Talk:Infectious mononucleosis/Archive 4

Agenda for MCOTW

This important article is MCOTW. Looking at the content I can identify a few things we can do early on to improve its quality.

• WP:MEDMOS needs to be applied to the sections, with content being moved appropriately.
• WP:MEDRS needs to be applied to the current references. Ideally, we should pick a few recent clinical reviews to base our work on. This is a PubMed search for all articles with infectious mononucleosis as its MAJR topic. Of the >4000 articles, 235 are reviews. PMID 15508538 is the first major candidate (Am Fam Physician, free). PMID 10887454 is another (Postgrad Med, not free). There must be others, and there is still an awful lot of crud in that rather narrow search.
• We need to mention typical symptoms, common complications, pathogenesis, adequacy of existing diagnostic tests, symptomatic management, epidemiology and history. There is a real risk of getting drawn into the discussion of EBV and malignancy, and numerous rare complications. We'd probably do best in staying focused on the actual disease.
• Images are needed.

When I've taken meningitis to GAC I will try help out here. JFW | T@lk 21:54, 2 November 2008 (UTC)

Regarding using steroids for difficult cases: Cochrane says no (PMID 16856045). JFW | T@lk 21:56, 2 November 2008 (UTC)

This is also the only article on the topic in the Cochrane library. JFW | T@lk 21:59, 2 November 2008 (UTC)

Amazing. It's already there... JFW | T@lk 22:16, 2 November 2008 (UTC)

I've rearranged the sections per MEDMOS as far as possible at the moment. It'll need further moving when the article is in a bit of a better condition. I'll get to work on sorting this aweful signs and symptoms section out. —Cyclonenim (talk · contribs · email) 22:19, 2 November 2008 (UTC)

My apologies for having been out of commission lately... still am, but I'll do what I can here, and also see if I can get some contribution from a class of microbiology students - might be worth a shot. - Jeyradan (talk) 06:50, 3 November 2008 (UTC)

←The signs and symptoms was a mess, full of unreferenced claims. Unfortunately, I believe much of it is true and that is why I've kept a copy of the original here: User:Cyclonenim/Workbook. However, for now, I've removed the unsourced claims and rewritten the section from two sources, the Am Fam Phys paper and my OHCM book, both of which are well referenced reviews of the topic. These two sources can probably, together, act as a base for the diagnosis, pathophysiology, treatment and epidemiology sections but we're going to need further sources (either free or otherwise accessable) to back them up and expand on the finer details. —Cyclonenim (talk · contribs · email) 16:47, 3 November 2008 (UTC)

I've also done the same to the diagnosis section, as well as removing the bits from the introduction which don't exist in a referenced form of the article yet. —Cyclonenim (talk · contribs · email) 17:44, 3 November 2008 (UTC)

≤"who invened it ?? who knows ?? answer here ...", is this intentional and does it need to be asked and stated at several points in the article? I was pointing it out for removal, I would rather not do it myself without bring it up.≥ ~~saijm~~ —Preceding unsigned comment added by 24.117.80.100 (talk) 11:51, 22 April 2009 (UTC)

Prognosis

Fatalities from mononucleosis are nearly impossible in developed nations.

This statement is unfounded, unscientific, imprecise and unhelpful. Delete ? Kpjas (talk) 11:00, 15 November 2008 (UTC)

Agreed. Done Wawot1 (talk) 22:16, 17 November 2008 (UTC)

Last section of the article says "Uncommon, nonfatal complications exist...", but a ruptured Spleen is 'life-threatening' according to the linked article. --Bobbozzo (talk) 08:55, 28 February 2009 (UTC)

Good pickup. I've tweaked it. Novangelis (talk) 16:32, 28 February 2009 (UTC)

Causes

I have copied this from my talk page --Arcadian (talk) 00:58, 24 November 2008 (UTC)

Hey. Can I ask why you've moved infectious mononucleosis to it's current title? I wasn't aware we were placing virus names in disease article names. I strictly believe infectious mononucleosis is more appropriate, it's aetiology is inferred from the article itself. Although, there are no other causes but EBV. Remember that page moves probably should be discussed first. —Cyclonenim (talk · contribs · email) 22:34, 22 November 2008 (UTC)

Did you read the references I added? MEDMOS defers to ICD-10. Observe this. The article as written assumed EBV, but if the article has the title "infectious mononucleosis", then we can't assume Epstein-Barr virus. At that name, cytomegalovirus (among other agents) would be one of the causes, not one of the differentials. (And it's not that ICD-10 is out of date or doesn't reflect current usage: see PMID 18371522, PMID 15168781, PMID 15113329, etc. According to this, "Primary CMV infection will cause up to 7 percent of cases of mononucleosis syndrome and will manifest symptoms almost indistinguishable from those of Epstein-Barr virus-induced mononucleosis.") In my opinion, the rename was the smallest change possible to make the article accurate. If you want to move it back, feel free, but make sure you rewrite it as needed to remove the errors that such a move would introduce. --Arcadian (talk) 23:59, 22 November 2008 (UTC)

I see your point, i'm just not entirely certain it was necessary. If we mention the causes in the article (i.e. EBV and CMV) then we could just leave the title as infectious mononucleosis and allow the reader to distinguish between the two pathologies. If we leave it as EBV infectious mononucleosis, then we should remove information regarding CMV and place it in its own article. —Cyclonenim (talk · contribs · email) 15:01, 23 November 2008 (UTC)

(Pardon me for butting in.) I see Arcadian's point about the rename being the smallest change necessary for accuracy. I much prefer "infectious mononucleosis", however: 1) it's icd-10 compliant, 2) it's the generally used term, 3) for the casual reader, the difference between EBV infectious mononucleosis and CMV infectious mononucleosis (especially in terms of clinical presentation, management, etc.) are academic, and 4) we have plenty of articles on diseases with multiple etiologies (cf. pneumonia, gastroenteritis, aseptic meningitis), giving us precedence for using the general term and simply discussing the various causative organisms. Shall we rename to Infectious mononucleosis and generalize the article? --David Iberri (talk) 00:37, 24 November 2008 (UTC) (PS: This discussion is probably better suited for Talk:EBV infectious mononucleosis.)

If that means you're volunteering, go for it. (You may want to take a look at PMID 17904463 while you're in there.) --Arcadian (talk) 00:55, 24 November 2008 (UTC)

If we're going to rename, it's gonna have to be a manual move and then turn this into a redirect. —Cyclonenim (talk · contribs · email) 07:42, 24 November 2008 (UTC)

I hadn't read this discussion before reverting Arcadian's move, and I apologise. I don't think there was consensus for this move (which is ok per WP:BOLD), so I think we should leave it like it was before until we reach consensus.

I've added a hatnote, which is imho a more appropriate way of addressing Arcadian's concern. The issue is already mentioned in the article, but I think it should be added to the introduction.

Note that moving back didn't necessitate any manual copy-pasting, moving to a redirect has become a lot simpler since a few months (at least for admins, not sure if it goes for others).

With regards to the content of this discussion, I'd say that since "infectious mononucleosis" is most commonly linked to EBV and since CMV-mononucleosis can easily be discussed in the CMV article, I don't think we need to create new articles or change titles, the two current articles suffice for me. --Steven Fruitsmaak (Reply) 19:25, 24 November 2008 (UTC)

So what is this article about? The contents of the article appears to be about EBV infectious mononucleosis. If that is the case, then the title should probably make that clear (e.g. be EBV infectious mononucleosis). If the article is about infectious mononucleosis in general, then the ICD 10 code should be B27, contents should be generalized to cover CMV and other causes, and title left as is. Although this discussion appears to be about this issue, it isn't clear what (if anything) was resolved. The CMV page doesn't seem to talk about mononucleosis, although this page indicates that that is place for information about CMV infectious mono.

Specific reason for asking - recently the mononucleosis article was made into a redirect to this article. If this article is about both CMV and EBV variants, then that seems fine. If this is just about EBV version, seems like disambiguation page may make more sense (allows connection to Monocytosis, and encourages making links to the specific page in question rather than to the ambiguous redirect).

Also, what is the relation between this page and EBV infection, which has several sections dealing with infectious mononucleosis? If this page is about mono in general, then EBV infection covering specific EBV parts makes sense. If this page is just about EBV version, then that material should be merged in here. Zodon (talk) 02:28, 24 April 2009 (UTC)

Timespan

This article doesn't mention how long Mono tends to last. It says there's an average incubation period of 4-7 weeks, but beyond that, nothing more is said. So, does anyone know how long the disease typically lasts? 173.51.196.2 (talk) 06:05, 4 September 2009 (UTC)

Its present for 18 months after infection. However the acute stage is only a few weeks.

I added that info--thanks for pointing out the lack. BTW, the unsigned message above is too general and not correct. Gandydancer (talk) 23:46, 27 March 2010 (UTC)

The article says: "Often, if symptoms are not apparent in the first two days of possible viral infection, then mononucleosis is not present." Does it mean, that despite the 4-7 week incubation period, some mild symptoms start to show up in two days, or something else? --Vitezg (talk) 16:47, 17 February 2011 (UTC)

I've found a number of sites which claim one or more studies show that mono can be contagious for up to 18 months, but I cannot find any actual references to the study. Could someone point me to any study which shows a longer contagious period than 6 months? 24.218.243.121 (talk) 23:28, 24 June 2011 (UTC)

mononucleosis vs. infections mononucleosis

Are these the same disease or not? After reading both articles I'm still not sure. Thanks. JH (talk) 15:34, 27 July 2012 (UTC)

More symptoms

When I had this disease (around 1968), the doctor administered penicillin. Consequently (not necessarily "therefore"), I developed a progressive rash which progressed on a daily basis from my forehead to my cheeks to my neck to my chest to my thighs, then returned to my crotch. At that point, I had a white urethral discharge. A minor encyclopedia which I consulted at that time indicated that the rash was common, that the white discharge was less common, that urination of blood was a more severe symptom and that there had been three known deaths in the United States attributed to mononucleosis. I don't know whether I could still find that particular reference, and an acquaintance with a medical background pointed out that the rash had corresponded to nerve locations in the spine, with the genital area nerves lower than those servicing the thighs, indicating that the infection progressed down the spine, influencing peripheral nerves as it went along. I would like to see some of these points addressed in the article, if anyone has specific expertise. Nostalgia, I supposed. Wowest (talk) 03:51, 20 December 2009 (UTC)

Under Signs and Symptoms the article states: "Some studies indicate that approximately 80-90% of patients with acute Epstein Barr virus infection treated with such antibiotics develop a red, diffuse rash.[13]" Later in the article, under Treatment:Medications, the article states: "The antibiotics ampicillin and later the related amoxicillin[32] are relatively contraindicated in the case of any coinciding bacterial infections during mononucleosis because their use precipitates a non-allergic rash close to 99% of the time.[33]" 80-90% and 99% seems like a big difference and almost contradictory. ~looloomama —Preceding unsigned comment added by Looloomama (talk • contribs) 13:04, 21 September 2010 (UTC)

mono

i am now more educated on the disease "mono" thank you it hashelped me understand better —Preceding unsigned comment added by 68.227.151.178 (talk) 00:22, 25 February 2010 (UTC)

doi:10.1128/CMR.00044-1 - review in Clin Microbiol Rev about primary EBV infections. JFW | T@lk 10:53, 14 January 2011 (UTC)

- - - - - - - - - - - - ABOUT THAT DESCRIPTION: Since when is North America not an "English-speaking" area?? PLEASE, if you're going to refer to the variants and dialects based on BRITISH standard English, just say so! — Preceding unsigned comment added by 203.219.228.141 (talk) 03:59, 18 April 2013 (UTC)

References do not support the conclusion that EBV "may trigger multiple host autoimmune diseases"

The article makes the popular claim that, EBV "may trigger multiple host autoimmune diseases"

This may be true, but references [3][38][39] do not substantiate it. Can someone find a better reference to substantiate the claim?

"Usually, a patient has few if any further symptoms or problems from the latent B lymphocyte infection. However, in susceptible hosts under the appropriate environmental stressors the virus can reactivate and cause vague physical symptoms (or may be subclinical), and during this phase the virus can spread to others. Similar reactivation or chronic subclinical viral activity in susceptible hosts may trigger multiple host autoimmune diseases, such as systemic lupus erythematosus, rheumatoid arthritis, Sjogren's syndrome, antiphospholipid antibody syndrome, and multiple sclerosis. Such chronic immunologic stimulation may also trigger multiple type of cancers, particularly lymphoma—strongest cancer associations with EBV are nasopharyngeal carcinomas, Burkitt's lymphoma, and Hodgkin's lymphoma. EBV's potential to trigger such a wide range of autoimmune diseases and cancers probably relates to its primary infection of B lymphocytes (the primary antibody-producing cell of the immune system) and ability to alter both lymphocyte proliferation and lymphocyte antibody production.[3][38][39]"

50.71.50.249 (talk) 06:54, 30 August 2011 (UTC)

Hi, I just read this after removing that text. None of that is correct nor supported by the source. — Preceding unsigned comment added by 71.197.146.147 (talk) 01:14, 26 March 2012 (UTC)

Recent reviews

This seems to be an excellent ref and we are not using it.

• Luzuriaga, K (2010 May 27). "Infectious mononucleosis". The New England journal of medicine. 362 (21): 1993–2000. PMID 20505178. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)

Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:05, 21 June 2013 (UTC)

Unfortunately, I don't have ready access to it. Could you send me a pdf if I email you? Thanks, 81.157.7.7 (talk) 22:24, 21 June 2013 (UTC)

Merge of mononucleosis

I think this is reasonable. Doc James (talk · contribs · email) 06:57, 11 March 2012 (UTC)

• Support, however belatedly... The ICD10 classification [1] includes both EBV (B27.0) and CMV (B27.1), as well as "other infectious" (B27.8) and "unspecified" (B27.9). In addition to the issue of page confusion with mononucleosis, wouldn't it be helpful to have information on the CMV cause here? 86.171.162.156 (talk) 21:33, 14 June 2013 (UTC)

Adding: Any reader who simply types 'mononucleosis' in the search bar, maybe expecting a redirect to Infectious mononucleosis, currently gets taken by default to Mononucleosis (where the lead links to the Infectious mononucleosis page only via "glandular fever", a term which could be unfamiliar to an American reader). 86.171.162.156 (talk) 10:37, 15 June 2013 (UTC)

Merge is done. Should be able to discuss all aspects here. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:59, 21 June 2013 (UTC)

Yes. Feel free to move here anything I put on your talk page. —81.157.7.7 (talk) 22:36, 21 June 2013 (UTC)

Signs and symptoms section

Well, I suppose if a shorter "Signs and symptoms" section is felt to be preferable, then the present draft [2] could be transplanted to a subpage. I've tried to make key available evidence easily retrievable for professionals, while at the same time keeping the section reasonably accessible to lay users. A bit like squaring the circle though perhaps...81.157.7.7 (talk) 17:07, 22 June 2013 (UTC)

First line - all infectious mononucleosis is caused by EBV

This is not true, as mentioned later in the article, EBV only accounts for the majority of infecitous mononucleosis. The first sentence is therefore misleading and should read. "infectoius mononocleosus is PRIMARILY caused by EBV" — Preceding unsigned comment added by 118.138.107.201 (talk) 01:12, 29 October 2013 (UTC)

Pathophysiology

Under the Pathophysiology header, the following sentence: "When symptoms of infectious mononucleosis have been caused by cytomegalovirus, or by adenovirus or Toxoplasma gondii (toxoplasmosis), a heterophile antibody test will test negative."

is misleading. Someone reading this might interpret this sentence as saying that toxoplasma gondii can cause infectious mononucleosis, which is just plain untrue. The language used is easy to misinterpret. Can someone please change this to reflect that toxoplasmosis can have similar symptoms to mononucleosis, but is not the same disease. Thanks.— Preceding unsigned comment added by 66.46.50.100 (talk • contribs) 14:57, 21 July 2014‎

I rephrased this as you suggested, 66.46.50.100. Thanks for speaking up. Blue Rasberry (talk) 20:20, 29 July 2014 (UTC)

Meaning of name?

I had hoped to find here some explanation of the name mononucleosis, which literally means "single" mono, "nucleus", "disease" -osis. To the best of my limited knowledge there are some specialized cells such as red blood cells with no nucleus, but I'm not aware of any type of body cells with more than a single nucleus. Thus very nearly every cell in a body contains a single nucleus - is "mononuclear".
The article Monocyte is not much help, saying Monocytes have bean-shaped nuclei that are unilobar, which makes them one of the types of mononuclear leukocytes... - but the accompanying image clearly shows two cells each with multilobar nuclei. The same lead paragraph goes on to say Monocytes are usually identified in stained smears by their large kidney shaped or notched nucleus. If anything, this sounds self-contradictory - in other words, they have two or more lobes. Perhaps what that article was meant to say was that the nuclei are multilobar, not unilobar. Still, none of this explains the "mono" part of either "mononucleosis" or "monocyte". Could it be because the multi-lobes might appear to be multiple separate nuclei, and the "mono-" prefix simply indicates that despite appearances, there is only a single nucleus? Milkunderwood (talk) 03:05, 27 June 2015 (UTC)

See response and explanation at Talk:Monocyte#Unilobar.3F. Some of that information should still be added to this Mononucleosis article. Milkunderwood (talk) 19:51, 27 June 2015 (UTC)

YouTube video

The text of the first half or so of this article has been incorporated into a recent Studio C sketch. Just thought I should notify watchers of this article. [3] Everymorning (talk) 00:19, 15 March 2016 (UTC)

JAMA

Rational Clinical Examination about this doi:10.1001/jama.2016.2111 JFW | T@lk 15:47, 13 April 2016 (UTC)