Subacute granulocytic leukemia; report of a case following infectious mononucleosis.
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Communicable Diseases↗
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[Encephalitis and infectious mononucleosis].
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Communicable Diseases↗
[False positive reactions of syphilis in infectious mononucleosis].
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Communicable Diseases↗
Successful plasmapheresis in corticosteroid-resistant hemolysis in infectious mononucleosis: role of autoantibodies against triosephosphate isomerase.
A 19-year-old girl fell ill with a high temperature and cervical lymphadenopathy. The detection of heterophile antibodies as well as Epstein-Barr-virus-specific antibodies confirmed the diagnosis of infectious mononucleosis. In the course of the infection, the patient developed severe hemolytic anemia with her hemoglobin falling from 14 to 8 g/dl. High-dose corticosteroid therapy did not stop hemolysis; this could only be achieved by seven plasmapheresis sessions. Antibodies against triosephosphate isomerase (TPI) and the blood group marker 'i' were found in the patient's serum. Anti-i cold agglutinins were not active at 37 degrees C, whereas antibodies against TPI caused increased 51Cr release from marked patient's erythrocytes in vitro. Plasmapheresis removed the autoantibodies effectively and stopped the hemolysis. After 8 weeks, the patient gradually recovered.
Adrenal Cortex Hormones↗
[Epidemiological analysis of infectious mononucleosis as primary Epstein-Barr virus infection].
We report the characteristics of 45 Epstein-Barr virus (EBV)-infected patients visiting our hospital from 1989 to 1991 in comparison with 102 patients seen from 1981 to 1988. Cases of infectious mononucleosis (IM) increased especially in patients over 30 years old. They tended to have nonspecific symptoms and signs for IM such as general fatigue. Immunologically showed twice higher positivity for anti-EBV VCA-IgM antibody in the recent 3 years when compared to the previous 8 years. The patients with anti-EBNA antibody decreased in the recent 3 years. This may be due to early diagnosis as IM. EBV also causes atypical diseases. non-IM in this report, including hematological or neurological disorders. We indicated here the increased number and advanced age of patients with IM and early diagnosis as IM in the recent 3 years compared to the previous 8 years.
Adolescent↗
EBV-IgA and new heterophile antibody tests in diagnosis of infectious mononucleosis.
An evaluation has been made of the EBV-IgA tests and the immune adherence hemagglutination assay (IAHA) as compared with standard diagnostic procedures in 119 serial sera from 22 clinical and 113 sera from 42 subclinical cases of EBV infectious mononucleosis. EBV-IgA antibody was demonstrable in 86.4 per cent of patients using EB3 cells as antigen and in 68.2 per cent with P3/HRIK cells. For heterophile antibody the IAHA test was more sensitive, gave higher titers, and was positive longer than the standard absorbed horse or sheep RBC tests in both clinical and subclinical EBV infections.
Adult↗
Neutropenic enterocolitis (typhlitis) associated with infectious mononucleosis.
Neutropenic enterocolitis (typhlitis) is an unusual acute complication of neutropenia, most often associated with leukaemia and lymphoma and characterized by segmental caecal and ascending colonic ulceration that may progress to necrosis, perforation, and septicaemia. We present a unique case of an 8-year-old girl with recently diagnosed infectious mononucleosis having findings consistent with typhlitis on abdominal CT.
Cecum↗
T lymphocytes in infectious mononucleosis. II. Response in vitro to interleukin-2 and establishment of T cell lines.
The addition of 20% interleukin-2 (IL-2) significantly reduced the percentage of T lymphocytes dying in vitro after being isolated from the peripheral blood of acute infectious mononucleosis (IM) patients. Moreover, the immediate addition of 20% IL-2 to freshly isolated blood allowed IM T cell lines to be readily established from the peripheral blood of acute IM patients. Characterization of seven of these IM T cell lines showed them to be T3+, T11+, T4-, T9- and generally T10-. Over half of the lines characterized were T8+. It will now be possible to re-evaluate IM T cell effector functions as previous assays of IM T cell functions may have been influenced by the presence of rapid and extensive T cell death in vitro.
Cell Line↗
Accumulation of p53 in infectious mononucleosis tissues.
Epstein-Barr virus (EBV) infects lymphocytes, where it persists indefinitely for the life of the host; whether the virus interacts with p53 to maintain itself in these cells is unknown. Lymphoid biopsy samples from 10 patients with infectious mononucleosis (IM) were examined for expression of p53 by immunohistochemistry. Accumulation of p53 was detected in all 10 cases, primarily in large lymphocytes of the expanded paracortex. The presence of EBV was confirmed in all 10 cases by EBER1 (EBV-encoded RNA) in situ hybridization, whereas 11 non-IM control samples lacked significant EBER1 and did not express p53 in paracortical lymphocytes. Interestingly, EBV infection alone does not cause accumulation of intracellular p53, because many more cells expressed EBER1 than p53 in the IM tissues. To determine whether p53 was confined to the subset of infected cells in which viral replication was occurring, BZLF1 immunostains were performed. Viral BZLF1 was detected in 8 of 10 IM tissues; however, the paucity and small size of the BZLF1-expressing lymphocytes suggests that they are not the same cells overexpressing p53. To further examine the relationship between p53 and EBV gene expression, the tissues were studied for latent membrane protein 1 (LMP1) expression by immunohistochemistry. Viral LMP1 was observed in the large paracortical lymphocytes of all 10 cases of IM, indicating co-localization of p53 and LMP1 in these cells. Our findings confirm that p53 overexpression is not specific for nodal malignancy and that p53 accumulation is characteristic of IM. Because p53 was not coexpressed in the same cells as BZLF1, it appears that BZLF1 is not directly responsible for p53 accumulation. Nevertheless, co-localization of p53 and LMP1 in activated-appearing lymphocytes suggests that EBV infection is responsible for p53 accumulation. HUM PATHOL 31:1397-1403.
Adolescent↗
Exudative ascites complicating infectious mononucleosis.
A case of Epstein-Barr virus mononucleosis with the unusual complication of exudative ascites is presented. The patient was a 22-yr-old man with the typical symptoms and physical findings of hepatitis secondary to infectious mononucleosis. Extensive evaluation including liver biopsy, failed to show another cause for the patient's ascites. The ascites and hepatitis disappeared with resolution of the acute mononucleosis infection. He is well 12 months after this illness with no evidence for chronic liver disease. This case adds to the list of causes for exudative ascites associated with acute hepatitis.
Adult↗
Is agranulocytosis following infectious mononucleosis caused by autoimmunity?
A patient developed agranulocytosis after Epstein-Barr infection. Bone marrow examination revealed normal myelopoiesis with reduced mature neutrophil polymorphonuclear cells. IgG-specific antineutrophil antibodies (anti-HNA-1a) were found in serum and on polymorphonuclear cells, suggesting that the agranulocytosis after infectious mononucleosis was caused by an autoimmune mechanism.
Agranulocytosis↗
Epstein-Barr virus-carrying B cells in the blood during acute infectious mononucleosis give rise to lymphoblastoid lines in vitro by release of transforming virus and by proliferation.
In accordance with earlier studies, we detected higher numbers of Epstein-Barr virus (EBV)-carrying lymphocytes (B-EBV) in the blood of acute infectious mononucleosis (IM) patients and higher amounts of transforming EBV particles in the saliva compared to healthy seropositive individuals. B cells grew in cultures seeded with the low and high density IM lymphocytes. The majority of B cells which grew acquired the infection in vitro (2-step outgrowth), because addition of virus neutralizing antibodies considerably reduced the emergence of lymphoblastoid cell lines (LCLs). Only the minority of the explanted B-EBV cells proliferated. The antiviral drug phosphonoformate (PFA) did not influence the frequency of 2-step LCLs in the IM cultures. This may indicate that a large proportion of EBV carrying B cells have already entered the viral productive cycle in vivo and passed the PFA-sensitive stage at the time of explantation. Earlier experiments with blood of healthy seropositive individuals showed an inhibitory effect of PFA on the generation of LCLs. One healthy individual who entered this study as a control, probably had a reactivated EBV infection as judged by the anti-EA activity in his serum and the high level of virus in his saliva. He had antibodies against EBV nuclear antigens (EBNA), and therefore he did not have a primary infection at the time of the test. Judged by the number of wells with B cell growth, the frequency of virus-carrying B cells in his blood was low. It seems that anti-EBV immunity can control the number of infected B cells in the blood, but does not influence the virus load in the epithelial cells.
Acute Disease↗
Lymphocyte responses to EBV-associated antigens in infectious mononucleosis, and Hodgkin's and non-Hodgkin's lymphoma patients, with the leukocyte adherence inhibition assay.
The leukocyte adherence inhibition (LAI) assay was utilized as a test for cellular immunity to Epstein-Barr virus (EBV) antigens in 22 patients with infectious mononucleosis (IM), 47 patients with lymphoma, 101 carcinoma patients, and 84 subjects without cancer. Response to EB virion ("v") antigen was generally present at the time of diagnosis in the IM patients but the response to EB soluble ("S") antigen was delayed. An increased CMI response to "v" antigen was found in patients with IM, Hodgkin's disease and non-Hodgkin's lymphoma as compared to controls with and without cancer. Patients with Hodgkin's disease had depressed responses to the EBV-associated "S" antigen. The finding of increased LAI responses to "v" antigen in Hodgkin's disease patients with high EBV antibody titers conflicts with previous reports attributing high antibody responses against EBV to a generalized depressed cell-mediated immunity.
Antibodies, Viral↗
Enzyme-linked immunosorbent assay of antibodies to Epstein-Barr virus nuclear and early antigens in patients with infectious mononucleosis and nasopharyngeal carcinoma.
A sensitive enzyme-linked immunosorbent assay was used to measure titers of IgG antibodies against bacterially synthesized Epstein-Barr virus nuclear antigen and early antigen in sera from 100 healthy North Americans, 40 North American patients with infectious mononucleosis, and 48 Asian patients with nasopharyngeal carcinoma. All healthy persons previously infected with Epstein-Barr virus had antibodies to nuclear antigen, and 70% had very low but detectable antibody titers to early antigen. In contrast, patients with mononucleosis had nondetectable or very low levels of antibodies to nuclear antigen and high antibody levels to early antigen. High levels of antibody to early antigen also were seen in patients with nasopharyngeal carcinoma, and a decrease in this response during the first 12 months after diagnosis and treatment was a significant prognostic indicator of survival. The probability of survival was 75% for patients whose antibody concentration to early antigen remained constant or decreased, and near 0% for patients with increasing levels of antibody.
Antibodies, Viral↗
Epstein-Barr virus and infectious mononucleosis in children.
The presence of IgG antibodies to Epstein-Barr virus (EBV) has been investigated in two groups of children aged 3 to 35 months. The test group consisted of 31 children from an institution in which a high incidence of suspected infectious mononucleosis (IMN) was found. The control group comprised 54 children, aged 1 to 26 months, with noninfectious diseases. In the test group, 29 of the 31 children were positive for IgG anti-EBV antibodies in the serum, whereas only 5 children were positive in the control group. None of the children in the test group had detectable heterophile antibodies, and most of them did not show the typical symptoms of IMN. The reliability of diagnosing IMN in early childhood, by means of detection of anti-EBV serum antibody levels, is discussed.
Age Factors↗
Airway obstruction in children with infectious mononucleosis.
Epstein-Barr Virus (EBV) infection generally has a benign clinical course. Upper airway obstruction is a known complication requiring the otolaryngologist's attention. EBV is usually associated with adolescence but has been increasingly documented in younger children. We review 36 pediatric admissions for infectious mononucleosis over a 12-year period at our institution, 11 of which required consultation for airway obstruction. Airway management was based on clinical severity and ranged from monitored observation, with or without nasopharyngeal stenting, to prolonged intubation or emergent tonsilloadenoidectomy. A rare case of a four-year-old with near total upper airway obstruction secondary to panpharyngeal and transglottic inflammatory edema prompted this review and is reported. The otolaryngologist must recognize the potential severity of EBV-related airway compromise and be prepared to manage it.
Adolescent↗
Role of screening for infectious mononucleosis in patients admitted with isolated, unilateral peritonsillar abscess.
Two hundred and four cases of in-patient admission with isolated, unilateral peritonsillar abscess over the three-year period 1999-2001 were reviewed retrospectively. One hundred and fifty-one patients had been screened for infectious mononucleosis (IM) using the heterophile antibody screening test. Of these 142 (94 per cent) tested negative and nine (six per cent) positive. There were no IM-typical clinical or haematological signs in any of the IM positive patients to facilitate the prediction of the diagnosis. Due to the comparatively high prevalence of positives, the low cost of screening, the lack of predictive signs and the diversity of potential complications of IM, routine screening in all patients presenting with peritonsillar abscess is recommended.
Adult↗
Infectious mononucleosis in Greenland: a disease of the non-indigenous population.
Greenland Eskimos have one of the highest incidences of nasopharyngeal carcinoma (NPC) in the world. Asian and African areas endemic for NPC show early infection with Epstein-Barr virus (EBV), and few cases of infectious mononucleosis (IM). Among 40 000 Eskimos and 10 000 Caucasians in Greenland there were 82 reported cases of IM from 1963 to 1980. Incidence rates from 1975 to 1980, age adjusted to the "world" population distribution, were 12.0 and 5.2/100 000/yr for males and females, respectively. Comparable Danish data revealed incidence rates of 97.4 and 105.1. From 1970 to 1981 Greenland hospital records verified 16 cases, of which only 2 were in Eskimos. The IM incidence in Eskimos is extremely low, and Danes living in Greenland have a comparatively much higher incidence.
Adolescent↗