Infectious mononucleosis: symptoms and treatment, photo

What is it - mononucleosis is an infectious viral disease that occurs with the involvement of tonsils, the liver, several groups of lymph nodes and the spleen;undergoes specific changes and the cellular composition of the blood.

The clinical picture is often so similar to a sore throat that one can not do without specific tests.

Surprising mainly children, the virus can remain in the body for the rest of human life. The association of this infection with slow infections and neoplastic processes( Burkitt's lymphoma, nasopharyngeal cancer) was also revealed.

Causes of infectious mononucleosis

The Epstein-Barra virus, which belongs to the herpesvirus group, has a common disease with the herpes simplex virus antigens. Has a special affinity for one of the two types of human lymphocytes( immune cells) in which they can remain for life.

The only source of infection is a person who can be both a patient and a carrier of the virus. This virus stands out with the saliva of an already recovered person for another 12-18 months. At the same time, the isolation of viruses can occur more actively if the carrier carries another viral or bacterial disease that is accompanied by inhibition of immunity, as well as chemotherapy or radiotherapy.

In order for the disease to develop, the virus must get on the mucous membrane of the nasopharynx or directly into the blood of a healthy person.

There are possible ways of transmission of the virus in children and adults:

1. 1) Drip: when talking at a distance, transmission of the virus is not so probable as when kissing, sneezing, coughing;
   
2. 2) Through household items, toothbrushes, dishes, toys;
   
3. 3) With transfusion of infected blood, transplanting organs from the virus carrier;
   
4. 4) Through the placenta;
   
5. 5) Sexual path - possible, but not proven.

The morbidity peaks occur at 2-10 and 20-30 years. Pathology develops in the form of family flashes, less often - small outbreaks in closed collectives.

Symptoms of infectious mononucleosis

In adults and children, the incubation period for mononucleosis is very long - 20-60 days.

During this time the virus from the nasopharynx, the gastrointestinal tract, the genital tract enters the bloodstream and is introduced into the lymphocytes, which become involuntary lifelong vectors of the virus.

Further prodromal symptoms of infectious mononucleosis develop:

• weakness;
  
• muscle and headache;
  
• nausea;
  
• chills;
  
• decreased appetite.

After a few days - 2 weeks, there are three main symptoms that are considered classic for infectious mononucleosis:

1. 1) Increase in temperature: often( in 85-90% of cases) to high figures, rarely the temperature remains within 38 ° C.Fever with this disease is not accompanied by a strong chill or sweat. There is hyperthermia from several days to months, does not affect the severity of other symptoms.
   
2. 2) Enlarged lymph nodes. The lymph nodes of the cervical group usually suffer first, then the axillary or inguinal arches increase( depending on the way the virus penetrated).In the process involved and nodes that collect lymph, coming from the internal organs - located in the mesentery of the intestine and near the bronchi.

Lymph nodes:

• the size of a pea to a walnut;
  
• moderately painful;
  
• freely move relative to the underlying tissues;
  
• the skin above them has a normal temperature and color;
  
• at an inflammation of sites of a peritoneum the person will feel a pain in a stomach( more often on the right below), at involving peribronhialnyh lymphonoduses - a cough, difficulty of breath.

Sore throat due to inflammatory changes in it:

• enlarged tonsils;
  
• whitish or dirty-gray coating on the tonsils, which is easily removed;
  
• the posterior pharynx wall is reddened, edematous.

In addition to the above triad of mononucleosis symptoms,

1. 1) The enlargement of the liver and spleen is maximal by the 5th-10th day of the disease. It can be accompanied by a slight icteric sclera, sometimes - and skin. This symptom is dangerous in terms of the possible rupture of these organs( especially the spleen) with the slightest trauma, which determines the appointment of strict bed rest for these patients. The liver and spleen begin to decrease from 3-4 days after the temperature has returned to normal.
   
2. 2) The rash on the skin in the form of spots, small hemorrhages, may be similar to a rash in scarlet fever. In the soft sky, too, the elements of the rash may appear. This symptom can develop and disappear in any period of the disease.
   
3. 3) In a general blood test, cells - atypical mononuclears, which are more than 10%, are detected.

The disease usually lasts at least 2 weeks. At 3-4 weeks, complications of this disease can develop, and recovery may begin. In rare cases, the process is delayed by 2-3 months or more.

Diagnosis of infectious mononucleosis

Mononucleosis can be suspected not only in the clinical picture, but after receiving results of a general blood test in which more than 10% of atypical mononuclear cells are detected.

To confirm the diagnosis, the following methods are used:

1. 1) Serological test of blood for antibodies to the Epstein-Barr virus: mononucleosis shows an increased titer of class M immunoglobulins to it, whereas detection of only anti-EBV IgG is indicative of the disease, not acuteprocess;
   
2. 2) In the serological laboratory, a determination is made in the blood of antigens( membrane and capsid) of the Epstein-Barr virus;
   
3. 3) PCR-examination of blood and buccal( from the side of the mucous membrane of the cheeks) scraping. If it is a mononucleosis, then the virus DNA will be found in the scrapes and in the blood.

Ultrasound of the abdominal cavity, chest X-ray, biochemical blood tests are performed to clarify the severity of the course of the disease.

Treatment of mononucleosis

Infectious mononucleosis with uncomplicated course is treated at home. The patient is assigned a diet number 5 with the exception of animal fats, fried, smoked, spicy and pickled products.

1. 1) If there are no complications of infectious mononucleosis, then non-specific antiviral therapy( "Groprinosine", "Arbidol"), homoeopathic treatment( "Lymphomyosot-Heel") is prescribed. With the development of complications from the nervous system, Valtrex and Acyclovir are prescribed.
   
2. 2) Antipyretics( "Nurofen", "Efferalgan", "Nimesil") - at a temperature above 38.5 ° C.Children are categorically prohibited from giving "Aspirin" or "Acetylsalicylic acid".
   
3. 3) In severe cases, glucocorticoid hormones( "Dexazon", "Prednisolone") are prescribed in combination with antibiotics( except ampicillin).
   
4. 4) According to the indications, "Human immunoglobulin against the Epstein-Barr virus" is used.
   
5. 5) It is also important to use antihistamines: Zodak, Erius, Loratadin.
   
6. 6) The throat is rinsed with chamomile broths, an aqueous solution of furacillin. Antiseptics such as "Tantum Verde" and "Hexa Spray" are used.

Prevention of mononucleosis

Vaccines against mononucleosis are still under development. It is planned to use them in those regions where malignant forms of the disease are often detected, as well as in youth groups( students, military personnel).

As a nonspecific prevention it is important to follow the rules of personal hygiene, acquiring the habit of not communicating without a mask with a febrile patient. Also, prevention consists in a thorough examination of donors for the carriage of the virus.

Because the virus is not highly contagious, special isolation, disinfecting treatment and prescribing of preventive drugs to contact persons is not provided.

Complications of infectious mononucleosis

From the nervous system:

• meningitis, which, most often, under the condition of treatment with "Acyclovir" and immunoglobulin, has a favorable prognosis;
  
• encephalitis is the inflammation of a brain substance that has the greatest danger to human life;
  
• spinal cord injury;
  
• inflammation of the cranial and peripheral nerves;
  
• mental disorders: hallucinations, depression or arousal;
  
• Guillain-Barre syndrome;
  
• Bell's paralysis.

On the part of the blood:

• decreased platelet count;
  
• decrease in the number of leukocytes;
  
• autoimmune anemia.

In addition, it is also possible:

1. 1) Hemorrhage in the retina.
   
2. 2) Spleen rupture( may be not spontaneous after injury, but spontaneous).
   
3. 3) Hepatitis.
   
4. 4) Respiratory failure due to sharp edema of the tonsils or pharyngeal mucosa, an increase in paratracheal lymph nodes.
   
5. 5) Inflammation of the kidneys - nephritis.
   
6. 6) Lesion of glandular tissue: parotitis, testicular inflammation, pancreatitis, inflammation of the thyroid gland.
   
7. 7) Due to the fact that the virus strongly suppresses immunity, it is easy to attach an infection, causing secondary purulent complications.

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