T lymphocytes from patients with acute EBV-induced infectious mononucleosis rapidly die by apoptosis in vitro. Because human and viral IL-10 are likely to be induced during acute EBV infection and display a variety of functions on human T cells, we examined IL-10 effects on infectious mononucleosis T cell death. After 12 h of incubation in medium alone, only 35.6 (+8.2%) of the originally seeded infectious mononucleosis T cells were viable. Addition of human IL-10 (100 U/ml) to T cell cultures significantly improved recovery of viable cells (71.3+6.2%, P = 0.0156). Viral IL-10 had comparable effects to human IL-10 in this system. Protection from death by human and viral IL-10 (100 U/ml) was dose dependent and continued over a 6-d culture period. The human IL-10 effect was neutralized by the anti-human IL-10 mAb 19F1. Morphology and analysis of DNA after separation on agarose gels showed that IL-10 inhibits loss of cell volume, chromatin condensation, and DNA fragmentation, characteristics of death by apoptosis. As assessed by [3Hjthymidine incorporation, the T cells were not induced to proliferate by IL-10 above the level exhibited when first removed from blood. T cells protected from death by IL-10 proliferated to IL-2 and spontaneously killed sensitive targets as effectively as medium-precultured T cells. Thus, IL-10 promotes the survival of infectious mononucleosis T cells otherwise destined to die by apoptosis and may be critical for the establishment of immunologic memory after resolution of the illness. (J. Clin. Invest. 1994. 94:251-260.)

Human interleukin 10 (hIL-10), a product of monocytes, T cells, and B cells, shares extensive structural and functional similarity with viral IL-10 (vIL-10), a product of Epstein-Barr virus (EBV) replication. With two ELISAs, one that recognizes both hIL-10 and vIL-10 and the other specific for vIL-10, IL-10 was measured in serum or plasma and in saliva from 50 patients with acute EBV-induced infectious mononucleosis and from 19 normal subjects. In serum or plasma, 60% of the patients had measurable hIL-10 and/or vIL-10 and 18% had measurable vIL-10. In saliva, 20% of the patients had detectable hIL-10 and/or vIL-10 and none had detectable vIL-10. In contrast, hIL-10 and/or vIL-10 was undetectable in all 19 normal serum or plasma samples (P < .001 vs. patient samples). Among normal saliva samples, 21% had detectable hIL-10 and/or vIL-10 but none had detectable vIL-10. Thus, most patients with acute EBV-induced infectious mononucleosis transiently have abnormally high levels of circulating IL-10.

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Throat cultures from 133 patients with infectious mononucleosis were compared with cultures from 2,881 patients who were seen during the same period because of pharyngitis. Less than 3 per cent of the cultures from each group contained Group A beta hemolytic streptococci. The inflamed pharynx and necrotic tonsils of infectious mononucleosis are seldom subject to bacterial superinfection, either initially or during the course of the illness. There is no indication for routine use of antibiotics when infectious mononucleosis is diagnosed. Should, however, a throat culture indicate presence of a bacterial pathogen, any appropriate antibiotic except ampicillin may be used without increasing the incidence of skin rash.

One hundred fifty-one patients with tinea pedis participated in a double-blind study to assess the efficacy and safety of a powder containing undecylenic acid 2% and zinc undecylenate 20% versus a placebo powder. Patients were assigned to apply twice-daily applications of either active powder or placebo for a period of 4 weeks. Trichophyton rubrum or Trichophyton mentagrophytes were isolated from pretreatment cultures of 85 patients. Of these, 88% treated with active powder had negative cultures after 4 weeks compared with 17% of those treated with placebo powder (p less than 0.001). Fungus was identified in potassium hydroxide (KOH) treated skin scrapings of all 151 patients before treatment. Of those treated with active powder, 80% were KOH negative after 4 weeks compared with 49% of those treated with placebow powder (p = 0.001). Erythema and scaling were significantly improved by therapy with active powder, as were subjective evaluations of itching and burning. There were no side-effects or adverse reactions to undecylenic acid and its zinc salt.