Mononucleosis is called an acute infection of viral origin, affecting the reticulo-endothelial system, which leads to a multiple increase in lymph nodes, involvement in the process of the liver and spleen, as well as changes in the blood system.
This leads to a decrease in immunity and the development of a typical clinical picture of the disease, toxicosis and tonsillitis.
Today it is precisely known that the disease is caused by the Ebbstein- Barr virus – a virus that affects mainly the lymphocytic unit of the immune system, belongs to the group of herpes viruses, 4 types. The virus is referred to as DNA-containing, in addition to mononucleosis, it can cause Burkitt ‘s lymphomas , carcinomas and lymphomas in immunodeficient patients.
In children, the entry of a virus causes infectious mononucleosis, and then the virus circulates in the body for a long time, sometimes for life, while in a state of latent infection.
The source of infection is a sick child in a typical or erased form, although the disease is slightly infectious and requires prolonged and close contact, kisses, transfusion of blood components, use of common utensils.
The carriers of the virus can excrete it at primary infection up to one and a half years, and in the future asymptomatic periods of virus excretion may occur.
Most children and adults suffer mononucleosis in erased form, typical forms mainly occur in frequently or long-term ill children from 5 to 14 years old.
Today there is no single way to classify mononucleosis. Today, there are typical and atypical forms that have a clinic that differs from the traditional one.
They also distinguish acute (acutely bright, occurring within a few weeks) and chronic mononucleosis (a process lasting up to six months).
Separately allocated infection with Ebbstein- Barr virus in immunodeficiency states and HIV.
The incubation period for mononucleosis can last from several days to 2 weeks, usually a week.
- The disease begins with a high fever, reaching 38-40 ° C, dramatically arising against the background of full health.
- For 2-3 days fever with symptoms of toxemia reach a maximum, there is a strong weakness and headaches, pain in muscles and joints, then there is a strong pain in the throat when swallowing and at rest.
- The temperature fluctuates during the day, having no definite patterns, is poorly amenable to antipyretic therapy, on average, the fever lasts for about a week, gradually diminishing.
The main symptom of mononucleosis is typical tonsillitis , sore throat on the background of fever and toxicosis. A sore throat can be catarrhal or lacunar in nature (i.e. be purulent or not), less often – membranous or necrotic, especially strong angina occurs when granulocytes decrease in blood. Characterized by severe pain in the throat when swallowing, there may be severe tingling, itching and dry throat.
Another of the typical manifestations is an increase in lymph nodes in the jaw and neck, axillary and inguinal lymph nodes. There may also be lesions of the intrathoracic and mesenteric lymph nodes, which gives cough and severe abdominal pain.
Approximately half of the patients with mononucleosis develop a rash on the body, which has a different character depending on the day of the disease – in 3-5 days of illness it may have a cortical pattern, may be in the form of roseol, papules or small hemorrhages. The rash can hold on the skin for 1-3 days and disappears without a trace without pigmentation and flaking. New rash does not appear additionally.
Against the background of mononucleosis in children, the size of the liver and spleen increases dramatically, they are detected from 3-5 days of illness and can be in this state for up to 4 weeks. The icteric forms are particularly difficult, with damage to the liver tissue and an increase in the number bilirubin, the level of liver enzymes, especially alkaline phosphatase.
Changes in the analysis of peripheral blood of children with mononucleosis are typical – there is not a pronounced leukocytosis to 10 * 10 9 / l of leukocytes, while the number of lymphocytes and monocytes , in the blood they reveal specific cells – atypical mononuclears, which confirm the diagnosis.
Changes in the blood hold the most, imbalance of leukocytes and lymphocytes can persist up to six months.Against the background of mononucleosis, immunity decreases, which leads to an increased incidence of respiratory infections.
The basis of the diagnosis is the clinical picture of the disease with the typical manifestations described earlier. Of particular importance for the diagnosis is a blood test with the identification of atypical mononuclear cells in combination with an increase in lymphocytes and a decrease in leukocytes.
Today, the most popular are the definition of antibodies to the Ebbstein- Barr class virus.Igm (antibodies of fresh infection) and IgG class that confirm post- factum infection.
It is necessary to distinguish mononucleosis from banal tonsillitis, diphtheria and cytomegalovirus lesions, HIV infection, hepatitis with liver damage and measles, rubella andother childhood infections with a rash.
Pediatricians and infectious disease specialists are engaged in the treatment of mononucleosis.
Specific therapy against Ebbstein- Barr virus has not been developed, therefore, non-specific therapy with antiviral drugs and immunomodulators (arbidol, Viferon , acyclovir, imudon ) is used.
The treatment is mainly aimed at combating the symptoms of the disease – the use of local antiseptics and painkillers for sore throat (bioparox, hexoral , pharyngosept ), antipyretic (paracetamol, nurofen ).
Close attention is paid to the restoration of the liver.
When the risk of complications are often used antibiotics to prevent secondary infection on the background of reduced immunity. Basically, the treatment is carried out at home, in rare cases of severe course inpatient treatment is carried out.
Mononucleosis is dangerous because of its complications hemolytic anemia. The most dangerous complication is spontaneous rupture of the spleen due to its sharp increase. In children, airway lesions with bronchial obstruction and the occurrence of pneumonia.
With mononucleosis, the prognosis is favorable, but after the infection that has been transferred, there is a long-lasting decrease in immunity, which leads to an increase in the incidence of colds. Reduced immunity lasts up to six months.
Specific vaccines and drugs for the prevention of mononucleosis has not been developed, general preventive measures are being taken – hardening, taking multivitamins, washing the mucous membranes of the nose and throat.