Clinical Manifestations Of Infectious Mononucleosis Research Articles

Clinical and laboratory aspects of infectious mononucleosis in different age groups

Infectious mononucleosis is an acute anthroponotic disease that develops as a result of human infection with viruses of the Herpesviridae family: Epstein – Barr virus (EBV), cytomegalovirus (CMV), herpes viruses of the 6th (HHV-6) and 7th types.The aim of our work was to study the clinical features and laboratory parameters of the course of infectious mononucleosis in patients of three age groups.Material and methods. A retrospective analysis of 156 medical records of patients who were on outpatient treatment by an infectious disease specialist at Clinical Medicine Center MedMix was carried out. Patients were divided into three categories according to the age criterion: the first group from 0 to 5 years consisted of 58 (37.2 %) children, the second group was represented by persons from 5 to 18 years old – 58 (37.2 %), the third group was formed by patients from 18 to 53 years old – 40 (25.6 %) people.Results and its discussion. Among children aged 0 to 5 years, boys (67.2 %) more frequently fell sick, and in the group from 18 to 53 years, females (70 %) were more likely to have the disease. Clinical symptoms such as generalized lymphadenopathy (82.7 %), nasopharyngeal lesions (79.3 %) and changes in the general blood test (86.2 %) were most frequently detected in children aged up to 5 years, while fever (81 %) and oropharyngeal lesions (74.1 %) were most frequently detected in patients aged from 5 to 18 years. Liver damage with the development of acute induced viral hepatitis was recorded in all age groups (24.1, 27.6 and 30 %). EBV infection was most frequently diagnosed among children aged from 5 to 18 years and persons aged from 18 to 53 years (in 62.1 and 70 % of cases, respectively, p < 0.05). Mixed infection with the combination of VEB + CMV + HHV-6 was significantly more frequent in children under 5 years of age (34.5 %; p < 0.05).Conclusions. In childhood, the clinical manifestations of infectious mononucleosis were more pronounced. Such intense course of the disease caused frequent visits to an infectious disease specialist and diagnostics with the establishment of an etiological agent. The dominance of EBV infection in the development of infectious mononucleosis in all groups was established. However, at the age up to 5 years, the most common mixed infections were the following combinations: EBV + CMV, EBV + HHV-6, EBV + CMV + HHV-6 and CMV + HHV-6.

Molecular genetic characterization of the epstein–Barr Virus: a relationship with the clinical features of pediatric infectious mononucleosis

Introduction. Infectious mononucleosis (IM) is an high priority viral infection in children. Epstein-Barr virus (EBV) is the main etiological agent of IM. EBV is classified into two main types EBV-1 and EBV-2. In addition, different variants of the virus are isolated based on individual genes, among which the LMP-1 gene and the oncoprotein it encodes are the most well known. So far, the study of the clinical significance of EBV genetic diversity in EBV-IM in children in Russia has not been conducted. The aim of the study was to evaluate a relationship between EBV LMP-1 molecular genetic variants and clinical and laboratory manifestations of IM in children.
 Materials and methods. The material of the study was presented by blood leukocyte and saliva samples of children aged 117 years with EBV-IM (n = 69). A total of 132 EBV isolates were studied. For differential detection of EBV-1/EBV-2, we used a previously optimized one-round PCR variant with electrophoretic detection of amplification products in agarose gel. The nucleotide sequences of the C-terminal region of the LMP-1 gene were determined by Sanger sequencing followed by analysis of the obtained sequences using the MEGA X software. Multiple Factor Analysis was used to search for the relationship between LMP-1 variants and clinical and laboratory manifestations of IM (32 signs and 8 groups of signs).
 Results. It was established that only one type of virus, EBV-1, was identified in all children. At the same time, the severity of clinical manifestations of EBV-IM in children varied significantly (from 15.5 to 35.5 scores in total). Molecular genetic analysis of the sequences of the LMP-1 C-terminal region in Nizhny Novgorod region EBV isolates demonstrated a significant heterogeneity of the viral population, which was not limited only to their grouping according to known variants. According to the frequency of detection, B95-8 was the dominant variant of LMP-1 (60.66.0% of cases), other variants were less common (China 1, NC, Med and China 1+В95-8). It was found that EBV-IM proceeded more easily and with less severity of the intoxication syndrome in cases of infection with a virus having the molecular genetic profile of EBV-1/B95-8, in particular EBV-1/B95-8/E214D. Conversely, EBV-1/Med, as well as EBV-1/Med/L338S, EBV-1/Med/S229T, EBV-1/China 1/L338S and EBV-1/NC/S229T profiles were associated with more severe infection.
 Conclusion. For the first time, the influence of the genetic diversity of EBV on the clinical manifestations of IM in children was revealed. In the context of the tasks to be solved in this study, it is necessary to conduct a larger-scale and systemic studies in different territories of Russia.

Клініко-сонографічні показники як діагностичні критерії інфекційного мононуклеозу в дітей

Актуальність. Значний поліморфізм клінічних проявів інфекційного мононуклеозу, поліорганність ураження, часта відсутність чітких клініко-параклічних критеріїв та відстроченість результатів доступних лабораторних тестів, а іноді і неможливість їх проведення утруднюють діагностику захворювання на догоспітальному етапі та при надходженні до стаціонару. Мета дослідження: оптимізувати діагностику та лікування інфекційного мононуклеозу в дітей шляхом вивчення сучасних особливостей перебігу та аналізу діагностичної цінності клінічних та інструментальних показників у верифікації захворювання. Матеріали та методи. На базі інфекційного боксованого відділення крапельних інфекцій КМУ «Обласна дитяча клінічна лікарня» (м. Чернівці) обстежені 65 дітей, хворих на інфекційний мононуклеоз, які знаходилися на стаціонарному лікуванні в період 2014–2015 рр., першу клінічну групу (І) сформували 42 дитини, заключний клінічний діагноз захворювання у яких верифіковано на підставі комплексу клініко-гематологічних критеріїв, до другої (ІІ) клінічної групи порівняння увійшли 23 дитини, хворі на серологічно підтверджений інфекційний мононуклеоз. За основними клінічними ознаками групи спостереження вірогідно не відрізнялися. Результати. Установлено, що для хворих на інфекційний мононуклеоз дітей характерні клінічні особливості, зокрема раптовий початок захворювання (у 93,8 %) із лихоманки, вищої за 37,5 °С (у 80 %), наявність ексудативного тонзиліту (у 81,6 %), підщелепної та шийної лімфаденопатії (у 90,7 %), утрудненого носового дихання (у 78,4 %) та гугнявості голосу (у 73,8 %). У підтвердженні інфекційного мононуклеозу Епштейна — Барр-вірусної етіології явища ексудативного тонзиліту та лімфаденопатії виявилися високочутливими (90 та 95 % відповідно), проте із значною часткою хибнопозитивних результатів. Висновок. Таким чином, з урахуванням недостатньої діагностичної цінності клініко-анамнестичних та сонографічних показників у виявленні інфекційного мононуклеозу Епштейна — Барр-вірусної етіології в дітей, що підтверджувалося низькими значеннями відношення правдоподібності та показників ризику, використання їх доцільне лише в комплексі.

Clinical manifestations and laboratory results of 61 children with infectious mononucleosis.

ObjectiveTo investigate the clinical manifestations of infectious mononucleosis in children of different ages.MethodsClinical data from pediatric patients with infectious mononucleosis admitted from May 2015 to April 2019 were retrospectively analyzed. Patients were stratified into three groups (age 1–3 years, 4–6 years, and 7–14 years) for analysis of clinical and laboratory results.ResultsData from 61 patients (male:female ratio 1.18:1) aged 5.15 ± 2.93 years (mean ± standard deviation; range: 1–14 years) were analyzed. Infectious mononucleosis occurred throughout the year and the main clinical manifestations were fever (98.3%), tonsillitis (100%), tonsillar white exudate (83.6%), cervical lymphadenopathy (98.3%), hepatomegaly (37.7%), splenomegaly (42.6%), eyelid edema (41.0%), and nasal obstruction (49.2%). Disease onset was most common during early childhood (37.7%) and at preschool age (37.7%). Younger children had more obvious symptoms of nasal obstruction and older children had more significant elevations of alanine aminotransferase and higher percentages of atypical lymphocytes.ConclusionThe clinical manifestations of infectious mononucleosis in children differed by age. These associations required attention for clinical decision making.

Clinical manifestations of infectious mononucleosis in primary or reactivated herpes virus infection

Based on the analysis of foreign and domestic literature, the article presents the features of infectious mononucleosis caused by the main pathogens from the Herpesviridae family, course of the disease at various phases of the infectious process. The article identifies clinical and laboratory manifestations characteristic of each pathogen. The authors discuss the issues related to the lack of the unified terminology for describing chronic herpes virus infection. The article discusses the causes of persistent herpes virus infections, risk factors for the adverse course and outcome of herpes virus infections.

Инфекционный мононуклеоз у детей: клинико-лабораторная характеристика в зависимости от этиологии и фазы инфекционного процесса

Objective. To assess the association between clinical and laboratory characteristics of infectious mononucleosis (IM) and disease etiology and phase of infection. Patients and methods. This prospective observational study was conducted at Z.A.Bashlyaeva Children's City Clinical Hospital, Moscow Healthcare Department and included 107 children with IM. Laboratory testing was performed at the Department of Virological Diagnostics, National Medical Research Center for Hematology, Ministry of Health of the Russian Federation. Results. IM is a polyetiologic disease. So far, researchers have failed to find a significant correlation between clinical manifestations of IM and its etiology and phase of infection. Patients with IM caused by primary monoinfection with Epstein–Barr virus (EBV) are at high risk of developing chronic EBV infection. Neutrophilia is a typical laboratory sign of IM during the acute phase of it. Conclusion. The improvement of IM diagnosis with a detailed evaluation of clinical and laboratory criteria, as well as risk assessment of unfavorable outcome are currently impossible without the identification of both disease etiology and phase of infection. Key words: human herpes virus VI, Epstein–Barr virus, children, infectious mononucleosis, cytomegalovirus

Analysis of clinical features of 21 cases of adult infectious mononucleosis

Objective To improve understanding of infectious mononucleosis by reporting the clinical data of 21 adults diagnosed as infectious mononucleosis. Methods We investigated retrospectively the clinical and laboratory data of 21 patients diagnosed as infectious mononucleosis. Results Among those 21 cases, the manifestations were fever(19 cases, 90%), angina(14 cases, 67%), lymphadenopathy(15cases, 71%), hepatosplenomegaly (9 cases, 43%). Laboratory results showed that increased leucocyte count(10 cases, 48%), high percentage of abnormal lymphocytes between 10% to 29%(14 cases, 67%), abnormal liver function(18 cases, 86%), positive Epstein-Barr virus capsid antigen IgM(18 cases, 86%). All 21 patients were get better. Conclusion It showed that the clinical manifestations of infectious mononucleosis in adults were complex and diverse.The diagnosis should be combined with clinical manifestations and relevant examination.The outcome of this disease is good. Key words: Infectious mononucleosis; Aged

Glomerulonephritis in a patient with chronic active Epstein-Barr virus infection

Renal involvement is rare in chronic active Epstein-Barr virus (EBV) infection. We report an 11-year-old girl who had focal mesangial proliferative glomerulonephritis with cellular crescents and renal tubular atrophy with foam cells in the lumen at the time of the first admission. However, the patient was not diagnosed with chronic active EBV infection until the third admission, 18 months later, because she did not exhibit typical clinical manifestations of infectious mononucleosis, i.e., fever, lymphadenopathy, hepatomegaly, or increased atypical lymphocytes. We performed in situ hybridization of EBV in renal biopsy and renal autopsy tissue and found EBV genome-positive cells in the enlarged vascular areas surrounding the renal tubules in both specimens. The relationship between mesangial proliferative glomerulonephitis with crescents and chronic active EBV infection is unknown.

Virologic Diagnosis, Viral Monitoring, and Treatment of Epstein-Barr Virus Infectious Mononucleosis.

Epstein-Barr virus (EBV) is the cause of infectious mononucleosis and is associated with severe infections in immunocompromised patients. EBV is also causally linked with several human malignancies. The heterophile antibody test and EBV-specific antibody tests remain the principal means of diagnosis of initial infection in otherwise healthy patients. Enzyme-linked immunosorbent assays have replaced the traditional immunofluorescence assays for EBV-specific antibodies. Several newer molecular diagnostic tests have become available that facilitate accurate monitoring of infection. The role of these tests for patients with uncomplicated infectious mononucleosis is limited, although these tests are being increasingly used to monitor the state and level of EBV replication for severe infections and among immunocompromised patients. Antiviral therapy has a limited, short-term effect on oropharyngeal shedding but has proven ineffective for the clinical manifestations of infectious mononucleosis. Patients with selected complications frequently benefit from short-term corticosteroid therapy.

Serum Cytokine Levels in Infectious Mononucleosis at Diagnosis and Convalescence

Infection with the Epstein-Barr virus (EBV) is common worldwide. A significant number of infected individuals develop infectious mononucleosis (IM). IM is manifested in most patients as a benign disease with mild symptoms. However, serious complications may develop in a subset of patients. Because EBV-infected B lymphocytes produce various cytokines that may provide the cells with a proliferative advantage, cytokine concentrations in serum samples taken from IM patients were measured in order to identify the cytokines responsible for the clinical manifestations of the disease. The concentrations of interleukin-1β (IL-1β), IL-2, IL-6, IL-8, IL-10, tumor necrosis factor-aL (TNF-aL), and lymphotoxin (LT) were measured using an enzyme-linked immunosorbent assay (ELISA) in serum obtained from 14 IM patients during the acute phase of the disease and during convalescence, 5 patients with identical clinical manifestations who did not have IM (sick controls), and 11 healthy volunteers. It was found that the serum levels of TNF-aL and IL-6 were significantly high in patients with acute IM compared with the serum levels in healthy individuals (P=0.008 and P 0.001, respectively) but returned to normal at convalescence (P=0.009 and P=0.005 respectively). However, whereas TNF-aL concentrations were significantly higher (P=0.04) in patients with acute IM than in the sick controls, no significant difference in IL-6 concentrations was found between the two groups of patients. Changes in IL-10 concentration were not statistically significant, and IL-1β IL-2, IL-8, and LT were detected only sporadically. The data in this study suggest that TNF-aL may have a specific role in causing the clinical manifestations of IM. Further studies should determine the clinical significance of TNF-aL inhibition in IM.

Clinical and Immunologic Features of Primary EpsteinBarr Virus Infection and Infectious Mononucleosis.

Meeting Abstracts1 May 1971Clinical and Immunologic Features of Primary EpsteinBarr Virus Infection and Infectious Mononucleosis.Daniel E. Lehane, M.D., Neil R. Newberg, M.D., Walter E. BeamDaniel E. Lehane, M.D.Search for more papers by this author, Neil R. Newberg, M.D.Search for more papers by this author, Walter E. BeamSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-74-5-828_3 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptSeveral investigators have demonstrated rising Epstein Barr (EB) virus antibody titers in infectious mononucleosis. Since most EB virus infections go unrecognized and EB virus has been associated with several other conditions, the causal relationship of EB virus to infectious mononucleosis remains uncertain. We have attempted to clarify this relationship by describing primary EB virus infections in terms of serum and nasal secretory immunoglobin responses. The clinical manifestations of infectious mononucleosis have been determined by reviewing 66 documented cases, and a mild illness similar to mononucleosis has been demonstrated during typical EB virus infections.Serum and nasal secretion specimens collected biweekly... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: MSC USN Camp LeJeune, N.C. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 May 1971Volume 74, Issue 5Page: 828-828KeywordsClinical immunologyEpstein-Barr virus Issue Published: 1 May 1971 PDF downloadLoading ...

Early clinical manifestations of infectious mononucleosis.

Early clinical manifestations of infectious mononucleosis.

Infectious mononucleosis hepatitis: A clinicopathologic study

1. 1. Twenty-two young men with clinical manifestations of infectious mononucleosis were studied by liver function tests and liver biopsy in an attempt to clarify aspects of hepatitis in this disease. 2. 2. Function tests and/or biopsy indicated hepatic involvement in all cases, biopsy specimens showing return to normal in all but one instance within five weeks. 3. 3. One case of persistent hepatitis, studied by function tests and serial biopsies, showed continuation of the disease for approximately eight months, and is still being followed up. 4. 4. In three of the twenty-two cases heterophil antibody determinations remained below diagnostic evels. All three had abnormal liver function tests and two biopsy specimens yielded positive findings despite lack of confirmation of the diagnosis by the Paul-Bunnell test. 5. 5. The significance of these results in the light of previous studies by other observers is discussed.

Pleural effusion in infectious mononucleosis.

Excerpt The extremely variable clinical manifestations of infectious mononucleosis may best be understood from studies1of the histologic features of the disease. These have shown widespread cellula...

INFECTIOUS MONONUCLEOSIS

The variegated clinical manifestations of infectious mononucleosis have been emphasized repeatedly by most writers on the subject in recent years. 1 It has also been emphasized that these manifold signs and symptoms often make the diagnosis difficult, because frequently some particular combination of symptoms of the disease will duplicate the important findings of other clinical entities. We have reviewed a series of 300 cases of infectious mononucleosis observed over the past twenty months at several large air force hospitals, and we also have encountered the same long list of heterogeneous symptoms and signs that have been observed and recorded by other investigators. Moreover, we find that the relative frequency of these manifestations, with but insignificant percentage variations, closely approximates that observed by previous authors. In addition, however, to these manifestations, we have observed in this series 3 cases characterized by a severe anemia with leukopenia and thrombopenia which presented considerable