Infectious Mononucleosis Caused by Epstein-Barr Virus
Infectious Mononucleosis Caused by Epstein-Barr Virus
Background: Knowledge regarding the clinical characteristics and natural history of acute infectious mononucleosis is based largely on older, often retrospective, studies without systematic follow-up. Differences in diagnosis, methodology, or treatment between historical and current practice might affect an understanding of this illness.
Methods: Using a prospective case series design, we enrolled 150 persons with an acute illness serologically confirmed as Epstein-Barr virus infection. The goal of the study was to assess symptoms, physical examination findings, laboratory tests, and functional status measures during the acute presentation and 1, 2, and 6 months later.
Results: Acutely, infectious mononucleosis was characterized by the symptoms of sore throat and fatigue and substantial functional impairment. Objective physical and laboratory examination findings included pharyngitis and cervical lymphadenopathy, a moderate absolute and atypical lymphocytosis, and mildly elevated transaminase levels. The traditional signs of fever and splenomegaly were relatively uncommon. By 1 month, most symptoms and signs and all laboratory tests had returned to normal. Fatigue, cervical lymphadenopathy, pharyngitis, and functional health status improved more slowly.
Conclusions: In contemporary practice most of the classical illness features of infectious mononucleosis are observed. Symptoms, signs, and poor functioning might be protracted in some patients.
Infection with Epstein-Barr virus (EBV) has diverse clinical manifestations. In children, EBV infection is often asymptomatic, whereas in adolescents and young adults, it classically appears as infectious mononucleosis with fever, lymphadenopathy, and pharyngitis. Although infectious mononucleosis is typically self-limited and treated only with supportive care, its duration and severity can vary considerably. Furthermore, most publications describing the natural history of infectious mononucleosis have been conducted in specialized populations; have incorporated nonstandard care; have evaluated only a limited number of biologic, psychologic, and functional measures; or have failed to provide systematic follow-up. Finally, many studies were conducted before serologic tests for EBV were developed, bringing into question the actual composition of the study populations and the validity of subsequent findings.
To examine the natural history of infectious mononucleosis, we observed a population-based cohort enrolled in a large health maintenance organization for 6 months after the onset of serologically confirmed infection with EBV. During the initial illness and 1, 2, and 6 months later, we obtained subjective and objective measures of clinical and functional status. The goal of this study was to describe systematically and comprehensively the characteristics and course of infectious mononucleosis in the setting of current medical practice.
Abstract and Introduction
Abstract
Background: Knowledge regarding the clinical characteristics and natural history of acute infectious mononucleosis is based largely on older, often retrospective, studies without systematic follow-up. Differences in diagnosis, methodology, or treatment between historical and current practice might affect an understanding of this illness.
Methods: Using a prospective case series design, we enrolled 150 persons with an acute illness serologically confirmed as Epstein-Barr virus infection. The goal of the study was to assess symptoms, physical examination findings, laboratory tests, and functional status measures during the acute presentation and 1, 2, and 6 months later.
Results: Acutely, infectious mononucleosis was characterized by the symptoms of sore throat and fatigue and substantial functional impairment. Objective physical and laboratory examination findings included pharyngitis and cervical lymphadenopathy, a moderate absolute and atypical lymphocytosis, and mildly elevated transaminase levels. The traditional signs of fever and splenomegaly were relatively uncommon. By 1 month, most symptoms and signs and all laboratory tests had returned to normal. Fatigue, cervical lymphadenopathy, pharyngitis, and functional health status improved more slowly.
Conclusions: In contemporary practice most of the classical illness features of infectious mononucleosis are observed. Symptoms, signs, and poor functioning might be protracted in some patients.
Introduction
Infection with Epstein-Barr virus (EBV) has diverse clinical manifestations. In children, EBV infection is often asymptomatic, whereas in adolescents and young adults, it classically appears as infectious mononucleosis with fever, lymphadenopathy, and pharyngitis. Although infectious mononucleosis is typically self-limited and treated only with supportive care, its duration and severity can vary considerably. Furthermore, most publications describing the natural history of infectious mononucleosis have been conducted in specialized populations; have incorporated nonstandard care; have evaluated only a limited number of biologic, psychologic, and functional measures; or have failed to provide systematic follow-up. Finally, many studies were conducted before serologic tests for EBV were developed, bringing into question the actual composition of the study populations and the validity of subsequent findings.
To examine the natural history of infectious mononucleosis, we observed a population-based cohort enrolled in a large health maintenance organization for 6 months after the onset of serologically confirmed infection with EBV. During the initial illness and 1, 2, and 6 months later, we obtained subjective and objective measures of clinical and functional status. The goal of this study was to describe systematically and comprehensively the characteristics and course of infectious mononucleosis in the setting of current medical practice.
