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PubMedDate not supplied

[Clinical and biological aspects of liver damage in infectious mononucleosis].

Liver damage, clinical manifest or inapparent is a frequent manifestation of infectious mononucleosis. This study has in view the forms and frequency of manifestation of liver damage in infectious mononucleosis. The retrospective study has included 115 patients with infectious mononucleosis, hospitalised in Braşov Infectious Diseases Hospital between 1.01.1998 and 31.12.2002. The enlargement of the liver as unique manifestation in liver damage was noticed in 27% of the cases; jaundice of the skin and sclerae in 10.4% of the cases; infectious mononucleosis hepatitis in 55.6% of the cases; and in 11.3% of cases high serum levels of GPT were noted. The levels of serum protein were also affected, low-grade increase of protein serum levels--18.2% of the cases, hypoalbuminemia--82.4% of cases and subunitary albumin/globulin ratio in 70.3% of the cases. All these levels might be indicators for liver damage.

Aspartate Aminotransferases↗
PubMed2001

[Hypoglossal nerve palsy and infectious mononucleosis].

Neurologic manifestations are infrequent in infectious mononucleosis and specially hypoglossal nerve involvement is very rare. To the best of our knowledge only 6 cases have been previously reported. We describe herein the case of a 20-years-old man who presented an unilateral hypoglossal nerve palsy secondary to infectious mononucleosis. He was treated i.v. steroids without recovery, but the palsy resolved spontaneously 2 months after the onset.

Adult↗
PubMed2000

[Infectious mononucleosis: when is tonsillectomy indicated?].

INTRODUCTION: Infectious mononucleosis is usually a benign, self-limited disorder of the lymphopoietic system. Tonsillopharyngitis is a common presentation of the disease. Occasionally upper airway obstruction or a prolonged swallowing disorder require surgical intervention. METHODS: We conducted a retrospective analysis of all infectious mononucleosis cases seen at the ENT clinic in St. Gallen, Switzerland, between 1994 and 1998. RESULTS: 21 records were analysed, among which 19 patients needed hospital care. 11 cases required tonsillectomy. The average duration of fever of the patients undergoing surgery was markedly lower (9 days) than the conservatively managed cases (14.2). DISCUSSION: Tonsillectomy is well tolerated, eliminates airway obstruction and rapidly improves swallowing.

Adolescent↗
PubMed1988

Severe optic neuritis in infectious mononucleosis.

Because the presentation and clinical features of infectious mononucleosis can be misleading in the elderly, a significant number of infections may go unrecognized. We report an unusual case of infectious mononucleosis in a 61-year-old man in whom marked visual impairment was the presenting complaint and severe optic neuritis was the only prominent finding. Confirmation of the diagnosis was made by serologic testing for Epstein-Barr virus antibody. Recovery of visual function was near complete, but optic atrophy persisted. We reviewed the English literature and collected seven cases of well-documented optic neuritis associated with infectious mononucleosis. A clinical profile of parainfectious optic neuritis is discussed along with the likely pathogenesis for this complication.

Humans↗
PubMed1981

IgM autoantibody to intermediate filaments in infectious mononucleosis.

Sera from 17 patients with infectious mononucleosis reacted with fine cytoplasmic fibrils in monolayer cultures of fibroblasts. In cells pre-treated with vinblastine, the sera reacted with peri- or juxta-nuclear coils of filaments. These staining patterns were similar to those obtained by anti-intermediate filament autoantibody but different from the "actin-cables" stained by anti-actin autoantibody and from the "tubulin paracrystals" stained by anti-microtubule autoantibody. The autoantibodies belonged to the IgM class and ranged in titre from 1 : 16 to 1:512 (mean 1:64). A change in antibody titre was noted in sequential acute and convalescent sera. The results show that IgM autoantibodies to intermediate filaments occur frequently in sera from patients with infectious mononucleosis.

Actins↗
PubMed1986

Epstein Barr virus-specific immune defects in patients with persistent symptoms following infectious mononucleosis.

In a number of patients recovery from infectious mononucleosis (IM) following primary Epstein Barr virus (EBV) infection, is complicated by the persistence of symptoms for months or years. Normally recovery from infectious mononucleosis is associated with the development of EBV-specific antibodies and memory cytotoxic T-cells, which are present in the peripheral blood of all normal seropositive individuals. We studied four patients who had persistent symptoms for more than two years after infectious mononucleosis to determine if this abnormality was associated with a defect in EBV-specific or non-specific immune responses. All four patients had normal immunoglobulin concentrations, T- and B-cell numbers, T-cell proliferative responses and natural killer cell activity. However three of the four had reduced or absent antibodies to the EBV nuclear antigen (EBNA) although other EBV-specific antibody titres were normal. All four also had reduced EBV-specific cytotoxic T-cell activity as measured by the EBV regression assay. This defect was probably EBV-specific as alloreactive cytotoxic T-cell responses were normal. In addition, three of three patients tested had reduced in vitro antibody synthesis following pokeweed mitogen stimulation. These studies indicate that the syndrome of persistent symptoms following EBV mononucleosis may be associated with a defect in EBV-specific immunity, and thus suggest a possible immunological basis for the syndrome.

Adolescent↗
PubMed2001

[Severe upper airway obstruction in infectious mononucleosis: a life emergency].

BACKGROUND: Upper airway obstruction can represent a severe, life-threatening complication of infectious mononucleosis. We report a rare case of airway obstruction in a child with infectious mononucleosis associated with herpes virus infection, and we discuss management strategy that can be proposed in such cases. CASE REPORT: A 9-year-old girl was hospitalised in intensive care unit for obstructive dyspnea during infectious mononucleosis. Despite five days of corticosteroids and tracheal intubation, persistent pharyngo-tonsillar tumefaction led us to perform a surgical adenotonsillectomy. This latter treatment allowed immediate tracheal extubation and a rapid recovery. Histology showed a herpes virus infection associated with infectious mononucleosis. CONCLUSION: Maintaining airway opening in infectious mononucleosis needs sometimes to use instrumental interventions: nasal trumpet, endotracheal intubation, even tracheostomy. Early tonsilloadenoidectomy may relieve airway obstruction and allow a rapid recovery in the most severe cases. Airway obstruction in infectious mononucleosis may be aggravated by concomitant herpes virus infection that should be searched for in this situation, in order to adapt the treatment.

Airway Obstruction↗
PubMedDate not supplied

Spontaneous splenic haematoma in a teenager with infectious mononucleosis.

Spontaneous subcapsular splenic hematoma formation without rupture in infectious mononucleosis is a very unusual occurrence. Splenic rupture in infectious mononucleosis (Pfeiffer disease, or glandular fever) is a rare but life-threatening complication. A conservative management is successful in those patients in stable condition. We describe the presentation and the clinical progress of a case in whom a sudden enlargement in hematoma's diameter needed a splenectomy to avoid the risk of blood effusion in the abdominal cavity. The contribution of the sonographic examination and follow-up in the diagnosis of infectious mononucleosis is emphasised.

Adolescent↗
PubMed1975

Infectious mononucleosis: histopathologic aspects.

The main histopathologic features of infectious mononucleosis are described. In the lymph nodes, the principal change is the appearance of numerous large pyroninophilic cells (immunoblasts), initially expanding the paracortical zone but later extending throughout the node. Similar, large lymphoid cells appear as infiltrates in many other organs and tissues. Cells morphologically similar to Sternberg-Reed cells may be found in the lymph nodes of patients with infectious mononucleosis and other conditions apart from Hodgkin's disease. The diagnostic importance of considering not only the Sternberg-Reed cells but their milieu is stressed. A possible relationship between infectious mononucleosis and lymphoreticular malignancy is suggested by a number of observations, but a definite etiologic link is yet to be established.

Bone Marrow↗
PubMed1996

Epstein-Barr virus-induced infectious mononucleosis complicated by acute renal failure: case report and review.

Infectious mononucleosis, most commonly caused by Epstein-Barr virus (EBV), is generally a benign, self-limited illness. Occasionally, however, more severe complications may arise such as acute renal insufficiency. While subclinical renal involvement appears to be relatively common in patients with infectious mononucleosis, patients with significant renal parenchymal dysfunction have rarely been described in the English-language literature. In this report, we review 27 previous cases ad present a case of oliguric renal failure complicating heterophil-positive infectious mononucleosis. The patient required hemodialysis but recovered promptly with treatment with the combination of corticosteroids plus acyclovir. Renal biopsy revealed interstitial nephritis, and immunoperoxidase studies demonstrated a predominance of suppressor/cytotoxic T cells, which has been described in only one previous case report. In situ hybridization done on renal biopsy tissue failed to reveal evidence of EBV-encoded RNA-1. Acute renal failure in infectious mononucleosis is rare, often self-limited, and usually caused by interstitial nephritis that is likely the result of immunopathologic injury precipitated by EBV infection.

Acute Kidney Injury↗
PubMed1976

Monocyte function in infectious mononucleosis: evidence for a reversible cellular defect.

Migration of blood monocytes from patients with acute infectious mononucleosis and from normal controls was measured against chemotactic factors in serum. Moncytes from patients with acute infectious mononucleosis showed decreased migration as compared with that of control monocytes. However, serum from patients with infectious mononucleosis contained normal or above normal amounts of chemotaxins for monocytes. The migratory defect of monocytes from patients with infectious mononucleosis was reversible within three months after the onset of diesease. The cause of this monocyte migration defect in infectious mononucleosis is though to be an in vivo blockade of receptors on monocytes for chemotaxins, and it is speculated that this defect can partially explain the explain the ablated delayed-hypersensitivity skin reactions in this disease.

Adult↗
PubMed1981

Increased numbers of cells with suppressor T cell phenotype in the peripheral blood of patients with infectious mononucleosis.

Peripheral blood cells from six patients with acute infectious mononucleosis were studied by two-colour immunofluorescence using antibodies to human T cells, inducer and suppressor-cytotoxic T cell subsets and Ia-like antigens. The absolute number of T cells with the suppressor-cytotoxic phenotype was substantially increased in each case; many of these cells also expressed Ia-like antigens and had the morphology of the large atypical cells characteristic of infectious mononucleosis. These activated suppressor T cells of infectious mononucleosis may therefore represent a control mechanism to prevent viral-induced proliferation of B cells.

Cytotoxicity Tests, Immunologic↗
PubMed1981

Infectious mononucleosis and peritonsillar abscess.

A 10-year material of infectious mononucleosis and concomitant peritonsillar abscess from an ENT department has been analysed retrospectively. The incidence of this combination was one per cent among all patients admitted for infectious mononucleosis. Only one patient showed signs of relative upper airway obstruction. All four patients improved shortly after stab incision. In diagnostic considerations and treatment it is important to bear in mind the rare combination of infectious mononucleosis and peritonsillar abscess.

Adolescent↗
PubMed1978

IgE response in heterophil-positive infectious mononucleosis.

Nineteen patients with heterophil-positive infectious mononucleosis were followed with serial blood sampling for an average of 14.6 mo. A preillness serum sample, obtained more than 2 mo before onset of illness, was available from 9 patients. A total of 141 samples were tested under identical conditions for total IgE levels by a paper-disc radioimmunoassay. Hematologic and serologic studies were also done. IgE changes showed a definite pattern, consisting of an elevation early in illness, rapidly followed by a significant drop reaching a nadir by the third month, then gradually returning to the preillness level (PIL) over a period of about a year. On the average, the peak was about 3 times the PIL, and the nadir about half the PIL. The IgE peak always coincided with the peak of atypical lymphocytes, and in no instance did it occur later than the peaks of other hematologic or serologic changes. No definite relationship was noted between IgE levels and the severity of illness. Heterophil-positive infectious mononucleosis is the first well-defined infectious disease found to be associated with such a pattern of IgE response.

Adolescent↗
PubMed2001

Nasopharyngeal endoscopy adds to reliability of clinical diagnosis of infectious mononucleosis.

Frequently, the clinical picture in the oropharynx alone does not lend itself to a reliable differentiation between acute pharyngotonsillitis in infectious mononucleosis and a streptococcal inflammation. Such a differentiation, however, is essential for the indication of antibiotic therapy. Therefore, it was the aim of the present study to investigate whether or not endoscopic verification of larger-than-normal lymphatic tissue with fibrinous membranes in the nasopharynx would enhance the reliability of diagnosis. Fifty hospitalized patients exhibiting the clinical picture of acute pharyngotonsillitis were examined for the following parameters: nasopharyngeal endoscopy, determination of glutamine-oxaloacetic transaminase (GOT), glutamine-pyruvic transaminase (GPT), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), leucocytes and haemogram, antibodies to viral capsid antigen (VCA)-IgM, Epstein-Barr virus nuclear antigen (EBNA), and cytomegalovirus (CMV). In 24 patients with acute tonsillitis/peritonsillar abscess, and in 26 patients with infectious mononucleosis, the total leucocyte count in the blood and the blood/erythrocyte sedimentation rate were comparable. Atypical lymphocytes or absolute lymphocytosis were not seen in acute tonsillitis, but were found in 88.5 per cent of patients with infectious mononucleosis. Elevated transaminase levels were noted in 77 (GOT) and 88.5 per cent (GPT) of patients with infectious mononucleosis, and in acute tonsillitis in 4.2 (GOT) and 12.5 per cent (GPT) of patients. The CRP was higher than normal in 91.7 per cent of patients with acute tonsillitis, and in 57.7 of patients with infectious mononucleosis. In none of the patients with acute tonsillitis was lymphatic tissue with fibrinous membranes seen in the nasopharyngeal cavity. In contrast, nasopharyngeal endoscopy in infectious mononucleosis was positive in 24 out of 26 patients. Hence, the sensitivity was 92.3 per cent, the specificity 100 per cent, and the prediction value for a positive test turned out to be 1. Endoscopy of the nasopharngeal cavity employed as a simple and supplementary procedure adds to the reliability of diagnosis of infectious mononucleosis.

Adolescent↗
PubMed1989

[Evaluation of serological criteria for the diagnosis of infectious mononucleosis].

We have evaluated the application for the diagnosis of infectious mononucleosis of several serologic criteria, including measurement of concentrations of IgM against viral capsid antigen (VCA) of Epstein-Bar virus (EBV) by ELISA, detection of heterophil antibodies and the presence of anti-VCA IgG in absence of IgG against nuclear antigen of EBV (EBNA). Such criteria were evaluated by using a board of sera obtained from cases who had clinically been diagnosed of infectious mononucleosis and identified in the laboratory as produced by EBV (84 sera) or cytomegalovirus (CMV) (9 sera). The measurement of anti-VCA IgM by any of the two tested methods is the best criteria for the serologic diagnosis of infectious mononucleosis. Positive anti-VCA IgM reactions were detected by IIF and ELISA in sera of patients with infectious mononucleosis-like syndrome due to cytomegalovirus, so an alternative method to the measurement of anti-VCA IgM is needed, the most adequate is the measurement of anti-VCA IgG in the absence of anti-EBNA IgG.

Adolescent↗
PubMed1994

Interleukin-10 inhibits apoptotic cell death in infectious mononucleosis T cells.

T lymphocytes from patients with acute EBV-induced infectious mononucleosis rapidly die by apoptosis in vitro. Because human and viral IL-10 are likely to be induced during acute EBV infection and display a variety of functions on human T cells, we examined IL-10 effects on infectious mononucleosis T cell death. After 12 h of incubation in medium alone, only 35.6 (+/- 8.2%) of the originally seeded infectious mononucleosis T cells were viable. Addition of human IL-10 (100 U/ml) to T cell cultures significantly improved recovery of viable cells (71.3 +/- 6.2%, P = 0.0156). Viral IL-10 had comparable effects to human IL-10 in this system. Protection from death by human and viral IL-10 (100 U/ml) was dose dependent and continued over a 6-d culture period. The human IL-10 effect was neutralized by the anti-human IL-10 mAb 19F1. Morphology and analysis of DNA after separation on agarose gels showed that IL-10 inhibits loss of cell volume, chromatin condensation, and DNA fragmentation, characteristics of death by apoptosis. As assessed by [3H]thymidine incorporation, the T cells were not induced to proliferate by IL-10 above the level exhibited when first removed from blood. T cells protected from death by IL-10 proliferated to IL-2 and spontaneously killed sensitive targets as effectively as medium-precultured T cells. Thus, IL-10 promotes the survival of infectious mononucleosis T cells otherwise destined to die by apoptosis and may be critical for the establishment of immunologic memory after resolution of the illness.

Adolescent↗