with tonsillitis of varying types and suspected infectious mononucleosis resp., antibodies, of the IgM class against the EB virus VCA were detected in 27%, a quadruple increase of IgG antibodies in 20% and a negative finding of IgG antibodies also in a second serum sample in 24%. In another group of 51 children admitted with suspected infectious mononucleosis IgM antibodies were found in 47%, a fourfold increase of IgG in 53% and a negative finding of IgG in 10%. In sub-groups of 25 and 30 children resp. from the above groups it was possible to compare the results of specific serology of the EB virus with tests for heterophil antibodies in two serum samples. IgM antibodies were detected in 40% and 50% of children resp., a fourfold rise of IgG in 20% and 67% of children resp., the absence of IgG in 20% and 7% of children resp. Paul-Bunnell reaction was positive in 64% and 60% resp., the OCH-test in 60% and 70% resp., Tomcsik reaction in 16% in the first sub-group and the IM-test in 60% in the second sub-group. In younger children (1-5 years) positive Paul-Bunnell and Tomcsik reactions were less frequent. The IM-test was not positive in any of the children in this age group. An EB-virus aetiology was proved in all types of tonsillitis, least frequently in angina streptococcia (11%), most frequently in angina pseudomembranosa (46%) and mononucleosis infectiosa susp. (54%).

Adolescent↗

PubMed1991

Infectious mononucleosis. Diagnosis by in situ hybridization in two cases with atypical features.

Two cases of infectious mononucleosis are reported in which in situ hybridization studies were of use to distinguish this disorder from non-Hodgkin's lymphoma. One patient was an 80-year-old man with a tonsillar mass that histologically resembled non-Hodgkin's lymphoma and, on fixed tissue immunohistochemistry, appeared to contain a population of cells anomalously coexpressing the B-cell marker L26 and the T-cell marker Leu-22, suggesting diffuse large-cell non-Hodgkin's lymphoma. The second patient was a 43-year-old woman with inguinal lymphadenopathy that, on histologic examination, also mimicked diffuse large-cell lymphoma. In situ hybridization studies for Epstein-Barr virus revealed both cases to possess EBV DNA in a pattern characteristic of infectious mononucleosis. In addition, in situ hybridization studies for immunoglobulin light-chain mRNA demonstrated a polyclonal pattern of kappa and lambda mRNA expression. This report demonstrates the utility of the in situ hybridization technique as an adjunct to routine diagnosis.

Aged↗

PubMed1978

Fatal aplastic anaemia complicating infectious mononucleosis.

A 7-year-old boy developed fatal aplastic anaemia, 2 weeks after the first signs of infectious mononucleosis. Although some drugs were administered, infection with the Epstein-Barr virus, leading to infectious mononucleosis, is assumed to be the cause of this aplastic anaemia. Some mechanisms possibly leading to the aplasia are discussed.

Adrenal Cortex Hormones↗

PubMed1973

Infectious mononucleosis complicated by acute haemolytic anaemia with a positive Donath-Landsteiner reaction.

A patient with infectious mononucleosis complicated by acute haemolytic anaemia is described. The patient had, in addition to non-specific cold agglutinins in the serum, a positive Donath-Landsteiner reaction in the absence of syphilis. The association of a positive Donath-Landsteiner reaction with haemolytic anaemia in infectious mononucleosis has been described only once before.

Adolescent↗

PubMed1981

Unusual case of progressive systemic sclerosis with onset in early childhood and following infectious mononucleosis.

A rare case of infantile progressive systemic sclerosis is reported. A Japanese girl suffered from infectious mononucleosis at the age of 1 year 3 months, and 5 months later she developed edema and sclerosis of the skin. She has been followed up for 4 years and now has grotesque features, with contractures of hands and feet due to advanced systemic sclerosis. The relationship between infectious mononucleosis and progressive systemic sclerosis is discussed.

Alopecia↗

PubMed1985

A 16-month-old boy with infectious mononucleosis, parotitis and Bell's palsy.

The case of a 16-month-old boy with infectious mononucleosis who developed bilateral parotitis and unilateral Bell's palsy is presented. The diagnosis was confirmed by the development of specific antibodies for various Epstein-Barr virus antigens typical of primary Epstein-Barr virus infection. Serological tests for other viruses were negative. The Bell's palsy subsided within three months, while the clinical signs of infectious mononucleosis and parotitis persisted for three weeks.

Antibodies, Viral↗

PubMed1980

Pseudohyperkalaemia and infectious mononucleosis.

Pseudohyperkalaemia is described from a patient with infectious mononucleosis. The in vitro release of potassium was associated with clotting and all the blood cells may have been involved.

Adolescent↗