We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Grand Rounds |

Infectious Mononucleosis in Middle Age

Paul G. Auwaerter, MD
JAMA. 1999;281(5):454-459. doi:10.1001/jama.281.5.454.
Text Size: A A A
Published online


Sprunt TP, Evans FA.Mononuclear leucocytosis in reaction to acute infections ("infectious mononucleosis"). Johns Hopkins Hosp Bull.1920;31:410-417.
Downey H, McKinlay CA.Acute lymphadenosis compared with acute lymphatic leukemia. Arch Intern Med.1923;32:82-112.
Paul JR, Bunnell WW.The presence of heterophile antibodies in infectious mononucleosis. Am J Med Sci.1932;183:90-104.
Davidsohn I.Serologic diagnosis of infectious mononucleosis. JAMA.1937;108:289-295.
Epstein MA, Achong BG, Barr YM.Virus particles in cultured lymphoblasts from Burkitt′s lymphoma. Lancet.1964;1:702-703.
Henle G, Henle W, Diehl V.Relation of Burkitt′s tumor-associated herpes-type virus to infectious mononucleosis. Proc Natl Acad Sci U S A.1968;59:94-101.
Schooley RT.Epstein-Barr virus (infectious mononucleosis).In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases. 4th ed. New York, NY: Churchill Livingstone Inc; 1995:1364-1377.
Fleisher GR, Pasquariello PS, Warren WS.  et al. Intrafamilial transmission of Epstein-Barr virus infections. J Pediatr.1981;98:16-19.
Nye FJ.Social class and infectious mononucleosis. J Hyg (Lond).1973;71:145-149.
Straus SE, Fleisher GR.Infectious mononucleosis epidemiology and pathogenesis.In: Schlossberg D, ed. Infectious Mononucleosis. 2nd ed. New York, NY: Springer-Verlag; 1989:8-28.
Evans AS.Infectious mononucleosis: recent developments. GP.1969;40:127-134.
Henke CE, Kurland LT, Elveback LR.Infectious mononucleosis in Rochester, Minnesota, 1950 through 1969. Am J Epidemiol.1973;98:483-490.
Heath Jr CW, Brodsky AL, Potolsky AI.Infectious mononucleosis in a general population. Am J Epidemiol.1972;95:46-52.
Henle G, Henle W.Observations on childhood infection with the Epstein-Barr virus. J Infect Dis.1970;121:303-310.
Thorley-Lawson DA, Mann KP.Early events in Epstein-Barr virus infection provide a model for B cell activation. J Exp Med.1985;162:45-59.
Straus SE, Cohen JI, Tosato G, Meier J.NIH conference: Epstein-Barr virus infections: biology, pathogenesis, and management. Ann Intern Med.1993;118:45-58.
Rickinson AB, Moss DJ.Human cytotoxic T lymphocyte responses to Epstein-Barr virus infection. Annu Rev Immunol.1997;15:405-431.
Sheldon PJ, Hemsted EH, Papamichail M, Holborow EJ.Thymic origin of atypical lymphoid cells in infectious mononucleosis. Lancet.1973;1:1153-1155.
Pattengale PK, Smith RW, Perlin E.Atypical lymphocytes in acute infectious mononucleosis: identification by multiple T and B lymphocyte markers. N Engl J Med.1974;291:1145-1148.
Callan MFC, Steven N, Krausa P.  et al. Large clonal expansions of CD8+ T cells in acute infectious mononucleosis. Nat Med.1996;2:906-911.
General features of infectious mononucleosis (roundtable discussion) In: Glade PR, ed. Infectious Mononucleosis: Proceedings of Symposium, New York, New York, April 7, 1972. Philadelphia, Pa: JB Lippincott; 1973:1-18.
Pullen H, Wright N, Murdoch JM.Hypersensitivity reactions to antibacterial drugs in infectious mononucleosis. Lancet.1967;2:1176-1178.
Cameron D, MacBean LM.A Clinical Study of Infectious Mononucleosis and Toxoplasmosis.Baltimore, Md: Williams & Wilkins; 1973:18-23.
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;62:256-262.
Axelrod P, Finestone AJ.Infectious mononucleosis in older adults. Am Fam Physician.1990;42:1599-1606.
Markin RS, Linder J, Zuerlein K.  et al. Hepatitis in fatal infectious mononucleosis. Gastroenterology.1987;93:1210-1217.
Halevy J, Ash S.Infectious mononucleosis in hospitalized patients over forty years of age. Am J Med Sci.1988;295:122-124.
Zahavi J, Seligsohn U.Unusual course of infectious mononucleosis. JAMA.1967;200:1181-1183.
Finkel M, Parker GW, Fanselau HA.The hepatitis of infectious mononucleosis: experience with 235 cases. Mil Med.1964;129:533-538.
Markin RS.Manifestations of Epstein-Barr virus-associated disorders in liver. Liver.1994;14:1-13.
Linderholm M, Boman J, Juto P, Linde A.Comparative evaluation of nine kits for rapid diagnosis of infectious mononucleosis and Epstein-Barr virus-specific serology. J Clin Microbiol.1994;32:259-261.
Linde A.Diagnosis of Epstein-Barr virus-related diseases. Scand J Infect Dis Suppl.1996;100:83-88.
Henle W, Henle G, Niederman JC, Klemola E, Haltia K.Antibodies to early antigens induced by Epstein-Barr virus in infectious mononucleosis. J Infect Dis.1971;124:58-67.
Straus SE.The chronic mononucleosis syndrome. J Infect Dis.1988;157:405-412.
Andersson J, Ernberg I.Management of Epstein-Barr virus infections. Am J Med.1988;85:107-115.
Tynell E, Aurelius E, Brandell A.  et al. Acyclovir and prednisolone treatment of acute infectious mononucleosis: a multicenter, double-blind, placebo-controlled study. J Infect Dis.1996;174:324-331.
Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview


Figure 1. Normal and Atypical Lymphocytes of Infectious Mononucleosis
Graphic Jump Location
A, Normal-appearing lymphocyte with compact nucleus and little cytoplasm. B and C, Bizarrely shaped atypical lymphocytes of infectious mononucleosis. Most are enlarged and have increased basophilia and cytoplasm. The nucleus may be irregular or indented (B), with lightly staining chromatin. Cytoplasmic edges may be indented by other blood cells, leading to a scalloped appearance called Dutch skirting (arrow) (C). Unlike leukemic cells, atypical lymphocytes show extreme variability of size and shape.
Figure 2. EBV-Specific Serologic Responses in Infectious Mononucleosis
Graphic Jump Location
Serologic responses to common Epstein-Barr virus (EBV) antigens after primary EBV infection. VCA indicates viral capsid antigen; EA, early antigen (diffuse [anti-D]); and EBNA, anti-EBV nuclear antigen. Figure adapted courtesy of the Scandinavian University Press.32



Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

41 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles