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Separation of Immune Cell Subpopulations in Peripheral Blood Samples from Children with Infectious Mononucleosis
Published on: September 7, 2022
Common questions about infectious mononucleosis
Jason Womack1, Marissa Jimenez1
1Rutgers University, Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Abstract:
Epstein-Barr is a ubiquitous virus that infects 95% of the world population at some point in life. Although Epstein-Barr virus (EBV) infections are often asymptomatic, some patients present with the clinical syndrome of infectious mononucleosis (IM). The syndrome most commonly occurs between 15 and 24 years of age. It should be suspected in patients presenting with sore throat, fever, tonsillar enlargement, fatigue, lymphadenopathy, pharyngeal inflammation, and palatal petechiae. A heterophile antibody test is the best initial test for diagnosis of EBV infection, with 71% to 90% accuracy for diagnosing IM. However, the test has a 25% false-negative rate in the first week of illness. IM is unlikely if the lymphocyte count is less than 4,000 mm3. The presence of EBV-specific immunoglobulin M antibodies confirms infection, but the test is more costly and results take longer than the heterophile antibody test. Symptomatic relief is the mainstay of treatment. Glucocorticoids and antivirals do not reduce the length or severity of illness. Splenic rupture is an uncommon complication of IM. Because physical activity within the first three weeks of illness may increase the risk of splenic rupture, athletic participation is not recommended during this time. Children are at the highest risk of airway obstruction, which is the most common cause of hospitalization from IM. Patients with immunosuppression are more likely to have fulminant EBV infection.
Insights
Epstein-Barr virus (EBV) causes infectious mononucleosis (IM), often in young adults. Diagnosis relies on heterophile antibody tests, but early illness may yield false negatives, necessitating further EBV-specific antibody testing.
Area of Science:
- Virology
- Infectious Diseases
- Immunology
Background:
- Epstein-Barr virus (EBV) is a widespread virus infecting most of the global population.
- While often asymptomatic, EBV can cause infectious mononucleosis (IM), typically in individuals aged 15-24.
- IM symptoms include sore throat, fever, fatigue, and lymphadenopathy.
Purpose of the Study:
- To outline the clinical presentation and diagnostic approaches for Epstein-Barr virus (EBV) infection manifesting as infectious mononucleosis (IM).
- To review current treatment strategies and highlight potential complications associated with IM.
Main Methods:
- Review of clinical presentation and diagnostic criteria for IM.
- Analysis of diagnostic test accuracy, including heterophile antibody and EBV-specific antibody tests.
- Evaluation of treatment efficacy and complication risks.
Main Results:
- The heterophile antibody test is the primary diagnostic tool for IM, with 71%-90% accuracy, but can have false negatives early in illness.
- EBV-specific IgM antibodies confirm infection but are more costly and time-consuming.
- Symptomatic treatment is standard; glucocorticoids and antivirals offer no proven benefit in reducing illness duration or severity.
- Splenic rupture is a rare complication, with physical activity restricted for three weeks post-onset to mitigate risk.
- Airway obstruction is the most common cause of hospitalization in children with IM.
Conclusions:
- Accurate diagnosis of EBV infection (IM) relies on clinical suspicion and appropriate serological testing, considering test limitations.
- Management focuses on symptomatic relief and preventing complications like splenic rupture and airway obstruction.
- Immunocompromised individuals face a higher risk of severe EBV infection.
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