Infectious mononucleosis - treatment. What is infectious mononucleosis Treatment and prevention of infectious mononucleosis

Infectious mononucleosis, aka Filatov's disease, glandular fever, monocytic tonsillitis, Pfeifer's disease. It is an acute form of Ebstein-Barr viral infection (EBVI or EBV - Epstein-Barr virus), characterized by fever, generalized lymphadenopathy, tonsillitis, hepatosplenomegaly (enlarged liver and spleen), as well as specific changes in the hemogram.

Infectious mononucleosis was first discovered in 1885 by N.F. Filatov, he noticed a febrile illness, accompanied by an increase in the majority of lymph nodes. 1909-1929 - Burns, Tydee, Schwartz and others described changes in the hemogram in this disease. 1964 - Epstein and Barr isolated one of the pathogens of the herpesvirus family from lymphoma cells, the same virus was isolated in infectious mononucleosis.

Epstein-Barr virus

As a result, we came to the conclusion that this virus (Epstein-Barr virus), depending on the form of the course, gives various diseases:

Acute or chronic mononucleosis
- malignant tumors (Brecita lymphoma, nasopharyngeal carcinoma, lymphogranulomatosis),
- launching autoimmune diseases (considering the involvement of the virus in lupus erythematosus and sarcoidosis),
- CFS (chronic fatigue syndrome).

Epstein-Barr virus

Epstein-Barr virus is a DNA-containing virus, the capsule of which is surrounded by a lipid membrane. It belongs to the Y-herpesvirus group (human herpesvirus type 4) and has antigenic components in common with other viruses from the herpesviridae family. EBV has a tropism (selective damage) to B-lymphacytes, this is the peculiarity of the pathogen, because it multiplies in the cells of the immune system, forcing these cells to clone their own viral DNA, which subsequently leads to secondary immunodeficiency! Also, EBV tropism is to some tissues - to lymphoid and reticular, this explains generalized lymphadenitis and hepatosplenomegaly (enlarged liver and tears). It is possible that the structural features and the presence of tropism for the cells of the immune system cause long-term persistence and create the risk of malignancy of the infected cells.

In the external environment, it is not particularly stable, sensitive to high temperatures (over 60⁰C) and disinfectants, but retains when frozen.

The prevalence is ubiquitous. An increase in the incidence is observed more often in the spring and autumn seasons. The frequency of epidemic rises is recorded every 7 years.

Causes of infection with infectious mononucleosis

Age features of infection: children 1-5 years old are more often sick. Up to a year they do not get sick due to the presence of passive immunity, which is created due to immunoglobulins passed from the mother transplacentally (through the placenta during pregnancy). Adults do not get sick, because 80-100% are already immunized, that is, they either got sick in childhood, or are sick in an erased clinical form.

The source of infection is sick people with various clinical symptoms (even with erased ones), the isolation of the pathogen can last up to 18 months.

Transmission ways:

Airborne (due to the instability of the pathogen, this pathway takes place in close contact),
- contact and household (contamination of household items with the patient's saliva),
- parenteral (blood transfusion, transplant - with organ transplant),
- transplacental (intrauterine infection, from mother to child)

Symptoms of infectious mononucleosis

The period of infection and symptoms can be divided into several periods:

1. Introduction of the pathogen \u003d the incubation period (from the moment of introduction to the first clinical manifestations), lasts 4-7 weeks. During this period, the virus penetrates through the mucous membranes (oropharynx, salivary glands, cervix, gastrointestinal tract). After that, the virus begins to contact with B-lymphocytes, infecting them, replacing their genetic information with its own, this causes further disorganization of the infected cells - in addition to foreign DNA, they also receive "cellular immortality" - almost uncontrolled division, and this is very bad, because they no longer perform a protective function, but are simply carriers of the virus.

2. Lymphogenous drift of the virus into regional lymph nodes, manifested by an increase in some groups of lymph nodes (for 2-4 days and lasts up to 3-6 weeks), near which there was a primary infection (airborne infection - cervical / submandibular and occipital lymph nodes, genital - inguinal ). The lymph nodes are enlarged 1-5 cm in diameter, painless, not welded together, arranged in a chain - this is especially noticeable when turning the head. Lymphadenitis is accompanied by intoxication and fever up to 39-40⁰C (appears simultaneously with an increase in lymph nodes and lasts up to 2-3 weeks).

3. The spread of the virus through the lymphatic and blood vessels will be accompanied by generalized lymphadenopathy and hepatosplenomegaly - appearance on the 3-5th day. This is due to the spread of infected cells, their death, and as a consequence, the release of the virus from the dead cells, followed by infection of new ones, and also further infection of organs and tissues. The defeat of the lymph nodes, as well as the liver and spleen, is associated with the affinity of the virus to these tissues. As a consequence of this, other symptoms may also join:

• yellowness of the skin and sclera,
• rashes of a different nature (polymorphic exanthema),
• darkening of urine and clarification of feces.

4. Immune response: interferons and macrophages act as the first lines of defense. Then, to help them, T-lymphocytes are activated - they lyse (absorb and digest) infected B-lymphocytes, including where they settle in the tissues, and the viruses released from these cells form CEC (circulating immune complexes) with antibodies , which are very aggressive for tissues - this explains the participation in the formation of autoimmune reactions and the risk of lupus, diabetes mellitus, etc., the formation of a secondary IDS (immunodeficiency state) - due to damage to B-lymphocytes, since they are the ancestors of IgG and M, as a consequence of this infection, there is no synthesis of them, as well as due to the depletion of T-lymphocytes and their increased apoptosis (programmed death).

5. The development of bacterial complications is formed against the background of IDS, due to the activation of our bacterial microflora or the addition of a foreign one. As a result, angina, tonsillitis, adenoiditis develop. These symptoms develop by the 7th day from the onset of the onset of intoxication.

6. The stage of convalescence or, in the case of severe IDS, chronic mononucleosis. After recovery, stable immunity is formed, and in the event of a chronic course, multiple bacterial complications with concomitant asthenovegetative and catarrhal syndrome.

Diagnosis of infectious mononucleosis

1. Virological (isolation of the pathogen from saliva, oropharyngeal smears, blood and cerebrospinal fluid), the results come in 2-3 weeks
2. Genetic - PCR (polymerase chain reaction) - detection of virus DNA
3. Serological: heterohemagglutination reaction (not used, because it is low-specific and uninformative) and ELISA (enzyme-linked immunosorbent assay) - the most used, because it allows you to determine specific IgG and M specifically to the Epstein-Barr virus, even with a small amount, which allows you to determine the stage of the disease (acute or chronic)
4. Immunological examination (immunogram):

• T-lymphocytes (CD8, CD16, IgG / M / A) and CEC - this indicates an immune response and good compensation;
• CD3, CD4 / CD8

5. The method of concentration of leukocytes allows you to determine the presence of atypical mononuclear cells and heterophilic antibodies, which are secreted by mononuclear cells. The detection of these atypical cells can be registered even during the incubation period.
6. Biochemical methods: will indicate decompensation from organs and systems:  direct bilirubin, ALT and AST, thymol test, transaminases and alkaline phosphatase.
7. Hematological examination (UAC): Lts, Lf, M, ESR, Nf with a shift of the formula to the left.

Treatment of infectious mononucleosis

1. Etiotropic treatment (against the pathogen): isoprinosine, arbidol, valciclovir, acyclovir

2. Patonenetic (blocks the mechanism of action of the pathogen): immunomodulators (interferon, viferon, thymolin, thymogen, IRS-19, etc.) and immunostimulants (cycloferon) - but the appointment is under the control of an immunogram, because with this disease there is a very high risk of developing autoimmune diseases that may be compromised by these drugs,

3. Antibiotic therapy with the addition of a secondary bacterial microflora, broad-spectrum antibiotics from the cephalosporin group are often prescribed until the sensitivity of the pathogen to the antibiotic is detected, and then a narrower focus.

4. Symptomatic therapy: antipyretic, local antiseptic, etc., that is, depending on the dominant symptomatology.

Rehabilitation

Dispensary observation for 6 months or more with the participation of a pediatrician, infectious disease specialist, specialists in narrow fields (ENT, cardiologist, immunologist, hematologist, oncologist), with the use of additional clinical and laboratory studies (see the section on diagnostics + EEG, ECG, MRI, etc.) e). Also, release from physical education, protection from emotional stress - compliance with the security regime for about 6-7 months. You should always be on the alert, as any compromise can trigger autoimmune reactions.

Complications of infectious mononucleosis

1. Hematological: autoimmune hemolytic anemia, thrombocytopenia, granulocytopenia; possible rupture of the spleen.
2. Neurological: encephalitis, cranial nerve palsy, meningoencephalitis, polyneuritis. Gastrointestinal tract: development of type 1 diabetes mellitus, liver damage.
3. Respiratory organs: pneumonia, airway obstruction.
4. Heart and blood vessels: systemic vasculitis, pericarditis and myocarditis.

Prevention of infectious mononucleosis

Compliance with hygiene. Isolation of the patient for 3-4 weeks, taking into account clinical and laboratory data. Also the use of diagnostic measures before and during pregnancy. No specific prophylaxis has been developed.

Physician therapist Shabanova I.E.

Definition of mononucleosis

Infectious mononucleosis (mononitary or glandular fever) - a disease caused by the filtering Epstein-Barr virus (human B-lymphotropic virus), which belongs to the herpes virus group. It can be present in human cells for a long time in the form of a latent infection.

Children are most often affected, with outbreaks occurring all year round, but the highest incidence is achieved in the fall months. They get sick with mononucleosis once, after which lifelong persistent immunity is developed.

Causes of mononucleosis

The disease is transmitted from a sick person in an acute period, and with erased forms of the disease, the virus carrier is also the source. Usually, infection occurs through close contacts, when the virus spreads by airborne droplets, with kissing, transmission is possible through blood transfusions, while traveling in public transport, when using other people's hygiene products.

Mononucleosis affects children with weak immunity, after suffering stress, with severe mental and physical stress. After the initial infection, the virus is released into the external space for 18 months. The incubation period is 5 to 20 days. Half of the adult population carries the infectious disease during adolescence.

In girls, infectious mononucleosis occurs at the age of 14-16, and boys are exposed to the disease at 16-18. Rarely, the disease affects people over 40 years old, since antibodies to the virus are present in the blood of adults. What is the reason for the rapid development of infection in an infected body? During the acute phase of the disease, some of the affected cells die, being released, the virus infects new, healthy cells.

When cellular and humoral immunities are disturbed, superinfection develops and a secondary infection builds up. It has been noted that the Epstein-Barr virus is capable of infecting lymphoid and reticular tissues, resulting in the appearance of generalized lymphadenopathy, enlargement of the liver and spleen.

Mononucleosis symptoms

Mononucleosis is characterized by lesions of the pharynx (tonsillitis) and lymph nodes, enlarged tonsils, severe sore throat, enlarged liver and spleen, changes in blood composition, sometimes it can take a chronic course. From the first days, slight malaise, weakness, headaches and muscle pains, painful sensations in the joints, a slight increase in temperature and mild changes in the lymph nodes and pharynx appear.

Later, there is pain when swallowing. The body temperature rises to 38-40 ° C, it can have a wavy character, such temperature drops persist during the day and can last 1-3 weeks. manifests itself immediately or after several days, it is catarrhal with mild swelling of the tonsils, lacunar with a more severe manifestation of inflammation in both tonsils or ulcerative necrotic with a fibrinous film as in.

Sharp difficulty breathing and profuse mucous discharge, slight nasal congestion, perspiration and mucous discharge on the back of the throat indicate the development of nasopharyngitis. In patients from the nasopharynx, a spear-shaped plaque can hang down, there are massive loose, curdled white-yellow overlays on the tonsils.

The disease is accompanied by damage to the angular jaw and posterior cervical lymph nodes, most clearly they swell in the cervical group, along the posterior edge of the sternocleidomastoid muscle in the form of a chain or packet. The diameter of the nodes can be up to 2 - 3 cm. Less often, the axillary, inguinal, and cubital lymph nodes increase.

The infection affects the lymph flow of the intestinal mesentery, causes inflammation, provokes pathological rashes on the skin in the form of spots, papules, age spots. The appearance of the rash is from 3 to 5 days after three days, it disappears without a trace. There is usually no recurrence of rashes.

There is no uniform systematization of the clinical forms of infectious mononucleosis; there can be not only typical (with symptoms), but also atypical (without symptoms) forms of the disease. Histological examination confirms the involvement of several important organs in the process. Inflammation of the interstitial tissue of the lung (interstitial pneumonia), a decrease in the number of cellular elements of the bone marrow (hypoplasia), inflammation of the choroid (uveitis) develop.

The clinical manifestations of the disease are poor sleep, nausea, abdominal pain, sometimes. Mononucleosis is characterized by the appearance of intraperitoneal tumors, and it is also associated with the occurrence of lymphatic lymphomas in patients with reduced immunity.

Diagnosis of mononucleosis

Infectious mononucleosis is quite widespread, its mild forms are difficult to diagnose. The peculiarity of this virus is that it prefers to infect the lymphoid tissue, which is in the tonsils, lymph nodes, spleen and liver, therefore, these organs are most affected.

During the initial examination, the doctor determines the main symptoms of the disease based on complaints. If you suspect mononucleosis, a blood test (monospot test) is prescribed, which excludes other diseases that can cause similar symptoms. The accuracy of the diagnosis is possible only with the collection of clinical and laboratory data.

In the blood formula, an increase in lymphocytes and the presence of atypical mononuclear cells in the blood are usually found. Serological studies can identify heterophilic antibodies to the erythrocytes of various animals.

The virus is found in saliva:

• after the incubation period of the infection;
• during its development;
• 6 months after recovery;

Epstein-Barr viruses in a latent form persist in B-lymphocytes and in the mucous tissue of the oropharyngeal membrane. Virus isolation is observed in 10-20% of patients who have suffered infectious mononucleosis in the past. In modern laboratories, laboratory diagnosis of the disease is performed on modern equipment using disposable sterile instruments when sampling biomaterial.

A positive result clarifies the presence of infection in the body, the transition of the disease into a chronic form, as well as the period of activation of the infectious process. Negative results mean no infection early in the course of the disease. Blood tests should be done every three days to track the progress of infection.

Consequences of mononucleosis

Complications of infectious mononucleosis are very rare, but if they do, they can be very dangerous. Hematologic complications include increased erythrocyte destruction (autoimmune hemolytic), decreased peripheral platelet count (thrombocytopenia), and decreased granulocyte count (granulocytopenia).

Patients with mononucleosis may experience rupture of the spleen, obstruction of the airways, which sometimes leads to death. There is a danger from a variety of neurological complications - from encephalitis, cranial nerve paralysis, damage to the facial nerve and, as a result, paralysis of the facial muscles. Meningoencephalitis, Guillain-Barré syndrome, multiple nerve lesions (polyneuritis), transverse myelitis, psychosis, cardiac complications, interstitial pneumonia are also among the complications of mononucleosis.

After an illness, children usually get tired for about six months, they need to sleep more, including in the daytime. Such students should be less burdened with classes at school.

Mononucleosis treatment and mononucleosis prevention

In the treatment of mononucleosis, symptomatic therapy is used. During the period of fever, antipyretic agents and drinking plenty of fluids are used. With the help of vasoconstrictor drugs, such as ephedrine, galazolin, etc., relieve the difficulty of nasal breathing.

They use desensitizing drugs that prevent or weaken allergic reactions, interferon, various immunostimulants or other effective antiviral drugs that are in the arsenal of doctors. Patients are prescribed rinsing the throat with warm furacilin solutions, soda solution and salt water.

Ibuprofen, acetaminophen are recommended to relieve headaches and reduce fever. To eliminate pain, reduce swelling of the tonsils, throat and spleen, it is advisable to take corticosteroids, always under constant supervision of the attending physician. Special preventive measures for mononucleosis are the same as for ARVI. An important role is played by increasing immunity and mobilizing the internal forces of the human body.

It is believed that for the treatment of mild and moderate forms of the disease, the patient's stay at rest, that is, bed rest, moderate nutrition. It is necessary to select dietary foods so as not to overload the affected liver. Meals should be fractional (4-5 times a day) with a full content of proteins, vegetable fats, carbohydrates, vitamins.

Therefore, preference is given to dairy products, lean fish and meat, fruits, sweet berries, vegetables and soups from them. You can eat porridge, coarse bread. The child is prohibited from butter, fried, smoked, pickled foods, canned food, pickles, hot seasonings. Walking in the fresh air, a calm, joyful atmosphere in the house, and a good mood will be beneficial.

Regular consultations of a hepatologist will not interfere with the child, it is imperative to be exempt from preventive vaccinations. Hypothermia and overheating are contraindicated, physical activity, sports, it is useful to engage in physiotherapy exercises.

Mononucleosis refers to those diseases that are extremely rare in the practice of modern doctors. However, it should be noted that this is a very dangerous ailment. Especially when it comes to children. In addition, in most cases, the disease appears suddenly. So, we propose to find out what is hidden behind the diagnosis "mononucleosis", what kind of ailment it is and how to protect a child from illness.

Characteristic

According to statistics, mononucleosis in adults is extremely rare. Almost 90% of the population is immune to the Epstein-Barr virus, since this infection was carried during adolescence. The presence of antibodies in the blood indicates that they had to have had the disease at least once. Most often, the virus occurs in adolescents and children. Girls are most susceptible to this disease at the age of 14-16, and boys - at the age of 16-18.

What kind of disease is mononucleosis? This is an acute infectious disease caused by the Epstein-Barr virus. It is quite stable in the external environment. The virus causes a primary specific infection. For every 10 people who become infected with it, about 9 have a chronic form. It is not accompanied by acute episodes.

Thus, these people are lifelong carriers of the virus. They will never survive the acute form of the disease. At the same time, without getting sick, carriers secrete the virus with saliva. That is why it is often the question: "Mononucleosis - what is it?", You can hear the answer: "Kissing disease."

This ailment has many names. For example: Filatov's disease, monocytic angina, Pfeifer's disease, glandular fever, recruits' disease, Epstein-Barr virus infection, EBV infection, and kissing disease.

Description

Due to the low prevalence of the disease, few people know what kind of disease is mononucleosis. As noted above, this is an acute illness of a viral nature.

It manifests itself as a significant increase in temperature, damage to the lymph nodes and palatine tonsils. In addition, the disease leads to enlargement of the spleen and liver. The causative agent of the disease belongs to type 4 herpes viruses.

Its feature is the selective damage to the cells of the immune system. B-lymphocytes are affected by the virus. This leads to changes in those organs in which they are present - the spleen, lymph nodes, liver.

After mononucleosis, a person develops strong immunity. Repeatedly do not get sick.

Causes of pathology

The main source of the disease is people whose blood contains the Epstein-Barr virus. An infected person releases it into the external environment. Moreover, the virus is spread not only by patients with an open form. The erased form of mononucleosis is also dangerous. Studies have shown that for 18 months after infection, the virus is released into the environment. This happens even when there are no clinical manifestations.

The main route of distribution is airborne. However, this is not always the case. The virus can penetrate into the oropharynx of a healthy person and by household contact, for example, with a kiss. This happens much more often than when sneezing. In addition, the virus can enter the body through blood transfusions. It should be remembered (if we are talking about mononucleosis) that this is an infectious disease.

As soon as the virus enters the oral mucosa (the most favorable conditions for it), it enters the lymphocytes. This is where it reproduces. Throughout the body, the infection spreads by the hematogenous route, infecting it along the way and provoking the signs that characterize mononucleosis. Patient's symptoms indicate infection.

Characteristic signs

The incubation period of the disease is 4 to 6 weeks. In most cases, acute infectious mononucleosis begins. Symptoms characterizing the disease appear almost immediately.

The main signs of the disease are:

1. Headache.
2. Enlargement of the spleen and liver.
3. Inflammation of the lymph nodes.
4. Mononuclear angina (films of a dirty gray color appear on the tonsils, they can be easily removed with tweezers).
5. Swollen lymph nodes (palpation is painful enough, they can reach the size of an egg).
6. Joint and muscle pain.
7. Weakness.
8. Fever.
9. Herpes lesions may occur on the skin.
10. Loss of appetite.
11. Bleeding gums.
12. A sore throat.
13. Runny nose.
14. Nausea.
15. Nasal congestion.
16. Increased susceptibility to infections.

In this case, the main symptoms characterizing mononucleosis are severe fatigue, high fever, swelling of the lymph nodes and sore throat.

The ailment begins with general malaise, the duration of which varies from several days to a week. After that, there is an increase in temperature, a sore throat occurs, and lymph nodes increase. As noted above, it is these signs that are the symptoms that characterize infectious mononucleosis. The maximum body temperature sometimes reaches 39 degrees. The throat is quite inflamed, pus may appear on the back wall.

Forms of the disease

This disease is divided into two types:

1. Typical shape. This infectious mononucleosis in children is characterized by the symptoms described above.
2. Atypical form. With this form, some symptoms are absent. Sometimes there are manifestations uncharacteristic of the disease:

• An asymptomatic form can be diagnosed. In this case, the child is exclusively a carrier of the infection, which is detected only by laboratory methods.
• With an erased form, all signs of infection are poorly expressed. They disappear very quickly.
• The visceral form is characterized by damage and enlargement of internal organs.

Diagnosis of the disease

Preparations are considered quite effective:

• "Arbidol";
• "Imudon";
• Anaferon;
• "Metronidazole".

With purulent deposits on the tonsils, it is advisable to introduce agents for treating the throat into therapy. Anti-inflammatory solutions and spray are effective. The appointment may include drugs:

• Hexoral;
• Tantum Verde.

If the symptoms of nasal congestion have provoked mononucleosis in children, it is recommended to regularly rinse it with solutions based on seawater. Some of the most effective means are:

• Aqua Maris;
• Salin;
• "Marimer";
• "Aqualor".

In addition, the nasal cavities must be instilled for about eight days with special drops. Effective in this case means "Protargol". The child will also need vasoconstrictor drugs. It is advisable to use drugs:

• "Tizine";
• "Rinonorm".

In case of a severe course of the disease, the doctor may prescribe glucocorticoids "Dexamethasone" and "Prednisolone", as well as probiotics "Bifidumbacterin", "Acipol".

It is imperative to control the humidity in the patient's room. This simple recommendation will make it much easier for your baby to breathe through the nose and avoid dry throat. If you are using a humidifier, it is helpful to add essential oils (preferably pine and eucalyptus).

Provide your baby with plenty of warm drinks. This will protect him from the risk of dehydration.

It is very important to provide your baby with proper nutrition. In no case should you overload the spleen and liver. The diet should include light meals fortified with vitamins. Fatty, sweet, salty, smoked, spicy foods are strictly prohibited.

A child is constantly tired if he is diagnosed with mononucleosis. Treatment involves more than just drug therapy. In this state, sleep is useful for the child. It will provide the body with a quick recovery.

It is important to remember that with this diagnosis, the child should be protected from physical exertion. In no case should damage to the abdomen be allowed, since mononucleosis in adults and in children provokes a significant increase in the spleen. The organ even begins to protrude from under the ribs. Any trauma to this area can rupture the spleen.

How does Komarovsky advise treating mononucleosis? The famous doctor focuses on the following aspects:

• drinking plenty of fluids;
• fresh air;
• maintaining optimal humidity and temperature in the room.

Recovery period

Now you know what is meant by the diagnosis "mononucleosis", what kind of ailment it is. However, treatment does not end solely with symptom relief. The disease is very exhausting the body. High fever, painful, enlarged lymph nodes, a dangerous virus in the blood - all this takes away the strength of the patient. That is why the child's body needs long-term rehabilitation.

Thus, despite the fact that the child has recovered from an ailment such as mononucleosis, treatment in children must continue.

1. During the first month, the little patient does not feel very well, he can often complain of weakness, malaise. At this time, he especially needs rest and sleep.
2. Do not forget that for another six months the child is a carrier of the virus. Therefore, it is recommended to provide the baby with a separate dish. This will keep other family members from getting infected.
3. The doctor will recommend that you take control tests of urine and blood. It is very important to conduct such surveys. They will show the state of the child's body.
4. For recovery, the doctor will advise you to take a course of vitamin therapy. As a rule, a vitamin and mineral complex should be taken for a month. It can be: "Vitrum", "Multi-tabs", "Kinder Biovital".
5. Immunomodulatory drugs are prescribed. They allow you to strengthen the body and avoid unwanted complications.

Effective immunomodulatory drugs that a child needs for the rehabilitation period are:

1. Drops "Derinat". Provide restorative and strengthening functions of the nasal mucosa.
2. Candles "Viferon". It is an antiviral agent. It belongs to the category of interferons, has antiviral properties and restores immunity.
3. The drug "Imudon". It is an excellent immunomodulator, topical preparation. Designed for the prevention and treatment of oropharyngeal ailments.

Following these recommendations will allow you to restore the child's body much faster after a disease such as mononucleosis. Treatment should not be limited to just managing symptoms, but should continue throughout the rehabilitation period.

Children are exempt from various preventive vaccinations for a whole year. They need to limit physical activity. In addition, children who have had mononucleosis should be protected from sun exposure. In the coming summer, sunbathing should be extremely careful. Active sun is strictly contraindicated for such children.

A big plus is that with proper treatment and adherence to rehabilitation measures, the disease is completely cured.

Diet food

Because infectious mononucleosis in children affects vital organs such as the liver and spleen, the child needs sparing nutrition. The doctors appoint diet table number 5.

In this case, the dishes are cooked boiled or baked. It is advisable to take food 5-6 times a day.

1. Fruit and non-acidic berry juices. Tomato juice is useful. Jelly, compote are allowed. The diet includes weak tea, coffee with milk. It is recommended to use rosehip decoction.
2. Rye or wheat bread, only yesterday's baked goods. Uncooked cookies.
3. Whole milk, dry, condensed. A little sour cream, low-fat cottage cheese, mild cheese.
4. A variety of soups, exclusively on vegetable broth. Fruit and dairy products are useful.
5. Vegetable, butter - not more than 50 g per day is allowed.
6. Lean (low-fat) meats, boiled or baked.
7. Loose porridge. It is recommended to give preference to buckwheat and oatmeal.
8. Low-fat types of fish - pike perch, carp, cod, navaga, pike, silver hake. Exclusively in steam or boiled form.
9. Vegetables, herbs, especially tomatoes are useful. Non-sour sauerkraut is allowed.
10. The diet can include no more than one egg per day (in the form of an omelet).
11. Jam, honey. Sugar is allowed.
12. A variety of fruits and berries are useful. At the same time, acidic foods are unacceptable.

Diet food means eliminating the following food categories from the diet:

1. Fresh bread, baked goods. You should give up cakes, pancakes, fried pies.
2. Lard, cooking fats.
3. Soups based on meat, fish, mushroom broths.
4. Legumes, spinach, mushrooms, sorrel, green onions, radishes, radishes.
5. Fatty meat - pork, lamb, beef, duck, goose, chicken.
6. Hard boiled or fried eggs
7. Fatty fish - beluga, stellate sturgeon, sturgeon, catfish.
8. Canned food, pickled vegetables, caviar, smoked meats.
9. Sour berries and fruits, cranberries.
10. Pepper, horseradish, mustard.
11. Black coffee, cold drinks, cocoa.
12. Cream products, ice cream, chocolate.
13. Adults are advised to exclude alcoholic beverages.

Conclusion

Despite such unpleasant symptoms and a severe course of the disease, children who have suffered from infectious mononucleosis become owners of persistent immunity to it. Despite the fact that the virus persists forever in the body, it will never again subject a person who has suffered a disease to new torments, since there are almost no relapses of the disease.

The source of infection, a potential danger can be the patient himself, with a pronounced course of pathology, less often - a clinical carrier of a pathogenic virus.

The main ways of penetration of a viral infection into the body:

1. Oral cavity - with the saliva of the carrier of the virus, sputum and when coughing. This is the most common route for a pathogenic virus to enter the body.
2. In the case of using common household items: it can be common clothing and cutlery, as well as a towel and much more.
3. When carrying out blood transfusion: if using reusable, but not previously disinfected syringes.
4. At the time of intercourse, or through the placenta from the infected mother to the baby, or when the fetus passes the birth canal.

The risk group includes all members of the infected patient, the team where the outbreak of the pathogenic virus was recorded. The virus is transmitted as - by airborne droplets, and most often doctors talk about the equal susceptibility of the body to an acute or chronic form of mononucleosis. The only difference is that in the latter case, the disease proceeds in a latent, blurred form, and a reduced and weakened immunity contributes to the spread of infection.

Acute and chronic form of pathology

During the latent, latent period, the virus will not manifest itself as negative symptoms in any way, and therefore we are talking about a chronic form of the course. At the same time, during the course and development of the acute form of mononucleosis, the patient will show an increase of up to 38-40 degrees in body temperature and sore throat, a deterioration in the general condition, and in the chronic course of the disease, such symptoms are absent.

The chronic form of pathology most often occurs when the body's defenses are weakened, or if poor-quality treatment was carried out during the acute form, or the acute form proceeds for a sufficiently long period of time without the necessary treatment and attention. As doctors note, the patient gets better in the autumn / summer period: however, during the winter period, with a chronic lack of vitamins and ultraviolet radiation, the risk of exacerbation of the disease also increases.

Symptoms of the pathological process

The symptomatology of the negative process is directly determined by the current form of mononucleosis. The pathological process itself is divided into acute and chronic forms - then we will expand on what symptoms each of them shows.

In the acute form, the disease in its course is marked by the manifestation of vivid symptoms - after the penetration of a pathogenic virus into the body, first of all, symptoms from the throat and liver show themselves, symptoms of a malfunction of the spleen appear.

What happens to the body during illness:

1. At the very beginning, an attack of fever shows itself - this is the first sign of the course of a viral pathological process, accompanied by an increase in body temperature to 38-40 degrees, which can last up to one and a half to two weeks.
2. Intoxication of the body also shows itself - this is general weakness and rapid fatigue even with a slight load, attacks of chills and dizziness, headaches and lack of appetite.
3. Pathological processes also occur in the mouth and throat - inflammation of the pharynx and other manifestations of sore throat also develop. Such symptoms, together with fever, can occur at the very beginning of the infection process - it is difficult for the patient to swallow and there is redness of the mucous membrane, enlargement of the tonsils and the back of the pharynx.
4. The increase in size under the influence of the virus and lymph nodes also shows itself - the posterior lymph nodes become especially noticeable, which gradually increase in their size. But in this case, they will not merge with the surrounding healthy tissues and do not show themselves as painful.
5. Under the influence of the virus: the liver and spleen increase in size, while the latter is enlarged many times more, which provokes not only nausea, but also pain in the side, bouts of vomiting.

An equally characteristic sign of the course of the acute form of mononucleosis are:

1. 3-5 days after infection - nonspecific symptoms of pathology show themselves, manifested in the appearance of spots and papules on the body.
2. The rashes themselves are not localized in one place: they will appear throughout the body. At the very beginning, rashes appear on the face, then spread throughout the body, less often - they cover the palate of the oral cavity.

This symptomatology will not be accompanied by itching and burning, will go away without any treatment and will not leave scars or scars. The rash disappears from the body after 5-6 days.

Suffice it to note that in practice there is also a separate type of rash on the body - an ampicillin rash that appears on the body if it is treated with a course of amoxicillin or ampicillin. In particular, such antibiotics are used in the treatment of angina, and it is they that are capable of provoking the course of infectious mononucleosis.

The chronic form of the course of mononucleosis is marked during the pathological process by the appearance of the following symptoms:

1. The patient's temperature rises to 39-40 degrees and lasts for a fairly long period of time, up to 2 weeks.
2. Rapid fatigue, even with the slightest exertion, also shows itself, as does the patient's general weakness, plus painful lethargy and drowsiness, and headache attacks.
3. An increase in the size of the lymph nodes is manifested, while it is not necessary that the virus enters the body together.
4. The mucous membranes are also affected - they often form purulent or herpes rashes.

Clinically, mononucleosis also shows itself as a sleep disorder, as well as bouts of nausea, bouts of abdominal pain, less often - bouts of gastrointestinal disorders, diarrhea, and vomiting. If the virus infects a patient with a weakened immune system, for example, with AIDS, the development of intra-abdominal types of tumors may also show itself.

Treatment

When detecting the symptoms of the current mononucleosis, you should not practice self-diagnosis, relying on the symptoms, as well as self-medication, but immediately seek help from your doctor, or a local therapist or an infectious disease doctor.

If doctors, based on the results of the diagnostics, reveal a mild or moderate form of mononucleosis, the treatment of an adult can be successfully carried out at home. In this case, it is recommended to observe, first of all, bed rest, however, the course of treatment is determined exclusively by the doctor, depending on the severity of the symptoms of intoxication.

As doctors note, in order to prevent the development of complications, it is important, first of all, to observe a certain diet in accordance with No. 5. In this diet, the menu should be rich in fats and proteins, carbohydrates, and also vitamins without fail. It is also worthwhile to transfer the diet, built on the principle of fractional - it is best to eat 5-6 times a day, in small portions.

Fermented milk products and fish, preferably seafood, low-fat meats, vegetable soups and mashed potatoes, a large amount of fresh vegetables and fruits, preferably according to the season and those that are characteristic of a given region of growth, must be introduced into the diet. It is worth giving up butter, both butter and vegetable, fatty sour cream and cheeses, spicy dishes and smoking, pickles and marinades.

Mononucleosis in an adult involves the use of the following drugs in the course of drug treatment:

1. First of all, this is a course of admission - most often doctors prescribe Arbidol, Groprinosin,.
2. They also prescribe drugs that lower body temperature, thereby speeding up recovery and removing negative symptoms - Paracetamol, Ibuprofen, while aspirin is contraindicated as a drug when diagnosing this disease.
3. In some cases, for the purpose of stopping and preventing the development of complications, doctors may prescribe the patient to take glucocorticoids, for example, such a drug as Prednisolone and antibiotics, with an active ingredient of the ampicillin series.
4. In the fight against the Epstein-Barr virus, the use of Immunoglobulin is shown, and to eliminate negative puffiness, antihistamines are prescribed.
5. In the fight against local symptoms in the form of attacks of sore throat and dryness, they practice the use of mucosal treatment with antiseptic solutions. Most often, doctors prescribe a decoction of the color of chamomile pharmacy or Furacillin, Gevalex.

After recovery, for at least six months, the patient is under dispensary observation - depending on the severity of the course, he is observed by both a local therapist and other narrow-profile specialists. Throughout the entire course of treatment, it is worth minimizing all physical activity, and also excluding psycho-emotional stressful situations, if possible.

The course of treatment for mononucleosis also provides for the use of recipes and remedies from the arsenal of traditional medicine. As phytotherapists note, in order to accelerate recovery and to enhance the effectiveness of drug treatment, it is important to use funds from the arsenal of traditional medicine, and, above all, those aimed at strengthening the immune system.

In particular, echinacea tincture perfectly helps to strengthen the immune system and increase the protective functions of the body. An excellent natural remedy for enhancing the body's defenses is a decoction of calamus rhizome, as well as fresh ginger rhizome - they act as natural antiseptics and help relieve sore throat. No less effective plants in the fight against a weakened immune system and headache attacks are elderberry and dandelion broth.

In addition, you can take on arms and such a medicinal plant as astragalus - it has pronounced antiviral properties and is used in the course of alternative therapy. An infusion is prepared from it for treatment - a salt spoon of dried raw material is steamed in a glass of hot water and insisted in a thermos for 1-2 hours. The decoction is effective in treatment - just boil the plant in a water bath, let it brew for 15-20 minutes and gargle. The proportions of the preparation of the broth - 6 grams of crushed dry rhizomes per glass of water.

With regard to preventive measures, it is very important for an adult, since a special composition of the vaccine has not yet been developed. Prevention involves observing the rules of not only personal hygiene, but also good rest, sufficient physical activity and good nutrition.

Since the virus itself is not classified by experts as a microflora with a high level of pathogenic infection, there are no disinfectants that can be used by the patient himself, the carrier of the virus.

Effects

Manifesting mononucleosis with characteristic symptoms can lead to severe, up to the defeat of the virus of the central, as well as the peripheral nervous system. In the latter case, it can show itself and, as well as hallucinations and depression, Bell's palsy. As a result, during the course of the disease, in the absence of treatment, autoimmune anemia gradually develops, as well as the formation of blood clots and a deficiency of leukocytes.

Among other things, the development of mononucleosis without proper and effective treatment can cause rupture of the spleen and subsequent internal hemorrhage. Such a pathological process can be provoked both as a result of trauma and as a consequence of spontaneous inflammation of the kidneys and liver - hepatitis and nephritis. Along with this, swelling of the mucous membrane can cause frequent attacks of suffocation and oxygen starvation of the body.

Due to the fact that the pathological process weakens the immune system and undermines the body's defenses, secondary diseases of an infectious nature of origin can also join mononucleosis in their course. Along with this, such negative consequences as polyneuritis - multiple lesions of the nervous system, as well as transverse myelitis and various forms and manifestations of neurosis show themselves. Gives disease and complications to the heart, and the interstitial form of pneumonia develops.

Useful information from doctors

In the course of mononucleosis, the forecasts of specialists with the timely detection of the disease and the appointment of the correct course of treatment are very favorable. Nevertheless, after the illness, the patient will feel slight weakness and malaise for a long period of time. The patient's recovery period lasts for 5-6 months after recovery.

Today, medicine has not yet developed a special vaccine composition for the successful prevention and prevention of mononucleosis. At the same time, doctors give extremely general recommendations in the field of prevention - this is hardening and rejection of bad habits, as well as washing the throat and nasal passages during an exacerbation of acute respiratory viral infections.

In addition, doctors in the course of treatment and prevention give their recommendations and advice:

1. The disease itself requires a special approach to treatment, as well as at the recovery stage - for 1-2 months the patient must observe a gentle exercise regimen and rest more. And the patient himself will be slightly unwell.
2. It is also important to understand the fact that for another six months, the patient acts as a hidden, latent carrier of the virus. Therefore, it is so important to protect household members and people close to him from possible infection - individual household items and dishes, things, everything must comply with the norms and provisions of prevention.
3. It is also important to take vitamin complexes, especially in winter - the best of them can be selected by a doctor, taking into account the general health of the patient, the level of his immune system.
4. In order to make sure that the disease is completely gone, it is important to undergo a second test to detect the virus in the body of mononucleosis. This will allow you to determine whether pathogenic microorganisms remain in the body, and how effectively and correctly the treatment was selected.

In conclusion, it is enough to note that mononucleosis, with all the seriousness of its course and negative consequences, can be overcome.

The main thing is taking care of your own health, and a timely visit to a doctor when diagnosing the first negative symptoms. In all other respects, in the absence of proper and effective treatment, and most importantly, timely referral to specialists, the consequences can be severe and irreversible.

Infectious mononucleosis - polyetiological acute viral disease affecting the reticuloendothelial system, which is manifested by disorders in the lymph nodes, pharynx, spleen, liver, hyperthermia and specific changes in blood composition. The causative agent of the disease belongs to viruses from the herpesvirus family.

The source of infection is carriers (people who have had mononucleosis) or sick. The main way of spreading the virus is aerosol, sometimes infection occurs through saliva. In children, transmission of the pathogen can occur through contaminated toys. Contact and blood transfusion (with donor blood) ways of spread are possible.

Varieties and classification of the disease

In the international classification of diseases, for the reasons that caused mononucleosis, there are:

1. Cytomegalovirus;
2. Infectious, unspecified;
3. Gamma herpesvirus;
4. Infectious other etiology.

In 50% of patients admitted to the clinic with this diagnosis, the disease is caused by epstein-Barr virus, in other cases - herpes virus type 6 and cytomegalovirus.

Mononucleosis can occur in acute (rapidly increasing symptoms that resolve within a few weeks) and chronic (the inflammatory process lasts up to six months) form.

By severity, viral mononucleosis is smooth, complicated, uncomplicated and protracted.

There are 2 types of disease:

Typical - accompanied by the main signs (angina, enlarged lymph nodes, hepatosplenomegaly, a large number of monocytes in the blood).
Atypical - include asymptomatic, erased and visceral (internal) types of the disease.

There are 2 forms of mononucleosis:

- Manifesto - these include the typical, visceral and erased type.
- Subclinical - asymptomatic type, detected during examination of people in contact with the patient.

Symptoms and signs

The incubation period can last from a few days to 2 weeks, usually 4-6 days. A high temperature of 38-40 ° C rises rapidly amid absolute well-being. Prodromal phenomena in the form of malaise, weakness and catarrhal manifestations are possible. On the 3rd day of mononucleosis, hyperthermia with signs of toxicosis reaches its apogee, headaches, arthralgia, chills, myalgia, increased sweating develop, then severe sore throat appears. Initially, the symptoms are similar to the course of ARVI.

Brief interesting data
- Infectious mononucleosis has other names: Filatov's disease, mononucleosis infectiosa, benign lymphoblastosis and monocytic angina.
- In medicine, the history of the disease begins in 1887, it was at this time that N.F. Filatov pointed out the infectious nature of mononucleosis and described the main symptoms.
- The name of the disease was given by American scientists Evans and Sprant, and in 1964 Epstein and Barr isolated the herpes-like virus from the patient's cells.

Temperature indicators are unstable, constantly "jumping", the fever practically does not lend itself to the antipyretic effect of drugs, the hyperthermia lasts about a week, gradually declining. The main symptom of the disease is tonsillitis against a background of high fever and toxicosis. Angina can have any form (catarrhal, necrotic, lacunar or membranous), the most severe course is typical with a decrease in granulocytes in the blood. Sore throat, pain, dryness and itching develop. The mucous membrane of the tonsils is hyperemic, covered with a yellow, loose bloom. Mucosal hemorrhages and follicular hyperplasia may develop.

Mononucleosis is characterized by polyadenopathy, enlargement of the submandibular, cervical, inguinal, axillary and occipital lymph nodes. Sometimes the mesenteric and intrathoracic lymph nodes become inflamed, which is manifested by abdominal pain and severe cough. On palpation, mobile, dense and painless formations are noted. In some cases, the tissue around the lymph nodes is swollen.

In some patients, a maculopapular rash occurs on the skin and mucous membranes. It passes quickly and without a trace, has a different localization, is not accompanied by burning and itching. The rash itself is measles-like, lasts no more than 3 days and passes without consequences, such as peeling, pigmentation. There is no further dripping.

Symptoms are usually pronounced only in children; in adult patients, only one manifestation is most often expressed - hepatolienal syndrome, while the spleen and liver are enlarged, urine darkens, yellowness of the skin and sclera, dyspepsia develops.

Mononucleosis can acquire a chronic form with relapses, due to which the duration of the disease increases to 18 months or more. If a man or woman has had this infectious disease, then it is not recommended to have children during the year. During pregnancy, the disease is doubly dangerous. Developing in women "in position", mononucleosis affects overall well-being, harms the baby and can provoke a miscarriage. In some cases, doctors insist on terminating the pregnancy.

Complications

Complications of mononucleosis rarely develop, usually occur in severe forms of the disease, a strong decrease in immunity and serious disruption of the functioning of organs and systems:

Thrombocytopenia, hemolytic anemia;
accession of a secondary infection (streptococcal, staphylococcal);
pneumonia, obstruction, meningoencephalitis;
hepatitis;
ruptured spleen;
interstitial lung infiltration.

Causes of the disease

The causes of mononucleosis are primarily associated with the Epstein-Barr virus. It is ranked among the group of herpes viruses and it mainly affects the lymphocytic element of the immune system. In addition to mononucleosis, the virus can cause carcinoma and Burkitt's lymphoma. Its resistance to environmental influences is minimal. The virus dies within a short time when boiling, drying, autoclaving, under the influence of high temperatures and when treated with any disinfectant.

Animals do not get mononucleosis, this infection is typically human. After a disease, the virus remains latent throughout life and at times a person can even be contagious.

The lymphoid formations of the oropharynx are the entrance gate. It is in them that the virus accumulates, and then, through lymph or blood, reaches other organs, primarily the liver, lymph nodes, B- and T-lymphocytes, and the spleen. The pathological course in them develops almost synchronously.

Mononucleosis usually affects children aged 3-7 years and adolescents. In isolated cases, the disease occurs in adults after 40 years. Infection of newborns can occur in utero. Mononucleosis is contagious and spreads very quickly in young people living together (hostels, boarding schools, camps). Typically, outbreaks occur in the spring. Quarantine in case of illness in the team is not declared. Repeated mononucleosis occurs in isolated cases and only in patients with immunodeficiency.

Diagnostics

First of all, it is necessary to examine an otolaryngologist and perform pharyngoscopy for differential diagnosis with angina. Laboratory diagnostics consists in a detailed analysis of the cellular composition of the blood.

In the KLA with mononucleosis, there is a moderate leukocytosis with an increase in monocytes and lymphocytes. In the blood, atypical mononuclear cells are formed - large cells of various shapes with extensive basophilic cytoplasm. The number of these cells during the disease reaches up to 10-12%, and in some cases their volume exceeds 80% of the total leukocyte mass.

At the beginning of the disease, atypical mononuclear cells may not be in the blood, since their formation takes up to 3 weeks. But the absence of these cells does not exclude the diagnosis. During recovery, the blood composition gradually returns to normal, but atypical mononuclear cells most often do not completely disappear.

The virus can be detected using PCR; an infection is easily identified in the oropharyngeal wash. But this diagnostic method is laborious and expensive, therefore it is practically not used.

Antibodies to the Epstein-Barr virus are isolated by a serological method of research. Serum immunoglobulins are often detected already during the prodromal period, and at the "peak" of symptoms they are found in all patients and they disappear 3 days after recovery. The isolation of such antibodies is sufficient for an accurate diagnosis. Immunoglobulins G remain in the blood for life.

A person with mononucleosis undergoes a three-fold (with a three-month interval) serological test for HIV infection, because it also produces mononuclear cells.

Differential diagnosis is carried out with diphtheria, angina, hepatitis, cytomegalovirus and HIV infection, rubella, measles and other "loose" childhood infectious diseases.

Treatment

Treatment of mononucleosis is carried out by infectious disease specialists and pediatricians. A therapy directed against the Ebstein-Barr virus has not been created, as a result of this, immunomodulators (Panavir, Viferon, Viruter, Imunofan, Imudon) and antiviral (acyclovir, Videx, Kagocel, Arviron) drugs help to fight the disease.

Symptomatic treatment is performed with antiseptic agents for the throat, which are also used for angina: iodopyrone, bioparox, miramistin, hexoral, chlorhexidine. Depending on the manifestations of the disease, antipyretic drugs (paracetamol, teraflu, nurofen, aspirin), desensitization, detoxification therapy are prescribed. Prednisolone is prescribed in short courses with the threat of asphyxia and severe hypertoxic course.

Antibiotics are prescribed to suppress the developed bacterial flora and prevent secondary infection, with the development of severe complications, such as pneumonia. Most often, antibiotic therapy is carried out with oxacillin, penicillin, tetracycline, amoxicillin. Levomycetin and sulfanilamide drugs are contraindicated due to the negative effect on the hematopoietic system. Particular attention is paid to the restoration of liver function, diet number 5 is prescribed. If the spleen is ruptured, an urgent surgical intervention is necessary - splenectomy.

Prevention

Non-specific prevention of mononucleosis consists in increasing immunity, hardening, taking light adaptogens, vitamins, immunoregulators in the absence of contraindications, washing the throat and nose. Vaccination (specific prophylaxis) for the disease has not been created. Immunoglobulin is prescribed for children who come into contact with the patient. In the focus of mononucleosis, wet cleaning and disinfection of objects are carried out.

Traditional methods of treatment

Folk remedies will help speed up the recovery of the body during and after illness. More effective natural immunomodulators are tincture and decoction of astragalus, echinacea root, lemon balm. For sore throat relief, use turmeric and ginger root tea. You can also do inhalation over the steam of this broth.

Oregon grapes and Canadian yellowroot will help to avoid joining another infection against the background of low immunity. They can be used in different forms, even in the form of juice or jam. Dandelion root and leaves will save from hepatosplenomegaly, they are sometimes consumed fresh.

With mononucleosis, a diet must be followed. For example, broth made from chicken will increase the production of antibodies. You must drink at least 1.5 liters of water. Eat whole foods to boost immunity. Because of the sore throat, the patient is more comfortable eating soft foods: yogurt and other dairy products, fresh bread, bananas, various cereals, applesauce, light vegetable soups, smoothies. Foods containing sugar should be avoided because they suppress the immune system. Also, remove smoked and pickled foods, onions, ice cream, peas, cakes, garlic, all kinds of mushrooms, beans, cream cakes, natural coffee and horseradish from the menu.