Mononucleosis, symptoms and treatment of infectious mononucleosis
- Causes of infectious mononucleosis
- Ways of transmission of infection
- Symptoms of acute infectious mononucleosis
- Symptoms of chronic mononucleosis
- Complications of infectious mononucleosis
- Diagnosis of infectious mononucleosis
- With what diseases can infectious mononucleosis be confused?
- Treatment of infectious mononucleosis
In 1885, for the first time among acute lymphadenitis, Russian pediatrician IF Filatov identified an infectious disease described as an idiopathic inflammation of the cervical glands. For a long time, specialists refused to consider this pathology as a separate nosological form, regarding the changes characteristic of the disease on the part of the blood, as a leukemoid reaction. And only in 1964, Canadian scientists M.E. Epshtein and I. Barr discovered the causative agent of infectious mononucleosis, in honor of which he was named. Other names of the disease: monocytic angina , glandular fever, Pfeifer's disease.
Infectious mononucleosis is an acute anthropo- nous infection caused by the Epstein-Barr virus. It is characterized by the defeat of the lymphoid tissue of the mouth and nasopharynx, the development of fever, lymphadenopathy and hepatosplenomegaly, as well as the appearance in peripheral blood of atypical mononuclears and heterophilic antibodies.
Causes of infectious mononucleosis
The causative agent of the infection is the low-contagious lymphotropic Epstein-Barr virus (EBV), which belongs to the family of herpes viruses. It has opportunistic and oncogenic properties, contains 2 DNA molecules and is able to persist in the human body, as well as other pathogens of this group, from the oropharynx to the external environment for 18 months after the primary infection. In the vast majority of adults, heterophile antibodies to EBV are detected, which confirms chronic infection with this pathogen.
The virus enters the body together with saliva (which is why, in some sources, infectious mononucleosis is called a "kiss disease"). The primary place of self-reproduction of virus particles in the host is the oropharynx. After the defeat of lymphoid tissue, the pathogen is introduced into B-lymphocytes (the main function of these blood cells is the production of antibodies). Providing a direct and indirect effect on immune responses, 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 detected in approximately 20% of B-lymphocytes circulating in the peripheral blood. Possessing proliferative action, the Epstein-Barr virus promotes the active reproduction of B-lymphocytes, in turn, stimulating the intensive immune response from CD8 + and CD3 + T-lymphocytes.
Ways of transmission of infection
The Epstein-Barr virus is the ubiquitous representative of the herpesvirus family. Therefore, infectious mononucleosis can be found in almost all countries of the world, usually 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 infectious mononucleosis suffer from children, adolescent girls and young men. Breasts are rarely sick. After the transferred illness practically in all groups of patients, stable immunity is produced. The clinical picture of the disease depends on the age, sex 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 by means of infected saliva. In rare cases, vertical infection (from mother to fetus), infection during transfusion and during sexual intercourse is possible. There is also the assumption that VEB can be transmitted through household items and alimentary (water-food) way.
Symptoms of acute infectious mononucleosis
On average, the duration of the incubation period is 7-10 days (according to the information of different authors, from 5 to 50 days).
In the prodromal period, patients complain of weakness, nausea, fatigue, sore throat. Gradually negative symptoms intensify, body temperature rises, signs of sore throat appear, nasal breathing becomes difficult, cervical 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 posterior surface of the neck, as well as the appearance in peripheral blood of atypical mononuclears.
In 3-15% of patients with infectious mononucleosis, eyelid swelling (swelling), edema of the cervical tissue and skin rashes (patchy-papular rash) are observed.
One of the most characteristic symptoms of the disease is 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 (compression) of the voice is noted, the patient breathes a half-open mouth, issuing characteristic "snoring" sounds. It should be noted that in infectious mononucleosis, despite the pronounced stuffiness of the nose, in the acute period of the disease there are no signs of rhinorrhea (constant discharge of nasal mucus). This condition is explained by the fact that in the development of the disease, the mucosa of the lower nasal shell (posterior rhinitis) is affected. At the same time, the pathological condition is characterized by puffiness and hyperemia of the posterior pharyngeal wall and the presence of thick mucus.
In most infected children (about 85%), palatine and nasopharyngeal tonsils are covered with plaque. In the first days of the disease they are solid, and then take the form of strips or islets. The occurrence of raids is accompanied by a worsening of the general condition and an increase in body temperature to 39-40 ° C.
The enlargement of the liver and spleen (hepatosplenomegaly) is another characteristic symptom observed in 97-98% of cases of infectious mononucleosis. Dimensions of the liver begin to change from the very first days of the disease, reaching the maximum values for 4-10 days. It is also possible to develop a mild icteric skin and yellowing of the sclera. As a rule, jaundice develops at the height of the disease and gradually disappears together with other clinical manifestations. By the end of the first, beginning of the second month, the liver is completely normalized, the organ rarely remains enlarged for three months.
The spleen, like the liver, reaches its maximum size on the 4th-10th day of the disease. By the end of the third week, half of the patients are no longer palpable.
The rash, which appears in the midst of the disease, can be urticaria, hemorrhagic, koreal and scarlet fever. Sometimes on the border of the hard and soft palate, there are petechial exanthems (pinpoint hemorrhages). Photo of the rash with infectious mononucleosis you see on the right.
There are no major changes from the cardiovascular system. Possible occurrence of systolic murmur, muffled heart tones and tachycardia . As the inflammatory process subsides, negative symptoms tend to disappear.
Most often, all signs of the disease go through 2-4 weeks (sometimes after 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 mononuclear cells in a general blood test.
Symptoms of chronic mononucleosis
This form of the disease is typical only for adult patients with weakened immunity. The reason for this can be some diseases, long-term use of certain medications, strong or persistent stress.
Clinical manifestations of chronic mononucleosis can be quite diverse. Some patients have an increase in the spleen (less pronounced than during the acute phase of the disease), an increase in lymph nodes, and 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 soreness in the abdomen, episodic nausea and vomiting. Often, the Epstein-Barr virus is activated in individuals infected with type 1 or 2 of herpesvirus. In such situations, the disease occurs with periodic painful eruptions on the lips and external genitalia. In some cases, the rash may spread to other parts of the body. There is an assumption that the causative agent of infectious mononucleosis is one of the causes of the development of the syndrome of chronic fatigue.
Complications of infectious mononucleosis
- Swelling of the mucous membrane of the pharynx and tonsils, leading to obstruction of the upper respiratory tract;
- Spleen rupture;
- Meningitis with predominance in the cerebrospinal mononuclear cells;
- Transverse myelitis;
- Acute flaccid paralysis with protein-cell dissociation in cerebrospinal fluid (Guillain-Barre syndrome);
- Psychosensory disorders;
- Interstitial pneumonia;
- Hemolytic and aplastic anemia;
- Thrombocytopenic purpura.
Diagnosis of infectious mononucleosis
When the diagnosis is made, the main role is played by laboratory blood tests. In general clinical analysis, moderate leukocytosis is revealed, in the leukocyte formula - broad-plasma lymphocytes (atypical mononuclears). Most often they are found in the midst of a disease. In children, these cells can be present in the blood for 2-3 weeks. The number of atypical mononuclear cells, depending on the severity of the inflammatory process, varies from 5 to 50% (or more).
With what diseases can infectious mononucleosis be confused?
Infectious mononucleosis should be differentiated with:
- ARVI adenovirus etiology with pronounced mononuclear syndrome;
- diphtheria of the oropharynx;
- 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 adenovirus etiology, characterized by the presence of a pronounced mononuclear syndrome. In this situation, the distinguishing features include conjunctivitis , runny nose, coughing and wheezing in the lungs, which are not characteristic of glandular fever. The liver and spleen in ARVI also increases quite rarely, and atypical mononuclears can be detected in small amounts (up to 5-10%) once.
In this situation, the final diagnosis is made only after carrying out serological reactions.
Note: the clinical picture of infectious mononucleosis, which develops in children of the first year of life, is characterized by some features. At an early stage of the pathological process, cough and runny nose, eyelid pastness, puffiness of the face, wheezing, polyadenia (inflammation of the lymph glands) are often observed. The first three days are characterized by the appearance of tonsillitis with a touch on the tonsils, skin rashes and an increase in the leukocyte formula for segmented and stab neutrophils. When posing serological reactions, positive results are much less common in lower titres.
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 in a hospital is required. When appointing bed rest, the degree of intoxication is taken into account. In the event that infectious mononucleosis occurs against a background of inflammation of the liver, a therapeutic diet is recommended (table number 5).
To date, there is no specific treatment for the disease. Patients undergo symptomatic therapy, a desensitizing, detoxifying and restorative treatment is prescribed. In the absence of bacterial complications, the use of antibiotics is contraindicated. It is absolutely necessary to rinse the oropharynx with antiseptic solutions. With hypertoxic flow and with signs of asphyxia due to pronounced enlargement of the tonsils and edema of the oropharynx, a short course of treatment with glucocorticoids is indicated.
In the treatment of chronic and chronic forms of infectious mononucleosis, immunocorrectors (drugs that restore the function of the immune system) are used.
Specific prevention of the disease has not been developed to date.