本邦における伝染性単核球症と伝染性単核球症症候群

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  • Infectious mononucleosis and its allied syndrome in Japan. Clinicopathological study of 55 cases.
  • Clinicopathological study of 55 cases

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Fifty-five patients who showed increased number of atypical lymphocytes (over 10% of total white blood cell count) were classified into four groups according to their titers of anti-Epstein-Barr virus (EBV) antibodies. The clinical and hematological findings, serological tests liver chemistries, serum immunoglobulin levels and lymphocyto surface phenotype in peripheral blood were examined in each group to delineate the clinicopathological features of infectious mononucleosis (IM) and IM syndrome (IMS) in Japan.<br>1. Less than half of the cases of IMS studied here were defined as IM, which is caused by primary infection of EBV, although the early antigens of EBV specific antibadies, examined by immunofluorescence technique, were hardly detected in some cases.<br>2. Clinical features of IM in Japan are quite similar to those in western countries except for the age distribution, which has two incidence peaks, in the first and third decades.<br>3. As for liver chemistry in IM, serum γ-GTP and alkaline phosphatase are elevated in comparison to HA-related IMS in which GOT is markedly elevated. This suggests that the main lesion of IM in the liver is in periportal and sinusoidal areas.<br>4. The elevation of serum IgE levels in IM is noteworthy in view of the high incidence of drug allergies and an expression of Fcε receptor/CD 23 by EBNA.<br>5. The clinical features of non-EBV-related IMS in Japan are as follows. The causal agent was unknown in more than half of the cases. The disease was common in childhood. In such cases, signs and symptoms and abnormal liver chemistry and immunoglobulin levels were similar to those of definite IM cases, but were milder.<br>6. MST, which is a simple test for detection of heterophil antibodies, were positive in 82% of the definite IM cases and in one-third of non-EBV-related cases. This suggests that MST is of clinical use in diagnosing IMS but is not necessarily specific for EBV infection.<br>7. Lymphocyte surface phenotype assay in peripheral blood showed low OKT 4+/8+ ratio in all groups, and increase of OKTIa 1+ cell only in IM.

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