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The Netherlands Journal of Medicine Sep 2009
Topics: Adolescent; Diagnosis, Differential; Edema; Female; Herpesvirus 4, Human; Humans; Infectious Mononucleosis; Orbital Diseases
PubMed: 19767662
DOI: No ID Found -
The Cochrane Database of Systematic... Nov 2015Infectious mononucleosis, also known as glandular fever or the kissing disease, is a benign lymphoproliferative disorder. It is a viral infection caused by the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Infectious mononucleosis, also known as glandular fever or the kissing disease, is a benign lymphoproliferative disorder. It is a viral infection caused by the Epstein-Barr virus (EBV), a ubiquitous herpes virus that is found in all human societies and cultures. Epidemiological studies show that over 95% of adults worldwide have been infected with EBV. Most cases of symptomatic infectious mononucleosis occur between the ages of 15 and 24 years. It is transmitted through close contact with an EBV shedder, contact with infected saliva or, less commonly, through sexual contact, blood transfusions or by sharing utensils; however, transmission actually occurs less than 10% of the time. Precautions are not needed to prevent transmission because of the high percentage of seropositivity for EBV. Infectious mononucleosis is self-limiting and typically lasts for two to three weeks. Nevertheless, symptoms can last for weeks and occasionally months.Symptoms include fever, lymphadenopathy, pharyngitis, hepatosplenomegaly and fatigue. Symptom relief and rest are commonly recommended treatments. Steroids have been used for their anti-inflammatory effects, but there are no universal criteria for their use.
OBJECTIVES
The objectives of the review were to determine the efficacy and safety of steroid therapy versus placebo, usual care or different drug therapies for symptom control in infectious mononucleosis.
SEARCH METHODS
For this 2015 update we searched the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 7), which includes the Cochrane Acute Respiratory Infections Group's Specialised Register; MEDLINE (January 1966 to August 2015) and EMBASE (January 1974 to August 2015). We also searched trials registries, however we did not identify any new relevant completed or ongoing trials for inclusion. We combined the MEDLINE search with the Cochrane search strategy for identifying randomised controlled trials (RCTs). We adapted the search terms when searching EMBASE.
SELECTION CRITERIA
RCTs comparing the effectiveness of steroids with placebo, usual care, or other interventions for symptom control for people with documented infectious mononucleosis.
DATA COLLECTION AND ANALYSIS
We used the standard methodological procedures expected by Cochrane.
MAIN RESULTS
For this 2015 update, we did not identify any new RCTs for inclusion. The previous version of the review included seven trials with a total of 362 participants. Four trials compared the effectiveness of a steroid to placebo for short-term symptom control in glandular fever, one to aspirin, and two trials explored the effects of steroids in conjunction with an antiviral. Heterogeneity between trials prevented a combined analysis.Trials under-reported methodological design features. Three trials did not adequately describe sequence generation for randomisation. Four trials provided adequate details of allocation concealment. All trials were double-blind but four were not specific as to who was blinded. Loss to follow-up was under-reported in four trials, making it difficult to exclude attrition bias. The risk of selective reporting in the included trials was unclear.Across the trials, no benefit was found in 8/10 assessments of health improvement. Two trials found benefit of steroid therapy over placebo in reducing sore throat at 12 hours (eight-day course odds ratio (OR) 21.00, 95% confidence interval (CI) 1.94 to 227.20; one-dose OR 4.20, 95% CI 1.08 to 16.32), but the benefit was not maintained.In combination with an antiviral drug, participants in the steroid group had less pharyngeal discomfort between days two to four (OR 0.31, 95% CI 0.09 to 1.08) compared to placebo. Across the trials the effects on other common symptoms were less clear. Two trials set out to measure safety; they documented no major adverse effects. In two other trials adverse events were reported, including respiratory distress and acute onset of diabetes. However, the association of the events with the steroid is not definite.
AUTHORS' CONCLUSIONS
There is insufficient evidence to the efficacy of steroids for symptom control in infectious mononucleosis. There is a lack of research on the side effects and long-term complications.
Topics: Adolescent; Adrenal Cortex Hormones; Adult; Humans; Infectious Mononucleosis; Randomized Controlled Trials as Topic; Young Adult
PubMed: 26558642
DOI: 10.1002/14651858.CD004402.pub3 -
Computational and Mathematical Methods... 2021To study the clinical features of infectious mononucleosis (IM) caused by Epstein-Barr virus (EBV) mixed with Mycoplasma pneumonia (MP) or/and cytomegalovirus... (Review)
Review
To study the clinical features of infectious mononucleosis (IM) caused by Epstein-Barr virus (EBV) mixed with Mycoplasma pneumonia (MP) or/and cytomegalovirus (CMV)infection, collected 201 hospitalized children who met the IM diagnostic criteria, the clinical manifestations, laboratory tests, complications, treatment, and outcome were compared among EBV infection alone and EBV mixed with MP or/and CMV infection. Most of the children with IM were preschoolers, more frequently occurred in boys than girls. EBV patients with MP had the longest duration of fever. When mixed pathogen infections were involved, the white blood cell count of preschool children was significantly increased, while splenomegaly was more common in older children. In the cases of EBV infection alone, abnormal liver function was positively correlated with age ( = 0.044). Mixed pathogen infections were more common in children with IM, occurring in all age groups, and some clinical characteristics were related to the age of onset and the pathogen of the infection.
Topics: Adolescent; Child; Child, Preschool; China; Coinfection; Computational Biology; Cytomegalovirus Infections; Empirical Research; Female; Humans; Infant; Infectious Mononucleosis; Male; Pneumonia, Mycoplasma; Treatment Outcome
PubMed: 34804192
DOI: 10.1155/2021/2867913 -
American Journal of Hematology Oct 1996Virus-associated hemophagocytic syndrome (VAHS) has been thought to be a distinct clinical entity, characterized by intermittent fever, enlarged liver and spleen, and... (Review)
Review
Virus-associated hemophagocytic syndrome (VAHS) has been thought to be a distinct clinical entity, characterized by intermittent fever, enlarged liver and spleen, and the appearance of hemophagocytosis. Hemopoietic cells are actively ingested by monocytes/macrophages in various organs, including lymph nodes, bone marrow, liver, and spleen. Epstein-Barr virus (EBV) is now thought to be one of the major causes for the development of this unique syndrome. Additionally, VAHS is often associated with fatal infectious mononucleosis (IM). The relationship between EBV-associated VAHS and fatal IM is discussed in this concise review.
Topics: Herpesvirus 4, Human; Histiocytosis, Non-Langerhans-Cell; Humans; Infectious Mononucleosis
PubMed: 8892735
DOI: 10.1002/(SICI)1096-8652(199610)53:2<111::AID-AJH8>3.0.CO;2-2 -
Current Opinion in Virology Jun 2014Epstein-Barr virus (EBV) is responsible for a farrago of acute and chronic human diseases including cancer. A prophylactic vaccine could reduce this disease burden.... (Review)
Review
Epstein-Barr virus (EBV) is responsible for a farrago of acute and chronic human diseases including cancer. A prophylactic vaccine could reduce this disease burden. Several EBV vaccines have been given to humans but none has been sufficiently studied to establish safety and efficacy. EBV vaccine development has been hampered by the lack of an animal model other than subhuman primates, proprietary issues, selection of an appropriate adjuvant, and failure to reach consensus on what an EBV vaccine could or should actually achieve. A recent conference at the U.S. National Institutes of Health emphasizing the global importance of EBV vaccine and advocating a phase 3 trial to prevent infectious mononucleosis should encourage research that could eventually lead to its licensure.
Topics: Animals; Clinical Trials as Topic; Epstein-Barr Virus Infections; Herpesvirus 4, Human; Humans; Infectious Mononucleosis; Viral Vaccines
PubMed: 24632197
DOI: 10.1016/j.coviro.2014.02.005 -
Italian Journal of Pediatrics Jan 2021This study aimed to compare the clinical features and laboratory tests of infectious mononucleosis (IM) and hemophagocytic syndrome (HLH) caused by Epstein-Barr virus...
OBJECTIVES
This study aimed to compare the clinical features and laboratory tests of infectious mononucleosis (IM) and hemophagocytic syndrome (HLH) caused by Epstein-Barr virus (EBV) in 1-3-year-old children and to explore the risk factor of HLH caused by EBV (EBV-HLH).
METHODS
The clinical data of 92 children with EBV infection admitted in our hospital from 2011 to 2019 were collected; 61 cases were diagnosed as EBV-IM, and 31 cases were diagnosed as EBV-HLH. The subjects' clinical manifestations and laboratory tests were analyzed retrospectively.
RESULTS
Compared with EBV-IM patients, EBV-HLH patients had longer durations of fever, both before hospitalization and overall, and a higher probability of hepatomegaly. The levels of ALT, AST, LDH, TG, SF, D-Dimer and the plasma EBV DNA load of EBV-HLH patients were significantly higher than those of EBV-IM patients. The absolute values of CD3, CD4, CD8, NK, and CD3-CD19 cells and IgA and IgM levels of EBV-HLH patients were significantly lower than those of EBV-IM patients. The plasma EBV DNA load was positively correlated with the PT, TT, α-HBDH, AST, LDH, CK, Scr, BUN, UA, TG, and CRP levels in EBV-HLH patients, and the plasma EBV DNA load was positively correlated with the D-Dimer level in the EBV-IM patients. Among the 10 different potential markers, at the cut-off point of 1721.500 μg/L, the sensitivity and specificity of D-Dimer was 88.90 and 90.20%, respectively.
CONCLUSION
The D-Dimer level may be a good prognostic indicator of EBV-HLH caused by EBV.
Topics: Child, Preschool; Female; Herpesvirus 4, Human; Hospitalization; Humans; Infant; Infectious Mononucleosis; Lymphohistiocytosis, Hemophagocytic; Male; Retrospective Studies; Sensitivity and Specificity; Symptom Assessment; Viral Load
PubMed: 33413556
DOI: 10.1186/s13052-020-00949-7 -
CMAJ : Canadian Medical Association... Jul 2021
Topics: Humans; Infectious Mononucleosis; Radionuclide Imaging; Tomography, X-Ray Computed
PubMed: 34312170
DOI: 10.1503/cmaj.79110 -
BMC Infectious Diseases Oct 2023Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH) and infectious mononucleosis (EBV-IM) share mimic symptoms in the early stages of childhood...
BACKGROUND AND AIM
Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH) and infectious mononucleosis (EBV-IM) share mimic symptoms in the early stages of childhood development. We aimed to examine the clinical features and laboratory indices of these two diseases in children and uncover unique indicators to assist pediatricians in identifying these diseases early.
METHODS
We collected clinical data from 791 pediatric patients diagnosed with EBV-IM or EBV-HLH, compared the clinical traits and laboratory biomarkers presented in the two groups, and constructed predictive models based on them.
RESULTS
Patients with EBV-IM had greater ratios of cervical lymphadenopathy, eyelid edema, and tonsillitis, whereas individuals with EBV-HLH were more likely to have hepatomegaly and splenomegaly. When using the criteria of interleukin (IL)-10 > 89.6 pg/mL, interferon (IFN)-γ > 45.6 pg/mL, ferritin > 429 μg/L, D-dimer > 3.15 mg/L and triglycerides > 2.1 mmol/L, the sensitivity was 87.9%, 90.7%, 98.1%, 91.1% and 81.5% to predict EBV-HLH, while the specificity was 98.4%, 96.3%, 96.5%, 94.1% and 80.6%, respectively. A logistic regression model based on four parameters (IL-10, ferritin, D-dimer, and triglycerides) was established to distinguish EBV-HLH patients from EBV-IM patients, with a sensitivity of 98.0% and a specificity of 98.2%.
CONCLUSIONS
IL-10, IFN-γ, ferritin and D-dimer levels are significantly different between EBV-HLH and EBV-IM. Predictive models based on clinical signs and laboratory findings provide simple tools to distinguish the two situations.
Topics: Child; Humans; Herpesvirus 4, Human; Infectious Mononucleosis; Lymphohistiocytosis, Hemophagocytic; Epstein-Barr Virus Infections; Interleukin-10; Biomarkers; Ferritins; Triglycerides
PubMed: 37880605
DOI: 10.1186/s12879-023-08654-6 -
The Yale Journal of Biology and Medicine 1982Epsten-Barr virus oropharyngeal shedding has been demonstrated in infectious mononucleosis patients many months after acute illness and long after the disease hallmarks,... (Review)
Review
Epsten-Barr virus oropharyngeal shedding has been demonstrated in infectious mononucleosis patients many months after acute illness and long after the disease hallmarks, atypical lymphocytes and heterophile antibody, have disappeared. Extracellular virus is present more frequently in saliva than in other oropharyngeal samples. Prolonged excretion of EBV in asymptomatic carriers explains the difficulty in tracing case-to-case spread and increased transmissibility in age groups in which salivary exchange is high.
Topics: Adolescent; Adult; Antibodies, Viral; Child; Child, Preschool; Female; Herpesvirus 4, Human; Humans; Immunosuppression Therapy; Infectious Mononucleosis; Male; Oropharynx; Saliva; Salivary Glands; Time Factors
PubMed: 6295004
DOI: No ID Found -
BMC Infectious Diseases Feb 2022Infectious mononucleosis, a common disease in children and young adults, is often accompanied by elevated transaminase levels and rarely, liver failure. This study aimed...
BACKGROUND
Infectious mononucleosis, a common disease in children and young adults, is often accompanied by elevated transaminase levels and rarely, liver failure. This study aimed to determine whether adenosine deaminase is a marker of severity in children with infectious mononucleosis, especially those with elevated alanine transaminase levels.
METHODS
This case-control study was conducted at the Children's Hospital of Soochow University. A total of 104 children with infectious mononucleosis and 50 controls with other acute infections and fever, tonsillitis, or lymphadenitis, were enrolled in the study. Among the 104 children with infectious mononucleosis, 54 had normal alanine transaminase levels and 50 had elevated alanine transaminase levels. The children's clinical and laboratory data were analyzed to assess the diagnostic value of adenosine deaminase in the three groups.
RESULTS
The adenosine deaminase level in the infectious mononucleosis group was significantly higher than that in the control group (P < 0.001). The adenosine deaminase levels were highly correlated with lymphocyte count, CD3CD8 T cells (%), CD4/CD8 ratio, and CD3CD19 (%) (r > 0.7, P < 0.01). The sensitivity and specificity of adenosine deaminase in predicting children with infectious mononucleosis were 97.1% and 94.0%, respectively. Furthermore, multivariate regression analysis revealed that adenosine deaminase level was a risk factor for elevated alanine transaminase in children with infectious mononucleosis.
CONCLUSIONS
Adenosine deaminase may be a marker of the severity of infectious mononucleosis in children, and a predictor of elevated alanine transaminase in children with infectious mononucleosis.
Topics: Adenosine Deaminase; CD8-Positive T-Lymphocytes; Case-Control Studies; Herpesvirus 4, Human; Humans; Infectious Mononucleosis
PubMed: 35189820
DOI: 10.1186/s12879-022-07150-7