And whether you know...
Infectious mononucleosis — what is it?
What the illness is as it proceeds and it is treated and this article is devoted. The mononucleosis is an acute virus frustration (A code by MKB 10: B27), which is followed by increase in a spleen and liver, disturbance of work of reticuloendothelial system, change of leukocytes and a lymphadenopathy.
What for an illness a mononucleosis as Wikipedia specifies, for the first time was told to the world in 1885 by the Russian scientist N. F. Filatov and originally called it idiopathic lymphadenitis. At the moment it is known that it is caused by a virus of herpes of the 4th type (Epstein-Burra's virus) exerting impact on an adenoid tissue.
How the mononucleosis is transferred?
Most of relatives and at the diseased often has questions: "On how many the mononucleosis is infectious whether it is infectious in general and how it is possible will catch?" The infection is transmitted in the airborne way, initially fixed on a stomatopharynx epithelium, and then gets into regional lymph nodes after transit through a blood channel. The virus remains in an organism during all life, and when lowering natural protective forces the disease is capable to recur.
What is an infectious mononucleosis and as it is treated at adults and in more detail it is possible to learn from children after reading of this article completely.
Whether it is possible to ache with a mononucleosis repeatedly?
Whether one of frequently asked questions "Can repeat infection with a mononucleosis?" It is impossible to catch repeatedly a mononucleosis as after the first meeting with an infection (unimportantly, there was a disease or not) the person becomes its carrier for the rest of life.
Reasons of emergence of an infectious mononucleosis in children
The most predisposed to this illness are children 10 years are younger. Epstein-Burra's virus circulates most often in the closed collective (kindergarten, school) where there is infection with an airborne way. At hit on open Wednesday the virus quickly perishes therefore infection happens only at rather close contacts. The activator of a mononucleosis is defined at the sick person in saliva therefore it is capable to be given also during the sneezing, cough, kisses, use of the general ware.
It is worth mentioning that this infection is registered twice more often at boys, than at girls. Some patients transfer a virus mononucleosis asymptomatically, however are carriers of a virus and are potentially hazardous to health of others. It is possible to reveal them only having carried out the special analysis on a mononucleosis.
Virus particles get into a blood stream through respiratory tracts. The incubation interval has average duration of 5-15 days. In some cases, as the Internet forum and some patients reports, it can last about one and a half months (the reasons of this phenomenon are unknown). The mononucleosis is rather widespread disease: to 5-year age more than a half of children catch Epstein-Burra's virus, however at the majority it proceeds without serious symptomatology and manifestation of a disease. Contamination among adult population fluctuates in different populations within 85-90% and only at some patients this virus is shown by symptoms on the basis of which make the diagnosis an infectious mononucleosis. Emergence of the following special forms of a disease is possible:
- atypical mononucleosis – its signs at children and adults are connected with stronger expressiveness of symptoms, than usually (for example, temperature can rise to 39,5 degrees or the disease can proceed without temperature at all); the diet has to be an obligatory component of treatment at this form because the atypical mononucleosis possesses tendency to cause heavy complications and effects in children;
- the chronic mononucleosis described in the section of the same name is considered as an effect of deterioration in work of immune system of the patient.
At parents often arises questions of that how many temperature at the described infection keeps. Duration of this symptom can vary considerably depending on specific features: from several days to one and a half months. At the same time a question of that to accept antibiotics at a hyperthermia or not, the attending physician has to solve.
Also rather widespread question: "to accept the Acyclovir or not?" The acyclovir is included into many officially approved schemes of treatment, however the last researches prove that such treatment does not influence the course of a disease and does not improve a condition of the diseased in any way.
Treatment and symptoms at children (than to treat a mononucleosis and how to treat at children) are also in detail described in E.O. Komarovsky's transfer "An infectious mononucleosis". Video from Komarovsky:
Mononucleosis at adults
At persons 35 years are more senior this disease develops seldom. But the atypical symptoms of an illness and a chronic mononucleosis having potentially dangerous effects, on the contrary, meet in a percentage ratio more often.
Treatment and symptoms at adult fundamental differences from those at children have no. In more detail about what to treat and how to treat at adults, it is described below.
Infectious mononucleosis, symptoms
Mononucleosis symptoms at children
So far methods of specific prevention from infection with the described virus therefore if the child did not manage to avoid contact with infected, parents need to watch carefully a condition of the child for the next 3 months are not developed. In the absence of emergence in the specified time of symptoms of a disease it is possible to claim that infection or did not occur, or immunity suppressed a virus and infection proceeded asymptomatically. If there were symptoms of the general intoxication (the increased temperature, a fever, rash, weakness, increased lymph nodes, then it is necessary to address immediately the pediatrician or the infectiologist (to a question of what doctor treats a mononucleosis).
Symptoms of a virus of Epstein-Burra at children at an initial stage of a disease include a febricula, the catarral phenomena and weakness. Then there is irritation in a throat, the subfebrile temperature, reddening and hypostasis mucous stomatopharynxes, a nose congestion, increase in almonds. In some cases the fulminant form of development of an infection when symptoms appear suddenly meets, and their expressiveness quickly amplifies (drowsiness, fever to 39 degrees within several days, a fever, the strengthened sweating, weakness, muscle and throat pains, a headache). Further there comes the period of the main clinical manifestations of an infectious mononucleosis at which it is observed:
- increase in sizes of a liver and spleen;
- rash on a body;
- granularity and hyperemia of a peripharyngeal ring;
- general intoxication;
- increase in lymph nodes.
Rash at a mononucleosis usually develops in an initial stage of a disease, along with a lymphadenopathy and fever, and is located on hands, a face, legs, a back and a stomach in the form of small reddish spots. This phenomenon is not followed by an itch and does not demand treatment, it passes independently in process of recovery of the patient. If at the patient accepting antibiotics, rash began to itch, it can indicate development of an allergy as at a mononucleosis skin rash does not scratch.
The polyadenitis arising because of a hyperplastic tissue of a lymph node is considered the most important symptom of the described infection. Often on almonds there are insular imposings of a light plaque which easily is removed. Also peripheral lymph nodes, especially cervical increase. At turn of the head aside they become rather noticeable. The palpation of lymph nodes is sensitive, but is not painful. Less often abdominal lymph nodes increase and, squeezing regional nerves, they provoke development of a symptom complex "acute abdomen". This phenomenon is capable to lead to statement of the incorrect diagnosis and carrying out a diagnostic laparotomy.
Mononucleosis symptoms at adults
The virus mononucleosis at persons is more senior than 25-30 years practically does not meet as this subpopulation already, as a rule, has the created immunity to an infestant. Symptoms of a virus of Epstein-Burra at adults if the disease nevertheless developed, differ in nothing from those at children.
Gepatosplenomegaliya at children and adults
As it was stated above, the gepatosplenomegaliya is characteristic of the described disease. The liver and a spleen are extremely sensitive to a virus, as a result increase in a liver and spleen at the child and the adult are observed in the first days of an illness. In general the gepatosplenomegaliya reasons at the child and the adult include various viral, oncological diseases, and also diseases of blood and a system lupus erythematosus therefore comprehensive inspection in this situation is necessary.
Symptoms of a sore spleen at the person:
- increase in the sizes of body which can be revealed at a palpation and ultrasonography;
- morbidity, feeling of weight and discomfort in the left departments of a stomach.
The illness of a spleen provokes its increase so that the parenchyma of body is capable to break off own capsule. The first 15-30 days continuous increase in the sizes of a liver and spleen and when body temperature is normalized is observed, there is a return of their sizes to normal indicators.
The symptoms of a rupture of a spleen at adults and children based on the analysis of stories of diseases of patients:
- nausea and vomiting;
- flashes of light;
- the amplifying abdominal pain of diffuse character.
Than to treat a spleen?
At increase in a spleen restriction of exercise stresses and a bed rest is shown. If nevertheless the rupture of body was diagnosed, then its urgent removal is necessary.
The long persistirovaniye of a virus seldom passes in an organism asymptomatically. Considering that at the masked viral infection emergence of the most various diseases is possible, it is necessary to allocate accurately the criteria allowing to diagnose a chronic virus mononucleosis.
Symptoms of a chronic form:
- the severe form of primary infectious mononucleosis postponed within half a year or associated with big antiserum capacities to a virus Epstein-Burra;
- the increase in maintenance of particles of a virus in the struck fabrics confirmed with method of anticomplementary immunofluorescence with activator antigen;
- the defeat of some bodies (splenomegaly, intersticial pneumonia, uveitis, marrow hypoplasia, persistent hepatitis, lymphadenopathy) confirmed with histologic researches.
Diagnosis of a disease
For the purpose of confirmation of a mononucleosis the following researches are usually appointed:
- blood test on existence of antibodies to Epstein-Burra's virus;
- biochemical and general blood tests;
- Ultrasonography of internals, first of all liver and spleen.
The main symptoms of a disease on the basis of which make the diagnosis are the increased lymph nodes, tonsillitis, a gepatosplenomegaliya, fever. Hematologic changes are a secondary symptom of an illness. The picture of blood is characterized by increase of SOE, emergence of atypical mononuklear and shirokoplazmenny lymphocytes. However it is necessary to consider that the specified cells can appear in blood only 3 weeks later after infection.
When carrying out differential diagnosis it is necessary to exclude an acute leukosis, an infectious disease, quinsy, diphtheria of a pharynx and a lymphogranulomatosis which can have similar symptoms.
Shirokoplazmenny lymphocytes and atypical mononukleara
Mononukleara and shirokoplazmenny lymphocytes – what whether is it and one it and too?
Often between these concepts put an equal-sign, however from the point of view of cell morphology between them there are essential distinctions.
Shirokoplazmenny lymphocytes are cells with big cytoplasm and a tyazhisty kernel which appear in blood at viral infections.
Mononukleara in the general blood test appear mainly at a virus mononucleosis. Atypical mononukleara in blood represent big cells with the cytoplasm divided by border and the big kernel containing small kernels.
Thus a specific character for the described disease is only emergence of atypical mononuklear, and shirokoplazmenny lymphocytes at it can not be. It is worth remembering also that mononukleara can be a symptom and other viral diseases.
Additional laboratory diagnosis
For the most exact statement of the diagnosis in difficult cases use more exact analysis on a mononucleosis: study value of an antiserum capacity to Epstein-Burra's virus or appoint the research PCR (polimerazny chain reaction). Interpretation of blood test on a mononucleosis and the general analysis (at children or at adults has similar parameters of an assessment) allows blood with the specified relative quantity of atypical mononuklear with a high share of probability to confirm or disprove the diagnosis.
Also to patients with a mononucleosis appoint a number of serological researches regarding detection of HIV infection (blood to HIV) as it can provoke increase in concentration of mononuklear in blood. At identification of symptoms of quinsy it is recommended to visit the ENT specialist and to carry out a faringoskopiya for definition of an etiology of frustration.
How not to catch from the sick child to adult and other children?
If is in a family infected with a virus mononucleosis, it will be difficult not to catch to other family members because after an absolute recovery the patient continues to allocate periodically a virus in environment and remains its carrier on for the rest of the life. Therefore in the patient in quarantine there is no need: if other family members are not infected in the period of an illness of the relative, with high probability it is possible to tell that infection will occur later.
Infectious mononucleosis, treatment
Than to treat and how to treat Epstein-Burra's virus at adults and children?
Treatment of an infectious mononucleosis at children, and also the symptomatology and treatment of a virus of Epstein-Burra at adults have no basic distinctions. The approaches and drugs used for therapy in most cases are identical.
Specific treatment of the described disease does not exist, is not present as well the general scheme of treatment or antiviral drug which could struggle with a virus effectively. As a rule the disease is treated in on an outpatient basis, in hard clinical cases of the patient place in a hospital and appoint a bed rest.
To hospitalization treat indications:
- development of complications;
- temperature is over 39,5 degrees;
- threat of asphyxia;
- symptoms of intoxication.
Treatment of a mononucleosis is carried out in the following directions:
- purpose of febrifugal drugs (for children Paracetamol or the Ibuprofen are used);
- use of local antiseptic drugs for treatment of mononukleozny quinsy;
- local nonspecific immunotherapy drugs IRS 19 and Imudon;
- purpose of the desensibilizing means;
- vitamin therapy;
- at detection of damage of a liver recommend cholagogue drugs and gepatoprotektor, the special diet is appointed (medical a table diet No. 5);
- purpose of immunomodulators (Viferon, Anaferon, Imudon, Tsikloferon) together with antiviral drugs for receiving the greatest effect is possible;
- antibiotics at a mononucleosis (the Metronidazole tablet) are appointed as prevention of development of microbic complications in the presence of an intensive inflammation of a stomatopharynx (a penicillinic number of antibiotics at an infectious mononucleosis is not appointed because of highly probability of emergence of a heavy allergy);
- during reception of antibiotics share a probiotics (Narine, Acipol, Primadofilus);
- in case of development of a severe hypertoxical form of an illness at risk of asphyxia the 7-day rate of Prednisolonum is shown;
- at the expressed hypostasis of a throat and development of difficulties with breath statement of a tracheostoma and transfer of the patient into artificial ventilation of the lungs is recommended;
- if the rupture of a spleen is diagnosed, the splenectomy in the emergency order is carried out (effects of a rupture of a spleen without rendering the qualified help can be lethal).
Forecast and effects of a mononucleosis
To patients, had a virus mononucleosis, as a rule, attribute the favorable forecast.
It should be noted that the main condition of lack of complications and adverse effects is timely detection of leukoses and continuous supervision over change of indicators of blood. Also, it is extremely important to watch health of patients until their absolute recovery. During scientific researches it is revealed:
- body temperature over 37,5 degrees remains approximately within several weeks;
- symptoms of quinsy and pharyngalgia remain for 1-2 weeks;
- the state lymphatic nodes is normalized within 4 weeks from the moment of disease manifestation;
- complaints to drowsiness, fatigue, weakness can come to light within 6 months.
The had adults and children need regular dispensary inspection for half a year-year with obligatory regular passing of blood test.
Complications arise in general seldom. The most widespread effects are hepatitis, yellowness of skin and darkening of urine, and the most serious effect of a mononucleosis are the rupture of a cover of a spleen arising because of thrombocytopenia and restretching of a capsule of body and demanding the emergency operative measure. Other complications are connected with development of a consecutive streptococcal or staphylococcal infection, development of an encephalomeningitis, asphyxia, severe forms of hepatitis and an intersticial bilateral infiltration of lungs.
Effective and specific prevention of the described frustration is not developed now.
Risks at pregnancy
The disease constitutes serious danger at pregnancy. Epstein-Burra's virus is capable to increase risk of its premature interruption, to provoke a small-for-date fetus, and also to cause a hepatopathy, the syndrome of respiratory frustration recuring hroniosepsis, changes of a nervous system and organs of sight.
At infection with a virus during pregnancy the probability of infection of a fruit is very high that in an effect can be the prime cause of a lymphadenopathy, long subfebrile condition, a syndrome of chronic fatigue and a gepatosplenomegaliya at the child.