Studies in glandular fever (infectious mononucleosis).

Abstract

Acutely hyperplastic lymphatic tissue from many causes, for example, scarlet fever, 1 whooping cough, typhoid fever, secondary syphilis, etc., has been known to result in an absolute increase in lymphoid cells in the circulating blood. This study is based on cases of apparently specific lymphadenopathy called glandular fever, 2 a condition characterized by general enlargement of the lymphatic glands, an absolute mononucleosis and the presence in the blood of abnormal mononuclear cells. 3 Our study is based on the findings in fifty clinical cases of glandular fever or infectious mononucleosis and in fifty-five medical students in whom the symptoms were so mild as to be negligible but in most of whom there was evidence of glandular enlargement and mononucleosis. Glands were removed from six patients.

Our purposes are: (1) to determine the etiology, (2) to ascertain whether or not the pathological changes in the glands are characteristic, (3) to establish the origin of the abnormal mononuclear cells, (4) to determine whether the mononucleosis is a specific response to the etiological agent, a response peculiar to certain individuals, or a compensatory reaction in individuals in which the granulocytic apparatus is rendered impotent by the infection.

(1) Blood cultures were done on fourteen cases, thirteen of which remained sterile. In one culture diphtheroids were obtained both from bouillon and blood agar plates. Glands removed from six patients were cultured and diphtheroids 4 were obtained in pure culture from four, one of which was removed six months after the acute symptoms had subsided. The organisms grew best in veal bouillon and four to seven days were required for clouding the media. One cc. of a five day old bouillon culture either subcutaneously or intraperitoneally in guinea pigs caused mild fever of three to five days duration but no special symptoms nor distinctive adenopathy.