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PubMed2003

Infectious mononucleosis presenting as spontaneous splenic rupture without other symptoms.

Splenic rupture is an uncommon complication of infectious mononucleosis (IM), occurring in 0.1% to 0.5% of all patients. It remains the most common lethal complication of IM. Rupture of the spleen with no other symptoms of IM is almost unheard of. This is the report of a case of spontaneous splenic rupture requiring splenectomy in a patient with a positive heterophil antibody test and no other signs or symptoms of IM. The diagnosis and management of splenic rupture in IM are discussed.

Adult↗
PubMed1966

Granulocyte changes in infectious mononucleosis.

Various changes in the granulocytes have been investigated in a large series of patients with infectious mononucleosis. A high proportion of cases regularly show a neutropenia with a shift to the left during the first three to four weeks of the disease; these changes, though transient, may be profound. The band cells present during the acute phase of the disease also show certain alterations in cytochemical staining and low alkaline phosphatase scores are common at this time. The maturation and release of leucocytes from the bone marrow is apparently normal. Theoretical mechanisms for the neutropenia are briefly discussed, including the possible role of excessive peripheral destruction.

Agranulocytosis↗
PubMed2006

Infectious mononucleosis and risk for multiple sclerosis: a meta-analysis.

OBJECTIVE: To characterize the association between infectious mononucleosis (IM), a frequent clinical manifestation of primary Epstein-Barr virus infection after childhood, and the risk for multiple sclerosis (MS). METHODS: We conducted a systematic review and meta-analysis of case-control and cohort studies of IM and MS. RESULTS: The combined relative risk of MS after IM from 14 studies was 2.3 (95% confidence interval, 1.7-3.0; p < 10(-8)). Potential sources of heterogeneity (ie, study design, MS definition, and latitude) barely influenced our results. INTERPRETATION: We conclude that Epstein-Barr virus infection manifesting as IM in adolescents and young adults is a risk factor for MS.

Adolescent↗
PubMed1996

Large clonal expansions of CD8+ T cells in acute infectious mononucleosis.

Primary infection with Epstein-Barr virus often results in the clinical syndrome of acute infectious mononucleosis (glandular fever). This illness is characterized by a striking lymphocytosis, the nature of which has been controversial. We show that large monoclonal or oligoclonal populations of CD8+ T cells account for a significant proportion of the lymphocytosis and provide molecular evidence that these populations have been driven by antigen. The results suggest that the selective and massive expansion of a few dominant clones of CD8+ T cells is an important feature of the primary response to this virus.

Acute Disease↗
PubMed1978

Antibodies to smooth muscle and other tissue components in infectious mononucleosis.

Antibodies to tissue components were studied by the indirect immunofluorescent method in 24 patients with infectious mononucleosis (IM). Smooth-muscle antibodies (SMA) were found in 70.8% of the patients, and in only one (3.8%) of 26 controls. SMA in patients were of the IgG (54.2%), the IgA (12.5%) and the IgM (41.6%) class. IgM-SMA occurred in the early phase of the disease, while IgG-SMA were found both early and late in its course. It was not possible to demonstrate that the development of SMA was due to liver involvement. Antinuclear antibodies, parietal-cell antibodies and antibodies to the cytoplasm of renal tubular cells were not detected significantly more often in patients than in controls. The serum concentrations of IgG, IgA and IgM were elevated in the acute phase of IM, and it was found that the Ig values were higher in patients with SMA than in those without.

Adolescent↗
PubMedDate not supplied

[Neurological complications of infectious mononucleosis (author's transl)].

The authors report three different and rare forms of neurological complication associated with infectious mononucleosis. The first two, which are faily unusual in their clinical signs, occurred during the course of two typical cases of mononucleosis, one in the form of progressively regressive myelitis and the other in that of amyotrophic paralysis of the shoulder. The third occurred in isolation, after an encephalitic attack combined with a state of epileptic mal, with no other accompanying infectious sign. On the basis of these three single cases, and recent data in the literature about the Epstein-Barr virus, the authors briefly recapitulate the neurological clinical forms of infectious monouncleosis and the means of serological diagnosis; they discuss the frequency and pathogeny of these complications and tentatively suggest certain similarities with other nervous disorders observed in the course of proliferative or dysglobulinaemic diseases.

Adolescent↗
PubMed1976

Immune deposit nephritis in infectious mononucleosis.

A 22-year-old white male (L.V.) died of gram-negative septicemia complicating infectious mononucleosis (IM) that was associated with jaundice and oliguric renal failure. The kidney showed mesangial granular deposits of IgM and C3, mesangial electrondense deposits, and interstitial infiltrates of infiltrates of mononuclear cells, including atypical lymphocytes. Eluates obtained from kidney, spleen and liver contained Paul--Bunnell (PB) antibodies. Presence of PB antigens in these tissues was indicated by absorption of PB antibodies from IM sera, with the sediments resulting from tissue elutions. The IgM mesangial deposits were partially eluted with acid buffer at 56 degrees C and then reconstituted by incubation with IM sera or with immunoglobulins eluted from tissues of patient L.V. The presence in renal structures of PB antigens, IgM heterophile antibody, C3 and electron-dense deposits is consistent with the hypothesis that heterophile immune complexes were localized in the kidney and that they contribute in the pathogenisis of IM nephritis.

Adult↗
PubMed1986

IgA antibodies to Epstein-Barr virus in infectious mononucleosis.

The IgA anti-EBV (Epstein-Barr virus) response during the course of IM (infectious mononucleosis) was investigated. The IgA anti-VCA (viral capsid antigen) response was found not to be restricted to the early acute phase of the EBV infection as is the IgM anti-VCA response. Some patients with normal total serum IgA levels did not respond with measurable EBV specific IgA. These patients and those with low titers of IgA anti-VCA had shorter duration of sore throat than responders with high titers indicative of a strong correlation between the IgA anti-VCA titers and the duration of sore throat. In this way the EBV specific IgA response is unique since recent observations show that local oropharyngeal symptoms during IM appear poorly synchronized with the IgM and the IgG antibody responses. As EB virus is excreted into the oropharynx during IM, antigens are available for local EBV immunization. The results of the present study imply a possible local immunization process as a positive correlation was found between serum IgA anti-VCA and total salivary IgA.

Adolescent↗
PubMed1973

Epstein-Barr virus antibody in cases and contacts of infectious mononucleosis; a family study.

Serological investigations were carried out on 147 patients with Paul-Bunnell positive infectious mononucleosis (IM) from the general population. All possessed antibody to the Epstein-Barr virus (EBV) and 63% showed serological evidence of recent infection. Contacts of 132 patients, 306 in all, were followed serologically; within 6 months of the index cases' illness twenty one contacts developed evidence of EBV infection or re-infection and of these five developed overt IM. The secondary attack rate of EBV infection among susceptible contacts was at least 19%; the corresponding figure for clinically apparent IM was 6%. EBV antibody prevalence among patients' siblings was significantly lower than among age-matched controls, suggesting that cases of IM come from families with a lower than normal previous experience of the virus. Of thirteen patients with persistently Paul-Bunnell negative ;glandular fever' four had serological evidence of recent EBV infection and two had probable cytomegalovirus mononucleosis. Recent EBV infection may have been associated with the illnesses of five of the remaining patients.

Adenoviridae↗
PubMed1974

Limitations of immunofluorescence tests in the diagnosis of infectious mononucleosis.

The relative value of heterophil agglutinins (HA) and of specific EBV antibodies in the diagnosis of infectious mononucleosis (IM) was assessed in 108 cases of the disease and in 280 controls. Among the 108 cases 93 were HA-positive by sheep cells in at least one of their sera, while 15 were HA-negative by the same test. Among the 280 controls false-positive HA tests were not encountered except in eight cases with the horse cell microtitre tests. With one of the two slide tests at least two false-positive tests and 12 false-negative tests were also found but these sera had low titres in microtitre tests. The HA life-span was found to be unexpectedly long in a few cases, sheep cell HA lasting up to 8 to 10 months and horse cell HA up to 21 to 23 months.Many false-positive tests may therefore not be true false-positives and may result from the persistence of HA following unrecognized mononucleosis months before. Virtually all cases of IM had (or developed) antibodies to Epstein-Barr virus, viral capsid antigen (EBV-VCA), whereas only half of the controls were EBV-VCA-positive. The comparative analysis of nonspecific and specific test results in mononucleosis allows the following conclusions: (1) horse cell microtitre tests and the monospot test are more sensitive than sheep cell microtitre tests and the monotest; (2) false-negative results are occasionally seen with the latter tests but not with the former; (3) more false-positive results, however, are probably seen with the former tests; and (4) specific EBV-IgM and EBV-EA antibody tests are useful in the diagnosis of selected borderline cases of mononucleosis.

Adult↗
PubMed1980

Demonstration of increased platelet-bound IgG in infectious mononucleosis complicated by severe thrombocytopenia.

In an attempt to confirm the immune nature of the thrombocytopenia complicating infectious mononucleosis, the amount of IgG bound to the platelets of 2 affected patients was measured. Using a sensitive quantitative antiglobulin consumption technique, increased amounts of IgG were demonstrated during the thrombocytopenic phase of the illness. This observation represents convincing evidence in favour of platelet destruction by an immune mechanism.

Adult↗
PubMed1978

[Clinical and hematological manifestations of infectious mononucleosis. Personal cases].

An account of the incidence and features of fever, angina, adenopathy and splenomegaly in infectious mononucleosis is followed by an explanation of the importance of palpebral oedema, nasal obstruction, and exanthema and enanthema, the characteristics of which may prove of diagnostic assistance. Attention is drawn to the presence of maculopapular and itching exanthema, particularly after semi-synthetic penicillins. An assessment is also made of liver, myocardial and renal changes, since it is felt that involvement of these organs is an integral part of the clinical picture.

Adolescent↗
PubMed2003

Infectious causes of pityriasis lichenoides: a case of fulminant infectious mononucleosis.

Pityriasis lichenoides is a rare cutaneous eruption of unknown cause that spans a spectrum of clinical severity. Infectious agents have long been suspected as etiologic factors. The present case is the first to demonstrate a known EBV-mediated process evolving and resolving in concert with pityriasis lichenoides. Epstein-Barr virus, Toxoplasma gondii, and HIV are the most frequently reported infectious triggers of pityriasis lichenoides. Pityriasis lichenoides may arise secondary to EBV-mediated acute infectious mononucleosis.

Adult↗
PubMed1980

Heterophile antibodies in Japanese patients with various diseases including infectious mononucleosis.

Sera of Japanese patients with various diseases including patients with lympho-proliferative disease similar to infectious mononucleosis (IM) were studied for the presence of heterophile antibodies. Antibodies to sheep erythrocytes were demonstrated in 9 of 19 such patients whereas similar antibodies were found only in 28 of 3570 (0.8%) patients with various other diseases. Adsorption studies revealed that these antibodies in patients with IM-like syndrome are of Hangantziu-Deicher or Forssman nature. On the other hand, Paul-Bunnell antibody characteristic for IM in Caucasians was not demonstrated in Japanese suffering from IM-like syndrome.

Animals↗
PubMed1979

Aplastic anemia following infectious mononucleosis: possible immune etiology.

A 17-year-old female developed severe aplastic anemia following serologically proven infectious mononucleosis. In vitro studies, using the granulocyte colony forming technique, suggested that the aplasia may have resulted from an immune mechanism. The patient's marrow grew no granulocyte colonies and caused inhibition of colony formation when mixed with normal marrows. The patient recovered fully after therapy with antithymocyte globulin and marrow cultures showed disappearance of the inhibitory effect. These observations suggest that the severe aplasia may have resulted from an aberrant immune response which followed infection by EB virus.

Adolescent↗
PubMed1983

Immunological reason for chronic ill health after infectious mononucleosis.

In a group of patients who suffered from chronic ill health after an attack of acute infectious mononucleosis a disorder of T cell regulation was found. By means of cytochemical reactions the staining pattern associated with T suppressor cells was found in a greater percentage and that associated with T helper cells in a smaller percentage than in normal subjects. In a few patients this finding was confirmed in a functional suppressor assay. The patients were unwell for at least a year but most later made a complete recovery, which was associated with return to normal of the lymphocyte subsets.

Adolescent↗
PubMedDate not supplied

[An acute meningo-encephalitis with a favourable prognosis and occasional severe electrical and clinical changes; infectious mononucleosis meningo-encephalitis (author's transl)].

Four cases of severe meningo-encephalitis in patients with infectious mononucleosis (IMN) are reported. In three cases the clinical context suggested a mononucleosis. In the other case there was fever but only isolated neurological signs, which demonstrates the importance of serological diagnostic tests because of the benign prognosis of this affection. In fact, neurological complications of IMN are considered to be reversible even though deaths have occurred from respiratory failure, from polyradiculoneuritis, or bulbar involvement. In the cases reported, the onset of a deep coma with loss of reflexes and pauses in respiration required resuscitation therapy, which enabled vital functions to be restored and complete recovery to be obtained. Electro-encephalographic changes were marked by the severity of the initial changes in the tracings with very slow delta waves and prolonged electrical silences which were, however, reversible. The prognostic value of the EEG has to be stressed as improvement in the EEG always preceded clinical improvement.

Adolescent↗