Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0021345 (infectious mononucleosis)
 3,358 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Despite the fact that nucleoside analogues, such as aciclovir and ganciclovir, and DNA-polymerase inhibitors, such as foscarnet, have a proven antiviral effect on oropharyngeal-Epstein-Barr virus (EBV) replication, they have been unable to show any effect on the severity or duration of infectious mononucleosis (IM), a condition for which there is currently no established treatment. Clinical symptoms may be due to an EBV-induced polyclonal humoral, as well as cellular, immunoreactivity with limited pathology caused by viral replication itself. However, despite an extensive immune response, 90% of tested IM patients (n = 36) had a spontaneous outgrowth of in vivo EBV-infected B-lymphocytes at onset of disease, indicating lack of specific EBV-restricted cellular cytotoxicity at this time. Establishment of an EBV-specific T-lymphocyte response occurred 90-180 days after onset of disease (human leukocyte antigen-restricted cytotoxicity against EBV-infected B-cells). Thus, development of a specific cytotoxic response was a gradual and slow process. Assessment of cytokine pattern, at the single cell level, was performed by immunocytochemical technique and by enzyme-linked immunosorbent assay. This revealed an increased production of interleukin (IL)-2, interferon (IFN)-gamma, IL-6 and tumour necrosis factor (TNF) beta in all IM patients. Those with disseminated disease were characterized by lack of IFN-gamma production. This loss was selective since in vitro stimulation with superantigen, such as streptococcal pyrogenic exotoxin A, induced a normal response. These patients lacked signs of EBV-specific T-cell cytotoxicity in vitro. Treatment with intravenous or subcutaneous IFN-gamma, 1.5 MU every second day, in combination with intravenous immunoglobulin G (0.5 g/kg three times per week) and oral aciclovir, 800 mg 5 times daily, has shown promising results in some patients. Cytokine production in tonsil tissue in 4 patients with fulminant IM and respiratory tract obstruction showed a concomitant expression of IL-2, IFN-gamma, IL-6, TNF beta, transforming growth factor (TGF) beta 1-3, granulocyte colony stimulating factor, granulocyte macrophage colony stimulating factor, IL-4 IL-1alpha, IL-beta and TNF alpha. The number of IL-2, IFN-gamma, IL-6 and TNF beta producing cells was significantly higher compared to tonsil tissue obtained from children with tonsillar hypertrophy. Thus, IM is associated with extensive local cytokine production. It is suggested that this extensive cytokine production is closely involved in the pathology of IM and that patients with atypical IM have a dysregulation in the cytokine network. However, the mechanism by which EBV-infected B-lymphocytes triggers this cytokine cascade is still unknown. These findings show the need for evaluation of patients with immunodeficiency and EBV-induced lymphoproliferative disorders and perhaps the introduction of new immunoregulatory treatment strategies.
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PMID:Clinical and immunological considerations in Epstein-Barr virus-associated diseases. 886 Mar 57

We report the case of a 23-year-old male who presented to the emergency department with severe upper airway obstruction resulting from infection of the palatine tonsils. Manifestations of tonsillar infection and airway obstruction included hoarseness and extreme difficulty breathing, severe sore throat and inability to swallow liquids or solids. Urgent otolaryngologic consultation was obtained, and the patient was taken directly to the operating suite for nasotracheal intubation with tracheostomy standby. The patient was maintained on broad-spectrum antibiotics and was discharged after a hospital course complicated by pulmonary oedema, tracheitis and difficulty weaning from the ventilator, requiring temporary tracheostomy. The Monospot test was negative for infection with the Epstein-Barr virus (EBV). We could find no previously reported cases of adults with severe palatine tonsillar-induced airway obstruction which was not due to infection with EBV (mononucleosis). The airway management of obstruction due to palatine tonsillar hypertrophy is discussed.
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PMID:Upper airway obstruction from tonsillar infection in adults. 942 36

Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH) is a non-malignant proliferative disorder characterized by histiocytic proliferation and hemophagocytosis following Epstein-Barr virus infection. Though quite rare, this condition represents an often fatal disease primarily affecting the pediatric population. We discuss the case of an adolescent female who presented initially with persistent cervical lymphadenopathy and the typical findings of tonsillar hypertrophy, pharyngitis, and splenomegaly associated with infectious mononucleosis. This case study outlines the pathogenesis, common clinical findings, diagnostic criteria, and a review of the HLH-94 treatment protocol. Early recognition and treatment is emphasized because of the fulminant course of the disorder.
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PMID:Persistent cervical lymphadenopathy in an adolescent with Epstein-Barr induced hemophagocytic syndrome: manifestations of a rare but often fatal disease. 1591 Oct 25

This review summarizes the information that supports the potential importance of anaerobic bacteria in the pharyngo-tonsillitis (PT) associated with infectious mononucleosis (IM). Evidence supportive of the potential of involvement of bacteria in IM was provided by several studies that showed increased recovery of bacteria on the tonsillar surfaces in IM. Several studies demonstrated that metronidazole therapy alleviated the clinical symptoms of tonsillar hypertrophy and shortened the duration of fever in IM. Metronidazole has no antimicrobial activity against aerobic bacteria and is only effective against anaerobic bacteria. A possible mechanism of its action is the suppression of the oral anaerobic flora that might contribute to the inflammatory process induced by the Epstein-Barr virus. This explanation is supported by the increased recovery of Prevotella intermedia and Fusobacterium nucleatum from the tonsillar surfaces during the acute phases of IM and an immune response against these organisms by patients with IM. Although more studies are needed, these findings support the possible pathogenicity of Gram-negative anaerobic bacteria in the PT associated with IM.
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PMID:The association of anaerobic bacteria with infectious mononucleosis. 1670 90

Infectious Mononucleosis (IM), a benign lymphoproliferative disease, is the best known clinical syndrome caused by Epstein-Barr Virus (EBV). It usually resolves over a period of weeks or months without sequelae but may occasionally be complicated by a wide variety of neurologic, hematologic, hepatic, respiratory, and psychological complications. In this report we describe a patient with acute hepatitis following EBV-IM in a previously healthy woman. A 26-year-old woman who presented with fever, generalized weakness, nausea, sore throat, yellowing of skin, and a generalized skin rash was admitted to our clinic. Tonsillar enlargement, pharyngeal erythema, palatal petechiae, lymphadenopathy, and jaundice were noted. Significant atypical lymphocytes ( > 10%) were seen on the peripheral blood smear. Liver function tests such as ALT: 303 U/L, AST: 172 U/L, ALP: 193 U/L and total bilirubin: 7.3 mg/dl were elevated. Serological tests for EBV infection were consistent with acute infection (EBV virus capsid antigen was reactive with IgM and IgG antibodies). The Monospot test was also positive. On the seventh day, liver function tests and bilirubin had risen to peak level and platelets were decreased. The patient was managed supportively and her critical condition improved and was finally stabilized. Although the prognosis for IM is very favorable, a variety of acute complications may occur.
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PMID:Acute hepatitis: a rare complication of Epstein-Barr virus (EBV) infection. 2104 62