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PubMed1966

Studies on infectious mononucleosis. II. Attempts at experimental transmission to monkeys.

Heparinized blood specimens obtained from two patients in the acute phase of infectious mononucleosis and from a healthy technician were injected intravenously into rhesus monkeys (Macaca mulatta) and the animals were observed for three weeks to one month for clinical, hematological and serological signs of infectious mononucleosis.Splenomegaly was the only definite clinical finding after 12 and 16 days, respectively. There were no definite hematological changes.At autopsy, hyperplasia of the germinal centres of lymphoid follicles, occasional foci of lymphocytic infiltration in the red pulp, and abnormal lymphoid cells in venules or arteries of the spleen were noted.The lesions in the spleen suggest that asymptomatic, presumably viral, infections occur in rhesus monkeys after inoculation with material from patients with infectious mononucleosis.

Adolescent↗
PubMed1982

Infectious mononucleosis encephalitis. Possible therapeutic response to vidarabine.

A comatose patient with seizures and focal neurological signs was given vidarabine because herpes simplex encephalitis was a likely diagnosis. Investigations showed that the illness was due to infectious mononucleosis. Although recovery is usual in infectious mononucleosis encephalitis, the complete clinical and neuropsychological recovery documented in this severe case raises the possibility that vidarabine may have exerted a therapeutic effect.

Adolescent↗
PubMed1975

Fatal infectious mononucleosis. Association with liver necrosis and herpes-like virus particles.

A 20-year-old woman died of infectious mononucleosis associated with extensive hepatic necrosis with herpes-type inclusions within nuclei of remaining liver cells. Electron microscopical examination of these liver cells showed intranuclear and occasional intracytoplasmic herpes-like virus. This case supports the concept that a herpes-like virus, or a structurally closely related agent, is the etiological agent of infectious mononucleosis.

Adult↗
PubMed1989

Infectious mononucleosis and mononucleosis-like illnesses in children and adults in Saudi Arabia.

The diagnosis of heterophil antibody positive, heterophil negative infectious mononucleosis and mononucleosis-like illnesses as made in 58 children and adult patients with clinical features suggestive of the mononucleosis syndrome and significant number of atypical lymphocytes. Epstein-Barr virus (EBV) specific serological tests revealed that six children and 23 adults had primary heterophil positive EBV infections based on the detection of IgM to EB-viral capsid antigens (IgM-VCA), presence of IgG to DB-early antigens (EA-D) and absence of antibodies to EB-nuclear antigen (EBNA). A further nine cases (five children, four in adults) of heterophil negative EBV infectious mononucleosis were likewise detected by EBV-specific serologic tests. Fourteen cases including one in children were due to active cytomegalovirus (CMV) infections as evident by positive CMV-IgM; they were all heterophil negative. Of the remaining heterophil negative cases, one was due to T. gondii with positive Toxo-IgM and five cases were of undetermined aetiology.

Adolescent↗
PubMed1978

Infectious mononucleosis and the Epstein-Barr virus.

Recent elucidation of the relationship between the Epstein-Barr virus and infectious mononucleosis has resulted in the development of new diagnostic serological tests, and has amplified our knowledge of the epidemiological and clinical aspects of the disease. The history, epidemiology, clinical characteristics, diagnostic features, and therapy of infectious mononucleosis are reviewed. This is done in the light of recent knowledge concerning the Epstein-Barr virus as well as previous studies employing the traditional diagnostic criteria of heterophil positivity, the classical clinical symdromes, and characteristic changes in the blood cell count. Immunological studies concerning host resistance and its occasional failure are reviewed with particular reference to T and B lymphocyte activity in the disease.

Age Factors↗
PubMed1987

Marked hyperbilirubinemia in infectious mononucleosis. Analysis of laboratory data in seven patients.

While mild to moderate hepatic dysfunction is commonly encountered in infectious mononucleosis induced by Epstein-Barr virus (EBV), clinical jaundice with high bilirubin levels (greater than or equal to 6.0 mg/dL [greater than or equal to 103 mumol/L] is only occasionally encountered. In this study, seven patients with primary EBV infections had peak bilirubin levels of 10.2 to 23.0 mg/dL (174 to 393 mumol/L) and, for the most part, presented initial diagnostic problems. Complications included the virus-associated hemophagocytic syndrome and acute respiratory distress syndrome in one patient and transient renal failure in another. The laboratory data suggested that a combination of hemolysis and viral-induced cholestasis was responsible for the intense hyperbilirubinemia in at least five patients. Physicians should be aware that marked hyperbilirubinemia can occur with EBV-induced infectious mononucleosis and, thereby, obviate the need for costly diagnostic laboratory tests and, occasionally, invasive procedures.

Adolescent↗
PubMed2000

Azithromycin eruption in infectious mononucleosis: a proposed mechanism of interaction.

The penicillin family of antibiotics may induce drug eruptions when prescribed to patients with infectious mononucleosis. Very similar phenomena have also been cited with other antibiotic families. We report the first case of a cutaneous reaction in a patient with infectious mononucleosis treated with azithromycin. We propose an immune-based hypothesis to explain the transient sensitivity resulting in this secondary cutaneous eruption.

Adult↗
PubMed2001

[Immunomodulatory treatment of lymphopenia after infectious mononucleosis].

Persistent lymphopenia of various intensity has been noted in 45% of persons who had a history of infectIous mononucleosis. The group consisted od 500 patients, (236 males and 264 females). In all of them the diagnosis of mononucleosis had been based on the characteristic clinical signs and symptoms and changes in the blood picture and confirmed by the non-specific and/or specific serologic tests. In 33 persons (10 males and 18 females) the total number of lymphocytes varied from 884 to 992 per 1 cmm, the distribution being as follows: B lymphocytes--146 to 198, CD4--482 to 645 and CD8--245 to 364 per 1 cmm. 18 persons (18 males and 10 females) were given thymosine (TFX) subcutaneously for 30 days in the dose of 0.02 g daily, the remaining 15 (7 males and 8 females) received 3.0 g of isoprinosine per day for the same period. The total lymphocytes count and that of B, CD4 and CD8 was performed before and after the treatment and then followed once a month until 180 days since the treatment had been started. The TFX therapy was repeated after 8-12 months since the end of the first course in 3 patients and that with isoprinosine in 4. The strategy and the examination pattern were the same as before, control examinations being performed every 6 months and final analysis was done after 5 years of follow-up. Among the 33 patients who received immunomodulating treatment, normalisation of the lymphocytes count appeared in 24 (64%). Among the 12 persons with less pronounced lymphopenia, who did not received any treatment, spontaneous normalisation appeared in 5 (40%). It may be therefore assumed, that in persons with the history of infectious mononucleosis with persistent marked lymphopenia, thymosine and isoprinosine may be used in the therapy as additional immunomodulators.

Acute Disease↗
PubMed1978

Atopic dermatitis, eczema herpeticum, infectious mononucleosis, and depressed cell-mediated immunity.

An immunologic investigation was undertaken in a patient with atopic dermatitis and infectious mononucleosis complicated by eczema herpeticum. Humoral immunity was normal. The cell-mediated immune (CMI) response was temporarily depressed during the acute phase of the illness as measured by in vivo skin tests, and in vitro tests using T-lymphocyte population, macrophage inhibition factor, and lymphocyte transformation. It is postulated that the depression of CMI caused by infectious mononucleosis precipitated the development of eczema herpeticum in this patient.

Adult↗
PubMed1998

Comparison of lymphocyte subpopulations in the peripheral blood of patients with infectious mononucleosis and human immunodeficiency virus infection: a preliminary report.

The aim of this study was to analyse the lymphocyte subpopulations in the peripheral blood of HIV-1-infected adults to compare them with four patients with acute EBV infection. Lymphocyte subsets in 15 healthy controls, 40 HIV-1-infected adults and 4 EBV-infected patients with infectious mononucleosis were analysed by flow cytometry. The immunophenotyping of HIV-1-infected patients in different stages of disease showed a significant reduction in the percentage and absolute count of CD4+ T-lymphocytes, significantly increased percentage of CD8+ T-lymphocytes, inverted CD4/CD8 ratio and an increase in the expression of activation marker HLA-DR compared to controls. The immuno-phenotyping profiles of HIV and EBV infection share some similarities as they both result in the decreased percentage of CD4+ T-lymphocytes, increased CD8+ T-lymphocytes and an inverted CD4/CD8 ratio. Patients with HIV infection could be distinguished from patients with EBV infection by the absolute lymphocytosis and increased expression of HLA-DR seen in the patients with infectious mononucleosis. In conclusion, both HIV-1 and EBV profoundly change the distribution of lymphocyte subpopulations in the peripheral blood. It is our opinion that flow cytometry could be an aid in the rapid distinguishing of patients with suspected primary HIV-1 infection from those with infectious mononucleosis (before serology data are available).

Acute Disease↗
PubMed1982

Urinary excretion of albumin and beta-2-microglobulin, glomerular filtration rate and immune complexes in serum during infectious mononucleosis.

Immune complexes in serum, urinary excretion of albumin and beta-2-microglobulin were determined in patients with infectious mononucleosis, both during the acute stage of the disease and one month later. At the first examination immune complexes were detected in 8 out of 12 patients, using both the ClqBA and the PP-Lc methods, but had disappeared in all after one month. Urinary excretion was initially increased for albumin in one of 9 and for beta-2-microglobulin in 5 of 9 patients. A significant fall in excretion was noted for beta-2-microglobulin during the acute phase (0.486 to 0.190 ng/min (medians), p less than 0.01) whereas albumin excretion did not change significantly (9.0 to 4.0 micrograms/min). Excretions were normal in all patients after one month. The magnitude of proteinuria was not correlated to the serum level of immune complexes. Serum beta-2-microglobulin was initially increased in 8 of 9 patients, but normal after one month (3.8 to 2.2 mg/l, p less than 0.01). There was a significant correlation between levels of beta-2-microglobulin in serum and urine (rho = 0.833, n = 9, p less than 0.01). 51Cr-EDTA clearance was the same during the acute illness and one month later. It is concluded that the abnormalities in urinary protein excretion do not seem to be related to the presence of circulating immune complexes in infectious mononucleosis and that the elevated urinary beta-2-microglobulin excretion is most likely due to increase production.

Acute Disease↗
PubMed1992

[Fatal course of acute appendicitis associated with infectious mononucleosis].

The case history is presented of a 10-year-old boy with a fatal combination of acute appendicitis and infectious mononucleosis, in the literature a particularly rare combination. The boy died of a perforative peritonitis. His appendicitis appeared not to be a complication of the infectious mononucleosis.

Acute Disease↗
PubMed1998

Infectious mononucleosis and bilateral peritonsillar abscesses resulting in airway obstruction.

Upper airway obstruction is an uncommon but recognized complication of infectious mononucleosis. The management depends upon the degree of airway compromise. In the case described, severe airway obstruction was treated by securing the airway with awake fibre-optic endoscopic intubation and then proceeding to tonsillectomy. Bilateral inferiorly loculated quinsies were encountered unexpectedly and drained. This is the first report of 'bilateral' quinsies, associated with infectious mononucleosis and severe airway obstruction. The association, pathogenesis and significance of this finding are also discussed.

Acute Disease↗
PubMed1971

Infectious mononucleosis and its relationship to EB virus antibody. A joint investigation by university health physicians and P.H.L.S. laboratories.

In October 1969 tests made on 1,457 students entering English universities and colleges showed that 57% already possessed antibody to EB virus. The students without antibody in these initial tests were retested seven months later and by then 12% had acquired antibody. In about one-third of them the acquisition of antibody was not associated with any illness. In about 20% respiratory and other illness had occurred, but these symptoms were almost equally frequent in students who had not acquired antibody. Nearly half had developed infectious mononucleosis. In students in whom the acquisition of EB virus antibody was associated with the clinical and haematological manifestations of infectious mononucleosis the Paul-Bunnell test was almost invariably positive. In contrast, when these manifestations were not associated with the acquisition of EB virus antibody the Paul-Bunnell test was always negative.Tests for cytomegalovirus antibody were also made on the students at entry. The proportion of students with this antibody was much less (30%) and only a small proportion (1.4%) of those without antibody had acquired cytomegalovirus antibody seven months later. In the only patient in whom the acquisition of cytomegalovirus antibody alone was associated with the clinical and haematological features of infectious mononucleosis the Paul-Bunnell test was negative.

Adolescent↗
PubMed1987

Postanginal sepsis following infectious mononucleosis.

During a five-year period, three patients were seen with postanginal sepsis occurring within ten days of the onset of infectious mononucleosis. Postanginal sepsis was not diagnosed in other hospitalized patients during this period. These cases demonstrate that postanginal sepsis can be a complication of infectious mononucleosis.

Adolescent↗
PubMed1978

Sub-acute thyroiditis and hepatitis in a case of infectious mononucleosis.

A viral aetiology for sub-acute (de Quervain's) thyroiditis has long been postulated although proof has been elusive. Infectious mononucleosis has been associated with sub-acute thyroiditis in only two papers, and histological evidence of sub-acute thyroiditis was lacking in both. A case of sub-acute thyroiditis, confirmed by histology, occurring in a patient with infectious mononucleosis is now reported.

Adult↗
PubMed1988

[Effect of i.v. gamma-globulin on T lymphocytes and on interleukin-2 secretion in infectious mononucleosis].

Biological and clinical effects of i.v. administration of gamma-globulin (0.9-1.5 g/kg) to 9 patients with infectious mononucleosis have been compared with the effects observed in 4 untreated patients. An increase of OKT4/OKT8 ratio has been measured in treated cases whereas this ratio remains low in untreated patients. Interleukin-2 secretion by stimulated lymphocytes increases also in treated patients but not in untreated ones. On the other hand gamma-globulin inhibits in vitro the cytotoxic activity of lymphocytes from immune subjects. Clinically gamma-globulin i.v. had a beneficial effect on the course of the disease and on adenopathies. As infectious mononucleosis has usually a favourable outcome, this treatment should be restrained to severe or chronic cases.

Adolescent↗