Infectious mononucleosis

OBJECTIVE: To present updated aspects of the Infectious Mononucleosis caused by the Epstein-Barr Virus. MATERIALS AND METHODS: Research of bibliographic references through the Medline and direct research of selected papers. RESULTS: A concise approach to some aspects related to the epidemiology of the virus, namely the two types that are presently known,EBVtypeAandEBVtype B, and some differences that they present. It was possible to establish a relationship between what one sees in the clinical picture and the immunological changes that occur at the same time. The author also describes the physiopathology, clinical features, complications and other syndromes associated to the EBV. As far as the laboratory workup is concerned, it is important to have a complete blood count as the first step, followed by the quantitative exam of the heterophile antibodies and antibodies antiEBV analysis. CONCLUSION: The pathologies related to the EBV are important, and certainly fascinating from the immunological point of view. Among these, the Infectious Mononucleosis caused by the EBV has shown some interesting clinical and laboratorial aspects.     

Infectious mononucleosis.

An up-to-date review of the clinical diagnostic and treatment of infectious mononucleosis, emphasizing on new etiological concepts (Epstein-Barr virus) and pathogenetic (T and B lymphocytes) interaction is presented.     

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目的探讨传染型单核细胞增多症(传单)、类传单和EB病毒(EBV)感染病例的临床特点。方法对重庆医科大学附属儿童医院2003—2004年收治的602例传单、类传单和EBV感染患儿的相关资料进行回顾性分析。结果传单组的临床表现较EBV感染组典型,淋巴结肿大和眼睑水肿的发生率显著高于类传单组,传单组眼睑水肿的发生率(62.7%)已接近常见的典型表现出现的比率;类传单组病例微小病毒(HPVB19)的感染率为54.8%,显著高于传单组;3组病例肝功能改变都以酶学改变为主,其中LDH改变最为明显;血液系统并发症表现为贫血、粒细胞减少和血小板减少,各组发生率没有统计学差异;类传单组病例肺炎发生率显著高于传单组;EBV感染组出现传单组没有的ITP病例和脑炎病例。结论眼睑水肿对传单有着与其它典型表现同样重要的诊断意义;HPVB19是类传单的一个重要病原;EBV感染后部分病例发展为传单,部分病例仍以EBV感染状态存在,可能存在异常的免疫反应。     

Infectious mononucleosis in adolescents.

Infectious mononucleosis is a clinical manifestation of primary EBV infection in adolescents, characterized by a triad of clinical, laboratory, and serologic features. The classic signs and symptoms are not seen in every patient; rather, the presentations tend to fit into one of three clinical forms (pharyngeal, glandular, or febrile). Recognizing these syndromes provides a useful framework for anticipating the clinical course, complications, and differential diagnosis. Nonclassic presentations of IM include a wide variety of neurologic abnormalities, thrombocytopenic purpura, and splenic rupture. The laboratory features of IM include absolute lymphocytosis with a large percentage of atypical lymphocytes, and abnormal liver chemistries in 90% of patients. The diagnosis of IM is confirmed serologically, usually with the demonstration of heterophile antibodies; the test can conveniently be performed in office laboratories. If the heterophile antibody test is negative, EBV-specific serologic tests can identify whether the illness is due to primary EBV infection. Once the diagnosis of IM is made, appropriate guidelines for resumption of activity should be provided to patients, especially to those with evidence of splenomegaly. Medical management includes supportive therapy with adequate analgesia. Corticosteroids are indicated for patients with upper airway obstruction; they may be helpful in patients with neurologic, hematologic, or cardiac complications. Acyclovir may prove to be useful, but further studies are needed before its use can be recommended.     

Infectious mononucleosis and the Epstein-Barr virus.

Recent elucidation of the relationship between the Epstein-Barr virus and infectious mononucleosis has resulted in the development of new diagnostic serological tests, and has amplified our knowledge of the epidemiological and clinical aspects of the disease. The history, epidemiology, clinical characteristics, diagnostic features, and therapy of infectious mononucleosis are reviewed. This is done in the light of recent knowledge concerning the Epstein-Barr virus as well as previous studies employing the traditional diagnostic criteria of heterophil positivity, the classical clinical symdromes, and characteristic changes in the blood cell count. Immunological studies concerning host resistance and its occasional failure are reviewed with particular reference to T and B lymphocyte activity in the disease.