Abstracts
Behavioural Effects
Behavioural Effects
Evaluated the acute and chronic effects of infectious mononucleosis (IM) on memory, attention, psychomotor performance and mood. Objective measures of memory, attention, motor skills and visual functions were obtained, as were subjective reports of mood.
Results showed selective effects of acute IM on performance and mood, with the profile of impairments being very similar to those observed in previous studies of influenza.
However, the performance impairments did not reflect symptoms or psychopathology. The study of IM will provide important data on both the acute and longer lasting effects of viral infections on the brain and behaviour.
Hall SR & Smith AP Behavioural effects of infectious mononucleosis. Neuropsychobiology, 1996, 33:4, 202-9
Chronic Fatigue
Chronic Fatigue
Chronic fatigue syndrome (CFS) is a condition that may be associated with substantial disability. The Medical Outcomes Study Short-Form General Health Survey (SF-36) is an instrument that has been widely used in outpatient populations to determine functional status. Described the usefulness of the SF-36 in CFS patients and to determine if subscale scores could distinguish patients with CFS from subjects with unexplained chronic fatigue (CF), major depression (MD), or acute infectious mononucleosis (AIM), and from healthy control subjects (HC).
Performance characteristics (internal reliability coefficients, convergent validity) of the SF-36 were excellent. A strikingly consistent pattern was found for the physical functioning, role functioning, social functioning, general health, and body pain subscales, with the lowest scores in CFS patients, intermediate scores in AIM patients, and the highest scores in the HC subjects. The emotional functioning and mental health scores were worst among those with MD.
The presence of fibromyalgia, being unemployed, and increasing fatigue severity all were associated with additional functional limitations across multiple functional domains, with increasing fatigue appearing to have the greatest effect.
The SF-36 distinguishes patients with CFS and CF from those with MD and AIM, and from HC, but does not discriminate between CF and CFS.
Buchwald D et al., Functional status in patients with chronic fatigue syndrome, other fatiguing illnesses, and healthy individuals. Am J Med, 1996 101(4): 364-70.
Chronicity of EBV (Mononucleosis)
Chronicity of EBV
Multiple lines of investigation have solidly established that "infectious mononucleosis" results from a primary "infection" with "EBV" [a member of the "herpes" group]. This "virus" is common throughout all areas of the world and that most "infections" are subclinical and inapparent.
Chronicity of Epstein Barr Virus Infection. Editorial - Niederman, J.C. Ann. Int. Med. 1985 Jan; 102(1): 119-21.
Diagnosis and Treatment (Mononucleosis)
Diagnosis and Treatment
"Infectious" mononucleosis is caused by the EBV and most commonly affects young adults from 15 to 35 years of "age". The diagnosis is made by accurate assessment of clinical, hematologic and serologic manifestations of the illness: the classic triad being: "fever", "pharyngitis" and cervical lymphadenopathy. The most valuable serologic finding is the presence of IgM antibody to EBV viral capsid antigen.
The most common potentially fatal complication is splenic rupture.
Diagnosis and treatment of infectious mononucleosis. Bailey, R.E. Am. Fam. Physician. 1994 Mar; 49(4): 879-88.
Epstein-Barr & Multiple Sclerosis
Epstein-Barr & Multiple Sclerosis
Brought together knowledge about Epstein-Barr virus (EBV) in relation to multiple sclerosis (MS) in order to evaluate its implications in this disease. All MS patients are EBV seropositive, but EBV is not normally detected in the brain. EBV can explain many of the epidemiological dogmas known in MS. In addition, other studies point towards the involvement of EBV in MS.
Despite this, other co-actors seem also to be involved. EBV may be an initiating factor in MS or a factor in the pathogenesis.
Munch M et al., The implications of Epstein-Barr virus in multiple sclerosis--a review. Acta Neurol Scand Suppl, 1997, 169:, 59-64.
Neurologic Complications(Mononucleosis)
Neurologic Complications
A review of the neurologic complications of Epstein-Barr viral (EBV) infections is presented. EBV has been associated with a wide range of acute neurological diseases in children: "encephalitis", "meningitis", cranial nerve palsies, mononeuropathies, and many other neurological ailments have been. It is important to recognize that EBV can cause a myriad of neurologic illnesses with or without the stigmata of infectious mononucleosis.
Neurologic complications of infectious mononucleosis. Connelly,P.K. & DeWitt, L.D. Pediatr. Neurol. 1994 May; 10(3): 181-4.
Pediatric (Mononucleosis)
Pediatric
Classic infectious mononucleosis (IM) is uncommon in children; therefore, the incidence of severe pharyngotonsillitis complicating the infection is not well established.
Founda higher incidence of admissions for severe pharyngotonsillitis complicating IM than reported in the adult literature. It suggests that routine use of parenteral steroids is indicated in cases of severe upper airway obstruction and may decrease the need for surgical intervention.
Ganzel TM et al., Otolaryngologic clinical patterns in pediatric infectious mononucleosis. Am J Otolaryngol, 1996 Nov-Dec, 17:6, 397-400.
Physical Activity (Mononucleosis)
Physical Activity
Practitioners involved with the medical care of active children often are called on for advice regarding physical activity recommendations in children and adolescents who are ill.
Covered many general and specific guidelines to be considered when counseling children and their parents. Recommendations regarding specific athletes must be individualized, and there is room for a great deal of common sense.
Noffsinger J: Physical activity considerations in children and adolescents with viral infections. Pediatr Ann, 1996 Oct, 25:10, 585-9.
Adverse Drug Reactions
Adverse Drug Reactions
A spectrum of adverse drug reactions caused by the combined action of drugs and viruses has been described: ampicillin rash in acute infectious mononucleosis; Reye's syndrome; hypersensitivity reactions to sulphonamides in patients with HIV infection; drug-induced agranulocytosis; paracetamol (acetaminophen) hepatotoxicity; aspirin (acetylsalicyclic acid)-induced asthma; Epstein-Barr virus-associated lymphoma and methotrexate; and AIDS-related Kaposi's sarcoma and nitrite use.
Changes in pharmacokinetics have been reported for: caffeine, sulfamethoxazole and fluconazole in patients with HIV infection; theophylline, following influenza and influenza vaccination; and recently, dipyrone metabolites in carriers of the hepatitis B virus.
In addition increased drug- and drug metabolite-related toxicity has been observed in virally infected cells. Pathogenetic mechanisms for the interaction between drugs and viruses are varied, and include biological mechanisms (often immunological) and changes in drug metabolism.
Levy M: Role of viral infections in the induction of adverse drug reactions. Drug Saf, 1997 Jan, 16:1, 1-8.
Runner (Mononucleosis)
Runner
Monitored altitude acclimatisation in an elite cohort of distance runners and follow the subsequent recovery from infectious mononucleosis in one of these athletes.
Data suggest that the athlete was in a state of over-reaching during the altitude sojourn. After return to sea level, the early stages of infectious mononucleosis resulted in a marked impairment in physiological response to endurance exercise, which improved over time. Longitudinal physiological monitoring in conjunction with a carefully prescribed training programme made recovery possible.
Bailey DM et al., Recovery from infectious mononucleosis after altitude training in an elite middle distance runner. Br J Sports Med, 1997 Jun, 31:2, 153-4.
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