Mononucleosis-like Syndromes Research Articles

Cytomegalovirus Primary Infection in an Immunocompetent Female with Mononucleosis Features: A Review of Mononucleosis-Like Syndromes

Background
 The clinical triad of fever, pharyngitis, and lymphadenopathy was first described in 1889 as “glandular fever” and later defined as infectious mononucleosis. We present a case report and review of mononucleosis-like syndromes in an immunocompetent patient. The review of common etiologies includes Epstein-Barr virus (EBV), acute human immunodeficiency virus (HIV), human herpesvirus 6 (HHV-6), cytomegalovirus (CMV), and Toxoplasmosis gondii.
 Case Vignette
 A 37-year- old, immunocompetent female presented with a three-week history of fever, pharyngitis, fatigue, night sweats, and abdominal pain. Physical examination revealed hepatosplenomegaly, but no lymphadenopathy, rashes, or tender joints. Investigations showed lymphocytosis and a normal peripheral smear. A Hematology consultation excluded hematologic malignancy. Her CD4/CD8 ratio was 0.2 in keeping with a viral infection, but EBV monospot test was negative. Serology for hepatitis B and C were negative. Human immunodeficiency virus (HIV) testing was not done in the absence of risk factors. Quantitative PCR for CMV was positive with a value of 965.25 units/mL. The patient was diagnosed with CMV viremia and treated with a two-week course of valganciclovir with resolution of symptoms. A two-month follow-up revealed a normal complete blood count and resolving hepatosplenomegaly.
 Conclusions
 In immunocompetent patients presenting with symptoms of mononucleosis, the differential diagnosis should include EBV, CMV, HHV-6, acute HIV and Toxoplasmosis gondii. CMV commonly affects young patients and is less associated with tonsillitis, pharyngitis, and lymphadenopathy. HHV-6 can present with headaches, encephalitis, and abdominal pain. Consideration of acute HIV mononucleosis should prompt early serologic testing. Toxoplasmosis is often associated with undercooked food or cat excrement, requiring anti-IgM antibody testing to distinguish from EBV. Although EBV infectious mononucleosis may be suspected, the general practitioner should consider a complete review of other infectious etiologies.

Study on Anti-Human Herpes Virus 6 Effects of Baicalin

Human Herpes Virus 6 (HHV-6), which is different with Human Immunoddficiency Virus (HIV) was first isolated from peripheral blood mononuclearcells of six patients with AIDS and lymphoproliferative disorders in 1986. It is one of the most common viral infection in AIDS patients. The pathological changes caused by HHV-6 are usually serious and easy to recur. The infection affect prognosis of AIDS apparently. HHV-6 infection is related to various diseases, such as chronic fatigue syndrome, necrotizing lymphadenitis, mononucleosis-like syndromes, AIDS, recipients of organ transplantation and hepatitis. HHV-6 can be found even in healthy bodies. At present, little is known about the mechanism of latency and reactivation of HHV-6 so there is no effective specificity drug on HHV-6 infection. Therefore, it is very important to find safety and effective anti-HHV6 drugs. To study the anti-HHV-6 action of Baicalin, the human T-cell strain was used to do the anti-HHV-6 effect in vitro. The result shows that Baicalin has evident effect on cytopathic effect (CPE) caused by HHV-6 GS. This result prompts that Baicalin has therapeutical effect on infection caused by HHV-6t.

Role of herpesvirus as a cause of mononucleosis-like and febrile syndromes in Cuba, 2006-2009

Herpesvirus infections are prevalent worldwide, but most run their course asymptomatically. Clinical presentations in symptomatic cases vary widely and include febrile and mononucleosis-like syndromes. In immunocompromised patients, herpetic infection can be lethal and routine laboratory tests are of little use. Use of novel techniques may provide important improvements in diagnosis and treatment of these patients. Investigate association between different herpesviruses and the etiology of mononucleosis and febrile syndromes in Cuban immunocompetent and immunocompromised patients. The study used multiplex nested polymerase chain reaction, enabling simultaneous detection of six herpesviruses--cytomegalovirus, herpes simplex (1 and 2), Epstein-Barr, varicella-zoster and human herpesvirus 6--to study 1157 samples (770 urine and 387 serum samples) from 1140 patients with mononucleosis-like syndrome or febrile syndrome, classified according to history of immunosuppressive disease. Samples were analyzed at the Laboratory for Sexually Transmitted Diseases (Virology) of the Pedro Kourí Tropical Medicine Institute from January 2006 through December 2009. SPSS statistical package was used and incidence rates calculated. Of samples studied, 20.1% were positive for some herpesvirus. Higher risk of developing active herpesvirus infections was detected in samples from immunocompromised patients with febrile syndrome compared to those of immunocompetent ones (OR 2.02, CI 1.20-3.42, p=0.007). Cytomegalovirus was the most frequently found herpesvirus in both mononucleosis-like syndrome (60.4%) and febrile syndrome (63.6%) and in both children (69.2%) and adults (55.2%), followed by Epstein-Barr virus. Cytomegalovirus was detected in 68.9% of positive urine samples and in just 47.2% of serum samples. This is the first Cuban study demonstrating the pathogenic role of herpesviruses, particularly cytomegalovirus, in patients with febrile or mononucleosis-like syndrome, in both immunocompetent and immunocompromised patients. Results highlight the importance of including molecular diagnosis of the herpesvirus family in investigating mononucleosis and febrile syndromes of unknown etiology and demonstrate that etiologic diagnosis would not have been feasible in many cases without the use of this diagnostic tool.

Role of Herpesvirus as a Cause of Mononucleosis-Like and Febrile Syndromes in Cuba, 2006–2009

INTRODUCTION: Herpesvirus infections are prevalent worldwide, but most run their course asymptomatically. Clinical presentations in symptomatic cases vary widely and include febrile and mononucleosis-like syndromes. In immunocompromised patients, herpetic infection can be lethal and routine laboratory tests are of little use. Use of novel techniques may provide important improvements in diagnosis and treatment of these patients. OBJECTIVE: Investigate association between different herpesviruses and the etiology of mononucleosis and febrile syndromes in Cuban immunocompetent and immunocompromised patients. METHODS: The study used multiplex nested polymerase chain reaction, enabling simultaneous detection of six herpesviruses-cytomegalovirus, herpes simplex (1 and 2), Epstein-Barr, varicella-zoster and human herpesvirus 6-to study 1157 samples (770 urine and 387 serum samples) from 1140 patients with mononucleosis-like syndrome or febrile syndrome, classified according to history of immunosuppressive disease. Samples were analyzed at the Laboratory for Sexually Transmitted Diseases (Virology) of the Pedro Kouri Tropical Medicine Institute from January 2006 through December 2009. SPSS statistical package was used and incidence rates calculated. RESULTS: Of samples studied, 20.1% were positive for some herpesvirus. Higher risk of developing active herpesvirus infections was detected in samples from immunocompromised patients with febrile syndrome compared to those of immunocompetent ones (OR 2.02, CI 1.20-3.42, p=0.007). Cytomegalovirus was the most frequently found herpesvirus in both mononucleosis-like syndrome (60.4%) and febrile syndrome (63.6%) and in both children (69.2%) and adults (55.2%), followed by Epstein-Barr virus. Cytomegalovirus was detected in 68.9% of positive urine samples and in just 47.2% of serum samples. CONCLUSIONS: This is the first Cuban study demonstrating the pathogenic role of herpesviruses, particularly cytomegalovirus, in patients with febrile or mononucleosis-like syndrome, in both immunocompetent and immunocompromised patients. Results highlight the importance of including molecular diagnosis of the herpesvirus family in investigating mononucleosis and febrile syndromes of unknown etiology and demonstrate that etiologic diagnosis would not have been feasible in many cases without the use of this diagnostic tool.

Involvement of adenovirus in clinical mononucleosis-like syndromes in young children

Although Epstein-Barr virus (EBV) commonly causes infectious mononucleosis (IM) or IM-like syndromes, other agents can be implicated. In this study, viral and parasitic screening was performed to determine the etiological agent of pediatric IM-like syndromes in 38 children. Adenovirus was the agent most frequently detected (47.3%), followed by EBV (31.5%) and cytomegalovirus (2.6%). Although the statistically significant difference between viral detection rates observed in patients who fulfilled clinical and hematological criteria and detection rates in those who presented clinical symptoms only (91.6% vs. 64.3%) indicates that hematological abnormalities are common in viral IM-like syndromes, the existence of syndromes of viral etiology without hematological criteria cannot be discarded. A further analysis showed an absence of lymphocytosis in adenovirus infections as well as a low number (14.3%) of EBV infections associated with increased neutrophils. These data suggest the usefulness of appropriate virological techniques for the detection of adenovirus in pediatric IM-like syndromes.

A case of simultaneous primary HIV-1 and CMV infections

HIV-1 and cytomegalovirus (CMV) share common routes of transmission and most HIV-infected persons are also infected by CMV. Primary infections by HIV-1 as well as by CMV may result in similar flu-like illnesses and can also present clinically as distinct mononucleosis-like syndromes. Symptoms include fever, malaise, myalgias, arthralgias, rash, headache, lethargy, sore throat, nausea, vomiting, diarrhea, and weight loss. Although both these primary infections can cause severe symptoms, these infections often pass asymptomatically or cause only mild disease. Patients with severe disease have been described in simultaneously co-infected patients (Berger et al., 1996; Bonetti et al., 1989; Raffi et al., 1990; Schindler and Neftel, 1990). We describe a patient presenting with an acute retroviral illness directly followed by an acute primary CMV infection. This is to our knowledge the first case in which close monitoring of serological and viral load measurements have been performed. A 55-year-old previously healthy man was send to our hospital with a 3-day history of a ulcerative skin eruption, a genital ulcer, headache, sore throat, and painful inguinal lymph node enlargements. He stated having infrequent, unprotected homosexual contacts, the last contact being 4 weeks before presentation. On physical examination, the temperature was 37.3 ◦C. Painful enlarged inguinal lymph nodes were found. Examination of the skin and genitalia revealed widespread nodular and papular lesions some of which showed central hemorrhagic necrosis and ulceration. Differential diagnosis of the skin eruption was secondary syphilis, leukaemia cutis, pityriasis lichenoides et varioliformis acuta and primary HIV-1 infection. Laboratory tests revealed the following values: haemoglobin 9.5 mmol/l; WBC count 4.1 × 109/l; platelet count 86 × 109/l; serum

Chronic fatigue syndrome in psychiatric patients: lifetime and premorbid personal history of physical health.

This preliminary report compares a group of chronic fatigue syndrome (CFS) patients and controls on several variables of potential significance in the etiology of CFS. The lifetime prevalence of reported physical disorders was compared among 46 CFS psychiatric patients, 92 relatively physically healthy psychiatric patients (C-I), and 46 psychiatric patients selected without regard to physical health (C-II). All patients were matched on age, sex, and psychiatric diagnosis and were drawn from the same psychiatric practice. The same groups were compared on a 7-point scale of lifetime physical health by three raters independently evaluating physical health narratives of the CFS patients up to the time of onset of CFS and that of the controls up to the corresponding age. The CFS patients had a significantly higher reported lifetime prevalence of irritable bowel syndrome (IBS), infectious mononucleosis-like syndromes (IM), infectious mononucleosis-like syndromes two or more times (IM x 2), and herpes (other than genital or perioral herpes) than one or both control groups. The CFS group also had a higher incidence of allergic rhinitis or asthma, IBS, IM, and IM x 2 than the combined controls. On the independent ratings, the CFS patients had significantly more impaired physical health up to the time of onset of the CFS than C-I at a comparable age. The findings suggest that a general health factor may be involved in the pathogenesis of some cases of CFS.

ACUTE AIDS RETROVIRUS INFECTION: Definition of a Clinical Illness Associated with Seroconversion

In the course of a prospective immunoepidemiological study of homosexual men in Sydney, seroconversion to the AIDS-associated retrovirus (ARV) was observed in 12 subjects. Review of the clinical files defined an acute infectious-mononucleosis-like illness in 11 subjects. The illness was of sudden onset, lasted from 3 to 14 days, and was associated with fevers, sweats, malaise, lethargy, anorexia, nausea, myalgia, arthralgia, headaches, sore throat, diarrhoea, generalised lymphadenopathy, a macular erythematous truncal eruption, and thrombocytopenia. In 1 subject an incubation period of 6 days after presumed exposure to ARV was determined and in 3 subjects seroconversion took place 19, 32, and 56 days after onset. Comparison of T-cell subsets before and after the acute illness showed inversion of T4:T8 ratio in 8 subjects, due to increased numbers of circulating T8+ cells. These findings support the notion of an acute clinical, immunological, and serological response to infection with ARV which should be considered in the differential diagnosis of mononucleosis-like syndromes in groups at high risk for the development of AIDS.