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[Spontaneous mononucleosis caused by cytomegalovirus in the immunocompetent adult]
Background:
The first Spanish series of spontaneous infectious mononucleosis (IM) by cytomegalovirus (CMV) in immunocompetent adults is reported.
Methods:
Patients whose clinical manifestations, physical exam, analysis and serology were compatible with acute CMV infection from 1984 to 1993 were retrospectively reviewed.
Results:
Thirty patients with a mean age of 36 years fulfilled the diagnostic criteria. All presented fever, alone or associated with other symptoms, with a mean duration of 18 days, which persisted over 3 weeks in 36%. Physical exam showed lymph node enlargement (50%), hepatomegaly (33%), splenomegaly (20%) and was normal in 8 patients (26%). Mean leukocyte count was 9.75 x 10(9) (+/- 4.63 x 10(9) with more than 50% lymphomonocytic cells in 22 patients (76%) and reactive lymphocytes, principally from the outset, although this was observed on days 2 and 60 in 11 cases (36%). LDH, ASAT and ALAT were moderately elevated and ESR was normal. Serologic diagnosis was established from IgM (13%) seroconversion or positive IgM in the two samples with IgG four-fold increase (23%), as well as the presence of positive IgM and invariable high IgG in both determinations (26%) or all IgM positive titers in a single sample (36%).
Conclusions:
Infectious mononucleosis by cytomegalovirus is an infrequently diagnosed disease which should be considered in any young patient with fever despite a little demonstrative initial physical exam absence of atypical lymphocytes or a lack of diagnostic serology.
Insights
Cytomegalovirus (CMV) infectious mononucleosis (IM) is an underdiagnosed condition in adults. This study details the first Spanish series, highlighting key diagnostic features in immunocompetent individuals.
Area of Science:
- Infectious Diseases
- Virology
- Immunology
Context:
- Cytomegalovirus (CMV) is a common virus that can cause infectious mononucleosis (IM) in immunocompetent adults.
- This study reports the first series of spontaneous CMV-induced IM in Spain.
Purpose:
- To describe the clinical, laboratory, and serological characteristics of CMV infectious mononucleosis in immunocompetent adults.
- To emphasize the importance of considering CMV IM in differential diagnoses.
Summary:
- A retrospective review of 30 adult patients diagnosed with CMV IM between 1984 and 1993.
- Common symptoms included prolonged fever, lymphadenopathy, and hepatosplenomegaly.
- Diagnostic criteria involved serological evidence of acute CMV infection, with varying presentations of IgM and IgG antibody responses.
Impact:
- Highlights CMV infectious mononucleosis as an infrequently diagnosed but significant cause of mononucleosis-like illness in adults.
- Provides valuable data on the presentation and diagnosis of CMV IM in a specific geographic region.
- Aids clinicians in recognizing and diagnosing CMV IM, especially when initial presentations are non-specific.