The initial stage of mononucleosis. Infectious mononucleosis - symptoms (photo) in children and adults, treatment

Mononucleosis is acute infection which affects the lymphatic system of the body. The disease progresses from acute fever, sometimes enlarging the spleen and liver. It leads to the occurrence of angina, a decrease in immunity. It is now known for sure that the Epstein Barr virus almost always causes infectious mononucleosis. Doctors attribute it to the group of herpes. The source of the spread of the disease is a sick person, and infection occurs through direct contact, through contaminated household items or by airborne droplets.

Causes of mononucleosis

The mechanisms of transmission of mononucleosis are simple: through saliva, mucus, tears. The disease is also transmitted through kissing, so the infection was nicknamed: “kissing disease”. The virus, once settled in the body, remains there forever, and even if it is not active, it is easily transmitted to other people. The main causes of mononucleosis in humans are:

weak immunity;
severe mental or physical stress;
transferred stress;
non-observance of hygiene rules;
use of shared linen, dishes, towels.

Symptoms and signs of the disease

Mononucleosis infection in a patient is characterized by the following symptoms diseases:

Fever. The temperature rises, which means the development of the activity of microbes or their poisons in the human body. chills occur, increased sweating.
Angina. There is a sore throat when swallowing, an inflammatory process on the mucous membranes and an increase in the tonsils.
Damage to the lymph nodes. The lymph nodes and tissues around them are enlarged, usually under the jaw, which indicates the spread of the focus of infection.
Damage to the spleen and liver. This causes pain in the abdomen varying degrees. By the 10th day of illness, yellowness of the skin can be observed.
Rash on the skin. Disappears after attenuation of acute symptoms of mononucleosis.
Change in blood picture. It is diagnosed by a doctor after testing by the presence of mononuclear cells in the blood, as well as an increase in lymphocytes and monocytes.
Pathology of the muscles of the heart, pancreas. Occurs when severe forms infectious mononucleosis in immunocompromised children.

Methods for the treatment of mononucleosis disease

Viral mononucleosis refers to infections that are self-limiting, so even if untreated, the disease can gradually go away on its own. But in order for the infection to pass faster, without developing into chronic form, and the risk of complications was minimal, it is recommended that sick people undergo certain treatment by doctor's prescription. Mononucleosis is easily treated at home, with prescribed bed rest and diet, but special therapy doctors have not yet developed against this disease.

Medical treatment

"Acyclovir". Because mononucleosis is viral infection, then doctors recommend taking antiviral drugs that reduce the secretion of the Epstein-Barr virus. "Acyclovir" for adult patients is prescribed 200 mg 5 times / day. The period of treatment of the disease with the drug is 5 days. Children's dose up to 2 years is half the adult, but requires constant medical supervision. During pregnancy, the use of the drug is possible only in exceptional cases.
"Viferon". It refers not only to antiviral, but also to immunomodulatory drugs. The medicine boosts immunity, helping the body fight the disease. Assign ointment or gel "Viferon" for the first or recurrent infections of the mucous membranes for external use. It has an effect on the mucous membrane in the lesion, on which it is applied thin layer 3 times / day for one week.
"Paracetamol". cleans up pain syndromes with mononucleosis various genesis(fever, headache). Method of application: 1-2 tablets 4 times / day for 3-4 days.
Faringosept. An anesthetic drug that helps relieve the symptoms of atypical sore throat. Assign 4 tablets / day, which should be absorbed until dissolved. The course of treatment lasts 3-4 days.

Folk remedies against the virus

Symptoms viral mononucleosis make it easier with the following folk recipes:

A decoction of cabbage. Availability a large number vitamin C allows you to quickly relieve the symptoms of fever. To do this, wash cabbage leaves, fill them with water and cook over low heat for 5 minutes. Then let the decoction infuse until cool, and take it 100 ml every hour until the body temperature drops.
To reduce pain in the throat, you need to rinse it with a decoction of chamomile and rose hips. To prepare it, take 150 g of dried chamomile flowers, 1 tbsp. l. pharmacy wild rose, brew in a thermos, let it brew for 2 hours. Then gargle every 1-1.5 hours until it is completely restored.
To reduce intoxication of the body and increase immunity in case of a viral disease, you need to prepare a decoction of calendula flowers, chamomile sage. To do this, take fresh or dry herbs in equal proportions, pour boiling water and put on water bath for 15 minutes. After the decoction has cooled, drink 150 ml 3 times a day until complete recovery.

Possible complications and consequences

The disease is dangerous for its complications. The virus has oncogenic activity, which is why after mononucleosis you can not be in the sun for 3-4 months. Although a mononucleosis infection is very rarely fatal, it is not excluded after the disease the development of inflammation of the brain, bilateral lung damage with severe oxygen starvation. Rarely, but with a severe course of the disease, rupture of the spleen is possible. In immunocompromised children, infectious mononucleosis can lead to hepatitis, the main symptom of which is jaundice.

Prognosis and prevention of the disease

In 90% of cases of detecting an infectious disease, mononucleosis has a favorable prognosis. However, after an infection, the body remains weak. Decreased immunity against the background of the disease can last up to 6 months, therefore it is indicated general strengthening body: regular washing of the throat and nose with decoctions of herbs, hardening, taking vitamin complexes, proper nutrition, frequent presence on fresh air.

Which doctor to contact to diagnose the disease

Mononucleosis is treated by an infectious disease specialist. This specialist is easy to find in any infectious diseases hospital city or district scale. The doctor is responsible for diagnosing and treating mononucleosis and other viral diseases. He studies the causes of the disease and the mechanism for the development of infection in each individual case, determining the clinical picture with the help of cultures, blood and urine tests, biochemical studies, ultrasound, x-rays, electrocardiography, irrigoscopy.

Video: how mononucleosis is transmitted and how to cure it

Children's mononucleosis often develops after the age of 10 years, and infants under 1 year of age practically do not get this infectious disease. This is due to the fact that children at this age do not communicate with their peers and with a large number of adults who are contagious. Into the child's body viral disease enters, as a rule, through the mucous membrane of the upper respiratory tract from where his journey through the body begins. Let's see in the video the opinion of the famous pediatrician Dr. Komarovsky on how best to treat infectious mononucleosis:

The content of the article

Infectious mononucleosis (synonyms of the disease: glandular fever, Filatov's disease, Pfeiffer's disease, Turk's disease, monocytic tonsillitis, etc.) - an acute infectious disease of a viral nature, mainly with an airborne mechanism of infection, characterized by fever, polyadenitis (especially cervical), acute tonsillitis with raids, enlargement of the liver and spleen, leukocytosis, lymphomonocytosis, the presence of atypical mononuclear cells (virocytes).

Historical data on infectious mononucleosis

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

Etiology of infectious mononucleosis

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

Epidemiology of infectious mononucleosis

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

Pathogenesis and pathomorphology of infectious mononucleosis

The entrance gate of infection is the mucous membrane of the nasopharynx and upper respiratory tract. The infectious mononucleosis virus is tropic to the lymphoid and reticular tissue, resulting in damage The lymph nodes, liver, spleen, to a certain extent - bone marrow, kidneys. Lymphogenically, the pathogen enters the regional lymph nodes, where primary lymphadenitis develops. In case of destruction of the lymphatic barrier, viremia occurs and the process is generalized. The next phase of pathogenesis is infectious-allergic, which predetermines the undulating course of the disease. The last phase is the formation of immunity and recovery.
The defeat of the lymphoid and reticular tissue leads to an increase in the number of lymphocytes, monocytes in the blood and the presence of monocyto-like lymphocytes, which are called differently: atypical mononuclear cells, glandular fever cells, virocytes, and similar lymphocytes.
Recently great attention given to infectious mononucleosis as a disease immune system. The virus does not destroy infected cells (B-lymphocytes), but stimulates their reproduction; can long peremetuvaty in lymphocytes. Fixation of the pathogen on the surface of B-lymphocytes leads to the activation of the body's defense factors. These include circulating antibodies against the surface antigen of the Epstein-Barr virus, cytotoxic lymphocytes, natural killers. The main mechanism of destruction of infected cells in infectious mononucleosis is the formation of specific cytotoxic T-killers capable of recognizing infected cells. During the intense destruction of B-lymphocytes, it is possible that substances are released that predetermine fever and have a toxic effect on the liver. In addition, it enters the lymph and bloodstream significant amount virus antigens that cause a general allergic reaction of a slow type. Infectious mononucleosis is also characterized by the activation of T-lymphocytes - suppressors that suppress the reproduction and at the same time differentiation of B-lymphocytes. This makes it impossible for infected cells to multiply.
Histologically, generalized hyperplasia of the lymphatic and reticular tissue of all organs and systems is detected, as well as mononuclear infiltration, sometimes shallow focal necrosis in the liver, spleen, kidneys, and central nervous system.

Clinic of infectious mononucleosis

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

Prognosis of infectious mononucleosis

The disease usually ends full recovery. Lethal outcome is observed very rarely.

Diagnosis of infectious mononucleosis

Supporting symptoms clinical diagnostics infectious mononucleosis is fever, acute tonsillitis, polyadenitis, hepatosplenomegaly, lymphocytosis, monocytosis and the presence of atypical mononuclear cells in the blood. In doubtful cases, apply serological studies, which are various modifications of heterohemagglutination. Among them, the most common Paul-Bunnell reaction in Davidson's modification, which makes it possible to detect heterophilic antibodies against ram erythrocytes in the blood serum of patients with infectious mononucleosis (diagnostic titer 1: 32 and higher).
The simplest and most informative is the Hoff-Bauer reaction with formalized horse erythrocytes on a glass slide. To conduct it, only one drop of the patient's blood serum is needed. The answer is immediate. The reaction is positive in 90% of cases. The agglutination reaction of trypsinized bovine erythrocytes with the patient's blood serum, which is pre-treated with an extract of guinea pig kidneys, is also used. In patients with infectious mononucleosis, this reaction is positive in 90% of cases. A reaction based on the ability of the blood serum of a patient with infectious mononucleosis to hemolyzate bovine erythrocytes is also used. These reactions are non-specific, some of them may be positive in other diseases, reducing their diagnostic information.

Differential diagnosis of infectious mononucleosis

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

Treatment of infectious mononucleosis

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

Prevention of infectious mononucleosis

Specific prevention of infectious mononucleosis has not been developed. Patients are hospitalized for clinical indications: Quarantine is not established. Disinfection measures in the focus of infection are not carried out.

Infectious mononucleosis (Filatov's disease) is a disease associated with the Epstein-Barr virus, which belongs to the group of herpes viruses. The disease is common on all continents. Most often, adolescents aged 14–18 years are sick, cases of the disease among people over 40 years of age are extremely rare, but in HIV-infected people, activation of a latent infection can occur at any age. When infected in childhood symptoms primary infection very similar to symptoms respiratory disease, in adults, primary infection may not cause any symptoms at all. By the age of 35, most people have antibodies to the Filatov disease virus in their blood.

The route of transmission of infection is airborne, often the virus is found in saliva, so infection and by contact through dirty hands, kisses and household items. Cases of infection with infectious mononucleosis during childbirth and during blood transfusions are recorded.

Symptoms of infectious mononucleosis

At the onset of the disease, mononucleosis is practically indistinguishable from ordinary SARS. Patients are worried about a runny nose, moderate sore throat, body temperature rises to subfebrile values.

The incubation period of the disease has no clear boundaries and can last from 5 days to 1.5 months. Sometimes the acute period is preceded by a prodromal one, which has general symptoms. In such cases, the disease develops gradually. For several days, the patient may experience subfebrile body temperature, weakness, nasal congestion, hyperemia of the mucous membrane of the throat. Such symptoms are most often regarded as manifestations of the common cold.

In some cases, the disease begins acutely with a sharp rise in body temperature, patients complain of severe headache, increased sweating, aching joints, sore throat when swallowing.

At the end of the first week, the period of the height of the disease begins, the state of health of patients deteriorates sharply. Infectious mononucleosis is characterized by such clinical symptoms as severe intoxication, damage to the pharynx, enlarged lymph nodes, liver and spleen.

The defeat of the oropharynx is manifested in the form of the development of angina, most often catarrhal or ulcerative necrotic. In this case, hyperemia (redness) rear wall the pharynx is pronounced, yellowish, loose, easily removable plaques appear on the tonsils. In addition, nasal congestion, difficulty in nasal breathing may appear.

In the first days of the disease, patients develop lymphadenopathy. An increase in lymph nodes is noted in all areas that are accessible to inspection, the symmetry of the lesion is characteristic. Most often, Filatov's disease affects the occipital, submandibular and posterior cervical lymph nodes. On palpation, they are usually painless, firm and mobile, and the size of the nodes can vary from a pea to a walnut.

In most cases, during the peak of the disease, patients have an increase in the liver and spleen. In severe cases, jaundice may develop, as well as dyspeptic symptoms (nausea, loss of appetite).

In rare cases, a maculopapular rash may appear on the skin of patients with infectious mononucleosis, which does not have a clear localization and is not accompanied by itching, which disappears without a trace on its own.

The peak period of the disease lasts 2-3 weeks, and then there is a period of recovery. The state of health of patients improves, signs of the disease gradually disappear. First, angina passes, the size of the liver and spleen normalize. Somewhat later, the size of the lymph nodes becomes normal. Despite the improvement in the condition, body temperature may remain elevated to 38C for several more weeks.

The course of infectious mononucleosis can be long, periods of exacerbation of the disease are replaced by periods of remission, due to which the total duration of the disease can be 1.5 years.

It should be noted that the course of the disease in adults and children is somewhat different. In adults, Filatov's disease most often begins with a prodromal period, damage to the lymph nodes and tonsils can be mild. At the same time, in adults, a significant increase in the liver with the development of jaundice often occurs. In children, infectious mononucleosis usually begins acutely, and lymphadenopathy also predominates in the clinical picture of the disease.

Treatment of infectious mononucleosis

For the period of hyperthermia, a patient with infectious mononucleosis is shown bed rest.

There is no specific treatment for this disease. Patients with mild to moderate severity of the disease can be treated at home. It is recommended to observe bed rest, but this is not necessary in the case of a satisfactory state of health of the patient. The diet of patients should be balanced and exclude fried, fatty and spicy foods.

Drug therapy is aimed at relieving the symptoms of the disease.

Detoxification therapy is necessary to reduce the symptoms of intoxication of the body. In mild forms of the disease, it is enough plentiful drink, and in more severe cases, intravenous infusions are indicated.

Local treatment of angina is carried out by rinsing the oropharynx with antiseptic solutions (Miramistin, Chlorhexidine), decoctions of herbs with anti-inflammatory effects (chamomile).

Vitamin therapy has a general strengthening effect on the body.

Antibacterial therapy is prescribed by a doctor only in case of bacterial complications.

Prevention of infectious mononucleosis

Funds specific prevention this disease not developed. General preventive measures include limiting contact with sick people, observing the rules of personal hygiene and strengthening immunity.

Which doctor to contact

A child with symptoms of an infectious disease can be consulted with a pediatrician. An adult with signs of infectious mononucleosis should be treated by an infectious disease specialist.

Mononucleosis is a pathology first described by the scientist Filatov back in 1885. Only in 1964 it became clear that the nature of the disease was infectious and the methods of therapy began to improve. From this article you will learn everything about what mononucleosis is, what are the symptoms and treatment of this disease, what are the signs of the onset of pathology and what are the reasons for its development.

What is mononucleosis

Acute infectious mononucleosis is a disease that affects lymphoid tissue oropharynx and nasopharynx. In another way, the pathology was called glandular fever or monocytic tonsillitis due to the similarity of clinical symptoms. The causative agent of the disease is the Epstein-Barr virus. Shortly after infection, the composition of peripheral blood changes and atypical mononuclear cells and heterophilic antibodies can be found in it.

Viral mononucleosis is diagnosed in both men and women. Although this infection is sometimes found in adults, it most often appears in. After this virus enters the body, a person develops lifelong immunity to it, although the infection itself remains for life. During the first 18 months after initial infection, viruses are shed into environment and that can infect others.

Note! Infection outbreaks are more common during the autumn months.

Features of the virus and how it is transmitted

Epstein-Barr virus belongs to the group of herpes viruses. It has two DNA molecules and is distinguished by oncogenic and opportunistic properties.

The incubation period of this pathogen is from 5-20 days. This infection is dangerous only for humans, animals do not become infected. You can only get the virus from another person who has the infection or is a carrier.

In another way, infectious mononucleosis is called the kissing disease, since the pathogen is transmitted mainly through saliva. That is why outbreaks of the disease most often occur among adolescents: they eat and drink more from the same bowl and kiss.

You can identify other causes of the disease and the mechanisms of transmission of infection to other people:

during a blood transfusion;
by airborne droplets;
through general subjects household;
while using shared toys among children;
during sexual intercourse;
due to the use of shared toothbrushes;
through the placenta;
when transplanting organs from a sick person to a healthy one.

Up to 50% of the world's adult population in certain moment survived this infection. The peak incidence among adolescent girls occurs at 14-16 years old, and among boys at 16-18 years old. In a child, dirty hands and poor hygiene become the cause of the development of the disease. After 40 years, such a diagnosis is extremely rare. For patients with immunodeficiencies, the risk of infection remains, regardless of age.

Important! During normal conversation next to a sick person or a carrier of an infection, the likelihood of becoming infected is extremely small, but during sneezing, coughing or close contact, the risk increases.

Although carriers of the infection are a large percentage population of the earth, complaints that occur with infectious mononucleosis occur quite rarely.

Disease classification

There is no specific classification for infectious mononucleosis. Allocate different types flow, namely:

lung;
average;
severe course.

The form in which mononucleosis will proceed depends on the state of human health, the immune system and the presence of concomitant diseases.

To determine the disease, it is important to be attentive to your body and detect the first signs of infection in time. After the pathogen has entered the body, it begins to actively divide. From the oral cavity, genital tract or intestines, where it immediately entered, it enters the bloodstream and is introduced into lymphocytes. These blood cells forever remain carriers of infection.

During the first few days, the initial stage of the disease begins, for which the following symptoms are characteristic:

general weakness in the body;
muscle pain;
nausea;
headache;
fever;
chills;
decreased appetite.

Then follows next stage a disease that in some patients occurs within a few days after the onset of the disease, while in others only after 2 weeks. Symptoms include three main signs:

temperature rise;
change in the state of the lymph nodes;
sore throat.

Note! Angina is different from mononucleosis, but an experienced doctor will surely be able to notice the differences.

Without a temperature, mononucleosis is extremely rare. Of all cases of the disease, only in 10% of cases this indicator does not increase. For most, the temperature remains within 38 degrees. Less commonly, it reaches the mark of up to 40 degrees. Even after the peak of the disease has passed, sometimes fever persists for several months. Patients during attacks of fever do not suffer from severe chills or increased sweating.

Lymph nodes undergo significant changes. First, the cervical lymph nodes are affected (polylymph adenopathy), then the axillary and inguinal. Less often, the internal intestinal lymph nodes and bronchial ones are involved in the pathological process. They are subject to the following changes:

become painful on palpation;
too tight;
increase in size;
become mobile.

Important! If the peritoneal or bronchial lymph nodes are affected, coughing and abdominal pain on the right side may occur.

Sore throat is accompanied by visible changes. A photo of the throat can be seen below. The obvious changes are:

the back wall is prone to hyperemia;
swelling is observed;
tonsils are enlarged;
they are covered with easily-removable plaque.

Problems can also affect vital internal organs. So, soon after the Epstein-Barr virus pathogen enters the body, the liver and spleen increase. The doctor should be able to immediately differentiate mononucleosis from other pathologies, as some patients experience yellowness of the sclera of the eyes, and sometimes of the skin.

Important! By 5-10 days of illness, the spleen reaches largest sizes and in case of accidental injury, the risk of its rupture is high, which entails backfire. Therefore, patients are shown complete rest.

Normalization of the size of the liver and spleen occurs a few days after the temperature normalizes. During this period, the likelihood of exacerbation decreases.

With mononucleosis angina, there is often a rash. It can be spread over the skin, and sometimes it is localized in the soft palate. This symptom may appear and disappear repeatedly during the course of the disease.

All these varieties of symptoms are not misleading. an experienced doctor, although it may seem that in children - frequent occurrence And the diagnosis should be just that. Thanks to modern diagnostic methods, the doctor's assumptions can be confirmed or refuted. In infectious mononucleosis, atypical mononuclear cells in general analysis blood levels are elevated.

In order to cure the disease, it takes at least 2 weeks. If it was not possible to get rid of the pathology during this period, there is a risk of complications. It is extremely rare to treat mononucleosis within 2-3 months. This is usually due to the fact that the disease was noticed very late, and first aid was not provided.

Note! It is believed that conjunctivitis and mononucleosis are incompatible diseases, but this has not been proven.

With proper therapy, especially in childhood, chronic mononucleosis does not develop. Relapses also do not occur, as the body produces antibodies that remain in the blood for life.

Possible Complications

If adequate therapy is not initiated medical methods and carry out treatment folk remedies, the risk of developing complications is high:

Restoration of the body is possible if a thorough diagnosis is carried out in a timely manner and drugs are selected for the treatment of pathology.

Diagnostic measures

In order to choose the right medicines, and not treat false sore throat, it is important to conduct the necessary blood tests and tests. The blood picture changes as follows:

plasmatization of the cytoplasm of lymphocytes is observed, that is, a violation of the structure of these cells;
the appearance of wide plasma lymphocytes;
the rate of mononuclear cells in acute period diseases - from 5-50%, depending on the intensity of the pathology.

Note! If more than 10% of atypical lymphocytes are found in the blood test, the diagnosis is considered confirmed.

Deciphering the results laboratory research carried out only by a specialist. It makes sense to conduct a blood test for antibodies to the Epstein-Barr virus. In the presence of class M immunoglobulin titers, it indicates an acute process. In the presence of IgG, one speaks of past illness in the past. Sometimes a PCR analysis is performed to identify the DNA of the pathogen.

Additional diagnostic methods can be carried out only in order to determine how badly the internal organs were affected and to exclude other pathologies.

Principles of treatment

If mononucleosis occurs in mild or moderate form, treatment is carried out at home. The patient must strictly follow the recommendations from the doctor's prescription and adhere to quarantine. The use of alternative methods of therapy is permissible, but only in agreement with the doctor and as an adjuvant therapy.

If inflammation of the liver has joined the pathological process, the patient must follow diet No. 5. At the same time, nutrition must be complete so that the body receives all the necessary nutrients during illness.

specific medicinal product, used against the Epstein-Barr virus, does not exist. Therefore, antiviral drugs of general action are prescribed:

It is important to consider that each drug has contraindications and side effects which should be reviewed prior to treatment. You should be especially careful during pregnancy, as many drugs can cause irreparable harm to the fetus.

Note! When the temperature rises above 38.5 degrees, it is necessary to take an antipyretic.

At severe course and in case of joining bacterial infection the use of antibiotics is recommended:

To stimulate the outflow of lymph and restore full functions lymphatic system the doctor may prescribe the drug "Lymphomyosot". Sometimes hormones, antihistamines and antiseptics are prescribed.

Prevention

There is no specific prevention. A vaccine for vaccination is still under development and is not widely used.

The best protection against infectious diseases is good hygiene, maintaining a good immune system, and avoiding contact with people suffering from a fever.

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The disease infectious mononucleosis in children is called glandular fever. This is a viral disease, which is characterized by prolonged fever, sore throat, increased various groups lymph nodes, specific changes in peripheral blood. This disease is relevant for all age groups, but to a greater extent for young children.

For the first time, infectious mononucleosis was described back in 1885 by Filatov, but then it was supplemented by the study of blood changes, and the identification specific pathogen. Due to all this, this disease got its official name of infectious mononucleosis. The causative agent was later identified by two scientists - and in honor of them the virus was named the Ebstein-Barr virus.

What kind of disease is mononucleosis: the causative agent of the disease

In order to correctly understand what kind of disease infectious mononucleosis is, and why this disease requires some attention, it is necessary to know some of the features of the virus itself.

The Epstein-Barr virus is immediate cause, that is infectious agent this disease in children and adults. This member of the herpesvirus family is prone to prolonged circulation in the human body, and also has a carcinogenic effect, which can lead to irreversible consequences. It can cause the development of not only infectious mononucleosis, but also the formation of nasopharyngeal carcinoma and Burkitt's lymphoma. The Epstein-Barr virus, like most other viruses, is transmitted by airborne droplets, through common utensils, kisses, toys and other objects that contain the saliva of the carrier of the infection. The disease is very common.

Once in the body of a child, the virus immediately begins to actively multiply in the mucous membrane of the nasopharynx, from where it then enters the bloodstream and infects type B lymphocytes responsible for the production of antibodies. The virus remains in these cells for the rest of its life.

There are statistics according to which, by the age of 5, a little more than 50% of children become infected with this infection. In more than 90% of the population, by the age of 35, a blood test shows the presence of antibodies to EBV. This fact gives the right to assert that the majority of the adult population has already suffered from infectious mononucleosis. In 80-85% of cases, its development occurs in an erased form, i.e., its characteristic symptoms either do not appear at all, or appear weakly, and the disease is mistakenly diagnosed as SARS or tonsillitis.

Incubation period

This is the period of time from the moment the Epstein-Barr virus enters the child's body through the pharynx and until the first signs of the disease appear. The incubation period varies widely from a few days to two months, averaging 30 days. At this time, the virus multiplies and accumulates in sufficient quantities for massive expansion.

It is possible to develop a prodromal period that does not have specific manifestations and is typical for everyone infectious diseases. In such cases, the disease will develop gradually - for several days there may be a low, subfebrile body temperature, general malaise and weakness, increased fatigue, the presence of catarrhal phenomena from the upper respiratory tract in the form of nasal congestion, redness in the mucous membranes of the oropharynx, as well as gradual increase and redness of the tonsils.

Symptoms of mononucleosis

From the first days there is a slight malaise, weakness, headache and muscle pain, pain in the joints, slight increase temperature and mild changes in the lymph nodes and pharynx.

The spleen and liver are also enlarged. Often skin acquire a yellow tint. There is a so-called jaundice. Mononucleosis is not severe. The liver remains enlarged for a long time. body accepts normal sizes only 1-2 months after the moment of infection.

A rash with mononucleosis appears on average on the 5-10th day of illness and in 80% of cases is associated with taking antibacterial drug- ampicillin. It has a maculopapular character, elements of its bright red color, are located on the skin of the face, trunk and extremities. 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 mild. clinical picture as . The disease is dangerous for babies with congenital immunodeficiency or atopic reactions. In the first case, the virus exacerbates the deficiency immune protection and promotes 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.

The main signs of mononucleosis include:

the appearance of a headache;
high temperature;
mononuclear angina (dirty gray films are noted on the tonsils, which are easily removed with tweezers);
pain in muscles, joints;
weakness, sore throat, nasal congestion;
high susceptibility to other infectious agents;
frequent skin lesions with herpes;
bleeding gums;
loss of appetite;
enlargement of the liver and spleen;
swollen lymph nodes (as a rule, lymph nodes increase along the posterolateral surface of the neck, they are woven into conglomerates or chains, painless on palpation, not soldered to surrounding tissues and sometimes increase to the size of an egg).

In the peripheral blood, leukocytosis is noted (9-10o109 per liter, sometimes it can be more). The number of mononuclear elements (monocytes, lymphocytes, atypical mononuclear cells) towards the end of the 1st week reaches about 80% -90%. In the first days of the disease, there may be a clear neutrophilia with a stab shift. A mononuclear reaction (mainly due to lymphocytes) can persist from 3-6 months and even up to several years. In convalescents, after a period of illness of infectious mononucleosis, another disease may appear, for example, acute flu or dysentery, etc., can also be accompanied by a quite significant increase in the number of single-core elements.

The illness lasts for one or more weeks. In the process of illness, a high temperature is maintained for a week. Preservation of other changes proceed with little dynamics. Then there is a gradual decrease in temperature. In some cases there is next wave temperature increase. During the decrease in temperature, plaque disappears in the pharynx. The lymph nodes gradually decrease. The liver and spleen generally return to normal within a few weeks or months. In the same way, the state of the blood is normalized. Rarely there are complications such as stomatitis, pneumonia, otitis media and others.

A photo

What does a nasopharyngeal lesion look like with mononucleosis - photo

Diagnostics

On first visit medical institution the doctor examines, finds out the symptoms. If infectious mononucleosis is suspected, a blood test is taken. It is necessary not only to confirm this disease, but also to exclude other health problems.

If atypical mononuclear cells are detected in the blood, then this confirms the diagnosis of mononucleosis. The more such cells are found in the blood, the more severe the disease will be.

Effects

Complications are rare. Highest value have, paratonsillitis,. In isolated cases, ruptures of the spleen occur, liver failure, acute liver failure, hemolytic anemia, acute hemolytic anemia, neuritis,. During antibiotic therapy with ampicillin and amoxicillin, patients almost always experience a skin rash.

How to treat infectious mononucleosis in children

Not developed to date specific treatment infectious mononucleosis in children, there is no single treatment regimen, there is no antiviral drug that would effectively suppress the activity of the virus. Usually, mononucleosis is treated at home, in severe cases in a hospital, and only bed rest, a chemically and mechanically sparing diet, and a water-drinking regimen are recommended.

To reduce high temperature, children's such as paracetamol, ibuprofen are used. Good result gives mephinamic acid due to the fact that the production of interferon is stimulated. It is necessary to refrain from lowering the temperature in children with aspirin, as Reye's syndrome may develop.

The throat is treated in the same way as with angina. You can use tantumverde, various aerosols, rinsing with herbal infusions, furacilin, etc. Close attention should be paid to the oral cavity, brush your teeth, rinse your mouth after each meal. When expressed, vasoconstrictor drops are used. But you should not get involved in them for more than five days. The symptoms of the disease are eliminated, this is the supportive treatment that eliminates the infection.

If changes in liver function are detected, a special diet, choleretic drugs, hepatoprotectors are prescribed. Immunomodulators together with have the greatest effect. Imudon can be prescribed, Children's Anaferon, Viferon, as well as Cycloferon at a dose of 6-10 mg / kg. Sometimes renders positive effect metronidazole (Trichopolum, Flagyl). Since the secondary microbial flora often joins, antibiotics are indicated, which are prescribed only in case of complications and an intense inflammatory process in the oropharynx (except for antibiotics penicillin series, which in infectious mononucleosis in 70% of cases cause severe allergic reactions)

A child's spleen can be enlarged during illness, and even minor trauma to the abdomen can cause it to rupture. Therefore, all children with mononucleosis should avoid contact species sports and strenuous activity for 4 weeks. Athletes especially should limit their activities until the spleen returns to normal size.

In general, the treatment of infectious mononucleosis in children and adults is exclusively symptomatic (drinking, lowering the temperature, pain relief, relief of nasal breathing, etc.). prescribing antibiotics, hormonal drugs carried out only with the development of appropriate complications.

Forecast

Infectious mononucleosis in children usually has a fairly favorable prognosis. However, the main condition for the absence of consequences and complications is timely diagnosis leukemia and regular monitoring of changes in blood composition. In addition, it is very important to monitor the condition of children until their final recovery.

Also, children who have been ill need a dispensary examination over the next 6-12 months in order to control residual effects in blood. It should be noted that measures for the specific and effective prevention of infectious mononucleosis in this moment does not exist.