Chronic mononucleosis in adults

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Infectious mononucleosis

General information

Infectious mononucleosis - what is it?

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

Table of contents:

What kind of disease is mononucleosis, as Wikipedia points out, was first told to the world in 1885 by the Russian scientist N.F. Filatov and initially called it idiopathic lymphadenitis. It is currently known that it is caused by the herpes virus type 4 (Epstein-Barr virus), which affects lymphoid tissue.

How is mononucleosis transmitted?

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

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

Is it possible to get mononucleosis again?

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

Causes of infectious mononucleosis in children

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

Infectious mononucleosis in children, photo

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

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

  • atypical mononucleosis - its symptoms in children and adults are associated with a stronger severity of symptoms than usual (for example, the temperature can rise to 39.5 degrees or the disease can occur without fever at all); diet should be a mandatory component of treatment for this form due to the fact that atypical mononucleosis tends to cause severe complications and consequences in children;
  • chronic mononucleosis, described in the section of the same name, is considered as a consequence of the deterioration of the patient’s immune system.

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

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

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

Mononucleosis in adults

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

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

Infectious mononucleosis, symptoms

Symptoms of mononucleosis in children

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

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

Rash due to mononucleosis, photo

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

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

Symptoms of mononucleosis in adults

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

Hepatosplenomegaly in children and adults

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

Symptoms of a diseased spleen in humans:

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

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

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

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

How to treat the spleen?

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

Chronic mononucleosis

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

Symptoms of the chronic form:

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

Diagnosis of the disease

To confirm mononucleosis, the following studies are usually prescribed:

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

Broad plasma lymphocytes and atypical mononuclear cells

Mononuclear cells and wide-plasma lymphocytes - what are they and are they the same thing?

Broad plasma lymphocytes in a child, photo

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

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

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

Mononuclear cells in the blood of a child, photo

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

Additional laboratory diagnostics

To make the most accurate diagnosis in difficult cases, a more accurate test for mononucleosis is used: the titer of antibodies to the Epstein-Barr virus is studied or a PCR (polymerase chain reaction) test is prescribed. Deciphering a blood test for mononucleosis and a general analysis (in children or adults has similar assessment parameters) of blood with the indicated relative amount of atypical mononuclear cells makes it possible to confirm or refute the diagnosis with a high degree of probability.

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

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

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

Infectious mononucleosis, treatment

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

Treatment of infectious mononucleosis in children, as well as symptoms and treatment of Epstein-Barr virus in adults, are not fundamentally different. The approaches and drugs used for therapy are in most cases identical.

Symptoms of Epstein-Barr virus

There is no specific treatment for the described disease, nor is there a general treatment regimen or antiviral drug that could effectively fight the virus. As a rule, the disease is treated on an outpatient basis; in severe clinical cases, the patient is placed in a hospital and prescribed bed rest.

Indications for hospitalization include:

Treatment of mononucleosis is carried out in the following areas:

  • prescription of antipyretic drugs (Paracetamol or Ibuprofen are used for children);
  • the use of local antiseptic drugs for the treatment of mononucleosis sore throat;
  • local nonspecific immunotherapy with IRS 19 and Imudon;
  • prescription of desensitizing agents;
  • vitamin therapy;
  • if liver damage is detected, choleretic drugs and hepatoprotectors are recommended, and a special diet is prescribed (therapeutic table-diet No. 5);
  • it is possible to prescribe immunomodulators (Viferon, Anaferon, Imudon, Cycloferon) together with antiviral drugs to obtain the greatest effect;
  • antibiotics for mononucleosis (Metronidazole tablets) are prescribed to prevent the development of microbial complications in the presence of intense inflammation of the oropharynx (penicillin antibiotics for infectious mononucleosis are not prescribed due to the high likelihood of severe allergies);
  • while taking antibiotics, probiotics are used together (Narine, Acipol, Primadofilus);
  • in case of development of a severe hypertoxic form of the disease with a risk of asphyxia, a 7-day course of Prednisolone is indicated;
  • in case of severe swelling of the larynx and the development of breathing difficulties, it is recommended to perform a tracheostomy and transfer the patient to artificial ventilation;
  • if a splenic rupture is diagnosed, splenectomy is performed on an emergency basis (the consequences of a splenic rupture without qualified assistance can be fatal).

Prognosis and consequences of mononucleosis

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

Timely prediction of mononucleosis

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

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

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

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

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

Risks during pregnancy

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

When infected with a virus during pregnancy, there is a very high probability of infection of the fetus, which may subsequently be the root cause of lymphadenopathy, prolonged low-grade fever, chronic fatigue syndrome and hepatosplenomegaly in the child.

Education: Graduated from Vitebsk State Medical University with a degree in Surgery. At the university he headed the Council of the Student Scientific Society. Advanced training in 2010 - in the specialty "Oncology" and in 2011 - in the specialty "Mammology, visual forms of oncology".

Work experience: Worked in a general medical network for 3 years as a surgeon (Vitebsk Emergency Hospital, Liozno Central District Hospital) and part-time as a district oncologist and traumatologist. Worked as a pharmaceutical representative for a year at the Rubicon company.

Presented 3 rationalization proposals on the topic “Optimization of antibiotic therapy depending on the species composition of microflora”, 2 works took prizes in the republican competition-review of student scientific works (categories 1 and 3).

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Infectious mononucleosis in adults, symptoms, treatment, causes

Infectious mononucleosis (Filatov's disease) is an acute infectious disease characterized by fever, tonsillitis, lymphadenopathy, enlargement of the liver and spleen, as well as a mononuclear blood reaction.

Infectious mononucleosis is characterized by changes in leukocytes in the blood and the development of reactive lymphadenitis with enlargement of the lymph nodes and spleen.

This disease is caused by several viruses, including herpes viruses. The source of infection is a sick person; infection occurs through airborne droplets or household contact (with saliva during a kiss, through tableware) routes. There have been cases of transmission of this infection through blood transfusions. In general, the peak incidence of infectious mononucleosis occurs during the cold period of the year. According to statistics, children and young people are more likely to suffer from it; This disease often occurs in children's and youth groups, becoming a group disease.

Infectious mononucleosis has many other names - glandular fever, Filatov's disease, Pfeiffer's disease, monocytic tonsillitis.

Like all infectious diseases, infectious mononucleosis begins with an incubation period, which usually lasts 4-12 days, but sometimes extends to 40 days.

According to the clinical course, the following forms of infectious mononucleosis are distinguished: typical, atypical (erased, asymptomatic).

The disease occurs in all countries in the form of sporadic cases or small outbreaks (usually in spring and autumn). Adolescents and young adults are most often affected. Transmission is carried out by airborne droplets.

Causes of mononucleosis in adults

Etiology, pathogenesis. The causative agent is considered to be a virus, but its properties have not been studied enough. It has the ability to selectively affect the reticuloendothelial system, especially the lymph nodes, which results in their hyperplasia. Irritation and increased mitotic activity of lymphoreticular tissue are observed. A large number of atypical mononuclear cells enter the peripheral blood. Infiltration of mononuclear cells can be observed in the liver, as well as in the spleen and other organs. The layering of secondary bacterial flora is important.

Symptoms, course of infectious mononucleosis

As a rule, body temperature rises to 38.5-39.5 ° C; This is followed by a sore throat when swallowing. In the patient’s throat you can see reddened, hyperemic and loosened tonsils covered with a gray coating; Enlarged anterior and posterior cervical lymph nodes can be found on the neck. Thus, the signs of infectious mononucleosis resemble a sore throat. Upon closer examination of the patient, an increase in the inguinal and axillary lymph nodes can be observed. In addition, this disease is characterized by an enlarged liver and spleen, as well as changes in the picture of peripheral blood - leukocytosis (increased number of white blood cells). The patient complains of malaise, headache, sore throat when swallowing, as well as pain in muscles and joints.

Incubation lasts about a week (4 to 13 days). The disease often begins acutely. Fever and symptoms of intoxication quickly increase and reach their maximum severity within 2-4 days. Patients complain of headache, weakness, weakness, pain when swallowing, pain in muscles and joints. The temperature reaches 38-40°. The temperature curve is of an irregular type, sometimes wavy (two-wave), the duration of fever is 1-3 weeks. Some patients experience prolonged low-grade fever with moderate symptoms of intoxication.

Tonsillitis in infectious mononucleosis can be catarrhal, follicular, ulcerative-necrotic, pseudomembranous, sometimes resembling changes in the pharynx in diphtheria. Sometimes tonsillitis appears only on the 4-7th day from the onset of the disease. Enlargement and tenderness of the lymph nodes are constant signs (in 90-95% of patients). The maxillary and posterior cervical lymph nodes are constantly affected, and less commonly the axillary, elbow, inguinal and femoral lymph nodes. Great difficulties sometimes arise when the mesenteric lymph nodes are affected. In 25% of patients, exanthema is observed (maculopapular, roseola, rubella-like, less often scarlet-like). Enlargement of the liver and spleen is observed in almost all patients (usually from the 3-5th day of illness) and lasts 3-4 weeks. Liver damage is especially pronounced in the so-called icteric forms of infectious mononucleosis. Changes in peripheral blood are manifested by moderate leukocytosis (9000 in 1 mm 3) and mononuclear blood reaction. The number of mononuclear elements (lymphocytes, monocytes, atypical mononuclear cells) reaches 70-85%. Mononuclear reaction can last 3-6 months.

Recognizing mononucleosis in adults

Recognition is based on characteristic clinical data (fever with symptoms of intoxication, lymphadenopathy, changes in the pharynx, enlargement of the liver and spleen, mononuclear blood reaction). For serological confirmation of the diagnosis, the sheep erythrocyte agglutination reaction (Paul-Bunnell reaction) is used, the diagnostic titer of which is considered to be 1:32 or higher. However, this reaction is not specific. Of greater importance is the formulation of the Hangenutiu-Deicher-Paul-Bunnel-Davidson (HD/PBD) reaction. It is considered positive when adsorption of anti-sheep antibodies is observed with an extract from bovine red blood cells and there is no adsorption when using a guinea pig kidney extract.

Treatment of infectious mononucleosis in adults

First of all, the patient is prescribed bed rest, plenty of fluids, vitamins, antipyretic and antibacterial drugs. Antibiotics are used

penicillin groups (cefazolin, cephalexin); antiseptics, for example iodinol - a long-acting iodine preparation. In this case, it is used to wash the tonsils (4-5 washes in 2-3 days). Caution should be exercised as a side effect of this drug is iodism. Furacilin, which has antimicrobial activity against a number of pathogenic bacteria, can be used as an antiseptic and antibacterial agent for rinsing the oropharynx. It is mainly used for purulent-inflammatory processes. The pharmacy chain may offer you a solution of furatsilin ready for gargling. A contraindication to its use is hypersensitivity to nitrofuran derivatives.

A complex of vitamins and symptomatic medications are prescribed. If there are pronounced changes in the pharynx, antibiotics (penicillin, tetracyclines) can be used to suppress the layered microbial infection. In severe forms (high fever, toxicosis, significant changes in the pharynx, jaundice), steroid hormones (cortisone, prednisone, prednisolone) can be recommended in medium doses (prednisolone 20-25 mg per day) for 5-10 days.

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Features of treatment and prevention of chronic mononucleosis

Infectious mononucleosis is a disease caused by a virus that was discovered in 1964 by English virologists: Professor M.E. Epstein and his assistant I. Barr. This pathogen was named after scientists, the disease itself is Epstein-Barr viral infection (EBV). Its synonyms are multiglandular adenosis, benign lymphoblastosis, monocytic tonsillitis, Filatov's disease. Infectious mononucleosis occurs in an acute form, but under certain conditions it can become chronic.

Chronic mononucleosis etiology

Any chronic process is preceded by the onset of the disease - an acute period when primary infection occurs and the initial manifestations of the disease appear.

In childhood and adolescence, 50% of people become infected with the Epstein-Barr virus, suffer acute mononucleosis and become carriers of the infection for life. By the age of forty, 90% of the world's population have an immune response to this infection.

EBV is an oncogenic herpes virus type 4. 1% of all neoplasms can be provoked by this microorganism: various lymphomas, carcinoma of the stomach, liver, salivary glands, thymus gland, lymphogranulomatosis.

Read more about chronic mononucleosis in our video:

Causes, provoking factors

EBV infection occurs from a sick person or a carrier of the virus. The transmission route is airborne and household contact. It can be hematogenous - through transfusion of donor blood and its preparations.

EBV infects new cells, which prolongs the healing process. The long stay of the virus in the body, penetration into the DNA of the cell, makes it inaccessible to immune bodies that destroy infectious agents.

This is one of the mechanisms for the formation of chronic mononucleosis. The virus can be in transformed cells in a dormant state (latent) - this is characteristic of EBV carriage. There are factors that reduce the strength of the immune response: chronic infections, xenobiotics, taking chemotherapy drugs, corticosteroids, disruption of the endocrine system.

The force restraining the virus from reproducing weakens, and it goes from a dormant state to an active one, triggering a mechanism that destroys the lymphocytic system. If the patient has dysfunction of the immune system (dysregulation of cytokines), a chronic process with relapses of the disease may develop.

Symptoms

In adults

The latent period of the disease (when the virus enters the body but does not yet multiply) lasts from 30 to 40 days. At this time, a person may feel increased fatigue, poor general health, and muscle pain.

After this period, the active manifestation of symptoms of infectious mononucleosis begins (acute course), at this time patients are concerned about:

The fever has an undulating course and can last for 7-20 days. Symptoms of tonsillitis are observed from the first days of the disease and may coincide in time with the onset of the rash. The rash is similar to that of measles, is localized on the face, torso, and limbs, and is pink in color. Usually it lasts 2-3 days and disappears without a trace.

Infectious mononucleosis can occur in typical and atypical forms. In mild, moderate and severe degrees. It has an acute, protracted and chronic course. If for 6 months or more after suffering an acute process the patient is concerned about:

  • Periodic or constant low-grade fever with moments of temperature rising to febrile levels.
  • Decreased performance, increased fatigue, sweating.
  • Sore throat, cough, discomfort.
  • Lymphadenitis.
  • Pain in the projection of the liver - under the right rib, jaundice.
  • Depression.
  • Periodic headaches.
  • Skin rashes.

You can think about chronic mononucleosis. It differs from a relapse of the disease in that there is no recovery - the disease drags on for a long period. This is a chronic active EBV infection (CA EBV).

With a latent course of chronic mononucleosis, patients may be concerned about:

  • Long-term low-grade fever.
  • Muscle and joint pain.
  • Frequent infections of the genitals and other mucous membranes that respond poorly to treatment or become chronic.
  • Weakness, decreased performance.
  • Prolonged sore throat.
  • Liver dysfunction.

What is mononucleosis, says Dr. Komarovsky:

In children

In children, 60% of infections are asymptomatic. The older the child, the greater the likelihood of clinical manifestations of this disease. In adolescence, the disease occurs in the form of infectious mononucleosis, which is especially difficult to tolerate after 24 years of age.

Children suffer from Epstein-Barr viral infection more often; the clinical manifestations of the disease are the same as in adults, but can occur in a mild form or with cold symptoms. In many children, infection occurs unnoticed. A clear clinical picture is observed during school and adolescence.

The photo shows the main signs of mononucleosis

Diagnostics, research methods

Diagnosis of Epstein-Barr viral infection is aimed at interviewing and examining the patient, conducting laboratory and special research methods. It is necessary not only to make a diagnosis, it is necessary to determine the form of the disease, its severity, and predict possible complications.

  1. Upon examination, specialists may see inflamed tonsils and follicular hyperplasia on the back wall of the pharynx. Tonsillitis can occur in catarrhal, lacunar or ulcerative-necrotic forms. Lasts up to two weeks, the enlargement of the tonsils reaches 2-3 degrees, adenoiditis may occur.
  2. Lymph node syndrome is characteristic of all forms of typical mononucleosis. It manifests itself as lymphadenopathy of various groups of lymph nodes, most often the cervical ones. Can be generalized - all groups are affected. Accompanied by lymphatic edema.
  3. In most patients, from the second week of the disease, the liver and spleen enlarge; this condition may be accompanied by jaundice and increased levels of liver enzymes.
  4. On the fifth or tenth day of illness (in 10-20% of cases), exanthema may appear - a papular pink rash on the skin. Lasts about a week, disappears without a trace.

When conducting laboratory diagnostics of the acute form of the disease, changes in blood tests characteristic of this disease can be detected:

  1. Atypical mononuclear cells.
  2. Lymphomonocytosis - an increase in the number of monocytes.
  3. Heterophilic antibodies and their growth.
  4. In the acute period, IgM VCA with subsequent disappearance after 1-1.5 months.
  5. IgG EA increases from the first weeks of the disease and is determined throughout life at a low level.
  6. IgG VCA is determined several weeks after the onset of the acute process, increases, and is determined at a low level throughout life.
  7. IgG EBNA appears several weeks after the onset of the disease and is detected throughout life at a low level.
  8. Viral DNA in blood and saliva.
  9. EBV antigen in blood and saliva.
  10. Increased levels of transaminases, alkaline phosphatase, total protein, bilirubin.

Be sure to test your urine and blood for CRP.

If there are doubts about the diagnosis and it is necessary to find differences from blood diseases, they may suggest performing a sternal puncture or bone marrow examination.

In cases of chronic infectious mononucleosis, the following is detected:

  1. Increased level of serum interferon;
  2. impairment of the ability of antibodies to bind to a foreign cell (antibody avidity);
  3. increasing the number of CECs;
  4. decrease – DR+ lymphocytes;
  5. often this form of the disease is accompanied by anemia, disorders of the blood coagulation system, hemophagocytic syndrome (the body’s own body begins to destroy its own blood cells);
  6. in this form of the disease, viral DNA can be determined by PCR in saliva, blood lymphocytes, biopsy samples of the intestinal mucosa, lymph nodes, and liver;

EBV can be detected in carriers of the infection, but when using a method with low sensitivity (100 copies), it can only be detected in patients with chronic mononucleosis.

The principle of treatment of mononucleosis

Treatment

General recommendations

When the diagnosis is known accurately, the severity of the disease and its form are determined, therapeutic measures are recommended. Patients with moderate and severe forms of the disease, with complications of the disease and for epidemic indications (any severity of the disease) are hospitalized in infectious diseases departments.

In the acute period of the disease and during exacerbation of the chronic process, bed rest, personal hygiene measures and diet are recommended: easily digestible food rich in vitamins and proteins. These can be lactic acid products, low-fat fish, meat, juices, compotes, fruit and milk jelly. Food should be pureed or liquid and served warm.

Medication

For the treatment of chronic mononucleosis, a system of medication measures has been developed aimed at reducing the manifestations of symptoms of the disease, strengthening the immune system, and suppressing the replication of the virus.

  • At high temperatures, Paracetamol and Ibuprofen are recommended.
  • To relieve the symptoms of tonsillitis - gargling with Furacilin solution, sucking Lisobakt, Strepsils, Decatylene lozenges.
  • Multivitamins.
  • Immunotherapy agents: alpha interferons, immunoglobulins, interferon inducers, thymus hormone analogues.
  • Antiviral drugs: Acyclovir.
  • If there is a bacterial infection, antibiotic therapy is recommended.
  • Laryngeal edema is treated with hormonal medications.
  • If detoxification is necessary, electrolyte solutions, Dextrose, Hemodez, and Reosorbilact are used.
  • For the treatment of catarrhal syndrome, Acetylcysteine ​​and Fenspiride are recommended.

Treatment is selected strictly individually, depending on concomitant diseases, the patient’s age, his condition at the time of seeking help, the form of the disease, and drug tolerance.

Folk remedies

Folk remedies can only treat mild forms of infectious mononucleosis with low fever, catarrhal tonsillitis, without enlarged lymph nodes. Viburnum and raspberry teas, honey, and natural vitamins are usually used. Thermal procedures are not recommended.

Physiotherapy for infectious mononucleosis is not used.

How to treat mononucleosis, watch our video:

Possible complications

With infectious mononucleosis, complications are rare but can be severe. On the part of the hematopoietic organs, autoimmune hemolytic anemia, thrombocytopenia and agranulocytopenia develop. From the central nervous system, the disease can lead to encephalitis, paralysis, polyneuritis, meningoencephalitis, and psychosis.

Prevention

Preventive measures are limited to isolating the patient at home in a separate room or in a hospital in a separate box for the entire duration of the disease (on average a day) in the acute form. Separate dishes and care items are provided.

No special disinfection is performed at the source of infection. Persons in contact with the sick person are not subject to quarantine. There is no specific prevention for this disease. Prevention of chronic mononucleosis - a healthy lifestyle, strengthening the immune system.

How to get infected with mononucleosis

Forecast

As a rule, the prognosis for recovery from acute mononucleosis is favorable. In rare cases, hemophagocytic syndrome may develop. In patients with immunodeficiencies, the development of meningitis, myocarditis, hepatitis, and pneumonia is possible.

In 80% of cases of complex treatment of chronic mononucleosis, it is possible to achieve long-term remission of the disease, and in some cases, suppression of virus replication. If necessary, maintenance therapy can be carried out.

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Mononucleosis, symptoms and treatment of infectious mononucleosis

In 1885, for the first time among acute lymphadenitis, Russian pediatrician I. F. Filatov identified an infectious disease described as idiopathic inflammation of the cervical glands. For a long time, experts refused to consider this pathology as a separate nosological form, regarding the 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 whom it was named. Other names for the disease: monocytic tonsillitis, glandular fever, Pfeiffer's 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 oro- and nasopharynx, the development of a febrile state, 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 low-contagious lymphotropic Epstein-Barr virus (EBV), which belongs to the family of herpetic viruses. It has opportunistic and oncogenic properties, contains 2 DNA molecules and is capable, like other pathogens of this group, of persisting in the human body for life, being released from the oropharynx into the external environment for 18 months after the initial infection. The vast majority of adults have heterophilic antibodies to EBV, which confirms chronic infection with this pathogen.

The virus enters the body along with saliva (which is why some sources call infectious mononucleosis the “kissing disease”). The primary site of self-reproduction of viral particles in the host body is the oropharynx. After damage to the lymphoid tissue, the pathogen invades 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 introduction, 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 the peripheral blood. Having a proliferative effect, the Epstein-Barr virus promotes the active proliferation of B lymphocytes, which in turn stimulate an intense immune response from CD8+ and CD3+ T lymphocytes.

Routes of transmission

Epstein-Barr virus is a ubiquitous member of the herpevirus family. Therefore, infectious mononucleosis can be found in almost all countries of the world, usually in the form of sporadic cases. Outbreaks of infection are often recorded in the autumn-spring period. The disease can affect patients of any age, but children, adolescent girls and boys most often suffer from infectious mononucleosis. Infants get sick quite rarely. After suffering an illness, almost all groups of patients develop lasting 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 latent (asymptomatic) forms of the disease. The virus is transmitted by airborne droplets or through infected saliva. In rare cases, vertical infection (from mother to fetus), infection during transfusion and during sexual intercourse is possible. There is also an assumption that EBV can be transmitted through household items and the nutritional (water-food) route.

Symptoms of acute infectious mononucleosis

On average, 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, and sore throat. Gradually, the negative symptoms intensify, the body temperature rises, signs of sore throat appear, nasal breathing becomes difficult, and the cervical lymph nodes become swollen. As a rule, by the end of the first week of the acute period of the disease, there is an enlargement of 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, pasty (swelling) eyelids, swelling of the neck tissue and skin rashes (maculopapular rash) are observed.

One of the most characteristic symptoms of the disease is damage to the oropharynx. The development of the inflammatory process is accompanied by enlargement 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 with a half-open mouth, making characteristic “snoring” sounds. It should be noted that with infectious mononucleosis, despite severe nasal congestion, 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 as the disease develops, the mucous membrane of the inferior turbinate is damaged (posterior rhinitis). At the same time, the pathological condition is characterized by swelling and hyperemia of the posterior pharyngeal wall and the presence of thick mucus.

In the majority of infected children (about 85%), the palatine and nasopharyngeal tonsils are covered with plaque. In the first days of the disease they are solid, and then take on the appearance of stripes or islands. The occurrence of plaque is accompanied by a deterioration in general condition and an increase in body temperature to 39-40°C.

Enlargement of the 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 values ​​on days 4-10. It is also possible to develop moderate jaundice 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 completely normalized; less often, the organ remains enlarged for three months.

The spleen, like the liver, reaches its maximum size on days 4-10 of illness. By the end of the third week, in half of the patients it is no longer palpable.

The rash that appears at the height of the disease can be urticarial, hemorrhagic, morbilliform and scarlet fever. Sometimes petichial exanthemas (point hemorrhages) appear at the border of the hard and soft palate. You see a photo of a rash with infectious mononucleosis on the right.

There are no significant changes observed in the cardiovascular system. Systolic murmur, muffled heart sounds and tachycardia may occur. As the inflammatory process subsides, negative symptoms usually disappear.

Most often, all signs of the disease disappear after 2-4 weeks (sometimes after 1.5 weeks). At the same time, normalization of the size of enlarged organs may be delayed by 1.5-2 months. It is also possible for a long time to detect atypical mononuclear cells in a general blood test.

In childhood, chronic or recurrent mononucleosis does not occur. The prognosis is favorable.

Symptoms of chronic mononucleosis

This form of the disease is typical only for adult patients with weakened immune systems. This may be caused by certain diseases, long-term use of certain medications, or severe or constant stress.

Clinical manifestations of chronic mononucleosis can be quite varied. Some patients experience an enlarged spleen (less pronounced than during the acute phase of the disease), enlarged lymph nodes, and hepatitis (inflammation of the liver). Body temperature is usually normal or low-grade.

Patients complain of increased fatigue, weakness, drowsiness, or sleep disturbances (insomnia), muscle pain and headaches. Occasionally, abdominal pain, occasional nausea and vomiting are observed. Often, the Epstein-Barr virus is activated in individuals infected with types 1-2 of herpesvirus. In such situations, the disease occurs with periodic painful rashes on the lips and external genitalia. In some cases, the rash may spread to other areas of the body. There is an assumption that the causative agent of infectious mononucleosis is one of the causes of the development 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;
  • Splenic rupture;
  • Meningitis with a predominance of mononuclear cells in the cerebrospinal fluid;
  • Paralysis;
  • Transverse myelitis;
  • Acute flaccid paralysis with protein-cell dissociation in the cerebrospinal fluid (Guillain-Baré syndrome);
  • Psychosensory disorders;
  • Interstitial pneumonia;
  • Hepatitis;
  • Myocarditis;
  • Hemolytic and aplastic anemia;
  • Thrombocytopenic purpura.

Diagnosis of infectious mononucleosis in adults

Laboratory blood tests play a major role in making a diagnosis. A general clinical analysis reveals moderate leukocytosis, and the leukocyte formula shows wide-plasma lymphocytes (atypical mononuclear cells). Most often they are discovered at the height of the 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, ranges from 5 to 50% (or more).

During serological diagnostics, heterophilic antibodies belonging to class M immunoglobulins are detected in the blood serum.

What diseases can infectious mononucleosis be confused with?

Infectious mononucleosis should be differentiated from:

  • ARVI of adenoviral etiology with severe 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 adenoviral etiology, characterized by the presence of pronounced mononuclear syndrome. In this situation, distinctive signs include conjunctivitis, runny nose, cough and wheezing in the lungs, which are not characteristic of glandular fever. The liver and spleen also rarely enlarge during ARVI, and atypical mononuclear cells can be detected in small quantities (up to 5-10%) once.

In this situation, the final diagnosis is made only after serological tests.

Note: the clinical picture of infectious mononucleosis developing 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, pasty eyelids, puffiness of the face, wheezing breathing, and polyadenia (inflammation of the lymph glands) are often observed. The first three days are characterized by the appearance of a sore throat with plaque on the tonsils, skin rashes and an increase in the leukocyte formula of segmented and band neutrophils. When performing serological reactions, positive results occur much less frequently 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 in a hospital is required. When prescribing bed rest, the severity of intoxication is taken into account. In the event that infectious mononucleosis occurs against the background of liver inflammation, a therapeutic diet is recommended (table No. 5).

To date, there is no specific treatment for the disease. Patients are given symptomatic therapy, desensitizing, detoxification and restorative treatment is prescribed. In the absence of bacterial complications, antibiotics are contraindicated. It is imperative to rinse the oropharynx with antiseptic solutions. In cases of hypertoxicity and in the presence of signs of asphyxia resulting from pronounced enlargement of 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.

To date, no specific prevention of the disease has been developed.

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