Epstein-Barr Virus Infectious Mononucleosis in Children

PEDIATRICS ◽  
1985 ◽  
Vol 75 (6) ◽  
pp. 1011-1019 ◽  
Author(s):  
Ciro Valent Sumaya ◽  
Yasmin Ench
Keyword(s):  
Infectious Mononucleosis ◽  
Epstein Barr Virus ◽  
Immunoglobulin M ◽  
Antibody Responses ◽  
Adult Patients ◽  
Nuclear Antigen ◽  
Barr Virus ◽  
Age Related ◽  
Slide Test ◽  
Epstein Barr

An investigation was performed to address the need to establish the rate of positive heterophil antibody responses, oropharyngeal isolation of Epstein-Barr virus (EBV), and the evolving pattern of EBV-specific antibody responses among children with documented EBV-infectious mononucleosis. Findings showed that the rate of heterophil antibody responses appeared to increase progressively with advancing age from infancy up to 4 years, after which the rates approached values similar to that reported in young adult patients. The rapid slide test detected a heterophil antibody response as frequently as the Paul-Bunnell-Davidsohn horse cell test, except in children less than 4 years old. The decreased sensitivity found with the rapid slide test in the very young was associated with their less intense heterophil response. The younger group of children also developed a lower acute mean titer and, as a result, a decreased persistence of immunoglobulin M antibody to EBV-capsid antigen, whereas they had more frequent responses to EBV-early antigen directed to restricted component than both the older subjects and adults reported elsewhere. Antibodies to EBV-nuclear antigen, characteristically a late-onset antibody, tended to develop earlier than noted in adult patients. In contrast, the prevalence and continued excretion of EBV from oropharyngeal secretions was similar to that reported in adult patients. It is speculated that these age-related differences in host responses are associated with the ontogeny of the immunologic system.

Epstein-Barr Virus Infectious Mononucleosis in Children

PEDIATRICS ◽  
1985 ◽  
Vol 75 (6) ◽  
pp. 1003-1010 ◽  
Author(s):  
Ciro Valent Sumaya ◽  
Yasmin Ench
Keyword(s):  
Infectious Mononucleosis ◽  
Epstein Barr Virus ◽  
Failure To Thrive ◽  
Adult Patients ◽  
Unexpected Finding ◽  
Older Children ◽  
Childhood Disease ◽  
Barr Virus ◽  
Age Related ◽  
Epstein Barr

Between 1976 and 1982, 113 children aged 6 months to 16 years with documented Epstein-Barr virus-induced infectious mononucleosis were studied prospectively, and in most instances serially. An unexpected finding was the large number of young children, less than 4 years old, with this disease. Children with infectious mononucleosis, in particular the very young, tended to have more rashes, significant neutropenia, abdominal pain (older children only), and possibly hepatosplenomegaly than have been reported in adult patients. The intensity of the characteristic relative atypical lymphocytosis found in peripheral blood was age-related; it was less in the very young. Findings of failure to thrive, otitis media, and episodes of recurrent tonsillopharyngitis appeared to be unique or more closely associated with childhood disease. Complications such as thrombocytopenia with hemorrhagic manifestations, significant airway obstruction, and neurologic problems occurred more frequently whereas jaundice occurred less frequently than noted in adult patients. Six children, all less than 4 years old, developed pneumonia during the disease course. The increased availability of Epstein-Barr virus-specific testing should continue to expand our knowledge of this disease in children of all ages.

scholarly journals Evaluation of an Immunofiltration Assay That Detects Immunoglobulin M Antibodies against the ZEBRA Protein for the Diagnosis of Epstein-Barr Virus Infectious Mononucleosis in Immunocompetent Patients

2009 ◽  
Vol 16 (6) ◽  
pp. 885-888 ◽  
Author(s):  
Dayana Bravo ◽  
Beatriz Muñoz-Cobo ◽  
Elisa Costa ◽  
M. Angeles Clari ◽  
Nuria Tormo ◽  
...  
Keyword(s):  
Infectious Mononucleosis ◽  
Epstein Barr Virus ◽  
Parvovirus B19 ◽  
Human Herpesvirus ◽  
Immunoglobulin M ◽  
Nuclear Antigen ◽  
Barr Virus ◽  
Ebv Infection ◽  
Epstein Barr ◽  
Immunocompetent Patients

ABSTRACT The performance of an immunofiltration assay (IMFA) that detects immunoglobulin M (IgM) antibodies to the Epstein-Barr virus (EBV) ZEBRA (BamHI Z EBV replication activator) protein was evaluated for the diagnosis of EBV infectious mononucleosis (IM) in immunocompetent patients. The test panel consisted of 47 sera displaying an EBV-specific antibody profile compatible with an acute primary EBV infection from patients with clinical and biological features of EBV IM, 20 sera from healthy individuals either with a past EBV infection or who were EBV seronegative, 20 sera displaying an equivocal EBV antibody pattern (viral capsid antigen IgG positive [VCA IgG+], VCA IgM+, and EBV nuclear antigen-1 IgG+), and 15 sera obtained from patients with a mononucleosis-like syndrome owing to cytomegalovirus, human herpesvirus 6, or parvovirus B19. Overall, the sensitivity and the specificity of the assay were found to be 92.5%, and 97.3%, respectively. The sensitivity of the assay for the diagnosis of heterophile antibody-negative EBV IM was 86.2%. The IMFA is rapid, easy to perform, and, thus, suitable for point-of-care testing, and it may be used as a first-line test for the diagnosis of acute EBV IM in immunocompetent patients.

Encephalitis in Infectious Mononucleosis: Diagnostic Considerations

PEDIATRICS ◽  
1976 ◽  
Vol 58 (6) ◽  
pp. 877-880
Author(s):  
Beverly J. Lange ◽  
Peter H. Berman ◽  
Joseph Bender ◽  
Werner Henle ◽  
John F. Hewetson
Keyword(s):  
Infectious Mononucleosis ◽  
Epstein Barr Virus ◽  
Nuclear Antigen ◽  
Diffuse Component ◽  
Early Antigen ◽  
Barr Virus ◽  
Ebv Infection ◽  
Antibody Titers ◽  
Epstein Barr ◽  
Etiologic Diagnosis

Four atypical cases of presumed infectious mononucleosis (IM) encephalitis are presented. To establish an etiologic diagnosis, Paul-Bunnell-Davidsohn heterophil titers (PBD), antibody titers to the antigens of the Epstein-Barr virus (EBV), and oropharyngeal excretion of EBV were determined. Criteria for a primary EBV infection are (1) an antiviral capsid antigen titer of 1:160 or greater, (2) the presence of antibody to the diffuse component of the early antigen, (3) absence of antibody to the nuclear antigen, and (4) excretion of the virus from the oropharynx. Three of the four cases met these criteria; of the three, one did not have a positive heterophil titer. The fourth case turned out not to be IM; there was a positive PBD heterophil, but there was no evidence of primary EBV infection. Although the PBD heterophil is usually a reliable test to diagnosis IM, it is not always present in children, and it is sometimes nonspecifically elevated. Some EBV titers can be nonspecifically elevated as well; however, the above criteria are diagnostic of primary EBV infection.

scholarly journals Establishment and characterization of an Epstein-Barr virus transformed cell line with strong phagocytic activity

Blood ◽  
1989 ◽  
Vol 74 (1) ◽  
pp. 430-436 ◽  
Author(s):  
P von den Driesch ◽  
R Bhardwaj ◽  
HD Flad ◽  
DC Neugebauer ◽  
HJ Pielken ◽  
...  
Keyword(s):  
Cell Line ◽  
Phagocytic Activity ◽  
Antigen Processing ◽  
Epstein Barr Virus ◽  
Interleukin 1 ◽  
Immunoglobulin M ◽  
Nuclear Antigen ◽  
Barr Virus ◽  
Transformed Cell Line ◽  
Epstein Barr

Abstract An immunoglobulin M (IgM)-positive cell line, Ms 28, apparently spontaneously transformed by Epstein-Barr virus (EBV) was established from peripheral blood cells of a patient with immature myeloblastic leukemia. It has been characterized according to phenotype, cytochemistry, and membrane antigen pattern. The cell line expresses lymphoid markers like CD 19, CD 22, and CD 30 and synthesizes and secretes IgM. Monocyte markers CD 11c, CD 14, and CD 15 are absent. Neither interleukin-1 (IL-1), nor tumor necrosis factor (TNF-alpha) are produced. But Ms 28 cells show strong phagocytic activity and engulf Latex particles and sheep RBCs (SRBCs) that need not to be opsonized. The phagocytic activity can be inhibited by chloroquine. Both phagocytosis and EBV nuclear-antigen (EBNA) expression can be observed in one and the same cell. Ms 28 cells might be useful to study immunologic activities like antigen processing and presentation.

scholarly journals Comparison of Three Automated Immunoassay Methods for the Determination of Epstein-Barr Virus-Specific Immunoglobulin M

2010 ◽  
Vol 17 (4) ◽  
pp. 559-563 ◽  
Author(s):  
Mario Berth ◽  
Eugene Bosmans
Keyword(s):  
Epstein Barr Virus ◽  
Antibody Test ◽  
Immunoglobulin M ◽  
Nuclear Antigen ◽  
Two Phase ◽  
Barr Virus ◽  
Epstein Barr ◽  
Automated Immunoassay ◽  
A Prospective Study

ABSTRACT In this study we compared the performances of three commercially available Epstein-Barr virus (EBV) immunoglobulin M (IgM) assays on highly automated immunoassay platforms: BioPlex 2200 (Bio-Rad Laboratories), Immulite 2000 (Siemens Healthcare Diagnostics), and Liaison (DiaSorin). As a confirmatory method, immunoblotting was performed. The specificity of the three EBV IgM assays was evaluated by testing 293 selected sera from patients with various infectious and noninfectious diseases. After the exclusion of 30 samples, the specificities were 96.2% for Liaison, 98.1% for Immulite, and 97.0% for BioPlex. For evaluation of the sensitivity, samples from 70 consecutive patients with a positive heterophile antibody test were examined, irrespective of clinical or biological findings. After the exclusion of six samples, the sensitivities were 89.1% for Liaison, 84.4% for Immulite, and 89.1% for BioPlex. Finally, in a prospective study performed with 500 samples obtained from consecutive patients and sent in by general practitioners, we also determined Epstein-Barr nuclear antigen IgG and viral capsid antigen IgG in a two-phase approach. Concordance of the EBV serologic status was 96.2% between Liaison and Immulite, 96.4% between Immulite and BioPlex, and 97.8% between BioPlex and Liaison. The three EBV IgM immunoassays that we evaluated have acceptable and comparable performances.

scholarly journals Plasmacytic differentiation of circulating Epstein-Barr virus-infected B lymphocytes during acute infectious mononucleosis.

1981 ◽  
Vol 153 (2) ◽  
pp. 235-244 ◽  
Author(s):  
J E Robinson ◽  
D Smith ◽  
J Niederman
Keyword(s):  
Infectious Mononucleosis ◽  
Epstein Barr Virus ◽  
Plasma Cells ◽  
Phase 1 ◽  
Acute Disease ◽  
Nuclear Antigen ◽  
Barr Virus ◽  
Infected Cells ◽  
Epstein Barr ◽  
Acute Infectious Mononucleosis

During the acute phase (1 wk of symptoms or less) of infectious mononucleosis (IM), 70--80% of circulating Epstein-Barr virus nuclear antigen (EBNA)-positive cells have differentiated toward plasma cells. Thus the characteristics of the infected cells in the majority of IM patients during early disease are indistinguishable from EBNA-positive tumor cells of a previously reported child who developed lymphoma during IM. IgA and IgG were the most frequent and IgM the least frequent immunoglobulin isotypes detected in EBNA-positive cells. In acute disease EBNA was present in 5.5--20% of T cell-depleted blood lymphocytes but in the 2nd or 3rd wk of illness the number of EBNA-positive cells sharply decreased to 0.4--1.4%. At the same time the fraction of antigen-positive cells containing cytoplasmic immunoglobulins also diminished, suggesting either that differentiation of infected cells was altered during the disease or that nondifferentiated antigen-positive cells had a survival advantage. Both the high proportion of plasmacytic EBNA-positive cells seen during acute disease and the apparent loss of differentiation by these cells later in disease may be regulated by host immunologic factors. Immunoglobulin-producing EBNA-positive cells may be the source of heterophile antibodies and other seemingly inappropriate antibodies usually found in serum during IM; however, increased numbers of noninfected plasma cells were present in some patients and may also be a potential source of these unusual antibodies.

scholarly journals Clinical and laboratory features of infectious mononucleosis caused by the Epstein-Barr virus

2014 ◽  
Vol 95 (5) ◽  
pp. 722-725 ◽  
Author(s):  
R A Gileva ◽  
Z A Hohlova ◽  
Yu S Chechet ◽  
A S Arsenenko ◽  
L M Povolotskaya
Keyword(s):  
G Proteins ◽  
Infectious Mononucleosis ◽  
High Frequency ◽  
Epstein Barr Virus ◽  
Mononuclear Cells ◽  
Severe Form ◽  
Immunoglobulin M ◽  
Standard Laboratory ◽  
Barr Virus ◽  
Epstein Barr

Aim. To study the clinical and laboratory characteristics of patients with infectious mononucleosis caused by the Epstein-Barr virus. Methods. In infectious hospital under observation there were 108 patients aged from 11 months to 31 years with a laboratory confirmed diagnosis of «infectious mononucleosis caused by the Epstein-Barr virus». Standard laboratory tests for blood serum immunoglobulin M to the capsid protein of Epstein-Barr virus, immunoglobulin class G proteins to early Epstein-Barr virus and the index of their avidity by ELISA were carried out. Tests for other infections were conducted if it is required. Results. Patients dominated by children aged 1-7 years - 73.1%. Adult patients was 1.8% (2 patients). Only 4.6% of the patients were sent to the hospital with a diagnosis of «infectious mononucleosis» or suspected of having the disease. The typical clinical picture of infectious mononucleosis was observed in 75% of cases, atypical - in 25%. Mononuclear cells in peripheral blood were found in less than half of the patients (44.4%), in 53.1% of cases with typical and in 18.5% of cases with atypical clinic. In the remaining patients, the diagnosis of infectious mononucleosis was verified by ELISA. In 90.4% of the cases the disease was in the moderate, and in 9.6% - in the severe form. Conclusion. The high frequency of atypical course of infectious mononucleosis caused by the Epstein-Barr virus justifies the need to include it into differential diagnosis process in case of unclear infectious disease, to identify the antibodies to the Epstein-Barr virus proteins, (immunoglobulin M and G) and the index of avidity antibodies (immunoglobulin G).

scholarly journals Epidemiology of Epstein-Barr Virus infection and Infectious Mononucleosis in the United Kingdom

2020 ◽  
Author(s):  
Ashvin Kuri ◽  
Benjamin Meir Jacobs ◽  
Nicola Vickaryous ◽  
Julia Pakpoor ◽  
Jaap Middeldorp ◽  
...  
Keyword(s):  
Infectious Mononucleosis ◽  
Epstein Barr Virus ◽  
Antibody Responses ◽  
Epstein Barr Virus Infection ◽  
List Type ◽  
White Ethnicity ◽  
Barr Virus ◽  
Ebv Infection ◽  
Epstein Barr ◽  
The Uk

AbstractBackgroundEpstein-Barr Virus (EBV) is a ubiquitous gamma-herpesvirus with which ∼95% of the healthy population is infected. EBV infection has been implicated in a range of haematological malignancies and autoimmune diseases. Delayed primary EBV infection increases the risk of subsequent complications. Over recent decades, the age of primary EBV infection has become later, largely due to improved sanitation and living conditions.Methods and findingsFirst, we conducted a sero-epidemiological survey of healthy volunteers between 0 and 25 years old to assess prevalence of detectable anti-EBV antibodies. 1982 of 2325 individuals (85.3%) were EBV seropositive. EBV seropositivity increased monotonically with age, and increased more among females than males during adolescence (ages 10 – 15). Second, we conducted a retrospective review of Hospital Episode Statistics to determine changes in Infectious Mononucleosis (IM) incidence over time. Between 2002 and 2013, the incidence of IM (derived from hospital admissions data) increased. We then conducted a large case-control study of 6306 prevalent IM cases and 1,009,971 unmatched controls extracted from an East London GP database to determine exposures associated with IM. Exposures associated with lower risk of IM were elevated BMI (Overweight OR 0.80 [0.75 to 0.86], obese OR 0.63 [0.57 to 0.70]), non-white ethnicity (Black OR 0.21 [0.18 to 0.23], Asian OR 0.14 [0.13 to 0.16], Other ethnicity OR 0.22 [0.19 to 0.25]), and a history of smoking (OR 0.87 [0.83 to 0.92]), whereas affluence was associated with a higher risk of IM (per increase in IMD decile OR 1.15 [1.13 to 1.17]. Finally, we used ELISA to determine antibody responses to common pathogens and vaccine antigens among EBV-seronegative individuals. EBV-seronegative donors did not display diminished serum antibody responses to pertussis, rubella, or varicella compared to EBV-seropositive donors.ConclusionsIn this study we make several important observations on the epidemiology of EBV infection in the UK. We find that overall EBV seroprevalence in the UK appears to have increased, and that the sharp increase in EBV seropositivity takes places earlier among females than males. We find that the incidence of IM requiring hospitalisation is increasing. We find that exposures associated with prevalent IM in a diverse population include white ethnicity, affluence, lower BMI, and never-smoking, and these exposures interact with each other. Lastly, we provide pilot evidence suggesting that antibody responses to vaccine and encountered pathogens do not seem to be diminished among EBV-seronegative individuals, which is a theoretical counter-argument to developing EBV vaccines. Our findings could help to inform vaccine study designs in efforts to prevent IM and late complications of EBV infection, such as Multiple Sclerosis.Key messages-Epstein-Barr Virus (EBV) is a ubiquitous virus which infects over 95% of the world’s population. The majority of infection is silent and without consequence. In a subset of individuals, EBV is thought to play a role in the pathogenesis of autoimmune disease and haematological cancers.-During childhood and adolescence, EBV seroprevalence increased monotonically with age from 0-5 (67.8% females, 72.0% males) to 20-25 (96.4% females, 95.5% males)-The incidence of Infectious Mononucleosis (IM) leading to hospital admission has increased over the past decade-Exposure associated with IM in a large, diverse East London cohort (n>1,000,000) were low BMI, never-smoking, white ethnicity, and affluence.

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