[Infectious mononucleosis].
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Communicable Diseases↗
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Interleukin-2 receptors in infectious mononucleosis.
The majority of peripheral blood mononuclear cells (PBMC) from acute-phase infectious mononucleosis (IM) patients express high levels of T10 (CD38) and HLA-DR surface antigens, which are markers characteristic of activated T cells. However, Tac antigen (p55) expression on these cells was not detectable by flow cytometric immunofluorescence, and only a low level of specific interleukin-2 (IL-2) binding was found by Scatchard analysis. These results suggest that IL-2 receptors (IL-2R) are lost or down-regulated on activated T cells in acute IM. Since a large proportion of T cells die during the first 24 h of in vitro culture in the absence of exogenous IL-2, the data implicate a physiological role for the observed low levels of IL-2R on T cells.
Humans↗
Human and viral interleukin-10 in acute Epstein-Barr virus-induced infectious mononucleosis.
Human interleukin 10 (hIL-10), a product of monocytes, T cells, and B cells, shares extensive structural and functional similarity with viral IL-10 (vIL-10), a product of Epstein-Barr virus (EBV) replication. With two ELISAs, one that recognizes both hIL-10 and vIL-10 and the other specific for vIL-10, IL-10 was measured in serum or plasma and in saliva from 50 patients with acute EBV-induced infectious mononucleosis and from 19 normal subjects. In serum or plasma, 60% of the patients had measurable hIL-10 and/or vIL-10 and 18% had measurable vIL-10. In saliva, 20% of the patients had detectable hIL-10 and/or vIL-10 and none had detectable vIL-10. In contrast, hIL-10 and/or vIL-10 was undetectable in all 19 normal serum or plasma samples (P < .001 vs. patient samples). Among normal saliva samples, 21% had detectable hIL-10 and/or vIL-10 but none had detectable vIL-10. Thus, most patients with acute EBV-induced infectious mononucleosis transiently have abnormally high levels of circulating IL-10.
Acute Disease↗
Agranulocytosis following infectious mononucleosis.
A girl developed acute agranulocytosis (45/mm3), 37 days after the onset of infectious mononucleosis. The bone marrow showed myeloid hyperplasia with maturation arrest and erythroid hypoplasia. A normal amount of colony forming units of granulocytes and macrophages (CFU-GM) colonies with a relative high number of clusters was observed. Neither anti-neutrophil antibodies nor circulating inhibitors of colony growth were found in serum. Granulocyte and macrophage colony stimulating factor (GM-CSF) activity in the patient's serum rose at this time. The agranulocytosis lasted 5 days and her clinical state soon improved. These results suggested that agranulocytosis was presumably not due to serum factors, including auto-antibodies and/or suppressive substances, and that Epstein-Barr virus (EBV) had some direct or indirect effect on the marrow cells of the myeloid series.
Agranulocytosis↗
The management of severe infectious mononucleosis tonsillitis and upper airway obstruction.
Acute tonsillectomy has been advocated for severe infectious mononucleosis (IM) pharyngotonsillitis with upper airway obstruction (UAO) and not responding to corticosteroids. This paper reviews and rationalizes our management. A five-year chart review was carried out with a follow-up telephone survey. There were 36 admissions. Nine had UAO of whom 89 per cent (eight of nine patients) had a tonsillectomy. The diagnosis of UAO was not standardized. Twenty-seven patients did not have UAO and only a small proportion of these patients, 16 per cent (four of 25) went on to have an elective tonsillectomy. Corticosteroids made no significant difference to the tonsillectomy rate. UAO appears to identify patients with more severe disease who are likely to suffer recurrent tonsillitis. Acute tonsillectomy is an appropriate treatment option for this subgroup. The diagnosis of significant IM UAO is not defined and a schema is proposed. Recurrent tonsillitis is an uncommon sequela of severe IM pharyngotonsillitis without UAO.
Adolescent↗
Clinical and laboratory presentation of EBV positive infectious mononucleosis in young adults.
Clinical descriptions of Epstein-Barr virus (EBV) positive infectious mononucleosis (IM) are rare and their results are inconsistent. Over a 4-year period, we prospectively studied 590 young adults with clinically suspected IM, all of whom were tested for the presence of EBV IgM antibodies. We investigated the demographical, clinical and laboratory features of subjects with positive EBV IgM serology and heterophile antibodies. Contrary to previous studies, we found a seasonal disease pattern with a peak incidence during summer months, and a lower-than-expected prevalence of lymphadenopathy (88.9%), leucocytosis (46.2%), atypical lymphocytosis (89.2%) and elevated liver enzymes (57.9%). The prevalence of hyperbilirubinemia was relatively high (14.9%). The classic triad of fever, sore throat and lymph-adenopathy had relatively low sensitivity (68.2%) and specificity (41.9%) for EBV infection. Our study provides a complete and updated description of the clinical and laboratory presentation of laboratory confirmed IM, which is important for both clinicians and epidemiologists.
Adolescent↗
Atypical lymphocytosis resembling non-Hodgkin's lymphoma in peritoneal effusion of infectious mononucleosis: a case report.
Peritoneal effusion appears to be an unusual complication of infectious mononucleosis (IM). The cytological features of peritoneal effusion from a patient affected by IM are presented. The patient was a 21-year-old Japanese woman, with typical and physical findings of IM. Ascites disappeared with resolution of acute IM. The cytospin smears of the ascitic fluid were highly cellular, consisting exclusively of lymphoid cells. Lymphoid cells were composed of large cells with broad basophilic cytoplasm, as well as of small to medium-sized cells having scant cytoplasm and irregularly shaped nuclei. The overall cytomorphological pictures posed serious difficulties in differentiating this condition from those of peripheral T-cell lymphomas manifesting ascites. The majority of atypical lymphocytes, including large cells, expressed CD3 and CD8. The present case indicates that IM should be added to the list of lesions considered for the differential diagnosis of non-Hodgkin's lymphoma of the peritoneal fluid, particularly regarding young adults.
Adult↗
Isolation and partial characterization of the heterophile antigen of infectious mononucleosis from bovine erythrocytes.
The heterophile antigen (Paul-Bunnell antigen, PBA) of infectious mononucleosis was isolated by extraction of an aqueous suspension of bovine erythrocyte stromata with chloroform-methanol (2:1). The upper aqueous layer contained gangliosides, PBA, and a high-molecular-weight glycoprotein. PBA and gangliosides were separated from the high-molecular-weight glycoprotein by extraction of lyophilized upper layer with chloroform-methanol solvents. Separation of PBA from gangliosides was carried out by chromatography on DEAE-cellulose with chloroform-methanol solvents. PBA appeared to be a minor glycoprotein component of the erythrocyte membrane and had both hydrophobic and hydrophilic properties. It was soluble in either organic or aqueous solvents. On SDS-polyacrylamide gel electrophoresis, it migrated as a single component that stained for protein with Coomassie blue, for carbohydrate with periodic acid-Schiff reagent, and for lipid with oil red 0; it had an apparent molecular weight of 26,000. It was composed of 62% protein with major amino acids; glutamic acid, proline, glycine, isoleucine, leucine, and threonine (158, 116, 98, 90, 85, and 82 residues per 1,000 residues, respectively). Carbohydrate content was 9.2% with major sugar constituents: sialic acid, galactosamine, and galactose. Serologic activity of PBA was destroyed by pronase but not by trypsin.
Amino Acids↗
Limitations of available tests for diagnosis of infectious mononucleosis.
Among 500 students seen at a university health service for illnesses resembling infectious mononucleosis (IM), the diagnosis of IM was established in 124 (25%) on the basis of the initial presence or subsequent emergence of the spectrum of Epstein-Barr virus (EBV) antibodies characteristic of a primary EBV infection. Of these 124 patients, 113 had an EBV-specific antibody pattern in the initial serum indicative of current primary infection; however, 11 (9%) had no detectable immunoglobulin G antibodies to EBV-specific antigens in their first serum. The sensitivity of this panel of EBV antibody assays was 91% and the specificity was 100%. Initial sera had detectable heterophil antibodies for 107 (86%) of the 124 students with IM and for 2 with other illnesses. Among our patients, the Monospot (Ortho Diagnostics Inc.) test had a sensitivity of 86% and a specificity of 99%. Reliance on hematological criteria (lymphocyte count greater than or equal to 50% and atypical lymphocyte count greater than or equal to 10%) gave a sensitivity of only 39%, but a specificity of 99%. Students with IM who showed a delayed emergence of the spectrum of EBV-specific antibodies characteristic of an acute infection were compared with control patients who had such antibodies at the time of their initial visit to the health service. They were found to have a briefer duration of illness (P greater than 0.05), lower leukocyte (P less than 0.005), lymphocyte (P less than 0.005), and atypical lymphocyte (P less than 0.05) counts, and a less frequent occurrence of heterophil antibodies (P less than 0.05).
Antibodies, Viral↗
Epstein-Barr virus (EBV) in infectious mononucleosis: detection of the virus in tonsillar B lymphocytes but not in desquamated oropharyngeal epithelial cells.
AIMS: Despite its well established tropism for B cells, the nature of the cellular compartment(s) mediating primary and persistent Epstein-Barr virus (EBV) infection is still a matter of controversy. In view of the association of EBV with several lymphoid and epithelial malignancies, resolution of this issue is important. METHODS: Desquamated oropharyngeal epithelial cells from 10 patients with acute infectious mononucleosis and from seven chronic virus carriers were studied for evidence of EBV infection using in situ hybridisation for the detection of the small EBV encoded RNAs (EBERs) and of the viral genome. In addition, immunocytochemistry was used to detect the BZLF1 transactivator protein of EBV. RESULTS: There was no evidence of latent or replicative EBV infection in oropharyngeal epithelial cells in any of the samples. In contrast, EBV infected B cells were readily identified in a tonsil from a patient with infectious mononucleosis. CONCLUSIONS: The results suggest that oropharyngeal epithelial cells are not a major site of EBV infection and provide further support for the notion that B cells mediate primary and persistent EBV infection.
B-Lymphocytes↗
Immunocytochemical localization of lysozyme and lactoferrin attached to surface bacteria of the palatine tonsils during infectious mononucleosis.
Bacterial samples were obtained from the tonsillar surfaces of seven patients (four males, three females; median age 18 years, range 15 to 21 years) suffering from acute infectious mononucleosis with concomitant pharyngotonsillitis, and from five healthy controls. By using gold-labelled antiserum to human lysozyme and lactoferrin, micro-organisms on the tonsillar surfaces coated with these antibacterial substances could be identified by tracing the gold particles in the transmission electron microscope. In healthy individuals, most of the bacteria were coated with lysozyme and significantly more bacteria were coated with lysozyme than with lactoferrin (p < 0.01). In patients there was a non-significant reduction in lysozyme-coating of the bacteria, whereas lactoferrin-coating was significantly increased (p < 0.01). Changes in the lysozyme and/or lactoferrin coating of the tonsillar surface bacteria on the palatine tonsils during infectious mononucleosis cannot explain the tendency to immense local bacterial colonization with commensals and proneness to bacterial penetration into the epithelial cells.
Adolescent↗
[Antibodies to cytoskeletal systems in patients with adult T-cell leukemia and infectious mononucleosis].
Serum antibodies to cytoskeletal systems were measured by indirect immunofluorescence using human skin fibroblasts and HEp2 cells as substrate. Healthy adults had IgM antibodies to vimentin and cytokeratin at 60 times serum dilution. IgG concentration did not have a correlation with IgG anti-cytoskeletal system antibodies and IgM concentration correlated with anti-vimentin and anti-cytokeratin antibodies. In patients with adult T-cell leukemia (ATL), IgG antibody titer against actin and vimentin was increased in spite of a decreased IgG concentration. IgM antibodies to vimentin was decreased in its titer together with a decreased IgM concentration. Antibody titer to HTLV-1, leukemic cell counts in peripheral blood and disease type, acute or chronic, did not have correlations with anti-cytoskeletal system antibodies. A third of the patients with ATL showed negative anti-EBNA antibody, suggesting that the functional impairment in EBV-specific killer cells was present. In contrast, the patients with infectious mononucleosis showed increased serum IgM concentration and IgM anti-vimentin antibody titer. It was suggested that the autoantibodies to cytoskeletal systems associated with viral infection were mainly composed of IgG in ATL and of IgM in infectious mononucleosis.
Adult↗
Spontaneous splenic rupture in infectious mononucleosis.
A case of spontaneous splenic rupture in a 23 year old man with infectious mononucleosis is described. The patient was successfully managed without surgery and remains well after 3 months' follow-up.
Adult↗
Infectious mononucleosis.
An up-to-date review of the clinical diagnostic and treatment of infectious mononucleosis, emphasizing on new etiological concepts (Epstein-Barr virus) and pathogenetic (T and B lymphocytes) interaction is presented.
Child↗
HLA types and ABO blood groups in patients with infectious mononucleosis.
Investigations of HLA and blood-groups were carried out in 68 patients with infectious mononucleosis comprising all known cases diagnosed within one year in a restricted geographical area of Denmark. The HLA distribution of these patients did not differ significantly from that of controls. Combining the results of the present investigation with two previous studies did not show any significantly different distribution from that of combined control groups. The ABO and Rhesus typing was in accordance with that found in a major Danish control group. However, available studies do not exclude the possibility that HLA-D/DR or still unknown HLA factors may be involved in the susceptibility to mononucleosis.
ABO Blood-Group System↗
Death from massive hepatic necrosis in infectious mononucleosis.
A case is reported of a 19-year-old youth who developed infectious mononucleosis and died 17 days after the onset of the illness. At autopsy massive hepatic necrosis was found, associated with enlargement of the liver.
Adult↗
Coronavirus-associated antibodies in nasopharyngeal carcinoma and infectious mononucleosis.
Coronavirus-like particles are found within the cytoplasm of NPC tumor cells, within the cytoplasm of the tumor cells of the regional metastases, and within tumor cells grown on nude mice. For the immunologic identification of the coronaviruses, the cultures of human tracheal epithelium (MRC-C) were used and inoculated with a known coronavirus strain. Whereas blood sera from NPC patients (n = 73) contain significantly elevated antibody titers against corona viruses, unselected sera from patients without NPC showed a low antibody titer (n = 83). Only patients suffering from infectious mononucleosis (n = 40) showed a titer pattern similar to that of NPC patients. For demonstration of antigen-antibody reaction within the NPC tumor cell cytoplasm, sera with a high antibody content against coronaviruses deriving from other than NPC patients or anticoronavirus sera from rabbits were used. By indirect immunofluorescence, the NPC tumor cells showed a bright cytoplasmic fluorescence. No fluorescence was seen when tumor cells were exposed to human sera with known low or absent corona antibody titer or to normal rabbit sera. The results indicate that next to a DNA virus infection (EBV), an RNA virus infection (coronavirus) may play a role in NPC as well as in infectious mononucleosis.
Antibodies, Viral↗