Lange B J, Berman P H, Bender J, Henle W, Hewetson J F
Pediatrics. 1976 Dec;58(6):877-80.
Four atypical cases of presumed infectious mononucleosis (IM) encephalitis are presented. To establish an etiologic diagnosis, Paul-Bunnell-Davidsohn heterophil titers (PBD), antibody titers to the antigens of the Epstein-Barr virus (EBV), and oropharyngeal excretion of EBV were determined. Criteria for a primary EBV infection are (1) an antiviral capsid antigen titer of 1:160 or greater, (2) the presence of antibody to the diffuse component of the early antigen, (3) absence of antibody to the nuclear antigen, and (4) excretion of the virus from the oropharynx. Three of the four cases met these criteria; of the three, one did not have a positive heterophil titer. The fourth case turned out not to be IM; there was a positive PBD heterophil, but there was no evidence of primary EBV infection. Although the PBD heterophil is usually a reliable test to diagnosis IM, it is not always present in children, and it is sometimes nonspecifically elevated. Some EBV titers can be nonspecifically elevated as well; however, the above criteria are diagnostic of primary EBV infection.
本文报告了4例疑似传染性单核细胞增多症（IM）脑炎的非典型病例。为了做出病因诊断，测定了嗜异性凝集试验（PBD）效价、针对爱泼斯坦-巴尔病毒（EBV）抗原的抗体效价以及EBV的口咽部排出情况。原发性EBV感染的标准为：（1）抗病毒衣壳抗原效价为1:160或更高；（2）存在针对早期抗原弥散成分的抗体；（3）不存在针对核抗原的抗体；（4）病毒从口咽部排出。4例中有3例符合这些标准；在这3例中，有1例嗜异性凝集试验效价未呈阳性。第4例结果并非IM；嗜异性凝集试验呈阳性，但没有原发性EBV感染的证据。尽管嗜异性凝集试验通常是诊断IM的可靠检测方法，但在儿童中并不总是出现，而且有时会非特异性升高。一些EBV效价也可能非特异性升高；然而，上述标准可诊断原发性EBV感染。
