Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Infectious Mononucleosis Workup

  • Author: Burke A Cunha, MD; Chief Editor: Michael Stuart Bronze, MD  more...
 
Updated: Oct 06, 2015
 

Laboratory Studies

Epstein-Barr virus (EBV) infection induces specific antibodies to EBV and various unrelated non-EBV heterophile antibodies. These heterophile antibodies react to antigens from animal RBCs.

  • Sheep RBCs agglutinate in the presence of heterophile antibodies and are the basis for the Paul-Bunnell test.
  • Agglutination of horse RBCs on exposure to heterophile antibodies is the basis of the Monospot test.

Heterophile test antibodies are sensitive and specific for EBV heterophile antibodies, they are present in peak levels 2-6 weeks after primary EBV infection, and they may remain positive in low levels for up to a year.

The latex agglutination assay, which is the basis of the Monospot test using horse RBCs, is highly specific. Sensitivity is 85%, and specificity is 100%.

The heterophile antibody test (eg, the Monospot test) results may be negative early in the course of EBV infectious mononucleosis. Positivity increases during the first 6 weeks of the illness. Patients who remain heterophile negative after 6 weeks with a mononucleosis illness should be considered as having heterophile-negative infectious mononucleosis.

  • Patients with heterophile infectious mononucleosis should be tested for EBV-specific antibodies before definitively diagnosing heterophile-negative infectious mononucleosis.
  • Patients with heterophile- or Monospot-negative infectious mononucleosis should be tested serologically as are patients who present with a mononucleosislike illness who are negative for heterophile antibodies. The heterophile test is less useful in children younger than 2 years, in whom the results are frequently negative.
  • Although virtual 100% specificity exists with the Monospot test, rarely, other disorders have been reported that may produce a false-positive Monospot test result. These causes of false-positive Monospot test results include toxoplasmosis, rubella, lymphoma, and certain malignancies, particularly leukemias and/or lymphomas.

Testing for EBV-specific antibodies is as follows:

  • EBV induces a serological response to the various parts of the Epstein-Barr viral particle. IgM and IgG antibodies directed against the VCA of EBV are useful in confirming the diagnosis of EBV and in differentiating acute and/or recent infection from previous infection. EBV IgM VCA titers decrease in most patients after 3-6 months but may persist in low titer for up to 1 year. EBV IgG VCA antibodies rise later than the IgM VCA antibodies but remain elevated with variable titers for life.
  • False-positive VCA antibody titer results may occur on the basis of cross-reactivity with other herpes viruses, eg, CMV, or with unrelated organisms, eg, Toxoplasma gondii.

Other antigens indicating EBV infection are less useful diagnostically and include early antigen (EA), which is present early in EBV infectious mononucleosis. EBV nuclear antigen (EBNA) appears after 1-2 months and persists throughout life. The presence of elevated EBNA titers has the same significance as elevated IgG VCA titers. The presence of these antibodies suggests previous exposure to the antigen (past infection) and excludes EBV infection acquired in the previous year.

As with heterophile antibody responses, specific EBV antibodies may not be present in children younger than 2 years.

Nonspecific tests are as follows:

  • Patients with infectious mononucleosis in the differential diagnoses should have a CBC count with differential and an evaluation of the erythrocyte sedimentation rate (ESR). The CBC count is more useful in ruling out other diagnoses that may mimic infectious mononucleosis than in providing any specific diagnostic information. Because leukocytosis is the rule in infectious mononucleosis, the presence of a normal or decreased WBC count should suggest an alternative diagnosis. Lymphocytosis accompanies infectious mononucleosis, increases during the first few weeks of illness, and then gradually returns to normal. The appearance, peak, and disappearance of atypical lymphocytes follow the same time course as lymphocytosis. Patients with fever, pharyngitis, and lymphadenopathy are likely to have EBV infectious mononucleosis if the relative atypical lymphocyte count is equal to or greater than 20%.
  • Atypical lymphocytes should be differentiated from abnormal lymphocytes. Abnormal lymphocytes are associated with lymphoreticular malignancies, whereas atypical lymphocytes are associated with various viral and noninfectious diseases, as well as drug reactions. Atypical lymphocytes are each different in their morphology as observed on the peripheral smear, whereas abnormal lymphocytes are monotonous in their sameness, which readily permits differentiation on the peripheral smear.
  • Because anemia is so rare with EBV infectious mononucleosis, patients with anemia should undergo workup for another cause of their anemia.
  • Thrombocytopenia not uncommonly accompanies EBV infectious mononucleosis, but it may be present in various other viral illnesses, including in patients with heterophile-negative infectious mononucleosis.
  • An ESR is most useful in differentiating group A streptococcal pharyngitis from EBV infectious mononucleosis. The sedimentation rate is elevated in most patients with EBV infectious mononucleosis, but it is not elevated in group A streptococcal pharyngitis. However, an elevated ESR does not differentiate EBV from the other heterophile-negative causes of infectious mononucleosis, nor does it differentiate infectious mononucleosis from malignancies.
  • Because the liver is uniformly involved in EBV infectious mononucleosis, mild elevation of the serum transaminases is a constant finding in early EBV infectious mononucleosis. Mild increases in the serum transaminases are also a feature of the infectious agents responsible for heterophile-negative infectious mononucleosis. High elevation of the serum transaminases should suggest viral hepatitis. The serum alkaline phosphatase and gamma-glutamyl transpeptidase (GGTP) levels are not usually elevated in individuals with EBV infectious mononucleosis.

Specific tests are as follows:

  • Heterophile antibody tests
    • Patients with infectious mononucleosis should first be tested with a heterophile antibody test. The most commonly used is the latex agglutination assay using horse RBCs, and it is marketed as the Monospot test. Enzyme-linked immunosorbent assay (ELISA) rapid diagnostic tests are also available, which are based on the detection of heterophile antibodies. Physicians should remember that heterophile antibody responses require 1-2 weeks to become positive. In a group of patients with EBV mononucleosis, the number of patients becoming positive increases to a maximum 6 weeks after the onset of the illness.
    • If results are initially negative, a Monospot test should be ordered weekly for 6 weeks in patients with suspected EBV infectious mononucleosis. If the Monospot test remains persistently negative after 6 weeks of weekly serial testing, then a specific EBV serological test should be ordered. Before patients with an infectious mononucleosis–like syndrome are labeled as having heterophile-negative infectious mononucleosis, specific EBV serological tests should be obtained, and the results should be negative (see below).
    • Major antibodies - Heterophile (Paul-Bunnell), EBV antigens, cold agglutinins (anti-1), smooth muscle antibodies (SMA)
    • Minor antibodies - Rheumatoid factor (RF), antinuclear antibodies (ANA), antimitochondrial antibodies, antireticulin antibodies, antimicrosomal antibodies, anti–intermediate filaments (IMF), lymphocytotoxin, Wasserman reagin
    • The Monospot test has high sensitivity and specificity, eg, 85% and nearly 100%, respectively. Rarely, Monospot test results may be falsely positive, particularly in patients with CMV or rubella but also in patients with SLE and rheumatoid arthritis. Potential false-positive reactions may occur in those with HIV infection or herpes simplex virus (HSV). If a false-positive Monospot test result is suspected, then specific testing using an EBV-based antibodies serological test is indicated. A false-negative Monospot test result may occur if testing is performed too early in the course of the illness or in very young children (< 2 y) and occasionally in elderly patients.
  • Specific EBV antibody tests
    • Specific EBV antibody testing is more time-consuming and expensive than the Monospot test. EBV serological tests should be obtained in patients with a mononucleosislike illness and a negative finding on the Monospot test. As with the heterophile test, the EBV antibody response may be falsely negative early in the course of the infection. False negativity may also occur in young children (< 2 y).
    • The antibody response to specific EBV serological testing consists of measuring the antibody response to surface and core EBV viral proteins. For clinical purposes, the most useful EBV-specific antibodies are the VCAs and the EBNA. Both VCA and EBNA antibodies are usually reported as IgM or IgG antibodies. Acute infection is diagnosed in patients who have an increased EBV IgM VCA titer. Later in the course of infection, the increase in IgM VCA antibodies may be accompanied by an increase in IgG VCA antibodies and an increase in IgG EBNA antibodies. Many laboratories report EBNA titers only, which usually measure the IgG EBNA.
    • Increased IgG VCA and/or increased IgG EBNA titers indicate past exposure to EBV, which may have been subclinical or clinical. Increased IgG VCA titers are not synonymous with chronic infectious mononucleosis, and these titers are not diagnostic of CFS. Following acute infection, the increase in IgM titers peaks after 4-8 weeks and usually remain positive for as long as 1 year. The Monospot heterophile antibodies follow the same time course as the IgM VCA titers.
    • Rarely, cross-reactivity occurs between VCA antibodies to EBV and those to CMV or toxoplasmosis. False-positive cross-reactivity to specific EBV antibodies is extremely rare. Such patients have high elevations of IgM CMV or toxoplasmosis titers, which helps to differentiate between the primary infectious agent and the serological cross-reactivity resulting in a false-positive test result.
    • Patients with heterophile-negative infectious mononucleosis, eg, those with persistently negative Monospot test results for 6 weeks and those with a negative EBV-specific test result, should be tested serologically for the infectious agents that cause heterophile-negative infectious mononucleosis (eg, HIV, HHV-6, toxoplasmosis, CMV, rubella, anicteric viral hepatitis).

Table 2. EBV Serologic Responses in EBV-Associated Diseases (Open Table in a new window)

EBV Diseases EBV Antibody Responses
Anti-VCA Anti-EA
IgM



Monospot/



Heterophile



IgM IgG Diffuse EA Restricted EA Anti-EBNA
Acute EBV mononucleosis + + + + - -
Past EBV infection - - + - - +
Chronic active EBV infection - - +++ + + +
Burkitt lymphoma - - +++ +/- + +
Nasopharyngeal carcinoma - - +++ + +/- +

 

Other tests are as follows:

  • Patients with suspected infectious mononucleosis should not have their throats cultured for group A streptococci because the carriage rate is approximately 30% in these patients. The mere recovery of group A streptococci from the oropharynx does not signify the cause of the patient's pharyngitis; it does not differentiate colonization from infection. In such patients, a Gram stain of the oropharynx is used to differentiate patients who have pharyngitis with positive cultures for group A streptococci from those colonized with group A streptococci.
  • Patients with EBV infectious mononucleosis or other causes of viral pharyngitis and group A streptococcal colonization have little or no white cell response on the Gram stain of the pharynx. Patients with group A streptococcal pharyngitis also have a positive finding on throat culture, but, in contrast to the patients with colonization, they show an intense polymorphonuclear cellular response with cellular debris and fibrous fragments indicating acute infection. The rapid streptococcal test cannot be used to differentiate colonization from infection any more than throat cultures.
  • Patients with presumed CNS involvement with EBV infectious mononucleosis should undergo serological tests for other causes of viral encephalitis appropriate to the patient's exposure history.
Next

Imaging Studies

See the list below:

  • Patients with presumed CNS involvement with EBV infectious mononucleosis should undergo a CT scan and/or MRI to rule out other causes of encephalitis.
Previous
Next

Other Tests

See the list below:

  • Patients with presumed CNS involvement with EBV infectious mononucleosis should also undergo an EEG to rule out other causes of encephalitis.
Previous
Next

Procedures

See the list below:

  • Rarely, if ever, is a bone marrow biopsy or lymph node biopsy needed in patients with EBV infectious mononucleosis. In the diagnosis of EBV infectious mononucleosis, the assessment of lymph node enlargement can be made confidently based on specific EBV antibody testing, and surgery is almost never necessary.
  • Patients with presumed CNS involvement with EBV infectious mononucleosis should also undergo a lumbar puncture to rule out other causes of encephalitis.
Previous
Next

Histologic Findings

Oropharyngeal epithelium demonstrates an intense lymphoproliferative response in the cells of the oropharynx. The lymph node and spleen show lymphocytic infiltration primarily in the periphery of a lymph node.

Previous
 
 
Contributor Information and Disclosures
Author

Burke A Cunha, MD Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

John W King, MD Professor of Medicine, Chief, Section of Infectious Diseases, Director, Viral Therapeutics Clinics for Hepatitis, Louisiana State University Health Sciences Center; Consultant in Infectious Diseases, Overton Brooks Veterans Affairs Medical Center

John W King, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, Association of Subspecialty Professors, American Society for Microbiology, Infectious Diseases Society of America, Sigma Xi

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, Oklahoma State Medical Association, Southern Society for Clinical Investigation, Association of Professors of Medicine, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Charles S Levy, MD Associate Professor, Department of Medicine, Section of Infectious Disease, George Washington University School of Medicine

Charles S Levy, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America, Medical Society of the District of Columbia

Disclosure: Nothing to disclose.

References
  1. Sprunt TPV, Evans FA. Mononuclear leukocytosis in reaction to acute infection (infectious mononucleosis). Bulletin of the Johns Hopkins Hospital. Baltimore, 1920. 31:410-417.

  2. Aalto SM, Linnavuori K, Peltola H, et al. Immunoreactivation of Epstein-Barr virus due to cytomegalovirus primaryinfection. J Med Virol. 1998 Nov. 56(3):186-91. [Medline].

  3. Akashi K, Eizuru Y, Sumiyoshi Y, et al. Brief report: severe infectious mononucleosis-like syndrome and primary human herpesvirus 6 infection in an adult. N Engl J Med. 1993 Jul 15. 329(3):168-71. [Medline].

  4. Al-Jitawi SA, Hakooz BA, Kazimi SM. False positive Monospot test in systemic lupus erythematosus. Br J Rheumatol. 1987 Feb. 26(1):71. [Medline].

  5. Ali J. Spontaneous rupture of the spleen in patients with infectious mononucleosis. Can J Surg. 1993 Feb. 36(1):49-52. [Medline].

  6. Allday MJ, Crawford DH. Role of epithelium in EBV persistence and pathogenesis of B-cell tumours. Lancet. 1988 Apr 16. 1(8590):855-7. [Medline].

  7. Anderson MD, Kennedy CA, Lewis AW, et al. Retrobulbar neuritis complicating acute Epstein-Barr virus infection. Clin Infect Dis. 1994 May. 18(5):799-801. [Medline].

  8. Andersson J. Clinical and immunological considerations in Epstein-Barr virus-associated diseases. Scand J Infect Dis Suppl. 1996. 100:72-82. [Medline].

  9. Andersson J, Ernberg I. Management of Epstein-Barr virus infections. Am J Med. 1988 Aug 29. 85(2A):107-15. [Medline].

  10. Andersson JP. Clinical aspects on Epstein-Barr virus infection. Scand J Infect Dis Suppl. 1991. 80:94-104. [Medline].

  11. Andiman WA, Miller G. Antibody responses to Epstein-Barr virus. Rose NR, Friedman H, eds. Manual of Clinical Immunology. 2nd ed. Washington, DC: American Society for Microbiology; 1980. 628-633.

  12. Asgari MM, Begos DG. Spontaneous splenic rupture in infectious mononucleosis: a review. Yale J Biol Med. 1997 Mar-Apr. 70(2):175-82. [Medline].

  13. Auwaerter PG. Infectious mononucleosis in middle age. JAMA. 1999 Feb 3. 281(5):454-9. [Medline].

  14. Baciewicz AM, Chandra R. Cefprozil-induced rash in infectious mononucleosis. Ann Pharmacother. 2005 May. 39(5):974-5. [Medline].

  15. Balfour HH, Holman CJ, Hokanson KM, 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. [Medline].

  16. Bender CE. The value of corticosteroids in the treatment of infectious mononucleosis. JAMA. 1967 Feb 20. 199(8):529-31. [Medline].

  17. Berger RG, Raab-Traub N. Acute monoarthritis from infectious mononucleosis. Am J Med. 1999 Aug. 107(2):177-8. [Medline].

  18. Bigazzi C, Galieni P, Scarinci R, et al. 11q- and constitutional X trisomy in a patient with M5b acute non-lymphocytic leukemia. Haematologica. 1993 May-Jun. 78(3):185-6. [Medline].

  19. Bird AG, Britton S. The relationship between Epstein-Barr virus and lymphoma. Semin Hematol. 1982 Oct. 19(4):285-300. [Medline].

  20. Bonoan JT, Cunha BA. Lymphoma vs. monospot negative EBV infectious mononucleosis. Infect Dis Pract. 1998. 22:63-64.

  21. Brooks LA, Crook T, Crawford DH. Epstein-Barr virus and lymphomas. Infections and Human Cancer. Harbor, NY: Cold Spring Harbor Press; 1999. 98-123.

  22. Buchwald DS, Rea TD, Katon WJ, et al. Acute infectious mononucleosis: characteristics of patients who report failure to recover. Am J Med. 2000 Nov. 109(7):531-7. [Medline].

  23. Burgio GR, Monafo V. Infectious mononucleosis fifty years after the discovery of the Paul- Bunnell test. Infection. 1983 Jan-Feb. 11(1):1-5. [Medline].

  24. Cameron B, Bharadwaj M, Burrows J, et al. Prolonged illness after infectious mononucleosis is associated with altered immunity but not with increased viral load. J Infect Dis. 2006 Mar 1. 193(5):664-71. [Medline].

  25. Carter RL. Granulocyte in infectious mononucleosis. Carter RL, Penman HG, eds. Infectious Mononucleosis. Boston, Mass: Blackwell Scientific Publications; 1969. 111-120.

  26. Carter RL, Penman HG. Infectious Mononucleosis. Boston, Mass: Blackwell Scientific Publications; 1969.

  27. Chaganti S, Heath EM, Bergler W, Kuo M, Buettner M, Niedobitek G, et al. Epstein-Barr virus colonization of tonsillar and peripheral blood B-cell subsets in primary infection and persistence. Blood. 2009 Jun 18. 113(25):6372-81. [Medline].

  28. Chang RS. Hall GK, ed. Infectious Mononucleosis. Boston, Mass: Thieme Medical Publishers; 1980.

  29. Cheeseman SH. Infectious mononucleosis. Semin Hematol. 1988 Jul. 25(3):261-8. [Medline].

  30. Cohen JI. Epstein-Barr virus and the immune system. Hide and seek. JAMA. 1997 Aug 13. 278(6):510-3. [Medline].

  31. Cohen JI. Epstein-Barr virus infection. N Engl J Med. 2000 Aug 17. 343(7):481-92. [Medline].

  32. Cohen JI. Epstein-Barr virus lymphoproliferative disease associated with acquired immunodeficiency. Medicine (Baltimore). 1991 Mar. 70(2):137-60. [Medline].

  33. Connelly KP, DeWitt LD. Neurologic complications of infectious mononucleosis. Pediatr Neurol. 1994 May. 10(3):181-4. [Medline].

  34. Cunha BA. CMV infectious mononucleosis presenting as FUO. Emerg Med. 2001. 33:73-75.

  35. Cunha BA. EBV mononucleosis in older patients. Emerg Med. 1996. 27:82-84.

  36. Cunha BA. EBV mononucleosis. Infect Dis Pract. 1994. 18:8.

  37. Cunha BA. False positive heterophile tests for EBV infectious mononucleosis. Infect Dis Pract. 2001. 25:7-9.

  38. Cunha BA. Heterophile negative infectious mononucleosis. Infect Dis Pract. 2001. 25:17-19.

  39. Cunha BA, Mickail N, Laguerre M. Babesiosis mimicking Epstein Barr Virus (EBV) infectious mononucleosis: another cause of false positive monospot tests. J Infect. 2012 May. 64(5):531-2. [Medline].

  40. Cunha BA, Mickail N, Petelin AP. Infectious mononucleosis-like syndrome probably attributable to Coxsackie A virus infection. Heart Lung. 2012 Sep-Oct. 41(5):522-4. [Medline].

  41. Davidsohn I. Serologic diagnosis of infectious mononucleosis. JAMA. 1937. 108:289-295.

  42. Decker GR, Berberian BJ, Sulica VI. Periorbital and eyelid edema: the initial manifestation of acute infectious mononucleosis. Cutis. 1991 May. 47(5):323-4. [Medline].

  43. Downey H, McKinlay CA. Acute lymphadenosis compared with acute lymphatic leukemia. Arch Inter Med. 1923. 32:82-112.

  44. Dror Y, Blachar Y, Cohen P, et al. Systemic lupus erythematosus associated with acute Epstein-Barr virus infection. Am J Kidney Dis. 1998 Nov. 32(5):825-8. [Medline].

  45. Epstein MA, Achong BC. The Epstein-Barr Virus. New York, NY: Springer-Verlag; 1979.

  46. Fafi-Kremer S, Morand P, Brion JP, et al. Long-term shedding of infectious epstein-barr virus after infectious mononucleosis. J Infect Dis. 2005 Mar 15. 191(6):985-9. [Medline].

  47. Farley DR, Zietlow SP, Bannon MP, et al. Spontaneous rupture of the spleen due to infectious mononucleosis. Mayo Clin Proc. 1992 Sep. 67(9):846-53. [Medline].

  48. Farrell PJ. Role for HLA in susceptibility to infectious mononucleosis. J Clin Invest. 2007 Oct. 117(10):2756-8. [Medline].

  49. Feranchak AP, Tyson RW, Narkewicz MR, et al. Fulminant Epstein-Barr viral hepatitis: orthotopic liver transplantation and review of the literature. Liver Transpl Surg. 1998 Nov. 4(6):469-76. [Medline].

  50. Finch SC. Laboratory findings in infectious mononucleosis. Carter RL, Penman HG, eds. Infectious Mononucleosis. Boston, Mass: Blackwell Scientific Publications; 1969. 47-52.

  51. Finkel M, Parker GW, Fangelau HA. The hepatitis of infectious mononucleosis: experience with 235 cases. Mil Med. 1964 Jun. 129:533-8. [Medline].

  52. Fleisher GR, Pasquariello PS, Warren WS, et al. Intrafamilial transmission of Epstein-Barr virus infections. J Pediatr. 1981 Jan. 98(1):16-9. [Medline].

  53. Fogeda M, de Ory F, Avellón A, Echevarría JM. Differential diagnosis of hepatitis E virus, cytomegalovirus and Epstein-Barr virus infection in patients with suspected hepatitis E. J Clin Virol. 2009 Jul. 45(3):259-61. [Medline].

  54. Gaffey MJ, Weiss LM. Association of Epstein-Barr virus with human neoplasia. Pathol Annu. 1992. 27 Pt 1:55-74. [Medline].

  55. Gill MV, Cunha BA. Streptococcal colonization versus infection. Infect Dis Pract. 1994. 18:16.

  56. Glaser SL, Lin RJ, Stewart SL, Ambinder RF, Jarrett RF, Brousset P, et al. Epstein-Barr virus-associated Hodgkin's disease: epidemiologic characteristics in international data. Int J Cancer. 1997 Feb 7. 70(4):375-82. [Medline].

  57. Godshall SE, Kirchner JT. Infectious mononucleosis. Complexities of a common syndrome. Postgrad Med. 2000 Jun. 107(7):175-9, 183-4, 186. [Medline].

  58. Gold WL, Kapral MK, Witmer MR, et al. Postanginal septicemia as a life-threatening complication of infectious mononucleosis. Clin Infect Dis. 1995 May. 20(5):1439-40. [Medline].

  59. Goldacre MJ, Wotton CJ, Yeates DG. Associations between infectious mononucleosis and cancer: record-linkage studies. Epidemiol Infect. 2009 May. 137(5):672-80. [Medline].

  60. Gray J, Wreghitt TG, Pavel P, et al. Epstein-Barr virus infection in heart and heart-lung transplant recipients: incidence and clinical impact. J Heart Lung Transplant. 1995 Jul-Aug. 14(4):640-6. [Medline].

  61. Halevy J, Ash S. Infectious mononucleosis in hospitalized patients over forty years of age. Am J Med Sci. 1988 Feb. 295(2):122-4. [Medline].

  62. Han XY, Hellerstedt BA, Koller CA. Postsplenectomy cytomegalovirus mononucleosis is a distinct clinicopathologic syndrome. Am J Med Sci. 2010 Apr. 339(4):395-9. [Medline].

  63. Haverkos HW, Amsel Z, Drotman DP. Adverse virus-drug interactions. Rev Infect Dis. 1991 Jul-Aug. 13(4):697-704. [Medline].

  64. Henle W, Henle GE, Horwitz CA. Epstein-Barr virus specific diagnostic tests in infectious mononucleosis. Hum Pathol. 1974 Sep. 5(5):551-65. [Medline].

  65. Hernandez AM, Shibata D. Epstein-Barr virus-associated non-Hodgkin's lymphoma in HIV-infected patients. Leuk Lymphoma. 1995 Jan. 16(3-4):217-21. [Medline].

  66. Herrod HG, Dow LW, Sullivan JL. Persistent epstein-barr virus infection mimicking juvenile chronic myelogenous leukemia: immunologic and hematologic studies. Blood. 1983 Jun. 61(6):1098-104. [Medline].

  67. Hjalgrim H, Smedby KE, Rostgaard K, et al. Infectious mononucleosis, childhood social environment, and risk of Hodgkin lymphoma. Cancer Res. 2007 Mar 1. 67(5):2382-8. [Medline].

  68. Hoagland RJ. Infectious Mononucleosis. New York, NY: Grune & Stratton; 1967.

  69. Hoagland RJ. Infectious mononucleosis. Am J Med. 1952 Aug. 13(2):158-71. [Medline].

  70. Hoagland RJ. The clinical manifestations of infectious mononucleosis: A report of two hundred cases. Am J Med Sci. 1960. 240:21-29.

  71. Horwitz CA, Henle W, Henle G, et al. Infectious mononucleosis in patients aged 40 to 72 years: report of 27 cases, including 3 without heterophil-antibody responses. Medicine (Baltimore). 1983 Jul. 62(4):256-62. [Medline].

  72. Horwitz CA, Henle W, Henle G, et al. Long-term serological follow-up of patients for Epstein-Barr virus after recovery from infectious mononucleosis. J Infect Dis. 1985 Jun. 151(6):1150-3. [Medline].

  73. Hurt C, Tammaro D. Diagnostic evaluation of mononucleosis-like illnesses. Am J Med. 2007 Oct. 120(10):911.e1-8. [Medline].

  74. Hurt C, Tammaro D. Diagnostic evaluation of mononucleosis-like illnesses. Am J Med. 2007 Oct. 120(10):911.e1-8. [Medline].

  75. Schlossberg D. Infectious Mononucleosis. 2nd Ed. New York: Springer-Verlag; 1988.

  76. Jacobs BC, Rothbarth PH, van der Meche FG, et al. The spectrum of antecedent infections in Guillain-Barre syndrome: a case-control study. Neurology. 1998 Oct. 51(4):1110-5. [Medline].

  77. Jappe U. Amoxicillin-induced exanthema in patients with infectious mononucleosis: allergy or transient immunostimulation?. Allergy. 2007 Dec. 62(12):1474-5. [Medline].

  78. Jenson HB. Acute complications of Epstein-Barr virus infectious mononucleosis. Curr Opin Pediatr. 2000 Jun. 12(3):263-8. [Medline].

  79. Johnson DH, Cunha BA. Epstein-Barr virus serology. Infect Dis Pract. 1995. 19:26-27.

  80. Kano K, Milgrom F. Heterophile antigens and antibodies in medicine. Curr Top Microbiol Immunol. 1977. 77:43-69. [Medline].

  81. Kaplan JM, Keller MS, Troy S. Nasopharyngeal obstruction in infectious mononucleosis. Am Fam Physician. 1987 Jan. 35(1):205-9. [Medline].

  82. Kaye KM, Kieff E. Epstein-Barr virus infection and infectious mononucleosis. Gorbach SL, Bartlett JG, Blacklow NR, eds. Infectious Diseases. Philadelphia, Pa: WB Saunders Co; 1992. 1646-1654.

  83. Khanna R, Moss DJ, Burrows SR. Vaccine strategies against Epstein-Barr virus-associated diseases: lessons from studies on cytotoxic T-cell-mediated immune regulation. Immunol Rev. 1999 Aug. 170:49-64. [Medline].

  84. Kieff E. Epstein-Barr virus and its replication. Fields BN, Knipe DM, Howley PM, eds. Fields Virology. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1996. 2343-2396.

  85. Kieff E, Dambaugh T, Heller M, et al. The biology and chemistry of Epstein-Barr virus. J Infect Dis. 1982 Oct. 146(4):506-17. [Medline].

  86. Kitazawa Y, Saito F, Nomura S, et al. A case of hemophagocytic lymphohistiocytosis after the primary Epstein-Barr virus infection. Clin Appl Thromb Hemost. 2007 Jul. 13(3):323-8. [Medline].

  87. Klein E, Masucci MG. Cell-mediated immunity against Epstein-Barr virus infected B lymphocytes. Springer Semin Immunopathol. 1982. 5(1):63-73. [Medline].

  88. Klein NC, Petelin A, Cunha BA. Mycoplasma pneumoniae preceding Lemierre's syndrome due to Fusobacterium nucleatum complicated by acute Epstein-Barr virus (EBV) infectious mononucleosis in an immunocompetent host. Heart Lung. 2013 Jan. 42(1):74-6. [Medline].

  89. Klemola E, Von Essen R, Henle G, et al. Infectious-mononucleosis-like disease with negative heterophil agglutination test. Clinical features in relation to Epstein-Barr virus and cytomegalovirus antibodies. J Infect Dis. 1970 Jun. 121(6):608-14. [Medline].

  90. Koj IG, Cunha BA. EBV infectious mononucleosis presenting with excruciating scalp tenderness. Infect Dis Pract. 1998. 22:83.

  91. Konvolinka CW, Wyatt DB. Splenic rupture and infectious mononucleosis. J Emerg Med. 1989 Sep-Oct. 7(5):471-5. [Medline].

  92. Lagona E, Sharifi F, Voutsioti A, et al. Epstein-Barr virus infectious mononucleosis associated with acute acalculous cholecystitis. Infection. 2007 Apr. 35(2):118-9. [Medline].

  93. Lai PK, Alpers MP. Cell-mediated immune responses in man to Epstein-Barr (EB) virus infection. Comp Immunol Microbiol Infect Dis. 1979. 2(4):565-85. [Medline].

  94. Lam KM, Crawford DH. The oncogenic potential of Epstein-Barr virus. Crit Rev Oncog. 1991. 2(3):229-45. [Medline].

  95. LeClaire AC, Martin CA, Hoven AD. Rash associated with piperacillin/tazobactam administration in infectious mononucleosis. Ann Pharmacother. 2004 Jun. 38(6):996-8. [Medline].

  96. Levine D, Tilton RC, Parry MF, et al. False positive EBNA IgM and IgG antibody tests for infectious mononucleosis in children. Pediatrics. 1994 Dec. 94(6 Pt 1):892-4. [Medline].

  97. Liebowitz D. Epstein-Barr virus and a cellular signaling pathway in lymphomas from immunosuppressed patients. N Engl J Med. 1998 May 14. 338(20):1413-21. [Medline].

  98. Linde A. Diagnosis of Epstein-Barr virus-related diseases. Scand J Infect Dis Suppl. 1996. 100:83-8. [Medline].

  99. Luzuriaga K, Sullivan JL. Infectious mononucleosis. N Engl J Med. 2010 May 27. 362(21):1993-2000. [Medline].

  100. MacGowan JR, Mahendra P, Ager S, et al. Thrombocytopenia and spontaneous rupture of the spleen associated with infectious mononucleosis. Clin Lab Haematol. 1995 Mar. 17(1):93-4. [Medline].

  101. MacMahon EM, Glass JD, Hayward SD, et al. Epstein-Barr virus in AIDS-related primary central nervous system lymphoma. Lancet. 1991 Oct 19. 338(8773):969-73. [Medline].

  102. Maddern BR, Werkhaven J, Wessel HB, et al. Infectious mononucleosis with airway obstruction and multiple cranial nerve paresis. Otolaryngol Head Neck Surg. 1991 Apr. 104(4):529-32. [Medline].

  103. Maki DG, Reich RM. Infectious mononucleosis in the athlete. Diagnosis, complications, and management. Am J Sports Med. 1982 May-Jun. 10(3):162-73. [Medline].

  104. Markin RS. Manifestations of Epstein-Barr virus-associated disorders in liver. Liver. 1994 Feb. 14(1):1-13. [Medline].

  105. Markin RS, Linder J, Zuerlein K, et al. Hepatitis in fatal infectious mononucleosis. Gastroenterology. 1987 Dec. 93(6):1210-7. [Medline].

  106. Maruyama K, Ushiku H, Kondou Y. Gallbladder wall thickening in children with infectious mononucleosis. J Clin Ultrasound. 1994 Nov-Dec. 22(9):576-8. [Medline].

  107. Mason WR Jr, Adams EK. Infectious mononucleosis; an analysis of 100 cases with particular attention to diagnosis, liver function tests and treatment of selected cases with prednisone. Am J Med Sci. 1958 Oct. 236(4):447-59 passim. [Medline].

  108. Mendoza N, Diamantis M, Arora A, Bartlett B, Gewirtzman A, Tremaine AM, et al. Mucocutaneous manifestations of Epstein-Barr virus infection. Am J Clin Dermatol. 2008. 9(5):295-305. [Medline].

  109. Mendoza N, Diamantis M, Arora A, Bartlett B, Gewirtzman A, Tremaine AM, et al. Mucocutaneous manifestations of Epstein-Barr virus infection. Am J Clin Dermatol. 2008. 9(5):295-305. [Medline].

  110. Milpied N, Coste-Burel M, Accard F, et al. Epstein-Barr virus-associated B cell lymphoproliferative disease after non-myeloablative allogeneic stem cell transplantation. Bone Marrow Transplant. 1999 Mar. 23(6):629-30. [Medline].

  111. Mroczek EC, Weisenburger DD, Grierson HL, et al. Fatal infectious mononucleosis and virus-associated hemophagocytic syndrome. Arch Pathol Lab Med. 1987 Jun. 111(6):530-5. [Medline].

  112. Murray BJ. Medical complications of infectious mononucleosis. Am Fam Physician. 1984 Nov. 30(5):195-9. [Medline].

  113. Nalesnik MA, Starzl TE. Epstein-Barr virus, infectious mononucleosis, and posttransplant lymphoproliferative disorders. Transplant Sci. 1994 Sep. 4(1):61-79. [Medline].

  114. Nystad TW, Myrmel H. Prevalence of primary versus reactivated Epstein-Barr virus infection in patients with VCA IgG-, VCA IgM- and EBNA-1-antibodies and suspected infectious mononucleosis. J Clin Virol. 2007 Apr. 38(4):292-7. [Medline].

  115. Ohno T, Ueda Y, Kishimoto W, Arimoto-Miyamoto K, Takeoka T, Tsuji M. Epstein-Barr virus-induced infectious mononucleosis after two separate episodes of virus-associated hemophagocytic syndrome. Intern Med. 2009. 48(13):1169-73. [Medline].

  116. Okano M, Gross TG. Acute or chronic life-threatening diseases associated with Epstein-Barr virus infection. Am J Med Sci. 2012 Jun. 343(6):483-9. [Medline].

  117. Okano M, Gross TG. Epstein-Barr virus-associated hemophagocytic syndrome and fatal infectious mononucleosis. Am J Hematol. 1996 Oct. 53(2):111-5. [Medline].

  118. Okano M, Thiele GM, Davis JR, et al. Epstein-Barr virus and human diseases: recent advances in diagnosis. Clin Microbiol Rev. 1988 Jul. 1(3):300-12. [Medline].

  119. Ooka T, de Turenne-Tessier M, Stolzenberg MC. Relationship between antibody production to Epstein-Barr virus (EBV) early antigens and various EBV-related diseases. Springer Semin Immunopathol. 1991. 13(2):233-47. [Medline].

  120. Oren I, Sobel JD. Human herpesvirus type 6: review. Clin Infect Dis. 1992 Mar. 14(3):741-6. [Medline].

  121. Osamah H, Finkelstein R, Brook JG. Rhabdomyolysis complicating acute Epstein-Barr virus infection. Infection. 1995 Mar-Apr. 23(2):119-20. [Medline].

  122. Paul JR, Brunnell WW. The presence of heterophile antibodies in infectious mononucleosis. Am J Med Sci. 1932. 183:90-104.

  123. Penman HG. Fatal infectious mononucleosis: a critical review. J Clin Pathol. 1970 Dec. 23(9):765-71. [Medline].

  124. Pflugfelder SC, Crouse CA, Atherton SS, et al. Ophthalmic manifestations of Epstein-Barr virus infection. Int Ophthalmol Clin. 1993 Winter. 33(1):95-101. [Medline].

  125. Pullen H, Wright N, Murdoch JM. Hypersensitivity reactions to antibacterial drugs in infectious mononucleosis. Lancet. 1967 Dec 2. 2(7527):1176-8. [Medline].

  126. Purtilo DT. Epstein-Barr virus: the spectrum of its manifestations in human beings. South Med J. 1987 Aug. 80(8):943-7. [Medline].

  127. Purtilo DT, Sakamoto K. Epstein-Barr virus and human disease: immune responses determine the clinical and pathologic expression. Hum Pathol. 1981 Aug. 12(8):677-9. [Medline].

  128. Rickinson AB, Fox CP. Epstein-barr virus and infectious mononucleosis: what students can teach us. J Infect Dis. 2013 Jan. 207(1):6-8. [Medline].

  129. Rickinson AB, Moss DJ. Human cytotoxic T lymphocyte responses to Epstein-Barr virus infection. Annu Rev Immunol. 1997. 15:405-31. [Medline].

  130. Robinson JE. The biology of circulating B lymphocytes infected with Epstein-Barr virus during infectious mononucleosis. Yale J Biol Med. 1982 May-Aug. 55(3-4):311-6. [Medline].

  131. Rosalki SB, Jones TG, Verney AF. Transaminase and liver-function studies in infectious mononucleosis. Br Med J. 1960 Mar 26. 1(5177):929-32. [Medline].

  132. Safran D, Bloom GP. Spontaneous splenic rupture following infectious mononucleosis. Am Surg. 1990 Oct. 56(10):601-5. [Medline].

  133. Sanefuji M, Ohga S, Kira R, Nomura A, Torisu H, Takada H, et al. Epstein-Barr virus-associated meningoencephalomyelitis: intrathecal reactivation of the virus in an immunocompetent child. J Child Neurol. 2008 Sep. 23(9):1072-7. [Medline].

  134. Schaller RJ, Counselman FL. Infectious mononucleosis in young children. Am J Emerg Med. 1995 Jul. 13(4):438-40. [Medline].

  135. Schlossberg D. Infectious Mononucleosis. 2nd ed. New York, NY: Springer-Verlag; 1989.

  136. Schmader KE, van der Horst CM, Klotman ME. Epstein-Barr virus and the elderly host. Rev Infect Dis. 1989 Jan-Feb. 11(1):64-73. [Medline].

  137. Schmitz H, Volz D, Krainick-Riechert C, et al. Acute Epstein-Barr virus infections in children. Med Microbiol Immunol. 1972. 158(1):58-63. [Medline].

  138. Schnipper LE. The Epstein-Barr virus and human lymphoproliferative disorders. Prog Hematol. 1981. 12:275-97. [Medline].

  139. Schumacher HR, Jacobson Wa, Bemiller CR. Treatment of infectious mononucleosis. Ann Intern Med. 1963. 58:217-228.

  140. Schumacher HR, Jacobson WA, Bemiller CR. Treatment of infectious mononucleosis. Ann Intern Med. 1952. 36:1498-1512.

  141. Seemayer TA, Oligny LL, Gartner JG. The Epstein-Barr virus: historical, biologic, pathologic and oncologic considerations. Perspect Pediatr Pathol. 1981. 6:1-33. [Medline].

  142. Seitanidis B. A comparison of the Monospot with the Paul-Bunnell test in infectious mononucleosis and other diseases. J Clin Pathol. 1969 May. 22(3):321-3. [Medline].

  143. Shashaty GG, Atamer MA. Hemolytic uremic syndrome associated with infectious mononucleosis. Am J Dis Child. 1974 May. 127(5):720-2. [Medline].

  144. Shurin SB. Infectious mononucleosis. Pediatr Clin North Am. 1979 May. 26(2):315-26. [Medline].

  145. Sitki-Green DL, Edwards RH, Covington MM, et al. Biology of Epstein-Barr virus during infectious mononucleosis. J Infect Dis. 2004 Feb 1. 189(3):483-92. [Medline].

  146. Statter MB, Liu DC. Nonoperative management of blunt splenic injury in infectious mononucleosis. Am Surg. 2005 May. 71(5):376-8. [Medline].

  147. Steere AC. Lyme disease. N Engl J Med. 1989 Aug 31. 321(9):586-96. [Medline].

  148. Straus SE. Acute progressive Epstein-Barr virus infections. Annu Rev Med. 1992. 43:437-49. [Medline].

  149. Straus SE, Cohen JI, Tosato G, et al. NIH conference. Epstein-Barr virus infections: biology, pathogenesis, and management. Ann Intern Med. 1993 Jan 1. 118(1):45-58. [Medline].

  150. Sugden B. Epstein-Barr virus: a human pathogen inducing lymphoproliferation in vivo and in vitro. Rev Infect Dis. 1982 Sep-Oct. 4(5):1048-61. [Medline].

  151. Sullivan JL. Hematologic consequences of Epstein-Barr virus infection. Hematol Oncol Clin North Am. 1987 Sep. 1(3):397-417. [Medline].

  152. Sumaya CV. Epstein-Barr virus infection: the expanded spectrum. Adv Pediatr Infect Dis. 1986. 1:75-97. [Medline].

  153. Sumaya CV. Epstein-Barr virus infections in children. Curr Probl Pediatr. 1987 Dec. 17(12):677-745. [Medline].

  154. Sumaya CV. Epstein-Barr virus serologic testing: diagnostic indications and interpretations. Pediatr Infect Dis. 1986 May-Jun. 5(3):337-42. [Medline].

  155. Sumaya CV. Infectious mononucleosis and other EBV infections: diagnostic factors. Lab Management. 1986. 24:37-43.

  156. Sumaya CV. Serological testing for Epstein-Barr virus--developments in interpretation. J Infect Dis. 1985 Jun. 151(6):984-7. [Medline].

  157. Sumaya CV, Ench Y. Epstein-Barr virus infectious mononucleosis in children. I. Clinical and general laboratory findings. Pediatrics. 1985 Jun. 75(6):1003-10. [Medline].

  158. Teglia O, Cunha BA. Cytomegalovirus mononucleosis. Emerg Med. 1991. 23:135-138.

  159. Tosato G, Taga K, Angiolillo AL, et al. Epstein-Barr virus as an agent of haematological disease. Baillieres Clin Haematol. 1995 Mar. 8(1):165-99. [Medline].

  160. Triantos D, Porter SR, Scully C, et al. Oral hairy leukoplakia: clinicopathologic features, pathogenesis, diagnosis, and clinical significance. Clin Infect Dis. 1997 Dec. 25(6):1392-6. [Medline].

  161. Tynell E, Aurelius E, Brandell A, et al. Acyclovir and prednisolone treatment of acute infectious mononucleosis: a multicenter, double-blind, placebo-controlled study. J Infect Dis. 1996 Aug. 174(2):324-31. [Medline].

  162. van der Horst C, Joncas J, Ahronheim G, et al. Lack of effect of peroral acyclovir for the treatment of acute infectious mononucleosis. J Infect Dis. 1991 Oct. 164(4):788-92. [Medline].

  163. Vaughan JH. The Epstein-Barr virus in autoimmunity. Springer Semin Immunopathol. 1995. 17(2-3):203-30. [Medline].

  164. Vidrih JA, Walensky RP, Sax PE, et al. Positive Epstein-Barr virus heterophile antibody tests in patients with primary human immunodeficiency virus infection. Am J Med. 2001 Aug 15. 111(3):192-4. [Medline].

  165. Vouloumanou EK, Rafailidis PI, Falagas ME. Current diagnosis and management of infectious mononucleosis. Curr Opin Hematol. 2012 Jan. 19(1):14-20. [Medline].

  166. Wallis S. It started with a kiss (perhaps). Lancet. 2007 Dec 15. 370(9604):2068. [Medline].

  167. White LR, Karofsky PS. Review of the clinical manifestations, laboratory findings, and complications of infectious mononucleosis. Wis Med J. 1985 Dec. 84(12):19-25. [Medline].

  168. White NJ, Juel-Jensen BE. Infectious mononucleosis hepatitis. Semin Liver Dis. 1984 Nov. 4(4):301-6. [Medline].

  169. Wolf P, Dorfman R, McClenahan J, et al. False-positive infectious mononucleosis spot test in lymphoma. Cancer. 1970 Mar. 25(3):626-8. [Medline].

  170. Wong SY, Bennett B. Natural history of severe thrombocytopenia in infectious mononucleosis. Postgrad Med J. 1982 Apr. 58(678):249-51. [Medline].

  171. Yamashita S, Murakami C, Izumi Y, et al. Severe chronic active Epstein-Barr virus infection accompanied by virus-associated hemophagocytic syndrome, cerebellar ataxia and encephalitis. Psychiatry Clin Neurosci. 1998 Aug. 52(4):449-52. [Medline].

  172. Ziegler JL, Drew WL, Miner RC, et al. Outbreak of Burkitt's-like lymphoma in homosexual men. Lancet. 1982 Sep 18. 2(8299):631-3. [Medline].

  173. Engelmann I, Nasser H, Belmiloudi S, et al. Clinically severe Epstein-Barr virus encephalitis with mild cerebrospinal fluid abnormalities in an immunocompetent adolescent: a case report. Diagn Microbiol Infect Dis. 2013 Jun. 76(2):232-4. [Medline].

  174. Muñoz-Gómez S, Cunha BA. Parvovirus B19 mimicking Epstein-Barr virus infectious mononucleosis in an adult. Am J Med. 2013 May. 126(5):e7-8. [Medline].

  175. Cunha BA, Petelin A, George S. Fever of unknown origin (FUO) in an elderly adult due to Epstein-Barr virus (EBV) presenting as "typhoidal mononucleosis," mimicking a lymphoma. Heart Lung. 2013 Jan-Feb. 42(1):79-81. [Medline].

  176. Hsu DT, Ruf M, O'Shea S, Costelloe S, Peck J, Tong CY. Diagnosing HIV infection in patients presenting with glandular fever-like illness in primary care: are we missing primary HIV infection?. HIV Med. 2013 Jan. 14(1):60-3. [Medline].

  177. Kessenich CR, Flanagan M. Diagnosis of infectious mononucleosis. Nurse Pract. 2015 Aug 15. 40 (8):13-4, 16. [Medline].

 
Previous
Next
 
Table 1. Differential Diagnoses of Infectious Mononucleosis
Clinical Parameters Epstein-Barr Virus Cyto-megalovirus Toxoplasmosis Viral Hepatitis
Symptoms Fatigue +++ + +/- +
Malaise ++ + - +
Mild sore throat + + +/- +/-
Early maculopapular rash ± - - +/-
Signs Early bilateral upper eyelid edema ± - - -
Unilateral localized adenopathy - - + -
Bilateral posterior cervical adenopathy + + - +/-
Tender hepatomegaly +/- +/- - +
Splenomegaly + +/- +/- -
Laboratory abnormalities WBC count N*/- N/- N ¯
Elevated SGOT/SGPT ++ + +/- +++
Atypical lymphocytes (≥ 10%) + + - -
Thrombocytopenia +/- +/- - +/-
Elevated IgM§ CMV titer - + - -
Elevated IgM EBV VCAII titer + - - -
Elevated IgM toxoplasmosis titer - - + -
Positive hepatitis (eg, A, B, D) test - - - +
*Normal



Serum glutamic-oxaloacetic transaminase



Serum glutamic-pyruvic transaminase



§ Immunoglobulin M



II Viral capsid antigen



Table 2. EBV Serologic Responses in EBV-Associated Diseases
EBV Diseases EBV Antibody Responses
Anti-VCA Anti-EA
IgM



Monospot/



Heterophile



IgM IgG Diffuse EA Restricted EA Anti-EBNA
Acute EBV mononucleosis + + + + - -
Past EBV infection - - + - - +
Chronic active EBV infection - - +++ + + +
Burkitt lymphoma - - +++ +/- + +
Nasopharyngeal carcinoma - - +++ + +/- +
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.