Atypical mononucleosis in adults. Features of treatment and prevention of chronic mononucleosis. How to avoid getting infected from a sick child to adults and other children

2 years ago

Most people know only influenza, sore throat and pharyngitis among viral infectious diseases, while there are many more of them - even those that everyone can encounter. For example, infectious mononucleosis, which affects the lymphatic system and affects mainly adolescents and people aged 18-25 years. Why does this disease occur, why is it dangerous, how to treat it?

This is acute viral disease V official medicine may also be referred to as Filatov's disease or monocytic tonsillitis, since it has a lot in common with the latter. Infectious mononucleosis is characterized by damage to the pharynx and lymphatic system, but can also affect the spleen, liver, will definitely affect chemical composition blood. It was discovered in the 19th century, however, at that time it was called “idiopathic inflammation of the lymph glands.” Modern name infectious mononucleosis was acquired only after hematological studies.

The causative agent of the disease is one of the forms Epstein-Barr virus, which is a human herpes virus type 4 and is capable of replication. A unique feature of this virus is the stimulation of proliferation (reproduction) of the cells with which it connects.

The infection is transmitted by airborne droplets from person to person, the source of infection can be either a virus carrier who is unaware of his status or a person with erased symptoms. Infectious mononucleosis in adults is predominantly transmitted through saliva, which is why it is called the “kissing disease,” or during the use of shared hygiene items and utensils. The most frequent outbreaks of mononucleosis are recorded in dormitories, camps and other places with high concentrations of people.

Duration incubation period For of this disease ranges from 7 days to 21 days, but the disease itself, even with therapeutic measures, goes away no earlier than after 1.5-2 months. Symptoms depend on which organs were affected and what state the body was in initially. In this case, all the signs of the disease can manifest themselves either comprehensively or selectively in different time replace each other. Mostly with infectious mononucleosis in adults there are complaints of:

dizziness;
migraine;
weakness, lethargy;
increased temperature (up to feverish conditions);
sore throat, worsening when swallowing (mononucleosis is similar to sore throat);
myalgia, arthralgia;
tracheitis;
bronchitis;
enlarged lymph nodes due to the inflammatory process, pain when palpated;
a gradual increase in the number of enlarged lymph nodes if the disease is chronic;
an increase in the size of the spleen or liver;
frequent colds, flu (susceptibility of the body respiratory diseases due to decreased immunity).

Additionally, since the Epstein-Barr virus is a subtype of the herpes virus, a person infected with mononucleosis may often experience cold sores on the lips. At the same time, the symptoms often do not manifest themselves fully, so it is difficult to establish mononucleosis directly without laboratory tests. During diagnosis, the doctor must differentiate this disease from diphtheria, viral hepatitis, leukemia, tonsillitis, as well as HIV infection and lymphogranulomatosis.

What consequences should we expect?

If you do not attend to treatment on time, or draw up a therapeutic regimen without the help of a doctor, the disease will develop into chronic form, which will accompany a person for several months and even years. Against this background, the patient constantly experiences enlarged lymph nodes, the number of which is constantly increasing, gradually forming large protruding chains. If we talk about the more complex consequences of mononucleosis in adults, then these are:

sinusitis;
otitis;
pneumonia;
paratonsillitis.

In rare cases, severe damage to the spleen or liver is observed, due to which the spleen ruptures or develops liver failure. Also not excluded hemolytic anemia due to changes in blood composition, follicular tonsillitis, neuritis, paralysis facial nerve. Complications should only be dealt with by a doctor, since antibiotic therapy cannot be avoided.

Despite the fact that this disease is no longer young, specific therapy Medicine has not yet developed a solution to it. Effects on the body of medications and folk remedies It is predominantly symptomatic in nature (therefore depends on the specific affected area), as well as restorative. A significant role is played by raising the body’s defenses responsible for fighting infection, and:

maximum liver sparing (applies to the choice of medications);
exception physical activity for a month or longer (to prevent splenic rupture).

For this reason, doctors do not advise taking aspirin or paracetamol (stress on the liver) or using antibiotics against the background of a high temperature. Symptomatic treatment for mild manifestations of the disease can even be carried out using traditional medicine:

Prepare a decoction from crushed cabbage leaves and drink half a glass before meals.
Make a collection of rose hips, currant and raspberry leaves (1 tbsp per 300 ml of boiling water), drink 1/4 cup 3-4 times a day.
Brew Echinacea flowers or roots to make tea (2 tsp of raw material per 500 ml of boiling water) and drink 3 glasses daily.

Two centuries ago, this disease was called “glandular fever,” but after it was discovered that it leads to mutation of monocytes, it was decided to rename the disease “infectious mononucleosis.”

In the middle of the 20th century (more precisely, in 1964), English professor Epstein and his assistant Yvonne Barr described a virus they discovered that multiplied well in the blood of sick people. It was named Epstein-Barr virus in their honor. It belongs to the fourth type of herpes virus.

General characteristics and methods of infection

Infectious mononucleosis– acute infectious pathology, in which two systems are affected:

reticuloendothelial;
lymphatic.

The source of infection is both the patient himself, who is the virus transmitter, and the infected person, who has not yet shown symptoms - the virus carrier.

In adults, the disease is transmitted mainly in several ways:

airborne - through saliva, mainly during a kiss;
contact - with a handshake;
through general subjects household or hygiene;
during sexual intercourse;
parenteral - with blood transfusion;
due to bone marrow transplantation;
during childbirth.

Saliva contains so many viruses that even after 6 months after recovery, a person can be a source of infection. In general, susceptibility to the pathogen is very high. In many cases, the disease can occur in a latent form.

Symptoms of the disease

After the pathogen enters the body, incubation period, which can last from 5 to 45 days. After this, in some cases, the so-called prodromal period, in which both general and specific symptoms, accompanied by changes in test results.

In this case, the following symptoms appear:

weakness;
nausea;
malaise;
slight increase in temperature;
some catarrhal phenomena - in particular, nasal congestion, nasal voice, enlargement and redness of the tonsils, swelling and hyperemia of the oropharyngeal mucosa.

The onset of the disease itself is acute. In this case, the following clinical picture is observed:

chills;
the temperature rises sharply to significant levels;
appears strong headache;
patients complain of sore throat, which intensifies during swallowing;
sweating increases;
aching appears in the joint area.

As the disease progresses, the temperature fluctuates. The fever may last just a few days or last for a month or more.

A week after the first signs appear, climax period diseases.

In this case, all the main symptoms appear:

signs of general intoxication;
lymphadenopathy;
signs of tonsillitis
hepatolienal syndrome, i.e. simultaneous enlargement of the liver and spleen;
the temperature remains high;
headache and joint pain, as well as aching joints intensify;
progression pathological process in the throat leads to the manifestation of a more intense pain syndrome and the appearance of catarrhal, follicular, membranous or ulcerative necrotizing tonsillitis.

The examination reveals:

Slight hyperemia of the mucous membranes.
Swelling of soft tissues and face due to delayed lymph flow.
The presence of an easily removable yellowish coating of loose consistency on the tonsils (sometimes the coating is similar to diphtheria).
Significant hyperemia back wall pharynx, while it becomes granular, loosened, the follicles are hyperplastic.
On the mucous membrane soft palate there may be hemorrhagic elements.
Enlarged lymph nodes with a characteristic symmetrical lesion are easily detected by palpation. Most often, the submandibular, occipital, and posterior cervical nodes on both sides are affected. At the same time, they become dense, mobile, and can reach sizes walnut, in many cases there is no pain or it is insignificant. Swelling of the subcutaneous tissue may be observed.
Enlargement of the spleen and liver - the result is icteric syndrome. Its manifestations are: nausea, sometimes accompanied by vomiting, decreased appetite, dark urine, pain and heaviness in the right hypochondrium, abdomen, yellowness (icterus) of the skin, sclera, diarrhea and constipation.
Blood serum analysis reveals an increase in bilirubin content and aminotransferase activity, as well as the presence of mononuclear cells - atypical cells.
A maculopapular rash may appear without a specific localization, in which there is no itching.

Duration peak period- from 14 days to 3 weeks.

Then comes convalescence, or recovery. Gradually, health returns to normal, the temperature becomes normal, the signs of sore throat and hepatolienal syndrome disappear. After this, the lymph nodes become normal size. The last sign to pass is low-grade fever. In some cases it may long time lymphadenopathy also persists.

The disease can last a very long time - up to 1.5 years, with acute periods followed by periods of remission.

Treatment of mononucleosis

There is no specific therapy for infectious mononucleosis. The main goals of treatment are:

elimination of symptoms;
prevention of complications - in particular, the addition of a bacterial infection.

Patients must comply bed rest.
It is necessary to rinse the oropharynx daily medicinal solutions with antiseptic effect: iodinol, furatsilin, chamomile decoction, sage infusion, etc.
Apply antihistamines: peritol, tavegil, claritin.
To reduce the temperature, patients are prescribed antipyretics: ibuprofen, ibuclin, etc.
If it was not possible to prevent an infectious disease bacterial etiology, appoint antibacterial drugs: erythromycin, amoxicycline, etc.
Severe disease (for example, if problems arise with the respiratory system) requires radical measures: the use of glucocorticosteroids is recommended: prednisolone, dexamethasone.
To strengthen the body's defenses, immunomodulators are used: immunal, echinacea, and Icelandic cetraria.
Patients are prescribed vitamin and mineral complexes to strengthen and restore the body.
At residual changes in the composition of peripheral blood, enlarged spleen and liver, dispensary observation is prescribed.

Diet for mononucleosis

Since this disease in most cases affects the liver, patients are recommended to eat a special diet. Its duration is determined by the attending physician individually.

The main requirement for it is balance: products must contain everything essential fats, proteins, carbohydrates, vitamins, microelements.

The menu should be selected with high calorie content. You should eat often, but in small portions.

The diet should include:

dairy products;
lean meats;
fish;
vegetable purees and soups;
a large amount of fresh fruits and vegetables;
pasta;
cereal porridge;
bread is better than wheat.

It is better to avoid some products or use them in small quantities:

butter and vegetable oil;
sour cream, fatty cheese;
sausages, semi-finished products;
pickled, smoked, salted, canned foods;
seasonings and spices;
eggs - especially the yolk;
sweets with cream;
beans, peas, other legumes;
coffee.

Traditional methods of treatment

You can speed up recovery by additionally using traditional medicine recipes.

1. The following can be used medicinal herbs: flowers of chamomile, calendula, immortelle, yarrow, string, elecampane root, edelweiss grass, cornflower flowers, coltsfoot leaves, chicory root, burdock.

All of them are suitable for cooking medicinal decoction. Plants can be mixed or used separately.

Take a tablespoon of the product, crushed or minced, pour in 500 ml of boiling water, and infuse (preferably in a thermos). Take 100 ml before meals.

2. To relieve signs of intoxication, use linden or regular black tea and lingonberry juice. You can add lemon to drinks.

3. Elderberry infusion. Pour 200 ml of boiling water over a tablespoon of flowers and leave for 25-30 minutes. Take 2 spoons up to 6-7 times during the day.

It is extremely rare. Statistics show that most people suffered from the disease in childhood or adolescence.

90% of the population at 35 years old has antibodies to the causative agent of infectious mononucleosis in their blood.

However, there are still cases of the disease occurring in adults, and the course of the disease in them is much more severe than in children, the symptoms are much more pronounced.

For infectious mononucleosis to begin its development, a pathogen is needed. In this case it is .

After entering the body through the respiratory tract, this virus infects the epithelium of the mucous membrane oral cavity and throat.

Upon contact with infected mucosa, B lymphocytes are also infected.

The virus settles in them and begins to multiply. As a result, [atypical mononuclear cells] are formed, which through the bloodstream reach the palatine and nasopharyngeal tonsils, lymph nodes, liver, and spleen.

All of these organs consist of lymphoid (immune) tissue. By settling on them, the virus also begins to multiply and provokes their increase.

The sick person develops a fever and sharp pain in the throat. You can become infected with the Epstein-Barr virus only from an infected person in whose saliva it is detected.

Even an apparently healthy person can become a source of infection if the Epstein-Barr virus is present in his saliva. Such a person is called a virus carrier.

In adults, there are several ways to “catch” the Epstein-Barr virus.

Airborne. Since the virus is in saliva, it can be transmitted through sneezing and coughing. However, outside human body The virus dies almost immediately. Therefore, to achieve a new “victim”, closer contact is necessary.
Contact and household. When kissing, using the same dishes and other household items, the pathogen successfully migrates and settles in another organism.
Sexual. The virus is present not only in saliva, but also in semen. Therefore, it can be easily obtained through sexual contact.
Blood transfusion. The pathogen is also found in the blood, so a procedure such as a blood transfusion hides the risk of contracting the virus.

However, it is not always the case that infectious mononucleosis begins to develop as soon as the pathogen enters the body. Only 10% of the population may develop pronounced symptoms of the disease after infection.

This means that either the virus is in a “dormant” state, or infectious mononucleosis was transferred to mild form and was diagnosed as ARVI.

Periods of development and manifestation of the disease

Infectious mononucleosis has several periods of its development, and each of them has its own characteristic symptoms, signs and duration.

Incubation period. This period is considered to be the time from the moment the Epstein-Barr virus enters the body until the moment when the first symptoms of infectious mononucleosis appear.

Incubation can last 5-45 days, the most common duration is 10-21 days.

During this period, the infected adult's condition may remain normal, but some symptoms of weakness, mild fever and runny nose may appear.

Beginning of the disease. The onset of infected mononucleosis in adults can be acute or gradual. The acute onset has symptoms such as high fever (39 C), headache, muscle and joint pain.

Symptoms of the gradual onset of infectious mononucleosis in adults are as follows: lethargy, slight fever, swelling of the eyelids and face.

Symptoms of the onset of the disease continue 4-5 days. And then comes the culmination of infectious mononucleosis in adults.

The peak period is the name of the most difficult stage diseases when symptoms appear one after another:

A sore throat. In 80% of cases, the tonsils are covered with a white-yellow coating;
High temperature, sometimes reaching 400C;
The lymph nodes are enlarged, especially the posterior cervical ones;
Skin rash. Appears on 5-10 days. Special treatment not required
Enlargement of the spleen is recorded on days 8-9;
Liver enlargement is observed on days 9-11. On the background inflammatory processes When baked, signs such as yellowing of the skin and darkening of the color of urine may appear.

Symptoms and signs of the high period last 2-4 weeks. After which the body begins to gradually recover.

The recovery period is long: 3-4 weeks, and is accompanied by symptoms such as drowsiness and fatigue.

What therapy is prescribed for adults?

Treatment of the disease in adults is aimed at relieving symptoms and preventing secondary infections.

It is worth noting that only a qualified doctor should prescribe treatment. So, adults can be treated with the following means:

Immunostimulating and antiviral drugs: “Viferon”, “Anaferon”, “Arbidol”, “Imudon”, etc.
Antipyretic "Ibuprofen";
Antihistamines “Zodak”, “Suprastin”, “Diazolin”, etc. With their help, allergic and inflammatory processes can be treated;
Antiseptics. They are used to treat the throat: “Miramistin”, “Chlorophyllipt”, “Furacilin”;
Treatment of swelling of the tonsils with Prednisone and Dexamethasone is prescribed in case of danger of suffocation;
Vasoconstrictor drugs for the nose - “Naphthyzin”, “Sanorin”, etc.
To support the liver, the doctor may prescribe Essentiale Forte, Antral.
Treatment also includes vitamin therapy. Vitamins B, C and P are prescribed.
Treatment of angina can be with the help of antibiotics "Sumamed", "Cephalosporin". Along with antibiotics, probiotics “Linex” and “Hilak Forte” are also prescribed.

However, treatment of infectious mononucleosis is carried out not only with medications; the body should be helped.

This requires diet and good rest. The diet is as follows:

You should eat a lot of healthy foods. A diet for mononucleosis includes whole grains, cereals, fish, eggs, and fruits.
The diet for this disease in adults completely excludes “fast” food (fast foods), carbonated drinks, coffee, and alcohol.
Eating food should be in small and frequent portions so as not to overload an already weakened body at one time. For mononucleosis in adults, the diet requires 6 meals a day.

If such complete treatment was carried out and the diet was followed, then it is unlikely that any consequences of infectious mononucleosis in adults will appear.

However, in some cases, consequences still occur, for example, chronic mononucleosis. It can only develop in adults who have a severely weakened immune system (for example, HIV-infected people).

Chronic mononucleosis during remission in different people symptoms may manifest differently: some have a slightly enlarged spleen, others have slightly enlarged lymph nodes, etc.
But, mostly, patients suffer from headaches and muscle pain, weakness, drowsiness, the so-called “constant fatigue syndrome” develops.

In very rare cases, complications and consequences such as liver failure, splenic rupture, hemolytic anemia, and myocarditis occur.

We hope that the material presented was interesting and informative for you.

Infectious mononucleosis - what is it?

This article is about what kind of disease this is, how it progresses and is treated. Mononucleosis is an acute viral disorder (ICD 10 code: B27), which is accompanied by an enlargement of the spleen and liver, disruption of the reticuloendothelial system , change and .

What kind of disease is mononucleosis, as Wikipedia points out, was first told to the world in 1885 by the Russian scientist N.F. Filatov and originally named her idiopathic lymphadenitis . It is currently known what causes it herpes virus type 4 ( ), affecting lymphoid tissue.

How is mononucleosis transmitted?

Most relatives and the sick themselves often have questions: “ How contagious is mononucleosis, is it contagious at all, and how can you get infected?» The infection is transmitted by airborne droplets, initially attaches to the epithelium of the oropharynx, and then enters the regional lymph nodes after transit through the bloodstream. The virus remains in the body throughout life, and when natural defenses are reduced, the disease can recur.

What is infectious mononucleosis and how it is treated in adults and children can be found out in more detail after reading this article in full.

Is it possible to get mononucleosis again?

One of the frequently asked questions " Can mononucleosis infection recur?» It is impossible to become infected with mononucleosis again, since after the first encounter with the infection (it does not matter whether the disease has occurred or not), the person becomes its carrier for life.

Causes of infectious mononucleosis in children

Children under 10 years of age are most susceptible to this disease. Epstein-Barr virus circulates most often in a closed group ( kindergarten, school), where infection occurs by airborne droplets. When released into an open environment, the virus quickly dies, so infection occurs only with sufficiently close contact. The causative agent of mononucleosis is detected in the saliva of a sick person, so it can also be transmitted by coughing, kissing, or using shared utensils.

It is worth mentioning that this infection is registered 2 times more often in boys than in girls. Some patients with viral mononucleosis are asymptomatic, but are carriers of the virus and are potentially dangerous to the health of others. They can only be identified by conducting a special test for mononucleosis.

Viral particles enter the bloodstream through the respiratory tract. The incubation period has an average duration of 5-15 days. In some cases, as reported by the Internet forum and some patients, it can last up to one and a half months (the reasons for this phenomenon are unknown). Mononucleosis is a fairly common disease: before the age of 5, more than half of children become infected Epstein-Barr virus , however, in the majority it occurs without serious symptoms or manifestation of the disease. Infection among the adult population varies in different populations within the range of 85-90%, and only in some patients this virus manifests itself with symptoms on the basis of which a diagnosis of infectious mononucleosis is made. The following may occur special forms diseases:

atypical mononucleosis – its signs in children and adults are associated with a stronger severity of symptoms than usual (for example, the temperature can rise to 39.5 degrees or the disease can occur without fever at all); should be a mandatory component of treatment for this form due to the fact that atypical mononucleosis has a tendency to cause severe complications and consequences in children;
chronic mononucleosis , described in the section of the same name, is considered as the consequences of deteriorating performance immune system sick.

Parents often have questions about how long the temperature lasts during the infection described. Duration this symptom can vary significantly depending on individual characteristics: from several days to one and a half months. In this case, the question of whether to take it for hyperthermia or not should be decided by the attending physician.

Also a fairly common question: “ Should I take Acyclovir or not?"is included in many officially approved treatment regimens, but recent studies prove that such treatment does not affect the course of the disease and does not in any way improve the condition of the patient.

Treatment and symptoms in children (how to treat mononucleosis and how to treat it in children) are also described in detail in the program by E.O. Komarovsky " Infectious mononucleosis" Video from Komarovsky:

Mononucleosis in adults

This disease rarely develops in people over 35 years of age. But atypical signs of the disease and chronic mononucleosis , having potentially dangerous consequences, on the contrary, are found in percentage terms more often.

Treatment and symptoms in adults are not fundamentally different from those in children. More details about what to treat and how to treat it in adults are described below.

Infectious mononucleosis, symptoms

Symptoms of mononucleosis in children

To date, methods for specific prevention against infection with the described virus have not been developed, so if the child was unable to avoid contact with the infected person, parents need to carefully monitor the child’s condition over the next 3 months. If no signs of the disease appear within the specified period, it can be argued that either the infection did not occur, or the immune system suppressed the virus and the infection was asymptomatic. If signs of general intoxication (elevated temperature, chills, weakness, enlarged lymph nodes, then you should immediately contact a pediatrician or infectious disease specialist (on the question of which doctor treats mononucleosis).

Symptoms Epstein-Barr virus in children on initial stage diseases include general malaise, catarrhal symptoms and weakness. Then there is a low-grade fever, redness and swelling of the mucous membranes of the oropharynx, and enlarged tonsils. In some cases, a fulminant form of infection occurs, when symptoms appear suddenly and their severity quickly intensifies (drowsiness, fever up to 39 degrees for several days, chills, increased sweating, weakness, muscle and throat pain, headache). Next comes the period of main clinical manifestations infectious mononucleosis , in which it is observed:

an increase in the size of the liver and spleen;
rash on the body;
graininess and hyperemia of the peripharyngeal ring ;
general ;
enlarged lymph nodes.

A rash with mononucleosis usually appears in the initial period of the disease, simultaneously with lymphadenopathy and, and is located on the arms, face, legs, back and stomach in the form of small reddish spots. This phenomenon It is not accompanied by itching and does not require treatment; it goes away on its own as the patient recovers. If a patient taking antibiotics , the rash began to itch, this may indicate the development, as with mononucleosis skin rash It doesn't itch.

The most important symptom the infection described is considered polyadenitis , arising due to hyperplasia of the lymph node tissue. Often islands of light plaque appear on the tonsils, which are easily removed. Peripheral lymph nodes are also enlarged, especially the cervical ones. When you turn your head to the side, they become quite noticeable. Palpation of the lymph nodes is sensitive but not painful. Less frequently, the abdominal lymph nodes enlarge and, squeezing the regional nerves, they provoke the development symptom complex " acute stomach» . This phenomenon can lead to an incorrect diagnosis and diagnostic laparotomy .

Symptoms of mononucleosis in adults

Viral mononucleosis practically does not occur in people over 25-30 years of age, since this subpopulation, as a rule, already has a developed immunity to the causative agent of the disease. Symptoms Epstein-Barr virus in adults, if the disease does develop, they are no different from those in children.

Hepatosplenomegaly in children and adults

As mentioned above, the described disease is characterized by hepatosplenomegaly . The liver and spleen are extremely sensitive to the virus; as a result, enlargement of the liver and spleen in children and adults is observed already in the first days of the disease. In general the reasons hepatosplenomegaly in children and adults include a variety of viral, oncological diseases, as well as blood diseases and, therefore, in this situation a comprehensive examination is necessary.

Symptoms of a diseased spleen in humans:

an increase in the size of the organ, which can be detected by palpation and ultrasound;
soreness, feeling of heaviness and discomfort in the left abdomen.

Disease of the spleen provokes its enlargement so much that the parenchyma of the organ is able to rupture its own capsule. During the first 15-30 days, there is a continuous increase in the size of the liver and spleen, and when the body temperature returns to normal, their size returns to normal.

Symptoms of splenic rupture in adults and children, based on analysis of patient records:

darkening of the eyes;
nausea and vomiting;
flashes of light;
weakness;
dizziness;
increasing diffuse abdominal pain.

How to treat the spleen?

If the spleen is enlarged, restriction of physical activity and bed rest are indicated. If an organ rupture is nevertheless diagnosed, then its urgent removal is necessary.

Chronic mononucleosis

Prolonged persistence of the virus in the body is rarely asymptomatic. Considering that with a latent viral infection, a wide variety of diseases can appear, it is necessary to clearly identify the criteria that make it possible to diagnose chronic viral mononucleosis .

Symptoms of the chronic form:

a severe form of primary infectious mononucleosis suffered within six months or associated with high titers to Epstein-Barr virus ;
an increase in the content of virus particles in affected tissues, confirmed by anti-complementary immunofluorescence method with pathogen antigen;
damage to some organs confirmed by histological studies ( splenomegaly , interstitial , uveitis , bone marrow hypoplasia, persistent hepatitis, ).

Diagnosis of the disease

To confirm mononucleosis, the following studies are usually prescribed:

blood test for the presence antibodies To Epstein-Barr virus ;
and general blood tests;
Ultrasound internal organs, primarily the liver and spleen.

The main symptoms of the disease on the basis of which the diagnosis is made are enlarged lymph nodes, hepatosplenomegaly , fever . Hematological changes are a secondary sign of the disease. The blood picture is characterized by an increase, the appearance atypical mononuclear cells And wirocoplasma lymphocytes . However, it should be borne in mind that these cells can appear in the blood only 3 weeks after infection.

When carrying out differential diagnosis, it is necessary to exclude spicy , diphtheria of the throat and, which may have similar symptoms.

Broad plasma lymphocytes and atypical mononuclear cells

Mononuclear cells And broad plasma lymphocytes – what is it and is it the same thing?

These concepts are often equated, but from the point of view of cell morphology there are significant differences between them.

Broad plasma lymphocytes - these are cells with large cytoplasm and a dense nucleus that appear in the blood during viral infections.

Mononuclear cells in a general blood test they appear predominantly in viral mononucleosis. Atypical mononuclear cells in the blood they are large cells with a separated border of cytoplasm and a large nucleus containing small nucleoli.

Thus, a specific sign for the described disease is only the appearance atypical mononuclear cells , A broad plasma lymphocytes it may not be with him. It is also worth remembering that mononuclear cells may be a symptom of other viral diseases.

Additional laboratory diagnostics

For the most accurate diagnosis in difficult cases, more accurate analysis for mononucleosis: study the titer value antibodies To Epstein-Barr virus or order a test PCR (polymerase chain reaction ). Interpretation of a blood test for mononucleosis and a general analysis (in children or adults it has similar evaluation parameters) of blood with the indicated relative amount atypical mononuclear cells allows you to confirm or refute the diagnosis with a high degree of probability.

Also, patients with mononucleosis are prescribed a series of serological tests for detection (blood for HIV ), since it can provoke an increase in concentration mononuclear cells in blood. If symptoms are detected, it is recommended to visit an ENT doctor and have pharyngoscopy to determine the etiology of the disorder.

How can adults and other children not get infected from a sick child?

If there is a family member infected with viral mononucleosis, it will be difficult not to infect other family members due to the fact that after full recovery the patient continues to periodically shed the virus in environment and remains its carrier for the rest of his life. Therefore, there is no need to quarantine the patient: if other family members do not become infected during the period of the relative’s illness, it is highly likely that infection will occur later.

Infectious mononucleosis, treatment

How to treat and how to treat Epstein-Barr virus in adults and children?

Treatment of infectious mononucleosis in children, as well as symptoms and treatment Epstein-Barr virus in adults there are no fundamental differences. The approaches and drugs used for therapy are in most cases identical.

There is no specific treatment for the described disease, nor is there any general scheme treatment or antiviral drug, which could effectively fight the virus. As a rule, the disease is treated on an outpatient basis, in severe clinical cases The patient is admitted to the hospital and prescribed bed rest.

Indications for hospitalization include:

development of complications;
temperature above 39.5 degrees;
threat ;
signs intoxication .

Treatment of mononucleosis is carried out in the following areas:

appointment antipyretic drugs (or are used for children);
usage local antiseptic medications for treatment mononucleosis sore throat ;
local nonspecific immunotherapy drugs and;
appointment desensitizing agents;
vitamin therapy ;
if liver damage is detected, it is recommended choleretic drugs And hepatoprotectors , is appointed special diet(therapeutic diet table No. 5 );
appointment possible immunomodulators (
in case of severe swelling of the larynx and the development of breathing difficulties, it is recommended to perform tracheostomy and transfer of the patient to artificial ventilation ;
if a splenic rupture is diagnosed, splenectomy urgently (the consequences of a splenic rupture without qualified assistance can be fatal).

The doctors

Medicines

Diet, nutrition for mononucleosis

Prognosis and consequences of mononucleosis

Patients who have recovered from viral mononucleosis are usually given a favorable prognosis.

It is worth noting that the main condition for the absence of complications and adverse consequences is timely detection leukemia and constant monitoring of changes in blood counts. It is also extremely important to monitor the well-being of patients until they fully recover. During scientific research revealed:

body temperature above 37.5 degrees persists for approximately several weeks;
symptoms sore throat and sore throat persists for 1-2 weeks;
state lymph nodes normalizes within 4 weeks from the moment of manifestation of the disease;
Complaints of drowsiness, fatigue, weakness can be detected for another 6 months.

Adults and children who have recovered from the disease need regular medical examinations for six months to a year, with mandatory regular blood tests.

Complications are generally rare. The most common consequences are hepatitis , yellowing of the skin and darkening of the urine, and most serious consequence mononucleosis is a rupture of the membrane of the spleen caused by thrombocytopenia and overstretching of the organ capsule and requiring emergency surgical intervention. Other complications are associated with the development of secondary streptococcal or staphylococcal infection, development meningoencephalitis , asphyxia , severe forms hepatitis A And interstitial bilateral infiltration of the lungs .

Effective and specific prevention of the described disorder has not currently been developed.

Risks during pregnancy

The disease poses a serious danger during pregnancy. Epstein-Barr virus can increase the risk of premature interruption, provoke fetal malnutrition , and also call hepatopathy , respiratory distress syndrome, recurrent chronic sepsis , changes in the nervous system and visual organs.

When infected with a virus during pregnancy, the likelihood of infection of the fetus is very high, which may subsequently be the root cause lymphadenopathy , long low-grade fever , chronic fatigue syndrome And hepatosplenomegaly The child has.

List of sources

Uchaikin V.F., Kharlamova F.S., Shashmeva O.V., Polesko I.V. Infectious diseases: atlas-guide. M.: GEOTAR-Media, 2010;
Pomogaeva A.P., Urazova O.I., Novitsky V.V. Infectious mononucleosis in children. Clinical and laboratory characteristics of various etiological variants of the disease. Tomsk, 2005;
Vasiliev V.S., Komar V.I., Tsyrkunov V.M. Infectious disease practice. - Minsk, 1994;
Kazantsev, A. P. Guide to infectious diseases/ A. P. Kazantsev. -SPb. : Comet, 1996;
Khmilevskaya S.A., Zaitseva E.V., Mikhailova E.V. Infectious mononucleosis in children. Tutorial for pediatricians and infectious disease specialists. Saratov: SMU, 2009.

(otherwise called benign lymphoblastosis, Filatov's disease) is an acute viral infection, characterized predominant defeat oropharynx and lymph nodes, spleen and liver. Specific sign The disease is the appearance in the blood of characteristic cells - atypical mononuclear cells. The causative agent of infectious mononucleosis is the Epstein-Barr virus, which belongs to the herpesvirus family. Its transmission from the patient is carried out by aerosol. Typical symptoms infectious mononucleosis includes general infectious phenomena, tonsillitis, polyadenopathy, hepatosplenomegaly; maculopapular rashes are possible on various areas of the skin.

ICD-10

B27

General information

Infectious mononucleosis (otherwise called benign lymphoblastosis, Filatov's disease) is an acute viral infection characterized by predominant damage to the oropharynx and lymph nodes, spleen and liver. A specific sign of the disease is the appearance of characteristic cells in the blood - atypical mononuclear cells. The spread of infection is widespread, seasonality has not been identified, there is an increased incidence in puberty(girls 14-16 years old and boys 16-18 years old). The incidence after 40 years is extremely rare, with the exception of HIV-infected individuals, who may develop a manifestation of a latent infection at any age. In case of early infection with the virus childhood the disease proceeds as an acute respiratory infection, at an older age - without severe symptoms. In adults clinical course the disease is practically not observed, since in the majority by the age of 30-35 the specific immunity.

Causes

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

The reservoir and source of infection is a sick person or a carrier of infection. The virus is released by sick people starting from the last days of the incubation period and lasts 6-18 months. The virus is released in saliva. In 15-25% healthy people With positive test for specific antibodies, the pathogen is detected in swabs from the oropharynx.

The transmission mechanism of the Epstein-Barr virus is aerosol, the predominant route of transmission is airborne droplets, it can be transmitted by contact (kissing, sexual contact, dirty hands, dishes, household items). In addition, the virus can be transmitted through blood transfusion and intrapartum from mother to child. Humans have a high natural susceptibility to infection, but when infected, mild and abrasive lesions predominantly develop. clinical forms. The insignificant incidence among children under one year of age indicates the presence of innate passive immunity. Severe course and generalization of infection is facilitated by immunodeficiency.

Pathogenesis

The Epstein-Barr virus is inhaled by humans and infects the epithelial cells of the upper respiratory tract, oropharynx (promoting the development of moderate inflammation in the mucous membrane), from there the pathogen enters the regional lymph nodes with the lymph flow, causing lymphadenitis. When the virus enters the blood, it invades B lymphocytes, where it begins active replication. Damage to B lymphocytes leads to the formation of specific immune reactions and pathological deformation of cells. The pathogen spreads throughout the body through the bloodstream. Due to the fact that the introduction of the virus occurs in immune cells And significant role Immune processes play a role in pathogenesis, and the disease is considered AIDS-associated. The Epstein-Barr virus persists in the human body for life, periodically being activated 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 phenomena (weakness, malaise, catarrhal symptoms) may be observed. In such cases, there is a gradual increase in symptoms, the malaise intensifies, the temperature rises to low-grade levels, nasal congestion and sore throat are noted. On examination, hyperemia of the oropharyngeal mucosa is revealed, and the tonsils may be enlarged.

When acute onset The disease develops fever, chills, increased sweating, symptoms of intoxication are noted (muscle aches, headache), patients complain of a sore throat when swallowing. Fever can persist from several days to a month, and the course (type of fever) can vary.

A week later, the disease usually enters the peak phase: all the main clinical symptoms appear (general intoxication, tonsillitis, lymphadenopathy, hepatosplenomegaly). The patient's condition usually worsens (symptoms of general intoxication worsen), the throat has a characteristic picture of catarrhal, ulcerative-necrotic, membranous or follicular sore throat: intense hyperemia of the mucous membrane of the tonsils, yellowish, loose plaque (sometimes like diphtheria). Hyperemia and granularity of the posterior pharyngeal wall, follicular hyperplasia, possible mucosal hemorrhages.

In the first days of the disease, polyadenopathy occurs. 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, the lymph nodes are dense, mobile, painless (or the pain is mild). Sometimes there may be moderate swelling of the surrounding tissue.

At the height of the disease, most patients develop hepatolienal syndrome - the liver and spleen are enlarged, icterus of the sclera may appear, skin, dyspepsia, darkening of urine. In some cases, maculopapular rashes of various localizations are observed. The rash is short-lived, is 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 clinical symptoms and a period of convalescence begins. The body temperature returns to normal, the signs of sore throat disappear, the liver and spleen return to their normal function. normal size. In some cases, signs of adenopathy and low-grade fever may persist for several weeks.

Infectious mononucleosis can acquire a chronic relapsing course, as a result of which 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 less severe clinical symptoms. Fever rarely lasts more than 2 weeks, lymphadenopathy and tonsil hyperplasia are mild, but symptoms associated with functional disorder liver function (jaundice, dyspepsia).

Complications

Complications of infectious mononucleosis are mainly associated with the development of an associated secondary infection (staphylococcal and streptococcal lesions). Meningoencephalitis, upper airway obstruction may occur hypertrophied tonsils. Children may experience severe hepatitis, and sometimes (rarely) interstitial bilateral infiltration of the lungs develops. Also to rare complications include thrombocytopenia, overstretching of the lienal capsule can provoke rupture of the spleen.

Diagnostics

Nonspecific laboratory diagnostics includes thorough research cellular composition blood. General analysis blood shows moderate leukocytosis with a predominance of lymphocytes and monocytes and relative neutropenia, a shift leukocyte formula to the left. Large cells of various shapes with wide basophilic cytoplasm appear in the blood - atypical mononuclear cells. For the diagnosis of mononucleosis, it is significant to increase the content of these cells in the blood to 10-12%; often their number exceeds 80% of all white blood elements. When examining blood in the first days, mononuclear cells may be absent, which, however, does not exclude the diagnosis. Sometimes these cells can take 2-3 weeks to form. The blood picture usually gradually returns to normal during the period of convalescence, while atypical mononuclear cells often persist.

Specific virological diagnostics are not used due to laboriousness and irrationality, although it is possible to isolate the virus in swabs from the oropharynx and identify its DNA using PCR. There are serological diagnostic methods: antibodies to the VCA antigens of the Epstein-Barr virus are detected. Serum immunoglobulins type M are often detected during the incubation period, and at the height of the disease they are observed in all patients and disappear no earlier than 2-3 days after recovery. Detection of these antibodies is sufficient diagnostic criterion infectious mononucleosis. After an infection, specific immunoglobulins G are present in the blood and remain for life.

Patients with infectious mononucleosis (or persons suspected of this infection) are subjected to three times (the first time - during the period acute infection, and at intervals of three months – twice more) serological study to detect HIV infection, since it can also cause the presence of mononuclear cells in the blood. To differentiate a sore throat in infectious mononucleosis from tonsillitis of other etiologies, consultation with an otolaryngologist and pharyngoscopy is necessary.

Treatment of infectious mononucleosis

Mild and moderate infectious mononucleosis is treated on an outpatient basis; bed rest is recommended in cases of severe intoxication and severe fever. If there are signs of liver dysfunction, diet No. 5 according to Pevzner is prescribed.

There is currently no etiotropic treatment; the complex of indicated measures includes detoxification, desensitization, restorative therapy and symptomatic remedies depending on the available clinic. Severe hypertoxic course, threat of asphyxia when the larynx is compressed by hyperplastic tonsils are an indication for short-term prescription of prednisolone.

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

Prognosis and prevention

Uncomplicated infectious mononucleosis has a favorable prognosis, dangerous complications, which can significantly aggravate it, occur quite rarely in this disease. Residual effects in the blood are the reason for dispensary observation within 6-12 months.

Preventive measures aimed at reducing the incidence of infectious mononucleosis are similar to those for acute respiratory infections. infectious diseases, individual measures nonspecific prevention consist of increasing immunity, both with the help of general health measures and with the use of mild immunoregulators and adaptogens in the absence of contraindications. Specific prevention(vaccination) has not been developed for mononucleosis. Emergency preventive measures are applied to children who have been in contact with the patient and consist of prescribing a specific immunoglobulin. The area where the disease is occurring is thoroughly cleaned and personal belongings are disinfected.