head JofIMAB
Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2019, vol. 25, issue1
Subject Area: Medicine
DOI: 10.5272/jimab.2019251.2332
Published online: 22 January 2019

Original article

J of IMAB. 2019 Jan-Mar;25(1):2332-2336
Tsvetelina Kostadinova1ORCID logo Corresponding Autoremail, Liliya Ivanova2,3, Zhivka Stoykova2,3ORCID logo, Tatina Todorova4ORCID logo, Denitsa Tsaneva2ORCID logo,
1) Section Medical Lab Technicians, Medical College, Medical University, Varna, Bulgaria.
2) Department of Microbiology and Virology-Medical University, Varna, Bulgaria.
3) Laboratory of Clinical Virology-University hospital St. Marina, Varna, Bulgaria
4) Department of Preclinical and Clinical Sciences, Faculty of Pharmacy, Medical University, Varna, Bulgaria.

Purpose: Infectious mononucleosis (IM) is an acute and self-limiting lymphoproliferative disease, and according to literature data in 90% of cases is associated with primary Epstein-Barr (EBV) viral infection. However, the mononucleosis-like syndrome is also caused by a number of other pathogens such as HHV-6, CMV, HIV, adenoviruses, etc., which makes the laboratory diagnosis necessary to identify the etiology of the disease. We compared clinical with serological IM data and defined serological profiles requiring further laboratory investigation.
Materials/ Methods: We investigated 746 patients with clinical symptoms for IM who had been tested in a virological laboratory at the „St.Marina“ University Hospital in the period 2010-2016, 57.6% (95% CI: 54.0% -61.2%, n = 430) were men. The average age of the subjects was 9.56 years (SD ± 8.26), lower in the boys. We used an indirect ELISA to detect anti-VCA IgM/IgG (Euroimmun, Germany).
Conclusion: The serological markers used in our laboratories (anti-VCA IgM/IgG) in combination with symptoms and other laboratory results are in most cases sufficient to confirm primary EBV infection, but there are cases where additional studies are needed to accurately determine the stage of the infection. Serological profiles requiring ongoing studies are the isolated anti-VCA IgM and anti-VCA IgG models.

Keywords: Infectious mononucleosis, Epstein-Barr virus, ELISA, anti-VCA IgM/IgG,

pdf - Download FULL TEXT /PDF 833 KB/
Please cite this article as: Kostadinova T, Ivanova L, Stoykova Zh, Todorova T, Tsaneva D. Analysis of infectious mononucleosis clinical cases in Varna region (2010-2016). J of IMAB. 2019 Jan-Mar;25(1):2332-2336. DOI: 10.5272/jimab.2019251.2332

Corresponding AutorCorrespondence to: Tsvetelina Kostadinova Popova, Section Medical Lab Technicians, Medical College, Medical University, Varna; 84 Tsar Osvoboditel Blvd., Varna, Bulgaria; E-mail: ckostadinova@abv.bg

1. Niedobitek G, Agathanggelou A, Herbst H, Whitehead L, Wright DH, Young LS. Epstein-Barr virus (EBV) infection in infectious mononucleosis: Virus latency, replicationand phenotype of EBV-infected cells. J Pathol. 1997 Jun;182(2):151-9. [PubMed]
2. Crawford DH, Macsween KF, Higgins CD, Thomas R, McAulay K, Williams H, et al. A cohort study among university students: identification of risk factors for Epstein-Barr virus seroconversion and infectious mononucleosis. Clin Infect Dis. 2006 Aug 1;43(3):276-82. [PubMed] [Crossref]
3. Hellwig T, Jude K, Meyer B. Management Options for Infectious Mononucleosis. US Pharm. 2013 May;38(5):38-41.
4. Grotto I, Mimouni D, Huerta M, Mimouni M, Cohen D, Robin G, et al. Clinical and laboratory presentation of EBV positive infectious mononucleosis in young adults. Epidemiol Infect. 2003 Aug;131(1): 683–689.
5. Morris MC, Edmunds WJ, The changing epidemiology of infectious mononucleosis?  J Infect. 2002 Aug;45 (2):107-109.
6. Hess RD. Routine Epstein-Barr Virus Diagnostics from the Laboratory Perspective: Still Challenging after 35 Years. J Clin Microbiol. 2004 Aug;42(8):3381-7. [PubMed] [Crossref]
7. Evans AS, Niederman JC, Cenabre LC, West B, Richards VA. A prospective evaluation of heterophile and Epstein-Barr virus-specific IgM antibody tests in clinical and subclinical infectious mononucleosis: specificity and sensitivity of the tests and persistence of antibody. J Infect Dis. 1975 Nov;132(5):546-54.[PubMed]
8. De Paschale M, Clerici P. Serological diagnosis of Epstein-Barr virus infection: Problems and solutions. World J Virol. 2012 Feb 12;1(1):31-43. [PubMed] [Crossref]
9. Klutts JS, Ford BA, Perez NR, Gronowski AM. Evidence-based approach for interpretation of Epstein-Barr virus serological patterns. J Clin Microbiol. 2009 Oct;47(10):3204-10. [PubMed] [CrossRef]
10. Gancheva G, Doychinova Ts, Lukanov Ts, Tsvetanova H, Gancheva S, Hristov H. [Infectious mononucleosis in the Pleven region (2008-2012) - Clinical, laboratory and immunological aspects.] [in Bulgarian] MedInfo. 2013 Oct;10;1-6.
11. De Paschale M, Cagnin D, Cerulli T,  Manco MT, Agrappi C, target="_blank"Mirri P, et al. Search for Anti-EA(D) Antibodies in Subjects with an “Isolated VCA IgG” Pattern. Int J Microbiol. 2010; 2010: 695104. [PubMed] [Crossref]
12. Ambinder R. Disease and Pathogenesis Associated with Epstein-Barr Virus. In: Human Cancer Viruses. Principles of Transformation and Pathogenesis. Editors: Nicholas J. Jeang KT, Wu TC. Transl Res Biomed. Basel, Karger. 2008, vol 1, pp 137-149.  [Crossref]
13. Becker N, Falster MO, Vajdic CM, de Sanjose S, Martínez-Maza O, Bracci PM, et al. Self-reported history of infections and the risk of non-Hodgkin lymphoma: an InterLymph pooled analysis. Int J Cancer. 2012 Nov 15;131(10):2342-8. [PubMed] [Crossref]
14. Balfour HH, Odumade OA, Schmeling DO, Mullan BD, Ed JA, Knight JA,et al. Behavioral, virologic, and immunologic factors associated with acquisition and severity of primary Epstein-Barr virus infection in university students. J Infect Dis. 2013 Jan 1;207(1):80-8. [PubMed] [Crossref]
15. Kostadinova Ts, Ivanova L, Raykov T, Stojkova Z, Tsankova G. Seroprevalence of Epstein-Barr Virus in North-Eastern Bulgaria. Acta Microbiol Bulg. 2016 Sep;32(3):33-38.
16. Balfour HH, Holman CJ, Hokanson KM, Lelonek MM, Giesbrecht JE, White DR, et al. A prospective clinical study of Epstein-Barr virus and host interactions during acute infectious mononucleosis. J Infect Dis. 2005 Nov 1;192(9):1505-12. [PubMed] [Crossref].

Received: 09 June 2018
Published online: 22 January 2019

back to Online Journal