RESUMO
Most cases of infectious mononucleosis are caused by Epstein-Barr virus (EBV). However, other rare but potentially serious etiologies need to be considered. Cytomegalovirus (CMV) and Toxoplasma gondii infections, although generally benign, can cause severe congenital infections. An acute infection by the human immunodeficiency virus (HIV) can also mimic infectious mononucleosis. Laboratory diagnostic of those infections relies primarily on the detection of specific antibodies and antigens. The interpretation of laboratory results can be impeded by cross-reactions or persistence over several months of markers of acute infection. This article reviews the most common causes of infectious mononucleosis and their diagnosis.
La majorité des cas de mononucléose infectieuse sont dus à une infection par le virus d'Epstein-Barr (EBV). D'autres étiologies plus rares peuvent cependant avoir des conséquences graves. L'infection primaire à cytomégalovirus (CMV) ou la toxoplasmose, généralement bénignes, peuvent causer des infections congénitales sévères. Une primo-infection par le virus de l'immunodéficience humaine (VIH) peut également se présenter sous forme de mononucléose. Le diagnostic de ces infections repose sur la détection d'anticorps et d'antigènes spécifiques. Les problèmes de réactions croisées ou de persistance des marqueurs d'infection aiguë durant plusieurs mois rendent parfois délicate l'interprétation des résultats de laboratoire. Cet article passe en revue les causes les plus fréquentes de mononucléose infectieuse et leur approche diagnostique.
Assuntos
Infecções por Citomegalovirus , Mononucleose Infecciosa , Toxoplasmose , Citomegalovirus , Infecções por Citomegalovirus/complicações , Infecções por Vírus Epstein-Barr/complicações , Herpesvirus Humano 4 , Humanos , Recém-Nascido , Mononucleose Infecciosa/congênito , Mononucleose Infecciosa/virologia , Toxoplasmose/complicaçõesAssuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Lactente , Pediatria , Transmissão Vertical de Doenças Infecciosas , Feto , Complicações Infecciosas na Gravidez , Diagnóstico Diferencial , Doenças do Recém-Nascido , Doenças Transmissíveis/diagnóstico , Varicela/congênito , Parvovirus B19 Humano , Infecções por Citomegalovirus/congênito , Hepatite B/congênito , Herpes Simples/congênito , Mononucleose Infecciosa/congênito , Malária/congênito , Doença de Chagas/complicações , Infecções por Enterovirus/congênito , Infecções por Parvoviridae/congênito , Sífilis Congênita/diagnóstico , Síndrome da Rubéola Congênita , Síndrome da Imunodeficiência Adquirida/congênito , Toxoplasmose Congênita/diagnósticoRESUMO
A male infant infected in utero with EBV clinically presented after birth with dystrophy, generalized hypotonia, hepatosplenomegaly, diffuse petechiae and hematomas, metaphysis of the long bones, anemia, hyperbilirubinemia and elevated serum transaminases, lymphocytosis and thrombocytopenia. Malformations were absent. Specific serologic studies suggested congenital EBV infection in the newborn infant and primary EBV infection in the mother. Other known congenital infections could be excluded.
Assuntos
Anticorpos Antivirais/análise , Herpesvirus Humano 4/imunologia , Mononucleose Infecciosa/congênito , Complicações Infecciosas na Gravidez/imunologia , Adulto , Feminino , Retardo do Crescimento Fetal/diagnóstico , Retardo do Crescimento Fetal/imunologia , Seguimentos , Humanos , Lactente , Recém-Nascido , Mononucleose Infecciosa/diagnóstico , Mononucleose Infecciosa/imunologia , Masculino , Gravidez , Complicações Infecciosas na Gravidez/diagnósticoRESUMO
An infant with uncorrectable extrahepatic bile duct atresia was found to have evidence of Epstein-Barr virus infection during the neonatal period. It is probable that the infection was acquired in utero. In view of the association of hepatitis with the Epstein-Barr virus in later life, it is possible that this infection was responsible for the development of bile duct obstruction.
Assuntos
Ductos Biliares/anormalidades , Colestase Extra-Hepática/congênito , Mononucleose Infecciosa/congênito , Anticorpos Antivirais/análise , Colestase Extra-Hepática/complicações , Feminino , Herpesvirus Humano 4/imunologia , Humanos , Imunoglobulina G/análise , Lactente , Recém-Nascido , Mononucleose Infecciosa/complicaçõesRESUMO
A male infant infected in utero with Epstein-Barr virus (EBV) demonstrated a syndrome of multiple congenital anomalies (micrognathia, cryptorchidism, central cataracts), hypotonia, thrombocytopenia, persistent monocytosis, proteinuria, and multiple areas of metaphysitis at birth. Lymphocytes were Epstein-Barr nuclear antigen (EBNA) positive (18%) and persisted in culture for three months. He had antibody to early antigen (anti-EA), IgM-viral capsid (anti-VCA), and EBNA (anti-EBNA) detectable at 22 days of age. All attempts to isolate infectious agents or to serologically identify other infectious causes for his syndrome were negative.