Infectious mononucleosis

Description:

The infectious mononucleosis is an antroponozny infection with characteristic symptoms and changes of a gemogramma. The disease is for the first time described by N. F. Filatov in 1885.

Reasons of the Infectious mononucleosis:

In 1938 it was proved that the activator of an infectious mononucleosis is the virus which filtrirutsya as a herpes virus. In 1964 the virus was in details described by Epstein and Barre. Children have this pathology preferential, boys, and persons of young age are more often. The disease is transmitted in the airborne and peroral way from the sick person. In the lymphatic ways the virus gets into regional lymph nodes, being the reason a hyperplasia a thymus gland - independent sites. There is an intensive proliferation in a cortical layer of T-cells.

Symptoms of the Infectious mononucleosis:

The beginning of a disease usually acute, but antecedent signs, such as weakness, muscle pain, faints are sometimes noted. Temperature increases suddenly and reaches level 39-39,5C in 1-2 days. But sometimes in the first 8-10 days temperature keeps on subfebrile figures and only later this time increases to the specified febrile figures.
In some cases temperature keeps at the level of 38-39C up to 2 weeks, and further on subfebrile figures up to 1-2 months. Against the background of temperature increase quinsy and hypostasis of lymph nodes develops. However often all three symptoms arise at the same time.
Constant and main symptom of a disease – a system hyperadenosis. The most typical is the hyperadenosis, located on the rear edge of a clavisternomastoid muscle (in 95% of cases), but at the same time also front cervical, submaxillary, inguinal and femoral lymph nodes increase. Their size makes from 1 to 3 cm in the diameter, they dense, mobile, not soldered among themselves, moderately painful at a palpation.  There are cases when lymph nodes do not increase, however are painful that confirms their participation in pathological process. Very seldom there is an increase in lymph nodes of a mediastinum and an abdominal cavity. Cases at which clinical picture imitated an acute appendicitis are described.
The major symptom is quinsy. Quinsy forms the most various: from catarral and follicular to ulcer and necrotic and ulcer and diphtheritic. Sometimes quinsy is followed by a considerable hyperemia mucous a pharynx  and a nasopharynx. In some cases quinsy can precede for 10-12 days to characteristic changes in peripheral blood. Petekhialny hemorrhagic rash on the lower extremities or nasal bleedings is very seldom observed.
From internals in 80-90% increase in a spleen 2-3 cm lower than a costal arch, to the touch it dense, painless is characteristic. The liver increases at 65-70% of patients – about 1-3 cm lower than a costal arch. Rather frequent symptom (20-30% of cases) is hepatitis with jaundice. Jaundice develops at the expense of direct bilirubin, the high level of transaminases, lactate dehydrogenases is noted. Sometimes the hepatargy which can lead to the death of the patient develops.
Besides, the infectious mononucleosis is followed by the adynamy phenomena. Practically at all patients the headache, a vision disorder, weakness, sometimes Bol in a stomach with nausea and vomiting is observed. In some cases there can be photophobia, eye pain, cough, sometimes – a skin erythema, thrombocytopenia, psychosis, paresis of cranial nerves, radiculoneurites.
Except an acute and subacute stage, the disease gets a chronic or recurrent form from some patients. However the forecast at an infectious mononucleosis favorable. The main symptoms of a disease are stopped in 1-3 weeks, but astenisation remains long enough.
The picture of peripheral blood differs in a lymphocytosis which reaches to 30-40•109, generally due to increase in lymphocytes (to 50-70%) and monocytes – from 10-12% at the beginning of a disease to 40-50% at the height of a disease.
At microscopic examination of a kernel in monocytes have spongy structure and more basphilic, than usually, cytoplasm. The phenomenon of a fragment of a kernel which is localized separately in cytoplasm is characteristic of monocytes at an infectious mononucleosis and is a consequence of destructive influence of a virus which gets into a cell. Besides, atypical mononukleara which presence is a pathognomonic sign take place. The same cells are observed in smears from a pharynx and in cerebrospinal fluid.
Anemia is not characteristic of an infectious mononucleosis, however at the height of a disease hemoglobin and quantity of erythrocytes decreases, especially it concerns cases when the main process is complicated by autoimmune hemolitic anemia. Level of thrombocytes usually remains within norm, and only in some cases their quantity decreases. In punctate of marrow moderate increase in level of lymphocytes, monocytes, plasmocytes of which 10% make atypical mononukleara is found.

Diagnosis:

Diagnosis of an infectious mononucleosis is based on a research of peripheral blood and identification in it the increased quantity of mononuklear in combination with a lymphocytosis. For verification of the diagnosis the serological test of Paul-Bunnel is carried out. This reaction is based that in blood of the person at an infectious mononucleosis the level of hemagglutinins to erythrocytes of a ram, a Guinea pig and a rabbit increases. Positive reaction the caption, not lower than 1:64 is considered. The highest antiserum capacity is observed for the 6-7th day of a disease, and keeps till 21-24th day. The antiserum capacity decreases, since 6th week of reconvalescence, and has ability to raise after any adenoviral infection. During an infectious mononucleosis concentration in blood serum of immunoglobulins – Ig M (increases by 100-300%), Ig A (for 100-200%), Ig G (for 50-70%). This reaction is not specific and can be positive at a viral hepatitis, acute leukemia, chronic lympho-and myeloleukemias, rheumatism, tuberculosis, syphilis, leptospirosis and other cases, but in smaller credits.
At an immunological research in the first week of a disease the disproportion in the ratio by T - and  V-lymphocytes is observed. The quantity of V-lymphocytes increases in the first week of a disease and decreases on 3-4 week. Level of T lymphocytes increases for 10-14 day of a disease, and is normalized by 5-6 week. At the height of a disease at patients with an infectious mononucleosis the insignificant albuminuria, an urobilinuria, a small amount of erythrocytes in urine can be observed.

Treatment of the Infectious mononucleosis:

Treatment of an infectious mononucleosis which was applied earlier (febrifugal drugs, vitamins of group B and vitamin C, in hard cases – antibiotics), has rather traditional character now.
At the present stage the most effective is use of recombinant interferon alfa-26 (it лаферон, intron-A, roferon-A, реальдирон, еберон, etc.) on 3 million ME daily subcutaneously within 15 days. Besides, patients need to be isolated for the term of 10-15 days, in especially hard cases the bed rest is appointed. Sports activities, exercise stresses are contraindicated.