Correlates of Illness Severity in Infectious Mononucleosis

Odame, John; Robinson, Joan; Khodai‐Booran, Nasser; Yeung, Simon S.; Mazzulli, Tony; Stephens, Derek; Allen, Upton

doi:10.1155/2014/514164

Cited by 12 publications

(13 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In one report, the details were not given [9]. In others, the scales, which appeared useful, were either not validated [10] or not validated specifically for use in IM [11,12]. In our study we developed a validated scale for rating IM.…”

Section: Discussionmentioning

confidence: 99%

“…In one study, however, the specifics of the severity measurements were not detailed [9], and in the other, the scale used was not validated for this use [10]. We are aware of two other tools that have been used to measure the severity of acute IM, but these scales also have not been validated either in general or for IM specifically [11,12]. As part of a study to assess risk factors for the development of CFS following IM, we developed and then attempted to validate a scale for rating the severity of IM, by first reviewing the literature available prior to beginning our study for risk factors for the severity of acute IM [13][14][15][16][17][18].…”

mentioning

confidence: 99%

See 1 more Smart Citation

A Validated Scale for Assessing the Severity of Acute Infectious Mononucleosis

Katz

Reuter

Lupovitch

et al. 2019

The Journal of Pediatrics

View full text Add to dashboard Cite

Objective: To develop a scale for the severity of mononucleosis (SOM). Study design:One to 5 percent of college students develop infectious mononucleosis annually, and about 10% meet criteria for chronic fatigue syndrome (CFS) 6 months following IM. We developed a SOM scale based on a review of the literature. College students were enrolled, generally when they were healthy. When the students developed IM an assessment was made as to the severity of their IM independently by two physicians using the SOM scale. This scale was correlated with corticosteroid use and hospitalization. Six months following IM an assessment is made for recovery from IM or meeting one or more case definitions of CFS.Results: 126 SOM scales were analyzed. The concordance between the two physician reviewers was 95%. All three hospitalized subjects had SOM scores ≥2. Subjects with SOM scores of ≥1 were 1.83 times as likely to be given corticosteroids. Students with SOM scores of 0 or 1 were less likely to meet more than one case definition of CFS six months following IM. Conclusions:The SOM scale has interobserver, concurrent and predictive validity for hospitalization, corticosteroid use and meeting criteria for CFS 6 months following IM. Chronic fatigue syndrome (CFS), or systemic exertion intolerance disease (SEID) is a complex condition involving severe fatigue and disabling cognitive and musculoskeletal symptoms [1][2][3][4]. Six months following IM, ~10% of adolescents or young adults meet criteria for CFS [5][6][7].One to 5% of college students develop acute infectious mononucleosis (IM) annually [8]. In an attempt to understand why about 10% of young adults meet criteria for CHS following IM, two previous studies related the severity of the acute illness (IM) to the development of

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

A Validated Scale for Assessing the Severity of Acute Infectious Mononucleosis

Katz

Reuter

Lupovitch

et al. 2019

The Journal of Pediatrics

View full text Add to dashboard Cite

show abstract

“…Disease severity and duration correlate much better with e.g. CD8+ cell counts than with the viral kinetics itself and the expansion of the CD8+ cell count is controlled in asymptomatic EBV infection despite virus loads similar to those experienced in symptomatic EBV infection [1,2,10–14]. Hence current understanding suggests that IM is caused by overreaction by the immune system, rather than EBV infection per se (viremia or B-cell expansion).…”

Section: Introductionmentioning

confidence: 99%

Primary Epstein-Barr virus infection with and without infectious mononucleosis

et al. 2019

View full text Add to dashboard Cite

BackgroundInfectious mononucleosis (IM) is a common adverse presentation of primary infection with Epstein-Barr virus (EBV) in adolescence and later, but is rarely recognized in early childhood where primary EBV infection commonly occurs. It is not known what triggers IM, and also not why IM risk upon primary EBV infection (IM attack rate) seemingly varies between children and adolescents. IM symptoms may be severe and persist for a long time. IM also markedly elevates the risk of Hodgkin lymphoma and multiple sclerosis for unknown reasons. The way IM occurrence depends on age and sex is incompletely described and hard to interpret etiologically, because it depends on three quantities that are not readily observable: the prevalence of EBV-naϊve persons, the hazard rate of seroconverting and the attack rate, i.e. the fraction of primary EBV infections that is accompanied by IM. We therefore aimed to provide these quantities indirectly, to obtain epidemiologically interpretable measures of the dynamics of IM occurrence to provide etiological clues.Methods and findingsWe used joint modeling of EBV prevalence and IM occurrence data to provide detailed sex- and age-specific EBV infection rates and IM attack rates and derivatives thereof for a target population of all Danes age 0–29 years in 2006–2011. We demonstrate for the first time that IM attack rates increase dramatically rather precisely in conjunction to typical ages of puberty onset. The shape of the seroconversion hazard rate for children and teenagers confirmed a priori expectations and underlined the importance of what happens at age 0–2 years. The cumulative risk of IM before age 30 years was 13.3% for males and 22.4% for females. IM is likely to become more common through delaying EBV infection in years to come.ConclusionsThe change in attack rate at typical ages of puberty onset suggests that the immunologic response to EBV drastically changes over a relatively short age-span. We speculate that these changes are an integrated part of normal sexual maturation. Our findings may inform further etiologic research into EBV-related diseases and vaccine design. Our methodology is applicable to the epidemiological study of any infectious agent that establishes a persistent infection in the host and the sequelae thereof.

show abstract

“…disorders. IM is traditionally considered to intensify with age of onset, although only few studies have explored this link [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Evolution of EBV seroprevalence and primary infection age in a French hospital and a city laboratory network, 2000–2016

Fourcade¹,

Germi²,

Guerber³

et al. 2017

PLoS ONE

View full text Add to dashboard Cite

BackgroundAccording to rare studies, the age at EBV primary infection (PI) has recently risen in some developed countries. A later age at infection is generally considered a risk factor for severe EBV PI, although few studies exist on this subject. Our investigation aimed to determine whether EBV seroprevalence and EBV PI epidemiology have evolved in France, and to what extent age and infection intensity (regarding biological parameters) are correlated.Methods and findingsWe conducted a retrospective study of the following EBV serological tests databases: tests carried out at Grenoble University Hospital (2000–2016) (n = 53,553); and tests carried out by a network of city laboratories in Grenoble area (2008–2015) (n = 27,485). The hospital population showed a continuous, significant decrease in EBV seroprevalence over the studied period for patients aged 20 and over (p<0.01). The seroprevalence also decreased for different age classes (<10, 15–19, 20–30, and 30–40 years old) over the periods 2001–2005, 2006–2010, and 2011–2015. Consistently, the age at PI was significantly higher in the years 2008–2015 than in the years 2001–2007 (15.6±12.0 vs. 13.7±11.0; p = 0.03). The city laboratory population showed the same trend of decreasing seroprevalence (p = 0.06); no significant variations in age at PI were observed. The age at PI was positively correlated with ASAT, ALAT, γGT, and bilirubin blood levels (p<0.01) and negatively correlated with platelet counts (p<0.05).ConclusionIn the last 15 years, the age at EBV PI has increased, whereas seroprevalence has decreased. Moreover, our findings confirm the positive correlation between age and biological abnormalities. Taken together, these results suggest that the incidence of severe EBV PI will increase in the future.

show abstract

Correlates of Illness Severity in Infectious Mononucleosis

Cited by 12 publications

References 28 publications

A Validated Scale for Assessing the Severity of Acute Infectious Mononucleosis

A Validated Scale for Assessing the Severity of Acute Infectious Mononucleosis

Primary Epstein-Barr virus infection with and without infectious mononucleosis

Evolution of EBV seroprevalence and primary infection age in a French hospital and a city laboratory network, 2000–2016

Contact Info

Product

Resources

About