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Case Study Adds Coxackie A to Growing List of Pathogens That May Cause Mono-Like Symptoms

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Article:
Infectious mononucleosis-like syndrome probably attributable to Coxsackie A virus infection
– Source: Heart & Lung, Jan 30, 2012

By Burke A Cunha, et al.

[Note: Coxsackie viruses are small RNA viruses in the enterovirus genus that, like polioviruses, are spread by respiratory secretions and feces.]

Abstract:
Infectious mononucleosis (IM) is a clinical syndrome most often attributable to Epstein-Barr virus (EBV).

Characteristic clinical features of EBV infectious mononucleosis include:

• Bilateral upper lid edema,

• Exudative or nonexudative pharyngitis [sore throat],

• Bilateral posterior cervical adenopathy [enlargement of the back lymph nodes on both sides of the neck],

• And splenomegaly [enlarged spleen]

• ± Maculopapular rash.

Laboratory features of EBV infectious mononucleosis include atypical lymphocytes and elevated levels of serum transaminases [liver enzymes that leak out into the bloodstream if the liver is damaged].

Leukopenia and thrombocytopenia [low numbers of white blood cells and platelets] are not uncommon.

The syndrome of infectious mononucleosis may also be attributable to other infectious diseases, e.g., cytomegalovirus (CMV), human herpes virus-6 (HHV-6), or Toxoplasma gondii [cause of toxoplasmosis, spread via cat feces].

Less commonly, viral hepatitis, leptospirosis, brucellosis, or parvovirus B19 may present as an infectious mononucleosis-like infection.

To the best of our knowledge, only 2 cases of infectious mononucleosis-like infections attributable to Coxsackie B viruses (B3 and B4) have been reported.

We present the first reported case of an infectious mononucleosis-like syndrome with sore throat, fatigue, atypical lymphocytes, and elevated levels of serum transaminases likely due to Coxsackie A in an immunocompetent adult.

Source: Heart & Lung, Jan 30, 2012. Cunha BA, Mickail N, Petelin AP. Infectious Disease Division, Winthrop-University Hospital, Mineola, New York; State University of New York School of Medicine, Stony Brook, New York. [Email: bacunha@Winthrop.org]

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