2002. of heterophile antibodies (Monospot or Paul-Bunnell Davidsohn test), and/or (iii) a positive PCR for EBV DNA. Individuals previously known as immunocompromised were excluded. Linear trends over time were analyzed by a nonparametric Spearman rank order correlation analysis, using years as the self-employed variable. values were based on two-tailed checks of significance Rabbit polyclonal to NPSR1 ( 0.05). Statistical analysis was performed using SPSS software version 11.5 (SPSS). Between 1990 and 2004, 38 individuals (15 male, 23 woman) were admitted to our division with EBV-related IM. The mean age was 22.6 years (standard deviation, 9.2 years; range, 16 to 53 years). Individuals were admitted because of severe hepatitis (= 12), severe dysphagia (= 8), hemophagocytic lymphohistiocytosis (HLH) (= 5), painful enlarged spleen (= 3), meningoencephalitis (= 3), or myocarditis, hemolytic anemia, or pleural effusion (one patient each). The maximal temp was 38C in 35 individuals (92.1%), having a mean of 39.7C. Pharyngitis was observed in 29 individuals (76.3%); it was exudative in most individuals (= 23). Additional common findings were lymphadenopathy (71.1%), splenomegaly (44.7%), hepatomegaly (31.6%), jaundice (31.6%), and rash (28.9%). Atypical lymphocytes were observed on blood smears in 34 individuals (89.4%). The white blood cell count was 8,000/mm3 in 26 individuals (68.4%), Trichostatin-A (TSA) having a mean of 13,470/mm3 (range, 2,500 to 64,900). Thirteen individuals (34.2%) had anemia, 10 (26.3%) had thrombocytopenia (platelet count of 150,000/mm3), and 33 (86.8%) had elevated aspartate aminotransferase and/or alanine aminotransferase. The median durations of fever and hospital stay were, respectively, 16.5 and 6 days (means were 22.5 and 10.7 days, respectively). Of 19 individuals (50%) who received systemic corticosteroids, 5 received additional immunomodulating treatment: intravenous immunoglobulins (IVIG) (= 5) and cyclosporine (= 3), rituximab (= 1), or antilymphocyte serum (= 1). Nine individuals (23.7%) received antiviral treatment: foscavir (= 0.623; = 0.013). The 1st patient who died was a 17-year-old male admitted in 2002 because of tonsillar enlargement causing airway compromise. He developed uncontrolled diffuse lymphoproliferation despite receiving corticosteroids, IVIG, cyclosporine, and Trichostatin-A (TSA) rituximab. No clonal lymphoproliferation was recognized in his peripheral blood, bone marrow smears, or lymph node biopsy despite repeated analysis by morphological exam, circulation cytometry immunophenotyping, Trichostatin-A (TSA) and molecular biology. The patient died with heavy enlarged lymph nodes, multiple-organ failure, and invasive aspergillosis. Screening for the genetic defect explained for the X-linked lymphoproliferative syndrome was negative. The second patient who died was a 20-year-old female admitted in 2003 for pancytopenia and severe hepatitis. On day time 3, she developed HLH and died after 7 days of refractory multiple-organ failure despite treatment with foscarnet, corticosteroids, IVIG, cyclosporine, and antilymphocyte serum. Open in a separate windowpane FIG. 1. Numbers of individuals admitted for EBV-related infectious mononucleosis inside a division of infectious diseases and an ICU (1990-2004). We observed a significant increase in the incidence of EBV-related IM requiring hospitalization. Potential biases include a lower threshold for hospitalization during recent years following our dreadful encounter with a young patient who died after one month of rigorous care in 2002. However, all individuals presented with objective indications of severe IM, and hospitalization was clearly indicated for most, if not all, of them. Moreover, recent studies from different settings showed related patterns: the incidence of IM requiring hospitalization for adolescents and young adults significantly increased in England during the years 1989 to 1998, but the database did not allow us to distinguish between different causes of IM (7). In Israel, during the years 1988 to 1991, 85% of 590 young adults with clinically suspected IM were hospitalized during their illness (3). Theories for the emergence of severe EBV-related IM in adolescents and young adults in industrialized countries include better personal hygiene, improved general public sanitation, and reducing family sizes, all factors that delay.
