Infectious Mononucleosis: diagnosis and clinical interpretation

Naughton, Patrick; Healy, M. J. R.; Enright, Frances; Lucey, Brigid

doi:10.1080/09674845.2021.1903683

Cited by 36 publications

(26 citation statements)

References 78 publications

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“…Epstein–Barr virus (EBV) is a common pathogen that can cause a variety of systemic infections. Among them is infectious mononucleosis (IM), otherwise known as glandular fever, and presents symptomatically with fever, pharyngitis, neck lymphadenopathy, fatiguability, and splenomegaly [ 1 ]. A less clinically ubiquitous sign is bilateral periorbital oedema or ‘Hoagland sign’ [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

A Protracted Course of Periorbital Oedema in Infectious Mononucleosis Caused by Epstein–Barr Virus

Ricardo

2022

Infectious Disease Reports

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Infectious mononucleosis (IM) is a viral disease most commonly caused by the Epstein–Barr virus (EBV). The triad of fever, pharyngitis, and cervical chain lymphadenopathy classically describe this benign condition. Ocular association is also possible, although less commonly reported, and manifests as bilateral periorbital oedema presenting early in the disease process. A case of a fit and well 18-year-old female patient who developed periorbital oedema before the classic triad is presented. Furthermore, her case describes a significantly longer duration of periorbital tissue involvement, contrary to what is described in the current literature. Clinicians should not only recognise periorbital oedema as an initial manifestation of IM but also be alerted of its possible protracted course.

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Section: Introductionmentioning

confidence: 99%

A Protracted Course of Periorbital Oedema in Infectious Mononucleosis Caused by Epstein–Barr Virus

Ricardo

2022

Infectious Disease Reports

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“…EBV infection is common, with more than 95% of all adults worldwide estimated to be seropositive for EBV. 4 EBV is typically transmitted person-to-person via exposure to infected saliva through kissing, sharing of food or drink, coughing, and, less commonly, through sexual transmission. Rarely, EBV can be transmitted by blood transfusion, solid organ transplant, or hematopoietic stem cell transplant.…”

Section: Discussionmentioning

confidence: 99%

Pharyngitis and Tonsillar Exudates in an 18-Year-Old Woman

Walter

2021

JAMA

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“…Cell culture 5×10 5 of PBMCs from 16 randomly selected IM patients were stimulated with gefitinib (R&D Systems, Minneapolis, MN, USA; final concentration: 1 µg/mL), which inhibits tyrosine kinase activity of EGFR through binding to the adenosine triphosphate-binding domain [25], for 72 h. 5×10 5 of PBMCs from 13 randomly selected IM patients were stimulated with AREG (the ligand for EGFR) (R&D Systems, Minneapolis, MN, USA; final concentration: 100 ng/mL) [21] in the presence or absence of anti-HIF-1α (R&D Systems, Minneapolis, MN, USA; Clone #241809; final concentration: 5 µg/mL) for 72 h. Gefitinib is an EGFR inhibitor that interrupts signaling by EGFR in target cells. AREG is a member of the EGF family.…”

Section: Plasma and Peripheral Blood Mononuclear Cells Isolationmentioning

confidence: 99%

“…Treatment of IM patients includes anti-EBV and supportive therapy. However, no antiviral agent has been confirmed for treatment of EBV infection and clinical efficacy is limited [ 5 ]. Importantly, the pathogenesis of IM is not fully understood, which limits the development of antiviral strategies for EBV-induced IM patients.…”

Section: Introductionmentioning

confidence: 99%

Amphiregulin/epidermal growth factor receptor/hypoxia inducible factor-1α pathway regulates T helper 9 and T cytotoxic 9 cell response in adult patients with infectious mononucleosis

Zhang

et al. 2022

Bosn J of Basic Med Sci

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Amphiregulin (AREG)/epidermal growth factor receptor (EGFR) signaling induces hypoxia-inducible factor-1α (HIF-1α), leading to promotion of T helper 9 (Th9) differentiation and anti-tumor functions. However, the role of the AREG/EGFR/HIF-1α pathway in regulating interleukin-9 (IL-9) production by T cells in adult patients with infectious mononucleosis (IM) has not been fully elucidated. Fifty IM patients and 20 controls were enrolled. The percentages of Th9 and T cytotoxic 9 (Tc9) cells, the mRNA relative expressions of the transcription factors of IL-9-secreting T cells, purine-rich nucleic acid binding protein 1 (PU.1) and forkhead box protein O1 (FOXO1), and the levels of IL-9, AREG, EGFR, and HIF-1α were measured. Peripheral blood mononuclear cells from IM patients were stimulated with EGFR inhibitor or exogenous AREG in the presence or absence of anti-HIF-1α. Regulation of the AREG/EGFR/HIF-1α pathway to IL-9 production by T cells was assessed. The percentages of Th9 and Tc9 cells, plasma IL-9 levels, and PU.1 and FOXO1 mRNA expressions were elevated in IM patients. Plasma levels of AREG and HIF-1α were also increased in IM patients. AREG levels correlated positively with the percentages of Th9 and Tc9 cells in IM patients. Inhibition of EGFR suppressed IL-9-producing T cell differentiation and HIF-1α production. Exogenous AREG stimulation not only induced EGFR and HIF-1α expression but also promoted IL-9-secreting T cell differentiation. Neutralization of HIF-1α abrogated AREG/EGFR-induced Th9 and Tc9 differentiation in IM patients. The current data suggested that the AREG/EGFR/HIF-1α pathway contributed to the elevation of Th9 and Tc9 differentiation in IM patients.

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Infectious Mononucleosis: diagnosis and clinical interpretation

Cited by 36 publications

References 78 publications

A Protracted Course of Periorbital Oedema in Infectious Mononucleosis Caused by Epstein–Barr Virus

A Protracted Course of Periorbital Oedema in Infectious Mononucleosis Caused by Epstein–Barr Virus

Pharyngitis and Tonsillar Exudates in an 18-Year-Old Woman

Amphiregulin/epidermal growth factor receptor/hypoxia inducible factor-1α pathway regulates T helper 9 and T cytotoxic 9 cell response in adult patients with infectious mononucleosis

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