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January 10, 1977

Infectious Mononucleosis

JAMA. 1977;237(2):119. doi:10.1001/jama.1977.03270290019012

To the Editor:  I recently read the brief report by Askinazi et al (236:1492, 1976) and wish to make the following comments.The report of Askinazi and coworkers regarding the persistence of Epstein-Barr virus in a symptomatic patient is extremely interesting and would bear further elucidation. The classical syndrome of infectious mononucleosis (IM) as caused by the Epstein-Barr virus has been the subject of much attention in the general medical literature. The fact that this may be a distinctly occult disease without any noticeable symptoms and signs to alert the physician has received little emphasis.A recent report by Niederman and co-workers1 was extremely informative in clarifying the excretion patterns, viral persistence, and sites of probable replication of the Epstein-Barr virus. It would appear that the salivary-parotid gland network is the major source of viral replication; consequently, it would not be unusual to see adjacent facial nerve palsies with this