Cameron Barbara, Bharadwaj Mandvi, Burrows Jacqueline, Fazou Chrysa, Wakefield Denis, Hickie Ian, Ffrench Rosemary, Khanna Rajiv, Lloyd Andrew
School of Medical Sciences, Inflammatory Diseases Research Unit, University of New South Wales, Sydney, Australia.
J Infect Dis. 2006 Mar 1;193(5):664-71. doi: 10.1086/500248. Epub 2006 Jan 30.
Primary Epstein-Barr virus (EBV) infection causes a spectrum of characteristics that range from asymptomatic seroconversion to severe infectious mononucleosis (IM), sometimes with prolonged symptoms and disability. We examined the relationships between clinical course, number of viral copies, and immunological parameters in a prospective cohort of subjects with recent IM.
Eight case patients with at least 6 months of disabling symptoms and 31 matched control subjects who had recovered promptly were included. Symptom scores were recorded at regular intervals over the course of 12 months. Cellular EBV load, EBV-specific antibody responses, lymphocyte subsets, and EBV-specific interferon (IFN)- gamma induction were measured.
In case patients with prolonged illness, the severity of acute-phase symptoms was greater, the development of anti-EBV nuclear antigen-1 immunoglobulin G was more rapid, and the time to development of the peak IFN- gamma response to the majority of latent-cycle EBV peptides was generally slower than those in control subjects. However, in both groups, neither viral nor immune parameters correlated with the severity or duration of symptoms.
The resolution of symptomatic IM is not determined by control of viremia, nor is it easily explained by altered host responses to EBV infection. The detailed determinants of delayed recovery remain to be elucidated.
原发性爱泼斯坦-巴尔病毒（EBV）感染可导致一系列症状，从无症状血清转化到严重的传染性单核细胞增多症（IM），有时症状会持续较长时间并导致残疾。我们在一个近期患IM的前瞻性队列中研究了临床病程、病毒拷贝数和免疫参数之间的关系。
纳入8例有至少6个月致残症状的病例患者和31例迅速康复的匹配对照受试者。在12个月的病程中定期记录症状评分。检测细胞EBV载量、EBV特异性抗体反应、淋巴细胞亚群和EBV特异性干扰素（IFN）-γ诱导情况。
在病程延长的病例患者中，急性期症状更严重，抗EBV核抗原-1免疫球蛋白G的产生更快，对大多数潜伏周期EBV肽产生IFN-γ反应峰值的时间通常比对照受试者慢。然而，在两组中，病毒参数和免疫参数均与症状的严重程度或持续时间无关。
有症状的IM的缓解不是由病毒血症的控制决定的，也不容易用宿主对EBV感染的反应改变来解释。延迟恢复的详细决定因素仍有待阐明。
