How does mononucleosis manifest?

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Mononucleosis

Mononucleosis is an acute infection of viral origin that affects a special reticuloendothelial system, which leads to multiple enlargement of the lymph nodes, involvement of the liver and spleen in the process, as well as changes in the blood system.

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This leads to a decrease in immunity and the development of a typical clinical picture of the disease, toxicosis and sore throat.

Causes

Today it is known for sure that this disease is caused by the Ebbstein-Barr virus - this is a virus that primarily affects the lymphocytic part of the immune system and belongs to the group of herpes viruses, type 4. The virus is classified as DNA-containing; in addition to mononucleosis, it can cause Burkitt's lymphomas, carcinomas and lymphomas in immunodeficient patients.

In children, exposure to the virus causes infectious mononucleosis, and then the virus circulates in the body for a long time, sometimes for life, being in a state of latent infection.

The source of infection is a sick child in a typical or erased form, although the disease is weakly contagious and requires prolonged and close contact, kissing, transfusion of blood components, and sharing utensils.

Carriers of the virus can shed it during primary infection for up to one and a half years, and subsequently asymptomatic periods of virus shedding may occur.

Most children and adults experience mononucleosis in an erased form; typical forms mainly occur in children aged 5 to 14 years who are often or long-term ill.

Classification

Today there is no uniform way to classify mononucleosis. Today, typical and atypical forms are distinguished, which have a clinical picture that differs from the traditional one.

Also distinguished are acute (occurring acutely, passing within a few weeks) and chronic mononucleosis (a process lasting up to six months).

Separately, infection with the Ebbstein-Barr virus is highlighted in immunodeficiency states and HIV.

Manifestations of mononucleosis

The incubation period for mononucleosis can last from several days to 2 weeks, usually a week.

  • The disease begins with a high fever, reaching 38-40°C, which suddenly appears against the background of complete health.
  • On days 2-3, fever with symptoms of toxicosis reach a maximum, severe weakness and headaches, pain in muscles and joints occur, then severe pain in the throat occurs when swallowing and at rest.
  • The temperature fluctuates throughout the day, without definite patterns, does not respond well to antipyretic therapy, on average the fever lasts about a week, gradually subsiding.

The main symptom of mononucleosis is typical tonsillitis, sore throat accompanied by fever and toxicosis. A sore throat can be catarrhal or lacunar in nature (i.e., be purulent or not), less often - membranous or necrotic; a particularly severe sore throat occurs when there is a decrease in granulocytes in the blood. Characterized by severe pain in the throat when swallowing, there may be severe soreness, itching and dryness in the throat.

Another typical manifestation is enlarged lymph nodes in the jaw and neck, axillary and inguinal lymph nodes. Lesions of the intrathoracic and mesenteric lymph nodes may also occur, resulting in cough and severe abdominal pain.

In approximately half of patients with mononucleosis, a rash appears on the body, which is of a different nature depending on the day of the disease - on the 3-5th day of the disease it can have a measles-like picture, can be in the form of roseola, papules or small hemorrhages. The rash can stay on the skin for 1-3 days and disappear without a trace without pigmentation or peeling. No new rash appears.

During the course of mononucleosis in children, the size of the liver and spleen sharply increases; they are detected from 3-5 days of illness and can remain in this state for up to 4 weeks. The icteric forms are especially severe with damage to the liver tissue and an increase in the amount of bilirubin and the level of liver enzymes, especially alkaline phosphatase.

Changes in the analysis of peripheral blood of children with mononucleosis are typical - a mild leukocytosis occurs up to 10 * 10 9 / l of leukocytes, while the number of lymphocytes and monocytes is sharply increased, specific cells are detected in the blood - atypical mononuclear cells, which confirm the diagnosis.

Changes in the blood last most of all; an imbalance of leukocytes and lymphocytes can persist for up to six months. Against the background of mononucleosis, a decrease in immunity occurs, which leads to an increased incidence of respiratory infections.

Diagnostics

The basis of diagnosis is the clinical picture of the disease with typical manifestations described earlier. Particularly important for diagnosis is a blood test with the identification of atypical mononuclear cells in combination with an increase in lymphocytes and a decrease in leukocytes.

Today, the most popular are the determination of antibodies to the Ebbstein-Barr virus of the IgM class (antibodies of fresh infection) and the IgG class, which confirm the infection after the fact.

It is necessary to distinguish mononucleosis from common tonsillitis, diphtheria and cytomegalovirus infection, HIV infection, hepatitis with liver damage and measles, rubella and other childhood infections with rash.

Treatment of mononucleosis

Pediatricians and infectious disease specialists treat mononucleosis.

Specific therapy against the Ebbstein-Barr virus has not been developed, so nonspecific therapy with antiviral drugs and immunomodulators (arbidol, viferon, acyclovir, imudon) is used.

Treatment is mainly aimed at combating the symptoms of the disease - the use of local antiseptics and painkillers for sore throat (Bioparox, Hexoral, Faringosept), antipyretics (paracetamol, Nurofen).

Close attention is paid to liver restoration.

If there is a danger of complications, antibiotics are often used to prevent secondary infection against the background of reduced immunity. Treatment is mainly carried out at home; in rare cases of severe cases, inpatient treatment is carried out.

Complications

Mononucleosis is dangerous due to its complications in the form of hemolytic anemia. The most dangerous complication is spontaneous rupture of the spleen due to its sharp enlargement. In children, respiratory tract lesions with bronchial obstruction and the occurrence of pneumonia are also common.

Prognosis and prevention

With mononucleosis, the prognosis is favorable, but after an infection, a decrease in immunity remains for a long time, which leads to an increased incidence of colds. The decrease in immunity lasts up to six months.

No specific vaccine or medications have been developed for the prevention of mononucleosis; general preventive measures are carried out - hardening, taking multivitamins, washing the mucous membranes of the nose and throat.

Diagnosis by symptoms

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Infectious mononucleosis

Infectious mononucleosis (otherwise called benign lymphoblastosis, Filatov's disease) is an acute viral infection characterized by predominant damage to the oropharynx and lymph nodes, spleen and liver. A specific sign of the disease is the appearance of characteristic cells in the blood - atypical mononuclear cells. The causative agent of infectious mononucleosis is the Epstein-Barr virus, which belongs to the herpesvirus family. Its transmission from the patient is carried out by aerosol. Typical symptoms of infectious mononucleosis are general infectious phenomena, tonsillitis, polyadenopathy, hepatosplenomegaly; maculopapular rashes are possible on various areas of the skin.

Infectious mononucleosis

Infectious mononucleosis (otherwise called benign lymphoblastosis, Filatov's disease) is an acute viral infection characterized by predominant damage to the oropharynx and lymph nodes, spleen and liver. A specific sign of the disease is the appearance of characteristic cells in the blood - atypical mononuclear cells. The spread of infection is widespread, seasonality has not been identified, and there is an increased incidence during puberty (girls and boys). The incidence after 40 years is extremely rare, with the exception of HIV-infected individuals, who may develop a manifestation of a latent infection at any age. In case of infection with the virus in early childhood, the disease proceeds as an acute respiratory infection, while at an older age - without severe symptoms. In adults, the clinical course of the disease is practically not observed, since most people have developed specific immunity.

Causes of infectious mononucleosis

Infectious mononucleosis is caused by the Epstein-Barr virus (a DNA virus of the Lymphocryptovirus genus). The virus belongs to the herpesvirus family, but unlike them, it does not cause the death of the host cell (the virus mainly multiplies in B lymphocytes), but stimulates its growth. In addition to infectious mononucleosis, the Epstein-Barr virus causes Burkitt's lymphoma and nasopharyngeal carcinoma.

The reservoir and source of infection is a sick person or a carrier of infection. The virus is released by sick people starting from the last days of the incubation period and lasts 6-18 months. The virus is released in saliva. In% of healthy people with a positive test for specific antibodies, the pathogen is detected in swabs from the oropharynx.

The transmission mechanism of the Epstein-Barr virus is aerosol, the predominant route of transmission is airborne droplets, it can be transmitted by contact (kissing, sexual contact, dirty hands, dishes, household items). In addition, the virus can be transmitted through blood transfusion and intrapartum from mother to child. People have a high natural susceptibility to infection, but when infected, mild and indolent clinical forms predominantly develop. The insignificant incidence among children under one year of age indicates the presence of innate passive immunity. Severe course and generalization of infection is facilitated by immunodeficiency.

Pathogenesis of infectious mononucleosis

The Epstein-Barr virus is inhaled by a person and infects the epithelial cells of the upper respiratory tract, oropharynx (promoting the development of moderate inflammation in the mucous membrane), from there the pathogen enters the regional lymph nodes with the lymph flow, causing lymphadenitis. When the virus enters the blood, it invades B lymphocytes, where it begins active replication. Damage to B lymphocytes leads to the formation of specific immune reactions and pathological deformation of cells. The pathogen spreads throughout the body through the bloodstream. Due to the fact that the virus invades immune cells and immune processes play a significant role in pathogenesis, the disease is classified as AIDS-associated. The Epstein-Barr virus persists in the human body for life, periodically being activated against the background of a general decrease in immunity.

Symptoms of infectious mononucleosis

The incubation period varies widely: from 5 days to one and a half months. Sometimes nonspecific prodromal phenomena (weakness, malaise, catarrhal symptoms) may be observed. In such cases, there is a gradual increase in symptoms, the malaise intensifies, the temperature rises to low-grade levels, nasal congestion and sore throat are noted. On examination, hyperemia of the oropharyngeal mucosa is revealed, and the tonsils may be enlarged.

In case of acute onset of the disease, fever, chills, increased sweating develop, symptoms of intoxication are noted (muscle aches, headache), patients complain of a sore throat when swallowing. Fever can persist from several days to a month, and the course (type of fever) can vary.

After a week, the disease usually enters the peak phase: all the main clinical symptoms appear (general intoxication, tonsillitis, lymphadenopathy, hepatosplenomegaly). The patient's condition usually worsens (symptoms of general intoxication worsen); the throat has a characteristic picture of catarrhal, ulcerative-necrotic, membranous or follicular sore throat: intense hyperemia of the mucous membrane of the tonsils, yellowish, loose plaque (sometimes like diphtheria). Hyperemia and granularity of the posterior pharyngeal wall, follicular hyperplasia, possible mucosal hemorrhages.

In the first days of the disease, polyadenopathy occurs. Enlarged lymph nodes can be detected in almost any group accessible to palpation; the occipital, posterior cervical and submandibular nodes are most often affected. To the touch, the lymph nodes are dense, mobile, painless (or the pain is mild). Sometimes there may be moderate swelling of the surrounding tissue.

At the height of the disease, most patients develop hepatolienal syndrome - the liver and spleen are enlarged, yellowness of the sclera and skin, dyspepsia, and darkening of urine may occur. In some cases, maculopapular rashes of various localizations are observed. The rash is short-lived, is not accompanied by subjective sensations (itching, burning) and does not leave behind any residual effects.

The height of the disease usually takes about 2-3 weeks, after which the clinical symptoms gradually subside and a period of convalescence begins. Body temperature returns to normal, signs of sore throat disappear, and the liver and spleen return to their normal size. In some cases, signs of adenopathy and low-grade fever may persist for several weeks.

Infectious mononucleosis can acquire a chronic relapsing course, as a result of which the duration of the disease increases to one and a half years or more. The course of mononucleosis in adults is usually gradual, with a prodromal period and less severe clinical symptoms. Fever rarely lasts more than 2 weeks, lymphadenopathy and tonsil hyperplasia are mild, but symptoms associated with a functional disorder of the liver (jaundice, dyspepsia) are more common.

Complications of infectious mononucleosis

Complications of infectious mononucleosis are mainly associated with the development of an associated secondary infection (staphylococcal and streptococcal lesions). Meningoencephalitis and obstruction of the upper respiratory tract by hypertrophied tonsils may occur. Children may experience severe hepatitis, and sometimes (rarely) interstitial bilateral infiltration of the lungs develops. Rare complications also include thrombocytopenia; overstretching of the lienal capsule can provoke rupture of the spleen.

Diagnosis of infectious mononucleosis

Nonspecific laboratory diagnostics include a thorough examination of the cellular composition of the blood. A general blood test shows moderate leukocytosis with a predominance of lymphocytes and monocytes and relative neutropenia, a shift in the leukocyte formula to the left. Large cells of various shapes with wide basophilic cytoplasm appear in the blood - atypical mononuclear cells. For the diagnosis of mononucleosis, it is significant to increase the content of these cells in the blood to 10-12%; often their number exceeds 80% of all white blood elements. When examining blood in the first days, mononuclear cells may be absent, which, however, does not exclude the diagnosis. Sometimes these cells can take 2-3 weeks to form. The blood picture usually gradually returns to normal during the period of convalescence, while atypical mononuclear cells often persist.

Specific virological diagnostics are not used due to laboriousness and irrationality, although it is possible to isolate the virus in swabs from the oropharynx and identify its DNA using PCR. There are serological diagnostic methods: antibodies to the VCA antigens of the Epstein-Barr virus are detected. Serum immunoglobulins type M are often detected during the incubation period, and at the height of the disease they are observed in all patients and disappear no earlier than 2-3 days after recovery. The detection of these antibodies serves as a sufficient diagnostic criterion for infectious mononucleosis. After an infection, specific immunoglobulins G are present in the blood and remain for life.

Patients with infectious mononucleosis (or persons suspected of having this infection) undergo serological testing three times (the first time during the period of acute infection, and twice more at an interval of three months) to detect HIV infection, since it may also include the presence of mononuclear cells in the blood. To differentiate a sore throat in infectious mononucleosis from tonsillitis of other etiologies, consultation with an otolaryngologist and pharyngoscopy is necessary.

Treatment of infectious mononucleosis

Mild and moderate infectious mononucleosis is treated on an outpatient basis; bed rest is recommended in cases of severe intoxication and severe fever. If there are signs of liver dysfunction, diet No. 5 according to Pevzner is prescribed.

There is currently no etiotropic treatment; the complex of indicated measures includes detoxification, desensitization, restorative therapy and symptomatic remedies, depending on the available clinic. Severe hypertoxic course, threat of asphyxia when the larynx is compressed by hyperplastic tonsils are an indication for short-term prescription of prednisolone.

Antibiotic therapy is prescribed for necrotizing processes in the pharynx in order to suppress the local bacterial flora and prevent secondary bacterial infections, as well as in case of existing complications (secondary pneumonia, etc.). The drugs of choice are penicillins, ampicillin and oxacillin, and tetracycline antibiotics. Sulfonamide drugs and chloramphenicol are contraindicated due to the side inhibitory effect on the hematopoietic system. Splenic rupture is an indication for emergency splenectomy.

Forecast and prevention of infectious mononucleosis

Uncomplicated infectious mononucleosis has a favorable prognosis; dangerous complications that can significantly aggravate it occur quite rarely in this disease. Residual effects in the blood are a reason for clinical observation for 6-12 months.

Preventive measures aimed at reducing the incidence of infectious mononucleosis are similar to those for acute respiratory infectious diseases; individual measures of nonspecific prevention consist of increasing immunity, both with the help of general health measures and with the use of mild immunoregulators and adaptogens in the absence of contraindications. Specific prevention (vaccination) for mononucleosis has not been developed. Emergency preventive measures are applied to children who have been in contact with the patient and consist of prescribing a specific immunoglobulin. The area where the disease is occurring is thoroughly cleaned and personal belongings are disinfected.

Infectious mononucleosis - treatment in Moscow

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Infectious mononucleosis: symptoms, diagnosis, treatment

Infectious mononucleosis is an infectious disease caused by the herpes virus type IV (Epstein-Barr virus). It is customary to distinguish between acute and chronic forms.

This disease is characterized by specific changes in the blood, lymphadenitis (enlarged lymph nodes), as well as damage to the pharynx (manifested by a sore throat), involvement of the liver and spleen in the process, as well as hyperthermia (increased general body temperature).

Pathogenesis of the disease

The infectious nature of pathology was first pointed out by N. F. Filatov, an outstanding Russian doctor who became the founder of the national pediatric school. For a long time, infectious mononucleosis was called “Filatov’s disease.” It is also known as “kissing disease” (the infectious mononucleosis virus is often transmitted to a healthy person from a carrier through saliva during a kiss), monocytic tonsillitis and benign lymphoblastosis.

The DNA genomic herpes-like virus was first isolated in 1964.

Infectious mononucleosis in young children usually occurs almost unnoticed. Clinical symptoms in children are usually blurred.

The main route of transmission of the infectious agent is airborne droplets. There is a possibility of infection through blood transfusion (blood transfusion), as well as through contact and household contact (for example, through shared utensils).

The disease most often develops in young people (onset in girls and onset in boys). In the age group from 25 to 35 years, antibodies to the Epstein-Barr virus are detected in the blood of almost 100% of subjects. The source of the infectious agent is a patient (including those with an “erased” form) or a virus carrier.

Please note : the disease is characterized by low contagiousness; For transmission of the pathogen, sufficiently prolonged contact with the carrier is required.

The “entry gate” for type IV herpes virus is the mucous membranes of the nasopharynx. The infectious agent penetrates into the epidermal cells of the mucous membrane, and then through the bloodstream penetrates into B lymphocytes, where it actively multiplies. The characteristic clinical manifestations of infectious mononucleosis are caused precisely by damage to lymphocytes.

Please note : replication of this virus in lymphocytes does not cause cell death (unlike other herpes-like pathogens), but activates their proliferation (division).

The duration of the incubation period can vary - from 4 days to 2 months (on average it ranges from 1 to 2 weeks).

Symptoms of infectious mononucleosis

The main clinical manifestations of benign lymphoblastosis are:

  • increased fatigue;
  • lymphadenopathy (enlargement of regional lymph nodes);
  • hyperthermia;
  • a sore throat.

The following clinical manifestations (alone or in various combinations) may also occur:

As a rule, the first symptom is general malaise without any other manifestations of pathology. The initial period lasts on average about a week. As the disease develops, enlargement (up to 2-3 cm) and tenderness of the cervical lymph nodes and an increase in general temperature to febrile values ​​(38-39°C) occur.

Infectious mononucleosis is accompanied by liver damage, and therefore symptoms such as a feeling of heaviness in the right hypochondrium and a change in the color of urine (it becomes dark) are often noted.

The spleen is also involved in the pathological process, so the patient has splenomegaly (an increase in size of this organ).

Important: if the patient received antibiotic therapy using ampicillin or amoxicillin, then in most cases with infectious mononucleosis, skin rashes appear.

The total duration of the disease is on average 1-2 weeks, after which a period of convalescence begins. The patient's condition gradually improves, but general weakness and enlargement of the cervical nodes may be observed for another 3 weeks.

Possible complications

In severe cases of the disease, various complications from the nervous system may develop.

Possible complications also include:

Some patients experience seizures and behavior disorders. Cases of inflammation of the soft meninges (meningitis) and brain tissue (encephalitis) have been recorded.

Important: splenic rupture cannot be ruled out, which is an indication for urgent surgery. This complication is extremely rare.

Diagnosis of infectious mononucleosis

The basis for diagnosis is the presence of characteristic clinical symptoms, but they cannot be called strictly specific. Very similar manifestations are observed, for example, with cytomegalovirus infection, as well as some other acute infectious diseases.

Blood tests confirm the diagnosis of infectious mononucleosis. When examining a smear, lymphocytosis and monocytosis are determined. The appearance of characteristic modified blood cells - mononuclear cells ("monolymphocytes" or "wide-plasma lymphocytes"), which are produced instead of B-lymphocytes affected by the Epstein-Barr virus, is also noted. In addition, antibodies to the pathogen are detected in the blood.

To carry out differential diagnosis with infectious diseases of bacterial origin (in particular, streptococcal sore throat, tularemia and listeriosis), a culture is performed. The material for the study is tonsil discharge.

When differential diagnosis in children should first exclude hepatitis A (jaundice or Botkin's disease), diphtheria, lymphogranulomatosis and acute leukemia.

In the vast majority of cases, complete recovery occurs. Serious (including life-threatening) complications are recorded in less than 1% of diagnosed cases. Immunity after infectious mononucleosis is persistent. With a sharp decrease in the body's resistance (in particular, against the background of HIV infection), reactivation of the virus is possible.

Important: it has been established that the Epstein-Barr virus, in addition to infectious mononucleosis, can cause such serious diseases as nasopharyngeal carcinoma and Burkitt's lymphoma.

Treatment of infectious mononucleosis

General recommendations

Infectious mononucleosis requires bed rest until acute symptoms subside. No specific therapy has been developed. Symptomatic treatment is carried out, and measures are taken to generally strengthen the body.

After recovery, it is recommended to avoid physical activity for 1-1.5 weeks to avoid such a serious complication as splenic rupture. Lifting heavy objects is strictly prohibited, even if no enlargement of the organ was observed during the acute period of the disease.

Please note : if necessary, high fever can be brought down with medications containing paracetamol. The use of acetylsalicylic acid in this case can lead to the development of a life-threatening disease - acute hepatic encephalopathy (Reye's syndrome).

How to treat infectious mononucleosis in children?

Possible symptoms of infectious mononucleosis in children include:

  • low-grade or febrile temperature;
  • nasal congestion;
  • sore throat;
  • general weakness;
  • drowsiness;
  • symptoms of general intoxication;
  • redness of the oropharyngeal mucosa;
  • granularity of the posterior pharyngeal wall;
  • hemorrhages in the pharyngeal mucosa;
  • pronounced enlargement of the tonsils;
  • lymphadenopathy;
  • hepatosplenomegaly.

Please note : the severity of clinical manifestations depends on the severity of the disease. Various combinations of symptoms are possible.

The most significant symptom, which with a high degree of probability indicates infectious mononucleosis in a child, is polyadenitis due to pathological proliferation of lymphoid tissue. During examination, characteristic overlays in the form of islands of a light yellow or grayish tint are found on the tonsils.

The involvement of regional lymph nodes is usually bilateral.

Up to 50% of children become infected with Epstein-Barr virus before the age of 5 years, but the disease is usually mild in early childhood. Maintenance therapy is indicated, which involves adequate hydration (consuming a sufficient amount of liquid), rinsing with solutions with an antiseptic effect (for severe sore throat, add a 2% solution of lidocaine hydrochloride).

To reduce the temperature during a febrile reaction, as well as reduce the severity or relieve symptoms of inflammation, it is recommended to use NSAIDs (Paracetamol, Ibuprofen).

To stimulate general immunity, the drug Imudon is indicated, and for general strengthening of the body, vitamin therapy (with vitamins C, P and group B) is required. A diagnosed decrease in the functional activity of the liver is an indication for a strict diet and the prescription of drugs from the groups of hepatoprotective and biliary drugs. Antiviral drugs are also indicated (Viferon, Cycloferon, Anaferon). Their dosages are determined at the rate of 6-10 mg per 1 kg of child’s body weight.

The addition of a secondary bacterial infection may require the use of antibiotics (penicillin drugs are not prescribed to avoid the development of hypersensitivity reactions). In parallel with antibiotics, children are prescribed probiotics (Acipol, Narine).

Children are prescribed strict bed rest. In some cases, treatment in a hospital setting is required. Severe intoxication is an indication for hormonal therapy (a weekly course of prednisolone is prescribed). If there is severe swelling of the larynx, a tracheostomy is performed, after which the child is connected to a ventilator.

You will learn more about the symptoms and treatment methods of infectious mononucleosis in children by watching this video review with the participation of pediatrician Dr. Komarovsky:

Konev Alexander, therapist

19,136 total views, 2 views today

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Mononucleosis: causes, signs, course, diagnosis, how to treat

Infectious mononucleosis is one of the most common viral infections on earth: according to statistics, 80-90% of adults have antibodies to the causative agent in their blood. It is the Epstein-Barr virus, named after the virologists who discovered it in 1964. Children, adolescents and young adults are most susceptible to mononucleosis. In people over 40 years of age, it develops extremely rarely, since before this age stable immunity is formed as a result of an infection.

The virus is especially dangerous for people over 25 years of age and pregnant women (subject to primary infection), as it causes a severe course of the disease, the addition of a bacterial infection, and can cause miscarriage or stillbirth. Timely diagnosis and proper treatment significantly reduce the risk of developing such consequences.

Pathogen and routes of transmission

The cause of mononucleosis is the Epstein-Barr virus, a large DNA-containing virus, a representative of the 4th type of the herpesvirus family. It has tropism for human B lymphocytes, that is, it is able to penetrate them thanks to special receptors on the cell surface. The virus integrates its DNA into cellular genetic information, thereby distorting it and increasing the risk of mutations with the subsequent development of malignant tumors of the lymphatic system. Its role in the development of Burkitt's lymphoma, Hodgkin's lymphoma, nasopharyngeal carcinoma, liver carcinoma, salivary glands, thymus, respiratory and digestive systems has been proven.

The virus is a strand of DNA compactly packaged in a protein shell - a capsid. On the outside, the structure is surrounded by an outer shell formed from the membrane of the cell in which the viral particle was collected. All of these structures are specific antigens, since in response to their introduction the body synthesizes immune antibodies. Detection of the latter is used to diagnose the infection, its stage and monitor recovery. In total, the Epstein-Barr virus contains 4 significant antigens:

  • EBNA (Epstein-Barr nuclear antigen) - contained in the core of the virus, is an integral part of its genetic information;
  • EA (early antigen) – early antigen, viral matrix proteins;
  • VCA (Viral capsid antigen) – viral capsid proteins;
  • LMP (latent membrane protein) – viral membrane proteins.

The source of the pathogen is a person suffering from any form of infectious mononucleosis. The virus is weakly contagious and requires prolonged and close contact for transmission. In children, the airborne route of transmission predominates; contact route is also possible - through profusely salivated toys and household items. In teenagers and older people, the virus is often transmitted through kissing with saliva or sexual intercourse. Susceptibility to the pathogen is high, that is, most of those infected for the first time become ill with infectious mononucleosis. However, asymptomatic and erased forms of the disease account for more than 50%, so often a person does not know about the infection.

The Epstein-Barr virus is unstable in the external environment: it dies when dried, exposed to sunlight and any disinfectants. In the human body, it can persist for life, being integrated into the DNA of B-lymphocytes. In this regard, there is another route of transmission - blood contact; infection is possible through blood transfusion, organ transplantation, and injection drug use. The virus causes the formation of stable lifelong immunity, so repeated attacks of the disease are the reactivation of a dormant pathogen in the body, and not a new infection.

Mechanism of disease development

The Epstein-Barr virus enters the oral mucosa with saliva or its droplets and attaches to its cells - epithelial cells. From here, viral particles penetrate the salivary glands, immune cells - lymphocytes, macrophages, neutrophils and begin to actively multiply. There is a gradual accumulation of the pathogen and infection of more and more new cells. When the mass of viral particles reaches a certain value, their presence in the body activates the immune response mechanisms. A special type of immune cells - T-killers - destroy infected lymphocytes, and therefore a large amount of biological active substances and viral particles are released into the blood. Their circulation in the blood leads to an increase in body temperature and toxic damage to the liver - at this moment the first signs of the disease appear.

A special feature of the Epstein-Barr virus is its ability to accelerate the growth and reproduction of B lymphocytes - they proliferate and subsequently transform into plasma cells. The latter actively synthesize and release immunoglobulin proteins into the blood, which, in turn, causes the activation of another series of immune cells - T-suppressor cells. They produce substances designed to suppress excessive proliferation of B lymphocytes. The process of their maturation and transition to mature forms is disrupted, and therefore the number of mononuclear cells in the blood - mononuclear cells with a narrow rim of cytoplasm - sharply increases. In fact, they are immature B lymphocytes and serve as the most reliable sign of infectious mononucleosis.

The pathological process leads to an increase in the size of the lymph nodes, since it is in them that the synthesis and further growth of lymphocytes occurs. A powerful inflammatory reaction develops in the palatine tonsils, outwardly indistinguishable from a sore throat. Depending on the depth of damage to the mucous membrane, its changes vary from friability to deep ulcers and plaque. The Epstein-Barr virus suppresses the immune response due to certain proteins, the synthesis of which occurs under the influence of its DNA. On the other hand, infected mucosal epithelial cells actively release substances that initiate an inflammatory reaction. In this regard, the amount of antibodies to the virus and a specific antiviral substance, interferon, gradually increases.

Most of the viral particles are eliminated from the body, but B-lymphocytes with embedded viral DNA remain in the human body for life, which they pass on to daughter cells. The pathogen changes the amount of immunoglobulins synthesized by the lymphocyte, and therefore can lead to complications in the form of autoimmune processes and atopic reactions. Chronic mononucleosis with a relapsing course is formed as a result of an insufficient immune response in the acute phase, due to which the virus escapes aggression and remains in sufficient quantities for exacerbations of the disease.

Clinical picture

Mononucleosis occurs cyclically and certain stages can be clearly distinguished in its development. The incubation period lasts from the moment of infection to the first signs of the disease and takes on average from 20 to 50 weeks. At this time, the virus multiplies and accumulates in quantities sufficient for massive expansion. The first signs of the disease appear during the prodromal period. A person feels weakness, increased fatigue, irritability, and muscle pain. The prodrome continues for 1-2 weeks, after which the height of the disease begins. Usually a person becomes ill acutely with an increase in body temperature up to degrees C, a sore throat, and enlarged lymph nodes.

The lymph nodes of the neck, back of the head, elbow and intestines are most often affected. Their size varies from 1.5 to 5 cm; upon palpation, a person feels slight pain. The skin over the lymph nodes is not changed, they are not fused with the underlying tissues, they are mobile, and have an elastic-elastic consistency. Severe enlargement of the intestinal lymph nodes leads to pain in the abdomen, lower back and indigestion. The spleen enlarges significantly, even to the point of rupture, since it belongs to the organs of the immune system and contains a large number of lymphatic follicles. This process is manifested by severe pain in the left hypochondrium, which increases with movement and physical activity. Reversal of lymph nodes occurs slowly, within 3-4 weeks after recovery. In some cases, polyadenopathy persists for a long time, from several months to lifelong changes.

Fever during mononucleosis is one of the most common symptoms of mononucleosis. Fever lasts from several days to 4 weeks and can change repeatedly throughout the course of the disease. On average, it begins at degrees C, gradually increasing to degrees C. Despite the duration and severity of the fever, the general condition of the patients suffers little. They generally remain active, with only a decrease in appetite and increased fatigue. In some cases, patients experience such severe muscle weakness that they cannot stand on their feet. This condition rarely lasts more than 3-4 days.

Another constant sign of mononucleosis is angina-like changes in the oropharynx. The palatine tonsils increase in size so much that they can completely block the lumen of the pharynx. A white-gray coating in the form of islands or stripes often forms on their surface. It appears on days 3-7 of illness and is associated with a sore throat and a sharp rise in temperature. The nasopharyngeal tonsil also enlarges, which is associated with difficulty in nasal breathing and snoring during sleep. The back wall of the pharynx becomes granular, its mucous membrane is hyperemic and swollen. If the swelling goes down into the larynx and affects the vocal cords, then the patient experiences hoarseness.

Liver damage in mononucleosis can be asymptomatic and with severe jaundice. The liver increases in size, protrudes 2.5-3 cm from under the costal arch, is dense, sensitive to palpation. Pain in the right hypochondrium is not associated with eating, but intensifies with physical activity and walking. The patient may notice a slight yellowing of the sclera, a change in skin tone to lemon yellow. The changes do not last long and disappear without a trace in a few days.

Infectious mononucleosis in pregnant women is usually a reactivation of the Epstein-Barr virus associated with a physiological decrease in immune defense. The incidence increases towards the end of pregnancy and accounts for about 35% of the total number of expectant mothers. The disease manifests itself as fever, enlarged liver, sore throat and reaction of the lymph nodes. The virus can penetrate the placenta and infect the fetus, which occurs when its concentration in the blood is high. Despite this, infection in the fetus rarely develops and is usually represented by pathologies of the eyes, heart, and nervous system.

A rash with mononucleosis appears on average on the 5-10th day of illness and in 80% of cases is associated with taking the antibacterial drug ampicillin. It is maculopapular in nature, its elements are bright red, located on the skin of the face, torso and limbs. The rash remains on the skin for about a week, after which it turns pale and disappears without a trace.

Mononucleosis in children is often asymptomatic or with a mild clinical picture in the form of ARVI. The disease is dangerous for babies with congenital immunodeficiency or atopic reactions. In the first case, the virus aggravates the lack of immune defense and promotes the addition of a bacterial infection. In the second, it enhances the manifestations of diathesis, initiates the formation of autoimmune antibodies and can become a provoking factor for the development of tumors of the immune system.

Classification

Infectious mononucleosis is divided according to severity into:

  1. Mild – intoxication is absent or lasts no more than 5 days. The temperature does not exceed 38 degrees C and lasts no more than 5 days. Sore throat is catarrhal in nature, with possible isolated islands of plaque on the tonsils, lasting no more than 3 days. Only the cervical lymph nodes are enlarged, their size does not exceed 1.5 cm. The liver protrudes from under the costal arch no more than 1.5 cm. Recovery occurs within 2 weeks.
  2. Moderate – intoxication is moderate and lasts up to one week. Body temperature reaches 38.5 degrees C and lasts up to 8 days. The palatine tonsils are enlarged, but do not completely cover the pharynx. On their surface there is a white-gray coating in the form of stripes; sore throat lasts no more than 6 days. The cervical lymph nodes are enlarged in a chain; the intra-abdominal lymph nodes are involved in the process. Their size does not exceed 2.5 cm. The liver protrudes from under the costal arch by no more than 2.5 cm. Complications occur, complete recovery occurs in 3-4 weeks.
  3. Severe – intoxication is severe and lasts more than 8 days. Body temperature reaches values ​​above 39.5 degrees C and persists for more than 9 days. Sore throat is necrotic in nature - ulcers and whitish films form on the surface of the tonsils. The tonsils are significantly increased in size and completely block the lumen of the pharynx. The size of the lymph nodes exceeds 2.5 cm; they are palpated under the skin in packets - in groups of several pieces. The liver protrudes from under the costal arch by more than 3 cm. Complications are sure to occur; the disease lasts at least 4 weeks.
By type, infectious mononucleosis is divided into:
  • Typical - characterized by a cyclical course, angina-like changes, enlarged lymph nodes, liver damage and characteristic changes in the blood picture.
  • Atypical - combines the asymptomatic course of the disease, its erased form, usually taken for ARVI, and the most severe form - visceral. The latter occurs with the involvement of many internal organs and leads to serious complications.

According to the duration of the course, infectious mononucleosis can be:

  1. Acute – manifestations of the disease last no more than 3 months;
  2. Prolonged – changes persist from 3 to 6 months;
  3. Chronic – lasts more than six months. This same form of the disease includes repeated fever, malaise, and enlarged lymph nodes within 6 months after recovery.

Relapse of infectious mononucleosis is the re-development of its symptoms a month after recovery.

Diagnostics

The diagnosis and treatment of infectious mononucleosis is carried out by an infectious disease specialist. It is based on:

  • Typical complaints include prolonged fever, sore throat-like changes in the oropharynx, enlarged lymph nodes;
  • Epidemiological history - household or sexual contact with a person who had a fever for a long time, blood transfusion or organ transplantation 6 months before the disease;
  • Examination data - hyperemia of the pharynx, plaque on the tonsils, enlargement of the lymph nodes, liver and spleen;
  • The results of laboratory tests - the main sign of damage by the Epstein-Barr virus is the appearance in the venous or capillary blood of a large number (more than 10% of the total number of leukocytes) of mononuclear cells. It is from this that the disease got its name - mononucleosis, and before the advent of methods for detecting the pathogen, it was its main diagnostic criterion.

Today, more accurate diagnostic methods have been developed that make it possible to establish a diagnosis even if the clinical picture is not typical for damage by the Epstein-Barr virus. These include:

  1. PCR diagnostics – isolation of pathogen DNA from saliva, lymph node biopsy, human blood;
  2. ELISA diagnostics is the detection of specific antiviral antibodies in the patient’s blood.

Based on the ratio of antibodies to various proteins of the virus, the doctor can determine the period of the disease, determine whether there was an initial encounter with the pathogen, a relapse or reactivation of the infection:

  • The acute period of mononucleosis is characterized by the appearance of IgMk VCA (from the first days of the clinic, persists for 4-6 weeks), IgG to EA (from the first days of the disease, persists throughout life in small quantities), IgG to VCA (appears after IgMVCA, persists for life) .
  • Recovery is characterized by the absence of IgMk VCA, the appearance of IgG to EBNA, a gradual decrease in the level of IgG to EA and IgG to VCA.

Also, a reliable sign of acute or reactivation of infection is high (more than 60%) avidity (affinity) of IgG for the Epstein-Barr virus.

In a general blood test, leukocytosis is observed with an increase in the proportion of lymphocytes and monocytes to 80-90% of the total number of leukocytes, and an acceleration of ESR. Changes in the biochemical blood test indicate damage to liver cells - the level of ALT, AST, GGTP and alkaline phosphatase increases, the concentration of indirect bilirubin may increase in jaundice. An increase in the concentration of total plasma protein is associated with excess production of a number of immunoglobulins by mononuclear cells.

Various imaging methods (ultrasound, CT, MRI, X-ray) allow you to assess the condition of the lymph nodes of the abdominal cavity, liver, and spleen.

Treatment

Treatment of mononucleosis is carried out on an outpatient basis for mild cases of the disease; patients with moderate and severe forms are hospitalized in an infectious diseases hospital. Hospitalization is also carried out for epidemiological reasons, regardless of the severity of the disease. These include living in crowded conditions - a dormitory, barracks, orphanage and boarding schools. To date, there are no drugs that can act directly on the cause of the disease - the Epstein-Barr virus - and remove it from the body, so therapy is aimed at alleviating the patient’s condition, maintaining the body’s defenses and preventing negative consequences.

During the acute period of mononucleosis, patients are advised to rest, bed rest, plenty of warm drinks in the form of fruit drink, weak tea, compote, and an easily digestible diet. To prevent bacterial complications, it is necessary to rinse the pharynx 3-4 times a day with antiseptic solutions - chlorhexidine, furacillin, chamomile decoction. Physiotherapy methods - ultraviolet irradiation, magnetic therapy, UHF are not carried out, as they cause additional activation of the cellular component of immunity. They can be used after the size of the lymph nodes has normalized.

Among the medications prescribed:

  1. Antiviral agents - act nonspecifically, increase the production of their own antiviral interferon (cycloferon, tiloron). Contraindicated for pregnant women;
  2. Human interferon alpha - is administered to strengthen the body's immune defense;
  3. Antipyretics (NSAIDs) – normalize body temperature (ibuprofen, nimesulide);
  4. Antibiotics – used for severe and moderate forms of the disease to prevent bacterial complications (ceftriaxone, azithromycin);
  5. Glucocorticoids – suppress the proliferation of immune cells, reduce body temperature (prednisolone, dexamethasone);
  6. Solutions for intravenous administration - have a detoxifying effect, alleviate the course of the disease (saline solution, dextrose);
  7. Antifungal agents – in case of development of fungal complications (fluconazole, nystatin).

Treatment of pregnant women is aimed at eliminating symptoms and is carried out with drugs that are safe for the fetus:

  • Human interferon in the form of rectal suppositories;
  • Folic acid;
  • Vitamins E, group B;
  • Troxevasin capsules;
  • Calcium preparations – calcium orotate, calcium pantothenate.

The average duration of treatment is days. After suffering from infectious mononucleosis, a person must be monitored by a local physician for 12 months. Every 3 months, laboratory monitoring is carried out, which includes a general and biochemical blood test, and, if necessary, determination of antibodies to the Epstein-Barr virus in the blood.

Complications of the disease

Rarely develop, but can be extremely severe:

  1. Autoimmune hemolytic anemia;
  2. Meningoencephalitis;
  3. Guillain-Barre syndrome;
  4. Psychosis;
  5. Damage to the peripheral nervous system – polyneuritis, cranial nerve palsy, paresis of facial muscles;
  6. Myocarditis;
  7. Rupture of the spleen (usually found in a child).

Specific prevention (vaccination) has not been developed, therefore, to prevent infection, general strengthening measures are carried out: hardening, walks in the fresh air and ventilation, varied and proper nutrition. It is important to promptly and fully treat an acute infection, as this will reduce the risk of chronicity of the process and the development of severe complications.

Source: http://uhonos.ru/infekcii/mononukleoz/