Concurrent Infectious Mononucleosis Research Articles

Antibiotic-Induced Rash in Patients With Infectious Mononucleosis.

To provide an extensive review of case reports, epidemiological data, and the underlying mechanism of antibiotic-induced skin rash in patients with concurrent infectious mononucleosis (IM). A MEDLINE literature search inclusive of the dates 1946 to June 2016 was performed using the search terms anti-bacterial agents and infectious mononucleosis. EMBASE (1980 to June 2016) was searched using the terms mononucleosis and antibiotic agent and drug eruption. References of all relevant articles were reviewed for additional citations and information. We selected English-language, primary literature, review articles, and mechanistic articles that addressed antibiotic-induced skin rash in patients with concurrent IM. We assessed all case reports available for causality utilizing a modified Naranjo nomogram specifically designed for this subject. We assembled the available epidemiological data into tables to identify trends in incidence rates over the years. We identified 17 case reports of antibiotic-associated rash in patients with IM. The median Naranjo score was 6 (range = 1 to 8). The top 3 reported drugs were ampicillin, azithromycin, and amoxicillin. Incidence of this adverse effect was higher in the 1960s (55.6%, 45%, and 33%) than in 2013 (33% and 15%). The mechanism most commonly proposed is a transient virus-mediated immune alteration that sets the stage for loss of antigenic tolerance and the development of a reversible, delayed-type hypersensitivity reaction to the antibiotic. A reassessment of the long-held belief of the high incidence (80%-100%) of antibiotic-induced skin rash in patients with IM seems prudent. Additional studies will be necessary to clarify this issue.

Management of Blunt Splenic Injury in Patients with Concurrent Infectious Mononucleosis

Selective nonoperative management is appropriate for most blunt splenic injuries in adults and children, but the efficacy of this approach is unknown when injury occurs in patients with concurrent infectious mononucleosis. We have reviewed our experience during the past 23 years with the selective nonoperative management of blunt splenic injury in these patients. Medical record review identified nine patients with blunt splenic injury and infectious mononucleosis from 1978 to 2001, representing 3.3 per cent of our total trauma population with blunt splenic injury treated during that interval. Two patients underwent immediate splenectomy because of hemodynamic instability. Seven patients were admitted with the intent to treat nonoperatively. Five patients were successfully managed nonoperatively. Two patients failed nonoperative management and underwent splenectomy, one because of hemodynamic instability and one because of an infected splenic hematoma. Concurrent infectious mononucleosis does not preclude the successful nonoperative management of blunt splenic injury. This small subset of patients may be managed nonoperatively using the same criteria as for patients whose splenic injuries are not complicated by infectious mononucleosis.

Concurrent infectious mononucleosis and measles: a potentially life-threatening association sharing underlying immunodeficiency

We report lethal interstitial pneumonia in an 18-year-old young man with measles infection following recent infectious mononucleosis. We speculate that the documented T cell immune impairment caused by the concurrent Epstein-Barr and measles viral infections (as expressed by a proportionately low CD4+ lymphocyte count) was responsible for the complicated clinical course and unfavorable outcome.

Concurrent infectious mononucleosis and acute myelocytic leukemia.

The case of a patient with infectious mononucleosis and acute myelocytic leukemia is presented. The course of the leukemia seems not to have been influenced beneficially by the infection. The total survival time was 11 months. The data of this patient are discussed in relation to those of other patients with concurrent infectious mononucleosis and acute leukemia, reported in the literature.

Concurrent mononucleosis and acute leukemia.

To the Editor.— With regard to the report on concurrent infectious mononucleosis and acute leukemia by Freedman et al ( 214 :1677, 1970), my associates, Drs. Levine, Lee, Sonley, and Waggoner, of the National Cancer Institute, Bethesda, Md, Children's Hospital, Montreal, and Hospital for Sick Children, Toronto, and I have been studying this phenomenon for the past two years. Our studies have been reported in preliminary form and will appear shortly in full. 1,2 We have tried to reach beyond the case report phase, and see if this concurrence will help us understand the lymphoproliferative potential of the Epstein-Barr (EB) virus, and what effect the concurrence might have on the survival of patients with acute lymphatic leukemia. To this end we have been gathering such cases from several centers, and we were interested in the experience of the Children's Hospital of Los Angeles, with their large leukemia service. Two comments appear

Concurrent infectious mononucleosis and acute leukemia: Case reports. Review of the literature and serologic studies with the herpes-type virus (EB virus)

The development of infectious mononucleosis (IM) in the course of acute lymphocytic leukemia (ALL) appears to have a favorable effect on the latter disease, as determined from published cases, unpublished data tabulated in this report and two closely followed cases presented in detail. In addition, after convalescence these patients appear to have high titers to EB virus (EBV), the agent considered by many to cause IM. When serial serum specimens were available, a secondary rise in antibody titer well after recovery from IM was documented. This rise possibly is unique to the concurrence of these two diseases, since titers in patients without leukemia fall after recovery from IM and remain relatively constant, and we have shown here that in ALL titers do not rise routinely. Serum samples from patients with long survival after ALL (three and a half to fifteen years) without a history of concurrent IM were also assayed and found to have a geometric mean anti-EBV titer higher than various control groups. However, there was considerable overlap in individual titers, and expanded study of this phenomenon is required to assess its significance. The features of IM in patients with ALL are noted. Seroconversion to EBV is indicated in one case during the incubation period and before symptoms of IM, in contrast to earlier reports; this is thought to be related to the sensitivity of the assay method. If further study supports an association of IM, clinical and subclinical EBV infection, titer of EBV antibodies and favorable course of leukemia, the mechanism remains to be elucidated. Precedents from laboratory investigation and clinical observation are noted, and some hypotheses are briefly discussed.

Concurrent Infectious Mononucleosis and Acute Leukemia

Despite speculation that infectious mononucleosis could be an abortive form of acute lymphatic leukemia, four children under our observation developed both diseases concurrently. Infectious mononucleosis preceded acute leukemia by three months in one case and occurred at various times during hematologic remission in the others. A review of these and five similar cases, reported previously, suggests that infectious mononucleosis is an intercurrent illness which is etiologically unrelated to acute leukemia.

Urticaria in infectious mononucleosis.

To the Editor:— In the recent article by Africk and Halprin describing concurrent infectious mononucleosis and (209:1524, 1969) it is stated that such an association has been infrequently documented in the past. I concur with this. The dearth of previous reports was noted during the preparation of a prior, recently published article discussing infectious mononucleosis and acute (Ann Allerg27:182, 1969). Five reports of patients with infectious mononucleosis and (as the sole dermatologic disorder) were included in that communication; thus, eight well-documented instances of such concurrence have been reported in the past six months. This would seem to buttress the argument for considering infectious mononucleosis in the presence of hives especially in the absence of any other clearcut unequivocal precipitant and apparently reinforces the conclusion of Africk and Halprin that urticaria does indeed occur as an infrequent manifestation of infectious mononucleosis. There are several theoretical