Mononucleosis in children - symptoms and treatment until the baby fully recovers. The temperature does not subside for a whole year and symptoms do not disappear after infectious mononucleosis

Currently, the diagnosis of “infectious mononucleosis” is made quite rarely. Moreover, the disease itself is very common. According to statistics, more than 65% of people by the age of 35 have already had it. It is impossible to prevent infectious mononucleosis.

Infectious mononucleosis is an acute respiratory viral disease which is caused by a virus Epstein-Barr(EBV, herpes virus type 4). This virus was named after the English virologist Professor Michael Anthony Epstein and his student Yvonne Barr, who isolated and described it in 1964.

However, on infectious origin Mononucleosis was indicated back in 1887 by the Russian doctor, founder of the Russian pediatric school, Nil Fedorovich Filatov. He was the first to notice febrile state with a concomitant increase in all lymph nodes body of a sick person.

In 1889, the German scientist Emil Pfeiffer described a similar clinical picture mononucleosis and defined it as glandular fever with damage to the pharynx and lymphatic system. Based on the hematological studies that appeared in practice, we studied characteristic changes blood composition in this disease. Special (atypical) cells appeared in the blood, which were called mononuclear cells(monos - one, nucleus - core). In this regard, other scientists, already from America, called it infectious mononucleosis. But already in 1964, M.A. Epstein and I. Barr received a herpes-like virus named after them Epstein-Barr virus, which was later found with high frequency in this disease.

Mononuclear cells- these are mononuclear blood cells, which also include lymphocytes and monocytes, which, like other types of leukocytes (eosinophils, basophils, neutrophils), protective function body.

How can you get infectious mononucleosis?

The source of the causative agent of infectious mononucleosis is a sick person (especially at the very peak of the disease, when there is heat), a person with erased forms illness (the illness occurs in mild degree, with weak severe symptoms, or under the guise of an acute respiratory infection), as well as a person without any symptoms of the disease, seemingly absolutely healthy, but at the same time being a virus carrier. A sick person can “donate” the causative agent of infectious mononucleosis to a healthy person in various ways, namely: contact-household (with saliva during a kiss, when using shared dishes, linen, personal hygiene items, etc.), airborne droplets, during sexual contact (with sperm), during blood transfusion, as well as from the mother to the fetus through the placenta.

Infectious mononucleosis usually occurs through close contact, so living with the patient and healthy people together, to put it mildly, is undesirable. Because of this, outbreaks of the disease often occur in dormitories, boarding schools, camps, kindergartens, and even within families (one of the parents can infect the child and, conversely, the child can be a source of infection). You can also become infected with mononucleosis in crowded places ( public transport, large shopping centers etc.). It is important to note that EBV does not live in animals, and therefore they are not capable of transmitting the virus that causes infectious mononucleosis.

How does infectious mononucleosis manifest?

Incubation period (the length of time from the moment the microbe enters the body until the symptoms of the disease appear) when infectious mononucleosis lasts up to 21 days, illness period up to 2 months. IN different time The following symptoms may be observed:

weakness,
headache,
dizziness,
pain in muscles and joints,
increased body temperature (cold-like condition with intoxication),
increased sweating (as a result of high temperature),
sore throat when swallowing and characteristic white plaques on the tonsils (as with a sore throat),
cough,
inflammation,
enlargement and tenderness of all lymph nodes,
enlarged liver and/or spleen.

As a consequence of all of the above, increased sensitivity to ARVI and other respiratory diseases, frequent lesions skin virus " herpes simplex(herpes simplex virus type 1), usually in the upper or lower lip area.

Lymph nodes are part of lymphoid tissue (tissues of the immune system). It also includes the tonsils, liver and spleen. All these lymphoid organs affected by mononucleosis. Lymph nodes located under lower jaw(submandibular), as well as cervical, axillary and inguinal lymph nodes, you can feel it with your fingers. In the liver and spleen, enlarged lymph nodes can be observed using ultrasound. Although, if the increase is significant, it can also be determined by palpation.

Test results for infectious mononucleosis

According to the results general analysis blood in infectious mononucleosis, one can observe moderate leukocytosis, sometimes leukopenia, the appearance of atypical mononuclear cells, an increase in the number of lymphocytes, monocytes and moderate accelerated ESR. Atypical mononuclear cells usually appear in the first days of illness, especially at the height of clinical symptoms, but in some patients this happens later, only after 1 – 2 weeks. Blood monitoring is also carried out 7–10 days after recovery.

The result of a general blood test for a girl (age 1 year 8 months) on initial stage illness (07/31/2014)

Test	Result	Unit measurements	Proper values
Hemoglobin (Hb)	117,00	g/l	114,00 – 144,00
Leukocytes	11,93	10^9/l	5,50 – 15,50
Red blood cells (Er.)	4,35	10^12/l	3,40 – 5,10
Hematocrit	34,70	%	27,50 – 41,00
MCV (average volume Er.)	79,80	fl	73,00 – 85,00
MCH (Hb content d 1 Er.)	26,90	pg	25,00 – 29,00
MCHC (average Hb concentration in Er.)	33,70	g/dl	32,00 – 37,00
Estimated distribution of erythrocyte width	12,40	%	11,60 – 14,40
Platelets	374,00	10^9/l	150,00 – 450,00
MPV (mean platelet volume)	10,10	fl	9,40 – 12,40
Lymphocytes	3,0425,50	10^9/l%	2,00 – 8,0037,00 – 60,00
Monocytes	3,1026,00	10^9/l%	0,00 – 1,103,00 – 9,00
Neutrophils	5,0142,00	10^9/l%	1,50 – 8,5028,00 – 48,00
Eosinophils	0,726,00	10^9/l%	0,00 – 0,701,00 – 5,00
Basophils	0,060,50	10^9/l%	0,00 – 0,200,00 – 1,00
ESR	27,00	mm/h	<10.00

Based on the results of a biochemical blood test for infectious mononucleosis, a moderate increase in the activity of AST and ALT (liver enzymes) and an increased bilirubin content are observed. Liver function tests (special tests that indicate the function and integrity of the main structures of the liver) normalize by the 15th-20th day of illness, but may remain abnormal for up to 6 months.

Behind the scenes, there is a distinction between mild, moderate and severe infectious mononucleosis. The disease can also occur in an atypical form, which is characterized by a complete absence or, conversely, excessive manifestation of any of the main symptoms of infection (for example, the appearance of jaundice in the icteric form of mononucleosis). In addition, it is necessary to distinguish between the acute and chronic course of infectious mononucleosis. In the chronic form, certain symptoms (for example, a severe sore throat) may disappear and then recur, more than once. Doctors often call this condition wavy.

Currently, the diagnosis of infectious mononucleosis is made quite rarely. Moreover, the disease itself is very common. According to statistics, more than 65% of people by the age of 35 have already had infectious mononucleosis. It is impossible to prevent this disease. Very often, mononucleosis is asymptomatic. And if symptoms do appear, then, as a rule, they are mistaken for acute respiratory infections. Accordingly, treatment for mononucleosis is not entirely correct, sometimes even excessive. It is important to differentiate between a sore throat (whatever type it is) and the syndrome of acute tonsillitis (inflammation of the tonsils), which manifests itself in mononucleosis. In order for the diagnosis to be as accurate as possible, you need to focus not only on external signs, but also on the results of all necessary tests. Any type of sore throat can be treated with antibiotics, but mononucleosis is a viral disease that does not require antibiotic therapy. Viruses are not sensitive to antibiotics.

When examining a patient with infectious mononucleosis, it is necessary to exclude HIV, acute respiratory infections, tonsillitis, viral hepatitis, pseudotuberculosis, diphtheria, rubella, tularemia, listeriosis, acute leukemia, lymphogranulomatosis.

Mononucleosis is a disease that can only be contracted once in a lifetime, after which lifelong immunity remains. Once the pronounced symptoms of the primary infection disappear, they usually do not recur. But, since the virus cannot be eliminated (drug therapy only suppresses its activity), once infected, the patient becomes a carrier of the virus for life.

Complications of infectious mononucleosis

Complications of infectious mononucleosis are rare. The most important are otitis media, sinusitis, paratonsillitis, and pneumonia. In individual cases, splenic ruptures, liver failure and hemolytic anemia (including acute forms), neuritis, and follicular tonsillitis occur.

In some cases, a consequence of mononucleosis is adenoiditis . This is an overgrowth of the nasopharyngeal tonsil. Adenoiditis is often diagnosed in children. The danger of this disease is that in addition to difficulty breathing, which significantly worsens the child’s quality of life, enlarged adenoids become a source of infection.

Adenoiditis has three stages of development, each of which is characterized by certain characteristics:

difficulty breathing and discomfort are felt only during sleep;
discomfort is felt both day and night, which is accompanied by snoring and breathing through the mouth;

the adenoid tissue grows so much that it is no longer possible to breathe through the nose.

Adenoiditis can have both an acute and chronic course.

If parents find such manifestations in their child, it is imperative to show him or her to an ENT doctor and receive recommendations for treatment.

After a sluggish course of infectious mononucleosis, long-term treatment, it may develop chronic fatigue syndrome(pallor of the skin, lethargy, drowsiness, tearfulness, temperature 36.9-37.3 o C for 6 months, etc.). In children, this condition is also manifested by decreased activity, mood swings, lack of appetite, etc. This is a completely natural consequence of infectious mononucleosis. Doctors say: “You just have to survive chronic fatigue syndrome. Relax as much as possible, be in the fresh air, swim, if possible, go to the village and live there for some time.”

Previously, it was believed that after suffering from infectious mononucleosis, you should never be in the sun, because this increases the risk of blood diseases (eg leukemia). Scientists argued that under the influence of ultraviolet rays, EBV acquires oncogenic activity. However, research in recent years has completely refuted this. In any case, it has long been known that it is not recommended to sunbathe between 12:00 and 16:00.

Deaths can only be caused by splenic rupture, encephalitis or asphyxia. Fortunately, these complications of infectious mononucleosis occur in less than 1% of cases.

Treatment of infectious mononucleosis

Specific therapy for infectious mononucleosis has not currently been developed. The main goals of treatment are to relieve symptoms of the disease and prevent bacterial complications. Treatment of infectious mononucleosis is symptomatic, supportive, and, first of all, involves bed rest, a ventilated and humidified room, drinking large amounts of liquid (plain or acidified water), eating small portions of light, preferably pureed food, avoiding hypothermia. In addition, due to the risk of splenic rupture, it is recommended to limit physical activity during illness and after recovery for 2 months. If the spleen ruptures, there is a high probability that surgery will be required.

When treating infectious mononucleosis, it is very important to try to avoid stress, not succumb to the disease, set yourself up for recovery and wait out this period. Some studies have shown that stress negatively affects our immune system, namely making the body more vulnerable to infections. Doctors say this: “Viruses love tears.” As for parents whose child has contracted infectious mononucleosis, do not panic or self-medicate under any circumstances, listen to what the doctors say. Depending on the child’s well-being, as well as the severity of symptoms, treatment can be done on an outpatient or inpatient basis (the attending physician from the clinic, the emergency doctor, if one is required, and the parents themselves make the decision). After suffering from infectious mononucleosis, children are exempt from all types of physical education, except exercise therapy and, of course, have a 6-month exemption from vaccinations. Quarantine is not required in kindergartens.

List of medications for the complex treatment of infectious mononucleosis

Acyclovir and valacyclovir as antiviral (antiherpetic) agents.
Viferon, anaferon, genferon, cycloferon, arbidol, immunoglobulin isoprinosine as immunostimulating and antiviral drugs.
Nurofen as an antipyretic, analgesic, anti-inflammatory agent. Preparations containing paracetamol and aspirin are not recommended, because Taking aspirin can trigger Reye's syndrome (rapidly developing swelling of the brain and accumulation of fat in liver cells), and using paracetamol overloads the liver. Antipyretics are prescribed, as a rule, at a body temperature above 38.5 o C, although it is necessary to look at the patient’s condition (it happens that the patient, no matter whether he is an adult or a child, feels normal at a temperature above this value, then it is better to give the body the opportunity fight the infection for as long as possible while monitoring your temperature more carefully).
Antigrippin as a general tonic.
Suprastin, zodak as agents that have antiallergic and anti-inflammatory effects.
Aqua Maris, Aqualor for washing and moisturizing the nasal mucosa.
Xylene, galazolin (vasoconstrictor nasal drops).
Protargol (anti-inflammatory nasal drops), albucid as an antimicrobial agent in the form of eye drops (used for bacterial conjunctivitis). Can also be used for nasal instillation. For conjunctivitis of viral origin, ophthalmoferon eye drops, which have antiviral activity, are used. Both types of conjunctivitis can develop against the background of mononucleosis.
Furacilin, baking soda, chamomile, sage for gargling.
Miramistin as a universal antiseptic in the form of a spray, tantum verde as an anti-inflammatory drug (can be useful as a spray for a sore throat, as well as for treating the oral cavity with stomatitis).
Marshmallow, ambrobene as expectorants for coughs.
Prednisolone, dexamethasone as hormonal agents (used, for example, for swelling of the tonsils).
Azithromycin, erythromycin, ceftriaxone as antibacterial therapy for complications (for example, pharyngitis). Ampicillin and amoxicillin are contraindicated for mononucleosis, because This is what causes a skin rash that can last up to several weeks. As a rule, a flora culture is taken from the nose and throat in advance to determine sensitivity to antibiotics.
LIV-52, Essentiale Forte to protect the liver.
Normobact, Florin Forte for intestinal flora disorders.
Complivit, multi-tabs (vitamin therapy).

It should be noted that the list of drugs is general. The doctor may prescribe a medicine not listed in this list and selects the treatment individually. For example, take just one drug from the antiviral group. Although transitions from one medicine to another are not excluded, as a rule, depending on their effectiveness. In addition, all forms of drug release, their dosage, course of treatment, of course, are determined by the doctor.

You can also turn to traditional medicine (cranberry, green tea), medicinal herbs (echinacea, rose hips), dietary supplements (omega-3, wheat bran), as well as homeopathic remedies to increase and strengthen the immune system for help in the fight against mononucleosis . Before using any products, dietary supplements or medications, you should always consult with your doctor.

After a course of treatment for infectious mononucleosis, the prognosis is favorable. Complete cure can occur within 2-4 weeks. However, in some cases, changes in blood composition can be observed for another 6 months (the most important thing is that there are no atypical mononuclear cells in it). There may be a decrease in immune blood cells - leukocytes. Children can go to kindergarten and calmly communicate with other children only after the number of leukocytes has returned to normal. Changes in the liver and/or spleen may also persist, so after an ultrasound, which is usually performed during illness, it is repeated after the same six months. Lymph nodes may remain enlarged for quite a long time. For one year after the illness, you must be registered with an infectious disease specialist.

Diet after infectious mononucleosis

During illness, EBV travels through the blood to the liver. The organ can fully recover from such an attack only after 6 months. In this regard, the most important condition for recovery is adherence to diet during illness and during the recovery stage. Food should be complete, varied and rich in all the vitamins, macro- and microelements necessary for humans. A split diet is also recommended (up to 4-6 times a day).

It is better to give preference to dairy and fermented milk products (they are able to control normal intestinal microflora, and with a healthy microflora, immunoglobulin A is formed, which is important for maintaining immunity), soups, purees, fish and lean meats, unsalted biscuits, fruits (in particular, “ your apples and pears), cabbage, carrots, pumpkin, beets, zucchini, and non-acidic berries. Bread, mainly wheat, pasta, various cereals, cookies, day-old baked goods and products made from soft dough are also useful.

The consumption of butter is limited, fats are introduced in the form of vegetable oils, mainly olive, sour cream is used mainly for dressing dishes. Allowed in small quantities are mild types of cheese, egg yolk 1-2 times a week (the white can be eaten more often), any dietary sausage, and beef sausages.

After suffering from infectious mononucleosis, all fried, smoked foods, pickled foods, pickles, canned food, spicy seasonings (horseradish, pepper, mustard, vinegar), radishes, radishes, onions, mushrooms, garlic, sorrel, as well as beans, peas, and beans are prohibited. Prohibited are meat products - pork, lamb, geese, ducks, chicken and meat broths, confectionery products - pastries, cakes, chocolate, ice cream, as well as drinks - natural coffee and cocoa.

Of course, some deviations from the diet are possible. The main thing is not to abuse prohibited products and have a sense of proportion.

Smoking and drinking alcohol are also unsafe.

Mononucleosis is an infectious disease that occurs quite often in childhood. The peculiarity of the disease is that it is quite difficult to diagnose . General symptoms resemble a common cold, sore throat or flu. The insidiousness of mononucleosis lies in its complications, which often affect internal organs.

If you notice and diagnose the disease in time and follow all the doctor’s recommendations, then serious complications can be avoided. In today’s article we’ll talk about the topic: “What is infectious mononucleosis in children, how to treat it and how long the disease lasts.” We hope our advice will be useful to many parents.

Mononucleosis is a disease caused by a herpes virus. As a rule, the disease is observed in children from 3 to 7 years old and in adolescents. Very common in children's groups.

Infectious mononucleosis is a very easily transmitted disease

Transmitted by air . The virus penetrates the oral cavity, takes hold there and lives for up to 2-3 weeks, actively developing.

But you can also become infected by using shared utensils and toys. Teenagers are often affected by the disease. The infection is transmitted through kissing.

In the external environment, the virus quickly dies. High air temperature, high humidity and ultraviolet rays are the main enemies for the virus.

This is interesting! Typically mononucleosis Every person gets sick at least once in their life. After suffering an illness, the body develops a strong immune system.

Signs of the disease

The incubation period can be from 2 weeks to a month . Once on the mucous membranes, the virus begins to actively multiply, then penetrates the blood, spreading throughout the body, at this time the lymph nodes begin to actively react to it, they increase in size, and the blood formula changes.

Advice! It is very important to correctly identify the disease at the initial stage. In this case, the doctor will prescribe treatment that will eliminate complications.

The main symptoms and signs of the disease are as follows:

Differences from sore throat

Upon external examination, it is difficult to distinguish a sore throat from mononucleosis.

It is important! An experienced doctor will be able to diagnose the disease without any problems. Its main differences from sore throat are as follows:

nasal congestion;
enlarged liver and spleen;
change in the general blood test.

Many parents, upon hearing a diagnosis of mononucleosis from a pediatrician, are immediately scared. Doctors assure that the disease can be treated quite quickly and effectively, all that matters is follow the recommendations of a specialist.

Diagnostic methods

During an abdominal ultrasound, the doctor checks the size of the spleen and liver.

When the first symptoms of mononucleosis appear, you should immediately consult a doctor. In addition to a general examination and questioning of the patient, the specialist will prescribe the following tests:

Blood analysis . It is necessary to see the number of components, for example, ESR, lymphocytes and leukocytes. If these data are increased by 1.5-2 times, we can safely talk about the inflammatory process and the presence of a virus in the body.
Blood chemistry . It is needed to see how the liver and kidneys work, whether they cope with the virus, and whether there are any changes in these internal organs.
Test for the determination of antibodies to the herpes virus . If the result is positive, then the diagnosis will be in question.
Abdominal ultrasound . The doctor pays special attention to the size of the spleen and liver. If they are enlarged, drug treatment is carried out and a special diet is prescribed.

It is important! There are markers that can detect mononuclear cells in the blood. But the peculiarity of the disease is that they fully manifest themselves in the blood only 2–3 weeks after the onset of the active stage of the disease. That is why such an analysis is considered uninformative.

How is mononucleosis treated in children?

If you have a sore throat, LIZOBACT will help.

Treatment should be with the following drugs:

Antipyretics . These remedies will help to quickly reduce body temperature and cope with fever. The following drugs are approved for children under 10 years of age: “ Ibuprofen" And " Paracetamol" They are valid for 20–40 minutes. Can be taken every 5–6 hours. If the temperature rises above 39 degrees, Analdim candles will help. They contain analgin and diphenhydramine. Such candles are allowed to be used once a day.
Painkillers . Often with mononucleosis, children experience a sore throat. You can eliminate it by rinsing. Use herbal decoctions, salt, soda, iodine for solutions. Among the medications we can recommend “ Faringosept», « Septefril», « Lysobacter», « Yox».
Antiviral . To overcome the herpes virus, doctors prescribe an appointment “ Acyclovir" In addition, they can recommend candles “ Viferon" and tablets " Aflubin" These drugs quickly “kill” the virus and help strengthen the immune system.

If an ultrasound scan reveals abnormalities in the liver and spleen, medications will be prescribed to support them. These can be funds like “ Karsil», « Hofitol», « No-shpa».

It is important! This is a viral disease. And as you know, viruses cannot be treated with antibiotics. Therefore, taking these drugs is pointless for this disease.

When are antibiotics needed?

If the high fever does not subside for more than five days, the pediatrician should prescribe an antibiotic.

But there are still cases when antibiotics are necessary:

The patient's temperature lasts more than 5 days ;
a bacterial infection has been added to the underlying disease;
the patient developed complications.

In this case, the doctor individually selects the drug, and in addition prescribes the use of bacteria that bring the intestinal and stomach flora in order.

conclusions

Mononucleosis is a disease that most often occurs in children.

You can cope with the disease quite quickly if you follow all the recommendations and prescriptions of doctors. Don't delay your visit to the pediatrician. Remember, delay can result in serious complications.

anonymous, Female, 21 years old

One fine night I woke up with a high temperature - 38.8, I brought it down with paracetamol, I don’t remember if it helped, but I remember for sure that after sleep it rose to 39. By the evening it was already 40, and I had to call the ambulance, which, by the way, I arrived only 4 hours later. Being prone to PA and fainting, she almost lost consciousness, but held on. The doctor arrived and took a long time to bring down the temperature to 38.8 with paracetamol suppositories and compresses. And so it stayed with me at around 38.5 for more than a week. At the beginning of the examination, the doctor diagnosed ARVI, prescribed antibiotics, nothing helped, and a rash also appeared, so I ended up going to the clinic. They said that the fever had been bad for a week and a half and sent Botkin to the hospital. There, blood and urine tests diagnosed me with mononucleosis, but not right away. This was discovered by a long-term fever, an enlarged liver, lymph nodes in the neck and an increase in something (I can’t say). They treated me with acyclovir, gave me suprastin injections, and gave me saline solution with vitamins. In fact, I was discharged with a temperature of 37.5 and a sore throat two weeks later. And since then everything has gone wrong. After a couple of weeks, the temperature subsided, as promised, but then a little later it rose to 37.5. I was warned that within six months this is the norm, if it does not rise higher. But everything has been going on for a year now. Plus, since that time, my chronic tonsillitis has never recovered from its acute form. There was and is terrible sweating, aching joints, tiredness, nervousness. I saw an infectious disease specialist for a long time, but she didn’t prescribe anything other than antibiotics, which I’m allergic to. After them, as expected, thrush immediately began. In December, severe pharyngitis began, which still has not gone away, so I went to the ENT specialist. I first prescribed calcium gluconate injections, and then added ceftriaxone, from which I had very unpleasant consequences (fever, sweating, rapid heartbeat, diarrhea and lack of appetite, then thrush with a very small amount of discharge during menstruation). The thrush was cured, the ENT doctor canceled the injections as soon as he found out what was wrong with me. He prescribed biseptol, ismigen and ketotifen. And oh, miracle, a week later my temperature dropped to 36.6 for the first time, and by the evening the maximum was 37. The tonsillitis also went away, which I was incredibly happy about. As a result, the doctor stopped the medication and told me to harden myself (pour a bowl of cold water over my entire body, stand for a minute, and then immediately dry off and warm up). The first four times were amazing, a huge lift in mood and well-being. That's all. Then I couldn’t do it, because the temperature rose to 38. And for three weeks now I have been walking around with a temperature of 37.3-38 day and night, I feel like I have the flu. I took analyses, however, before hardening - everything was normal, no signs of inflammation. Just a month ago, during thrush after ceftriaxone, I had very scanty periods. I was treated during them. Now I have my period again, a week before my period I have been experiencing lower back pain, and from the very beginning there have been rare clots of brown discharge. The gaskets are clean, just wipe them off, although before everything was fine. How to bring down the temperature? At least get rid of the symptoms? I know that mononucleosis is incurable, like all herpes viruses. I am afraid of the consequences in the form of cancer, ruptured spleen and constant illnesses. Previously, the temperature was 35.6, but now I don’t even remember what it’s like to feel good.

Good afternoon. Afterwards, asthenic syndrome lasts for a really long time (weakness, lethargy, temperature rise to low-grade levels). Asthenic syndrome could be aggravated by chronic tonsillitis. Hardening is, of course, good, but it was still advisable to do it gradually, especially if you had no such experience before. It is advisable to strengthen the immune system in at least this way: (start with air baths, pouring water over your hands and feet with a gradual decrease in temperature), walk more often, maintain adequate temperature and humidity at home (temperature 21-23 degrees, humidity 50-70%), In autumn and winter, take multivitamins (Alphabet, Gerimax), and for prevention during periods of increased incidence, you can apply interferon preparations with antioxidants in the form of a gel (Viferon gel) twice a day to the nasal mucosa. Now, judging by the temperature, there is either an exacerbation of chronic tonsillitis, or a sluggish ARVI, or another inflammatory disease (urinary organs, gynecological area). You definitely need to see a doctor in person and have a urine, ultrasound scan of the pelvic organs, kidneys and bladder, you should be examined by a therapist and/or ENT doctor, gynecologist, and, if indicated, a urologist (if there are changes in general, ultrasound of the kidneys).

Consultation with a general practitioner on the topic “The temperature does not subside for a whole year and symptoms do not disappear after infectious mononucleosis” is given for informational purposes only. Based on the results of the consultation received, please consult a doctor, including to identify possible contraindications.

About the consultant

Details

General practitioner since 2006. Gastroenterologist.

Participant in conferences on general therapy, gastroenterology, pain therapy and restorative techniques, diet therapy. Participant of the XIX Annual educational course “Internal diseases: review and new achievements” (Columbia University Medical Center (New York, USA).

Area of professional interests: ARVI, acute viral and bacterial infections of the upper respiratory tract (including in pregnant women), gastrointestinal diseases, diet therapy, restorative medicine, rheumatological diseases.

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 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 - increases sharply. 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. 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 to 38-39 degrees C and enlarged lymph nodes.

Symptoms of mononucleosis

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 37-38 degrees C, gradually increasing to 39-40 degrees C. Despite the duration and severity of the fever, the general condition of 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- This is, as a rule, 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 often occurs asymptomatically or with a blurred clinical picture in the form. 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:

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:

Acute– manifestations of the disease last no more than 3 months;
Protracted– changes last from 3 to 6 months;
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– prolonged fever, sore throat-like changes in the oropharynx, enlarged lymph nodes;
Epidemiological anamnesis– household or sexual contact with a person who has had a fever for a long time, blood transfusion or organ transplantation 6 months before the disease;
Inspection data– hyperemia of the pharynx, plaque on the tonsils, enlargement of the lymph nodes, liver and spleen;
Laboratory test results– 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:

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 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 shown rest, bed rest, plenty of warm drink in the form of fruit drink, weak tea, compote, 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:

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.

On average, the duration of treatment is 15-30 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:

Autoimmune hemolytic anemia;
Meningoencephalitis;
Guillain-Barre syndrome;
Psychosis;
Damage to the peripheral nervous system – polyneuritis, cranial nerve palsy, paresis of facial muscles;
Myocarditis;
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.

Video: infectious mononucleosis, “Doctor Komarovsky”

It provokes several infectious pathologies with an acute course and specific symptoms. One of them is Filatov’s disease or mononucleosis, which is diagnosed mainly in children over 3 years of age. The symptoms and treatment of the disease have been thoroughly studied, so it is easy to cope with without complications.

Mononucleosis in children - what kind of disease is it?

The pathology in question is an acute viral infection that attacks the immune system through inflammation of lymphoid tissues. Mononucleosis in children affects several groups of organs at once:

lymph nodes (all);
tonsils;
spleen;
liver.

How is mononucleosis transmitted in children?

The main route of spread of the disease is airborne. Close contact with an infected person is another common way mononucleosis is transmitted, which is why it is sometimes called “kissing disease.” The virus remains viable in the external environment; you can become infected through common objects:

toys;
dishes;
underwear;
towels and other things.

Incubation period of mononucleosis in children

The pathology is not very contagious, epidemics practically do not happen. After infection, infectious mononucleosis in children does not appear immediately. The duration of the incubation period depends on the degree of immune activity. If the defense system is weakened, it is about 5 days. A strong body quietly fights the virus for up to 2 months. The intensity of the immune system also affects how mononucleosis occurs in children - symptoms and treatment are much easier when the defense system is strong. The average duration of the incubation period is within 7-20 days.

Mononucleosis - how contagious is a child?

The causative agent of Filatov's disease is embedded in some cells of the body forever and is periodically activated. Viral mononucleosis in children is contagious for 4-5 weeks from the moment of infection, but it constantly poses a danger to others. Under the influence of any external factors that weaken the immune system, pathogenic cells again begin to multiply and be excreted in saliva, even if the child is apparently healthy. This is not a serious problem; about 98% of the world's population are carriers of the Epstein-Barr virus.

Negative consequences occur in exceptional cases, only when the body is weakened or a secondary infection is attached. Mononucleosis in children is mostly easy - symptoms and treatment, detected and started in a timely manner, help prevent any complications. Recovery is accompanied by the formation of stable immunity, due to which re-infection either does not occur or is tolerated unnoticed.

Rare consequences of mononucleosis in children:

paratonsillitis;
sinusitis;
neuritis;
hemolytic anemia;
liver failure;
skin rash (always when using antibiotics).

Mononucleosis in children - causes

The causative agent of Filatov's disease is an infection belonging to the herpes family. Epstein-Barr virus is common in children due to constant exposure to crowded places (schools, kindergartens and playgrounds). The only cause of the disease is infection with mononucleosis. The source of infection is any carrier of the virus with whom the baby comes into close contact.

Mononucleosis in children - symptoms and signs

The clinical picture of the pathology may change at different periods of the disease. Infectious mononucleosis in children - symptoms:

weakness;
swelling and tenderness of the lymph nodes;
catarrhal bronchitis or;
increased body temperature;
pain in joints and muscles due to lymphostasis;
an increase in the size of the spleen and liver;
dizziness;
migraine;
sore throat when swallowing;
herpetic rashes in the mouth area;
susceptibility to acute respiratory viral infections and acute respiratory infections.

It is important to differentiate between similar diseases and mononucleosis in children - the symptoms and treatment of the Epstein-Barr virus are confirmed only after a thorough diagnosis. The only reliable way to identify the infection in question is a blood test. Even the presence of all the listed symptoms does not indicate the progression of Filatov’s disease. Similar symptoms may be accompanied by:

diphtheria;
angina;
listeriosis;
tularemia;
rubella;
hepatitis;
pseudotuberculosis and other pathologies.

Skin manifestations of the described disease occur in 2 cases:

Activation of the herpes virus. Signs of mononucleosis in children sometimes include the formation of blisters with cloudy fluid on the upper or lower lip, especially in children with weak immune systems.
Taking antibiotics. Treatment of secondary infection is carried out with antimicrobial agents, mainly Ampicillin and Amoxicillin. In 95% of children, such therapy is accompanied by a rash, the nature of which has not yet been clarified.

Throat with mononucleosis

The pathology is caused by the Epstein-Barr virus - the symptoms of its introduction into the body always affect lymphoid tissues, including the tonsils. Against the background of the disease, the tonsils become very red, swollen and inflamed. This causes pain and itching in the throat, especially when swallowing. Due to the similarity of the clinical picture, it is important to differentiate between sore throat and mononucleosis in children - the main symptoms and treatment of these diseases are different. Tonsillitis is a bacterial infection and can be treated with antibiotics, while Filatov’s disease is a viral infection; antimicrobial drugs will not help.

Temperature with mononucleosis

Hyperthermia is considered one of the earliest specific signs of the disease. Body temperature rises to subfebrile levels (37.5-38.5), but lasts a long time, about 10 days or more. Due to prolonged fever, in some cases mononucleosis in children is difficult to tolerate - symptoms of intoxication against a background of fever worsen the child’s well-being:

drowsiness;
headache;
lethargy;
aching joints;
nagging muscle pain;
severe chills;
nausea.

Blood test for mononucleosis in children

The given symptoms are not considered a basis for making a diagnosis. To clarify it, a special test for mononucleosis in children is performed. It consists of a blood test; in case of Filatov’s disease, the following is found in the biological fluid:

the presence of atypical cells – mononuclear cells;
decrease in the number of leukocytes;
increased concentration of lymphocytes.

Additionally, an Epstein-Barr virus test is prescribed. There are 2 options for carrying it out:

Enzyme immunoassay. A search is carried out for antibodies (immunoglobulins) IgM and IgG to infection in the blood.
Polymerase chain reaction. Any biological material (blood, saliva, sputum) is analyzed for the presence of DNA or RNA of the virus.

There are no effective medications yet that can stop the proliferation of infectious cells. Treatment of mononucleosis in children is limited to relieving the symptoms of the pathology, alleviating its course and generally strengthening the body:

Semi-bed rest. The main thing is to provide the child with peace, not to overload physically and emotionally.
Drink plenty of warm drinks. Fluid intake helps prevent dehydration due to fever and helps improve the rheological composition of the blood, especially taking fortified drinks.
Careful oral hygiene. Doctors recommend gargling after every meal and brushing your teeth 3 times a day.

Treatment of infectious mononucleosis in children may include the use of pharmacological agents:

Antipyretics – Acetaminophen, Ibuprofen. It is allowed to lower the temperature if it rises above 38.5 degrees.
Antihistamines - Cetrin, Suprastin. Allergy medications help alleviate symptoms of intoxication.
Vasoconstrictors (local, in the form of drops) – Galazolin, Ephedrine. The solutions provide relief from nasal breathing.
Antitussives – Bronholitin, Libexin. The drugs are effective in the treatment of tracheitis or bronchitis.
Antibiotics – Ampicillin, Amoxicillin. They are prescribed only in the event of a secondary infection of bacterial origin, for example, when a purulent sore throat begins.
Corticosteroids – Prednisolone, Methylprednisolone. Hormones are selected for the treatment of exceptional situations (hypertoxic course of the pathology, threat of asphyxia due to severe swelling of the tonsils and other life-threatening conditions).

Epstein-Barr virus damages lymphoid organs, one of which is the liver. For this reason, a specific diet for mononucleosis in children is recommended. Preferably small but frequent (4-6 times a day) meals. All food and drinks should be served warm; if you have a severe sore throat while swallowing, it is better to grind any irritating food. A moderate diet is being developed that does not overload the liver, with a complete content of proteins, vitamins, vegetable and animal fats, and carbohydrates.

The following products are limited or excluded:

fatty meat and fish;
fresh hot baked goods;
fried and baked dishes with a crust;
strong broths and rich soups;
marinades;
smoked meats;
hot spices;
conservation;
any acidic foods;
tomatoes;
sauces;
mushrooms;
nuts;
strawberry;
garlic;
meat by-products;
cabbage;
radish;
spinach;
radish;
fatty cheeses;
citruses;
raspberries;
melons;
black bread;
pears;
sweets with butter and fat cream;
chocolate;
baked goods;
cocoa;
whole milk;
carbonated drinks, especially sweet ones.

vegetable broths and soups;
dietary meat, fish (boiled, steamed, baked in pieces, in the form of meatballs, cutlets, mousse and other minced meat products);
yesterday's white bread, crackers;
cucumbers;
boiled and slimy porridge in water;
casseroles;
low fat fermented milk products;
vegetable salads, sauté;
sweet fruits;
baked apples;
dry cookies, biscuits;
jelly;
steamed dried apricots, prunes;
weak tea with sugar;
jam;
paste;
marmalade;
dried fruits compote;
rosehip decoction;
cherries;
apricots;
peaches (without skin), nectarines;
watermelons;
still mineral water;
herbal tea (preferably sweetened).

Recovery from mononucleosis in children

The next 6 months from the moment of recovery, the child must be periodically shown to the doctor. This helps determine whether mononucleosis in children has caused any negative side effects—symptoms and treatment, when properly identified, do not guarantee protection against damage to liver and spleen tissue. Scheduled examinations are carried out three times - after 1, 3 and 6 months from the day of recovery.

Recovery from mononucleosis involves following a number of general measures:

Load limitation. Children who have had the pathology considered should be subject to fewer requirements at school. Gentle physical exercises are recommended; after the pathology, the child is still weakened and gets tired quickly.
Increased rest time. Doctors advise allowing your baby to sleep about 10-11 hours at night and 2-3 hours during the day if he needs it.
Maintaining a balanced diet. Children should eat as nutritiously as possible and receive important vitamins, amino acids and minerals. It is advisable to continue feeding your baby healthy foods to speed up the healing and repair of damaged liver cells.
Visiting resorts. Modern studies have shown that relaxing by the sea is not harmful for children who have had mononucleosis. You just need to limit the time your child spends in the sun.