James C. Niederman

Seroepidemiologic Studies of Infectious Mononucleosis with Eb Virus

Abstract Certain epidemiologic features of infectious mononucleosis are indicated by antibody patterns to the EB or herpes-like virus of Burkitt lymphoma. The absence of antibody correlated well with susceptibility: of 268 entering college students whose serums lacked EBV antibody, infectious mononucleosis developed in 15 per cent; in 94 whose serums already contained antibody, none had clinical disease. EBV antibody also correlated well with heterophil antibody; EBV antibody was present in the serums of all 135 patients who had heterophil-antibody-positive infectious mononucleosis and also in six with clinically and hematologically typical cases whose serums were persistently heterophil-antibody negative, suggesting that EB virus may be associated with both forms of illness. In a third group of patients clinical features resembled infectious mononucleosis, but the serums contained neither heterophil nor EBV antibodies. At present, EB virus is strongly implicated as a cause of infectious mononucleosis.

Prevalence, Incidence and Persistence of EB Virus Antibody in Young Adults

Abstract The prevalence rate for antibody to EB virus measured by the indirect immunofluorescence technic in 1084 young adults varied from 26 to 87 per cent depending on age and geographic area. In a prospective study of 150 Yale students 53 had EBV antibody on entry into college; 43 of 97 students lacking antibody had seroconversion during the next four to eight years, 28 with recognized clinical infectious mononucleosis and 15 with inapparent or unrecognized illness. This was an infection rate of 11.1 per cent per year in the susceptible group. Of 164 Peace Corps volunteers 76 per cent had detectable anti-EBV titers on entrance into service, and of 30 lacking antibody 27 per cent were infected over one year while working in Colombia, South America. In Yale students EBV antibody was always present in serum specimens obtained as long as eight years after clinical or subclinical infection, usually at levels of 1:40 or higher.

Prolonged Oropharyngeal Excretion of Epstein–Barr Virus after Infectious Mononucleosis

Abstract A factor that transforms human and simian blood leukocytes into continuous cell lines was present in throat washes from 23 of 25 patients with the infectious-mononucleosis syndrome. The factor was not detected in similar materials obtained from 17 control subjects. The factor was found eight days to 16 months after onset of the syndrome. Transformation of umbilical-cord leukocytes by this factor allowed detection by complement fixation of Epstein-Barr viral antigens; however, such antigens detectable by immunofluorescence were found in transformed cells derived only from adult human beings or marmosets. The transforming capacity of three throat washes was neutralized by reference serums with Epstein-Barr virus antibody but was unaffected by serums without the antibody. The results suggest that the transforming factor present in throat washes of patients with infectious mononucleosis is the Epstein-Barr virus. This agent is present in the oropharynx long after the appearance of serum antibodies an...

Depression of Cell-Mediated Immunity during Acute Infectious Mononucleosis

Abstract To elucidate mechanisms responsible for depression of cell-mediated immunity associated with viral infections, we studied 41 patients with infectious mononucleosis. Intradermal tests, lymphocyte stimulation in vitro and enumeration of peripheral blood T and B cells were performed. There was significant anergy and diminished lymphocyte responsiveness in vitro to mitogens and antigens during the first weeks of illness. This depression of cell-mediated immunity was accompanied by increased numbers of peripheral blood T and B cells. The numbers of atypical lymphocytes in the peripheral blood of several patients were too great to be classified as entirely T or B cells in type, and probably represent both types of lymphocytes. On the basis of these data, we hypothesize that T-cell response to viral infections results in antigenic competition, which is the major mechanism responsible for depression of cell-mediated immunity during infectious mononucleosis. (N Engl J Med 291:1149–1153, 1974)

Epstein-Barr Virus

Epstein-Barr virus (EBV), a member of the herpes group of viruses, is the cause of heterophil-positive infectious mononucleosis, of most heterophil-negative cases, and of occasional cases of tonsillitis and pharyngitis in childhood. Rarely, it may involve the liver or central nervous system as primary manifestations. This virus is also implicated as having a causal relationship to African Burkitt lymphoma, B- and T-cell malignant lymphomas, including those in patients with the acquired immunodeficiency syndrome (AIDS), and nasopharyngeal cancer. High antibody titers are present in some patients with sarcoidosis, and in systemic lupus erythematosus.

Psychosocial risk factors in the developmental of infectious mononucleosis.

&NA; In a 4‐year prospective seroepidemiological study of infectious mononucleosis (IM) of one class of some 1400 cadets at the West Point Military Academy, susceptibles and immunes were identified by the absence or presence of antibody to Epstein‐Barr virus (EBV), the causative agent, and new infections by the appearance of antibody (seroconversion). On entry, about ⅓ lacked EBV antibody, of whom some 20% became infected (seroconverted); about ¼ of seroconverters developed definite, clinical and recognized IM. Psychosocial factors that significantly increased the risk of clinical IM among seroconverters included: 1) having fathers who were “overachievers”; 2) having a high level of motivation; 3) doing relatively poorly academically. The combination of high motivation and poor academic performance interacted in predicting clinical IM. Additional data on presence of elevated titers among seroconverters with inapparent disease and on length of hospitalization among cases of clinical IM revealed that these two additional indices of infection or illness could also be predicted from the same set of psychosocial risk factors.

Antibody responses to two Epstein-barr virus nuclear antigens defined by gene transfer

By transfecting small fragments of Epstein-Barr virus (EBV) DNA into cells, we defined two nuclear antigens, termed M and K, and examined serum from 258 subjects for antibodies against these antigens. We hoped to learn whether such single-antigen systems would clarify the association of EBV with various diseases. Although reactivity to M antigen was found in only 14 per cent of healthy EBV-seropositive subjects, 90 per cent of Chinese and North African patients with nasopharyngeal carcinoma had antibody to M. Nearly all persons (96 per cent) who were EBV seropositive, as judged by their serologic reaction to a nuclear antigen encoded by the complete virus (EBNA), had a reaction to K antigen. However, serum samples from three patients with chronic active EBV infection did not react to K, even though the serum contained anti-M titers above 1:1000. Lymphoid cells from one such patient carried a normal gene for K and made K protein of correct size. Therefore, in this patient the absence of antibody to K had not resulted from a viral mutation that destroyed the K protein. These serologic studies show that some patients with chronic active EBV infection have an abnormal immune response to a specific viral gene product.

Review: Topical acyclovir is of limited or no benefit to patients with recurrent herpes labialis

Source Citation Worrall G. Topical acyclovir for recurrent herpes labialis in primary care. Can Fam Physician. 1991 Jan;37:92-8.

Intravenous IgG did not benefit patients with the chronic fatique syndrome

Source Citation Peterson PK, Shepard J, Macres M, et al. A controlled trial of intravenous IgG in chronic fatigue syndrome. Am J Med. 1990;89:554-60.