Mononucleosis, symptoms and treatment of infectious mononucleosis
- Causes of Infectious Mononucleosis
- Ways of transmission
- Symptoms of acute infectious mononucleosis
- Symptoms of chronic mononucleosis
- Complications of Infectious Mononucleosis
- Diagnosis of infectious mononucleosis
- What diseases can be confused with infectious mononucleosis?
- Treatment of infectious mononucleosis
In 1885, for the first time among the acute lymphadenitis, the Russian pediatrician I. F. Filatov identified an infectious disease, described as idiopathic inflammation of the cervical glands. For a long time, the specialists refused to consider this pathology as a separate nosological form, regarding changes in the blood characteristic of the disease as a leukemoid reaction. And only in 1964, Canadian scientists M.E. Epstein and I.Barr discovered the causative agent of infectious mononucleosis, after which it was named. Other names of the disease: monocytic angina , glandular fever, Pfeifer disease.
Infectious mononucleosis is an acute anthroponotic infection caused by the Epstein-Barr virus. It is characterized by damage to the lymphoid tissue of the roto-and nasopharynx, the development of fever, lymphadenopathy and hepatosplenomegaly, as well as the appearance of atypical mononuclear cells and heterophilic antibodies in the peripheral blood.
Causes of Infectious Mononucleosis
The causative agent of the infection is the slightly contagious lymphotropic Epstein-Barr virus (EBV), belonging to the herpetic viruses family. It possesses opportunistic and oncogenic properties, contains 2 DNA molecules and, like other pathogens of this group, is capable of persisting for life in the human body for a lifetime, being released from the oropharynx to the external environment for 18 months after the initial infection. In the vast majority of adults, heterophilic antibodies to EBV are detected, which confirms chronic infection with this pathogen.
The virus enters the body along with saliva (which is why in some sources infectious mononucleosis is called “kissing disease”). The primary place of self-reproduction of viral particles in the host is the oropharynx. After affection of the lymphoid tissue, the pathogen is introduced into B-lymphocytes (the main function of these blood cells is the production of antibodies). Having a direct and indirect effect on immune reactions, about a day after the introduction of the virus antigens are detected directly in the nucleus of the infected cell. In the acute form of the disease, specific viral antigens are found in approximately 20% of B lymphocytes circulating in peripheral blood. Possessing a proliferative effect, Epstein-Barr virus promotes the active reproduction of B-lymphocytes, in turn, stimulating an intense immune response from CD8 + and CD3 + T-lymphocytes.
Ways of transmission
The Epstein-Barr virus is a ubiquitous member of the herpevirus family. Therefore, infectious mononucleosis can be found in almost all countries of the world, as a rule, in the form of sporadic cases. Often, outbreaks of infection are recorded in the autumn-spring period. The disease can affect patients of any age, but most often children, adolescent girls and boys suffer from infectious mononucleosis. Babies get sick quite rarely. After the illness, almost all groups of patients develop strong immunity. The clinical picture of the disease depends on age, gender and the state of the immune system.
Sources of infection are virus carriers, as well as patients with typical (manifest) and erased (asymptomatic) forms of the disease. The virus is transmitted by airborne droplets or through infected saliva. In rare cases, it is possible vertical infection (from mother to fetus), infection during transfusion and during sexual intercourse. There is also an assumption that EBV can be transmitted through household items and alimentary (water-food) by.
Symptoms of acute infectious mononucleosis
On average, the duration of the incubation period is 7-10 days (according to various authors, from 5 to 50 days).
In the prodromal period, patients complain of weakness, nausea, fatigue, sore throat. Gradually, the negative symptoms increase, the body temperature rises, signs of angina appear, nasal breathing becomes difficult, and the neck lymph nodes swell. As a rule, by the end of the first week of the acute period of the disease there is an increase in the liver, spleen and lymph nodes on the back of the neck, as well as the appearance of atypical mononuclear cells in the peripheral blood.
In 3-15% of patients with infectious mononucleosis, there is pastosity (swelling) of the eyelids, swelling of the cervical tissue and skin rashes (maculopapular rash).
One of the most characteristic symptoms of the disease is a lesion of the oropharynx. The development of the inflammatory process is accompanied by an increase and swelling of the palatine and nasopharyngeal tonsils. As a result, nasal breathing becomes difficult, a change in the timbre (contraction) of the voice is noted, the patient breathes with his mouth open, emitting characteristic “snoring” sounds. It should be noted that in infectious mononucleosis, despite the pronounced nasal congestion, in the acute period of the disease there are no signs of rhinorrhea (persistent discharge of nasal mucus). This condition is explained by the fact that during the development of the disease, the mucous membrane of the inferior nasal concha is affected (posterior rhinitis). At the same time, the edema and hyperemia of the posterior pharyngeal wall and the presence of thick mucus are characteristic of the pathological condition.
The majority of infected children (about 85%) palatine and nasopharyngeal tonsils become covered with raids. In the early days of the disease they are solid, and then take the form of strips or islets. The appearance of raids is accompanied by a deterioration of the general condition and an increase in body temperature to 39-40 ° C.
An enlarged liver and spleen (hepatosplenomegaly) is another characteristic symptom observed in 97-98% of cases of infectious mononucleosis. The size of the liver begins to change from the very first days of the disease, reaching maximum rates for 4-10 days. It is also possible the development of moderate yellowness of the skin and yellowing of the sclera. As a rule, jaundice develops at the height of the disease and gradually disappears along with other clinical manifestations. By the end of the first, beginning of the second month, the size of the liver is fully normalized, less often the organ remains enlarged for three months.
The spleen, as well as the liver, reaches its maximum size at 4-10 days of illness. By the end of the third week in half of the patients, it is no longer palpable.
A rash that occurs in the midst of a disease can be urtikarnoy, hemorrhagic, core-like and scarlet. Sometimes on the border of hard and soft palate petichial exanthemas appear (point hemorrhages). Photo rash with infectious mononucleosis you see on the right.
On the part of the cardiovascular system, no major changes are observed. Systolic murmur may occur, muffled heart sounds and tachycardia . As the inflammatory process subsides, the negative symptoms tend to disappear.
Most often, all signs of the disease disappear in 2-4 weeks (sometimes in 1.5 weeks). At the same time, the normalization of the size of enlarged organs may be delayed by 1.5-2 months. Also for a long time it is possible to detect atypical mononuclears in the general blood test.
Symptoms of chronic mononucleosis
This form of the disease is characteristic only for adult patients with a weakened immune system. The reason for this may be some diseases, long-term use of certain medications, strong or persistent stress.
The clinical manifestations of chronic mononucleosis can be quite diverse. In some patients, there is an increase in the spleen (less pronounced than during the acute phase of the disease), an increase in lymph nodes, hepatitis (inflammation of the liver). Body temperature is usually normal, or subfebrile.
Patients complain of increased fatigue, weakness, drowsiness, or sleep disorders (insomnia), muscle and headaches. Occasionally there is pain in the abdomen, occasional nausea and vomiting. Often, Epstein-Barr virus is activated in persons infected with type 1-2 herpevirus. In such situations, the disease occurs with periodic painful rash on the lips and external genitalia. In some cases, the rash can spread to other areas of the body. There is an assumption that the causative agent of infectious mononucleosis is one of the causes of chronic fatigue syndrome.
Complications of Infectious Mononucleosis
- Swelling of the mucous membrane of the pharynx and tonsils, leading to blockage of the upper respiratory tract;
- Rupture of the spleen;
- Meningitis with predominance of mononuclear cells in the cerebrospinal fluid;
- Transverse myelitis;
- Acute flaccid paralysis with protein-cell dissociation in the cerebrospinal fluid (Guillain-Barre syndrome);
- Psychosensory disorders;
- Interstitial pneumonia;
- Hemolytic and aplastic anemia;
- Thrombocytopenic purpura.
Diagnosis of infectious mononucleosis
When making a diagnosis, laboratory blood tests play a major role. In general clinical analysis, moderate leukocytosis is detected, in leukocyte formula - wide plasma lymphocytes (atypical mononuclear cells). Most often they are found in the midst of the disease. In children, these cells may be present in the blood for 2-3 weeks. The number of atypical mononuclear cells, depending on the severity of the inflammatory process, ranges from 5 to 50% (and more).
What diseases can be confused with infectious mononucleosis?
Infectious mononucleosis should be differentiated from:
- ARVI of adenoviral etiology with pronounced mononuclear syndrome;
- oropharyngeal diphtheria;
- viral hepatitis (icteric form);
- 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 pronounced mononuclear syndrome. In this situation, the distinctive signs include conjunctivitis , runny nose, cough and wheezing in the lungs, which are not characteristic of glandular fever. Liver and spleen with ARVI also increases quite rarely, and atypical mononuclear cells can be detected in small quantities (up to 5-10%) once.
In this situation, the final diagnosis is carried out only after serological reactions.
Note: the clinical picture of infectious mononucleosis that develops in children of the first year of life is characterized by some peculiarities. At an early stage of the pathological process, cough and runny nose, eyelid pastos, puffiness of the face, wheezing breath, polyadenia (inflammation of the lymph glands) are often observed. The first three days are characterized by the occurrence of angina with a touch on the tonsils, skin lesions and an increase in the leukocyte formula of segmented and stab neutrophils. When setting serological reactions, positive results are much less common and in lower titers.
Treatment of infectious mononucleosis
Treatment of patients with mild and moderate forms of the disease can be carried out at home (the patient must be isolated). In more severe cases, hospitalization is required. When assigning bed rest, the degree of intoxication is taken into account. In the event that infectious mononucleosis occurs on the background of inflammation of the liver, a therapeutic diet is recommended (table No. 5).
To date, the specific treatment of the disease does not exist. Symptomatic therapy is given to patients, desensitizing, detoxifying and restorative treatment is prescribed. In the absence of bacterial complications, taking antibiotics is contraindicated. It is imperative that the oropharynx be rinsed with antiseptic solutions. In case of hypertoxic course and in the presence of signs of asphyxia, which has arisen due to a pronounced increase in the tonsils and swelling of the oropharynx, a short course of treatment with glucocorticoids is indicated.
In the treatment of protracted and chronic forms of infectious mononucleosis, immunocorrectors (drugs that restore the function of the immune system) are used.
Specific prevention of the disease today is not developed.