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PubMed1987

Spontaneous splenic rupture in infectious mononucleosis.

Spontaneous splenic rupture occurs in association with infectious mononucleosis. Three cases of serologically proven infectious mononucleosis complicated by spontaneous splenic rupture are described. In two, the diagnosis was confirmed preoperatively by abdominal computerized tomographic (CT) scan. Treatment by splenectomy was curative in all three patients. Infectious mononucleosis patients who have acute abdominal pain must be considered for potential splenic hemorrhage.

Adolescent↗

PubMed1978

Infectious mononucleosis and Hodgkin's disease.

A cohort of 9,454 patients with infectious mononucleosis, serologically confirmed, was followed up to determine their risk of developing lymphoproliferative diseases. A total of 1,759 patients was identified in Scotland from 1959 to 1971 and 7,695 in Sweden from 1952 to 1970. The cancer cases were identified by matching the list of patients with infectious mononucleosis against a list of patients with lymphoma, nasopharyngeal and colon carcinomas registered through 1972 in Sweden and through 1973 in Scotland. A four-fold increase in risk was found for Hodgkin's disease based on 7 cases observed against 1.8 expected. Most of the excess cases of Hodgkin's disease occurred within three years of the diagnosis of infectious moonucleosis and among females. These results are similar to those of four other cohort studies and it is concluded that a positive association exists between infectious mononucleosis and Hodgkin's disease. Several explanations of this association were evaluated. Firstly, it may be that a very small proportion of persons who are in the course of developing Hodgkin's disease are temporarily misdiagnosed as having infectious mononucleosis. Secondly, infectious mononucleosis may increase the susceptibility to a factor which causes or promotes the development of Hodgkin's disease. Thirdly, infectious mononucleosis and Hodgkin's disease may share a common aetiology. Arguments in favour of, or against, each of these explanations are presented.

Adolescent↗

PubMed2001

[Infectious mononucleosis].

The diagnosis of infectious mononucleosis is usually based on the clinical signs and symptoms, characteristic changes in the peripheral blood picture and the results of specific and non-specific serologic tests. However, despite of these precise diagnostic criteria this disease is often misdiagnosed, misunderstood and therefore treated in a wrong way. Therefore, because of our long lasting clinical experience based on a very large number of cases, we have decided to present the results of our studies on the clinical features of this interesting disease as well as some laboratory findings (serum bilirubin level and AspAt, AlAt, AP and GGTP activity). The analysis of clinical and biochemical markers comprised 500 patients (236 males and 264 females) aged 15-35, in whom mononucleosis had been diagnosed according to the commonly approved criteria. The clinical signs and symptoms appearing during the first week of the disease, the results of the laboratory findings and the therapy are described in detail. It has been stressed, that the diagnosis of mononucleosis should be considered mainly in young patients with fever persistent for over one week accompanied by inflammatory changes in the throat and enlargement of the lymph nodes, liver and spleen and other pathologic signs and symptoms. Blood picture and the results of non-specific and specific serologic tests are helpful in the final diagnosis of this interesting disease.

Acute Disease↗

PubMedDate not supplied

IgM cold-warm hemolysins in infectious mononucleosis.

A patient with infectious mononucleosis and immune hemolytic anemia is described. The hemolysis was mediated by the temporary appearance of both a serum IgM anti-i cold agglutinin and an increase of red blood cell i antigen. The cold agglutinin had a high titer, low thermal amplitude and cold-warm hemolytic activity.

Adult↗

PubMed2005

Determination of safe return to play for athletes recovering from infectious mononucleosis: a review of the literature.

OBJECTIVE: Infectious mononucleosis is an acute self-limited disorder diagnosed by clinical and hematologic measures. This paper reviews the literature regarding the decision-making process for return to play in individuals at risk for complications due to infectious mononucleosis. DATA SOURCES: Computerized literature search identified articles using the keywords infectious mononucleosis, athlete, injury, exercise, spleen rupture, and spleen radiography. Symptoms, physical examination, hematological markers, and radiographic evaluation were considered. CONCLUSIONS: No strong evidence-based information supports use of a single parameter to predict the safe return to sports participation. Current consensus supports that athletes be afebrile, well hydrated, and asymptomatic with no palpable liver or spleen. Clinical judgment incorporating these criteria 1 month after diagnosis has been suggested as a safe predictor for gradual return to competition. These conditions for return to play do not guarantee that the spleen has returned to normal size and compliance, or that the risk of spleen rupture has returned to baseline. For those athletes participating in contact sports who wish to return to sports in an earlier time frame, or those with an equivocal examination, radiographic modalities may be used to help determine liver and spleen size. Further studies are required to support this practice.

Decision Making↗

PubMed1993

[Pelvic vein thrombosis in protein C deficiency after infectious mononucleosis].

Subsequent to an infectious mononucleosis a 15 year old girl developed a thrombosis of the iliaca vein. Laboratory evaluation revealed a heterozygous form of protein C deficiency. An infusion with r-tPA (= recombinant tissue plasminogen activator) at a rate of 0.02 mg/kg BW/h over 96 hours failed to reopen the vessel. After intermittent heparin therapy longterm treatment with coumarin began. Three months later the iliaca vein was partially recanalised.

Adolescent↗

PubMedDate not supplied

CT manifestations of infectious mononucleosis.

A case of infectious mononucleosis (IM) which, on computed tomography (CT) scan, mimicked the morphologic features of lymphoma is reported. The CT findings in this case include generalized lymphadenopathy, splenomegaly, and focal low-attenuation splenic lesions in a fifty-three year old woman; these findings have not previously been described in patients with IM. This is most likely because IM is usually a clinical diagnosis confirmed by serologic testing. Imaging modalities such as CT scan have not routinely been utilized to support this diagnosis.

Diagnosis, Differential↗

PubMed1979

Infectious mononucleosis in the elderly.

Infectious mononucleosis (IM) was diagnosed in four patients over the age of 50 years. Their age, absence of splenomegaly, lack of significant lymphadenopathy in three and an atypical presentation in one all contributed to a delay in the diagnosis. In two patients, in whom complications occurred, the Paul-Bunnell test was repeatedly negative. Confirmation of the diagnosis was made by the measurement of the Epstein-Barr virus IgM using differential sucrose gradient centrifugation. Because the presentation and clinical features of IM can be misleading in the elderly, we believe that a significant number of cases may go unrecognized.

Age Factors↗

PubMed1975

Studies on the presence of antibodies to EB virus and other herpesviruses in normal children and in infectious mononucleosis.

Children free from infectious disease have been examined by indirect immunofluorescence for the presence of antibodies to the intracellular capsid antigen of Epstein-Barr virus (EBV). In the first year of life 46%, between 2 and 6 years of age 66%, and between 7 and 14 years 91%, of the children proved positive. The corresponding percentages for the presence of antibodies to cytomegalovirus (CMV) and herpes simplex virus were about 50%, irrespective of the children's age. Serum samples from 69 patients suffering from infectious mononucleosis (IM) were tested for anti-EBV antibodies. Of the 29 Paul-Bunnell-positive patients 22 had antibodies, 11 of them in high titres (greater than 1 : 80). Of the 40 Paul-Bunnell-negative cases only 21 had antibodies, 8 in high titres. Of the Paul-Bunnell-negative cases, 73% were found to have anti-CMV antibodies, 32% in high titre. The respective percentages for the Paul-Bunnell-positive cases were 42% and 10%.

Acute Disease↗

PubMed1991

[Large granule-containing lymphocytes in patients with infectious mononucleosis].

A study of 50 children with infectious mononucleosis is presented. Results indicate that the content of large granule-containing lymphocytes corresponds to the severity of the clinical course of infectious mononucleosis. Absence of large granule-containing lymphocytes evidences severe course of the disease while their appearance favoured normal reconvalescence of patients. A high content of large granule-containing lymphocytes is an evidence of a favourable prognosis of the course of infectious mononucleosis.

Adolescent↗

PubMed2002

Acute interstitial nephritis secondary to infectious mononucleosis.

Renal involvement in infectious mononucleosis (IM) is infrequent. In most cases it is self-limited and is rarely associated with loss of renal function. The purpose of this case report is to document a case of acute interstitial nephritis (AIN) leading to acute renal failure (ARF) in a patient with Epstein-Barr virus (EBV) infection and to review literature of EBV infection and its renal manifestation. The patient was managed with hemodialysis and steroids and made an uneventful recovery. Renal involvement in IM may be more common than generally appreciated and may occasionally lead to ARF. Therapy with corticosteroids may have role in the management of IM-induced ARF and may shorten the duration of renal failure.

Acute Kidney Injury↗

PubMed2004

Analysis of immune activation and clinical events in acute infectious mononucleosis.

The symptoms of infectious mononucleosis (IM) are thought to be caused by T cell activation and cytokine production. Surface lymphocyte activation marker (SLAM)-associated protein (SAP) regulates lymphocyte activation via signals from cell-surface CD244 (2B4) and SLAM (CD150). We followed T cell activation via this SAP/SLAM/CD244 pathway in IM and analyzed whether the results were associated with clinical severity. At diagnosis, SAP, SLAM, and CD244 were significantly up-regulated on CD4 and CD8 T cells; expression decreased during IM, but CD244 and SLAM levels remained higher on CD8 cells 40 days later. There were significantly more lymphocytes expressing CD8 and CD244/CD8 in patients with severe sore throat. The expression of CD8 alone and CD244 on CD8 cells correlated with increased virus load. We suggest that T cells expressing CD244 and SLAM are responsible for the clinical features of IM but that the control of activation is maintained by parallel increased expression of SAP.

Acute Disease↗

PubMed1984

Virologic, immunologic, and clinical observations on a patient during the incubation, acute, and convalescent phases of infectious mononucleosis.

One patient with infectious mononucleosis (IM) was studied from the probable time of Epstein-Barr virus (EBV) infection (38 days before the onset of clinically overt disease), during the incubation and acute phases, until 6 months after clinical remission. Analysis of spontaneous outgrowth of EBV-carrying lymphoblastoid cells, by limiting dilution on feeder layer cultures, showed that virus containing B lymphocytes are already present early during the incubation period. Also low interferon serum levels were detected early after infection, and only before the onset of clinical disease. All other studied clinical laboratory and virus-associated variables were within normal range during the incubation phase, but changed to a pattern characteristic of IM in parallel to the clinical symptoms. During the acute disease EBV-associated nuclear antigen (EBNA)-positive cells could be directly detected among the lymphocytes, and antibodies to EBV antigens appeared. Lymphocytes stained by monoclonal antibodies, detecting Ia-like determinants (activated cells) and suppressor cells, increased dramatically, in parallel to a strong increase of functional suppressor cell activity, measured by inhibition of blastogenesis and PWM-induced immunoglobulin production. During the acute phase there was also a decrease of spontaneous cytotoxicity against the NK-sensitive cell line K562, while cytotoxicity (spontaneous) against an autologous EBV-positive lymphoblastoid cell line (LCL) was detected only during this phase. These reactions correlated to the presence of blasts, and the autologous reaction was exerted mainly by Fc-receptor-negative cells. Lymphokine production in response to EBV antigens was also initiated during the acute phase. During the convalescence period the serological and cellular immune parameters adjusted to the pattern of a normal EBV-seropositive person.

Adolescent↗

PubMed2006

Steroids for symptom control in infectious mononucleosis.

BACKGROUND: Glandular fever (infectious mononucleosis) is associated with fatigue, fever, sore throat and swollen lymph nodes. The severity of symptoms can vary. In extreme cases, breathing difficulties because of swelling in the throat and other complications can require hospitalization. The duration of symptoms is also variable; in some instances they can last for months. There are few treatments available. There are no universal criteria for using steroids in glandular fever. While their use is generally reserved for severe complications, there are reports of practitioners treating most symptomatic people with steroids. As glandular fever often affects young people at a time in their studies where they need to be continually productive, the potential duration of the condition is perhaps a key factor in prescribing such a potent drug for symptom control. OBJECTIVES: To determine the efficacy and safety of steroid therapy for symptom control in glandular fever. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2005); MEDLINE (January 1966 to November 2005); EMBASE (January 1974 to November 2005); and the UK National Research Register (November 2005). SELECTION CRITERIA: Randomised controlled trials (RCTs) that compared the effectiveness for symptom control of a steroid to placebo or to another intervention for people of any age with documented glandular fever were included. DATA COLLECTION AND ANALYSIS: Authors independently assessed trial inclusion according to predetermined criteria. Results are presented separately for each symptom and, where possible, it was intended to combine results in a meta-analysis. MAIN RESULTS: Seven trials were included. The diagnosis, steroid regime, outcomes and methodological quality varied between trials. The sample size ranged from 24 to 94. For sore throat the results of two studies suggest a benefit at 12 hours of steroid therapy over placebo; however this benefit was not maintained. The evidence from one trial suggests a longer benefit when the steroid is combined with an antiviral drug. There was evidence from one trial that steroids may improve resolution of fatigue around four weeks; however it is unclear if this is only in combination with an antiviral. Two trials reported severe complications in participants in the steroid group. AUTHORS' CONCLUSIONS: There is insufficient evidence - the trials were few, heterogeneous and some were of poor quality, to recommend steroid treatment for symptom control in glandular fever. There is also a lack of research on the side effects, potential adverse effects or complications, particularly in the long term.

Adrenal Cortex Hormones↗

PubMed2003

[Spontaneous rupture of the spleen in infectious mononucleosis: case report and review of the literature].

OBJECTIVE: Spontaneous splenic rupture is a rare but potentially fatal complication of infectious mononucleosis. Abdominal pain is uncommon in infectious mononucleosis, and splenic rupture should be strongly considered whenever abdominal pain occurs. The onset of pain may be insidious or abrupt. The pain is usually in the left upper quadrant. AIM: To indicate that infectious mononucleosis is not always the innocent kissing disease, but could be complicated with splenic rupture as a life-threathenig condition. CASE-REPORT: Our first case is described and a short literature review is provided. We report on the case of a 27-year-old man with infectious mononucleosis who had spontaneous splenic rupture that was successfully managed by splenectomy. On admission, he was febrile (38.5 degrees C) with hepatosplenomegaly, and had a blood pressure of 100/70 mm Hg. Six hours later, the patient complained of increasing abdominal pain. Abdominal ultrasound and computed tomography showed a 16.5 cm heterogeneous splenomegaly with subcapsular hematoma as well as free ascites. Laparotomy confirmed spontaneous rupture of the splenic capsule with active abdominal bleeding. Splenectomy was performed with a good clinical response. Examination of the spleen revealed a ruptured capsule with a subcapsular hematoma. DISCUSSION: Infectious mononucleosis is the most common infectious disease to result in spontaneous spleen rupture. The prognosis is favorable when diagnosis is made on time and correct treatment is started immediately. Although splenectomy was advocated as definitive therapy in the past, numerous recent reports have documented good outcomes with non-operative management. Based on the literature review, an approach to the management of a spontaneously ruptured spleen secondary to infectious mononucleosis is suggested. Non-operative management can be successful in hemodynamically stable patients, i.e. in patients with subcapsular hematoma without overt rupture of the capsule to avoid complications of splenectomy (e.g. post-splenectomy sepsis). CONCLUSION: We report on a 27-year-old man with infectious mononucleosis who had spontaneous splenic rupture that was successfully managed by splenectomy.

Adult↗

PubMed1984

Infectious mononucleosis presenting as acute intermittent porphyria.

We have described a patient with infectious mononucleosis, confirmed by serologic studies, who had an initial episode of acute intermittent porphyria during the course of the infection. Although infections have been implicated in precipitating AIP, infectious mononucleosis has rarely, if ever, been described. A similar constellation of symptoms has been described for both infectious mononucleosis and AIP. Although infectious mononucleosis is a common infection, with 90% to 95% of the United States population showing seropositivity by adulthood, neurologic complications are uncommon. Acute intermittent porphyria should be considered in the differential diagnosis of patients with infectious mononucleosis, neuropathy, and abdominal pain.

Acute Disease↗

PubMed2005

[Clinical analysis of infectious mononucleosis misdiagnosised as tonsillitis].

OBJECTIVE: Discussing the clinical features of infectious mononucleosis misdiagnosised as tonsillitis. METHOD: We used the methods of variant lymphocyte count, heterophil agglutination test and EBVCA-IgA detection to diagnose 6 cases of infectious mononucleosis misdiagnosised as tonsillitis. RESULT: Six cases of infectious mononucleosis misdiagnosised as tonsillitis are cured without upper airway obstruction. CONCLUSION: We must pay attention to the variant lymphocyte count when tonsillitis is diagnosed. Some cases of infectious mononucleosis in convalescence or without hepatic functional lesion and renal functional lesion are easily misdiagnosised and missed.

Adult↗

PubMed2005

Epiglottitis and necrotizing fasciitis: a life-threatening complication of infectious mononucleosis.

Life-threatening cervical complications associated with infectious mononucleosis are rare. The combination of acute epiglottitis and subsequent necrotizing fasciitis of the head and neck in a patient with infectious mononucleosis has not been reported to date.A 47-year-old female with infectious mononucleosis and epiglottitis was admitted to hospital for i.v. therapy. Owing to her poor clinical condition and the spread of the infection to the throat and superior mediastinum, as evidenced by CT, a cervical debridement was performed. After cervical debridement, histological findings were consistent with necrotizing fasciitis. The bacteria identified were Streptococcus viridans, Veilonella spp. and Capnocytophaga spp. The patient was hospitalized for 33 days.Mononucleosis, usually a benign condition, may be associated with life-threatening septic complications in the neck and chest. Serial CT or MRI scans are necessary to assess the development of the infection in the deep layers of the neck. Rapid medical treatment, extensive surgical debridement and intensive care are vital.

Capnocytophaga↗