Infectious mononucleosis - Causes, Symptoms and Treatment .MF .
Infectious mononucleosis, also known as - Filatov's disease, glandular fever monocytic angina Pfeiffer's disease.It is a severe form of Ebstein-Barr virus infection (EBVI or EBV - Epstein-Barr virus), characterized by fever, lymphadenopathy geniralizovannoy, tonsillitis, hepatosplenomegaly (enlargement of the liver and spleen), as well as the specific changes in the hemogram.
Infectious mononucleosis was first discovered in 1885 Filatov, he noticed a feverish illness accompanied by an increase in the majority of the lymph nodes.1909-1929g - Burns, Tidy, Schwartz and others have described changes in the hemogram in this disease.1964 - Epstein Barr virus and lymphoma cells isolated from one of the causative agents of herpes viruses of the family, the same virus identified in infectious mononucleosis.
As a result, came to the conclusion that this virus (Epstein-Barr virus), depending on the current form gives different diseases:
- acute or chronic mononucleosis,
- malignancies (lymp
- launch of autoimmune diseases (consider the involvement of the virus to lupus erythematosus and sarcoidosis),
- CFS (chronic fatigue syndrome).
Epstein-Barr virus - DNA virus, the capsule is surrounded by a lipid envelope.It refers to a group Y-herpesviruses (Human herpesvirus type 4) and has antigenic components common with other viruses of the herpesvirus family (Herpesviridae).VEB has tropic (selective damage) to a B-lymphocyte, and this feature of the pathogen, because it multiplies in the cells of the immune system, causing these cells to clone her, the viral DNA, which subsequently leads to secondary immunodeficiencies!Also tropism EBV have some tissues - to lymphoid and reticular, this is due to a generalized adenopathy and hepatosplenomegaly (enlargement of the liver and slezёnki).It is possible that the presence of structural features and tropism to the cells of the immune system cause long-term persistence and create a risk of malignant transformation of infected cells.
In the external environment is not particularly stable, sensitive to high temperatures (more than 60⁰S) and disinfectants, but preserved by freezing.
is widespread.The rise of incidence is observed more frequently in the spring and autumn seasons.The frequency of epidemic ups recorded every 7 years.
Causes infection infectious mononucleosis
Age features of infection: more common in children 1-5 years.Before the year is not ill because of passive immunity, which is created by immunoglobulins, have passed from the mother transplatsentarno (through the placenta during pregnancy).Adults do not get sick, because 80-100% already immunized, ie either chickenpox as a child or sick in the erased clinical form.
source of infection - the sick people with different clinical symptoms (even with obliterated), pathogen isolation can save up to 18 months duration.
- airborne (iz-za instability exciter this way we have to be in close contact),
- contact-household (household items saliva contamination of the patient),
- parenteral (blood transfusion, transplantation - whenorgan transplants),
- transplacental (intrauterine infection from mother to child)
symptoms of infectious mononucleosis
period of infection and symptoms can be divided into several periods:
1. The introduction of the pathogen = incubation period (the time from the introduction to the first clinicalmanifestations), lasts 4-7 weeks.During this period, the penetration of the virus through the mucous membranes (oropharynx, salivary gland, cervix, gastrointestinal tract).Once the virus comes into contact with B-lymphocytes, infecting them and replace them with genetic information on its own, this causes further disruption of the infected cells - they are in addition to a foreign DNA is obtained more "cellular immortality" - virtually uncontrolled division, and that's too bad, becausethey no longer serve a protective function, but simply are carriers of the virus.
2. Lymphogenous drift of the virus in the regional lymph nodes, seen some increase in lymph node groups (2-4 derzhet day and up to 3-6 weeks), near which was the primary infection (airborne infection -cervical / submandibular and occipital lymph nodes, floor - groin).Lymph nodes are enlarged 1-5 cm in diameter, painless, not soldered to each other, are arranged in a chain - especially noticeable when turning head.Lymphadenitis is accompanied by intoxication and fever to 39-40⁰S (it appears simultaneously with the increase in the lymph nodes, and holds up to 2-3 weeks).
3. The spread of the virus on the lymph and blood vessels will be accompanied by generalized lymphadenopathy and hepatosplenomegaly - the emergence of 3-5 days.This is due to the proliferation of infected cells, and their death, and as a result, the yield of virus from dead cells, followed by infection of new and tekzhe further infection of organs and tissues.Lymph nodes, liver and spleen and are associated with viral tropism to these tissues.As a consequence, may join and other symptoms:
- jaundiced skin and sclera,
- rash of different nature (polymorphic rash),
- dark urine and feces clarification.
4. immune response: as the first lines of defense are the interferons, macrophage.After that, to help them, activated T cells - they are lysed (engulf and digest) infected B-lymphocytes, including where they are deposited in the tissues as viruses released from these cells to form antibody CEC (circulating immune complexes)which is very aggressive for the tissues - this explains part in the formation of autoimmune reactions and the risk of lupus, diabetes, etc., the formation of secondary IDS (immunodeficiency) - due to damage in lymphocytes, because they are the ancestors of IgG andM, as a consequence, no contamination of their synthesis as well as the depletion of T-lymphocytes and their enhanced apoptosis (programmed death).
5. The development of bacterial complications is formed on the background of IDS, because the activation of our bacterial flora or joining foreign.As a result, developing a sore throat, tonsillitis, adenoids.These simpomy develop the 7th day from the beginning of the emergence of intoxication.
6. Stage of recovery or in case of severe CID - chronic mononucleosis.After recovery, formed a strong immunity, and in the event of chronic course - multiple bacterial complications with concomitant astenovegetative and catarrhal syndrome.
diagnosis of infectious mononucleosis
1. Virological (abjection of saliva, oropharyngeal swabs, blood and cerebrospinal fluid), the results come in 2-3 weeks
2. Genetic - PCR (polymerase chain reaction) - DNA virus detection
3. Serological: geterogemagglyutinatsii reaction (not used because it is uninformative and nizkospetsifichnym) and EIA (enzyme immunoassay) - the most widely used, because it allows to define specific IgG and M is to Epstein-Barr virus, even when a small amount, to determine thatstage of the disease (acute or chronic)
4. Immunological examination (immunogram):
- T lymphocytes (CD8, CD16, IgG / M / A) and the CEC - it speaks of a good immune response and compensation;
- CD3, CD4 / CD8
5. leukocyte concentration method to determine the presence of atypical mononuclear cells and heterophile antibodies, which are released by mononuclear cells.The discovery of these atypical cells may still be registered in the incubation period.
6. Biochemical techniques: point to decompensation from the organs and systems: pryamogo bilirubin, ALT and AST, thymol, transaminases and alkaline phosphatase.
7. Hematological Study (UAC): Lts, Lf, M, ESR, Nf with a shift to the left.
Treatment of infectious mononucleosis
1. Etiotropic treatment (against the causative agent): izoprinozin, Arbidol, valtsiklovir acyclovir
2. Patoneneticheskoe (blocks exciter mechanism of action): immunomodulators (interferon viferon, timolin, timogen, IRS-19, etc.) and adjuvants (tsikloferon) - but the appointment immunogram under control, because this disease is very high risk of developing autoimmune diseases that may be compromised by these drugs,
3. antibiotic accession secondary bacterial microflora, usually appointed from the group of antibiotics shirokospektornyecephalosporins to identify the sensitivity of the pathogen to the antibiotic, and after more than a narrow focus.
4. Symptomatic therapy: antipyretics, local antiseptic, etc., ie, depending on the predominant symptoms.
Clinical supervision for 6 months or more involving a pediatrician, infectious diseases, specialists narrow areas (ENT, cardiologist, immunology, hematology, oncology), with additional clinical and laboratory studies (see Diagnosis + EEG, ECGMRI, etc.).Also exemption from physical education, protection from emotional stress - compliance with the security regime around 6-7 months.You should always be on the alert, because any compromise can cause autoimmune reactions run.
Complications of infectious mononucleosis
- Hematologic: autoimmune hemolytic anemia, thrombocytopenia, granulocytopenia;possible rupture of the spleen.
- Neurological: encephalitis, cranial nerve palsy, meningoencephalitis, polyneuritis.GI: the development of type 1 diabetes, liver disease.
- Respiratory: pneumonia, airway obstruction.
- Heart and blood vessels: systemic vasculitis, pericarditis and myocarditis.
Prevention of infectious mononucleosis
Good hygiene.Isolation of the patient for 3-4 weeks, taking into account the clinical and laboratory data.Also, the use of diagnostic measures before and during pregnancy.Specific prophylaxis has not been developed.
therapists Shabanova I.E