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Infectious mononucleosis treatment. Infectious mononucleosis - symptoms and treatment. Get treatment in Korea, Israel, Germany, USA

Infectious mononucleosis is an infectious disease of a viral nature that affects the liver, spleen and lymphoid tissue. Children aged 3 to 10 years are most prone to this type of infection, but adults can also get sick.

Infectious mononucleosis in most cases is mild, and its symptoms resemble a sore throat or a cold, so it is not always possible to make a timely diagnosis. But the most difficult in terms of diagnosis is atypical mononucleosis in children, since its symptoms can be disguised as other diseases.

The danger of infectious mononucleosis lies in its complications, which, if not detected in time, can lead to death.

To help you protect your child from this disease, we suggest taking a closer look at its first signs, symptoms, treatment and effective methods of prevention. We will also demonstrate educational photos and videos on this topic.

Epstein-Barr virus type 4 belongs to the herpesvirus family and is the causative agent of infectious mononucleosis.

This virus contains genetic material, which is represented by double-stranded DNA. The virus multiplies in human B lymphocytes.

Antigens of the pathogen are represented by capsid, nuclear, early and membrane types. In the early stages of the disease, capsid antigens can be detected in the child’s blood, since other antigens appear during the height of the infectious process.

The Epstein-Barr virus is adversely affected by direct sunlight, heat and disinfectants.

How is mononucleosis transmitted?

The source of infection in mononucleosis is a patient with a typical or atypical form, as well as an asymptomatic carrier of Epstein-Barr virus type 4.

Infectious mononucleosis is characterized by airborne droplet spread, that is, it expands its presence when sneezing, coughing, or kissing.

The virus can also be transmitted through household and hematogenous routes.

Since the causative agent of infectious mononucleosis is transmitted mainly through saliva, this disease is often called the “kissing disease”.

More often children who live in dormitories, boarding schools, orphanages, as well as those who go to kindergarten get sick.

What is the mechanism of development of infectious mononucleosis?

The infection enters the human body through the mucous membrane of the upper respiratory tract (mouth, nose and throat), which leads to swelling of the tonsils and local lymph nodes. After this, the pathogen spreads throughout the body.

Infectious mononucleosis is characterized by hyperplasia of lymphoid and connective tissues, as well as the appearance of atypical mononuclear cells in the blood, which are a specific marker of this disease. In addition, there is an enlargement of the liver, spleen and lymph nodes.

Infectious mononucleosis can be cured, but even after recovery, the virus remains in the child’s body and can, under unfavorable conditions, begin to multiply again, which can lead to a relapse of the disease.

Infectious mononucleosis can have an acute and chronic course. It is also customary to distinguish between typical and atypical forms of the disease. Typical mononucleosis, in turn, is divided by severity: mild, moderate and severe.

Atypical mononucleosis can occur with mild symptoms, asymptomatic, or only with signs of damage to internal organs.

If we classify the disease depending on the presence of complications, then infectious mononucleosis can be uncomplicated and complicated.

How long is the incubation period for infectious mononucleosis?

The incubation period is the initial stage of infectious mononucleosis, which generally takes from 1 to 4 weeks in the acute course and from 1 to 2 months in the chronic course of the disease. This stage is necessary for virus replication, which occurs in B lymphocytes.

It is impossible to say exactly how long this stage of the disease will last in a particular child, since the duration directly depends on the state of the patient’s immunity.

How does infectious mononucleosis manifest in children?

The clinical manifestations of infectious mononucleosis depend on its course, so we will consider each form of the disease separately.

In children, symptoms of acute mononucleosis appear abruptly. The incubation period of the disease ends with a rise in body temperature to high numbers (38-39 °C).

With mononucleosis in children there are the following symptoms:

lymphadenopathy, primarily of the cervical postauricular lymph nodes;
pain in the area of enlarged lymph nodes;
swelling of the throat mucosa, which is expressed by difficulty breathing;
throat hyperemia;
sore throat;
nasal congestion;
general weakness;
chills;
loss of appetite;
pain in muscles and joints;
white plaque on the mucous membranes of the tongue, palate, tonsils and back of the pharynx;
splenomegaly (enlarged spleen);
hepatomegaly (enlarged liver);
a small, red, thick rash on the face, neck, chest, or back;
swelling of the eyelids;
photophobia and others.

Answering the question of how dangerous the patient is to others in this case, we can say that the release of the virus into the external environment occurs during the incubation period and in the first 5 days of the height of the disease. That is, a child is contagious even when he does not yet show symptoms of infectious mononucleosis.

Experts have not yet been able to reliably determine the cause of chronic mononucleosis.

But a number of factors can be identified which contribute to this:

Chronic mononucleosis in children is characterized by symptoms of the acute course of the disease, only their severity is less intense.

Fever during chronic infection is rare, and the spleen and liver, if hypertrophied, are insignificant.

Children experience a deterioration in their general condition, which is expressed by general weakness, drowsiness, fatigue, decreased activity, etc. Abnormal bowel habits in the form of constipation or diarrhea, nausea, and rarely, vomiting may also occur.

How dangerous is mononucleosis?

In general, the course of infectious mononucleosis is mild and uncomplicated. But in rare cases there may be the following complications:

bronchial obstruction;
myocarditis;
inflammation of the meninges and brain tissue;
addition of bacterial flora (bacterial tonsillitis, pneumonia and others);
hepatitis;
immunodeficiency and others.

But the most dangerous complication of infectious mononucleosis is rupture of the splenic capsule, which is characterized by the following symptoms:

Treatment of this complication consists of emergency hospitalization and surgical intervention - removal of the spleen.

Algorithm for diagnosing infectious mononucleosis in children consists of several steps.

Subjective diagnostic methods:

interviewing the patient;
collection of anamnesis of illness and life.

Objective methods of examining the patient:

examination of the patient;
palpation of the lymph nodes and abdomen;
percussion of the abdomen.

Additional diagnostic methods:

laboratory diagnostics (complete blood count, biochemical blood test, blood test to determine antibodies to the Epstein-Barr virus);
instrumental diagnostics (ultrasound examination of the abdominal organs, including the liver and spleen).

When interviewing the patient, they pay attention to symptoms of intoxication, pain in the throat and behind the jaw, and also clarify whether there has been contact with children with infectious mononucleosis.

When examining patients with mononucleosis, an enlargement of the postauricular lymph nodes is often observed, and in young children an enlarged liver or even spleen is clearly visible. When examining the throat, its granularity, redness and swollen mucous membrane are determined.

Palpation reveals enlarged and painful lymph nodes, liver and spleen.

In the patient’s blood, indicators such as slight leukocytosis, an increase in erythrocyte sedimentation rate, and the presence of wide-plasma lymphocytes can be detected.

A specific sign of infectious mononucleosis is the appearance in the blood of atypical mononuclear cells - giant cells with a large nucleus, which consists of many nucleoli. Atypical mononuclear cells can remain in the blood of a recovered child for up to four months, and sometimes longer.

But the most informative blood test for mononucleosis is the detection of antibodies to the pathogen or the determination of the genetic material of the virus itself. To do this, enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR) are performed.

Why do you need to carry out and decipher ELISA and PCR? Deciphering the listed blood tests is necessary to identify the virus and confirm the diagnosis.

The diagnosis and treatment of infectious mononucleosis is carried out by an infectious disease specialist. But patients can also be referred for consultation to related specialists, for example, an otolaryngologist, an immunologist and others.

If the diagnosis is unclear, the attending physician will consider the need for an HIV test, since this disease can cause the growth of atypical mononuclear cells in the blood.

Ultrasound examination of the abdominal organs allows us to determine the degree of hepato- and splenomegaly.

In his book, Komarovsky dedicated an article to infectious mononucleosis in children, where he describes in detail the symptoms and treatment of this disease.

The well-known TV doctor, like most specialists, claims that a specific treatment for mononucleosis has not yet been developed and, in principle, it is not necessary, since the body is able to cope with the infection on its own. In this case, adequate prevention of complications, symptomatic treatment, limitation of exercise and nutrition play an important role.

Infectious mononucleosis in children can be treated at home under the guidance of a pediatrician and an infectious disease specialist. In severe cases, the patient is hospitalized in the infectious diseases department or hospital.

Indications for inpatient treatment is:

temperature above 39.5°C;
severe swelling of the upper respiratory tract;
severe intoxication;
the appearance of complications.

In the treatment of infectious mononucleosis, Komarovsky recommends following the following principles:

bed rest;
diet;
antipyretic therapy for body temperatures above 38.5 degrees, as well as if the child does not tolerate fever well. In such cases, Nurofen, Efferalgan, Ibuprofen and others are prescribed;
in case of severe inflammation in the throat, local antiseptics are used - Septefril, Lisobakt, Orosept, Lugol, as well as local immunotherapy drugs, such as Immudon, IRS-19 and others;
vitamin therapy with complex vitamin preparations, which necessarily contain B vitamins, as well as ascorbic acid;
in case of liver dysfunction, choleretic agents and hepatoprotectors are used;
immunotherapy, which consists of prescribing interferons or their inducers, namely: Viferon, Cycloferon, Imudon, human interferon, Anaferon and others;
antiviral therapy: Acyclovir, Vidabarin, Foscarnet and others. Acyclovir for mononucleosis is prescribed at a dose of 5 mg/kg body weight every 8 hours, Vidabarin - 8-15 mg/kg/day, Foscarnet - 60 mg/kg every 8 hours;
Antibiotics for a child with mononucleosis can only be prescribed if a secondary bacterial flora is present (streptococcal tonsillitis, pneumonia, meningitis, etc.). It is prohibited to use penicillin antibiotics for mononucleosis, since they cause allergies in many children. Also, the child must be prescribed probiotics, such as Linex, Bifi-form, Acipol, Bifidumbacterin and others;
Hormone therapy is indicated for children with severe intoxication. Prednisolone is used for this.

The period of convalescence for infectious mononucleosis takes from two weeks to several months, its duration depends on the severity of the disease and whether there were consequences.

The patient's condition improves literally a week after body temperature normalizes.

During treatment and 1.5 months after recovery, the child is freed from any physical activity in order to prevent the development of such consequences as rupture of the spleen capsule.

If the temperature persists during mononucleosis, this may indicate the addition of secondary bacterial flora, since during the recovery period it should not exceed 37.0 ° C.

You can visit kindergarten after mononucleosis when blood levels return to normal, that is, atypical mononuclear cells disappear.

Both during treatment for infectious mononucleosis and after recovery, patients should adhere to a diet, especially if the liver has been affected.

Nutrition should be balanced and easily digestible so as not to overload the liver. For hepatomegaly, table No. 5 according to Pevzner is prescribed, which involves limiting animal fats, excluding hot seasonings, spices, marinades, sweets and chocolate.

The patient's menu should consist of liquid soups, semi-liquid cereals, lean meats, poultry and fish. When preparing food, it is recommended to use gentle heat treatment methods, such as boiling, baking or steaming.

The diet after infectious mononucleosis should be followed for 3 to 6 months, depending on the severity of the disease. After this period, the menu can be expanded and diversified.

Medicinal herbs such as chamomile, milk thistle, corn silk, lemongrass and others, which are consumed in the form of tea, help restore liver cells.

It is also important for infectious mononucleosis to maintain adequate drinking regimen according to age.

What methods exist for preventing infectious mononucleosis in children?

Specific prevention of infectious mononucleosis has not been developed. The development of the disease can be prevented by strengthening the immune system using the following methods:

active and ;
the child’s adherence to a rational daily routine;
elimination of mental and physical overload;
dosed sports loads;
sufficient time in the fresh air;
healthy and balanced diet.

Despite the fact that infectious mononucleosis does not cause death, it should not be taken lightly. The disease itself is not fatal, but can cause life-threatening consequences - meningitis, pneumonia, bronchial obstruction, splenic rupture, etc.

Therefore, at the first signs of infectious mononucleosis in your child, we strongly recommend that you consult a pediatrician at the nearest clinic or immediately see an infectious disease doctor and under no circumstances self-medicate.

Infectious diseases, of which there are more than two hundred, have a variety of names. Some of them have been known for many centuries, some appeared in the modern era after the development of medicine, and reflect some of the features of clinical manifestations.

For example, it is so called because of the pink color of the skin rash, and typhus is so named because the patient’s state of consciousness is disturbed by the type of toxic “prostration”, and resembles fog, or smoke (translated from Greek).

But mononucleosis stands apart: perhaps this is the only case when the name of the disease reflects a laboratory syndrome that is “not visible to the naked eye.” What kind of disease is this? How does it affect blood cells, how does it progress and how is it treated?

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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 tonsillitis”, then you know that we are talking about mononucleosis.

If we decipher the name “mononucleosis”, then this term means an increase in the content of mononuclear, or mononuclear cells in the blood. These cells include special types of leukocytes, or white blood cells, which perform a protective function. These are monocytes and lymphocytes. Their content in the blood is not just increased during mononucleosis: they become altered, or atypical - this is easy to detect when examining a stained blood smear under a microscope.

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

After all, the transmission mechanism of mononucleosis is aerosol, that is, airborne droplets, and the disease itself occurs with damage to lymphoid tissue: pharyngitis and tonsillitis (angina) occur, hepatosplenomegaly appears, or an enlargement of the liver and spleen, and the content of lymphocytes and monocytes in the blood increases, which become atypical.

Who is guilty?

Causes infectious mononucleosis, which belongs to the herpes viruses. In total, there are almost a dozen families of herpes viruses and even more of their types, but only this type of virus is so sensitive to lymphocytes, since on their membrane they have receptors for the envelope protein of this virus.

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

A characteristic feature of this virus is its 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 cells, but causes their proliferation, that is, active growth. It is this fact that lies in the development of the clinical picture of mononucleosis.

Epidemiology and routes of infection

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

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

kissing, sexual intercourse;
through toys, especially those that have been in the mouth of a virus-carrying child;
through donor blood transfusion, if donors are carriers of the virus.

Susceptibility to infectious mononucleosis is universal. It may seem incredible, but most healthy people are infected with this virus and are carriers. In underdeveloped countries, where the population is very crowded, this occurs in children, and in developed countries - in adolescence and young adulthood.

Upon reaching 30–40 years of age, the majority of the population is infected. It is known that men are more likely to get infectious mononucleosis, and people over 40 years of age get sick very rarely: infectious mononucleosis is a disease of young people. True, there is one exception: if a patient is sick with HIV infection, then at any age he can not only develop mononucleosis, but also recur. 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 target of the virus attack and quickly become infected. After this, they begin to transform into plasma cells and synthesize various and unnecessary antibodies, for example, hemagglutinins, which can glue foreign blood cells together.

A complex cascade of activation and suppression of various parts of the immune system is launched, and this leads to the accumulation of young and immature B lymphocytes in the blood, which are called “atypical mononuclear cells”. Despite the fact that these are its own cells, albeit 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 addition of microbial and bacterial infections, since the body and its immunity are “busy with other things.”

All this manifests itself as a generalized process in lymphoid tissue. Proliferation of immune cells causes hypertrophy of all regional lymph nodes, enlargement of the spleen and liver, and in the case of severe disease, necrosis in the lymphoid tissue and the appearance of various infiltrates in organs and tissues are possible.

Symptoms of infectious mononucleosis in children and adults

High temperature up to 40 is a symptom of mononucleosis (photo 2)

Infectious mononucleosis has a “vague” incubation period, which can last from 5 to 60 days, depending on age, immune status and the number of viruses that have entered the body. The clinical picture of symptoms in children and adults is approximately the same, only in children an enlargement of the liver and spleen manifests early, which in adults, especially with erased forms, may not be detected at all.

As with most diseases, infectious mononucleosis has a period of onset, peak and recovery, or convalescence.

Initial period

The disease is characterized by an acute onset. Almost on the same day, the temperature rises, chills occur, then a sore throat and regional lymph nodes become enlarged. If the onset is subacute, then lymphadenopathy occurs first, and only then fever and catarrhal syndrome develop.

Usually the initial period lasts no more than a week, and people often think that this is the “flu” or another “cold”, but then the height of the disease occurs.

Clinic at the height of the disease

The classic signs of “apotheosis of mononucleosis” are:

High fever up to 40 degrees, and even higher, which can remain at this level for several days, and at lower numbers - up to a month.
A kind of “mononucleosis” intoxication, which is not similar to ordinary viral intoxication. Patients get tired, have difficulty standing and sitting, but usually maintain an active lifestyle. They do not have the desire, as with ordinary infections, to go to bed even with a high temperature.
Polyadenopathy syndrome.

The lymph nodes close to the “entrance gate” become enlarged. More often than others, the nodes on the lateral surface of the neck are affected, which remain mobile and painful, but are enlarged, sometimes to the size of a chicken egg. In some cases, the neck becomes bullish and mobility when rotating the head is limited. The damage to the inguinal and axillary nodes is somewhat less pronounced.

This symptom of infectious mononucleosis persists for a long time and disappears slowly: sometimes 3-5 months after recovery.

Enlargement and severe swelling of the palatine tonsils, with the appearance of loose plaque, or sore throat. They even close together, making breathing difficult. The patient's mouth is open, there is a nasal tone, and swelling of the back of the throat (pharyngitis).
The spleen and liver are almost always enlarged. This symptom of infectious mononucleosis in children is observed quite often, and can be well expressed. Sometimes there is pain in the side and right hypochondrium, mild jaundice and increased enzyme activity: ALT, AST. This is nothing more than benign hepatitis, which soon goes away.
Peripheral blood picture. Of course, the patient does not complain about this, but the exceptional originality of the test results requires indicating this sign as the main symptom: against the background of moderate or high leukocytosis (15-30), the number of lymphocytes and monocytes increases to 90%, of which almost half are atypical mononuclear cells. This sign gradually disappears, and after a month the blood “calms down.”
Approximately 25% of patients experience various rashes: bumps, dots, spots, small hemorrhages. The rash does not bother you, it appears towards the end of the period of initial appearance, and after 3-6 days it disappears without a trace.

About 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, enlarged lymph nodes, hepatosplenomegaly and tonsillitis combined.

Additional research methods are:

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

Treatment of infectious mononucleosis, drugs

Uncomplicated and mild forms of infectious mononucleosis are treated at home by both children and adults. Patients with jaundice, significant enlargement of the liver and spleen, and an unclear diagnosis are hospitalized. The principles of treatment of infectious mononucleosis are:

The diet requires giving up spicy, smoked, fatty and fried foods to ease the work of the liver;
Semi-bed rest, plenty of vitamin drinks are recommended;
It is necessary to rinse the oropharynx with antiseptic solutions (Miramistin, Chlorhexidine, Chlorophyllipt) to avoid secondary infection;
Antipyretic drugs from the NSAID group are indicated.

Attention! How to treat infectious mononucleosis in children, and what drugs should not be used? All parents should remember that taking aspirin in any type and dose is strictly prohibited in children until they reach the age of at least 12-13 years, since a serious complication may develop - Reye's syndrome. Only paracetamol and ibuprofen are used as antipyretic drugs.

Antiviral therapy: interferons and their inducers. "Neovir", Acyclovir. They are used, although their effectiveness has been proven only in laboratory studies;
Antibiotics are prescribed when suppuration appears on the tonsils or other purulent-necrotic complications. Fluoroquinolones are used most often, but ampicillin can cause a rash in most patients;
If a rupture is suspected, the patient should be urgently operated on, for health reasons. And the attending physician should always draw the attention of patients who are being treated at home that if jaundice increases, acute pain appears in the left side, severe weakness, or decreased blood pressure, it is necessary to urgently call an ambulance and hospitalize the patient in a surgical hospital.

How long to treat infectious mononucleosis? It is known that in 80% of cases, significant improvement occurs between 2 and 3 weeks of illness, so active treatment should be carried out for at least 14 days from the moment of the first signs of the disease.

But, even after improving your health, you need to limit your physical activity and sports for 1 to 2 months after discharge. This is necessary because the spleen is enlarged for a long time, and there is a significant risk of rupture.

If severe jaundice has been diagnosed, the diet must be followed for 6 months after recovery.

Consequences of mononucleosis

After infectious mononucleosis, persistent immunity remains. There are no recurrent cases of the disease. In rare exceptions, death can occur with mononucleosis, but it can be caused by complications that have little to do with the development of the virus in the body: this may be obstruction and swelling of the airways, bleeding due to rupture of the liver or spleen, or the development of encephalitis.

In conclusion, it must be said that EBV is not at all as simple as it seems: remaining persistent in the body for life, it often tries to “show its ability” to proliferate cells in other ways. It causes Burkitt's lymphoma, and is considered a possible cause of some carcinomas, since it has been proven to be oncogenic, or the ability to “tend” the body to develop cancer.

Its role in the rapid course of HIV infection is also possible. Of particular concern is the fact that the hereditary material of EBV is firmly integrated in the affected cells with the human genome.

Data 02 Apr ● Comments 0 ● Views

Doctor Dmitry Sedykh

Infectious mononucleosis is predominantly a childhood disease that develops against the background of the activity of the Epstein-Barr virus (one of the types of herpes). In rare cases, pathology occurs in adults. Mononucleosis is treated with medications that suppress the herpes virus. The treatment regimen is selected taking into account the nature of the general symptoms.

In addition to the Epstein-Barr virus, the causative agent of infectious mononucleosis can be either cytomegalovirus. In rare cases, pathology develops against the background of the activity of three of these infections.

Herperoviruses (herpesviruses) after entering the body infect the cells of the central nervous system, as a result of which an exacerbation occurs when the body is affected by other diseases. Pathology can be provoked by other factors that weaken the immune system.

Herpes viruses enter the body mainly through direct contact with the carrier of the pathogen. The incubation period lasts up to 1.5 months. During this time period, the patient does not experience discomfort associated with infection with viral agents. Less commonly, adults experience the following symptoms:

general weakness;
attacks of nausea;
increased fatigue;
sore throat.

In infectious mononucleosis, inflammation of the tonsils and lymph nodes is observed. The course of the pathology is accompanied by the following clinical phenomena:

redness of the mucous membranes of the oral cavity;
headache;
nasal congestion;
chills;
body aches;
loss of appetite along with an increase in the frequency of attacks of nausea.

These phenomena bother the patient for 2-14 days. As the pathological process develops, other symptoms arise that make it possible to differentiate infectious mononucleosis from other pathologies:

increase in body temperature up to 38 degrees;
normal functioning of the sweat glands, which is not typical for diseases with similar symptoms;
slight enlargement of the cervical lymph nodes;
swelling and friability of the tonsils, covered with a yellowish-gray coating;
hyperplastic changes in the throat mucosa.

Simultaneously with the above symptoms, a red rash appears on the patient’s body, localized in various areas.

Often the course of infectious mononucleosis causes damage to the spleen and liver. Dysfunction of the latter causes pain localized in the right hypochondrium, darkening of urine and jaundice. When the spleen is damaged, an increase in the size of the organ is observed.

In the case of a secondary infection, the nature of the clinical picture changes depending on the type of pathogenic agent.

On average, it takes up to 1-2 weeks for a patient to fully recover. Fever and enlarged cervical nodes may bother you for about one month.

Video about infectious mononucleosis. What is it, symptoms. Competent treatment.

How to treat mononucleosis with medication?

During treatment of mononucleosis, it is necessary to observe bed rest until the patient's condition is completely restored. Treatment of the disease is carried out at home. Hospitalization of the patient is necessary only in extreme cases, when the disease develops against the background of immunodeficiency.

Specific therapy for mononucleosis has not been developed. This is partly due to the fact that the disease occurs against the background of herperovirus activity, which cannot be completely cured.

In the treatment of infections that cause mononucleosis, it is recommended to use an integrated approach. This pathology requires medical intervention. Treatment of the disease is carried out with antiviral agents that suppress the activity of herperoviruses of any type:

"Valtrex";
"Acyclovir";
"Groprinosin".

In case of increased body temperature, non-steroidal anti-inflammatory drugs are prescribed:

"Ibuprofen";
"Paracetamol";
"Nimesulide".

These drugs suppress the inflammatory process, thereby relieving swelling of the tonsils. The latter can also be relieved with antihistamines:

"Suprastin";
"Loratadine";
"Cetirizine."

Less commonly, patients are prescribed immunotherapy, which involves the introduction into the body of a specific immunoglobulin against the Epstein-Barr virus. In some cases, when the course of the disease is accompanied by signs of asphyxia, treatment is supplemented by taking glucocorticoids. These drugs should not be used without consulting a doctor. Failure to comply with the dosage of glucocorticoids causes severe complications.

Often the course of the disease is accompanied by a sore throat, for which antiseptic solutions of Furacilin and Chlorhexidine are prescribed. In order to strengthen general immunity, vitamin complexes or immunomodulators are prescribed.

An antibiotic is also used in the treatment of mononucleosis, which is prescribed in case of a secondary infection. More often, the activity of the latter is stopped with the help of antibacterial drugs of the ampicillin series. In case of liver damage, hepatoprotectors are indicated.

How to treat mononucleosis using traditional medicine?

Traditional methods of treating mononucleosis in adults should not replace drug therapy. They are allowed to be used only after consultation with a doctor.

The following traditional medicines are indicated in the treatment of mononucleosis:

Echinacea tincture (strengthens the immune system);
decoction of calamus or ginger (suppresses secondary infection, reduces the intensity of sore throat);
decoction of elderberry or dandelion (relieves headaches, strengthens the immune system).

When selecting traditional medicine, one should take into account the presence of individual intolerance to individual components of the selected drug.

How long does it take to treat the disease?

The duration of treatment for infectious mononucleosis in adults directly depends on the patient's immune status. On average, complete recovery of the body takes about one month. Moreover, over the past weeks, the intensity of general symptoms has gradually subsided. During this period, the patient is mainly concerned about certain clinical phenomena: enlarged lymph nodes, sore throat, etc.

Infectious mononucleosis in adults takes longer to treat if the drugs are chosen incorrectly or the disease is caused by immunodeficiency.

What recommendations should be followed during treatment?

During therapy, it is important to limit the patient’s communication with healthy people. In addition, it is recommended to use personal utensils.

For mild and moderate forms of pathology, drinking plenty of fluids is recommended, which helps remove toxins from the body. In case of liver damage, it is necessary to adjust the daily diet, giving up alcohol and fried fatty foods in favor of broths, kefir, yoghurts, and natural juices.

To cure infectious mononucleosis, it is important to carry out complex therapy. Antiviral, antipyretic and antihistamine drugs help get rid of the symptoms of the disease.

Historical data on infectious mononucleosis

In 1885 p. N.F. Filatov was the first to describe this disease as an independent nosological unit and gave it the name “idiopathic inflammation of the lymphatic glands.” In 1889 p. E. Pfeiffer described the clinical picture of a disease called glandular fever. Since 1962, a single name for this disease has been used - infectious mononucleosis. In 1964 p. M. Epstein and J. Wagg isolated a herpes-like virus, which is consistently found in patients with infectious mononucleosis.

Etiology of infectious mononucleosis

Recently, the viral nature of infectious mononucleosis has been considered the most likely. Most authors believe that the Epstein-Barr virus, which belongs to DNA-containing lymphoproliferative viruses, plays a major role in the etiology of infectious mononucleosis. The Epstein-Barr virus is manifested not only in infectious mononucleosis, but also in other diseases - Burkitt's lymphoma, in which it was first isolated, nasopharyngeal carcinoma, and lymphogranulomatosis. Antibodies against this virus are also found in the blood of patients with systemic lupus erythematosus and sarcoidosis.

Epidemiology of infectious mononucleosis

The source of infection in infectious mononucleosis is patients and virus carriers. It is believed that the pathogen is contained in the secretions of the oral cavity and is excreted in saliva. Transmission mechanism- predominantly airborne. The possibility of contact, nutritional and transfusion transmission of infection is not denied. Infectious mononucleosis is recorded mainly in children (2-10 years) and young people. At the age of over 35-40 years, the disease is almost not observed. The contagiousness of patients with infectious mononucleosis is relatively low. The incidence is sporadic. Epidemic outbreaks occur rarely. Seasonality is not determined, but most cases of the disease occur in the cold season. Immunity after illness is stable, as evidenced by the absence of repeated cases of the disease.

Pathogenesis and pathomorphology of infectious mononucleosis

The entry point for infection is the mucous membrane of the nasopharynx and upper respiratory tract. The infectious mononucleosis virus is tropic to lymphoid and reticular tissue, as a result of which the lymph nodes, liver, spleen, and to a certain extent the bone marrow and kidneys are affected. Lymphogenously, the pathogen enters the regional lymph nodes, where primary lymphadenitis develops. If the lymphatic barrier is destroyed, viremia occurs and the process generalizes. The next phase of pathogenesis is infectious-allergic, which determines the undulating course of the disease. The last phase is the formation of immunity and recovery.
Damage to lymphoid and reticular tissue leads to an increase in the blood of the number of lymphocytes, monocytes and the presence of monocytopodibnyh lymphocytes, which are called differently: atypical mononuclear cells, glandular fever cells, virocytes, and plasmatic lymphocytes, etc.
Recently, much attention has been paid to infectious mononucleosis as a disease of the immune system. The virus does not destroy infected cells (B-lymphocytes), but stimulates their reproduction; may be mixed up in lymphocytes for a long time. Fixation of the pathogen on the surface of B-lymphocytes leads to the activation of the body's defense factors. These include circulating antibodies against the surface antigen of the Epstein-Barr virus, cytotoxic lymphocytes, and natural killer cells. The main mechanism of destruction of infected cells during infectious mononucleosis is the formation of specific cytotoxic killer T cells that can recognize infected cells. During intensive destruction of B-lymphocytes, substances may be released that predetermine fever and have a toxic effect on the liver. In addition, a significant amount of virus antigens enters the lymph and bloodstream, causing a general allergic reaction of a slow type. Infectious mononucleosis is also characterized by activation of T-lymphocytes - suppressors that suppress the reproduction and at the same time differentiation of B-lymphocytes. This makes it impossible for infected cells to reproduce.
Histologically, generalized hyperplasia of lymphatic and reticular tissue of all organs and systems is detected, as well as mononuclear infiltration, sometimes shallow focal necrosis in the liver, spleen, kidneys, and central nervous system.

Clinic of infectious mononucleosis

The incubation period for infectious mononucleosis ranges from 6-18 days (up to 30-40 days). Sometimes the disease begins with a prodromal period lasting 2-3 days, during which fatigue, lethargy, decreased appetite, muscle pain, and dry cough appear.
In typical cases, the onset of the disease is acute, body temperature rises to 38-39 ° C. Patients complain of headache, runny nose, sore throat when swallowing, sweating.
Already in the first 3-5 days, characteristic clinical signs of the disease appear: fever, sore throat (acute tonsillitis), enlarged lymph nodes, difficulty in nasal breathing, enlarged liver and spleen.
Noteworthy is the characteristic appearance of the patient with infectious mononucleosis - swollen eyelids and brow ridges, nasal congestion, half-open mouth, dry and red lips, slightly thrown back head, hoarse breathing, noticeable enlargement of the lymph nodes. Fever in infectious mononucleosis can be constant, remitting or irregular, and sometimes wave-like. The duration of the febrile period is from 4-5 days to 2-4 weeks or more.
Lymphadenopathy is the most persistent symptom of the disease. First of all, the cervical lymph nodes enlarge, especially those located along the posterior edge of the sternocleidomastoid muscle, at the angle of the lower jaw. The enlargement of these nodes is noticeable at a distance when the head is turned to the side. Sometimes the lymph nodes look like a chain or a package and are often symmetrically located; their size (diameter) can reach 1-3 cm. They are elastic, moderately painful to the touch, not welded together, mobile, the skin over them is not changed. Swelling of the subcutaneous tissue (lymphostasis) is possible, which spreads to the submandibular area, neck, sometimes up to the collarbones. At the same time, an increase in the axillary and inguinal lymph nodes is detected. Less commonly observed is an increase in bronchopulmonary, mediastinal and mesenteric lymph nodes.
As a result of damage to the pharyngeal tonsil, nasal congestion appears, difficulty in nasal breathing, and the voice changes. However, despite this, almost no nasal discharge is observed in the acute period of the disease because with infectious mononucleosis, posterior rhinitis develops - the mucous membrane of the inferior turbinate, the entrance to the nasal part of the pharynx, is affected.
Simultaneously with adenopathy, symptoms of acute tonsillitis appear. Sore throat can be catarrhal, follicular, lacunar, ulcerative-necrotic, sometimes with the formation of pearly-white or cream-colored plaque, and in some cases - fibrinous films that resemble diphtheria. Plaques may spread beyond the tonsils, accompanied by an increase in fever or its restoration after a previous decrease in body temperature. Cases of infectious mononucleosis without signs of tonsillitis have been described.
An enlarged liver and spleen is one of the constant symptoms of infectious mononucleosis. In most patients, an enlarged spleen is detected already from the first days of the illness; it has a relatively soft consistency and reaches its maximum size on the 4-10th day of illness. Normalization of its size occurs no earlier than the 2-3rd week of illness, after normalization of the size of the liver. The liver also enlarges to its maximum on the 4th-10th day of illness. In some cases (15%), liver enlargement may be accompanied by a slight impairment of its function, moderate jaundice.
In 5-25% of patients with infectious mononucleosis, a rash appears, which can be macular, maculopapular, urticarial, hemorrhagic. The timing of the appearance of the rash varies; it lasts for 1-3 days and disappears without a trace.
Changes in the blood of patients with infectious mononucleosis are characteristic. Leukopenia, which can manifest itself in the first 2 days of illness, is modified by leukocytosis - 10-25 | 109 in 1 l. The number of mononuclear cells (lymphocytes, monocytes) increases significantly (up to 50-80%); ESR-15-ZO mm/year. The most characteristic feature is the presence of atypical mononuclear cells (monocytic lymphocytes) - mature atypical mononuclear cells, ranging in size from a medium lymphocyte to a large monocyte, which have a large spongy nucleus. The protoplasm of the cells is wide, basophilic, and contains delicate azurophilic granules. Their number can reach 20% or more. Atypical mononuclear cells are found in 80-85% of patients. They appear on the 2-3rd day of illness and are observed in the blood for 3-4 weeks, sometimes up to 2 months or more.
There is no uniform classification of clinical forms of infectious mononucleosis. There are typical and atypical forms. Atypical forms include cases of the disease when there are only some typical symptoms (for example, polyadenitis) or the most significant signs that are not typical - exanthema, jaundice, symptoms of damage to the nervous system and others. An erased, asymptomatic course of the disease is observed.
In 10-15% of cases, a relapse of the disease is possible (sometimes several), milder, with less prolonged fever. A protracted course of the disease - more than 3 months - is much less common.
Complications rarely develop. Otitis media, paratonsillitis, and pneumonia may occur, which is associated with the addition of bacterial flora. In some cases, splenic rupture, acute hemolytic anemia, meningoencephalitis, neuritis, polyradiculoneuritis, etc. may be observed.

Prognosis of infectious mononucleosis

The disease usually ends with complete recovery. Death is very rare.

Diagnosis of infectious mononucleosis

The main symptoms of the clinical diagnosis of infectious mononucleosis are fever, acute tonsillitis, polyadenitis, hepatosplenomegaly, lymphocytosis, monocytosis and the presence of atypical mononuclear cells in the blood. In doubtful cases, serological tests are used, which are various modifications of heterohemaglutination. Among them, the most common is the Paul-Bunnell reaction, modified by Davidson, which makes it possible to detect heterophilic antibodies against sheep erythrocytes (diagnostic titer 1: 32 and higher) in the blood serum of patients with infectious mononucleosis.
The simplest and most informative is the Hoff-Bauer reaction with formalinized horse erythrocytes on a glass slide. To perform it, only one drop of the patient’s blood serum is needed. The answer is immediate. The reaction is positive in 90% of cases. They also use the agglutination reaction of trypsinized bovine erythrocytes with the patient’s blood serum, which is pre-treated with Guinea pig kidney extract. In patients with infectious mononucleosis, this reaction is positive in 90% of cases. A reaction based on the ability of the blood serum of a patient with infectious mononucleosis to hemolyze bovine erythrocytes is also used. The given reactions are nonspecific, some of them may be positive in other diseases, which reduces their diagnostic value.

Differential diagnosis of infectious mononucleosis

Infectious mononucleosis is differentiated from diphtheria, tonsillitis, lymphogranulomatosis, fellinosis, acute leukemia, listeriosis, viral hepatitis, AIDS.
Plaques on the tonsils with infectious mononucleosis often resemble diphtheria. However, diphtheria plaques are distinguished by greater density, smooth surface, and grayish-white color.
In infectious mononucleosis, plaque is easily removed. Regional lymph nodes with diphtheria are slightly enlarged, there is no polyadenitis and no enlargement of the spleen. On the blood side, diphtheria is characterized by neutrophilic leukocytosis, and infectious mononucleosis is characterized by lymphomonocytosis and the presence of atypical mononuclear cells.
With angina, unlike infectious mononucleosis, only regional lymph nodes are enlarged, the spleen is not enlarged, and neutrophilic leukocytosis is observed.
Lymphogranulomatosis has a long course with a wave-like temperature curve, sweating, and itching of the skin. The lymph nodes reach larger sizes than in infectious mononucleosis, are painless, first elastic, and then dense. There are no changes in the peripheral blood typical of infectious mononucleosis; eosinophilia is detected quite often during exacerbations. In doubtful cases, it is necessary to conduct histological studies of bone marrow punctate and lymph nodes.
With phallinosis (benign lymphoreticulosis, cat scratch disease), lymphocygosis and the presence of atypical mononuclear cells in the blood are possible, but, unlike infectious mononucleosis, primary affect is detected, isolated enlargement of the lymph nodes, regional relative to the entrance gate of the infection, there is no sore throat and enlargement of other lymph nodes .
In some cases of infectious mononucleosis with high leukocytosis (30-109 in 1 l and above) and lymphocytosis (up to 90%), it should be differentiated from acute lymphocytic leukemia. An acyclic course of the disease, progressive deterioration of the patient's condition, severe pallor of the skin, a decrease in the number of red blood cells and hemoglobin, thrombocytopenia are the main manifestations of lymphocytic leukemia. The final diagnosis is based on analysis of punctate lymph node and sternum.
The anginal-septic form of listeriosis, like infectious mononucleosis, is characterized by significant intoxication, sore throat, enlargement of regional lymph nodes, and possibly an increase in other groups of lymph nodes, liver, spleen, and the number of mononuclear cells in the blood. Therefore, it is difficult to differentiate these two diseases. However, if the patient has symptoms of purulent conjunctivitis, a runny nose with intense discharge, a polymorphous rash on the body, tonsillitis, and meningeal symptoms, it is possible to suspect listeriosis.
If infectious mononucleosis is accompanied by jaundice, it must be differentiated from viral hepatitis. Patients with viral hepatitis usually do not have prolonged fever, polyadenitis, pronounced biochemical changes in the blood serum (increased activity of serum aminotransferases and other indicators), accelerated ESR, or atypical mononuclear cells in the peripheral blood.
Sometimes it becomes necessary to differentiate infectious mononucleosis from AIDS, which is also characterized by enlarged lymph nodes and fever. However, unlike infectious mononucleosis, AIDS occurs with prolonged lymphadenopathy due to enlargement of two or more groups of lymph nodes, intermittent or persistent fever, diarrhea, weight loss, sweating, lethargy, and skin lesions. Immunological studies of the blood of patients with AIDS reveal a decrease in the number of helper T-lymphocytes, a decrease in the ratio of T-helpers to T-suppressors, an increase in the level of serum immunoglobulins, and an increase in the number of circulating immune complexes.

Treatment of infectious mononucleosis

Specific therapy for infectious mononucleosis has not been developed, so in practice symptomatic, desensitizing, and restorative treatment is carried out. Antibiotics are used only in cases where the fever lasts longer than 6-7 days, the manifestations of tonsillitis are pronounced and are accompanied by a significant increase in tonsillar lymph nodes.
For the treatment of patients with severe forms, glycocorticosteroids are used, the basis for the prescription of which is the morphological substrate of the disease (hyperplasia of lymphoid tissue). Detoxification is carried out. In all cases, gargling with solutions of rivanol, iodinol, furatsilin and other antiseptics is required.

Prevention of infectious mononucleosis

Specific prevention of infectious mononucleosis has not been developed. Patients are hospitalized according to clinical indications: Quarantine is not established. Disinfection measures are not carried out at the source of infection.

What is infectious mononucleosis? We will discuss the causes, diagnosis and treatment methods in the article by Dr. P. A. Aleksandrov, an infectious disease specialist with 11 years of experience.

Definition of disease. Causes of the disease

Infectious mononucleosis(Filatov's disease, glandular fever, "kissing disease", Pfeyer's disease) is an acute infectious disease caused by the Epstein-Barr virus, which affects circulating B lymphocytes, disrupting cellular and humoral immunity. Clinically characterized by a syndrome of general infectious intoxication of varying severity, generalized lymphadenopathy, tonsillitis, enlarged liver and spleen and pronounced specific changes in the hemogram.

Etiology

The disease was first described in 1884 by Filatov and in 1889 by Pfeier. In 1964, the causative agent of the disease was isolated (Michael Anthony Epstein and Yvonne Barr).

The virus belongs to the kingdom of viruses, the herpesvirus family, the subfamily of gamma viruses, the species is the Epstein-Barr virus (type 4). It is a B-lymphotropic virus with affinity and tropism for CD-21. Contains double-stranded DNA, the nucleocapsid is enclosed in a lipid-containing shell. Contains several main antigens - capsid (VCA), nuclear (EBNA), early (EA), membrane (MA). It can persist in the body for a long time (lifelong). Plays an etiological role in the development of Burkitt's lymphoma and nasopharyngeal carcinoma in immunocompromised individuals (mainly in residents of the African continent). The virus is not resistant to temperatures above 60℃, ultraviolet radiation, disinfectants, and is not resistant to low temperatures and drying.

Epidemiology

The source of infection is a sick person with manifest and latent forms of the disease, but mainly virus carriers who do not have any obvious signs of the disease (both clinically and laboratory).

Transmission mechanisms:

airborne (aerosol);
contact (through saliva - “kissing disease”);
blood contact (parenteral, sexual);
vertical (transplacental).

The virus can be excreted up to 18 months after the initial infection, mainly with saliva, then the possibility of excretion is significantly reduced and depends on the specific conditions in which the life of the infected person occurs (diseases, injuries, taking drugs that reduce immunity). The maximum frequency of infection occurs at the age of 10-18 years, and the earlier it occurs (with the exception of early childhood), the less pronounced clinical manifestations correspond to the manifestation of the disease. An increase in incidence occurs in the winter-spring period and is associated both with a decrease in the general resistance of the body, team cohesion, and, to a large extent, with an increase in hormonal levels and romantic attraction of young people. By the age of 25, more than 90% of the world’s population have markers of infection with the virus (i.e., they are EBV-infected), with the vast majority without any obvious health problems, which, apparently, should be considered an absolutely normal state of the human body of appropriate age groups categories. The immunity is stable (protects against repeated infections and exacerbations), the mortality rate is low.

Symptoms of infectious mononucleosis

The incubation period is from 4 to 15 days, according to some sources - up to 1 month.

Characteristic syndromes:

general infectious intoxication;
organ damage (generalized lymphadenopathy);
tonsillitis (is the main one in the typical form of the disease);
hepatolienal (enlarged liver and spleen);
changes in hemogram (mononucleosis syndrome);
exanthema (more often when using antibiotics);
pigment metabolism disorders (jaundice);
hospital withdrawal.

The onset of the disease is gradual (i.e., the main syndrome appears later than 3 days from the onset of clinical manifestations). Fever gradually appears and increases with an increase in body temperature to 38-39 ℃, lasting up to 3 weeks or more, weakness, lack of appetite. Myalgia is not typical. Lymph nodes of different groups symmetrically enlarge, mainly posterior cervical, anterior cervical, occipital, in some patients the axillary, elbow, inguinal, intra-abdominal (mesadenitis) are also involved. A characteristic feature is their low pain, soft elasticity, and the absence of changes in the covering tissue. The increase in size persists for up to 1 month or more and often leads to significant differential diagnostic difficulties. After a certain initial period, in typical cases, acute tonsillitis develops (lacunar, ulcerative necrotic) with abundant white, dirty gray cheesy deposits, easily crumbled and removed with a spatula and rubbed on glass. Sore throat is moderate.

In a certain percentage of cases, periorbital edema develops, manifested by bilateral transient swelling of the eyelids. Almost always there is an enlargement of the spleen, which is characterized by smoothness, elasticity, and sensitivity to palpation. Sometimes reaching large sizes, the spleen can rupture. Normalization of its value occurs no earlier than 4 weeks from the onset of the disease, and may take several months. With a slightly lower frequency, liver enlargement occurs, accompanied by disruption of its function and the development of hepatitis of varying severity (benign course).

If the symptoms are misinterpreted and antibiotics of the aminopenicillin series are used, in 70-80% a rash appears (can be spotted, maculopapular, bright red, with a tendency to merge, of different localization, without obvious stages of appearance). When infected in early childhood, the course of the disease is usually asymptomatic or minimally symptomatic and often passes under the guise of a mild acute respiratory infection.

With an adequate immune response, the course of the disease is usually benign and ends with the formation of virus carriage, in the complete absence of symptoms and laboratory changes. In rare cases of congenital or acquired immunodysfunctions, immunosuppressive diseases, or taking cytostatic drugs, the so-called reactivation type may form or develop. “chronic mononucleosis”, which occurs cyclically with periods of exacerbations and remissions. The clinical picture of this disease includes almost all syndromes of the acute process, but they are much less pronounced, often in the absence of tonsillitis and withdrawal syndrome comes to the fore. Due to the fact that this condition is not an independent disease, but only a consequence of the existing underlying immunopathological process, it should be understood not as mononucleosis, but as a chronic active Epstein-Barr viral infection and accordingly approach examination and treatment taking this position into account.

The possibility of transplacental transmission of EBV during primary infection in pregnant women and the development of congenital EBV infection in a newborn, manifested in the form of multiple organ damage to internal organs, the frequency and severity depending on the timing, have been proven.

Pathogenesis of infectious mononucleosis

The entrance gate is the mucous membrane of the oropharynx and upper respiratory tract. By multiplying in epithelial cells, the virus causes their destruction, then new EBV virions and inflammatory mediators are released into the blood, which causes viremia and generalization of the infection, including the accumulation of the virus in the lymphoid tissue of the oropharynx and salivary glands, and the development of intoxication syndrome. Due to the tropism of EBV for CD-21 B-lymphocytes, the virus invades them, but does not destroy them, but causes them to proliferate, i.e., acts as a B-cell activator. Violations of cellular and humoral immunity develop, which leads to severe immunodeficiency, resulting in a layering of bacterial flora (purulent tonsillitis). Over time, T-lymphocytes (CD-8), which have suppressor and cytotoxic activity, are activated, atypical mononuclear cells appear, which leads to suppression of the virus and the transition of the disease to the inactive carriage phase. EBV has a number of properties that allow it to evade the immune response to a certain extent, which is especially pronounced during chronic active infection.

In some cases, with a defective (absent, incomplete) T-reaction, the proliferation of B-lymphocytes becomes uncontrolled, which can lead to the development of a lymphoproliferative disease (lymphoma).

Classification and stages of development of infectious mononucleosis

1. According to clinical form:

a) typical;

b) atypical;

icteric (with the development of severe liver damage);
exanthema (with the use of aminopenicillin antibiotics);
specific (loss of one of the syndromes, for example, complete absence of tonsillitis);
erased (mild clinical picture);
asymptomatic (complete absence of clinical symptoms);

2. With the flow:

uncomplicated;
complicated;

3. By severity:

light;
average;
severe (toxic).

Complications of infectious mononucleosis

A) specific

rupture of the spleen (rarely occurs with significant enlargement of the spleen and impacts in this area);
Duncan syndrome (a rare X-linked lymphoproliferative syndrome, manifested by recurrent mononucleosis-like symptoms, accompanied by the development of hepatitis, nephritis, hemophagocytic syndrome, interstitial pneumonia, hemovasculitis. Most often, with progression, it ends in death);

b) nonspecific

Diagnosis of infectious mononucleosis

Laboratory diagnostics

detailed clinical blood test (first leukopenia, then hyperleukocytosis, absolute and relative neutropenia, lymphocytosis, monocytosis. Slight transient thrombocytopenia is characteristic. The most specific sign of the disease is the appearance of atypical mononuclear cells - these are altered large T-lymphocytes with a lobulated nucleus. Their number is considered diagnostic - 10% and more);
general clinical urine analysis (changes are uninformative and indicate the degree of intoxication);
biochemical blood tests (increased ALT and AST, sometimes total bilirubin. It should be understood that an increase in ALT and AST is part of the manifestation of the disease and is not always bad - this is a protective reaction of the body, manifested in increased energy production);
serological reactions (the most important in modern practice are methods for detecting antibodies of various classes to EBV antigens using ELISA and nucleic acids of the pathogen itself in a PCR reaction (blood!). It is especially worth noting that The detection of only class G antibodies to the nuclear, capsid and early proteins of the virus in the absence of class M antibodies (and even more so characteristic clinical and general laboratory signs of EBV infection) is not a reason for diagnosing active (persistent) EBV infection and prescribing expensive treatment, This is what many unscrupulous medical “dealers” do. Previously used methods based on agglutination reactions, such as the Hoff-Bauer reaction, HD/PBD (Hengenuciu-Deicher/Paul-Bunnell-Davidson) are currently not used in the civilized world as they are uninformative, labor-intensive and low-specific, leaving us only a legacy in in the form of beautiful sonorous names.

Treatment of infectious mononucleosis

The location and treatment and protective regimen depend on the severity of the process and the presence or absence of complications. Patients with mild forms of the disease may well be treated at home, moderate and more severe - in an infectious diseases hospital, at least until the process normalizes and tendencies towards recovery appear.

The purpose of table No. 15 (common table) for mild forms or No. 2 according to Pevzner (liquid and semi-liquid dairy-vegetable food, not containing extractives, rich in vitamins, low-fat meat broths, etc.), plenty of drink up to 3 l / days (warm boiled water, tea).

The question of the specific effect on EBV in acute disease is quite controversial. Etiotropic therapy is indicated only for patients with moderate (with a tendency to protracted course and complications) and severe forms of the disease. Due to the fact that its capabilities are quite limited by the lack of a highly effective direct antiviral agent (drugs based on acyclovir and derivatives that have only a partial effect on EBV are used) and the frequent development of herpes viral hepatitis, their prescription should be weighed and justified in each specific case. The use of immunomodulators at the height of the disease should be considered inappropriate, since their action is nonspecific, poorly predictable, and with the development of an immunopathological hyperproliferative process during EBV infection can lead to unpredictable consequences. On the contrary, in the recovery phase, their intake can speed up the process of returning immune homeostasis to normal.

With the development of bacterial complications (tonsillitis), antibiotics are indicated (excluding the aminopenicillin series, sulfonamides, chloramphenicol, since they can cause the development of rashes and inhibit hematopoiesis). In some cases, their use may be justified when severe immunodeficiency (absolute neutropenia) is detected, even in the absence of an obvious purulent process.

Pathogenetic therapy includes all the main links of the general pathological process: reduction of elevated body temperature, multivitamins, hepatoprotectors according to indications, detoxification, etc.

In severe forms, it is possible to prescribe glucocorticosteroids and carry out a complex of resuscitation measures.

Forecast. Prevention

Those who have recovered from infectious mononucleosis are subject to medical observation for a period of 6 months (in cases of severe disease - up to 1 year). In the first month, every 10 days an examination by an infectious disease specialist, a clinical blood test with a leukocyte formula, and ALT are indicated. Further, when the indicators are normalized, examination once every 3 months until the end of the observation period, including blood tests, 2-fold testing for HIV and ultrasound of the abdominal organs at the end of the observation period.

Due to the risk of complications, it is necessary to limit physical activity and sports for up to 6 months. (depending on the severity of the disease), a ban on travel to countries and regions with hot climates for up to 6 months. (depending on laboratory test data).

In terms of preventing primary infection and the development of a chronic disease (given the universal nature of infection), we can only recommend maintaining a healthy lifestyle, avoiding drug use and risky sexual behavior, and engaging in physical exercise and sports.

There is no specific prevention; experiments with a vaccine are underway.

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