Prospective studies of infectious mononucleosis in university students

Abstract

We performed an intensive prospective study designed to obtain as much data as possible on the incubation and early illness periods of primary Epstein–Barr virus (EBV) infection. Undergraduate students who lacked EBV antibody and oral EBV DNA (EBV-naive) were seen every 2 weeks during their freshman year. Clinical and behavioral data, oral washes and venous blood were obtained. EBV antibodies were quantified by enzyme immunoassay and viral loads by PCR. During a median 8 months of observation, 14/85 subjects experienced primary EBV infections (24 cases/100 person-years). The only significant risk factor for acquisition of EBV infection was deep kissing (P=0.02). Eleven subjects had infectious mononucleosis with a median duration of 21 days. Two subjects were hospitalized. Infections were initially identified in 12 subjects by finding EBV DNA in oral cells before onset of symptoms and in 2 subjects by symptom reporting. EBV DNA and viral capsid antigen (VCA) IgM and gp350 IgG antibodies were present in the blood before onset of illness. To provide a more robust evaluation of primary EBV infection in undergraduate university students, we combined data on risk factors and antibody responses from this and an earlier study that used the exact same clinical and laboratory methods. The observation that the only significant risk factor for acquisition of EBV infection was deep kissing was confirmed. Most importantly, higher amounts of gp350 antibody correlated significantly with a lower severity of infectious mononucleosis (P<0.0001), which strengthens the rationale for a gp350-based prophylactic EBV vaccine.

Intrathecal immunoreactivity in people with or without previous infectious mononucleosis

“…35 We particularly in the latter case but still probable, as the proportion of IM patients with positive EBNA1 titers increase slowly during several weeks, even months, after the onset. 36 We approached the The non-significant trend toward higher CSF cytokine levels in the present study did not reject the hypothesis that IM may incur persisting alterations in pro-inflammatory cyto-/chemokine expression approaching an MS-related endophenotype. Future studies on the post-IM state with improved statistical power are warranted and might re-evaluate the selection of "pre-MS" cyto-/chemokines, 23 and include cellular immunity assays to probe the persistence of the post-IM state.…”

Asymptomatic Primary Infection with Epstein-Barr Virus: Observations on Young Adult Cases

“…Whether IM is a legitimate model for the successful control of primary EBV infection or an artifact of inefficient control remains to be determined. The fact that not all delayed primary infections are clinically manifest as IM ( 3 – 6 ) affords an opportunity to address this issue, provided that one can identify asymptomatic cases. An earlier study ( 37 ) serendipitously identified four IgM anti-VCA-positive individuals during serologic screening of volunteers for an EBV vaccine trial.…”

“…This often leads to infectious mononucleosis (IM), an illness whose symptoms (fever, sore throat, cervical lymphadenopathy, and fatigue) range from mild to severe and may take between 1 and 6 weeks to resolve ( 2 ). The proportion of delayed primary infections that are symptomatic varies from 25 to >80% in different reports, likely reflecting differences in the rigor of follow-up and clinical monitoring ( 3 – 6 ). Such symptomatic cases have been extensively studied; indeed, what little is known about the virology and immunology of primary EBV infection comes almost exclusively from IM patients.…”

An Atypical Presentation of Epstein-Barr Virus Associated Infectious Mononucleosis Mistaken for Pyelonephritis

“…An increase in lymphocytes, some of which may be atypical, is found in the peripheral blood. Mild elevations of aminotransferases are common as well in IM [1][2][3][4][5][6]9]. EBV-related IM should be in the differential diagnosis of any teen or young adult presenting with a fever (usually low-tomoderate grade), sore throat, and lymph node enlargement, which are all archetypical findings in EBV-induced IM.…”

“…However, the epidemiology of EBV infection may be changing. Children are acquiring EBV infection later in age in industrialized countries [2][3][4][5]. This is important given the recognized association between the age of primary EBV infection and disease severity.…”