Mononucleosis in children - symptoms and treatment, what kind of disease it is and whether it happens in adults. Symptoms and Treatments for Infectious Mononucleosis in Children

On the neck.

In this article, we will talk about the symptoms and treatment of infectious mononucleosis in children.

Pathogens

There are many hypotheses about pathogens that can cause infectious mononucleosis in a child. Currently, the proven cause of the disease is the Epstein-Barr virus (herpes virus type VI, EBV infection) and. In addition to mononucleosis, the role of EBV infection has also been proven in other pathologies (Burkitt's lymphoma, carcinomas, tumors of the oral cavity, etc.).

The disease has a spring-autumn seasonality, it is characterized by peaks in the rise in incidence, with a frequency of every 5-7 years.

Ways of infection of the child

The virus can enter the baby's body from a sick person or from a carrier. Those who have been ill with mononucleosis can actively excrete the pathogen into the body for several months. environment. In the future, a life-long carriage of the virus is formed, which does not manifest itself in any symptoms.

There are several possible ways for the virus to enter the child's body:

1. Airborne. This is the most common form of infection with infectious mononucleosis. The virus with saliva can be carried over long distances when talking, coughing or sneezing, getting on the mucous membranes. respiratory tract.
2. Contact household. The causative agent remains viable human body during few hours. When using dishes, individual towels, toys infected with the Epstein-Barr virus, it is likely that the child may become infected with it.
3. Hemotransfusion. The herpes virus actively multiplies in blood culture, therefore, when transfusing an infected donated blood or transplantation of an organ, an acute process of the disease occurs with a pronounced clinical picture.

In half of the sick children, the disease is not clinically manifested by bright and clear symptoms, the infectious process proceeds in an erased form. If the immune system works well, there may be an asymptomatic course of the disease.

Clinic of the disease

From the moment the pathogen enters the child's body and until the first clinical manifestations may take from 1 week to several months. There are several main symptoms, the appearance of which indicates infectious mononucleosis in children:

1. High persistent fever.
2. Neck enlargement lymph nodes, especially the rear group.
3. Angina or bright hyperemia of the oropharynx.
4. Enlargement of the spleen and.
5. The appearance in the peripheral blood of altered monocytes (mononuclear cells).

Among the secondary symptoms, babies may develop a rash on the body or hard palate, swelling of the eyelids, face, catarrhal phenomena (nasal congestion, runny nose, sneezing), in rare cases it is noted.
The acute process begins suddenly, against the background of absolute health, the temperature rises to high performance, and the traditional complex of symptoms of infectious mononucleosis is fully manifested within one week.

From the first days of the illness, the doctor can see or palpate enlarged lymph nodes on the neck, and when examining the oropharynx, he can detect a purulent plaque on the tonsils. By the end of the first week of illness, atypical mononuclear cells are detected in the general blood test.

There is a variant of the development of infectious mononucleosis with a gradual increase in body temperature, general weakness, minor catarrhal symptoms. At the peak of the disease appears high fever, soreness of the lymph nodes and swelling of the tissue around them. When the virus spreads through the bloodstream, there is an increase in nodes in other parts of the body ( abdomen, rib cage).

With an increase in the size of the liver in children, icteric staining of the skin and sclera is sometimes noted, and in the peripheral blood, the ALT indicator also increases. The spleen increases simultaneously with the liver, but the decrease in its parameters occurs somewhat earlier.

Older children with infectious mononucleosis may experience pain in the knee joints.

Classification of pathology

Depending on the expression specific symptoms, infectious mononucleosis can occur:

• typical: the disease is characterized by a full-fledged detailed picture of the disease;
• asymptomatic: completely absent clinical symptoms pathology, and only special laboratory tests help to establish the diagnosis;
• with erased symptoms: the main manifestations of the disease are minimally expressed or resemble more a respiratory tract disease;
• with predominant defeat internal organs(visceral form): changes in the nervous, cardiovascular, urinary, endocrine and other systems or organs come to the fore in clinical manifestations.

Depending on the duration of clinical manifestations, the disease can be acute, protracted or chronic. Acute infectious mononucleosis is considered from the first day of the disease to 3 months, from 3 to 6 months - a protracted course, chronic - the presence of symptoms of pathology for more than 6 months.

Complications and consequences of mononucleosis

Regardless of the severity of a child's symptoms, infectious mononucleosis can cause certain serious complications:

• suffocation (asphyxia): the condition develops as a result of blocking the lumen of the respiratory tract with a package of enlarged lymph nodes;
• rupture of the spleen capsule with a significant increase in it;
• changes in the blood (, violation of hematopoiesis);
• defeat nervous system (serous meningitis, impaired coordination of movements);
• infectious-toxic shock (severe disruption of work important organs when the virus enters the blood in large quantities);
• suppuration of the lymph nodes and surrounding tissue (lymphadenitis, paratonsillar abscess);
• damage to ENT organs (sinusitis, mastoiditis), etc.

After the postponed acute form infectious mononucleosis, children can fully recover, become virus carriers, or the process will go into chronic form with occasional exacerbations.

Diagnosis of mononucleosis

With infectious mononucleosis, characteristic changes in the blood are detected.

To detect infectious mononucleosis, the child must undergo a complete laboratory examination. At the first stage of diagnosis, a general blood test is performed. It shows signs of inflammation (leukocytosis, accelerated ESR), altered mononuclear cells appear, their number exceeds 10%. If the disease is not caused by EBV infection, but by another type of herpes virus, then there will be no atypical monocytes in the blood.

In addition to the general blood test, heterophile antibodies in the patient's serum are determined laboratory using ram erythrocytes. The LA-IM test is also carried out, its effectiveness is about 80%.

Via enzyme immunoassay in a sick baby, the level of antibodies to various types herpes. PCR method allows you to identify the DNA of the pathogen not only in the blood, but also in saliva or urine.

Principles of treatment

Candles "Viferon" - antiviral agent for kids

Therapy of most typical cases of infectious mononucleosis is carried out in the conditions of the infectious department. With a mild course, treatment can be carried out on an outpatient basis, but under the supervision of a local doctor and an infectious disease specialist.

During the height of the pathology, the child must observe bed rest, a chemically and mechanically sparing diet and a water-drinking regimen.

Symptomatic therapy includes antipyretic drugs, local antiseptics for the throat (hexoral, tandum-verde, strepsils, bioparox), analgesics, rinsing the mouth with herbal decoctions, furacilin. Etiotropic treatment (the action is aimed at the destruction of the pathogen) has not been finally determined. In children, it is recommended to use on the basis of interferon (Viferon suppositories), (isoprinosine, arbidol).

In small or weakened babies, the appointment is justified antibacterial drugs with a wide range action, especially in the presence of purulent complications (pneumonia, otitis media, meningitis). With involvement in the process of the central nervous system, symptoms of asphyxia, a decrease in the work of the bone marrow (

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 which is 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 mononucleosis and defined it as glandular fever with lesions of the pharynx and lymphatic system. On the basis of emerging in practice hematological research characteristic changes in the composition of the blood 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 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 perform, like other types of leukocytes (eosinophils, basophils, neutrophils), protective function organism.

How can you get infectious mononucleosis?

The source of the causative agent of infectious mononucleosis is a sick person (especially at the peak of the disease, when heat), a person with erased forms disease (the disease occurs in mild degree, with mild symptoms, or under the guise of acute respiratory infections), as well as a person without any symptoms of the disease, who looks absolutely healthy, but is at the same time a virus carrier. A sick person can “give” the causative agent of infectious mononucleosis to a healthy person different 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 the mother to the fetus through the placenta.

Infection with infectious mononucleosis occurs, as a rule, through close contact, so living sick and healthy people together, to put it mildly, undesirable. 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 time the following symptoms may be observed:

• 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 consequence of all of the above, an increase in sensitivity to SARS and other respiratory diseases, frequent lesions skin virus " herpes simplex” (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 under lower jaw(submandibular), as well as cervical, axillary and inguinal lymph nodes, you can feel 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 general analysis blood with 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) on the initial stage diseases (31.07.2014)

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 do 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:

1. difficulty breathing and discomfort are felt only during sleep;
2. 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), 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, mostly 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. Mild cheeses, 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 in children most often appears between the ages of two and fifteen. This is an infectious disease that resembles the flu or a sore throat, but it also affects the internal organs. It is transmitted by airborne droplets, and the pathology persists for life, and with a decrease in immunity, it is capable of relapse. In severe cases, when the infection cannot be detected, it can be fatal.

The course and forms of the disease

A virus occurs in the oral mucosa, then it affects the tonsils and throat. Then, through the circulation of blood and lymph, the infection enters the internal organs, affecting many internal organs. As a rule, the pathology proceeds without complications, they occur only when a relapse occurs when the immune system is weakened. Symptoms of mononucleosis in children, with repeated pathogenic microflora, occur with pneumonia, sinusitis and edema of the middle ear begin.

At the first infection, the incubation period lasts from five days to three weeks, and when the disease becomes severe, the duration increases from 2 to 4 weeks. With untimely treatment, the mononucleosis virus becomes chronic. Then the lymph nodes become constantly enlarged in the child, damage to the heart, brain and nerve centers may occur, as a result of this, facial expressions are disturbed, and frequent psychoses occur.

Infectious mononucleosis in children Komarovsky divides into forms:

• Typical. Occurs with pronounced symptoms. The child develops a sore throat, fever, enlarged liver and spleen.
• Atypical. Symptoms of the disease are either completely absent, or manifest in the form of a disease of the heart, nervous system, and the lungs and kidneys are also affected.

The pathology can proceed in a smooth form, uncomplicated, complicated or protracted. In order to prevent infection of the child, it is necessary to strengthen the immune system from birth.

The etiology of the disease

The main cause of the disease is infection. The main ways of infection with mononucleosis:

• Occurs after kissing an infectious person.
• Patient contact.
• Sharing the same dishes, clothes, bedding with an infected person.

In addition, the disease is transmitted by airborne droplets, it is enough for a person to sneeze or cough, and the causative agent of the disease enters the environment. Most often, infection occurs in schoolchildren and preschool children, less often mononucleosis occurs in infants. If the infection appeared in a newborn, then the disease was transmitted from the mother during pregnancy through the blood. Based on statistics, boys are much more likely to be affected than girls.

Symptoms and signs of the disease

After contact with an infected person, it is necessary to monitor the condition of the baby for the next three months. If the disease did not manifest itself, then it is considered that infection did not occur, the immune system overcame the virus, or the disease was asymptomatic. To the main Symptoms of infectious mononucleosis in children include:

A mononucleosis-like syndrome is similar to the symptoms of a sore throat, but the main difference is that a runny nose also joins the sore throat. In addition, an increased content of mononuclear cells occurs in the blood, which can only be established with the help of a medical analysis.

In very young children, the mononucleosis-like syndrome manifests itself weakly, and it is quite difficult to distinguish it from SARS. The main distinguishing feature in one-year-old children is the appearance of a rash, which is more common in them than in older babies.

In children from six to fifteen years old, the syndrome manifests itself more clearly. Typically, when children show only signs of a fever, it means that the body is fighting an infection.

Diagnostic measures

In order to distinguish mononucleosis from another disease and prescribe the correct treatment, a specialist prescribes a diagnosis. Take a blood sample to perform the following types of analysis:

Since mononuclear cells occur in the blood of children and with other diseases, an analysis is taken for antibodies to other types of infections. In addition to the basic tests, the specialist writes out a referral for an ultrasound scan of the internal organs to exclude their enlargement.

(otherwise called benign lymphoblastosis, Filatov's disease) is an acute viral infection characterized by a predominant lesion of the oropharynx and lymph nodes, spleen and liver. A specific sign of the disease is the appearance in the blood of characteristic cells - atypical mononuclear cells. The causative agent of infectious mononucleosis is the Epstein-Barr virus, belonging to the herpesvirus family. Its transmission from the patient is carried out by aerosol. Typical symptoms of infectious mononucleosis are general infectious phenomena, tonsillitis, polyadenopathy, hepatosplenomegaly; maculopapular rashes are possible on various parts of the skin.

ICD-10

B27

General information

Infectious mononucleosis (otherwise called benign lymphoblastosis, Filatov's disease) is an acute viral infection characterized by a predominant lesion of the oropharynx and lymph nodes, spleen and liver. A specific sign of the disease is the appearance in the blood of characteristic cells - atypical mononuclear cells. The spread of infection is ubiquitous, seasonality has not been identified, there is an increased incidence during puberty (girls 14-16 years old and boys 16-18 years old). The incidence after 40 years is extremely rare, with the exception of HIV-infected persons who may develop a manifestation of a latent infection at any age. In case of infection with a virus in early childhood, the disease proceeds as an acute respiratory infection, at an older age - without severe symptoms. In adults, the clinical course of the disease is practically not observed, since most of them have developed specific immunity by the age of 30-35.

Causes

Infectious mononucleosis is caused by the Epstein-Barr virus (a DNA-containing virus of the genus Lymphocryptovirus). The virus belongs to the herpesvirus family, but unlike them, it does not cause the death of the host cell (the virus mainly multiplies in B-lymphocytes), but stimulates its growth. In addition to infectious mononucleosis, Epstein-Barr virus causes Burkitt's lymphoma and nasopharyngeal carcinoma.

The reservoir and source of infection is a sick person or a carrier of the infection. Isolation of the virus by sick people occurs from the last days of the incubation period, and lasts 6-18 months. The virus is shed in saliva. In 15-25% of healthy people with a positive test for specific antibodies, the pathogen is found in swabs from the oropharynx.

The mechanism of transmission of the Epstein-Barr virus is aerosol, the predominant route of transmission is airborne, contact is possible (kissing, sexual contact, dirty hands, dishes, household items). In addition, the virus can be transmitted through blood transfusion and intrapartum from mother to child. People have a high natural susceptibility to infection, but when infected, mild and blurred clinical forms are predominantly developed. A slight incidence among children under one year old indicates the presence of innate passive immunity. Severe course and generalization of infection contributes to immunodeficiency.

Pathogenesis

The Epstein-Barr virus is inhaled by a person and affects the epithelial cells of the upper respiratory tract, oropharynx (promoting the development of moderate inflammation in the mucous membrane), from there the pathogen enters the regional lymph nodes with the lymph flow, causing lymphadenitis. When it enters the bloodstream, the virus invades B-lymphocytes, where it begins active replication. The defeat of B-lymphocytes leads to the formation of specific immune reactions, pathological deformation of cells. With the blood flow, the pathogen spreads throughout the body. Due to the fact that the introduction of the virus occurs in immune cells and immune processes play a significant role in pathogenesis, the disease is classified as AIDS-associated. The Epstein-Barr virus persists in the human body for life, periodically activating against the background of a general decrease in immunity.

Symptoms of infectious mononucleosis

The incubation period varies widely: from 5 days to one and a half months. Sometimes there may be non-specific prodromal phenomena (weakness, malaise, catarrhal symptoms). In such cases, there is a gradual increase in symptoms, malaise intensifies, the temperature rises to subfebrile values, nasal congestion, sore throat are noted. On examination, hyperemia of the oropharyngeal mucosa is revealed, the tonsils can be enlarged.

In the case of an acute onset of the disease, fever, chills, increased sweating develop, symptoms of intoxication (muscle aches, headache) are noted, patients complain of sore throat when swallowing. Fever can persist from several days to a month, the course (type of fever) can become different.

A week later, the disease usually enters the peak phase: all the main clinical symptoms appear (general intoxication, tonsillitis, lymphadenopathy, hepatosplenomegaly). The patient's condition usually worsens (symptoms of general intoxication worsen), in the throat there is a characteristic picture of catarrhal, ulcerative-necrotic, membranous or follicular tonsillitis: intense hyperemia of the mucous membrane of the tonsils, yellowish, loose plaques (sometimes like diphtheria). Hyperemia and granularity of the posterior pharyngeal wall, follicular hyperplasia, mucosal hemorrhages are possible.

In the first days of the disease, polyadenopathy occurs. An increase in lymph nodes can be detected in almost any group accessible for palpation, most often the occipital, posterior cervical and submandibular nodes are affected. To the touch, the lymph nodes are dense, mobile, painless (or pain is mild). Sometimes there may be a moderate swelling of the surrounding tissue.

At the height of the disease, most patients develop hepatolienal syndrome - the liver and spleen are enlarged, yellowness of the sclera, skin, dyspepsia, and darkening of the urine may appear. In some cases, maculopapular rashes of various localization are noted. The rash is short-term, not accompanied by subjective sensations (itching, burning) and does not leave behind any residual effects.

The height of the disease usually takes about 2-3 weeks, after which there is a gradual subsidence of clinical symptoms and a period of convalescence begins. The body temperature returns to normal, the signs of sore throat disappear, the liver and spleen return to their normal size. In some cases, signs of adenopathy and low-grade fever may persist for several weeks.

Infectious mononucleosis can acquire a chronic relapsing course, as a result of which the duration of the disease increases to one and a half years or more. The course of mononucleosis in adults is usually gradual, with a prodromal period and less clinical symptoms. Fever rarely lasts more than 2 weeks, lymphadenopathy and hyperplasia of the tonsils is mild, but more often there are symptoms associated with a functional disorder of the liver (jaundice, dyspepsia).

Complications

Complications of infectious mononucleosis are mainly associated with the development of an associated secondary infection (staphylococcal and streptococcal lesions). Meningoencephalitis, an obstruction of the upper airways by hypertrophied tonsils, may occur. Children may have severe hepatitis, sometimes (rarely) bilateral interstitial infiltration of the lungs. Also rare complications include thrombocytopenia, overstretching of the lienal capsule can provoke rupture of the spleen.

Diagnostics

Nonspecific laboratory diagnostics includes a thorough study of the cellular composition of the blood. A complete blood count shows moderate leukocytosis with a predominance of lymphocytes and monocytes and relative neutropenia, a shift of the leukocyte formula to the left. Large cells of various shapes with a wide basophilic cytoplasm appear in the blood - atypical mononuclear cells. For the diagnosis of mononucleosis, it is significant to increase the content of these cells in the blood to 10-12%, often their number exceeds 80% of all elements of white blood. When examining blood in the first days, mononuclear cells may be absent, which, however, does not exclude the diagnosis. Sometimes the formation of these cells can take 2-3 weeks. The blood picture usually gradually returns to normal during the period of convalescence, while atypical mononuclear cells often persist.

Specific virological diagnostics is not used due to laboriousness and irrationality, although it is possible to isolate the virus in the swab from the oropharynx and identify its DNA using PCR. There are serological diagnostic methods: antibodies to the VCA antigens of the Epstein-Barr virus are detected. Serum immunoglobulins type M are often determined during the period of incubation, and at the height of the disease are noted in all patients and disappear no earlier than 2-3 days after recovery. The detection of these antibodies serves as a sufficient diagnostic criterion for infectious mononucleosis. After the infection has been transferred, specific immunoglobulins G are present in the blood, which persist for life.

Patients with infectious mononucleosis (or persons suspected of having this infection) are subjected to a three-time (first time during the period of acute infection, and twice more at intervals of three months) serological examination to detect HIV infection, since it may also indicate the presence mononuclear cells in the blood. For the differential diagnosis of tonsillitis in infectious mononucleosis from tonsillitis of another etiology, consultation with an otolaryngologist and pharyngoscopy is necessary.

Treatment of infectious mononucleosis

Infectious mononucleosis of mild and moderate course is treated on an outpatient basis, bed rest is recommended in case of severe intoxication, severe fever. If there are signs of impaired liver function, diet No. 5 according to Pevzner is prescribed.

Etiotropic treatment is currently absent, the complex of indicated measures includes detoxification, desensitization, restorative therapy and symptomatic agents, depending on the available clinic. Severe hypertoxic course, the threat of asphyxia when the larynx is clamped by hyperplastic tonsils are an indication for the short-term appointment of prednisolone.

Antibiotic therapy is prescribed for necrotizing processes in the pharynx in order to suppress the local bacterial flora and prevent secondary bacterial infections, as well as in case of existing complications (secondary pneumonia, etc.). Penicillins, ampicillin and oxacillin, tetracycline antibiotics are prescribed as drugs of choice. Sulfanilamide preparations and chloramphenicol are contraindicated due to the side inhibitory effect on the hematopoietic system. A ruptured spleen is an indication for emergency splenectomy.

Forecast and prevention

Uncomplicated infectious mononucleosis has a favorable prognosis, dangerous complications that can significantly aggravate it, with this disease occurring quite rarely. Residual effects in the blood are the reason for dispensary observation for 6-12 months.

Preventive measures aimed at reducing the incidence of infectious mononucleosis are similar to those for acute respiratory infectious diseases, individual measures of non-specific prevention are to increase immunity, both with the help of general health measures, and with the use of mild immunoregulators and adaptogens in the absence of contraindications. Specific prophylaxis (vaccination) for mononucleosis has not been developed. Measures of emergency prevention are applied in relation to children who communicated with the patient, they consist in the appointment of a specific immunoglobulin. In the focus of the disease, a thorough wet cleaning is carried out, personal belongings are disinfected.

Data 02 May ● Comments 0 ● Views

Doctor Maria Nikolaeva

Infectious mononucleosis is a disease of viral etiology, which is transmitted mainly by airborne droplets. Most often, children aged 3 to 10 years are infected. With the outward similarity of symptoms with the common cold, mononucleosis has its own characteristics. The effectiveness of the treatment of infectious mononucleosis in children largely depends on the correct diagnosis of the disease, the state of the child's immune system and adherence to a special diet.

In most cases, the treatment of mononucleosis in children is carried out on an outpatient basis, under the supervision of a local pediatrician. For an accurate diagnosis, a number of tests are required, usually these are:

1. General or clinical blood test.
2. PCR (polymerase chain reaction) - to identify a specific pathogen.
3. A biochemical blood test - its results allow you to determine how well the internal organs of the child are functioning.
4. ELISA (enzymatic immunoassay) analysis - determines the presence in the blood of antibodies to the pathogen virus.

In a hospital setting, a pediatrician, infectious disease specialist or other specialized specialist can manage the treatment, depending on the characteristics of the course of the disease.

Medical practice shows that the local pediatrician does not always correctly diagnose mononucleosis, attributing the symptoms to a common sore throat, a cold (ARI, SARS). But the disease is more complicated: the infection affects the internal organs (spleen, liver), respiratory tract, provokes an increase in lymph nodes in the abdominal cavity and on the neck, and rashes on the skin.

Improper treatment can lead to a deterioration in the child's condition and the development of severe complications. If there is no improvement, and there are doubts about the correctness of the diagnosis, it is advisable to require tests, call an ambulance team, or seek advice from an infectious disease specialist.

Mononucleosis, unlike tonsillitis, occurs with special symptoms. A visually definable sign is an increase in lymph nodes. Changes in the condition of the child become noticeable a few days or weeks after infection. Diagnosis is complicated by the fact that there are typical and atypical forms of infectious mononucleosis. In the second case, one or more characteristic signs of pathology are completely absent in the clinical picture.

When is hospitalization necessary?

The expediency of outpatient treatment for mononucleosis in children depends on the form of the disease. Indications for urgent hospitalization is a serious condition of the patient:

• pronounced edema of the respiratory tract (may lead to death from suffocation);
• severe intoxication - accompanied by vomiting, diarrhea, prolonged fever and fainting;
• high temperature - 390 C and more;
• the development of complications, including severe disorders in the work of internal organs, secondary bacterial and viral infections.

If infection with infectious mononucleosis is diagnosed in a child of the first year of life, treatment in a hospital is also recommended. This will allow you to receive medical assistance in a timely manner in case of a sharp deterioration in the condition of the baby, to prevent the development of severe complications and consequences.

How to treat mononucleosis in children

The causative agent of the disease is the Epstein-Barr virus (EBV), or cytomegalovirus. Effective drugs to suppress the activity of these infectious agents do not exist, so therapy is aimed at relieving symptoms and shortening the acute period of the disease. Infectious mononucleosis in children should be treated by selecting drugs according to age restrictions. None of the available methods eliminates the presence of this virus in the body. An ill person remains a carrier of the infection for the rest of his life.

Dr. Komarovsky - how to treat mononucleosis

General treatment regimen

Infectious mononucleosis simultaneously affects different organs and systems, so the fight against it requires an integrated approach. The treatment regimen usually includes:

• bed rest, rest;
• drug relief of symptoms (antipyretic, vasoconstrictor, antihistamines);
• special diet;
• strengthening and stimulating the immune system;
• normalization and maintenance of the work of internal organs;
• in severe complications, surgical intervention may be required (in particular, removal of the spleen in case of rupture).

The acute period of the disease is 14-20 days, in some babies it can last longer. After completion of the course of therapy, the time of rehabilitation comes, it can last up to a year.

Medical therapy

Modern pharmacology does not have drugs to destroy the mononucleosis virus, but it can alleviate the patient's condition and speed up recovery. Depending on the individual clinical picture of the disease, the following are used for these purposes:

1. Antipyretic drugs based on paracetamol or ibuprofen - at elevated temperatures.
2. Vitamin complexes to strengthen the body.
3. Furacilin, soda, medicinal herbs - for gargling (to relieve inflammation and reduce pain).
4. Vasoconstrictor drops for nasal congestion.
5. Antiallergic drugs (including glucocorticosteroids) according to indications. They help prevent bronchospasm, cope with skin rashes, reduce the reaction to toxins and drugs.
6. To stimulate the body's immunity, Anaferon, Imudon, Cycloferon and other immunomodulators are prescribed.
7. In the case of the development of a secondary bacterial infection, in the presence of a pronounced inflammatory process, antibiotics are used.
8. To restore the intestinal microflora, probiotics are simultaneously prescribed (Normobakt, Linex, Bifiform).
9. To protect the internal organs and improve their work, drugs with a hepatoprotective effect ("Karsil") and choleretic drugs are prescribed.

It is permissible to treat mononucleosis only under the guidance of a qualified doctor; self-medication can provoke serious consequences for the life and health of the child.

ethnoscience

Alternative methods of treating mononucleosis in a child can give good results, but only as an addition to the main course. Their use must be agreed with the attending physician. As part of complex therapy, the use of herbal infusions accelerates recovery and strengthens the body's defenses. It is recommended to take decoctions of the following plants:

• calendula flowers;
• yarrow;
• coltsfoot leaves;
• chamomile flowers;
• series;
• elecampane;
• echinacea purpurea.

The effect is based on the antibacterial, immunostimulating and restorative properties of these herbs. You can brew them both individually and in various combinations. An important requirement is the absence of an allergic reaction to the components of the herbal collection.

How long does the treatment last

The duration of the course of therapy depends on the characteristics of the course of the disease, the state of the immune system. On average, the treatment of infectious mononucleosis in a child lasts 2-3 weeks, until the end of the acute phase. During this period, you must:

• observe bed rest;
• limit as far as possible contact with healthy people;
• drink more fluids, stick to the prescribed diet;
• strictly follow the recommendations and prescriptions of the attending physician.

In severe cases of the disease, it may take more time to stop the main symptoms.

Acute mononucleosis is curable, but the complete recovery of the child's body after an illness takes from several months to a year. During this period, it is necessary to carefully monitor the condition of the child, adhere to the prescribed diet, and pay attention to strengthening the immune system.

Diet for mononucleosis in children

In the fight against infection, the observance of a certain diet plays an important role. The Epstein-Barr virus infects the spleen, liver and other organs, making it difficult for them to function. This explains the need for a diet for mononucleosis - both in the acute phase of the disease and during the rehabilitation period.

The diet of the patient should be complete, but at the same time sparing, not loading the liver with additional work. You must adhere to the following rules:

1. Nutrition should be "fractional" - 4-6 times a day, in small portions.
2. The patient needs to drink more fluids, this reduces the intoxication of the body.
3. To minimize the consumption of fats - their splitting creates an additional burden on the liver. Preference should be given to vegetable oils (olive, sunflower), and the use of butter should be limited. A little sour cream, mild cheese is allowed. Egg yolk - 1-2 times a week.
4. The menu must contain fermented milk and dairy products, vegetables and fruits, lean meats and fish. Soups, cereals and non-rich wheat bread are useful. Berries and fruits are allowed not sour.
5. Confectionery, fatty, fried, smoked foods, pickled foods should be categorically excluded. Spicy seasonings, canned food, fatty meat and poultry (including broths), mushrooms, cocoa and coffee are banned.

Compliance with these recommendations will speed up recovery and help the body recover faster after an illness. It is necessary to adhere to a diet during the treatment of infectious mononucleosis and during the rehabilitation period, since the restoration of normal liver function can take up to six months.

If infectious mononucleosis is diagnosed, it is possible to cure the baby. The virus in the body will remain even after the completion of therapy, but usually the medical prognosis for this disease is positive. With adequate treatment and compliance with all recommendations, the child's health will be restored in full, and he will be able to lead a normal life without restrictions.

Andrey Duiko - treatment, symptoms and prevention of mononucleosis

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