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Current Pediatric Reviews


ISSN (Print): 1573-3963
ISSN (Online): 1875-6336

General Review Article

Infectious Mononucleosis: An Updated Review

Author(s): Alexander K.C. Leung*, Joseph M. Lam and Benjamin Barankin

Volume 20, Issue 3, 2024

Published on: 07 August, 2023

Page: [305 - 322] Pages: 18

DOI: 10.2174/1573396320666230801091558

Price: $65


Background: Infectious mononucleosis is common among adolescents and young adults. Although the majority of cases resolve spontaneously, life-threatening manifestations, and complications have been recognised.

Objective: The purpose of this article is to familiarize clinicians with the clinical manifestations, evaluation, diagnosis, and management of infectious mononucleosis.

Methods: A search was conducted in October 2022 in PubMed Clinical Queries using the key terms "infectious mononucleosis" OR “Epstein-Barr virus” OR “EBV”. The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the aforementioned search was used in the compilation of the present article.

Results: Infectious mononucleosis, caused by Epstein-Barr virus, most commonly affects adolescents and adults aged 15 to 24 years. Epstein-Barr virus is transmitted primarily in saliva. Infectious mononucleosis is characterized by a triad of fever, tonsillar pharyngitis, and lymphadenopathy. Fatigue may be profound but tends to resolve within three months. Periorbital and/or palpebral edema, typically bilateral, occurs in one-third of patients. Splenomegaly and hepatomegaly occur in approximately 50% and 10% of cases, respectively. A skin rash, which is usually widely scattered, erythematous, and maculopapular, occurs in approximately 10 to 45% of cases. Peripheral blood leukocytosis is observed in most patients; lymphocytes make up at least 50% of the white blood cell differential count. Atypical lymphocytes constitute more than 10% of the total lymphocyte count. The classic test for infectious mononucleosis is the demonstration of heterophile antibodies. The monospot test is the most widely used method to detect the serum heterophile antibodies of infectious mononucleosis. When confirmation of the diagnosis of infectious mononucleosis is required in patients with mononucleosis-like illness and a negative mono-spot test, serologic testing for antibodies to viral capsid antigens is recommended. Infectious mononucleosis is a risk factor for chronic fatigue syndrome. Spontaneous splenic rupture occurs in 0.1 to 0.5% of patients with infectious mononucleosis and is potentially life-threatening. Treatment is mainly supportive. Reduction of activity and bed rest as tolerated are recommended. Patients should be advised to avoid contact sports or strenuous exercise for 8 weeks or while splenomegaly is still present. Most patients have an uneventful recovery.

Conclusion: Infectious mononucleosis is generally a benign and self-limited disease. Prompt diagnosis is essential to avoid unnecessary investigations and treatments and to minimize complications. Splenic rupture is the most feared complication. As avoiding exposure to EBV is almost impossible, the most effective way to prevent EBV infection and infectious mononucleosis is the development of an effective, safe, and affordable EBV vaccine that can confer life-long immunity.

Keywords: Epstein-Barr virus, fever, lymphadenopathy, maculopapular rash, splenomegaly, tonsillar pharyngitis, monospot, chronic fatigue syndrome.

Graphical Abstract
Kuri A, Jacobs BM, Vickaryous N, et al. Epidemiology of Epstein-Barr virus infection and infectious mononucleosis in the United King-dom. BMC Public Health 2020; 20(1): 912.
[] [PMID: 32532296]
Leung AKC, Pinto-Rojas A. Infectious Mononucleosis. Consultant 2000; 40: 134-6.
Leung AK. Infectious mononucleosis The Encyclopedia of Molecular Mechanism of disease. Berlin: Springer-Verlag 2009; pp. 1346-7.
Filatov N. Lectures on acute infectious diseases in children. Moscow, Russia 1887; p. 2.
Pfeiffer E. Yearbook of paediatrics and physical education 1889; 29: 257-64.
Sprunt TPV, Evans FA. Mononuclear leukocytosis in reaction to acute infection (infectious mononucleosis). Bulletin Johns Hopkins Hos-pital (Balitmore) 1920; 31: 410-7.
Downey H, McKinlay CA. Acute lymphadenosis compared with acute lymphatic leukemia. Arch Intern Med 1923; 32(1): 82-112.
Epstein MA, Achong BG, Barr YM. Virus particles in cultured lymphoblasts from Burkitt’s lymphoma. Lancet 1964; 283(7335): 702-3.
[] [PMID: 14107961]
Henle G, Henle W, Diehl V. Relation of Burkitt’s tumor-associated herpes-ytpe virus to infectious mononucleosis. Proc Natl Acad Sci USA 1968; 59(1): 94-101.
[] [PMID: 5242134]
Aronson MD, Auwaerter PG. Infectious mononucleosis in adults and adolescents. UpToDate
Ebell MH, Call M, Shinholser J, Gardner J. Does this patient have infectious mononucleosis? The rational clinical examination systematic review. JAMA 2016; 315(14): 1502-9.
[] [PMID: 27115266]
Leung AKC, Wong AH, Leong KF. Infectious mononucleosis: Clinical manifestations, investigations, and management Advances in Health and Disease. New York: Nova Science Publishers, Inc. 2018; Vol. 6: pp. 45-71.
Mohseni M, Boniface MP, Graham C. Mononucleosis. Treasure Island, (FL): StatPearls Publishing 2022.
Mohseni M, Boniface MP, Graham C, Doerr C. Mononucleosis (Nursing). Treasure Island, (FL): StatPearls Publishing 2022.
Correia S, Bridges R, Wegner F, et al. Sequence variation of Epstein-Barr virus: Viral types, geography, codon usage, and diseases. J Virol 2018; 92(22): e01132-18.
[] [PMID: 30111570]
Ebell MH. Epstein-Barr virus infectious mononucleosis. Am Fam Physician 2004; 70(7): 1279-87.
[PMID: 15508538]
Ellen Rimsza M, Kirk GM. Common medical problems of the college student. Pediatr Clin North Am 2005; 52(1): 9-24.
Becker JA, Smith JA. Return to play after infectious mononucleosis. Sports Health 2014; 6(3): 232-8.
[] [PMID: 24790693]
Womack J, Jimenez M. Common questions about infectious mononucleosis. Am Fam Physician 2015; 91(6): 372-6.
[PMID: 25822555]
Kazama I, Miura C, Nakajima T. Nonsteroidal anti-inflammatory drugs quickly resolve symptoms associated with EBV-induced infectious mononucleosis in patients with atopic predispositions. Am J Case Rep 2016; 17: 84-8.
[] [PMID: 26874639]
Dunmire SK, Hogquist KA, Balfour HH. Infectious Mononucleosis. Curr Top Microbiol Immunol 2015; 390(Pt 1): 211-40.
[] [PMID: 26424648]
Marshall-Andon T, Heinz P. How to use … the Monospot and other heterophile antibody tests. Arch Dis Child Educ Pract Ed 2017; 102(4): 188-93.
[] [PMID: 28130396]
Balfour HH Jr, Dunmire SK, Hogquist KA. Infectious mononucleosis. Clin Transl Immunology 2015; 4(2): e33.
[] [PMID: 25774295]
Balfour HH Jr. Editorial commentary: Genetics and infectious mononucleosis. Clin Infect Dis 2014; 58(12): 1690-1.
[] [PMID: 24696239]
Hwang AE, Hamilton AS, Cockburn MG, et al. Evidence of genetic susceptibility to infectious mononucleosis: A twin study. Epidemiol Infect 2012; 140(11): 2089-95.
[] [PMID: 22152594]
Rostgaard K, Wohlfahrt J, Hjalgrim H. A genetic basis for infectious mononucleosis: Evidence from a family study of hospitalized cases in Denmark. Clin Infect Dis 2014; 58(12): 1684-9.
[] [PMID: 24696238]
Zhang L, Zhou P, Meng Z, et al. Low uric acid level increases the risk of infectious mononucleosis and this effect is more pronounced in women. Mol Clin Oncol 2017; 7(6): 1039-44.
[] [PMID: 29285370]
Maghzi H, Ataei B, Khorvash F, Yaran M, Maghzi AH. Association between acute infectious mononucleosis and vitamin D deficiency. Viral Immunol 2016; 29(7): 398-400.
[] [PMID: 27505106]
Cui X, Snapper CM. Epstein Barr virus: Development of vaccines and immune cell therapy for EBV-associated diseases. Front Immunol 2021; 12: 734471.
[] [PMID: 34691042]
Mendoza N, Diamantis M, Arora A, et al. Mucocutaneous manifestations of Epstein-Barr virus infection. Am J Clin Dermatol 2008; 9(5): 295-305.
[] [PMID: 18717604]
Liu M, Wang X, Zhang L, Feng G, Zeng Y, Wang R, et al. Epidemiological characteristics and disease burden of infectious mononucleosis in hospitalized children in China: A nationwide retrospective study. Virol Sin 2022; 37(5): 637-45.
Odame J, Robinson J, Khodai-Booran N, et al. Correlates of illness severity in infectious mononucleosis. Can J Infect Dis Med Microbiol 2014; 25(5): 277-80.
[] [PMID: 25371691]
Dasari V, Sinha D, Neller MA, Smith C, Khanna R. Prophylactic and therapeutic strategies for Epstein-Barr virus-associated diseases: Emerging strategies for clinical development. Expert Rev Vaccines 2019; 18(5): 457-74.
[] [PMID: 30987475]
Jean-Pierre V, Lupo J, Buisson M, Morand P, Germi R. Main targets of interest for the development of a prophylactic or therapeutic Ep-stein-Barr virus vaccine. Front Microbiol 2021; 12: 701611.
[] [PMID: 34239514]
Mui UN, Haley CT, Vangipuram R, Tyring SK. Human oncoviruses: Mucocutaneous manifestations, pathogenesis, therapeutics, and pre-vention. J Am Acad Dermatol 2019; 81(1): 23-41.
[] [PMID: 30502415]
Hoover K, Higginbotham K. Epstein Barr virus. Treasure Island, (FL): StatPearls Publishing 2021.
Dunmire SK, Verghese PS, Balfour HH Jr. Primary Epstein-Barr virus infection. J Clin Virol 2018; 102: 84-92.
[] [PMID: 29525635]
Israele V, Shirley P, Sixbey JW. Excretion of the Epstein-Barr virus from the genital tract of men. J Infect Dis 1991; 163(6): 1341-3.
[] [PMID: 1645383]
Näher H, Gissmann L, Freese UK, Petzoldt D, Helfrich S. Subclinical Epstein-Barr virus infection of both the male and female genital tract--indication for sexual transmission. J Invest Dermatol 1992; 98(5): 791-3.
[] [PMID: 1314867]
Rezk E, Nofal YH, Hamzeh A, Aboujaib MF, AlKheder MA, Al Hammad MF. Steroids for symptom control in infectious mononucleosis. Cochrane Libr 2015; 2015(12): CD004402.
[] [PMID: 26558642]
Sixbey J, Lemon S, Pagano J. A second site for Epstein-Barr virus shedding: The uterine cervix. Lancet 1986; 328(8516): 1122-4.
[] [PMID: 2877273]
Walter K. Pharyngitis and tonsillar exudates in an 18-year-old woman. JAMA 2021; 326(21): 2195-6.
[] [PMID: 34779824]
Naughton P, Healy M, Enright F, Lucey B. Infectious Mononucleosis: Diagnosis and clinical interpretation. Br J Biomed Sci 2021; 78(3): 107-16.
[] [PMID: 33721513]
Sullivan JL. Clinical manifestations and treatment of Epstein-Barr virus infection. UpToDate
Odumade OA, Hogquist KA, Balfour HH Jr. Progress and problems in understanding and managing primary Epstein-Barr virus infections. Clin Microbiol Rev 2011; 24(1): 193-209.
[] [PMID: 21233512]
Forgie SED, Marrie TJ. Cutaneous eruptions associated with antimicrobials in patients with infectious mononucleosis. Am J Med 2015; 128(1): e1-2.
[] [PMID: 25261013]
Chen Y, Wang H, Liu X, Luo B. A gene expression signature that correlates with CD8+T cell expansion in acute Epstein-Barr virus infec-tion. Acta Virol 2022; 66(3): 216-27.
[] [PMID: 36029087]
American Academy of Pediatrics. Epstein-Barr virus infection (infectious mononucleosis)Red Book: 2021-2024 Report of the Committee on Infectious Diseases. (32nd ed.). Kimberlin DW, Barnett ED, Lynfield R, Swayer MH, Eds. Itasca, IL: American Academy of Pediatrics. 2021; pp. 422-5.
Leung AK. Infectious mononucleosis Common Problems in Ambulatory Pediatrics: Specific Clinical Problems. New York: Nova Science Publishers, Inc. 2011; Vol. 1: pp. 313-6.
Worku D, Chang LH, Blyth I. An unusual presentation of glandular fever. Case Rep Infect Dis 2022; 2022: 1-6.
[] [PMID: 35340747]
Wu Y, Ma S, Zhang L, et al. Clinical manifestations and laboratory results of 61 children with infectious mononucleosis. J Int Med Res 2020; 48(10)
[] [PMID: 33045888]
Schwartzkopf J. Infectious mononucleosis. JAAPA 2018; 31(11): 52-3.
[] [PMID: 30358681]
Macsween KF, Higgins CD, McAulay KA, et al. Infectious mononucleosis in university students in the United kingdom: Evaluation of the clinical features and consequences of the disease. Clin Infect Dis 2010; 50(5): 699-706.
[] [PMID: 20121570]
Bonito FJP, Cerejeira D, Cunha H. Bilateral palpebral edema in a girl. Pediatr Dermatol 2020; 37(1): 211-2.
[] [PMID: 31997442]
Hoagland RJ. Infectious mononucleosis. Am J Med 1952; 13(2): 158-71.
[] [PMID: 12976417]
Inokuchi R, Iida H, Ohta F, Nakajima S, Yahagi N. Hoagland sign. Emerg Med J 2014; 31(7): 561.
[] [PMID: 24071946]
Louppides S, Kakoullis L, Parpas G, Panos G. Upper eyelid oedema in a patient with pharyngitis/exudative tonsillitis and malaise: Hoa-gland sign in infectious mononucleosis. BMJ Case Rep 2019; 12(12): e233719.
[] [PMID: 31871012]
Nakagawa H, Miyata Y, Maekawa M. Infectious mononucleosis with eyelid edema and palatal petechiae. Korean J Intern Med (Korean Assoc Intern Med) 2021; 36(4): 1027-8.
[] [PMID: 32872732]
Otsuka Y, Kishida M. Hoagland sign: Bilateral upper eyelid oedema. BMJ Case Rep 2022; 15(6): e250857.
[] [PMID: 35732375]
Sasaki Y, Ishii T, Maeda T, et al. Sex difference in clinical presentation of patients with infectious mononucleosis caused by Epstein-Barr virus. J Infect Chemother 2020; 26(11): 1181-5.
[] [PMID: 32620422]
Leung A, Robson W. Childhood cervical lymphadenopathy. J Pediatr Health Care 2004; 18(1): 3-7.
[] [PMID: 14722499]
Hosey RG, Kriss V, Uhl TL, DiFiori J, Hecht S, Wen DY. Ultrasonographic evaluation of splenic enlargement in athletes with acute infec-tious mononucleosis. Br J Sports Med 2007; 42(12): 974-7.
[] [PMID: 18801776]
McCorkle R, Thomas B, Suffaletto H, Jehle D. Normative spleen size in tall healthy athletes: Implications for safe return to contact sports after infectious mononucleosis. Clin J Sport Med 2010; 20(6): 413-5.
[] [PMID: 21079435]
Akiyama Y, Ishikane M, Ohmagari N. Epstein-Barr virus induced skin rash in infectious mononucleosis. IDCases 2021; 26: e01298.
[] [PMID: 34631423]
Mori F, Fili L, Barni S, et al. Sensitization to amoxicillin/clavulanic acid may underlie severe rashes in children treated for infectious mon-onucleosis. J Allergy Clin Immunol Pract 2019; 7(2): 728-731.e1.
[] [PMID: 30009989]
Ando Y, Senda S, Ono Y. Skin rash following amoxicillin treatment. Eur J Intern Med 2022; 102: 114-5.
[] [PMID: 35577680]
Leung AKC, Rafaat M. Eruption associated with amoxicillin in a patient with infectious mononucleosis. Int J Dermatol 2003; 42(7): 553-5.
[] [PMID: 12839608]
Chovel-Sella A, Ben Tov A, Lahav E, et al. Incidence of rash after amoxicillin treatment in children with infectious mononucleosis. Pediatrics 2013; 131(5): e1424-7.
[] [PMID: 23589810]
Ónodi-Nagy K, Kinyó Á, Meszes A, Garaczi E, Kemény L, Bata-Csörgő Z. Amoxicillin rash in patients with infectious mononucleosis: Evidence of true drug sensitization. Allergy Asthma Clin Immunol 2015; 11(1): 1.
[] [PMID: 25784943]
Thompson DF, Ramos CL. Antibiotic-induced rash in patients with infectious mononucleosis. Ann Pharmacother 2017; 51(2): 154-62.
[] [PMID: 27620494]
Mergoum AM. Amoxicillin rash in infectious mononucleosis. N Engl J Med 2021; 385(11): 1033.
[] [PMID: 34496177]
Fields DA. Methicillin rash in infectious mononucleosis. West J Med 1980; 133(6): 521.
[PMID: 6451082]
Paily R. Quinolone drug rash in a patient with infectious mononucleosis. J Dermatol 2000; 27(6): 405-6.
[] [PMID: 10920588]
Baciewicz AM, Chandra R. Cefprozil-induced rash in infectious mononucleosis. Ann Pharmacother 2005; 39(5): 974-5.
[] [PMID: 15827073]
McCloskey GL, Massa MC. Cephalexin rash in infectious mononucleosis. Cutis 1997; 59(5): 251-4.
[PMID: 9169264]
Pendleton N, Mallik LJ, Williams JG. Erythromycin rash in glandular fever. Int J Clin Pract 1989; 43(12): 464-5.
[] [PMID: 2532924]
Banerjee I, Mondal S, Sen S, Tripathi SK, Banerjee G. Azithromycin-induced rash in a patient of infectious mononucleosis - a case report with review of literature. J Clin Diagn Res 2014; 8(8): HD01-2.
[] [PMID: 25302218]
Schissel DJ, Singer D, David-Bajar K. Azithromycin eruption in infectious mononucleosis: A proposed mechanism of interaction. Cutis 2000; 65(3): 163-6.
[PMID: 10738636]
Wargo KA, McConnell V, Jennings M. Amoxicillin/telithromycin-induced rash in infectious mononucleosis. Ann Pharmacother 2005; 39(9): 1577.
[] [PMID: 16046485]
LeClaire AC, Martin CA, Hoven AD. Rash associated with piperacillin/tazobactam administration in infectious mononucleosis. Ann Pharmacother 2004; 38(6): 996-8.
[] [PMID: 15113982]
Candy B, Hotopf M. Steroids for symptom control in infectious mononucleosis. Cochrane Database Syst Rev 2006; (3): CD004402.
[] [PMID: 16856045]
Wemel AC, Mayet A, Bellier S, Bigaillon C, Rapp C, Ficko C. Severe infectious mononucleosis in immunocompetent adults. Med Mal Infect 2017; 47(8): 540-5.
[] [PMID: 28987291]
De Alwis AC, Kwon S. Lingual tonsillitis: An under-recognised manifestation of infectious mononucleosis. J Paediatr Child Health 2021; 57(3): 459.
[] [PMID: 33728778]
Auwaerter PG. Infectious mononucleosis in middle age. JAMA 1999; 281(5): 454-9.
[] [PMID: 9952206]
Horwitz CA, Henle W, Henle G, Schapiro R, Borken S, Bundtzen R. Infectious mononucleosis in patients aged 40 to 72 years: Report of 27 cases, including 3 without heterophil-antibody responses. Medicine (Baltimore) 1983; 62(4): 256-62.
[] [PMID: 6308383]
Welch JL, Holland D. What elements suggest infectious mononucleosis? Ann Emerg Med 2018; 71(4): 521-2.
[] [PMID: 28712603]
Cai J, Yuan L, Gao H, Hu B, Gui M. Clinical characteristics and empirical research model of infectious mononucleosis complicated with Mycoplasma pneumoniae or/and Cytomegalovirus infection. Comput Math Methods Med 2021; 2021: 1-5.
[] [PMID: 34804192]
Cunha BA, Mickail N, Laguerre M. Babesiosis mimicking Epstein Barr Virus (EBV) infectious mononucleosis: Another cause of false positive monospot tests. J Infect 2012; 64(5): 531-2.
[] [PMID: 22266386]
Hess RD. Routine Epstein-Barr virus diagnostics from the laboratory perspective: Still challenging after 35 years. J Clin Microbiol 2004; 42(8): 3381-7.
[] [PMID: 15297472]
Klemola E, von Essen R, Henle G, Henle W. Infectious-mononucleosis-like disease with negative heterophil agglutination test. Clinical features in relation to Epstein-Barr virus and cytomegalovirus antibodies. J Infect Dis 1970; 121(6): 608-14.
[] [PMID: 4316146]
Lennon P, Crotty M, Fenton JE. Infectious mononucleosis. BMJ 2015; 350(apr21 2) h1825. PMID: 25899165
Medović R, Igrutinović Z, Radojević-Marjanović R, et al. Clinical and laboratory differences between Epstein-Barr and cytomegalovirus infectious mononucleosis in children. Srp Arh Celok Lek 2016; 144(1-2): 56-62.
[] [PMID: 27276859]
Taga K, Taga H, Tosato G. Diagnosis of atypical cases of infectious mononucleosis. Clin Infect Dis 2001; 33(1): 83-8.
[] [PMID: 11389499]
Gaines H, von Sydow M, Pehrson PO, Lundbegh P. Clinical picture of primary HIV infection presenting as a glandular-fever-like illness. BMJ 1988; 297(6660): 1363-8.
[] [PMID: 3146367]
Horwitz CA, Henle W, Henle G, et al. Heterophil-negative infectious mononucleosis and mononucleosis-like illnesses. Am J Med 1977; 63(6): 947-57.
[] [PMID: 204189]
Ishii T, Sasaki Y, Maeda T, Komatsu F, Suzuki T, Urita Y. Clinical differentiation of infectious mononucleosis that is caused by Epstein-Barr virus or cytomegalovirus: A single-center case-control study in Japan. J Infect Chemother 2019; 25(6): 431-6.
[] [PMID: 30773381]
Karpathios T, Drakonaki S, Zervoudaki A, et al. Arcanobacterium haemolyticum in children with presumed streptococcal pharyngotonsillitis or scarlet fever. J Pediatr 1992; 121(5): 735-7.
[] [PMID: 1432423]
Brown M, Schubert T. Phenytoin hypersensitivity hepatitis and mononucleosis syndrome. J Clin Gastroenterol 1986; 8(4): 469-77.
[] [PMID: 3093562]
Lupton JR, Figueroa P, Tamjidi P, Berberian BJ, Sulica VI. An infectious mononucleosis-like syndrome induced by minocycline: A third pattern of adverse drug reaction. Cutis 1999; 64(2): 91-6.
[PMID: 10467499]
Maquiera E, Yañez S, Fernández L, et al. Mononucleosis-like illness as a manifestation of carbamazepine-induced anticonvulsant hyper-sensitivity syndrome. Allergol Immunopathol (Madr) 1996; 24(2): 87-8.
[PMID: 8933895]
Afonso A, Cachão J, Pinto Junior VL, Gouveia T. Gianotti-Crosti syndrome: A challenging exanthema. BMJ Case Rep 2021; 14(4): e240747.
[] [PMID: 33795277]
Chisholm KM, Bohling SD, Tsuchiya KD, Paulson VA. A malignant mimicker: Features of Kikuchi-Fujimoto disease in the pediatric pop-ulation. Pediatr Dev Pathol 2022; 25(5): 538-47.
[] [PMID: 35583198]
Hurt C, Tammaro D. Diagnostic evaluation of mononucleosis-like illnesses. Am J Med 2007; 120(10): 911.e1-8.
[] [PMID: 17904463]
Leung AKC, Kellner JD. Group A β-hemolytic streptococcal pharyngitis in children. Adv Ther 2004; 21(5): 277-87.
[] [PMID: 15727397]
Leung AKC, Hon KL, Leong KF, Sergi CM. Measles: A disease often forgotten but not gone. Hong Kong Med J 2018; 24(5): 512-20.
[] [PMID: 30245481]
Leung AKC, Hon KL, Leong KF. Rubella (German measles) revisited. Hong Kong Med J 2019; 25(2): 134-41.
[] [PMID: 30967519]
Leung AKC, Sergi CM, Lam JM, Leong KF. Gianotti-Crosti syndrome (papular acrodermatitis of childhood) in the era of a viral recrudes-cence and vaccine opposition. World J Pediatr 2019; 15(6): 521-7.
[] [PMID: 31134587]
Leung AKC, Davies HD. Cervical lymphadenitis: Etiology, diagnosis, and management. Curr Infect Dis Rep 2009; 11(3): 183-9.
[] [PMID: 19366560]
Leung TNH, Hon KL, Leung AKC, Group A, Group A. Streptococcus disease in Hong Kong children: An overview. Hong Kong Med J 2018; 24(6): 593-601.
[] [PMID: 30416105]
Major-Monfried H, Friedman S, Moerdler S. Hemophagocytic Lymphohistiocytosis. Pediatr Rev 2022; 43(10): 596-8.
[] [PMID: 36180536]
Tumminello R, Glaspey L, Bhamidipati A, Sheehan P, Patel S. Early disseminated Lyme disease masquerading as mononucleosis: A case report. J Emerg Med 2017; 53(6): e133-5.
[] [PMID: 29102094]
Vishnani R, Malkani R, Topal A, Desai HG. Mononucleosis-like drug rash: An interesting case presentation. J Family Med Prim Care 2014; 3(1): 74-6.
[] [PMID: 24791243]
Watanabe Y, Mashimo S, Ichige H, Nagata H, Kojima M. Scrub typhus mimicking the clinical course of infectious mononucleosis: A case report. J Rural Med 2021; 16(1): 62-6.
[] [PMID: 33442438]
Cai X, Ebell MH, Haines L. Accuracy of signs, symptoms, and hematologic parameters for the diagnosis of infectious mononucleosis: A systematic review and meta-analysis. J Am Board Fam Med 2021; 34(6): 1141-56.
[] [PMID: 34772769]
Leung AK. More on heterophil antibody tests. Postgrad Med 1985; 77(8): 23.
[PMID: 3889890]
Stuempfig ND, Seroy J. Monospot test. Treasure Island, (FL):: StatPearls Publishing 2021.
Wang EX, Kussman A, Hwang CE. Use of Monospot testing in the diagnosis of infectious mononucleosis in the collegiate studentathlete population. Clin J Sport Med 2022; 32(5): 467-70.
[] [PMID: 36083325]
Al-Jitawi SA, Hakooz BA, Kazimi SM. False positive Monospot test in systemic lupus erythematosus. Rheumatology (Oxford) 1987; 26(1): 71.
[] [PMID: 3814978]
Pavletic AJ, Marques AR. Early disseminated Lyme disease causing false-positive serology for primary Epstein-Barr virus infection: Re-port of 2 cases. Clin Infect Dis 2017; 65(2): 336-7.
[] [PMID: 28379435]
Schumacher HR, Austin RM, Stass SA. False-positive serology in infectious monoucleosis. Lancet 1979; 1(8118): 722.
Thamcharoen N, Sornprom S, Permpalung N, Hyman CL. False positivity of monospot test in an immunocompetent elderly woman with acute cytomegalovirus infection. Am J Emerg Med 2015; 33(10): 1544.e1-2.
[] [PMID: 26275628]
Van Essen GG, Lieverse AG, Sprenger HG, Schirm J, Weits J. False-positive Paul-Bunnell test in HIV seroconversion. Lancet 1988; 332(8613): 747-8.
[] [PMID: 2901598]
Jiang SY, Yang JW, Shao JB, Liao XL, Lu ZH, Jiang H. Real-time polymerase chain reaction for diagnosing infectious mononucleosis in pediatric patients: A systematic review and meta-analysis. J Med Virol 2016; 88(5): 871-6.
[] [PMID: 26455510]
Zhang L, Zhou P, Meng Z, et al. Infectious mononucleosis and hepatic function. Exp Ther Med 2018; 15(3): 2901-9.
[] [PMID: 29456696]
Wang Y, Li J, Ren Y, Zhao H. The levels of liver enzymes and atypical lymphocytes are higher in youth patients with infectious mononu-cleosis than in preschool children. Clin Mol Hepatol 2013; 19(4): 382-8.
[] [PMID: 24459643]
Simpson L, Sutherland E, Wilkinson D, Saman R, Edafe O. Infectious mononucleosis - should we routinely assess liver function in acute presentation and follow up? J Laryngol Otol 2022; 1-13.
[] [PMID: 35465858]
Tan ET, Wilkinson D, Edafe O. The utility of liver function tests and abdominal ultrasound in infectious mononucleosis—A systematic review. Clin Otolaryngol 2022; 47(6): 611-9.
[] [PMID: 35834363]
Bartlett A, Williams R, Hilton M. Splenic rupture in infectious mononucleosis: A systematic review of published case reports. Injury 2016; 47(3): 531-8.
[] [PMID: 26563483]
Bakal DR, Kasitinon D, Kussman AL, Hwang CE. Splenomegaly from recurrent infectious mononucleosis in an NCAA Division I Athlete. Curr Sports Med Rep 2021; 20(10): 511-3.
[] [PMID: 34622813]
Baker CR, Kona S. Spontaneous splenic rupture in a patient with infectious mononucleosis. BMJ Case Rep 2019; 12(9): e230259.
[] [PMID: 31570350]
Barnwell J, Deol PS. Atraumatic splenic rupture secondary to Epstein-Barr virus infection. BMJ Case Rep 2017; 2017: bcr2016218405.
[] [PMID: 28119438]
Dessie A, Binder W. Spontaneous rupture of the spleen due to infectious mononucleosis. RI Med J 2017; 100(7): 33-5.
Khoo SG, Ullah I, Manning KP, Fenton JE. Spontaneous splenic rupture in infectious mononucleosis. Ear Nose Throat J 2007; 86(5): 300-1.
[] [PMID: 17580813]
Rinderknecht AS, Pomerantz WJ. Spontaneous splenic rupture in infectious mononucleosis: Case report and review of the literature. Pediatr Emerg Care 2012; 28(12): 1377-9.
[] [PMID: 23222107]
Ruymbeke H, Schouten J, Sermon F. EBV: Not your everyday benign virus. Acta Gastroenterol Belg 2020; 83(3): 485-7.
[PMID: 33094599]
Sivakumar P, Dubrey SW, Goel S, Adler L, Challenor E. Spontaneous rupture of the spleen resulting from infectious mononucleosis. Br J Hosp Med 2013; 74(11): 652.
[] [PMID: 24220533]
Mk S. S S, H VN. Spontaneous splenic rupture in a case of infectious mononucleosis. J Assoc Physicians India 2019; 67(7): 90-2.
[PMID: 31559784]
Sylvester JE, Buchanan BK, Paradise SL, Yauger JJ, Beutler AI. Association of splenic rupture and infectious mononucleosis: A retrospective analysis and review of return-to-play recommendations. Sports Health 2019; 11(6): 543-9.
[] [PMID: 31550435]
Chóliz-Ezquerro J, Allué-Cabañuz M, Martínez-Germán A. Hypovolemic shock due to nontraumatic splenic rupture in adolescent patient. A rare complication of infectious mononucleosis. Cir Cir 2021; 89(6): 844-5.
[] [PMID: 34851595]
Gilmartin S, Hatton S, Ryan J. Teenage kicks: Splenic rupture secondary following infectious mononucleosis. BMJ Case Rep 2019; 12(5): e229030.
[] [PMID: 31133551]
Hicks J, Boswell B, Noble V. Traumatic splenic laceration: A rare complication of infectious mononucleosis in an athlete. Curr Sports Med Rep 2021; 20(5): 250-1.
[] [PMID: 33908910]
Kinderknecht JJ. Infectious mononucleosis and the spleen. Curr Sports Med Rep 2002; 1(2): 116-20.
[] [PMID: 12831720]
Lu Q, Fu W, Ouyang G, Xu Q, Huang D. A case of infectious mononucleosis complicated with spontaneous atraumatic splenic rapture caused by Epstein-Barr virus infection. J Med Virol 2022; 94(12): 6127-32. Online ahead of print [
[PMID: 35996203]
Siliézar MM, Muñoz CC, Solano-Iturri JD, et al. Spontaneously ruptured spleen samples in patients with infectious mononucleosis: Anal-ysis of histology and lymphoid subpopulations. Am J Clin Pathol 2018; 150(4): 310-7.
[] [PMID: 30007337]
Asgari MM, Begos DG. Spontaneous splenic rupture in infectious mononucleosis: A review. Yale J Biol Med 1997; 70(2): 175-82.
[PMID: 9493849]
Johnson MA, Cooperberg PL, Boisvert J, Stoller JL, Winrob H. Spontaneous splenic rupture in infectious mononucleosis: Sonographic diagnosis and follow-up. AJR Am J Roentgenol 1981; 136(1): 111-4.
[] [PMID: 6779555]
Heo DH, Baek DY, Oh SM, Hwang JH, Lee CS, Hwang JH. Splenic infarction associated with acute infectious mononucleosis due to Ep-stein-Barr virus infection. J Med Virol 2017; 89(2): 332-6.
[] [PMID: 27357912]
Li Y, George A, Arnaout S, Wang JP, Abraham GM. Splenic infarction: An under-recognized complication of infectious mononucleosis? Open Forum Infect Dis 2018; 5(3): ofy041.
[] [PMID: 29577060]
Ma Z, Wang Z, Zhang X, Yu H. Splenic infarction after Epstein-Barr virus infection in a patient with hereditary spherocytosis: A case report and literature review. BMC Surg 2022; 22(1): 136.
[] [PMID: 35397569]
Machado C, Melo Salgado J, Monjardino L. The unexpected finding of a splenic infarction in a patient with infectious mononucleosis due to Epstein-Barr virus. BMJ Case Rep 2015; 2015: bcr2015212428.
[] [PMID: 26607191]
Naviglio S, Abate MV, Chinello M, Ventura A. Splenic infarction in acute infectious mononucleosis. J Emerg Med 2016; 50(1): e11-3.
[] [PMID: 26602427]
Noor M, Sadough M, Chan S, Singh G. Splenic infarct in a patient with Infectious Mononucleosis: A rare presentation. J Community Hosp Intern Med Perspect 2017; 7(4): 248-50.
[] [PMID: 29046754]
Patruno JV, Milross L, Javaid MM. Not quite a Mono spot diagnosis. Splenic infarction complicating infectious mononucleosis. Am J Med 2021; 134(5): e306-7.
[] [PMID: 33220284]
Pervez H, Tameez Ud Din A, Khan A. A mysterious case of an infarcted spleen due to kissing disease: A rare entity. Cureus 2020; 12(1): e6700.
[] [PMID: 32117651]
Minotti B, Reichlin M, Bosbach SJ. Splenic infarction diagnosed by contrast-enhanced ultrasound in infectious mononucleosis - An ap-propriate diagnostic option: A case report with review of the literature. J Med Ultrasound 2022; 30(2): 140-2.
[] [PMID: 35832357]
Suzuki Y, Kakisaka K, Kuroda H, Sasaki T, Takikawa Y. Splenic infarction associated with acute infectious mononucleosis. Korean J Intern Med (Korean Assoc Intern Med) 2018; 33(2): 451-2.
[] [PMID: 28480876]
Nishioka H, Hayashi K, Shimizu H. Case report: Splenic infarction in infectious mononucleosis due to Epstein-Barr virus infection. Am J Trop Med Hyg 2022; 106(2): 623-5.
[] [PMID: 34844205]
Harvey JM, Broderick G, Bowie A, et al. Tracking post-infectious fatigue in clinic using routine Lab tests. BMC Pediatr 2016; 16(1): 54.
[] [PMID: 27118537]
Katz BZ, Shiraishi Y, Mears CJ, Binns HJ, Taylor R. Chronic fatigue syndrome after infectious mononucleosis in adolescents. Pediatrics 2009; 124(1): 189-93.
[] [PMID: 19564299]
Hickie I, Davenport T, Wakefield D, et al. Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: Prospective cohort study. BMJ 2006; 333(7568): 575.
[] [PMID: 16950834]
Petersen I, Thomas JM, Hamilton WT, White PD. Risk and predictors of fatigue after infectious mononucleosis in a large primary-care cohort. QJM 2006; 99(1): 49-55.
[] [PMID: 16330509]
Ahmed SI, Aziz K, Gul A, Samar SS, Bareeqa SB. Risk of multiple sclerosis in Epstein-Barr virus infection. Cureus 2019; 11(9): e5699.
[] [PMID: 31720167]
Alanazi A. Epstein-Barr virus (EBV) and multiple sclerosis disease: A biomedical diagnosis. Comput Intell Neurosci 2022; 2022: 1-4.
[] [PMID: 36082345]
Jons D, Persson Berg L, Sundström P, et al. Follow-up after infectious mononucleosis in search of serological similarities with presymp-tomatic multiple sclerosis. Mult Scler Relat Disord 2021; 56: 103288.
[] [PMID: 34634626]
Läderach F, Münz C. Epstein Barr virus exploits genetic susceptibility to increase multiple sclerosis risk. Microorganisms 2021; 9(11): 2191.
[] [PMID: 34835317]
Läderach F, Münz C. Altered immune response to the Epstein-Barr virus as a prerequisite for multiple sclerosis. Cells 2022; 11(17): 2757.
[] [PMID: 36078165]
Loosen SH, Doege C, Meuth SG, Luedde T, Kostev K, Roderburg C. Infectious mononucleosis is associated with an increased incidence of multiple sclerosis: Results from a cohort study of 32,116 outpatients in Germany. Front Immunol 2022; 13: 937583.
[] [PMID: 35983044]
Marrie RA, Wolfson C, Sturkenboom MCJM, et al. Multiple sclerosis and antecedent infections. Neurology 2000; 54(12): 2307-10.
[] [PMID: 10881258]
Marrie RA, Wolfson C. Multiple sclerosis and Epstein-Barr virus. Can J Infect Dis 2002; 13(2): 111-8.
[] [PMID: 18159380]
Münz C. Kissing genetic MS risk loci to life. EBioMedicine 2021; 72: 103594.
[] [PMID: 34563927]
Nielsen TR, Rostgaard K, Nielsen NM, et al. Multiple sclerosis after infectious mononucleosis. Arch Neurol 2007; 64(1): 72-5.
[] [PMID: 17210811]
Tao C, Simpson-Yap S, Taylor B, et al. Markers of Epstein-Barr virus and Human Herpesvirus-6 infection and multiple sclerosis clinical progression. Mult Scler Relat Disord 2022; 59: 103561.
[] [PMID: 35131728]
Thacker EL, Mirzaei F, Ascherio A. Infectious mononucleosis and risk for multiple sclerosis: A meta-analysis. Ann Neurol 2006; 59(3): 499-503.
[] [PMID: 16502434]
Xu Y, Hiyoshi A, Smith KA, et al. Association of infectious mononucleosis in childhood and adolescence with risk for a subsequent multiple sclerosis diagnosis among siblings. JAMA Netw Open 2021; 4(10): e2124932.
[] [PMID: 34633426]
Vindegaard N, Petersen LV, Lyng-Rasmussen BI, Dalsgaard S, Benros ME. Infectious mononucleosis as a risk factor for depression: A nationwide cohort study. Brain Behav Immun 2021; 94: 259-65.
[] [PMID: 33571632]
Cheng J. Obstructive sleep apnea (OSA): A complication of acute infectious mononucleosis infection in a child. Int J Pediatr Otorhinolaryngol 2014; 78(3): 562-3.
[] [PMID: 24480119]
Fukumasa H, Tanaka C, Kobayashi M, Hayano S, Amamoto M. Nasopharyngeal airway for upper airway obstruction in infectious mono-nucleosis. Pediatr Int 2020; 62(5): 642-3.
[] [PMID: 32346948]
He XT, Lee CH, Wu PW, Wang CC. Epstein-Barr virus-associated infectious mononucleosis causing upper airway obstruction in a child with a history of adenoid hypertrophy. Pediatr Neonatol 2020; 61(1): 127-8.
[] [PMID: 31628027]
Lloyd AM, Reilly BK. Infectious mononucleosis and upper airway obstruction: Intracapsular tonsillectomy and adenoidectomy with microdebrider for prompt relief. Ear Nose Throat J 2021; 100(10_suppl (Suppl.): 958S-60S.
[] [PMID: 32511006]
Monem SA, O’Connor PF, O’Leary TG. Peritonsillar abscess and infectious mononucleosis: An association or a different presentation of the same condition. Ir Med J 1999; 92(2): 278-80.
[PMID: 10360113]
Piessens P, Indesteege F, Lemkens P. Alice in Wonderland syndrome and upper airway obstruction in infectious mononucleosis. B-ENT 2011; 7(1): 51-4.
[PMID: 21563558]
Sforza E, Hupin D, Roche F. Mononucleosis: A possible cause of idiopathic hypersomnia. Front Neurol 2018; 9: 922.
[] [PMID: 30429823]
Wu M, Li SX, Xue P, Zhou J, Tang X. COVID-19 vaccine could trigger the relapse of secondary hypersomnia. Nat Sci Sleep 2021; 13: 2267-71.
[] [PMID: 35002346]
Hasibi M, Zargaran M, Asadollahi-Amin A. Infectious mononucleosis complicated with bilateral peritonsillar abscess and splenic infarc-tion. Case Rep Infect Dis 2021; 2021: 1-4.
[] [PMID: 33777464]
Levi JM, Nassif SJ, Shetty K, McKee-Cole KM, Barth PC. A pilot study on pediatric mononucleosis presenting with abscess. Am J Otolaryngol 2020; 41(6): 102716.
[] [PMID: 32979664]
Tissot C, Chidiac C, Ader F, Ferry T. Necrotic sore throat, tender lymphadenopathies, hepatitis and activated lymphocytes in circulating blood as a clinical presentation of severe infectious mononucleosis. BMJ Case Rep 2014; 2014(nov20 1) :bcr2014207434.
[] [PMID: 25414230]
Yaxley KL. Infectious mononucleosis complicated by peritonsillar abscess and postural orthostatic tachycardia syndrome: A case report SAGE Open Med Case Rep 2020; 8 2050313X20915413.
Sandman C, Mitchell C. Not just a sore throat: A case of spontaneous tonsillar hemorrhage in acute mononucleosis infection. J Emerg Med 2019; 57(3): e77-9.
[] [PMID: 31376948]
Wahba A, ElBeblawy R. Spontaneous tonsillar hemorrhage due to infectious mononucleosis. Cureus 2020; 12(9): e10367.
[] [PMID: 33062490]
Muhammad Hussein, Amir Khalil, Najeeb Rehman, et al. et al. Infectious mononucleosis presenting with loss of taste and smell during the SARS-CoV-2 pandemic? Eur J Case Rep Intern Med 2020; 7(LATEST ONLINE): 002048.
[] [PMID: 33313018]
Poplin V, McKinsey DS. Arcanobacterium brain abscesses, subdural empyema, and bacteremia complicating Epstein-Barr virus mononu-cleosis. Kans J Med 2018; 11(1): 1-12.
[PMID: 29844849]
Vali Betts E, Gandour-Edwards R. Infectious mononucleosis affecting sinonasal mucosa. Blood 2019; 134(22): 1996.
[] [PMID: 31778547]
Din-Lovinescu C, Berg H. Cervical necrotising fasciitis: A rare complication of infectious mononucleosis. BMJ Case Rep 2019; 12(3): e228172.
[] [PMID: 30826780]
Zamor R, Edmunds K, Orscheln E, Duma E. Severe complications from infectious mononucleosis after prolonged steroid therapy. Pediatr Emerg Care 2021; 37(12): e1741-4.
[] [PMID: 31851074]
Bhaskaran PN, Puliyel M, Myers M, Abughali N. Multiple pulmonary nodules in an immunocompetent adolescent with infectious mono-nucleosis. Indian Pediatr 2018; 55(2): 161-2.
[] [PMID: 29503273]
Forsberg M, Galan M, Kra J. Infectious mononucleosis causing acute liver failure and hemolytic anemia in a patient with underlying he-reditary hemochromatosis. Case Rep Oncol 2020; 13(3): 1232-8.
[] [PMID: 33173490]
Teijido J, Tillotson K, Liu JM. A rare presentation of Epstein-Barr virus infection. J Emerg Med 2020; 58(2): e71-3.
[] [PMID: 31973958]
Chen JJ, Anand SK, Porter PJ. Infectious mononucleosis with thrombocytopenic purpura. Pediatrics 1968; 41(2): 526-8.
[] [PMID: 5688970]
Justiz Vaillant AA, Gupta N. ITP-immune thrombocytopenic purpura. Treasure Island, (FL): StatPearls Publishing 2022.
Yusuf H, Kou A, Zelinskas C, et al. Secondary immune thrombocytopenic purpura due to primary Epstein- Barr virus infection. Cureus 2022; 14(6): e26112.
[] [PMID: 35875282]
Zhang C, Kelly AM. Severe thrombocytopenia in a case of Epstein-Barr virus-induced infectious mononucleosis. Cureus 2021; 13(9): e17706.
[] [PMID: 34650880]
Zhao B, Hou H, Gao R, Tian B, Deng B. Mononucleosis-like illnesses due to co-infection with severe fever with thrombocytopenia syn-drome virus and spotted fever group rickettsia:a case report. BMC Infect Dis 2021; 21(1): 829.
[] [PMID: 34407756]
Massoll AF, Powers SC, Betten DP. Agranulocytosis occurrence following recent acute infectious mononucleosis. Am J Emerg Med 2017; 35(5): 803.e5-6.
[] [PMID: 27912922]
Yokoyama T, Tokuhisa Y, Toga A, et al. Agranulocytosis after infectious mononucleosis. J Clin Virol 2013; 56(3): 355-7.
[] [PMID: 23261081]
Berlot G, Tomasini A, Zandonà L, Leonardo E, Bussani R, Zarrillo N. Fatal septic shock in a patient with hemophagocytic lymphohistiocytosis associated with an infectious mononucleosis. Case Rep Crit Care 2018; 2018: 1-4.
[] [PMID: 30356381]
Hattori A, Hamada Y, Kawabata H, Tanaka K. Acute liver injury secondary to hemophagocytic lymphohistiocytosis triggered by Epstein-Barr virus infection. JGH Open 2021; 5(1): 166-8.
[] [PMID: 33490632]
Kato M, Lee S, Morishita T, et al. Hemophagocytic syndrome due to Epstein-Barr virus and cytomegalovirus coinfection in a patient on adalimumab. J Infect Chemother 2022; 28(6): 823-7.
[] [PMID: 35135708]
Kraskovsky V, Harhay J, Mador MJ. Case of haemophagocytic lymphohistiocytosis following Epstein-Barr virus infection. BMJ Case Rep 2021; 14(3): e241222.
[] [PMID: 33789863]
Lee AC. Peripheral hemophagocytosis in infectious mononucleosis: Red herring or early warning? J Pediatr Hematol Oncol 2020; 42(7): 446-7.
[] [PMID: 32000199]
Shi J, Chu C, Yu M, et al. Clinical warning of hemophagocytic syndrome caused by Epstein-Barr virus. Ital J Pediatr 2021; 47(1): 3.
[] [PMID: 33413556]
Zimmer M, Gill I, Anusim N, Gaikazian SS. Epstein-Barr virus induced haemophagocytic lymphohistiocytosis. BMJ Case Rep 2021; 14(5): e241348.
[] [PMID: 33952568]
Chin YY, Chang TCC, Chang CH. Idiopathic pure sudomotor failure and cholinergic urticaria in a patient after acute infectious mononu-cleosis infection. Clin Exp Dermatol 2013; 38(2): 156-9.
[] [PMID: 22924754]
Vaivanijkul J, Boonsiri K. Conjunctival tumor caused by Epstein-Barr virus-related infectious mononucleosis: Case report and review of literature. Orbit 2017; 36(2): 91-4.
[] [PMID: 28388350]
Iovieno A, Coassin M, Viscogliosi F, Adani C, Cimino L, Fontana L. Delayed-onset bilateral peripheral posterior interstitial keratitis asso-ciated with Epstein-Barr virus-induced infectious mononucleosis. Ocul Immunol Inflamm 2022; 30(2): 290-3.
[] [PMID: 32946296]
Xiao H, Hu B, Luo R, et al. Chronic active Epstein-Barr virus infection manifesting as coronary artery aneurysm and uveitis. Virol J 2020; 17(1): 166.
[] [PMID: 33121509]
Suzuki K, Namba K, Hase K, et al. A case of Epstein-Barr virus acute retinal necrosis successfully treated with foscarnet. Am J Ophthalmol Case Rep 2022; 25: 101363.
[] [PMID: 35146210]
Valenzise M, Cucinotta U, Aversa T, Messina MF, Wasniewska M, Pajno GB. Transient hyperthyroidism in a 6-year-old girl with Epstein-Barr virus infection: A link between infectious mononucleosis and autoimmune thyroid disease. J Biol Regul Homeost Agents 2021; 35(1): 349-51.
[] [PMID: 33634672]
Toussirot É, Roudier J. Epstein-Barr virus in autoimmune diseases. Best Pract Res Clin Rheumatol 2008; 22(5): 883-96.
[] [PMID: 19028369]
Forci B, Novelli A, Sodero A, Sorbi S. Bilateral isolated facial palsy with fast recovery in infectious mononucleosis. Neurol Sci 2017; 38(2): 369-71.
[] [PMID: 27651385]
Joki-Erkkilä VP, Hietaharju A, Dastidar P, Numminen J, Puhakka H. Multiple cranial nerve palsies as a complication of infectious mono-nucleosis due to inflammatory lesion in jugular foramen. Ann Otol Rhinol Laryngol 2000; 109(3): 340-2.
[] [PMID: 10737322]
Kennedy M, Apostolova M. A rare case of infectious mononucleosis complicated by Guillain-Barre syndrome. Neurol Int 2013; 5(2): 7.
[] [PMID: 23888210]
Long CM, Kerschner JE. Parotid mass: Epstein-Barr virus and facial paralysis. Int J Pediatr Otorhinolaryngol 2001; 59(2): 143-6.
[] [PMID: 11378191]
Steiner LA, Erbay A, Pache F, et al. Oculomotor nerve palsy as a presenting symptom of Epstein-Barr virus-associated infectious mono-nucleosis: Case report and review of the literature. Case Rep Neurol 2021; 13(3): 756-62.
[] [PMID: 35082645]
Schellinger PD, Sommer C, Leithäuser F, et al. Epstein-Barr virus meningoencephalitis with a lymphoma-like response in an immunocompetent host. Ann Neurol 1999; 45(5): 659-62.
[<659:AID-ANA16>3.0.CO;2-9] [PMID: 10319890]
Hussain RS, Hussain NA. Ataxia and encephalitis in a young adult with EBV mononucleosis: A case report. Case Rep Neurol Med 2013; 2013: 1-3.
[] [PMID: 23781357]
Patnaik S, Samal P, Sahoo A, Mohanty B, Turuk J. A fulminant case of Epstein-Barr Virus encephalitis with multiorgan dysfunction. J Neurovirol 2022; 28(3): 464-6.
[] [PMID: 35796862]
Sabat S, Agarwal A, Zacharia T, Labib S, Yousef J. Epstein-Barr virus encephalitis presenting as cerebellar hemorrhage. Neuroradiol J 2015; 28(6): 555-8.
[] [PMID: 26475484]
Mohsen H, Abu Zeinah GF, Elsotouhy AH, Mohamed K. Acute disseminated encephalomyelitis following infectious mononucleosis in a toddler. BMJ Case Rep 2013; 2013(jul10 1) bcr 2013010048. PMID: 23845679
D’Ambrosio E, Khalighinejad F, Ionete C. Intravenous immunoglobulins in an adult case of post-EBV cerebellitis. BMJ Case Rep 2020; 13(2): e231661.
[] [PMID: 32075812]
Jason LA, Cotler J, Islam MF, Sunnquist M, Katz BZ. Risks for developing myalgic encephalomyelitis/chronic fatigue syndrome in college students following infectious mononucleosis: A prospective cohort study. Clin Infect Dis 2021; 73(11): e3740-6.
[] [PMID: 33367564]
Jason LA, Yoo S, Bhatia S. Patient perceptions of infectious illnesses preceding myalgic encephalomyelitis/chronic fatigue syndrome. Chronic Illn 2021; 17423953211043106.
[] [PMID: 34541918]
Jason LA, Cotler J, Islam MF, Furst J, Katz BZ. Predictors for developing severe myalgic encephalomyelitis/chronic fatigue syndrome following infectious mononucleosis. Journal of Rehabilitation Therapy 2022; 4(1): 1-5.
[] [PMID: 35350440]
Greydanus DE, Merrick J. Infectious mononucleosis: Be aware of its lethality! Int J Adolesc Med Health 2019; 31(1): 20180284.
[] [PMID: 30645196]
Maier-Stocker C, Hellwig D, Hanses F. Lemierre’s syndrome following infectious mononucleosis: An unusual reason for neck pain. Lancet Infect Dis 2021; 21(7): 1050.
[] [PMID: 34174227]
Chen JJ, Chang HF, Liu CY, Chen DL. Infectious mononucleosis complicated with acute cerebral infarction: A case Report. Acta Neurol Taiwan 2015; 24(1): 25-9.
[PMID: 26179687]
Abidoye O, Raybon-Rojas E, Ogbuagu H. A rare case of Epstein-Barr virus: Infectious mononucleosis complicated by Guillain-Barré syndrome. Cureus 2022; 14(1): e21085.
[] [PMID: 35165547]
Houen G, Trier NH. Epstein-Barr virus and systemic autoimmune diseases. Front Immunol 2021; 11: 587380.
[] [PMID: 33488588]
Poole BD, Scofield RH, Harley JB, James JA. Epstein-Barr virus and molecular mimicry in systemic lupus erythematosus. Autoimmunity 2006; 39(1): 63-70.
[] [PMID: 16455583]
Wang S, Wang S, Singh S. Development of systemic lupus erythematosus after infectious mononucleosis in a 64-year-old woman. J Investig Med High Impact Case Rep 2020; 8.
[] [PMID: 32964755]
Luo H, Yuan Z, Qin B. Case report: Chronic active Epstein-Barr virus infection with subcutaneous nodules and systemic damage. Front Med (Lausanne) 2022; 9: 759834.
[] [PMID: 35433738]
Chen J, Konstantinopoulos PA, Satyal S, Telonis J, Blair DC. Just another simple case of infectious mononucleosis? Lancet 2003; 361(9364): 1182.
[] [PMID: 12686041]
Shinozuka J, Awaguni H, Tanaka S, et al. Spontaneous regression of pulmonary nodules presenting as Epstein-Barr virus-related atypical infectious mononucleosis. J Pediatr Hematol Oncol 2016; 38(5): e162-5.
[] [PMID: 27123664]
Avcu G. Acute acalculous cholecystitis due to EBV infection presenting as acute abdomen. J Coll Physicians Surg Pak 2022; 32(5): 662-4.
[] [PMID: 35546706]
Boninsegna S, Storato S, Riccardi N, et al. Epstein-Barr Virus (EBV) acute acalculous cholecystitis in an immunocompromised adult pa-tient: A case report and a literature review of a neglected clinical presentation. J Prev Med Hyg 2021; 62(1): E237-42.
[] [PMID: 34322642]
Cameron A, Akilan K, Carr D. Infectious mononucleosis - not always a benign condition: A case report of infectious mononucleosis-associated acute acalculous cholecystitis. CJEM 2019; 21(1): 154-6.
[] [PMID: 29490709]
Harvey KG, Tice JG, Sigal A. Epstein-Barr virus causing clinical jaundice and acute acalculous cholecystitis in a previously healthy 17-year-old girl. Am J Case Rep 2021; 22: e932285.
[] [PMID: 34642291]
Kim A, Yang HR, Moon JS, Chang JY, Ko JS. Epstein-barr virus infection with acute acalculous cholecystitis. Pediatr Gastroenterol Hepatol Nutr 2014; 17(1): 57-60.
[] [PMID: 24749090]
Koufakis T, Gabranis I. Another report of acalculous cholecystitis in a Greek patient with infectious mononucleosis: A matter of luck or genetic predisposition? Case Reports Hepatol 2016; 2016: 1-3.
[] [PMID: 26885417]
Mazur-Melewska K, Derwich A, Mania A, Kemnitz P, Służewski W, Figlerowicz M. Epstein‐Barr virus infection with acute acalculous cholecystitis in previously healthy children. Int J Clin Pract 2019; 73(9): 1-6.
[] [PMID: 31243873]
Young C, Lampe R. Primary Epstein-Barr virus infection in an adolescent female complicated by acute acalculous cholecystitis. Cureus 2019; 11(6): e5044.
[] [PMID: 31501735]
Adidam S, Adidam Venkata S, Benn G, Oppong-Twene P, Delapenha RA. Hepatocellular-cholestatic pattern of liver injury in a patient with infectious mononucleosis. Cureus 2021; 13(12): e20395.
[] [PMID: 35036225]
Da Cunha T, Mago S, Bath RK. Epstein-Barr virus reactivation causing cholestatic hepatitis. Cureus 2022; 14(4): e24552.
[] [PMID: 35664414]
Herold J, Grimaldo F. Epstein-Barr virus-induced jaundice. Clin Pract Cases Emerg Med 2020; 4(1): 69-71.
[] [PMID: 32064430]
Rodrigues Santos L, Silva Cruz M, Veiga Ferraz R, Ferraz Moreira V, Castro A. Jaundice as a rare manifestation of Epstein-Barr virus primary infection. Cureus 2021; 13(6): e15609.
[] [PMID: 34277228]
Santos VM. Letter to the editor: Infectious mononucleosis and cholestatic hepatitis. (Acta Med Port.)2018; 31(1): 69.
Alli A, Nabil F, Ortiz JF. Infectious mononucleosis: A case report with unusual features and abnormal laboratory findings. Cureus 2021; 13(5): e14790.
[] [PMID: 34094752]
Čalkić L, Bajramović-Omeragić L, Mujezinović A. Infectious mononucleosis (Epstein-Barr virus infection) and chronic hepatitis. Med Glas 2019; 16(2)
[] [PMID: 31257838]
Ghosh A, Ghoshal UC, Kochhar R, Ghoshal P, Banerjee PK. Infectious mononucleosis hepatitis: Report of two patients. Indian J Gastroenterol 1997; 16(3): 113-4.
[PMID: 9248190]
Hussaini SH, Pilkington N, Barnes JN. Infectious mononucleosis hepatitis; an unwelcome present for Father Christmas. Acute Med 2013; 12(2): 98-101.
[] [PMID: 23732134]
Ikeda S, Sugihara T, Kihara T, et al. Chronic active Epstein-Barr virus infection indistinguishable from autoimmune hepatitis: A case re-port. Yonago Acta Med 2022; 65(2): 160-5.
[] [PMID: 35611062]
Manappallil RG, Mampilly N, Josphine B. Acute hepatitis due to infectious mononucleosis. BMJ Case Rep 2019; 12(8): e229679.
[] [PMID: 31473633]
Mu J, Xue D, Li M, Wang T, Ma Q, Dong H. Fatal unexpected death due to X-linked lymphoproliferative disease. Leg Med 2021; 52: 101900.
[] [PMID: 34023582]
Zhang C, Cui S, Mao G, Li G. Clinical characteristics and the risk factors of hepatic injury in 221 children with infectious mononucleosis. Front Pediatr 2022; 9: 809005.
[] [PMID: 35096718]
Accomando S, Restivo GA, Scalzo S, Guardino M, Corsello G, Giuffrè M. Epstein-Barr virus-associated acute pancreatitis: A clinical re-port and review of literature. Ital J Pediatr 2022; 48(1): 160.
[] [PMID: 36064422]
Zhu Z, Yin SJ, Kong ZB, et al. Pancreatitis combined with Epstein-Barr virus-induced infectious mononucleosis. Chin Med J (Engl) 2017; 130(16): 2001-2.
[] [PMID: 28776557]
Páez-Guillán EM, Campos-Franco J, Alende R, Garitaonaindía Y, González-Quintela A. Transient hypertriglyceridemia: A common finding during Epstein-Barr virus-induced infectious mononucleosis. Lipids Health Dis 2021; 20(1): 177.
[] [PMID: 34895245]
Devereaux CE, Bemiller T, Brann O. Ascites and severe hepatitis complicating Epstein-Barr infection. Am J Gastroenterol 1999; 94(1): 236-40.
[] [PMID: 9934763]
Tamura S, Maruyama D, Miyagi Maeshima A, et al. Epstein-Barr virus-associated enteropathy as a complication of infectious mononucleosis mimicking peripheral T-cell lymphoma. Intern Med 2013; 52(17): 1971-5.
[] [PMID: 23994994]
AlMudaiheem FA, Alhabdan S, Alhalafi MS, Alshieban S. An insidious case of infectious mononucleosis presenting with acute appendici-tis diagnosed postoperatively: A case report. J Surg Case Rep 2021; 2021(3): rjab039.
[] [PMID: 33732427]
Cattaneo L, Milani GP, Lava SA, et al. Visceral serositis in acute Epstein-Barr virus infectious mononucleosis. Minerva Med 2021; 112(3): 415-7.
[] [PMID: 31638357]
Martín-Gómez MA, Caba Molina M, Cruz Caparros G, Guerrero Sánchez E, Caballero González A, Gómez Morales M. Immuno complex mediated acute glomerulonephritis in a patient with infectious mononucleosis. Nefrología 2017; 37(4): 439-41.
[] [PMID: 28750880]
Kien C, Ganta K. An atypical presentation of Epstein-Barr virus associated infectious mononucleosis mistaken for pyelonephritis. Cureus 2020; 12(4): e7583.
[] [PMID: 32399317]
Moretti M, Lava SAG, Zgraggen L, et al. Acute kidney injury in symptomatic primary Epstein-Barr virus infectious mononucleosis: Sys-tematic review. J Clin Virol 2017; 91: 12-7.
[] [PMID: 28410496]
Acharya R, Zeng X, Upadhyay K. Concomitant nephrotic syndrome and tubulointerstitial nephritis in a child with Epstein-Barr virus mononucleosis. BMJ Case Rep 2021; 14(2): e240108.
[] [PMID: 33541950]
Robson WLM, Leung AKC, Kaplan BS. Hemolytic-uremic syndrome. Curr Probl Pediatr 1993; 23(1): 16-33.
[] [PMID: 8453889]
Hudson L, Perlman SE. Necrotizing genital ulcerations in a premenarcheal female with mononucleosis. Obstet Gynecol 1998; 92(4): 642-4.
[] [PMID: 9764645]
Vatopoulou A, Dinas K, Deligeoroglou E, Papanikolaou A. Genital ulceration in adolescent girls: A diagnostic challenge. J Obstet Gynaecol 2021; 41(6): 994-5.
[] [PMID: 33645404]
Sako K, Kenzaka T, Kumabe A. Epstein-Barr virus-associated infectious mononucleosis with acute epididymitis: A case report. BMC Infect Dis 2022; 22(1): 147.
[] [PMID: 35144561]
Clotet S, Matas L, Pomar V, Casademont J. Acute mediastinitis as a rare complication of an infectious mononucleosis.Enfermedades infecciosas y microbiologia clinica (English ed) 2018; 36(9): 601-2.
[] [PMID: 29269099]
Fuller GW, Rao JN. Fulminant descending mediastinitis secondary to infectious mononucleosis. J Surg Case Rep 2018; 2018(8): rjy203.
[] [PMID: 30093999]
Samuel Markowicz, Serge Cappeliez, Cherifi Soraya, Cherifi S. Infectious mononucleosis resulting in acute necrotizing mediastinitis: A case report and literature review. Eur J Case Rep Intern Med 2020; 7: 001829.
[] [PMID: 33194856]
Papadopoulou-Legbelou K, Papadopoulou-Alataki E, Fleva A, Spanou S, Pavlitou A, Varlamis G. Cardiac complications and immunophenotypic profile of infectious mononucleosis syndrome in children. Indian Pediatr 2012; 49(3): 195-8.
[] [PMID: 21992856]
Pohlgeers KM, Stumbo JR. Syncope in an Athlete. Curr Sports Med Rep 2016; 15(1): 41-5.
[] [PMID: 26745170]
Bakkalci D, Jia Y, Winter JR, Lewis JEA, Taylor GS, Stagg HR. Risk factors for Epstein Barr virus-associated cancers: A systematic re-view, critical appraisal, and mapping of the epidemiological evidence. J Glob Health 2020; 10(1): 010405.
[] [PMID: 32257153]
Hjalgrim H, Askling J, Rostgaard K, et al. Characteristics of Hodgkin’s lymphoma after infectious mononucleosis. N Engl J Med 2003; 349(14): 1324-32.
[] [PMID: 14523140]
Hjalgrim H, Ekström Smedby K, Rostgaard K, et al. Infectious mononucleosis, childhood social environment, and risk of Hodgkin lym-phoma. Cancer Res 2007; 67(5): 2382-8.
[] [PMID: 17332371]
Saal J, Aboudan B, Brossart P, Heine A. Two cases of EBV infection preceding lymphoma. J Cancer Res Clin Oncol 2022; 148(10): 2929-32.
[] [PMID: 35732965]
Cohen JI, Dropulic L, Hsu AP, et al. Association of GATA2 deficiency with severe primary Epstein-Barr virus (EBV) infection and EBV-associated cancers. Clin Infect Dis 2016; 63(1): 41-7.
[] [PMID: 27169477]
Heng YJ, Love S, DeHart JC, Fingeroth JD, Wulf GM. The association of infectious mononucleosis and invasive breast cancer in The Health of Women (HOW) Study®. Breast Cancer 2022; 29(4): 731-9.
[] [PMID: 35347575]
Kap EJ, Konrad M, Kostev K. Clinical characteristics and sick leave associated with infectious mononucleosis in a real‐world setting in Germany. Int J Clin Pract 2021; 75(10): e14690.
[] [PMID: 34331837]
Vlastarakos PV, Michailidou E. How safe is it to prescribe cephalosporins in patients with infectious mononucleosis? Implications for clinical ENT practice. Turk Otolarengoloji Arsivi/Turkish. Archives of Otolaryngology 2018; 56(3): 183-4.
[] [PMID: 30319879]
Shephard RJ. Exercise and the athlete with infectious mononucleosis. Clin J Sport Med 2017; 27(2): 168-78.
[] [PMID: 27347865]
Hu S, Belcaro G, Ledda A, et al. Mononucleosis-related fatigue: Supplementary management with Robuvit®. Minerva Pediatr 2018; 70(5): 425-9.
[] [PMID: 30302988]
Lennon P. No new evidence to support the routine use of steroids in the treatment of infectious mononucleosis. Evid Based Med 2016; 21(3): 103.
[] [PMID: 27099076]
Singer-Leshinsky S. CME ARTICLE Pathogenesis, diagnostic testing, and management of mononucleosis. JAAPA 2012; 25(5): 58-62.
[] [PMID: 22712150]
Andersson J, Britton S, Ernberg I, et al. Effect of acyclovir on infectious mononucleosis: A double-blind, placebo-controlled study. J Infect Dis 1986; 153(2): 283-90.
[] [PMID: 3003206]
Andrei G, Trompet E, Snoeck R. Novel therapeutics for Epstein−Barr virus. Molecules 2019; 24(5): 997.
[] [PMID: 30871092]
De Paor M, O’Brien K, Fahey T, Smith SM. Antiviral agents for infectious mononucleosis (glandular fever). Cochrane Libr 2016; 2016(12): CD011487.
[] [PMID: 27933614]
Hu H, Deng H, Bi J, et al. Clinical characteristics and effectiveness of antiviral agents in hospitalized children with infectious mononucleosis in China: A multicenter retrospective study. Pediatr Investig 2021; 5(3): 188-94.
[] [PMID: 34589674]
Pagano JS, Sixbey JW, Lin JC. Acyclovir and Epstein-Barr virus infection. J Antimicrob Chemother 1983; 12 (Suppl. B): 113-21.
Pagano J, Whitehurst C, Andrei G. Antiviral Drugs for EBV. Cancers 2018; 10(6): 197.
[] [PMID: 29899236]
Zhang S, Zhu Y, Jin Y, Sun H, Wang W, Zhan L. Difference between acyclovir and ganciclovir in the treatment of children with Epstein-Barr virus-associated infectious mononucleosis. Evid Based Complement Alternat Med 2021; 2021: 1-6.
[] [PMID: 34721648]
Balfour HH Jr, Sifakis F, Sliman JA, Knight JA, Schmeling DO, Thomas W. Age-specific prevalence of Epstein-Barr virus infection among individuals aged 6-19 years in the United States and factors affecting its acquisition. J Infect Dis 2013; 208(8): 1286-93.
[] [PMID: 23868878]
Balfour HH Jr, Meirhaeghe MR, Stancari AL, Geris JM, Condon LM, Cederberg LE. Declining Epstein-Barr virus antibody prevalence in college freshmen strengthens the rationale for a prophylactic EBV vaccine. Vaccines 2022; 10(9): 1399.
[] [PMID: 36146477]
Fourcade G, Germi R, Guerber F, et al. Evolution of EBV seroprevalence and primary infection age in a French hospital and a city labora-tory network, 2000-2016. PLoS One 2017; 12(4): e0175574.
[] [PMID: 28414725]
Takeuchi K, Tanaka-Taya K, Kazuyama Y, et al. Prevalence of Epstein-Barr virus in Japan: Trends and future prediction. Pathol Int 2006; 56(3): 112-6.
[] [PMID: 16497243]
Maple PA, Ascherio A, Cohen JI, et al. The Potential for EBV vaccines to prevent multiple sclerosis. Front Neurol 2022; 13: 887794.
[] [PMID: 35812097]
Balfour HH Jr. Progress, prospects, and problems in Epstein-Barr virus vaccine development. Curr Opin Virol 2014; 6: 1-5.
[] [PMID: 24632197]
Cai J, Zhang B, Li Y, et al. Prophylactic and therapeutic EBV vaccines: Major scientific obstacles, historical progress, and future direction. Vaccines 2021; 9(11): 1290.
[] [PMID: 34835222]
Dasari V, Bhatt KH, Smith C, Khanna R. Designing an effective vaccine to prevent Epstein-Barr virus-associated diseases: Challenges and opportunities. Expert Rev Vaccines 2017; 16(4): 377-90.
[] [PMID: 28276306]
Escalante GM, Mutsvunguma LZ, Muniraju M, Rodriguez E, Ogembo JG. Four decades of prophylactic EBV vaccine research: A system-atic review and historical perspective. Front Immunol 2022; 13: 867918.
[] [PMID: 35493498]
Sun C, Chen X, Kang Y, Zeng M. The status and prospects of Epstein-Barr virus prophylactic vaccine development. Front Immunol 2021; 12: 677027.
[] [PMID: 34168649]
Moutschen M, Léonard P, Sokal EM, et al. Phase I/II studies to evaluate safety and immunogenicity of a recombinant gp350 Epstein-Barr virus vaccine in healthy adults. Vaccine 2007; 25(24): 4697-705.
[] [PMID: 17485150]
Rees L, Tizard EJ, Morgan AJ, et al. A phase I trial of epstein-barr virus gp350 vaccine for children with chronic kidney disease awaiting transplantation. Transplantation 2009; 88(8): 1025-9.
[] [PMID: 19855249]
Sokal EM, Hoppenbrouwers K, Vandermeulen C, et al. Recombinant gp350 vaccine for infectious mononucleosis: A phase 2, random-ized, double-blind, placebo-controlled trial to evaluate the safety, immunogenicity, and efficacy of an Epstein-Barr virus vaccine in healthy young adults. J Infect Dis 2007; 196(12): 1749-53.
[] [PMID: 18190254]
Rozman M, Korać P, Jambrosic K, Židovec Lepej S. Progress in prophylactic and therapeutic EBV vaccine development based on molecular characteristics of EBV target antigens. Pathogens 2022; 11(8): 864.
[] [PMID: 36014985]
Rühl J, Leung CS, Münz C. Vaccination against the Epstein-Barr virus. Cell Mol Life Sci 2020; 77(21): 4315-24.
[] [PMID: 32367191]
Tangye SG, Palendira U, Edwards ESJ. Human immunity against EBV-lessons from the clinic. J Exp Med 2017; 214(2): 269-83.
[] [PMID: 28108590]
A study of an Epstein-Barr virus (EBV) candidate vaccine, mRNA-1189, in 18- to 30-year-oldhealthy adults Available online at:https://clinicaltrialsgov/ct2/history/NCT05164094?V_1=View[Accessed on November 16, 2022][320] Safety and immunogenicity of Epstein-Barr virus (EBV) gp350-ferritin nanoparticle vaccine inadults with or without EBV infection Available online at: https:/ results/NCT04645147 [Accessed on November 16, 2022]
Zhang XY, Teng QB. Recurrence of infectious mononucleosis in adults after remission for 3 years: A case report. World J Clin Cases 2022; 10(12): 3951-8.
[] [PMID: 35647138]
Avgil M, Diav-Citrin O, Shechtman S, Arnon J, Wajnberg R, Ornoy A. Epstein-Barr virus infection in pregnancy—A prospective con-trolled study. Reprod Toxicol 2008; 25(4): 468-71.
[] [PMID: 18534816]

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