Journal of Bacteriology & Parasitology

Difficulties in clinical and laboratory diagnosis of infectious mononucleosis

3^rd International Congress on Bacteriology and Infectious Diseases

August 04-06, 2015 Valencia, Spain

N C Sargsyants, H BMagdesieva and N SStepanyan

Posters-Accepted Abstracts: J Bacteriol Parasitol

Abstract:

Introduction: Epstein-Barr virus (EBV) or human herpesvirus 4 causative agent of infectious mononucleosis (IM) is
ubiquitous.But diagnosis of IM because of clinical diversities and laboratory diagnosis difficulties till date is not on proper level.
Materials & Method:We study epidemiological, clinical and laboratory peculiarities of IM in 10 patients (60% male). Patients
age was from 19 to 29 years old (average 22.7±3.1), 50% were students.
Results: Acute IM cases in 60% observed in winter-spring season (from February to May), in 40% during summer. In
majority of patients diagnosis was done after 7 days from the onset of disease (average 11.0 ± 4.6), in 90% only after infectious
disease specialist consultation. No cases among family members (house-hold contact).The onset of disease was with febrile
temperature in 80% of patients. Maculo-papular rash we noticed only in one case and areassociated with amoxacillin intake.
Periorbitaledema mentioned in 90% of patients, nasal breath difficulties-in 80%, hypernasal voice-in 40%. Neck edema around
enlarged lymphatic nodes took place only in one patient. Catarrhal nasopharingytis we observed in 40% of caseswhile follicular
and lacunar tonsillitis in 60% of patients with acute IM. Best effect on fever and tonsillitisresolution among antibacterial
drugswas associated with azitromycine. Generalized lymphadenopathy reveled in all patientswith maximal enlargement of
angular-mandibular lymphatic nodes. Hepatosplenomegaly was mandatory.Laboratory parameters (m±SD): Lymphocytes
5.16±1.5; Lymphocytes-%51.8±5.7; Monocytes-%14.3±3.1; Leucocytes 10.9±2.1; ESR 15.5±8.75; ALT 240.7±106.4; AST
123.9±52.2; GGT 154.2±95.3; ALP 346.4±114.9. Valacyclovir was prescribed in 6 patients;dexametasone due to severe upper
respiratory tract edema in 2 patients (4 mg for3-5 days). The heterophile antibodiesagglutination test with horse RBCs was
positive in 8 patients, in 2 patients diagnosis was conformed only after positive result of VCA IgM, EA-D IgMand VCA IgG
detection.
Conclusions: Besides characteristic clinical signs and diagnostically useful parameters (lymphomonocytosis, atypical
lymphocytes, abnormal liver function test, etc.) serological tests for antibodies specific for EBV antigens (viral capsid antigen
(VCA) IgG, VCA IgM and EBV nuclear antigen (EBNA)-1 IgG) are used to define infection status and for the differential
diagnosis of acute IM.