Acute infectious mononucleosis and coincidental measles virus infection.
BACKGROUND
Both Epstein-Barr and measles viruses (MV) cause immune suppression, and the association of the two viruses is evaluated as life threatening. The cell immune impairment caused by simultaneous Epstein-Barr and measles viral infections was responsible for the complicated course of the disease in all described previously reports and for unfavorable outcomes in most of the cases. Timely diagnosis of coincidental viral infections could be a useful predictor for the clinical course and complications. Diagnosis must be based on an accurate assessment of clinical, hematologic, serologic manifestations and supported by appropriate laboratory methods. Recognizing the infectious etiology of concomitant infections is important for both clinicians and epidemiologists.


OBJECTIVE
To describe a case report of a 20-year-old woman previously vaccinated against measles infected with acute mononucleosis and coincidental measles virus infection.


METHODS
The clinical, routine laboratory, as well as serological and virologic findings of this patient were scrutinized. Special emphasis was placed on the use of RT-PCR/PCR for confirming the involvement of both measles virus and Epstein-Barr virus (EBV) in this patient's illness.


RESULTS
Infectious mononucleosis was not suspected at admission to the hospital. The final diagnosis of a concomitant measles virus infection and acute infectious mononucleosis was facilitated using viral serology to detect virus-specific IgG and IgM antibodies and by RT-PCR for the detection of measles virus RNA and EBV DNA from peripheral blood monocyte cells (PBMC).


CONCLUSIONS
The present report highlights the difficulty of diagnosing two coincidental virus infections on clinical grounds. Serological and molecular laboratory methods, specifically the PCR (RT-PCR) analysis, are found to be useful for confirming the concomitant viral infections and proper identification of the infecting pathogens.
Atrasheuskaya
A V
AV
Institute of Molecular Biology, State Research Center of Virology and Biotechnology Vector, Koltsovo, Novosibirsk region 630559, Russia. ignat@vector.nsc.ru
Kameneva
S N
SN
Neverov
A A
AA
Ignatyev
G M
GM
D000208:Acute Disease; D000328:Adult; D000956:Antigens, Viral / Q000097:blood; D005260:Female; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D006801:Humans; D007108:Immune Tolerance; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007244:Infectious Mononucleosis / Q000150:complications* / Q000175:diagnosis / Q000276:immunology / Q000821:virology; D008457:Measles / Q000150:complications* / Q000175:diagnosis / Q000276:immunology / Q000821:virology; D008459:Measles virus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D020133:Reverse Transcriptase Polymerase Chain Reaction
D000956:Antigens, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M