Infectious mononucleosis

Definition:

is caused by Epstain-Barr virus and is characterized by:

• Intoxication

• Acute tonsillitis

• Generalized polylymphadenopathy,

• Hepatosplenomegaly

Diseases with mononucleosis-like syndrome:

ЕВV infection – 90% (infectious mononucleosis

СМV infection (cytomegaloviral mononucleosis

HIV infection

Rubella

Toxoplasmosis

Viral hepatitis

Etiology of EBV:

Family Herpesviridae – IV type

DNA-containing

Target cells - В- and Т- lymphocytes

Life-long persistense in B-cells

Oncogenic (Berkitt’s lymphoma, nasopharyngeal carcinoma, CNS lymphoma at HIV infection)

Epidemiology of EBV infection:

Way of transmission: contact (saliva), sexual, hemotransfusions

Children under 5 years – 80 %

In 50 % asymptomatic

After infection the person excretes the virus during 6 months; after – periodically through the life

Pathogenesis of EBV infection:

Penetration and viral replication in pharyngeal mucosa

Viremia

Infection of peripheral B-lymphocytes

Uncontrolled prolipheration of B-cells (CBC – absolute lymphocytosis and ESR)

Responsive production of T-cells supressors (СД8+) for inhibition of B-cell proliferation (CBC – atypical mononuclears)

Depression of cellular immunity

Clinics of EBV infection:

Fever

Lymphadenopathy

Exudative pharyngitis (prominent)

Adenoiditis, nasal obstruction

Hepatomegaly

Possible exanthema

Complications of EBV infection:

Respiratory tract obstruction (5-8%)

Splenic rupture (0,5%)

Neurologic disturbances:

- seizures,

- Alice in Wonderland (metamorphopsia),

- transverse myelitis,

- facial paralysis,

- meningitis (monocytic cytosis)

Hematological:

- hemolytic and aplastic anemia,

- thrombocytopenia,

- neutropenia (2-3^rd wk of the disease)

Laboratory diagnosis of EBV infection:

Heterophylic test (antibodies)

in children older 6 years (1:28 - 1:56)

Serologic – antibodies to early, capsid and nuclear antigens

CBC:

leucocytosis (leucopenia), lymphocytosis, atypical mononuclears, accelerated ESR.

Increased activity of ALT

Serological profile of EBV infection:

Periods of the disease	At-EA Early	AT-CA-IgM Capsid	AT-CA-IgG Capsid	AT-NA Nuclear
Onset (<1 week)	+	+	+ | -	-
Height (1 - 4 weeks)	+ | -	+	+	+ | -
Recovery (>4 weeks)	_	_	+	+

Therapy of EBV infection:

NSAIDs (acetaminofen, ibuprofen) for fever

Corticosteroids (on indications)

Acyclovir – questionable.

Marcolides – for exudative purulent pharyngitis. Azythromycin 10 mg/kg/day – 5 days

N.B.! Amoxicillin (ampicillin) is contraindicated

Indications for corticosteroid therapy:

Airway obstruction

Autoimmune hemolytic anemia

Thrombocytopenia

Hemorrhagic syndrome

Seizures

Meningitis

Paratonsillar abscess:

25%-30% in childhood

Most common – GAS

Possible joining of anaerobic bacteria

Symptoms:

Throat pain / dysphagia

l 5-7 days

l No effect from antibiotics

Trismus

l Pain at mouth opening

Fever

Muffled voice

Pain irradiation into ear

Oropharyngeal signs:

l Assymetrical edema of soft tissue around tonsils with tonsillar dislocation

l Fluctuation by palpation

l Tonsils can be normal, or hyperemic, or covered with axudate

l Uvula is dislocated to healthy side

l Soft palate is hyperemic and edemstous

l Bilateral tonsillar involvement in 3%

l Malodor from mouth

l Cervical lymphadenopathy

Treatment:

Penicillin G benzathine:

Adults - 600 mg (~1 million U) IV q6h

Children -12,500-25,000 U/kg IV q6h + Metronidazole (Flagyl) 15 mg/kg or 1 g per 70-kg adults IV during 1 hour
supportive dosage: 6 h infusion 7.5 mg/kg or 500 mg per 70-kg adults during 1 hour every 6-8h; not more than 4 g/d

Clindamycin – infants and children: 15-25 mg/kg/d PO every 8h; 25-40 mg/kg/d IV/IM every 8h

Erythromycin

Дата добавления: 2015-11-16