Pathology and Clinical Manifestations

Although the pathological findings may be multivis-ceral, the predominant finding is follicular hyperplasia of the lymph nodes. The lymphoid tissues show diffuse proliferation of the atypical lymphocyte that is present in the spleen and the walls of blood vessels, is periportal in the liver, and appears in the peripheral bloodstream. These monocytoid lymphocytes (Downey cells) may make up 10 percent or more of the white cells and are of diagnostic significance.

In childhood the disease is subclinical or masquerades as one of many episodes of upper respiratory infection. In the typical youthful adult, after an incubation period of about 5 or 6 weeks, clinical disease shows itself with prodromes of malaise, fatigue, headache, and chilliness followed by high fever, sore throat, and tender swollen cervical lymph nodes. Examination shows, in addition to the lymphadenop-athy, paryngitis often with scattered petechiae and swelling of the pharyngeal lymphoid structures, hepatosplenomegaly, and, not infrequently, a transient maculopapular rash. Palpebral and periorbital edema may develop. Mild jaundice appears in some 10 percent of patients. Rarely are symptoms related to the central nervous system. Following an initial leukopenia, a leucocytosis of 15,000 to 20,000 or higher appears with an absolute lymphocytosis and with atypical lymphocytes prominent as noted above.

In most patients the disease is mild, and recovery occurs within several weeks. College students are generally up and about within a week or so. Complications in the nervous system may occasionally occur in adults, but death from the disease is extremely rare, splenic rupture being the most serious complication.

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