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[Profile of microorganisms isolated in nasopharyngeal swabs from the patients with acute infectious mononucleosis].

Infectious mononucleosis is a self-limiting lymphoproliferative disorder, which contribute to the development of the various clinical symptoms. Exudative tonsillitis was found to be caused by Epstein-Barr virus in 19% of all viral infections and may imitate a bacterial etiology. The aim of this study was to identify the microbes from the nasopharyngeal swabs obtained from the patients with exudative tonsillitis and to assess their susceptibility to antibiotics. The patients were hospitalized as an infectious mononucleosis after unsuccessful antibiotic therapy. 84 patients were investigated: group I--patients with serological positive infectious mononucleosis tests and group II--patients with acute exudative tonsillitis and with serologically excluded infectious mononucleosis. The diagnosis was confirmed clinically, haematologically, biochemically and serologically. Nasopharyngeal specimens were taken, once, at the first day of hospitalization. Then, routine microbiological assays were performed. Isolated strains were identified biochemically: API Strep, API Staph, API E, API Ne, APINH (bioMerieux). The susceptibility to antibiotics with an agar diffusion assay was performed according to Kirby-Bauer. We concluded that various, potentially pathogenic bacterial flora was found in throat during infectious mononucleosis. Haemophilus spp. and Staphylococcus aureus MSSA were isolated more frequently. Haemophilus influence was susceptible to cefotaxime and azytromycine. Candida albicans was isolated in every fourth patient. Streptococcus pyogenes as an etiological agent of exudative tonsillitis was confirmed in the group II. The pharyngeal candidiosis was also observed more frequently in the group II.

Acute Disease↗

Activation of suppressor T cells during Epstein-Barr-virus-induced infectious mononucleosis.

Infectious mononucleosis is caused by the Epstein-Barr virus (EBV), an unusual human pathogen because it preferentially infects B lymphocytes and consequently activates them to produce immunoglobulins. When cultures of lymphocytes from patients with infectious mononucleosis were stimulated with polyclonal activators, unseparated cells failed to produce immunoglobulins, whereas purified B cells responded normally. Cocultures demonstrated profound suppressor T-cell activity in blood from patients with infectious mononucleosis. Early in this disease, circulating immunoglobulin-secreting cells were elevated, but during the second week their number was strikingly depressed. These data indicate that during infectious mononucleosis, EBV causes polyclonal activation of B cells, reflected by hypergammaglobulinemia and increased circulating immunoglobulin-secreting cells. Next, suppressor T cells become activated and inhibit further B-cell activation. Thus, activation of suppressor T cells in infectious mononucleosis provides a unique additional mechanism of host defense because these T cells inhibit the activation and proliferation of an important target of the causative virus.

Adolescent↗

Infectious mononucleosis.

Infectious mononucleosis is a unique disease in its hematologic aspects; it is different from the frequently occurring acute microbial diseases in that it affects primarily the reticuloendothelial system; and it is interesting serologically because of the heterophil antibody reaction, as well as the multiplicity of antibodies which may be produced. The diagnosis should be suspected clinically before hematology is reported - by remembering the prototypes. In fact, a patient between 16 and 25 years old who complains of sore throat and fever is more likely to have infectious mononucleosis than another disease; and if - in addition - he is jaundiced, a diagnosis of infectious mononucleosis is almost certain. Finally, a negative result of treatment with corticosteroid has the diagnostic significance mentioned above. Positive effect of treatment has no diagnostic significance.

Adolescent↗

Quinolone drug rash in a patient with infectious mononucleosis.

Infectious mononucleosis and the associated ampicillin rash are well documented. The case of a patient with infectious mononucleosis who was treated with levofloxacin and developed a rash similar to the ampicillin rash is reviewed. The exact mechanism is not understood. With closer observation, physicians may be able to recognize more cases with similar phenomena.

Administration, Oral↗

Severe chest pain due to infectious mononucleosis.

Infectious mononucleosis complicated by acute myopericarditis was finally diagnosed in a 17-year-old boy who presented with sore throat and severe left-sided chest pain. A mononucleosis spot test and heterophil agglutination test turned strongly positive only on the sixth hospital day. The natural course of infectious mononucleosis complicated by myopericarditis appears to be benign.

Adolescent↗

Detection of cell-free Epstein-Barr virus DNA in serum during acute infectious mononucleosis.

Infectious Epstein-Barr virus (EBV) is shed from the oropharynx of infected hosts intermittently throughout life, but in the peripheral circulation the viral genome characteristically maintains itself in a noninfectious, cell-associated form. Sera from 125 persons with heterophil-positive acute infectious mononucleosis or EBV-associated nasopharyngeal carcinoma or who were healthy virus carriers were examined for evidence of cell-free viral DNA. EBV DNA suggesting viremia was detected in 11 (27%) of 41 infectious mononucleosis patients by polymerase chain reaction analysis but infrequently in healthy seropositive carriers and patients with nasopharyngeal carcinoma. In serial samples examined from 2 patients, serum EBV DNA was detected over a 3-day interval. Viral DNA was found in concert with one serologic marker of acute infection, EBV-specific polymeric IgA, that could affect patterns of viral spread and clinical symptomatology.

Acute Disease↗

Medical complications of infectious mononucleosis.

Infectious mononucleosis is usually a benign, self-limited disease, but complications may develop in up to 5 percent of patients. The complications can be life-threatening and may precede, follow or coincide with the usual symptoms of infectious mononucleosis. Occasionally, a complication is the only clinical manifestation of the disease. Complications may be due to an autoimmune response, a lymphocytic infiltrative reaction, generalized edema of the airway tissues or enlargement of the spleen.

Adolescent↗

Diagnosing infectious mononucleosis.

Infectious mononucleosis can be diagnosed with certainty only when suggestive clinical findings are corroborated by relative and absolute lymphocytosis, lymphocyte atypia of more than 20 percent and a positive serologic test. A serologic test is not absolutely necessary when atypical lymphocytes exceed 40 percent since this is specific to infectious mononucleosis. The diagnosis is difficult when clinical findings are scanty and the blood picture is unhelpful.

Adolescent↗

Chromosome aberrations, apoptosis, and DNA repair in peripheral blood lymphocytes in children with infectious mononucleosis.

Infectious mononucleosis is associated with suppression of lymphocyte apoptosis and accumulation of cells with chromosome aberrations in the peripheral blood. The type and severity of these aberrations do not depend on the etiological variant of infection and patient age. At the same time in 3-6-year-old children with infectious mononucleosis caused by Epstein-Barr virus we observed activation of DNA repair system in lymphoid cells.

Adolescent↗

[Sialadenitis at an unusual site in acute infectious mononucleosis].

Infectious mononucleosis is found worldwide. The clinical manifestations vary widely. We report a case with impressive swelling of the hard and soft palate. Inflammation in the region of the efferent ducts of the palatinal glands resulted in congestion in the region of the mucinous salivary glands. The subsequent secretory stasis caused degeneration of the acini and rupture of a salivary retention cyst. The surrounding connective tissue was soaked with mucin, and unspecific chronic granular inflammation was found. Immunohistochemical examination with a monoclonal EBV antibody was necessary to show that the exceptional clinical picture was due to infectious mononucleosis.

Adult↗

Acute complications of Epstein-Barr virus infectious mononucleosis.

Infectious mononucleosis caused by Epstein-Barr virus (EBV) usually resolves over a period of weeks or months without sequelae but may occasionally be complicated by a wide variety of neurologic, hematologic, hepatic, respiratory, and psychological complications. The strength of association of EBV with many of these complications remains based on scattered case reports, often using unsophisticated diagnostic tests, and the evidence for causation in many instances is unconvincing. There is little benefit of antiviral treatment of uncomplicated or complicated infectious mononucleosis. Corticosteroids may have a role in hastening resolution of some complications, especially upper airway obstruction and possibly immune-mediated anemia and thrombocytopenia, but should be used judiciously.

Adrenal Cortex Hormones↗

[Intense icterus in the course of EBV infectious mononucleosis].

Infectious mononucleosis induced by the Epstein Barr Virus (EBV) is a benign illness that is frequently accompanied by a slight hepatic disfunction. On occasion it may be accompanied by autoimmune hemolytic anemia of little clinical importance. Nevertheless, this association can cause a serious set of symptoms that can put the patient's life in danger if it is not treated quickly. We present the case of a 21-year-old male with infectious mononucleosis and severe jaundice (total bilirubin 40 mg/dl) due to the combination of diseased liver and secondary autoimmune hemolytic anemia, caused by the EBV infection.

Adult↗

Infectious mononucleosis.

Infectious mononucleosis is an acute, self-limiting, nonneoplastic lymphoreticular proliferative disorder characterized by peripheral lymphocytosis and circulating atypical lymphocytes. Epstein-Barr virus is the causative agent in 90% of cases. Highest incidence is in the 15- to 25-year-old age-group, with 1% to 3% of all college students in the United States affected each year. Clinical manifestations vary according to age at presentation. Incubation period is 4 to 7 weeks. Diagnosis is primarily made with the monospot test but may include throat culture and complete blood count with differential. Cytomegalovirus and human immunodeficiency virus are among the many other conditions that may present initially as infectious mononucleosis. Treatment is supportive with prevention of complications as the goal; good personal hygiene and avoidance of contact sports should be stressed.

Adolescent↗

Splenic rupture and infectious mononucleosis.

Infectious mononucleosis is an acute viral illness associated with a high incidence of splenomegaly, although the incidence of splenic rupture is low. When rupture occurs, the mortality has been significant, presumably, because a history of trauma is not present. The spleen may be vulnerable to injury due to the histopathologic changes that occur as a result of this illness. Essentially all patients with spontaneous rupture related to infectious mononucleosis have epigastric or upper abdominal pain. The diagnosis of splenic rupture may be confirmed in a variety of ways. In those patients who are hemodynamically stable, CT scan, ultrasound, or radionuclide scan may aid in establishing the diagnosis. Selective splenic angiography is very accurate but has been largely abandoned because of the invasive nature of the study. Peritoneal lavage is efficacious in establishing the diagnosis in hemodynamically unstable patients. The treatment of choice, at this time, is splenectomy. Current interest in splenic salvage has resulted in reports of nonoperative therapy in stable patients and splenorrhaphy in one instance. Due to the extent of the histologic changes in the spleen, caution is urged in electing the conservative approach to this clinical situation.

Adult↗

Peritonsillar abscess associated with infectious mononucleosis.

Infectious mononucleosis (IM) is characterized as a viral disease; thus, no antibiotic treatment is recommended. However, some of these patients tend to develop a long-lasting, painful disease, which can be relieved by antibiotic administration. Due to this bed-side knowledge, we re-evaluated 928 patients with peritonsillar abscess (PA), treated during a 5.5-year period in the Department of Otorhinolarygology of Turku University Central Hospital. Of these patients 15 (1.6%) also had infectious mononucleosis (IM). During this period, 64 patients with severe pharyngeal IM were treated in our department and thus the proportion of PA in patients with IM was 23.4%. A control of 15 age- and sex-matched patients with PA but without mononucleosis was formed in order to evaluate the possible differences in patient history, clinical symptoms and findings. Such differences were small and did not affect the chosen treatment of PA, abscess tonsillectomy. There was no peri- or postoperative difference in complications or recovery, but the hospitalization time was longer in IM patients with PA (3.1 days) than in patients with PA only (2.4 days). IM patients referred to ENT departments make a special group of patients, who may also need surgical treatment.

Adolescent↗

Diagnosis and treatment of infectious mononucleosis.

Infectious mononucleosis is caused by the Epstein-Barr virus (EBV) and most commonly affects young adults from 15 to 35 years of age. The diagnosis is made by accurate assessment of clinical, hematologic and serologic manifestations of the illness. Manifestations include the classic triad of fever, pharyngitis and cervical lymphadenopathy; lymphocytosis with a predominance of atypical lymphocytes; a positive heterophil (Monospot) antibody test; and in some cases, serologic evidence of EBV-specific antibodies produced against antigens related to the virus. The most valuable serologic finding is the presence of IgM antibody to EBV viral capsid antigen, which is found during acute primary EBV infection. Infectious mononucleosis is considered a self-limited illness, but it may result in serious complications involving the pulmonary, ophthalmologic, neurologic and hematologic systems. Treatment is focused on managing the symptoms, unless more severe disease involving other organ systems occurs. The most common potentially fatal complication is splenic rupture.

Convalescence↗

Infectious mononucleosis.

Infectious mononucleosis in its classical presentation consists of the clinical triad of fever, pharyngitis, and cervical lymphadenopathy. The majority of cases are caused by primary infection with the Epstein-Barr virus (EBV). There is, however, a wide clinical spectrum of disease manifestations, including pulmonary, hematologic, and neurologic findings and a series of associated laboratory abnormalities, such as lymphocytosis, heterophile antibodies, and anti-EBV antibodies. The disease is typically self-limited and treated with supportive therapy only. Rarely, serious complications such as airway obstruction, severe thrombocytopenia, or severe hemolytic anemia can occur. Infectious mononucleosis does not cause congenital anomalies, and pregnant women are not at increased risk of serious complications resulting from the disorder.

Journal Article↗