Mononucleosis natural history: Difference between revisions
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==Prognosis== | ==Prognosis== | ||
Fatalities from mononucleosis are extremely rare in developed nations. Potential mortal complications include splenic rupture, bacterial [[superinfection]]s, [[hepatic failure]] and the development of [[Myocarditis|viral myocarditis]]. | *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 lymphocyte|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.[http://www.cdc.gov/ncidod/diseases/ebv.htm]Usually, a patient has few, if any, further symptoms or problems from the latent [[B lymphocyte|B lymphocyte]] infection. However, in susceptible hosts under the appropriate environmental stressors, the virus can reactivate and cause vague physical symptoms (or may be subclinical), and during this phase the virus can spread to others. | |||
*Similar reactivation or chronic subclinical viral activity in susceptible hosts may trigger multiple host autoimmune diseases, such as: | |||
:*[[Systemic lupus erythematosus]] | |||
:*[[Rheumatoid arthritis]] | |||
:*[[Sjogren's syndrome]] | |||
:*[[Antiphospholipid antibody syndrome]] | |||
:*[[Multiple sclerosis]] | |||
*Such chronic immunologic stimulation may also trigger multiple type of cancers, particularly [[lymphoma]]—strongest cancer associations with [[Epstein Barr virus|EBV]] are: | |||
:*[[Nasopharyngeal carcinoma]]s | |||
:*[[Burkitt's lymphoma]] | |||
:*[[Hodgkin's lymphoma]] | |||
*[[Epstein Barr virus|EBV's]] potential to trigger such a wide range of autoimmune diseases and cancers probably relates to its primary infection of [[B lymphocyte|B lymphocytes]] (the primary antibody-producing cell of the immune system) and ability to alter both lymphocyte proliferation and lymphocyte antibody production.<ref name="pmid12525618">{{cite journal |author=Sitki-Green D, Covington M, Raab-Traub N |title=Compartmentalization and transmission of multiple epstein-barr virus strains in asymptomatic carriers |journal=[[Journal of Virology]] |volume=77 |issue=3 |pages=1840–7 |year=2003 |month=February |pmid=12525618 |pmc=140987 |doi= |url=http://jvi.asm.org/cgi/pmidlookup?view=long&pmid=12525618 |accessdate=2012-02-23}}</ref><ref name="pmid17991806">{{cite journal |author=Hadinoto V, Shapiro M, Greenough TC, Sullivan JL, Luzuriaga K, Thorley-Lawson DA |title=On the dynamics of acute EBV infection and the pathogenesis of infectious mononucleosis |journal=[[Blood]] |volume=111 |issue=3 |pages=1420–7 |year=2008 |month=February |pmid=17991806 |pmc=2214734 |doi=10.1182/blood-2007-06-093278 |url=http://bloodjournal.hematologylibrary.org/cgi/pmidlookup?view=long&pmid=17991806 |accessdate=2012-02-23}}</ref> | |||
*Fatalities from mononucleosis are extremely rare in developed nations. Potential mortal complications include splenic rupture, bacterial [[superinfection]]s, [[hepatic failure]] and the development of [[Myocarditis|viral myocarditis]]. | |||
==Complications== | ==Complications== | ||
Revision as of 22:34, 23 February 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
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.[2]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, the virus can reactivate and cause vague physical symptoms (or may be subclinical), and during this phase the virus can spread to others.
- Similar reactivation or chronic subclinical viral activity in susceptible hosts may trigger multiple host autoimmune diseases, such as:
- Such chronic immunologic stimulation may also trigger multiple type of cancers, particularly lymphoma—strongest cancer associations with EBV are:
- EBV's potential to trigger such a wide range of autoimmune diseases and cancers probably relates to its primary infection of B lymphocytes (the primary antibody-producing cell of the immune system) and ability to alter both lymphocyte proliferation and lymphocyte antibody production.[1][2]
- Fatalities from mononucleosis are extremely rare in developed nations. Potential mortal complications include splenic rupture, bacterial superinfections, hepatic failure and the development of viral myocarditis.
Complications
Hematological
Neurological
- Cranial nerve palsies (Bell’s palsy)
- Encephalitis
Hepatology
Cardiology
Respiratory
- Airway obstruction (adenopathy)
Non-fatal compliactions
Uncommon, nonfatal complications exist, including various forms of CNS and hematological affection:
- CNS: Meningitis, encephalitis, hemiplegia and transverse myelitis. EBV infection has also been proposed as a risk factor for the development of multiple sclerosis (MS)[3], but this has not been affirmed.
- Hematologic: EBV can cause autoimmune hemolytic anemia (direct Coombs test is positive) and various cytopenias.
References
- ↑ Sitki-Green D, Covington M, Raab-Traub N (2003). "Compartmentalization and transmission of multiple epstein-barr virus strains in asymptomatic carriers". Journal of Virology. 77 (3): 1840–7. PMC 140987. PMID 12525618. Retrieved 2012-02-23. Unknown parameter
|month=ignored (help) - ↑ Hadinoto V, Shapiro M, Greenough TC, Sullivan JL, Luzuriaga K, Thorley-Lawson DA (2008). "On the dynamics of acute EBV infection and the pathogenesis of infectious mononucleosis". Blood. 111 (3): 1420–7. doi:10.1182/blood-2007-06-093278. PMC 2214734. PMID 17991806. Retrieved 2012-02-23. Unknown parameter
|month=ignored (help) - ↑ Ascherio A, Munger KL (2007). "Environmental risk factors for multiple sclerosis. Part I: the role of infection". Ann. Neurol. 61 (4): 288–99. doi:10.1002/ana.21117. PMID 17444504.