Mononucleosis prognosis

Overview

Fatalities from mononucleosis are extremely rare in developed nations. However, chronic sub-clinical infection may persist secondary to the dormant virus within the B cells. Reactivation of the virus may occur in susceptible hosts under the appropriate environmental stressors. Similar such reactivation or chronic sub-clinical viral activity in susceptible hosts may trigger multiple host autoimmune diseases and cancers secondary to virus predilection to B lymphocytes and its ability to alter both lymphocyte proliferation and lymphocyte antibody production.

Prognosis

• Once the acute symptoms of an initial infection disappear, they often do not return. But once infected, the patient carries the virus for the rest of their life. The virus typically lives dormantly in B lymphocytes. Independent infections of mononucleosis may be contracted multiple times, regardless of whether the patient is already carrying the virus dormantly.

• Periodically, the virus can reactivate, during which time the patient is again infectious, but usually without any symptoms of illness. Usually, a patient has few, if any, further symptoms or problems from the latent B lymphocyte infection. However, in susceptible hosts under the appropriate environmental stressors, reactivation of the virus is observed and known to cause vague subclinical symptoms or remain mostly asymptomatic and is diagnosed by positive serologic response. Additionally, its imperative to note that during this phase the virus can spread to others.

• Similar such reactivation or chronic sub-clinical viral activity in susceptible hosts may trigger multiple host autoimmune diseases and cancers secondary to EBV's predilection to B lymphocytes (the primary antibody-producing cell of the immune system) and its ability to alter both lymphocyte proliferation and lymphocyte antibody production.

• Commonly caused autoimmune diseases include:

• Systemic lupus erythematosus
• Rheumatoid arthritis
• Sjogren's syndrome
• Antiphospholipid antibody syndrome
• Multiple sclerosis

• Chronic immunologic stimulation by the virus, particularly causes lymphoma including:

• Nasopharyngeal carcinomas
• Burkitt's lymphoma
• Hodgkin's lymphoma

Mortality & Morbidity

• Fatalities from mononucleosis are extremely rare in developed nations.

• However, potential mortal complications include:

• Bacterial superinfections,
• Splenic rupture,
• Hepatic failure secondary to extensive hepatic necrosis caused by proliferation of EBV,
• Development of viral myocarditis,
• Post transplant lymphoproliferative disorder (PTLD) secondary to EBV infection has emerged as a significant cause of morbidity & mortality in solid organ transplant recipients.

References

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