Infectious mononucleosis.
Infectious mononucleosis.
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DOI：
10.1038/cti.2015.1
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发表时间：
2015-02
影响因子：
5.8
通讯作者：
中科院分区：
文献类型：
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传染性单核细胞增多症是一种以咽炎、颈部淋巴结肿大、疲劳和发热为特征的临床实体，其最常由原发性EB病毒（EBV）感染引起。EBV是一种淋巴细胞病毒和γ-疱疹病毒家族的成员，感染全球至少90%的人口，其中大多数人没有可识别的疾病。该病毒通过青少年之间的亲密口腔接触传播，但尚不清楚青春期前如何获得病毒。在大约6周的潜伏期内，病毒首先在口咽部复制，随后在发病前2周出现病毒血症。急性疾病的特征是口腔和血液中的高病毒载量，伴随着针对EBV病毒衣壳抗原的免疫球蛋白M抗体的产生和针对EBV感染的B细胞的CD 8 + T淋巴细胞的异常扩增。在恢复期，CD 8 + T细胞恢复到正常水平，并产生针对EBV核抗原-1的抗体。一个典型的临床图片在一个青少年或年轻的成年人与一个积极的嗜异性试验通常是足以作出诊断传染性单核细胞增多症，但嗜异性抗体是不具体的，不发展在一些患者，特别是年幼的儿童。EBV特异性抗体谱是对EBV感染进行分期的最佳选择。除了引起急性疾病外，长期后果与传染性单核细胞增多症有关，特别是霍奇金淋巴瘤和多发性硬化症。目前还没有获得许可的预防疫苗，也没有具体的批准治疗方法。未来的研究目标是开发EBV疫苗，了解急性疾病严重程度的风险因素以及发展癌症或自身免疫性疾病的可能性，并发现抗EBV药物来治疗传染性单核细胞增多症和其他EBV刺激的疾病。
Infectious mononucleosis is a clinical entity characterized by pharyngitis, cervical lymph node enlargement, fatigue and fever, which results most often from a primary Epstein–Barr virus (EBV) infection. EBV, a lymphocrytovirus and a member of the γ-herpesvirus family, infects at least 90% of the population worldwide, the majority of whom have no recognizable illness. The virus is spread by intimate oral contact among adolescents, but how preadolescents acquire the virus is not known. During the incubation period of approximately 6 weeks, viral replication first occurs in the oropharynx followed by viremia as early as 2 weeks before onset of illness. The acute illness is marked by high viral loads in both the oral cavity and blood accompanied by the production of immunoglobulin M antibodies against EBV viral capsid antigen and an extraordinary expansion of CD8+ T lymphocytes directed against EBV-infected B cells. During convalescence, CD8+ T cells return to normal levels and antibodies develop against EBV nuclear antigen-1. A typical clinical picture in an adolescent or young adult with a positive heterophile test is usually sufficient to make the diagnosis of infectious mononucleosis, but heterophile antibodies are not specific and do not develop in some patients especially young children. EBV-specific antibody profiles are the best choice for staging EBV infection. In addition to causing acute illness, long-term consequences are linked to infectious mononucleosis, especially Hodgkin lymphoma and multiple sclerosis. There is no licensed vaccine for prevention and no specific approved treatment. Future research goals are development of an EBV vaccine, understanding the risk factors for severity of the acute illness and likelihood of developing cancer or autoimmune diseases, and discovering anti-EBV drugs to treat infectious mononucleosis and other EBV-spurred diseases.