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Infectious mononucleosis in patients aged 40 to 72 years: report of 27 cases, including 3 without heterophil-antibody
Abstract:
Epstein-Barr-virus (EBV)-induced infectious mononucleosis usually occurs in young adults between the ages of 15 and 30. When it occurs in older individuals, it frequently presents diagnostic problems. This report describes data from 27 such patients aged 40 to 72, all of whom had definitive evidence of a current EBV primary infection. Protracted fever, jaundice, pleural effusion, anemia, or the Guillain-Barré syndrome were dominant clinical findings among these patients. Fourteen patients were hospitalized and numerous diagnostic procedures were performed, including bone-marrow aspirations (8 patients), abdominal CAT scan procedures (4 patients), and liver (2 patients) or lymph-node biopsies (1 patient). Overall, the laboratory data in these patients were similar to those seen in young adults, with the exception of more marked hepatic dysfunction and more prominent antibody responses to the restricted (R) component of the early antigen complex. Particularly difficult were the diagnostic problems encountered in three patients in this study (3/27) who failed to develop heterophil antibodies.
Insights
Epstein-Barr virus (EBV) infectious mononucleosis presents diagnostic challenges in older adults, often mimicking other conditions. This study highlights key clinical and laboratory findings in patients over 40 with primary EBV infection.
Area of Science:
- Infectious Diseases
- Virology
- Internal Medicine
Background:
- Epstein-Barr virus (EBV) infectious mononucleosis (IM) typically affects young adults (15-30 years).
- Diagnosis of EBV IM in older adults (≥40 years) can be challenging due to atypical presentations.
- This study focuses on the clinical characteristics and diagnostic difficulties of primary EBV infection in an older demographic.
Purpose of the Study:
- To describe the clinical presentation and diagnostic challenges of primary Epstein-Barr virus infection in individuals over 40.
- To compare laboratory findings in older adults with EBV IM to those in younger adults.
- To identify specific difficulties in diagnosing EBV IM in older patients, particularly those lacking heterophil antibodies.
Main Methods:
- Retrospective analysis of 27 patients aged 40-72 with confirmed primary EBV infection.
- Review of clinical findings, including fever, jaundice, anemia, and neurological syndromes.
- Analysis of laboratory data, including hepatic function tests and antibody responses.
- Evaluation of diagnostic procedures such as bone marrow aspiration, CT scans, and biopsies.
Main Results:
- Dominant clinical findings included protracted fever, jaundice, pleural effusion, anemia, and Guillain-Barré syndrome.
- Laboratory data were largely similar to younger adults, with notable exceptions of increased hepatic dysfunction and stronger antibody responses to EBV early antigen R component.
- Diagnostic difficulties arose in three patients (3/27) who did not produce heterophil antibodies.
Conclusions:
- Primary EBV infection in older adults presents with diverse and sometimes severe clinical manifestations.
- Atypical presentations and lack of heterophil antibodies can complicate the diagnosis of EBV IM in this age group.
- Awareness of these specific challenges is crucial for timely diagnosis and management of EBV infection in older individuals.
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