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PubMed1979

Persistent falsely positive rapid tests for infectious mononucleosis. Report of five cases with four--six-year follow-up data.

In many laboratories, rapid slide tests incorporating differential absorption have replaced heterophil antibody tube tests in the investigation of suspect infectious mononucleosis. The present report describes serologic data from five individuals whose Monospot tests remained falsely positive for four years or more without other evidence of infectious mononucleosis or underlying disease states. Three of the five had never been infected with the Epstein-Barr virus. All five had negative results when studied with the ox cell hemolysin and the horse cell differential absorption tube tests. False-positive test results have also been encountered in healthy controls, as frequently as in patients with underlying disease states. The authors are unable to attach any clinical significance to the findings of an isolated falsely positive Monospot test even when it persists for many months or years.

Adolescent↗
PubMed2001

Predictions and associations of fatigue syndromes and mood disorders that occur after infectious mononucleosis.

BACKGROUND: Certain infections can trigger chronic fatigue syndromes (CFS) in a minority of people infected, but the reason is unknown. We describe some factors that predict or are associated with prolonged fatigue after infectious mononucleosis and contrast these factors with those that predicted mood disorders after the same infection. METHODS: We prospectively studied a cohort of 250 primary-care patients with infectious mononucleosis or ordinary upper-respiratory-tract infections until 6 months after clinical onset. We sought predictors of both acute and chronic fatigue syndromes and mood disorders from clinical, laboratory, and psychosocial measures. FINDINGS: An empirically defined fatigue syndrome 6 months after onset, which excluded comorbid psychiatric disorders, was most reliably predicted by a positive Monospot test at onset (odds ratio 2.1 [95% CI 1.4-3.3]) and lower physical fitness (0.35 [0.15-0.8]). Cervical lymphadenopathy and initial bed rest were associated with, or predicted, a fatigue syndrome up to 2 months after onset. By contrast, mood disorders were predicted by a premorbid psychiatric history (2.3 [1.4-3.9]), an emotional personality score (1.21 [1.11-1.35]), and social adversity (1.7 [1.0-2.9]). Definitions of CFS that included comorbid mood disorders were predicted by a mixture of those factors that predicted either the empirically defined fatigue syndrome or mood disorders. INTERPRETATION: The predictors of a prolonged fatigue syndrome after an infection differ with both definition and time, depending particularly on the presence or absence of comorbid mood disorders. The particular infection and its consequent immune reaction may have an early role, but physical deconditioning may also be important. By contrast, mood disorders are predicted by factors that predict mood disorders in general.

Chi-Square Distribution↗
PubMed1980

Lymphocyte reactivity in infectious mononucleosis.

Reactivity of lymphocytes to a purified preparation of Epstein-Barr virus (EBV) was studied in 17 healthy individuals and 15 patients with primary EVB infection and clinical signs of infectious mononucleosis. Lymphocyte reactivity to EBV was negative in individuals who were seronegative for antibody to EBV and in seven of 15 patients examined less than or equal to 21 days after onset of clinical signs of illness. Positive lymphocyte reactivity was observed in all patients by day 36; once it was established, it remained in individual patients for up to 480 days. During the acute phase of infectious mononucleosis, negative lymphocyte reactivity was always associated with a strong antibody response to EBV capsid antigens. This disparity was paralleled by the inability of lymphocytes to respond to recall antigens and mitogens, especially concanavalin A. Positive lymphocyte reactivity to EBV indicates a specific cellular memory function, probably of thymus-cell origin, which is acquired following primary EBV infection, and may be retained into later life.

Adolescent↗
PubMed1990

Making a rash diagnosis: amoxicillin therapy in infectious mononucleosis.

The ampicillin analog, amoxicillin, can potentially produce the same hypersensitivity reaction as the ampicillin. The case of a patient treated with amoxicillin for a sore throat, who later presented with a rash, is reviewed. Infectious mononucleosis was considered and then supported by a positive mono spot. It would appear therefore that amoxicillin can produce the same hypersensitivity reaction as ampicillin in the setting of acute infectious mononucleosis. The clinical decision to use antibiotics in acute pharyngitis is complicated by the identical presentation of both viral and bacterial illnesses. If empiric therapy is elected, the incidence of hypersensitivity reaction is less common with penicillin or tetracycline compared to ampicillin or its analog, amoxicillin.

Adult↗
PubMed2006

Simultaneous manifestation of fulminant infectious mononucleosis with haemophagocytic syndrome and B-cell lymphoma in X-linked lymphoproliferative disease.

X-linked lymphoproliferative disease is a rare T and NK cell immune deficiency which most frequently presents as fulminant infectious mononucleosis following infection with the Epstein-Barr virus (EBV). We report the case of a 4-year-old boy from a Spanish family presenting with severe infectious mononucleosis. In the course of the disease he developed hepatic failure, pancytopenia and neurologic impairment, leading to death after less than 2 months. The results of bone marrow biopsy and autopsy indicated a histological diagnosis of both high-grade B-cell lymphoma and virus-associated haemophagocytic syndrome, thereby confirming the simultaneous presence of two different manifestations of X-linked lymphoproliferative disease (XLP) in this patient. The family history revealed four close male relatives dying under similar circumstances, one of whom died following a vaccination against measles. Molecular genetic studies identified a novel mutation in the SH2D1A gene in several members of the family, establishing the diagnosis of XLP. Fatal EBV infection in male infants is highly indicative of XLP. Virus-associated haemophagocytic syndrome and B-cell lymphoma can occur concomitantly and may be difficult to distinguish due to their similar histological pictures.

Child, Preschool↗
PubMed1983

[Acute cerebellar ataxia associated with infectious mononucleosis--a case report and review of the literature].

A 20-year-old man, a college student, was admitted to Kochi Municipal Central Hospital with a month's history of slurring of speech and unsteadiness of gait. He had developed fever, sore throat and cervical lymphadenopathy. On admission, the throat was mildly injected, and enlarged lymph nodes were palpable in the lateral cervical regions. His speech was slightly slurred. Bilateral dysmetria, dyssynergia and intention tremor were noted in both extremities. The gait was grossly ataxic. Plantar responses were extensor. Examination of his peripheral blood revealed atypical lymphocytes, and the titer of Paul-Bunnell was 1:16. The CSF protein was 25 mg/dl with normal cell count. Epstein-Barr virus (EBV) antibody titers by indirect immunofluorescence in the serum of the second hospital day were as follows: VCA-IgG was 1:640, VCA-IgM less than 1:10, EBV-EA 1:160, and EBNA less than 1:10, while the CSF-EBV antibody titer was negative. Treatment with prednisolone was started and within 7 days he began to recover. Six weeks after admission he was completely free of neurological symptoms and signs. We also reviewed 18 cases of acute cerebellar ataxia with infectious mononucleosis in the literature. It was postulated that the neurological symptoms complicating infectious mononucleosis were possibly caused by infectious and immuno-allergic mechanisms.

Adult↗
PubMed1975

The relationship of autoantibodies to depression of cell-mediated immunity in infectious mononucleosis.

It has been postulated that autoantibody formation occurs as a consequence of a depression of function of certain thymus-derived lymphocytes (T cells). We have examined cell-mediated immunity, a T-cell function, in infectious mononucleosis, a condition in which autoantibodies are known to develop. We have shown some evidence of depressed cell-mediated immunity in patients with infectious mononucleosis but have been unable to correlate this with autoantibody production. These results do not support the hypothesis that depression of T-cell function leads to autoantibody formation.

Antibodies, Antinuclear↗
PubMed1980

Antitubulin antibody in healthy adults and patients with infectious mononucleosis and its relationship to smooth muscle antibody (SMA).

Antibody to tubulin in man has been studied using a specific radioimmunoassay, affinity chromatography radioimmunoassay but markedly increased levels were noted in patients with infectious mononucleosis where the antibody was predominantly IgM in type. This finding was confirmed on fluorescence microscopy. Affinity chromatography purified antibody produced characteristic microtubular staining of fixed 3T3 cells, but in addition, produced weak staining of cryostat sections of rat tissue, similar in distribution to that of smooth muscle antibody. Our studies indicate that the IgM smooth muscle antibody found in infectious mononucleosis by IF techniques is at least in part due to an antitubulin antibody.

Adolescent↗