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PubMed1981

Spontaneous splenic rupture in infectious mononucleosis: sonographic diagnosis and follow-up.

Spontaneous rupture of the spleen occurs as a serious but relatively infrequent complication of infectious mononucleosis. Over 100 such cases have been reported. In all but one of the cases previously reported, diagnosis of splenic rupture was made at laparotomy. Three new cases are reported where the diagnosis of splenic rupture was made using sonography. The patients were followed by sonography and none required laparotomy. Aspiration of the hematoma under sonographic control confirms the diagnosis and may be curative.

Adolescent↗
PubMed1980

Blood lymphocytes in infectious mononucleosis share the following characteristics with activated T cells: natural attachment, stable E rosetting and glucocorticoid sensitivity.

Blood lymphocytes of infectious mononucleosis (IM) patients, unlike these obtained from healthy individuals, exhibit the following characteristics of activated T cells: (1) "stable" E rosette formation; (2) natural attachment to various human normal and malignant cells; (3) sensitivity in vitro to the lytic effect of glucocorticoids. Although the IM T cells attach in vitro to all the human cells tested, they kill only the EBV genome carrying targets. The possibility is discussed that some of the activated T cells in IM result from a non-specific activation elicited by the T cells responding specifically to the EBV associated antigens.

Cell Adhesion↗
PubMed2004

High Th1-type cytokine serum levels in patients with infectious mononucleosis.

Most adults are asymptomatically infected with Epstein-Barr virus (EBV). Primary EBV infection is commonly associated with acute infectious mononucleosis (IM). T cell immune activation plays an important role in EBV-associated diseases. IM shows a mainly Th1-type profile, so Th1-type cytokines such as interleukin-2 (IL-2), interferon-gamma (IFN-gamma), and lymphotoxin (LT) are moderately enhanced. We measured IL-2 and IFN-gamma in serum during acute phase of the disease and during convalescence. Sera were collected from 23 IM patients, 13 patients with similar clinical manifestations but without IM, and 10 healthy donors. The levels of IL-2, IFN-gamma and IL-12 were significantly higher in patients with acute IM than in healthy individuals. IL-2, IFN-gamma and IL-12 decreased during convalescence. These three cytokines may be useful as sensitive markers of IM during severe illness and its later phases.

Adult↗
PubMed1985

T lymphocytes in infectious mononucleosis. I. T cell death in vitro.

A large proportion of T lymphocytes isolated from the peripheral blood of acute infectious mononucleosis (IM) patients rapidly die when cultured in vitro, with greater than 50% dying within 12-15 h of seeding and up to 80% dying within 24 h. The cells die by apoptosis, a morphologically distinct mode of cell death that occurs in circumstances where death is a regulated event such as in embryonic development and hormone-dependent atrophy. In contrast, the level of cell death remained low in cultures of lymphocytes from controls and in the T cell depleted subpopulation from acute IM patients, with less than 2% and 10% of the lymphocytes dying by apoptosis after 36 h in culture, respectively. The rapid death of acute IM T cells in vitro does not involve soluble factors (including the serum fraction) or T cell to T cell contact. It is suggested that this observation may necessitate a re-evaluation of IM T cell function in vitro.

Cell Communication↗
PubMed1999

Acyclovir for treatment of infectious mononucleosis: a meta-analysis.

A meta-analysis of 5 randomized controlled trials (RCT), involving 339 patients with acute infectious mononucleosis (IM) treated with acyclovir (ACV) was performed. ACV was given intravenously in 2 RCTs, which included patients with more severe disease, and orally in the remaining 3 RCTs, which included patients with mild to moderate IM. Both clinical and virological endpoint data available from RCT were evaluated in this study. There was a trend towards clinical effectiveness of ACV treatment, but no statistically significant results were achieved. In contrast, a significant reduction in the rate of oropharyngeal EBV shedding was observed at the end of the therapy (overall OR: 6.62; 95% CI: 3.56-12.29; p < 0.00001). However, no difference in EBV shedding was observed 3 weeks later. There was no significant difference on adverse events in the groups of patients treated with ACV or placebo. In conclusion, clinical data do not support use of ACV for the treatment of acute IM, despite good virological activity of this drug. There is a need for more effective treatment of EBV infection.

Acyclovir↗
PubMed1980

Infectious mononucleosis and acute lymphoblastic leukemia--hand mirror cells: a qualitative and quantitative ultrastructural study.

The hand mirror cell (HMC) in infectious mononucleosis (IM) is a T cell which appears at the time of improvement and apparently has an important role in immune surveillance. Fifty electron micrographs of HMC from an unusual untreated patient with ALL-HMC variant were compared to 50 electron micrographs of HMC from five patients beginning to recover from IM. Quantitative differences between the IM-HMC and ALL-HMC were observed in multivariate analysis of variance (p < 0.001), nuclear perimeter (p < 0.0001), nuclear length (p < 0.0001), cytoplasmic length (p < 0.0001), total cell area (p < 0.0001), cytoplasmic area (p < 0.0001) and nuclear cytoplasmic ratio (p < 0.004), and numbers of mitochondria (p < 0.001). The qualitative differences included greater nuclear irregularity in the IM-HMC, and prominent nucleolonema in some of the ALL-HMC. In addition, the IM-HMC showed more polyribosomes, parallel tubular arrays and microtubules, but much less glycogen. Since the IM-HMC apparently enter effectively into immune surveillance, and some cases of ALL have HMC, the ultrastructural similarities and differences above contribute to a better understanding of the importance of this unique cell configuration in benign and malignant disorders.

Genetic Variation↗
PubMed1997

Epstein-Barr virus (EBV) gene expression in lymphoid B cells during acute infectious mononucleosis (IM) and clonality of the directly growing cell lines.

We examined the patterns of viral gene expression in acute infectious mononucleosis (IM) patients and the clonality of the directly growing EBV-carrying cell lines. Both low- and high-density EBV-carrying B cells obtained from the patients' tonsils expressed EBNA1, EBNA2 and LMP1. Like LCLs and immunoblastic B-cell lymphomas, the in vivo EBV-carrying low-density cells used only the latency III program for viral gene expression. The in vivo EBV-carrying high-density B cells used both the latency I program, as indicated by the QUK-, and the latency III program, as indicated by the YUK-EBNA1. This suggests that the lymphoid tissues contained not only proliferating immunoblasts but also cells programmed for latent viral persistence in vivo. EBV-carrying cells that grew directly into permanent cell lines in the presence of virus-neutralizing antibody and a late viral inhibitor were polyclonal, as indicated by JH rearrangement. Two of the high-density-derived lines had identical JH and TR patterns, indicating a common parental origin. Our investigation indicates that EBV-carrying cells divide and survive in a fully competent immune system during the outbreak of acute IM.

Antigens, Viral↗
PubMed1990

Oligoclonal T cell receptor gene rearrangements in blood lymphocytes of patients with acute Epstein-Barr virus-induced infectious mononucleosis.

Gene rearrangement studies were performed on blood lymphocytes from eight patients with acute Epstein-Barr virus-induced infectious mononucleosis. The diagnosis in each case was based on characteristic clinical, hematologic, and serologic findings. The blood lymphocytes in each patient consisted predominantly of CD8+ T cells. EBV DNA was detected in seven patients by Southern blot analysis (EBV Bam HI W probe, Bam HI). A germline configuration was found for the immunoglobulin heavy and light chain genes (JH probe, Bam HI and Eco RI; C kappa probe, Bam HI; and C lambda probe, Eco RI). T cell receptor gene rearrangements were detected with J gamma and J beta 1 + 2 probes. Using a J gamma probe with two different restriction enzymes (Bgl II and Eco RI), the blood from each patient showed several bands corresponding to the polyclonal pattern previously described in the blood of normal individuals. Using J beta 1 + 2 probes with two different restriction enzymes (Bgl II and Bam HI), each case showed from 3 to about 12 extragermline bands of varying intensity and in different locations from case to case. In addition, each case showed relative deletion of the J beta 1 germline band. This oligoclonal pattern of T cell receptor gene rearrangements has not been previously reported in benign or malignant T cell populations.

Acute Disease↗
PubMed1998

Immune complex disease associated with Epstein-Barr virus infectious mononucleosis.

We describe a patient with immune complex-mediated glomerulonephritis and leukocytoclastic vasculitis associated with Epstein-Barr virus (EBV) infectious mononucleosis. The patient required hemodialysis and has residual hypertension. This case implicates acute EBV infection as a cause of immune complex-mediated glomerulonephritis.

Acute Disease↗
PubMed1999

Peritonsillar abscess and infectious mononucleosis: an association or a different presentation of the same condition.

Few reports document the coexistence of Peritonsillar Abscess (PTA) and Infectious Mononucleosis (IM). In this paper, we are reporting on two cases that presented to our department with the two conditions simultaneously. We also review the literature and discuss the current theories behind what was considered, for sometime, an unusual presentation of a common problem.

Adolescent↗
PubMed1980

[Agranulocytosis in the course of infectious mononucleosis. Demonstration of leukoagglutinins (author's transl)].

A case of agranulocytosis, quickly and spontaneously reversible, occurring in the fourth week of infectious mononucleosis in a 7-year old girl, is reported. The interest of the case lies in the importance of the symptomatology (jaundice, eruption, fever for 40 days), the serological detection of the role of the Epstein-Barr virus and, in particular, in the presence of leukoagglutinins judged to be responsible for the agranulocytosis.

Agglutinins↗
PubMed1989

Fatal infectious mononucleosis with staphylococcal pyoderma in a girl with hereditary immunological dysregulations.

We describe a 14-year-old girl with fatal infectious mononucleosis with high fever, pancytopenia, and multiple skin ulcers due to Staphylococcus aureus. Immunological studies revealed low serum IgM, low natural killer (NK) activity, and high CD4/CD8 ratio. Her father had also low NK activity and high CD4/CD8 ratio. It is suggested that she had a dominantly inherited immunodeficiency predisposing to severe Epstein-Barr virus infection.

Adolescent↗
PubMed1974

Distinct alkaline phosphatase in serum of patients with lymphatic leukemia and infectious mononucleosis.

A distinct alkaline phosphatase (phosphatase N) was demonstrated in the serum of patients with acute lymphatic leukemia, chronic lymphatic leukemia, and infectious mononucleosis. This enzyme closely resembles that extracted from the thymus of mice with lymphoma or lymphatic leukemia, both in its electro-phoretic mobility and its substrate specificity. The phosphatase N activity was related to the clinical state of patients with lymphatic leukemia and disappeared with recovery from infectious mnononucleosis.

Adolescent↗
PubMed1996

Aspecific membranous laryngitis after infectious mononucleosis.

Aspecific membranous laryngitis is an unusual but very serious complication of viral infections. Here, we report the uncommon finding of infectious mononucleosis characterized by aspecific membranous laryngitis with fever, dysphonia and severe dyspnea in a 12-year-old girl. Endoscopy showed mucopus and sloughed epithelium forming a pseudomembrane covering almost all the supraglottal region and a supraglottal swelling including the epiglottis and arytenoids. The importance of suspecting diphtheria, epiglottitis, viral or bacterial croup and laringo-tracheo-bronchitis and including them in the differential diagnosis is emphasized.

Anti-Bacterial Agents↗
PubMed1988

Genetic polymorphism of natural Epstein-Barr virus isolates from infectious mononucleosis patients and healthy carriers.

We analyzed Epstein-Barr virus (EBV) genomes from lymphoblastoid cell lines isolated from patients with infectious mononucleosis and from healthy subjects from California, Hawaii, and Hong Kong between 1970 and 1987. Using genetic polymorphism as epidemiological markers, we found that several genotypes of EBV cocirculate in a community and that although most EBV strains isolated from California and Southern China may be differentiated genotypically, there was no specific association between genotype and disease or time of isolation.

B-Lymphocytes↗
PubMedDate not supplied

Surveillance of infectious mononucleosis cases by use of existing data from state laboratories.

In a pilot study to explore the feasibility of surveillance of cases of infectious mononucleosis, data were collected on 8,258 positive specimens. These specimens had been submitted to six State laboratories--Connecticut, Georgia, Iowa, South Carolina, Virginia, and Wisconsin--during a 2-year period. April 1974-March 1976. Case reporting varied in completeness and geographic coverage. Data concerning case occurrence, by age, sex, and race of patients and month of specimen collection, confirmed previous observations regarding the descriptive epidemiology of the disease. The results indicated that the public health usefulness of extensive surveillance of infections mononucleosis laboratory tests is limited.

Adolescent↗