Chronic Infectious Mononucleosis

This term is used for patients who have the following clinical syndrome:

1. Chronic and relapsing illness and fatigue, myalgia, adenopathy, hepatospleno-megaly, mild pharyngitis, and intermittent fever

2. Absence of known predisposing cause or chronic illness

3. Anemia, neutropenia, lymphocytopenia, or lymphocytosis, thrombocytopenia, polyclonal hypergammaglobulinemia may be present.

To diagnose this condition, the following criteria must be met and the symptoms must be present for more than 1 year:

1. Elevated IgG antibody titers to viral capsid antigen (VCA) greater than 5120, VCA IgA positive. Early antigen diffuse (EAD) IgG greater than 640, EAD IgA positive. Early antigen restricted (EAR) IgG greater than 640 or detection of genomes in affected tissues, EBNA1 low or negative—an indicator of recent EBV infection

2. Detection of EBV genome in affected tissues.

3. Oligoclonal or monoclonal EBV-infected lymphocyte population may be of T- or B-cell lineage. Occasionally, there may be hemophagocytic lymphohis-tiocytosis (HLH).

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