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

Currently, the diagnosis of "infectious mononucleosis" is made quite rarely. However, the disease itself is very common. According to statistics, more than 65% of people by the age of 35 have already had it. There is no way to prevent infectious mononucleosis.

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

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

In 1889, the German scientist Emil Pfeiffer described a similar clinical picture of mononucleosis and defined it as glandular fever with damage to the pharynx and lymphatic system. Based on the hematological studies that appeared in practice, characteristic changes in the blood composition in this disease were studied. Special (atypical) cells appeared in the blood, which were named mononuclear cells(monos - one, nucleus - nucleus). 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 the 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), perform the protective function of the 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 a high temperature), a person with erased forms of the disease (the disease is mild, with mild symptoms, or under the guise of acute respiratory infections), as well as a person without any symptoms of the disease, seemingly completely healthy, but at the same time being a virus carrier. A sick person can “give” the causative agent of infectious mononucleosis to a healthy person in various ways, namely: contact-household (with saliva when kissing, when using common dishes, linen, personal hygiene items, etc.), airborne, during sexual contact ( with sperm), during blood transfusion, as well as from mother to fetus through the placenta.

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

How does infectious mononucleosis manifest itself?

The incubation period (the length of time from the moment the microbe enters the body until the onset of symptoms of the disease) with infectious mononucleosis lasts up to 21 days, the disease period is up to 2 months. At different times, the following symptoms may occur:

weakness,
headache,
dizziness,
muscle and joint pain,
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 tonsillitis),
cough,
inflammation,
enlargement and soreness of all lymph nodes,
enlargement of the liver and/or spleen.

As a result of all of the above, an increase in sensitivity to SARS and other respiratory diseases, frequent lesions of the skin with the herpes simplex virus (herpes simplex virus type 1), usually in the area of the upper or lower lip.

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 the lower jaw (submandibular), as well as cervical, axillary and inguinal lymph nodes, can be felt with your fingers. In the liver and spleen, an increase in 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 of a general blood test in infectious mononucleosis, moderate leukocytosis, sometimes leukopenia, the appearance of atypical mononuclear cells, an increase in the number of lymphocytes, monocytes, and a moderately accelerated ESR can be observed. Atypical mononuclear cells usually appear in the first days of the disease, especially at the height of clinical symptoms, but in some patients this occurs later, only after 1 to 2 weeks. Blood control is also carried out 7-10 days after recovery.

The result of a general blood test of a girl (age 1 year 8 months) at the initial stage of the disease (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
Erythrocytes (Er.)	4,35	10^12/l	3,40 – 5,10
Hematocrit	34,70	%	27,50 – 41,00
MCV (Medium Er. Volume)	79,80	fl	73,00 – 85,00
MCH (Hb content d 1 Er.)	26,90	pg	25,00 – 29,00
MCHC (mean concentration of Hb in Er.)	33,70	g/dl	32,00 – 37,00
Estimated erythrocyte width distribution	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

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

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

Currently, the diagnosis of infectious mononucleosis is made quite rarely. However, 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 appear, then, as a rule, they are mistaken for acute respiratory infections. Accordingly, not quite the right treatment for mononucleosis is selected, sometimes even excessive. It is important to differentiate angina (whatever type it is) and acute tonsillitis syndrome (inflammation of the tonsils), which manifests itself in mononucleosis. In order for the diagnosis to be as accurate as possible, it is necessary to focus not only on external signs, but also on the results of all necessary tests. Any type of sore throat is treated with antibiotics, and mononucleosis is a viral disease in which antibiotic therapy is not required. 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 be ill only 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. Otitis, sinusitis, paratonsillitis, pneumonia are of the greatest importance. In individual cases, there are ruptures of the spleen, liver failure and hemolytic anemia (including their acute forms), neuritis, follicular tonsillitis.

In some cases, the consequence of mononucleosis is adenoiditis . This is an overgrowth of the nasopharyngeal tonsil. Often adenoiditis is diagnosed in children. The danger of this disease is that in addition to shortness of breath, which significantly impairs the quality of life of the child, overgrown adenoids become a focus of infection.

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

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 acute and chronic course.

If parents found such manifestations in their child, it is imperative to show it to an ENT doctor and get recommendations for treatment.

After a sluggish course of infectious mononucleosis, its long-term treatment may develop chronic fatigue syndrome(pallor of the skin, lethargy, drowsiness, tearfulness, temperature 36.9-37.3 ° 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: “Chronic fatigue syndrome just needs to be experienced. Rest 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, in no case should you be in the sun, because. this increases the risk of blood disorders (eg leukemia). Scientists argued that under the influence of ultraviolet rays, EBV acquires oncogenic activity. However, studies in recent years have completely refuted this. In any case, it has long been known that it is not recommended to sunbathe between 12:00 and 16:00.

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

Treatment of infectious mononucleosis

There is currently no specific therapy for infectious mononucleosis. The main goals of treatment are to relieve the 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 rupture of the spleen, it is recommended to limit physical activity during illness and after recovery for 2 months. A ruptured spleen is likely to require surgery.

It is very important to try to avoid stress in the treatment of infectious mononucleosis, not to succumb to the disease, tune in to recovery and wait out this period. Some studies have shown that stress has a negative effect on our immune system, namely making the body more vulnerable to infections. Doctors say this: "Viruses love tears." As for parents whose child is ill with infectious mononucleosis, in no case should they panic and self-medicate, listen to what the doctors say. Depending on the child's well-being, as well as the severity of the symptoms, it is possible to undergo outpatient or inpatient treatment (the attending physician from the clinic, the ambulance doctor, if required, and the parents themselves decide). After suffering from infectious mononucleosis, children are exempted from physical education in all forms, except for exercise therapy, and, of course, they have a 6-month exemption from vaccinations. Quarantine in kindergartens is not required.

List of drugs for the complex treatment of infectious mononucleosis

Acyclovir and valaciclovir 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, as well as aspirin, are not recommended, because. taking aspirin can provoke Reye's Syndrome (rapidly developing cerebral edema and accumulation of fat in the liver cells), and the use of paracetamol overloads the liver. Antipyretics are prescribed, as a rule, at a body temperature above 38.5 ° C, although it is necessary to look at the patient's condition (it happens that the patient, no matter whether it 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 the temperature more carefully).
Antigrippin as a general tonic.
Suprastin, zodak as anti-allergic and anti-inflammatory agents.
Aqua maris, aqualor for washing and moisturizing the nasal mucosa.
Xilen, galazolin (vasoconstrictor nasal drops).
Protargol (anti-inflammatory nose drops), albucid as an antimicrobial agent in the form of eye drops (used for conjunctivitis of a bacterial nature). Can also be used for nasal instillation. With conjunctivitis of viral origin, ophthalmoferon eye drops with antiviral activity are used. Both types of conjunctivitis can develop against the background of mononucleosis.
Furacilin, drinking 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 coughing.
Prednisolone, dexamethasone as hormonal agents (used, for example, for swelling of the tonsils).
Azithromycin, erythromycin, ceftriaxone as antibiotic therapy for complications (eg, pharyngitis). Ampicillin and amoxicillin are contraindicated in mononucleosis, tk. it causes a skin rash that can last up to several weeks. As a rule, cultures are taken from the nose and pharynx in advance to determine sensitivity to antibiotics.
LIV-52, Essentiale forte for liver protection.
Normobact, florin forte in violation of the intestinal flora.
Complivit, multi-tabs (vitamin therapy).

It should be noted that the list of drugs is general. The doctor may prescribe a medicine that is not on this list and selects the treatment individually. A drug from the antiviral group, for example, one is taken. Although switching from one drug to another is not ruled out, 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.

Also, for help in the fight against mononucleosis, you can turn to traditional medicine (cranberries, green tea), medicinal herbs (echinacea, rose hips), biologically active food supplements (omega-3, wheat bran), as well as homeopathic remedies to increase and strengthen immunity. . Before using certain products, dietary supplements and medicines, it is necessary to consult with your doctor.

After the course of treatment for infectious mononucleosis, the prognosis is favorable. Full recovery can occur within 2-4 weeks. However, in some cases, a change in the composition of the blood 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 communicate calmly with other children only after the number of leukocytes returns to normal. Changes in the liver and / or spleen may also persist, therefore, after ultrasound, which is usually performed during illness, after the same six months, it is repeated. Enlarged lymph nodes can remain for quite a long time. Within one year after the illness, it is necessary to be registered with an infectious disease doctor.

Diet after infectious mononucleosis

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

It is better to give preference to dairy and sour-milk products (they are able to control the normal intestinal microflora, and with a healthy microflora, immunoglobulin A is formed, which is important for maintaining immunity), soups, mashed potatoes, fish and meat of low-fat varieties, unsalted biscuits, fruits (in particular, " their "apples and pears), cabbage, carrots, pumpkin, beets, zucchini, non-acidic berries. Bread, mainly wheat, pasta, various cereals, biscuits, yesterday's pastries and pastry products are also useful.

The use of butter is limited, fats are introduced in the form of vegetable oils, mainly olive, sour cream is used mainly for dressing dishes. Non-sharp varieties of cheese, egg yolk 1-2 times a week (protein can be eaten more often), any dietary sausage, beef sausages are allowed in a small amount.

After 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, beans are prohibited. Prohibited meat products - pork, lamb, geese, ducks, chicken and meat broths, confectionery - cakes, 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 foods 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 quite difficult to diagnose . Common symptoms resemble a common cold, sore throat or flu. The insidiousness of mononucleosis lies in the complications that often affect the internal organs.

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

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

Infectious mononucleosis is a very easily transmitted disease.

Transmitted through the air . The virus enters the oral cavity, is fixed there and lives up to 2-3 weeks, actively developing.

But you can also get infected when using shared utensils, toys. Adolescents are often affected. 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! Usually mononucleosis everyone gets sick at least once in their life. After suffering an illness, a strong immunity is produced in the body.

Signs of the disease

The incubation period can be from 2 weeks to a month . Getting on the mucous membranes, the virus begins to actively multiply, then penetrates into the blood, spreading throughout the body, at this time the lymph nodes begin to actively react to it, they increase in size, 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 a treatment that will eliminate complications.

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

Differences from angina

With an external examination, it is difficult to distinguish angina from mononucleosis.

It is important! An experienced doctor can easily diagnose the disease. Its main differences from angina are as follows:

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

Many parents, having heard a diagnosis of mononucleosis from a pediatrician, are immediately frightened. Doctors assure that the disease is treated quite quickly and effectively, it is only important follow the advice of a specialist.

Diagnostic methods

On an ultrasound of the abdominal cavity, the doctor checks the size of 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, questioning the patient, the specialist will prescribe the following tests:

Blood analysis . It is necessary in order 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 in order to see how the liver and kidneys work, whether they cope with the virus, whether there are any changes in these internal organs.
Analysis for the determination of antibodies to the herpes virus . If the result is positive, then the diagnosis will be a big 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 identify mononuclear cells in the blood. But the peculiarity of the disease is that they are fully manifested 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 experience a sore throat, LIZOBACT will help.

Treatment should be the following drugs:

Antipyretic . These funds will help to quickly reduce body temperature, cope with fever. For children under 10 years of age, the following drugs are allowed: Ibuprofen" And " Paracetamol". They operate during 20–40 minutes. You can take every 5–6 hours. If the temperature has risen above 39 degrees, Analdim candles will help. They include analgin and diphenhydramine. Such candles are allowed to be used 1 time per day.
Painkillers . Often with mononucleosis in children there is a sore throat. You can eliminate it with rinsing. Use herbal decoctions, salt, soda, iodine for solutions. From medicines it is possible to recommend " Pharyngosept», « Septefril», « Lizobakt», « Yoks».
Antiviral . To overcome the herpes virus, doctors prescribe a reception " Acyclovir". In addition, candles can be recommended Viferon"and pills" Aflubin". These funds quickly "kill" the virus, help strengthen the immune system.

If an ultrasound specialist detects abnormalities in the functioning of the liver and spleen, drugs will be prescribed to maintain them. These may be of the type Karsil», « Hofitol», « No-shpa».

It is important! This is a viral disease. And as you know, viruses are not treated with antibiotics. Therefore, taking these drugs is meaningless in this disease.

When are antibiotics needed?

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

But still there are cases when antibiotics are necessary:

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

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

conclusions

Mononucleosis is a disease that in most cases occurs in children.

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

anonymous , Woman, 21

One fine night I woke up from a high temperature - 38.8, knocked 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 an ambulance, which, by the way, Arrived just 4 hours later. Being prone to PA and fainting, she almost lost consciousness, but held on. A doctor arrived, for a long time they brought down the temperature with paracetamol candles and compresses to 38.8. And so it lasted around 38.5 for more than a week. During the examination, at the beginning, the doctor put orvi, prescribed antibiotics, nothing helped, and a rash appeared, as a result, she went to the clinic. They said that the fever was bad for a week and a half and Botkin was sent to the hospital. They diagnosed mononucleosis based on blood and urine tests, and not immediately. Found it by a long fever, enlarged liver, lymph nodes in the neck and an increase in something (can't tell). He was treated with acyclovir and injections of suprastin were given, saline solution with vitamins was given. Actually, they were discharged with a temperature of 37.5 and a sore throat in two weeks. And since then, everything has gone wrong. After a couple of weeks, the temperature subsided, as promised, but then a little more time later, it rose to 37.5. I was warned that within six months this is the norm, if it does not rise above. But it's been going on for a year now. Plus, since that time, my chronic tonsillitis has never gone from an exacerbated form. There was and is a terrible sweating, aching joints, tiredness, neurosis. I was observed by an infectious disease specialist for a long time, but she did not prescribe anything other than antibiotics, to which I am allergic. After them, as expected, thrush immediately began. In December, severe pharyngitis began, which has not yet passed, went to Laura. He first prescribed calcium gluconate injections, and then added ceftriaxone, from which I had very unpleasant consequences (fever, sweating, heart palpitations, diarrhea and lack of appetite, then thrush with a very small amount of discharge during menstruation). I cured the thrush, the ENT canceled the injections as soon as he found out what was wrong with me. He prescribed biseptol, ismigen and ketotifen. And oh, a miracle, a week later my temperature dropped to 36.6 for the first time, and by the evening the maximum was 37. Tonsillitis also passed, which I was incredibly happy about. As a result, the doctor canceled the medication and said to harden (pour a basin of cold water over the whole body, stand for a minute, and then immediately dry off and warm up). The first four times were amazing, a huge rise in mood, well-being. And that's it. Then I couldn’t do it, because the temperature rose to 38. And for three weeks now I have been walking with a temperature of 37.3-38 day-night, I feel like I have the flu. She handed over anilises, however, before hardening - everything is normal, no signs of inflammation. A month ago, during thrush after ceftriaxone, there were very meager periods. I was treated during them. Now menstruation is back, a week before they pull the lower back, from the very beginning there are rare clots of brown discharge. The gaskets are clean, it is enough to wipe, although everything was normal before. How to bring down the temperature? Get rid of the symptoms? I know that mononucleosis is incurable like all herpes viruses. I'm afraid of the consequences in the form of cancer, rupture of the spleen and permanent illness. I used to have a temperature of 35.6, but now I don't even remember what it's like to feel good.

Good afternoon. After that, the asthenic syndrome (weakness, lethargy, fever to subfebrile figures) lasts for a very long time. Asthenic syndrome could be aggravated by chronic tonsillitis. Hardening is, of course, good, but it was still desirable to do it gradually, especially if you had no such experience before. It is advisable to strengthen the state of the immune system at least in this way: (start with air baths, dousing hands and feet with water 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, gerimaks), and for prevention during periods of rising incidence, interferon preparations with antioxidants in the form of a gel (viferon gel) can be applied twice a day to the nasal mucosa. Now, judging by the temperature, there is either an exacerbation of chronic tonsillitis, or a sluggish acute respiratory viral infection, or another inflammatory disease (of the urinary organs, gynecological sphere). You need to go to the doctor in person and do urine, ultrasound of the pelvic organs, kidneys and bladder, you should be examined by a therapist or / and an ENT doctor, a gynecologist, according to indications - a urologist (if there are changes in general, ultrasound of the kidneys).

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

About consultant

Details

Physician since 2006. Gastroenterologist.

Participant of conferences on general medicine, gastroenterology, pain therapy and restorative techniques, diet therapy. Participant of the XIX Annual Educational Course "Internal Medicine: Review and New Advances" (Columbia University Medical Center (New York, USA).

Area of professional interests: SARS, 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 pathogen in their blood. It is the Epstein-Barr virus, named after the names of the virologists who discovered it in 1964. Children, adolescents and young adults are most susceptible to mononucleosis. In persons over 40 years of age, it develops extremely rarely, since before this age a strong immunity is formed as a result of an infection.

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

Pathogen and transmission routes

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

A virus is a strand of DNA wrapped in a protein coat called a capsid. Outside, the structure is surrounded by an outer shell formed from the cell membrane in which the viral particle was assembled. All of these structures are specific antigens, since in response to their introduction, the body synthesizes immune antibodies. The detection of the latter is used to diagnose the infection, its stage and control of 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) – virus capsid proteins;
LMP (latent membrane protein) – viral membrane proteins.

The source of the pathogen is a person with any form of infectious mononucleosis. The virus is weakly contagious, so long-term and close contact is required for transmission. In children, the airborne route of transmission prevails, and the implementation of the contact route is also possible - through heavily salivated toys and household items. In adolescents and older people, the virus is often transmitted during kissing with saliva, during sexual intercourse. Susceptibility to the pathogen is high, that is, most of those infected for the first time develop 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 is able to persist for life, having integrated into the DNA of B-lymphocytes. In this regard, there is another way of transmission - blood contact, infection is possible through blood transfusion, organ transplantation, injection drug use. The virus causes the formation of stable lifelong immunity, therefore, repeated attacks of the disease are the reactivation of a pathogen dormant in the body, and not a new infection.

The mechanism of the development of the disease

The Epstein-Barr virus enters with saliva or its droplets on the mucous membrane of the oral cavity and is fixed on its cells - epitheliocytes. From here, viral particles penetrate into the salivary glands, immune cells - lymphocytes, macrophages, neutrophils and begin to multiply actively. There is a gradual accumulation of the pathogen and infection of all new cells. When the mass of viral particles reaches a certain value, their presence in the body turns on the mechanisms of the immune response. A special type of immune cells - T-killers - destroy infected lymphocytes, and therefore a large amount of biologically 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 feature of the Epstein-Barr virus is its ability to accelerate the growth and reproduction of B-lymphocytes - they proliferate with subsequent transformation into plasma cells. The latter actively synthesize and secrete immunoglobulin proteins into the blood, which, in turn, causes the activation of another series of immune cells - T-suppressors. They produce substances designed to suppress the excessive proliferation of B-lymphocytes. The process of their maturation and transition to mature forms is disrupted, in connection with which the number of mononuclear cells sharply increases in the blood - mononuclear cells with a narrow rim of the cytoplasm. 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 the lesion of the mucous membrane, its changes vary from friability to deep ulcers and plaque. The Epstein-Barr virus inhibits the immune response due to some proteins, the synthesis of which occurs under the influence of its DNA. On the other hand, infected mucosal epithelial cells actively secrete substances that initiate an inflammatory response. In this regard, the number of antibodies to the virus and a specific antiviral substance, interferon, is gradually increasing.

Most of the viral particles are excreted from the body, however, B-lymphocytes with embedded virus 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, therefore, it 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 eludes aggression and remains in sufficient quantities for exacerbations of the disease.

Clinical picture

Mononucleosis proceeds 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 an average of 20 to 50 weeks. At this time, the virus multiplies and accumulates in sufficient quantities for massive expansion. The first signs of the disease occur during the prodromal period. A person feels weakness, fatigue, irritability, muscle pain. The prodrome continues for 1-2 weeks, after which the peak of the disease begins. Usually a person becomes ill acutely with an increase in the body to 38-39 degrees C, an increase in lymph nodes.

Symptoms of mononucleosis

The lymph nodes of the neck, neck, elbows and intestines are most often affected. Their size varies from 1.5 to 5 cm; on palpation, a person feels slight pain. The skin over the lymph nodes is not changed, they are not soldered to the underlying tissues, mobile, elastic consistency. A pronounced increase in the lymph nodes of the intestine leads to pain in the abdomen, lower back and indigestion. Significantly, up to the rupture, the spleen enlarges, since it belongs to the organs of the immune system and a large number of lymphatic follicles lie in it. This process is manifested by severe pain in the left hypochondrium, which increases with movement and physical activity. The reverse development of the lymph nodes occurs slowly, within 3-4 weeks after recovery. In some cases, polyadenopathy persists for a long time, from several months to life-long changes.

Temperature in mononucleosis is one of the most common symptoms of mononucleosis. Fever lasts from several days to 4 weeks, can change repeatedly throughout the illness. On average, it starts at 37-38 degrees C, gradually increasing to 39-40 degrees C. Despite the duration and severity of fever, the general condition of patients suffers little. Basically, they remain active, there is only a decrease in appetite and increased fatigue. In some cases, patients experience such pronounced 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. On their surface, a white-gray plaque often forms in the form of islands or stripes. It appears on the 3-7th day of illness and is combined with a sore throat and a sharp rise in temperature. The nasopharyngeal tonsil also increases, which is associated with difficulty in nasal breathing and snoring during sleep. The back wall of the pharynx becomes granular, its mucosa is hyperemic, edematous. If the edema descends into the larynx and affects the vocal cords, then the patient develops 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, dense, sensitive to palpation. Pain in the right hypochondrium is not associated with food intake, aggravated by physical activity, walking. The patient may notice a slight yellowing of the sclera, a change in skin tone to lemon yellow. Changes do not last long and pass without a trace in a few days.

Infectious mononucleosis in pregnant women- this is, as a rule, reactivation of the Epstein-Barr virus associated with a physiological decrease in immune defense. The incidence increases towards the end of pregnancy and is about 35% of the total number of expectant mothers. The disease is manifested by fever, enlargement of the liver, tonsillitis and the reaction of the lymph nodes. The virus can cross the placenta and infect the fetus, which occurs at high concentrations in the blood. Despite this, infection in the fetus rarely develops and is usually represented by pathology of the eyes, heart, and nervous system.

A rash with mononucleosis appears on average on the 5th-10th day of illness and in 80% of cases is associated with taking an 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 persists on the skin for about a week, after which it turns pale and disappears without a trace.

Mononucleosis in children often asymptomatic or with an erased clinical picture in the form. The disease is dangerous for babies with congenital immunodeficiency or atopic reactions. In the first case, the virus exacerbates the lack of immune defense and contributes to the attachment 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 according to the severity of the course is divided into:

According to the type of infectious mononucleosis is divided into:

Typical- characterized by a cyclic 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 proceeds 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;
lingering– changes persist from 3 to 6 months;
Chronic- lasts more than six months. The same form of the disease includes repeated fever, malaise, swollen lymph nodes within 6 months after recovery.

A relapse of infectious mononucleosis is the recurrence of its symptoms a month after recovery.

Diagnostics

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

characteristic complaints- prolonged fever, angina-like changes in the oropharynx, swollen lymph nodes;
Epidanamnesis- 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, raids on the tonsils, enlarged lymph nodes, liver and spleen;
Lab 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 was for him that the disease got its name - mononucleosis, and before the advent of methods for detecting the pathogen, it was its main diagnostic criterion.

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

By the ratio of antibodies to various proteins of the virus, the doctor can determine the period of the disease, determine whether there was a primary meeting with the pathogen, relapse or reactivation of the infection:

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

High (over 60%) avidity (affinity) of IgG to the Epstein-Barr virus is also a reliable sign of acute or reactivation of the infection.

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

Treatment

Treatment of mononucleosis is carried out on an outpatient basis with a mild course of the disease, patients with moderate and severe forms are hospitalized in an infectious diseases hospital. Hospitalization is also carried out according to epidemiological indications, regardless of the severity of the disease. These include living in crowded conditions - a hostel, a barracks, a children's home and boarding schools. To date, there are no drugs that can directly affect 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, plentiful warm drink in the form of fruit drink, weak tea, compote, easily digestible diet. To prevent bacterial complications, it is necessary to rinse the throat 3-4 times a day with antiseptic solutions.- chlorhexidine, furacillin, chamomile decoction. Physiotherapy methods - ultraviolet irradiation, magnetotherapy, UHF are not carried out, since they cause additional activation of the cellular link of immunity. They can be used after normalizing the size of the lymph nodes.

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:

Interferon human 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 under dispensary observation with a local therapist for 12 months. Every 3 months, a laboratory control is carried out, which includes a general and biochemical blood test, if necessary, the determination of antibodies to the Epstein-Barr virus in the blood.

Complications of the disease

Develop rarely, but can be extremely severe:

Autoimmune hemolytic anemia;
Meningoencephalitis;
Guillain-Barré syndrome;
Psychosis;
Damage to the peripheral nervous system - polyneuritis, paralysis of cranial nerves, paresis of facial muscles;
Myocarditis;
Rupture of the spleen (usually occurs in a child).

Specific prophylaxis (vaccination) has not been developed, therefore, to prevent infection, general strengthening measures are carried out: hardening, walking in the fresh air and airing, varied and proper nutrition. It is important to treat an acute infection in a timely and complete manner, 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 signs. One of them is Filatov's disease or mononucleosis, which is diagnosed mainly in children from 3 years old. The symptoms and treatment of the disease are thoroughly studied, so it is easy to deal with it without complications.

Mononucleosis in children - what is this disease?

The pathology under consideration is an acute viral infection that attacks the immune system through inflammation of the 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 referred to as "kissing sickness." The virus remains viable in the external environment, you can become infected through common objects:

toys;
dishes;
underwear;
towels and other things.

The incubation period of mononucleosis in children

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 immunity activity. If the protective system is weakened, it is about 5 days. A strong body imperceptibly fights the virus for up to 2 months. The intensity of the immune system also affects how mononucleosis proceeds in children - symptoms and treatment are much easier when the defense system is strong. The average duration of the incubation period is in the range of 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 with saliva, even if the child is outwardly healthy. This is not a serious problem, the carriers of the Epstein-Barr virus are about 98% of the world's population.

Negative consequences occur in exceptional cases, only with a weakened body or the addition of a secondary infection. Mostly mononucleosis is easy in children - 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 imperceptibly.

Rare effects 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 in children is common due to constant stay in 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 which the baby is in close contact.

Mononucleosis in children - symptoms and signs

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

weakness;
swelling and soreness of the lymph nodes;
catarrhal bronchitis or;
increased body temperature;
pain in the joints and muscles against the background of lymphostasis;
an increase in the size of the spleen and liver;
dizziness;
migraine;
sore throat when swallowing;
herpetic eruptions in the mouth;
susceptibility to SARS and ARI.

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 these symptoms does not indicate the progression of Filatov's disease. Similar signs 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 cloudy blisters on the upper or lower lip, especially in immunocompromised children.
Taking antibiotics. Treatment of a 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

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 turn red, swell and become inflamed. This provokes pain and itching in the throat, especially when swallowing. Due to the similarity of the clinical picture, it is important to differentiate angina and mononucleosis in children - the main symptoms and treatment of these diseases are different. Tonsillitis is a bacterial lesion and can be treated with antibiotics, and Filatov's disease is a viral infection, antimicrobials will not help against it.

Temperature in mononucleosis

Hyperthermia is considered one of the very first specific signs of the disease. Body temperature rises to subfebrile values (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 - the symptoms of intoxication against the background of fever worsen the child's well-being:

drowsiness;
headache;
lethargy;
aches in the joints;
drawing pain in the muscles;
severe chills;
nausea.

Blood test for mononucleosis in children

These symptoms are not considered a basis for a diagnosis. To clarify it, a special analysis is performed for mononucleosis in children. It consists in the study of blood, with Filatov's disease in the biological fluid is found:

the presence of atypical cells - mononuclear cells;
decrease in the number of leukocytes;
an increase in the concentration of lymphocytes.

Additionally, an analysis for the Epstein-Barr virus is prescribed. There are 2 options for doing it:

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

So far, there are no effective drugs that can stop the reproduction of infectious cells. Treatment of mononucleosis in children is limited to stopping the symptoms of pathology, alleviating its course and general strengthening of the body:

Half bed mode. The main thing is to provide the child with peace, not to overload physically and emotionally.
Plentiful warm drink. Fluid intake helps prevent dehydration due to heat, improves the rheological composition of the blood, especially the intake of fortified drinks.
Thorough 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. Bringing down the temperature is allowed if it rises above 38.5 degrees.
Antihistamines - Cetrin, Suprastin. Allergy medications help relieve the symptoms of intoxication.
Vasoconstrictor (local, in the form of drops) - Galazolin, Ephedrine. 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 case of accession of a secondary infection of bacterial origin, for example, when purulent tonsillitis begins.
Corticosteroids - Prednisolone, Methylprednisolone. Hormones are selected for the treatment of exceptional situations (hypertoxic course of pathology, the threat of asphyxia due to severe swelling of the tonsils and other life-threatening conditions).

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

The following products are limited or excluded:

fatty meat and fish;
fresh hot pastries;
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 butter cream;
chocolate;
sweet products;
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 mucous porridges on the water;
casseroles;
low-fat dairy products;
vegetable salads, sautéed;
sweet fruits;
baked apples;
dry cookies, biscuits;
jelly;
steamed dried apricots, prunes;
weak tea with sugar;
jam;
paste;
marmalade;
dried fruits compote;
decoction of rose hips;
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 of the child must be periodically shown to the doctor. This helps to determine if mononucleosis has caused any negative side effects in children - symptoms and treatment, correctly identified, do not guarantee protection against tissue damage to the liver and spleen. Scheduled examinations are carried out three times - after 1, 3 and 6 months from the date of recovery.

Recovery from mononucleosis involves following a number of general measures:

Load limit. For children who have been ill with the considered pathology, fewer requirements should be made at school. Gentle physical training is recommended, the child is still weakened after the pathology and gets tired quickly.
Increase rest time. Doctors advise letting your baby sleep for 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 fully as possible, receive important vitamins, amino acids and minerals. It is advisable to continue feeding your child healthy meals to speed up the healing and repair of damaged liver cells.
Visiting resorts. Modern research has shown that rest by the sea is not harmful for children who have had mononucleosis. You just need to limit the time your child stays in the sun.