Trip Answers

Question answered:19/09/07 Warning! this question is over two years old.

We searched the TRIP and Medline databases but found no robust information to answer this question. A number of patient information leaflets suggest recurrence to be a rare event.

 

For example, the familydoctor.org website website produced by the American Academy of Family Physicians in its discussion of infectivity states: “Generally, people only get mono[nucleosis] once. It's most common among people 15 to 35 years old.” [1]

 

NHS Direct notes in a section on pregnancy and glandular fever:

 

“Glandular fever is an infectious illness that's caused by the herpes family of viruses. Lots of people have already had the virus by the time they're an adult, but symptoms may have been so mild you didn't realise. Once you've had glandular fever, your body makes antibodies against it, and it's extremely rare to get it again.” [2]

 

Bupa’s leaflet on infectious mononucleosis:

 

“Once you have recovered from glandular fever, it is unlikely that you will get it again as you develop an immunity to the infection. However, EBV, like other herpes viruses, is able to live in your body without causing symptoms.” [3]

 

Pichler present a case report of recurrent infectious mononucleosis:

 

“We present the clinical case of a 20-year-old male soldier who appeared in general good physical condition. He suffered from infectious mononucleosis caused by Epstein-Barr virus that had recurred 2 years after the first serologically documented episode. The detected splenomegaly persisted in the healthy young man, who otherwise showed no apparent immune deficiency. To our knowledge, this is an extremely rare condition.” [4]

 

A second case report describes chronic active infection with Epstein-Barr infection:

 

“Infectious mononucleosis (IM) is a self-limiting, lymphoproliferative disease induced by primary infection with the Epstein-Barr virus (EBV). Infection with EBV leads in general to lifelong asymptomatic persistence of the virus. We report the case of a woman who acquired IM at the age of 15 years and then suffered from recurrent high fever, fatigue, and signs of immunologic disorder for more than 12 years until she died of liver failure. In an attempt to describe and to define the course of chronic active infection with EBV, we performed immunologic and molecular assays that demonstrated lytic replication of EBV in the B and T cells of the peripheral blood. In addition to signs of humoral and cellular immune deficiency, we detected an EBV strain with an impaired capability to immortalize B cells and a tendency to lytic replication, thus contributing to the pathogenesis of this chronic active infection.” [5]

 

You may also find an article on active Epstein-Barr virus infection with persistent, unexplained illnesses, published in 1985. The Medline abstract of this paper reads:

 

“Forty-four patients, including 26 adults and 18 children under 15 years of age, were referred for evaluation of recurrent or persistent illnesses, with symptoms including pharyngitis, lymphadenopathy, fever, headaches, arthralgia, fatigue, depression, dyslogia, and myalgia. Thirty-nine patients were positive for Epstein-Barr virus antibody with antibody levels compatible with active infection for at least 1 year. Antiviral capsid antigen and anti-early antigen titers of patients were significantly greater (p less than 0.001) than age-group-matched controls. The frequency, number, duration, and patterns of symptoms, as well as patient sex, were compared by age in study patients seropositive and seronegative for Epstein-Barr virus. Illness patterns were not associated with changes in specific antibody titers or clinical findings. Lymphocyte phenotype and function analyses were done in 11 of the 39 patients positive for Epstein-Barr virus antibody; no consistent differences from normal were found. Only 1 of 32 patients had circulating interferon, in contrast to 7 of 7 patients with acute infectious mononucleosis. There were many adverse consequences of the illness. Epstein-Barr virus infection may not be self-limiting, and the virus may be associated with clinically recognizable illness other than infectious mononucleosis in children as well as in adults.” [6]

 

References
1. familydoctor.org. Entry on mononucleosis. (http://familydoctor.org/077.xml).
2. NHS Direct. Common health questions: pregnancy and glandular fever. September 2007. (http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=1836 )
3. Bupa. Infectious mononucleosis. July 2005. (http://hcd2.bupa.co.uk/fact_sheets/html/Infectious_mono.html
4. Pichler R, Berg J, Hengstschläger A et al. Recurrent infectious mononucleosis caused by Epstein-Barr virus with persistent splenomegaly. Mil Med. 2001 Aug;166(8):733-4. (http://www.hubmed.org/display.cgi?uids=11515329)
5. Schwarzmann F, von Baehr R, Jäger M et al.. A case of severe chronic active infection with Epstein-Barr virus: immunologic deficiencies associated with a lytic virus strain. Clin Infect Dis. 1999 Sep;29(3):626-31. (http://www.hubmed.org/display.cgi?uids=10530459)
6. Jones JF, Ray CG, Minnich LL et al. Evidence for active Epstein-Barr virus infection in patients with persistent, unexplained illnesses: elevated anti-early antigen antibodies. Ann Intern Med. 1985 Jan;102(1):1-7. (http://www.hubmed.org/display.cgi?uids=2578266)

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