Deputy Editor Nigel Brown provides a brief glimpse of the articles on offer in the third issue of 2021.
Issue 3 starts with a review of infectious mononucleosis (glandular fever) and the challenges in its diagnosis (Naughton et al.). Correct and early diagnosis of the disease is important to avoid the unnecessary administration of antibiotics and reduce the need for other investigations, as some cases can present with splenomegaly, hepatomegaly or even suggest haematological disorders. The review starts with a description of the disease and its causative pathogen, Epstein–Barr virus (EBV). EBV infection is very common with 95% of the entire world’s population being infected at some stage in their life. The main route of transmission appears to be via saliva, though blood transfusions and transplantation are clinically important routes. EBV is able to force B cells into becoming “memory” cells and can thus persist and only display a limited number of the viral proteins, thus avoiding detection by the host immune system. Typically, in immunocompetent individuals, the virus is able to remain in the host for life. The review then considers the laboratory tests available for the diagnosis of the infection. EBV is able to cause the presence of heterophile (non-specific) antibodies, which are the basis of the older Paul Bunnell test and the more sensitive monospot test. This test is very useful in diagnosis, as the antibodies may not be present at high levels in active disease or be present at high levels after the acute phase, but this can lead to misdiagnosis. The authors then go on to describe more specific tests for the virus and highlight the lack of a standard international diagnostic algorithm for the disease.
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