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Infectious mononucleosis - symptoms (photo) in children and adults, treatment

Mononucleosis refers to those diseases that are extremely rare in the practice of modern doctors. However, it should be noted that this is a very dangerous disease. Especially when it comes to children. In addition, in most cases, the disease appears suddenly. So, we propose to find out what lies behind the diagnosis of "mononucleosis", what kind of ailment and how to protect the child from the disease.

Characteristic

According to statistics, mononucleosis in adults is extremely rare. Nearly 90% of the population is immune to the Epstein-Barr virus, as this infection was transferred during adolescence. The presence of antibodies in the blood suggests that they had had the disease at least once. Most often, the virus is found in adolescents and children. Girls are most susceptible to this ailment at the age of 14-16 years, and boys - in the period of 16-18 years.

What kind of mononucleosis disease? This is an acute infectious disease caused by the Epstein-Barr virus. It is quite stable in the external environment. The virus causes a primary specific infection. Of every 10 people who become infected with it, approximately 9 have a chronic form. It is not accompanied by acute episodes.

Thus, these people are lifelong carriers of the virus. They will never suffer the acute form of the disease. At the same time, without hurting themselves, carriers emit a virus with saliva. That is why often the question: “Mononucleosis - what is it?”, You can hear the answer: “Kissing disease”.

This ailment has many names. For example: Filatov's disease, monocytic sore throat, Pfeifer disease, glandular fever, recruit disease, Epstein-Barr virus infection, EBV infection, and kissing disease.

Due to the low prevalence of the disease, few people know what kind of disease is mononucleosis. As noted above, this is an acute affliction of a viral nature.

It manifests itself by a significant increase in temperature, damage to the lymph nodes and palatine tonsils. In addition, the disease leads to an increase in the spleen and liver. The causative agent of the disease refers to the herpes virus type 4.

Its feature is selective damage to the cells of the immune system. V-lymphocytes are affected by the virus. This leads to changes in the organs in which they are present - the spleen, lymph nodes, liver.

After mononucleosis, a person develops a strong immunity. Do not get sick again ailment.

Causes of pathology

The main source of the disease are people in whose blood the Epstein-Barr virus is present. An infected person excretes it into the external environment. At the same time, not only patients with an open form spread the virus. The erased form of mononucleosis is also dangerous. Studies have shown that for 18 months after infection, the virus is released into the environment. This happens even when clinical manifestations are absent.

The main pathway is airborne. However, this is not always the case. The virus can penetrate into the oropharynx of a healthy person and by contact-household way, for example, when kissing. This happens much more often than during sneezing. In addition, the virus can enter the body through blood transfusions. It should be remembered (in the case of mononucleosis) that it is an infectious disease.

As soon as the virus enters the oral mucosa (the most favorable conditions for it), it enters the lymphocytes. It is here that he multiplies. Throughout the body, the infection spreads through the hematogenous route, infecting it along the way and provoking the symptoms that characterize mononucleosis. Symptoms that occur in a patient indicate that they are infected.

Characteristic features

The incubation period of the disease ranges from 4 to 6 weeks. In most cases, acute infectious mononucleosis begins. Symptoms that characterize the disease, manifests itself almost immediately.

The main signs of the disease are:

  1. Headache.
  2. Enlarged spleen and liver.
  3. Inflammation of the lymph nodes.
  4. Mononuclear tonsillitis (on the tonsils appear dirty gray films, they are easily removed with tweezers).
  5. Enlarged lymph nodes (their palpation is quite painful, in size can reach the size of an egg).
  6. Pain in the joints and muscles.
  7. Weakness.
  8. Fever.
  9. Diseases of the skin can be observed with herpes.
  10. Loss of appetite.
  11. Bleeding gums.
  12. Sore throat.
  13. Runny nose
  14. Nausea.
  15. Nasal congestion.
  16. Increased susceptibility to infections.

At the same time, the main symptoms characterizing mononucleosis are severe fatigue, high fever, swelling of the lymph nodes and sore throat.

The illness begins with general malaise, the duration of which varies from a few days to a week. After that, there is an increase in temperature, there is pain in the throat, lymph nodes are enlarged. As noted above, these are the symptoms that characterize infectious mononucleosis. Maximum body temperature sometimes reaches 39 degrees. The throat is quite severely inflamed, pus may appear on the back wall.

Disease forms

This disease is divided into two types:

  1. Typical shape. Characterize such infectious mononucleosis in children the symptoms described above.
  2. Atypical form. In this form, some symptoms are absent. Sometimes manifestations that are not typical for an illness are observed:
  • Asymptomatic form can be diagnosed. In this case, the child is exclusively a carrier of the infection, which is detected only by laboratory methods.
  • When erased, all signs of infection are mild. They disappear very quickly.
  • The visceral form is characterized by lesion and enlargement of the internal organs.

Diagnosis of ailment

It is difficult enough to detect mononucleosis in children. Symptoms of illness are characteristic of most viral diseases. Mononucleosis can be suspected by preserving the main features over a long period. In this case, you should immediately consult a doctor.

On the initial examination, the doctor, on the basis of complaints, determines the symptoms of the disease. In the case of suspected mononucleosis, a blood test is the most important study. After all, a diagnosis can only be made after careful collection of laboratory and clinical data. Blood tests determine the increase in lymphocytes, as well as the presence of atypical mononuclears.

Such a study, with positive results, clarifies the presence of infection in the body, the transition of the disease to the chronic form. A negative result of the analysis confirms the absence of infection. To track the progress of infection, it is recommended to take a blood test every 3 days.

Drug treatment

Until today, there is not a single drug that allows you to fight the virus. Therefore, if mononucleosis is diagnosed, treatment in children and adults is based on combating symptoms.

Antibiotics are included in therapy if the disease has given complications, and there are also pronounced overlaps in the oropharynx. Do not forget that the doctor must prescribe the necessary medication. After all, some of them are absolutely not suitable for the treatment of this disease. For example, choosing an antibiotic, you should know that penicillin drugs, and especially the medicine "Ampicillin", are absolutely contraindicated in case of the disease infectious mononucleosis. In children, after the use of such antibiotics, in 70% of all cases severe allergic reactions are observed. As a rule, it is angioedema, rash.

Considered effective are drugs:

Recommended to use the drug "Wobenzym." It has anti-inflammatory and immunomodulatory effects on the children's body.

When purulent raids on the tonsils, it is advisable to introduce into the treatment means for treating the throat. Anti-inflammatory solutions and spray are effective. The appointment may include drugs:

If mononucleosis was provoked in children with symptoms of nasal congestion, it is recommended to regularly flush it with solutions based on seawater. One of the most effective are:

In addition, the nasal cavities need to bury for about eight days with special drops. In this case, Protargol is effective. The child will need and vasoconstrictor drugs. It is advisable to use drugs:

In case of severe illness, the glucocorticoid Dexamethasone and Prednisone can be prescribed by the doctor, as well as the probiotics Bifidumbacterin and Acipol.

Additional recommendations

It is mandatory to control the humidity of the air in the room of the patient. Such a simple recommendation will greatly facilitate the breathing of the child through the nose and avoid the drying out of the throat. If you use a humidifier, it is useful to add essential oil to it (preferably pine and eucalyptus).

Provide the child with abundant warm drink. This will protect him from the risk of dehydration.

It is very important to organize the baby proper nutrition. In no case should not overload the spleen and liver. The diet should include light meals enriched with vitamins. It is strictly forbidden fatty, sweet, salty, smoked, spicy.

The child constantly experiences fatigue if he is diagnosed with mononucleosis. Treatment involves not only drug therapy. In this state, sleep is good for the child. It will provide the body a quick recovery.

It is important to remember that with this diagnosis should protect the child from physical exertion. In no case should the abdominal area be damaged, since mononucleosis in adults and in children provokes a significant increase in the spleen. The body even starts to bulge from under the ribs. Any injury to this area can lead to rupture of the spleen.

How advises to treat mononucleosis Komarovsky? The famous doctor focuses on the following aspects:

  • drink plenty of water
  • fresh air,
  • maintaining optimum humidity and temperature in the room.

If necessary, it is recommended to take antipyretic. The doctor advises parents to suffer three or four days, and not “stuff” the baby with antibiotics and various unnecessary medicines.

Recovery period

Now you know what is meant by the diagnosis of "mononucleosis", what is this disease. However, treatment does not end solely with relief from symptoms. The disease is exhausting the body. High fever, painful, enlarged lymph nodes, a dangerous virus in the blood - all this takes away strength from the patient. That is why the children's body needs a long rehabilitation.

Thus, despite the fact that the child recovered from such a disease as mononucleosis, treatment in children must continue.

We give a number of recommendations for the recovery period.

  1. During the first month, a small patient does not feel too well, can often complain of weakness, indisposition. At this time, he especially needs rest and sleep.
  2. Do not forget that for six months the child is a carrier of the virus. Therefore, it is recommended to allocate a separate dish for the baby. This will keep other family members from getting infected.
  3. The doctor will recommend to pass the control tests of urine and blood. It is very important to conduct such surveys. They will show the state of the child's body.
  4. For recovery, the doctor will advise you to take a course of vitamin therapy. As a rule, a vitamin and mineral complex should be taken throughout the month. This could be: “Vitrum”, “Multi-tabs”, “Kinder Biovital”.
  5. Immunomodulatory drugs are required. They allow you to strengthen the body and avoid unwanted complications.

Effective immunomodulatory drugs needed by the child for the rehabilitation period are:

  1. Drops "Derinat". Provide regenerating and strengthening functions of the nasal mucosa.
  2. Candles "Viferon". This is an antiviral agent. It belongs to the category of interferon, has antiviral properties and restores immunity.
  3. The drug "Imudon". This is an excellent immunomodulator, a drug of local action. Designed for the prevention and treatment of diseases of the oropharynx.

Following these recommendations will allow you to significantly faster restore the body of the child after a disease such as mononucleosis. Treatment should not be limited to fighting symptoms, but should continue during the rehabilitation period.

The guys for the whole year are exempt from various preventive vaccinations. They need to limit physical exertion. In addition, children undergoing mononucleosis should be protected from exposure to the sun. In the coming summer, sunbathing should be extremely cautious. Active sun is strictly contraindicated for such children.

The big plus is that with proper treatment and compliance with rehabilitation measures, the disease is completely cured.

Diet food

Since infectious mononucleosis in children affects vital organs such as the liver and spleen, the child needs a sparing diet. Doctors prescribe dietary table number 5.

In this case, the dishes are cooked in boiled or boiled form. It is advisable to take food 5-6 times a day.

The child is recommended to include in the diet:

  1. Fruit and non-sour berry juices. Useful tomato juice. Allowed kissel, compote. The diet includes a weak tea, coffee with milk. It is recommended to use broth hips.
  2. Bread rye or wheat, just yesterday's pastries. Snacky biscuits.
  3. Whole milk, powdered, condensed. A little sour cream, low-fat cottage cheese, not sharp cheese.
  4. A variety of soups, exclusively on vegetable broth. Useful fruit and dairy.
  5. Vegetable, butter - allowed no more than 50 g per day.
  6. Lean (low-fat) meat varieties in boiled or baked form.
  7. Crumbly porridge. It is recommended to give preference to buckwheat and oatmeal.
  8. Low-fat types of fish - pike perch, carp, cod, navaga, pike, silver hake. Only in steam or boiled form.
  9. Useful vegetables, herbs, especially tomatoes. Non-sour sauerkraut is allowed.
  10. The diet can include no more than one egg per day (in the form of an omelet).
  11. Jam, honey. It is allowed to consume sugar.
  12. Useful variety of fruits, berries. In this case, unacceptable acidic products.

Dietary food implies the exclusion from the diet of the following categories of products:

  1. Fresh bread, baking. It is necessary to refuse cakes, pancakes, fried pies.
  2. Salo, cooking oils.
  3. Soups based on meat, fish, mushroom broths.
  4. Legumes, spinach, mushrooms, sorrel, green onions, radish, radishes.
  5. Fat meat - pork, lamb, beef, duck, goose, chicken.
  6. Hard boiled or fried eggs
  7. Fat fish - beluga, sturgeon sturgeon, sturgeon, catfish.
  8. Canned food, pickled vegetables, caviar, smoked meats.
  9. Sour berries and fruits, cranberries.
  10. Pepper, horseradish, mustard.
  11. Black coffee, cold drinks, cocoa.
  12. Cream products, ice cream, chocolate.
  13. Adults are advised to exclude alcoholic beverages.

Conclusion

Despite such unpleasant symptoms and the severe course of the disease, children who have suffered infectious mononucleosis, become owners of a strong immunity to it. Despite the fact that the virus remains permanently in the body, it will never again expose a person who has suffered a disease to new torments, since there is almost no recurrence of the disease.

Causes of Infectious Mononucleosis

Infectious mononucleosis is caused by Epstein-Barr virus (a DNA-containing virus of the genus Lymphocryptovirus). The virus belongs to the family of herpes viruses, but unlike them, it does not cause the death of the host cell (the virus multiplies mainly in B-lymphocytes), but stimulates its growth. In addition to infectious mononucleosis, Epstein-Barr virus causes Burkitt's lymphoma and nasopharyngeal carcinoma.

The reservoir and source of infection is a sick person or carrier of the infection. Virus isolation by sick people occurs from the last days of the incubation period, and lasts 6-18 months. The virus is excreted with saliva. In 15-25% of healthy people with a positive test for specific antibodies, the pathogen is found in the oropharyngeal washings.

The Epstein-Barr virus transmission mechanism is an aerosol, the predominant mode of transmission is airborne, it can be realized by contact (kisses, sex, dirty hands, dishes, household items). In addition, the virus can be transmitted through blood transfusion and intranatally from mother to child. People have a high natural susceptibility to infection, but when infected, light and erased clinical forms develop predominantly. Minor morbidity among children under one year speaks of innate passive immunity. Severe and generalization of infection contributes to immunodeficiency.

Pathogenesis of infectious mononucleosis

Epstein-Barr virus is inhaled by humans and infects the epithelium cells of the upper respiratory tract, oropharynx (contributing to the development of mild inflammation in the mucous membrane), from there the pathogen with lymph flow enters the regional lymph nodes, causing lymphadenitis.When it enters the blood, the virus invades B-lymphocytes, where it begins active replication. The defeat of B-lymphocytes leads to the formation of specific immune reactions, pathological deformation of cells. With the bloodstream, the pathogen spreads through the body. Due to the fact that the introduction of the virus occurs in immune cells and immune processes play a significant role in the pathogenesis, the disease is referred to as AIDS-associated. Epstein-Barr virus persists in the human body for life, periodically activating against the background of a general decrease in immunity.

Symptoms of Infectious Mononucleosis

The incubation period varies widely: from 5 days to one and a half months. Sometimes nonspecific prodromal events (weakness, malaise, catarrhal symptoms) may occur. In such cases, there is a gradual increase in symptoms, malaise increases, the temperature rises to subfebrile values, nasal congestion, and sore throat. On examination, revealed hyperemia of the mucosa of the oropharynx, the tonsils can be enlarged.

In the case of an acute onset of the disease, fever, chills, increased perspiration develop, intoxication symptoms (muscle aches, headache) are noted, patients complain of sore throat when swallowing. Fever may persist from several days to a month, the course (type of fever) may acquire a different one.

After a week, the disease usually goes into a phase of heat: all the main clinical symptoms (general intoxication, tonsillitis, lymphadenopathy, hepatosplenomegaly) manifest. The patient's condition usually worsens (symptoms of general intoxication are aggravated), a characteristic pattern of catarrhal, necrotizing, membranous or follicular tonsillitis in the throat: intense hyperemia of the mucous membrane of the tonsils, yellowish, friable deposits (sometimes diphtheria). Hyperemia and granularity of the posterior pharyngeal wall, follicular hyperplasia, mucosal hemorrhages are possible.

In the first days of the disease, polyadenopathy occurs. An enlarged lymph nodes can be detected in almost any group accessible to palpation, the occipital, posterior cervical and submandibular nodes are most often affected. To the touch lymph nodes are dense, mobile, painless (or pain is mild). Sometimes there may be mild swelling of the surrounding fiber.

In the midst of the disease, most patients develop hepatolienal syndrome - the liver and spleen are enlarged, jaundice of the sclera, skin, dyspepsia, and darkening of the urine may appear. In some cases, there are maculopapular rashes of various localization. The rash is short-term, not accompanied by subjective sensations (itching, burning) and does not leave behind any residual effects.

The height of the disease usually takes about 2-3 weeks, after which there is a gradual subsidence of clinical symptoms and a period of recovery occurs. Body temperature returns to normal, signs of angina disappear, and the liver and spleen return to their normal size. In some cases, signs of adenopathy and subfebrile condition may persist for several weeks.

Infectious mononucleosis may acquire a chronic relapsing course, with the result that the duration of the disease increases to one and a half years or more. The course of mononucleosis in adults is usually gradual, with a prodromal period and a lesser severity of clinical symptoms. Fever rarely lasts more than 2 weeks, lymphadenopathy and tonsil hyperplasia are mild, but symptoms associated with a functional disorder of the liver (jaundice, dyspepsia) are more common.

Complications of Infectious Mononucleosis

Complications of infectious mononucleosis are predominantly associated with the development of an adhering secondary infection (staphylococcal and streptococcal lesions). There can be a meningoencephalitis, obstruction of the upper respiratory tract hypertrophied tonsils. In children, severe hepatitis can occur, sometimes (rarely) interstitial bilateral infiltration of the lungs is formed. Also rare complications include thrombocytopenia, overstretching of the lienal capsule can cause spleen rupture.

Diagnosis of infectious mononucleosis

Nonspecific laboratory diagnostics includes a thorough study of the cellular composition of the blood. Complete blood count shows moderate leukocytosis with a predominance of lymphocytes and monocytes and relative neutropenia, a shift of the leukocyte formula to the left. In the blood appear large cells of various shapes with a wide basophilic cytoplasm - atypical mononuclear cells. For the diagnosis of mononucleosis significantly increase the content of these cells in the blood up to 10-12%, often their number exceeds 80% of all elements of white blood. In the study of blood in the first days of mononuclear cells may be missing, which, however, does not exclude the diagnosis. Sometimes the formation of these cells can take 2-3 weeks. The picture of blood usually gradually returns to normal in the period of convalescence, while atypical mononuclear cells are often preserved.

Specific virological diagnostics is not used due to laboriousness and inefficiency, although it is possible to isolate the virus in the oropharyngeal wash and identify its DNA using PCR. There are serological methods of diagnosis: antibodies to VCA antigens of Epstein-Barr virus are detected. Serum immunoglobulins of type M are often determined during the incubation period, and in the midst of the disease are noted in all patients and disappear not earlier than 2-3 days after recovery. Identification of these antibodies serves as a sufficient diagnostic criterion for infectious mononucleosis. After the infection is transferred, specific immunoglobulins G are present in the blood, which persist for life.

Patients with infectious mononucleosis (or persons suspected of having this infection) undergo a three-time (for the first time — in the period of acute infection, and with an interval of three months — two more times) a serological examination to detect HIV infection. mononuclear cells in the blood. For the differential diagnosis of angina in infectious mononucleosis from angina of a different etiology, consultation of an otolaryngologist and pharyngoscopy are necessary.

Treatment of infectious mononucleosis

Infectious mononucleosis of the mild and moderate course is treated on an outpatient basis, bed rest is recommended in case of severe intoxication, severe fever. When there are signs of abnormal liver function, Pevzner diet No. 5 is prescribed.

Etiotropic treatment is currently absent, the complex of the shown measures includes detoxification, desensitization, general strengthening therapy and symptomatic means depending on the available clinic. Severe hypertoxicity, the threat of asphyxia during compression of the larynx with hyperplastic tonsils is an indication for the short-term prescription of prednisolone.

Antibiotic therapy is prescribed for necrotizing processes in the throat in order to suppress the local bacterial flora and prevent secondary bacterial infections, as well as in the case of existing complications (secondary pneumonia, etc.). Penicillins, ampicillin and oxacillin, and tetracycline antibiotics are prescribed as drugs of choice. Sulfonamide drugs and chloramphenicol are contraindicated due to adverse suppressive effects on the hematopoietic system. Splenic rupture is an indication for emergency splenectomy.

Prognosis and prevention of infectious mononucleosis

Uncomplicated infectious mononucleosis has a favorable prognosis, dangerous complications that can significantly aggravate it, with this disease occur quite rarely. The residual effects in the blood are the reason for the follow-up at 6-12 months.

Preventive measures aimed at reducing the incidence of infectious mononucleosis are similar to those in acute respiratory infectious diseases, individual measures of nonspecific prophylaxis consist in enhancing immunity, both with the help of general health measures and with the use of mild immunoregulators and adaptogens in the absence of contraindications. Specific prophylaxis (vaccination) for mononucleosis has not been developed. Measures of emergency prophylaxis are applied in relation to children communicating with the patient, consist in prescribing a specific immunoglobulin. In the focus of the disease, a thorough wet cleaning is carried out, and personal items are disinfected.

Infectious mononucleosis - what is it?

the onset of the disease may be similar to a cold

First of all, this disease has several other names. If you hear terms such as “glandular fever,” “Filatov's disease,” or “monocytic sore throat,” then know that we are talking about mononucleosis.

If the name "mononucleosis" is deciphered, this term means an increase in the content of mononuclear or mononuclear cells in the blood. Such cells include special types of white blood cells, or white blood cells, which perform a protective function. These are monocytes and lymphocytes. Their content in the blood is not just increased with mononucleosis: they become altered, or atypical - it is easy to detect when studying a stained blood smear under a microscope.

Infectious mononucleosis is a viral disease. Since it is caused by a virus, and not by a bacterium, it must immediately be said that the use of any antibiotics is completely meaningless. But this is often done because the disease is often confused with a sore throat.

After all, the transmission mechanism of mononucleosis is aerosol, that is, airborne, and the disease itself affects lymphoid tissue: there is pharyngitis and tonsillitis (angina), hepatosplenomegaly appears, or an increase in the liver and spleen, and the blood lymphocyte and monocyte count which become atypical.

Who is guilty?

It causes infectious mononucleosis Epstein-Barr virus, which belongs to the herpes viruses. In total, there are almost a dozen families of herpes viruses and even more of their types, but lymphocytes are so sensitive to this type of virus, because on their membrane they have receptors for the envelope protein of this virus.

The virus is unstable in the environment, and quickly dies with any available methods of disinfection, including ultraviolet radiation.

A characteristic feature of this virus is a special effect on cells. If ordinary viruses of the same herpes and chickenpox exhibit a pronounced cytopathic effect (that is, leading to cell death), then EBV (Epstein-Barr virus) does not kill the cells, but causes their proliferation, that is, active growth. This fact lies in the development of the clinical picture of mononucleosis.

Epidemiology and ways of infection

Since only people are infected with infectious mononucleosis, a sick person can infect a healthy person, and not only a bright, but also an erased form of the disease, as well as an asymptomatic carrier of the virus. It is due to healthy carriers that the "virus cycle" is maintained in nature.

In most cases of the disease, the infection is transmitted by airborne droplets: when talking, crying, crying, sneezing and coughing. But there are other ways in which infected saliva and body fluids can enter the body:

  • kisses, sexual way,
  • through toys, especially those who have been in the child’s mouth - the virus carrier,
  • through blood transfusion, if donors are carriers of the virus.

Susceptibility to infectious mononucleosis is universal. This may seem incredible, but most healthy people are infected with this virus, and are carriers. In the underdeveloped countries, where there is a big overcrowding of the population, this occurs in babies, and in developed countries - in adolescence and youth.

Upon reaching 30 - 40 years of age, the majority of the population is infected. It is known that men suffer from infectious mononucleosis more often, and people over 40 suffer very rarely: infectious mononucleosis is a disease of a young age. True, there is one exception: if a patient is sick with HIV infection, then at any age he may not only have mononucleosis, but also repeat. How does this disease develop?

Pathogenesis

Infectious mononucleosis in adults and children begins with the fact that infected saliva enters the oropharynx, and there the virus replicates, that is, its primary reproduction occurs. It is the lymphocytes that are the object of an attack of the virus, and they quickly become infected. After that, they begin to transform into plasma cells, and synthesize various and unnecessary antibodies, for example, hemagglutinins, which can glue foreign blood cells.

A complex cascade of activation and suppression of various parts of the immune system is launched, and this leads to the fact that young and immature B lymphocytes accumulate in the blood, which are called “atypical mononuclear cells”. Despite the fact that they are their own cells, even if they are immature, the body begins to destroy them, because they contain viruses.

As a result, the body weakens, trying to destroy a large number of its own cells, and this contributes to the accession of a microbial and bacterial infection, since the body and its immunity are "occupied with another matter."

All this is manifested by a generalized process in the lymphoid tissue. The proliferation of immunity cells causes hypertrophy of all regional lymph nodes, the spleen and liver are enlarged, and in the case of severe disease, there may be necrosis in the lymphoid tissue and the appearance of various infiltrates in organs and tissues.

On the diagnosis of mononucleosis

Infectious mononucleosis is a disease with a characteristic clinical picture, and it is always possible to identify atypical mononuclear cells in peripheral blood. This is a pathognomonic symptom, just like fever, swollen lymph nodes, hepatosplenomegaly and tonsillitis combined.

Additional research methods are:

  • Reaction Hoff - Bauer (positive in 90% of patients). Based on the detection of hemagglutinating antibodies, with an increase in their titer 4 or more times,
  • ELISA methods. Allows you to identify marker antibodies that confirm the presence of virus antigens (against capsid and nuclear antigens),
  • PCR detection of virus in blood and saliva. It is often used in newborns, since it is difficult to focus on the immune response, since the immunity is not yet formed.

Effects of mononucleosis

After infectious mononucleosis remains stable immunity. Repeated cases of the disease is not observed. As the rarest of exceptions, mononucleosis can be fatal, but it can be caused by complications that have little to do with the development of the virus in the body: it may be obstruction and swelling of the respiratory tract, bleeding due to rupture of the liver or spleen, or encephalitis.

In conclusion, VEB is not at all as simple as it seems: while remaining persistent in the body for life, he often tries to “demonstrate his abilities” in cell proliferation in other ways. It causes Berkit's lymphoma, it is considered a possible cause of certain carcinomas, since its oncogenicity, or the ability to "incline" the body to cancer, has been proven.

Also, its role in the rapid course of HIV infection is not excluded. Of particular caution is the fact that the EBV genetic material is firmly integrated in the affected cells with the human genome.

Currently studying this phenomenon, and it is possible that the Epstein-Barr virus will give a clue to the creation of a vaccine against cancer and other malignant tumors.

Causative agent and transmission routes

The cause of mononucleosis - Epstein-Barr virus is a large DNA-containing virus, a member of the 4th type of herpesvirus family. It has tropism for human B-lymphocytes, that is, it is able to penetrate into them thanks to special receptors on the cell surface. The virus embeds its DNA into cellular genetic information, which distorts it and increases the risk of mutations with the subsequent development of malignant tumors of the lymphatic system. Its role has been proven in the development of Burkitt's lymphoma, hozhdinsky's lymphoma, nasopharyngeal carcinoma, liver carcinoma, salivary glands, thymus, respiratory and digestive organs.

The virus is a DNA strand, compactly packed in a protein shell - a capsid. Outside, the structure is surrounded by an outer shell formed from the cell membrane in which the viral particle was assembled. All of these structures are specific antigens, as in response to their introduction the body synthesizes immune antibodies. Detection of the latter is used to diagnose the infection, its stage and control of recovery. Total Epstein-Barr virus contains 4 significant antigen:

  • EBNA (Epstein-Barr nuclear antigen) - contained in the virus core, is a part of its genetic information,
  • EA (early antigen) - an early antigen, viral matrix proteins,
  • VCA (Viral capsid antigen) - virus capsid proteins,
  • LMP (latent membrane protein) - proteins of the viral membrane.

The source of the pathogen is a human patient with any form of infectious mononucleosis. The virus is slightly infectious, so long and close contact is required for transmission.In children, the airborne transmission path prevails, it is also possible to realize a contact path through abundantly salted toys and household items. In adolescents and older people, the virus is often transmitted during kisses with saliva, during sexual intercourse. The susceptibility to the pathogen is high, that is, the majority of those infected for the first time become infected with infectious mononucleosis. However, asymptomatic and erased forms of the disease account for more than 50%, so often a person does not know about the infection.

Epstein-Barr virus is unstable in the environment: it dies during drying, exposure to sunlight and any disinfectants. In humans, it is able to survive for life by incorporating into the DNA of B-lymphocytes. In this regard, there is another way of transmission - blood-contact, infection is possible with blood transfusions, organ transplants, injecting drug use. The virus causes the formation of a persistent life-long immunity, so repeated attacks of the disease are a reactivation of the dormant pathogen in the body, and not a new infection.

Mechanism of disease development

Epstein-Barr virus with saliva or its droplets on the mucous membrane of the oral cavity and is fixed on its cells - epithelial cells. From here viral particles penetrate the salivary glands, immune cells - lymphocytes, macrophages, neutrophils, and begin to actively proliferate. There is a gradual accumulation of the pathogen and infection of all new cells. When the mass of viral particles reaches a certain size, their presence in the body includes mechanisms of the immune response. A special type of immune cells - T-killers - destroy infected lymphocytes, and therefore a large number of biological active substances and virus particles are released into the blood. Their circulation in the blood leads to an increase in body temperature and toxic liver damage - at this moment the first signs of the disease appear.

A feature of the Epstein-Barr virus is its ability to accelerate the growth and reproduction of B-lymphocytes - their proliferation occurs with subsequent transformation into plasma cells. The latter actively synthesize and release immunoglobulin proteins into the blood, which, in turn, causes the activation of another set of immunity cells - T-suppressors. They produce substances designed to suppress the excessive proliferation of B-lymphocytes. The process of their maturation and the transition to mature forms are disrupted, in connection with which the number of mononuclear cells — mononuclear cells with a narrow rim of cytoplasm — increases sharply in the blood. In fact, they are immature B-lymphocytes and are the most reliable indication of infectious mononucleosis.

The pathological process leads to an increase in the size of the lymph nodes, since it is in them that the synthesis and further growth of lymphocytes occurs. A powerful inflammatory reaction develops in the tonsils, outwardly indistinguishable from sore throat. Depending on the depth of the lesion of the mucous membrane, its changes range from looseness to deep ulcers and plaque. Epstein-Barr virus inhibits the immune response due to certain proteins, the synthesis of which occurs under the influence of its DNA. On the other hand, infected mucosal epithelium cells actively release substances initiating an inflammatory response. In this regard, the number of antibodies to the virus and the specific antiviral substance, interferon, gradually increases.

Most of the viral particles are excreted from the body, but B-lymphocytes with the DNA of the virus, which they transmit to their daughter cells, persist for life in humans. The causative agent changes the number of immunoglobulins synthesized by the lymphocyte, therefore it can lead to complications in the form of autoimmune processes and atopic reactions. Chronic mononucleosis with a recurrent course is formed as a result of an insufficient immune response during the acute phase, due to which the virus escapes aggression and is kept in sufficient quantity for exacerbations of the disease.

Clinical picture

Mononucleosis occurs cyclically and in its development can be clearly identified certain stages. The incubation period lasts from the moment of infection to the first signs of the disease and takes an average of 20 to 50 weeks. At this time, the virus multiplies and accumulates in sufficient quantity for massive expansion. The first signs of the disease occur in the prodromal period. A person feels weakness, fatigue, irritability, muscle pain. Prodrome lasts for 1-2 weeks, after which comes the height of the disease. Usually, a person becomes ill acutely with a rise in body temperature of 38-39 degrees C, sore throat, and an increase in lymph nodes.

The lymph nodes of the neck, neck, elbow crease and intestines are most often affected. Their size varies from 1.5 to 5 cm, while palpating a person feels a slight soreness. The skin above the lymph nodes is not changed, they are not soldered to the underlying tissues, motile, elastic-elastic consistency. A pronounced increase in intestinal lymph nodes leads to abdominal pain, lower back and digestive disorders. Significantly, until the gap, the spleen increases, because it belongs to the organs of the immune system and it contains a large number of lymphatic follicles. This process is manifested by severe pain in the left hypochondrium, which increases with movement and physical exertion. The reverse development of lymph nodes occurs slowly, within 3-4 weeks after recovery. In some cases, polyadenopathy persists for a long time, from several months to lifelong changes.

Temperature in mononucleosis is one of the most common symptoms of mononucleosis. Fever lasts from several days to 4 weeks, may repeatedly change during the course of the disease. On average, it starts from 37-38 degrees C, gradually increasing to 39-40 degrees C. Despite the duration and severity of fever, the general condition of the patients suffers little. Basically, they remain active, there is only a decrease in appetite and fatigue. In some cases, patients experience such pronounced muscle weakness that they can not stand on their feet. This condition rarely lasts more than 3-4 days.

Another permanent symptom of mononucleosis is angina-like changes in the oropharynx. Palatine tonsils increase in size so much that they can completely block the lumen of the throat. On the surface of them often forms a bloom of white-gray in the form of islands or stripes. It appears on the 3-7 day of illness and is combined with sore throat and a sharp rise in temperature. The nasopharyngeal tonsil also increases, with the difficulty of nasal breathing and snoring during sleep. The back wall of the pharynx becomes grainy, its mucous is hyperemic, edematous. If the edema goes down into the larynx and affects the vocal cords, then the patient has a hoarseness.

Liver damage in mononucleosis may be asymptomatic and with severe jaundice. The liver grows in size, 2.5-3 cm out of the costal arch, dense, sensitive to palpation. Pain in the right hypochondrium is not associated with eating, aggravated by physical exertion, walking. The patient may notice a slight yellowing of the sclera, a change in skin tone to lemon yellow. The changes do not last long and pass without a trace in a few days.

Infectious mononucleosis in pregnant women - this is usually the Epstein-Barr virus reactivation associated with the physiological decline in immune defense. The incidence increases by the end of pregnancy and accounts for about 35% of the total number of expectant mothers. The disease manifests itself with fever, enlarged liver, sore throat and lymph node reaction. The virus can penetrate the placenta and infect the fetus, which occurs when it is high in the blood. Despite this, infection in the fetus develops rarely and is usually represented by pathology of the eyes, heart, nervous system.

A rash in mononucleosis appears on average at 5-10 days of illness and in 80% percent of cases is associated with the intake of the antibacterial drug ampicillin. It is spotty-papular in nature, the elements of its bright red color, located on the skin of the face, torso and limbs. The rash on the skin lasts about a week after which it fades and disappears without a trace.

Mononucleosis in children often asymptomatic or with an erased clinical picture in the form of ARVI. The disease is dangerous for babies with congenital immunodeficiency or atopic reactions. In the first case, the virus exacerbates the lack of immune protection and contributes to the accession of a bacterial infection. In the second, it enhances the manifestation of diathesis, initiates the formation of autoimmune antibodies, and may become a provoking factor for the development of tumors of the immune system.

Classification

Infectious mononucleosis according to the severity of the flow is divided into:

  1. Light - intoxication is absent or lasts no more than 5 days. The temperature does not exceed 38 degrees C, holds no more than 5 days. Angina is catarrhal in nature, possible single islands of plaque on the tonsils, lasts no more than 3 days. Only the cervical lymph nodes are enlarged, their size does not exceed 1.5 cm. The liver protrudes from under the costal arch no more than 1.5 cm. Recovery occurs within 2 weeks.
  2. Average - intoxication is expressed moderately, lasts up to one week. Body temperature reaches 38.5 degrees C, lasts up to 8 days. Palatine tonsils are enlarged, but do not overlap the pharynx completely. On their surface is a white-gray bloom in the form of stripes, a sore throat lasts no more than 6 days. The cervical lymph nodes are enlarged by a chain; the intra-abdominal lymph nodes are involved in the process. Their size does not exceed 2.5 cm. The liver protrudes from under the costal arch not more than 2.5 cm. Complications join, full recovery occurs in 3-4 weeks.
  3. Heavy - intoxication is strongly expressed, lasts more than 8 days. Body temperature reaches values ​​above 39.5 degrees C, persists for more than 9 days. Angina is necrotic in nature - ulcers and whitish films form on the surface of the tonsils. The tonsils are greatly enlarged and cover the entire lumen of the pharynx. The size of the lymph nodes is more than 2.5 cm, they are felt under the skin in bags - in groups of several pieces. The liver stands out from under the costal arch for more than 3 cm. Complications are sure to join, the disease lasts for at least 4 weeks.

By type of infectious mononucleosis is divided into:

  • Typical - characterized by cyclical course, anginous changes, an increase in lymph nodes, liver damage and characteristic changes in the blood picture.
  • Atypical - combines the asymptomatic course of the disease, its erased form, usually taken for ARVI and the most severe form - visceral. The latter proceeds with the involvement of many internal organs and leads to serious complications.

For the duration of the course of infectious mononucleosis can be:

  1. Sharp - manifestations of the disease last no more than 3 months,
  2. Lingering - changes persist from 3 to 6 months,
  3. Chronic - lasts more than six months. To the same form of the disease include recurrent fever, malaise, swollen lymph nodes within 6 months after recovery.

Relapse of infectious mononucleosis is the re-development of its symptoms a month after recovery.

Disease complications

Rarely developed, but can be extremely difficult:

  1. Autoimmune hemolytic anemia,
  2. Meningoencephalitis
  3. Guillain-Barre syndrome,
  4. Psychosis,
  5. The defeat of the peripheral nervous system - polyneuritis, paralysis of the cranial nerves, paresis of facial muscles,
  6. Myocarditis,
  7. Spleen rupture (usually found in a child).

Specific prophylaxis (vaccination) has not been developed, therefore, to prevent infection, they carry out bracing measures: hardening, walking in the fresh air and airing, varied and proper nutrition. It is important to treat an acute infection in time and in full, as this will reduce the risk of chronic process and the development of severe complications.

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