They is Epstein-Barr virus, so named by the names of virologists who discovered it in 1964. Most susceptible mononucleosis children, adolescents and young people. Persons older than 40 years, he is extremely rare, because before that age formed a strong immunity as a result of infection.
Of particular danger is the virus for people over 25, pregnant women (subject to primary infection), as causes severe course of the disease, a bacterial infection may cause abortion or stillbirth. Timely diagnosis and competent treatment significantly reduced the risk of such effects.
What it is?
Infectious mononucleosis - an acute infectious pathology genesis and anthroponotic profile for which it is accompanied by feverish reaction oropharyngeal lesions and organs of the reticuloendothelial system as well as provoking violation qualitative and quantitative composition blood.
Story
On the infectious nature of the disease have more N. F. Filatov in 1887, who first drew attention to the febrile illness with swollen lymph nodes, and called him idiopathic inflammation of the lymph glands. Described the disease for many years bore his name - Filatov's disease. In 1889 the German scientist Emil Pfeiffer (German. Emil Pfeiffer) described a similar clinical picture and define it as glandular fever with the defeat of the pharynx and the lymphatic system.
With the introduction of specific changes in the blood were studied in practice hematological studies in this disease, whereby the American scientists T. Sprent and F. Evans named the disease infectious mononucleosis. In 1964, M. BUT. Epstein and I. Barr virus isolated from Burkitt's lymphoma cells gerpesopodobny virus, named in their honor Epstein - Barr virus, which was later more consistently found in infectious mononucleosis.
Pathogenesis
Epstein-Barr virus is inhaled by a person and affects the cells of the upper airway epithelium of the oropharynx (contributing to the development moderate inflammation in the mucous membrane), there exciter current lymph misses the regional lymph nodes, causing lymphadenitis. When injected into the blood of the virus being introduced into the B-lymphocytes, which starts an active replication.
Defeat of B lymphocytes leads to the formation of specific immune reactions, pathological cell strain. From the blood stream the pathogen spreads throughout the body. Due to the fact that the introduction of the virus occurs in immune cells and a significant role in the pathogenesis of immune processes play, a disease attributed to AIDS-related. Epstein-Barr virus persists in the body for a lifetime, periodically being activated on the background of the general decrease in immunity.
transmission path
Epstein-Barr virus - is a ubiquitous member of the family gerpevirusov. Therefore, infectious mononucleosis can be found in almost all countries of the world, usually as sporadic cases. Often outbreaks of infection are registered in the autumn and spring.
The disease can affect patients of any age, but often suffer from infectious mononucleosis children, adolescent girls and boys. Babies get sick very often. After undergoing the disease in almost all patients groups produced strong immunity. The clinical picture of the disease depends on age, sex and condition of the immune system.
The sources of infection are the virus carrier, as well as patients with the typical (overt) and erased (asymptomatic) forms of the disease. The virus is transmitted by airborne droplets or infected by saliva. In rare cases it is possible vertical transmission (from mother to fetus), infection during transfusion and sexual contact. There is also a suggestion that EBV may be transmitted through household items and nutritional (water and food) by.
Epidemiology
The source of infection is a sick person, including by peeling off the forms of the disease, and the virus carrier. From a sick person to a healthy pathogen is transmitted by airborne droplets, often with saliva (eg, kissing, hence called the "kissing disease", using common dishes, linens, bed, and so on. p.), the possibility of transmission by transfusion blood. Infection contribute to overcrowding and close living patients and healthy people, so frequent outbreaks in the dormitories, boarding schools, camps, kindergartens.
Mononucleosis is also called the "disease of the students", as the clinical picture of the disease develops in adolescence and young adulthood. About 50% of adults carry the infection during adolescence. The maximum incidence in girls is aged 14-16, in boys - 16-18 years. For 25-35 years, most people in the blood reveals antibodies to infectious mononucleosis. However, in HIV-infected resumption of activity of the virus can occur at any age.
Symptoms of mononucleosis in the child
Symptoms of infectious mononucleosis are varied. Sometimes manifested general signs prodormalnogo nature, such as fatigue, malaise, and catarrhal symptoms. Gradually the temperature increases to subfebrile, deteriorating health, there is a sore throat, nasal congestion impairs breathing. Symptoms of mononucleosis also relates pathological proliferation migdalin hyperemia and mucous membranes of the oropharynx.
Sometimes the disease begins suddenly and is pronounced symptoms. In this case, it is possible:
- increased sweating, vomiting, drowsiness, weakness;
- fever, it occurs in different ways (usually 38 -39S) and lasts for several days or even a month;
- signs of intoxication - headache, muscle aches and pain when swallowing.
At the culmination of the disease are manifested main features mononukleza infection, such as:
- sore throat - at the rear pharyngeal mucosa arises graininess, follicular hyperplasia, gipereziya may hemorrhage in the mucosa;
- lymphadenopathy - increasing the size of lymph nodes;
- lepatosplenomegaliya - enlargement of the spleen and liver;
- skin rash all over the body;
- general intoxication of the organism.
The most important symptom of infectious mononucleosis, traditionally considered polyadenylation. It arises as a result of hyperplasia of the lymphoid tissue. In most cases, the tonsils nasopharynx and palate develop islet imposing gray or whitish-yellowish. Their texture is loose and uneven, they can be easily removed.
Rash with mononucleosis most often occurs early in the disease, along with fever and lymphadenopathy, while it can be quite intense, localized on the legs, arms, face, abdomen and back in the form of small red or pale pink specks. The rash does not require treatment, since it does not itch, it can not be anything to smear it on their own liquidated as strengthening the fight against immunity to the virus. However, if the child is prescribed antibiotics and rashes start to itch - this indicates an allergic reaction to an antibiotic (Most often it is a series of penicillin antibiotics - ampicillin, amoxicillin) because when mononucleosis rash does not itch.
For infectious mononucleosis is characterized by hepatosplenomegaly, that is abnormal enlargement of the spleen and liver. They are also very susceptible to the disease, so the changes in them are beginning to occur in the first days after infection. The spleen may increase so much that it can not withstand the pressure of tissue, and it is broken. In addition, increased peripheral lymph nodes. They actively proliferate the virus lingers. Especially intensively grow the lymph nodes in the back of the neck: they become very noticeable when the child turns his head to the side. Adjacent lymph nodes are interconnected, and almost always defeat them is two-way in nature.
The first 2-4 weeks there is a continuous increase in the size of these bodies, to some extent, it continues after the child recovers. When body temperature is returned to physiological values, the normalization condition of the spleen and liver.
What diseases can be mistaken for infectious mononucleosis?
Infectious mononucleosis should be differentiated from:
- SARS adenoviral etiology with severe mononuclear syndrome;
- diphtheria oropharynx;
- viral hepatitis (icteric);
- acute leukemia.
It should be noted that the greatest difficulties arise in the differential diagnosis of infectious mononucleosis and acute respiratory viral infection of adenoviral etiology, characterized by the presence of severe mononuclear syndrome. In this situation, the distinctive signs include conjunctivitis, runny nose, coughing and wheezing in the lungs, which are not characteristic for glandular fever. Liver and spleen also increases with SARS quite rare and atypical mononuclear cells can be determined in small amounts (5-10%) once.
In this situation, the final diagnosis is carried out only after the serological reactions.
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diagnosis of the disease
The following studies are usually appointed by the order to confirm mononucleosis:
- blood test for antibodies to the Epstein-Barr virus;
- biochemical and clinical blood tests;
- US of internal organs, primarily the liver and spleen.
The main symptoms of the disease, based on which the diagnosed are enlarged lymph nodes, tonsillitis, hepatosplenomegaly, fever. Hematologic changes are a secondary symptom of the disease. The painting is characterized by increased blood sedimentation rate, the advent of atypical mononuclear cells and lymphocytes shirokoplazmennyh. Note, however, that these cells may appear in the blood only 3 weeks after infection.
When the differential diagnosis is necessary to exclude acute leukemia, infectious disease, angina, diphtheria pharynx and lymphoma, which may have similar symptoms.
chronic mononucleosis
Long-term persistence of the virus in the body rarely asymptomatic. Given that the latent viral infections may cause a variety of diseases, you need to clearly identify the criteria to diagnose chronic viral mononucleosis.
Symptoms of chronic forms:
- transferred for six months severe primary infectious mononucleosis or associated with high titers of antibodies to the Epstein-Barr virus;
- increase of virus particles in the infected tissues confirmed by immunofluorescence with anticomplementary pathogen antigen;
- histologically confirmed loss of some organs (splenomegaly, interstitial pneumonia, uveitis, marrow hypoplasia, persistent hepatitis, lymphadenopathy).
complications
Complications of infectious mononucleosis are predominantly associated with the development joined secondary infection (staphylococcal and streptococcal lesions). It may be meningoencephalitis, upper airway obstruction, hypertrophic tonsils.
Children may experience severe hepatitis, sometimes (rarely) formed bilateral interstitial infiltration of the lungs. Also rare complications include thrombocytopenia, splenic capsule pererastyazhka can cause rupture of the spleen.
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How to treat infectious mononucleosis
Therapy most typical cases of infectious mononucleosis is conducted under conditions of infection department. In less severe treatment may be performed on an outpatient basis, but under the supervision of the local doctor and infectious diseases.
At the height of disease the child must comply with bed rest, chemically and mechanically sparing diet, and water and drinking regime.
Symptomatic therapy includes antipyretics, local antiseptic for the throat (Geksoral, tandum verde, strepsils, bioparoks), analgesics, oral rinse decoctions of herbs furatsilinom. Causative treatment (action aimed at the destruction of the pathogen) has not been determined. In children, it recommends the use of antiviral drugs based on interferon (candles "Viferon"), immunomodulating agents (izoprinozin, Arbidol).
In young or debilitated children justified the appointment of antibacterial drugs with a wide spectrum of action, especially in the presence of purulent complications (pneumonia, otitis media, meningitis). With involvement of the central nervous system, asphyxia symptoms, reduced bone marrow (thrombocytopenia) is used hormonal therapy within 3-5 days.
Rehabilitation
Clinical supervision for 6 months or more involving a pediatrician, infectious diseases, specialists narrow areas (ENT, cardiologist, immunologist, hematology, oncology) with application of additional clinical laboratory tests (refer to diagnostics + EEG, EKG, MRI etc).
Exemption from physical education, protection from emotional stress - compliance with the security regime around 6-7 months. It should always be on the alert, because any compromise can cause autoimmune reactions run.
prevention
In most situations, infectious mononucleosis proceeds favorably, and yet, like any other infection, this pathology reserves development of severe consequences of meningoencephalitis type, obstructive airway diseases and pathological increase tonsils.
Rare consequences of infectious mononucleosis is the development of bilateral interstitial lung infiltration, toxic hepatitis, thrombocytopenia and splenic rupture, which can avoid observing elementary preventive nonspecific Events.
Given that specific prevention of such diseases as infectious mononucleosis is not carried out, with particular attention to its prevention should be given to the activities of non-specific values. The most effective in the prevention of infectious mononucleosis have measures to ensure the formation of normal operation of the human immune system, it is possible to subject a healthy lifestyle, eating rationalization people of different ages, using a variety of tempering techniques and periodic use of immunomodulators of plant origin. As such drugs should be used ESP reception Immunal, Immunorma which besides stimulation immune reactions cause the activation of the regeneration of the mucous membranes, providing full protection of the respiratory organs system.
Non-specific prevention of infectious mononucleosis in children involves minimizing possible close oral contact with others, carrying out an adequate scheme of measures for sanitary Profile.
Forecast
In most patients, the prognosis is favorable. The disease is mild and abortive forms and easily amenable to symptomatic treatment. Problems happen in patients with low immunity, in which the virus begins to actively proliferate, which leads to the spread of infection.
Preventive measures against infectious mononucleosis does not exist, except for the general strengthen the body's immune system with the help of a balanced diet, and physical hardening activity. In addition, you should avoid places of high density of people, ventilate the room and isolate such patients, especially children.
