With all the variety of viral diseases, there is a group of infections that become our companions for life. It is these diseases that include infectious mononucleosis (synonyms - monocytic tonsillitis, Filatov's disease). This is a disease that is difficult to distinguish from a common respiratory viral infection, but which can lead to severe complications. And since it is in children that infectious mononucleosis occurs more often than in adults, this article may be useful for parents.
Many-faced herpesvirus
The causative agent of this disease belongs to the Herpesviridae family, which includes 8 serotypes of human viruses. Infectious mononucleosis is caused by the herpes simplex virus serotype 4 (Human gammaherpesvirus 4). The original name - Epstein-Barr virus - he received in honor of his discoverers, virologists from England MichaelEpstein and Yvonne Barr, they described it in 1964.
According to statistics, 90-95% of the adult population have antibodies to this disease in their blood, which indicates an infection. The Epstein-Barr virus, like all herpes viruses, contains hereditary information in the form of a double-stranded DNA helix, which causes a lifelong virus carrier in humans. This virus has a complex shell - supercapsid, which consists of glycoproteins and lipids, forming a kind of spikes on its surface. And he himself looks like a polyhedral cube with a diameter of up to 200 nanometers.
Target cells and virions
The extracellular form of the virus - the virion - is quite stable in the external environment. Under normal environmental conditions, the virus retains virulence for 2-12 hours. On different surfaces, these times may vary. It is resistant to freezing, but dies when boiled, it takes less than half an hour. The virus that causes infectious mononucleosis (photo below) is clearly tropical - this means that it especially “loves” the cells of the lymphatic system and affects its organs (oropharyngeal lymph nodes, tonsils, spleen).
Unlike other viruses of the herpetic family, the interaction of the Epstein-Barr virus with target cells (group B lymphocytes) follows a conciliatory scenario. Penetrating into the cells of the lymphatic tissue, the virus inserts its DNA into the DNA of the host cell. After that, the process of replication (doubling) of the virus genome begins. But the parasite does not kill lymphocytes, but leads to their proliferation -tissue growth due to the increase in host cells. In addition, recently there have been data on the involvement of this pathogen in the formation of various types of tumor cells in the human body. The danger of the virus lies in the fact that although the virus is asymptomatic, it can still lead to damage to internal organs.
Etiology and reservoir
Statistics show that out of every 100,000 people, only 45 experience mononucleosis. The causative agent of the disease is ubiquitous. A weak seasonality of the disease was revealed: the virus is more active in the autumn-winter and spring periods. Infectious mononucleosis in children under 2 years of age is very rare, older children are more likely to get sick. The peak incidence occurs during puberty (10-14 years). Boys are more susceptible to infection than girls, with the latter more likely to get sick at 12-14 years old, and the former at 14-16 years old.
The nature of this pattern is not completely clear, but it can be traced in adults as well. Infectious mononucleosis in childhood has symptoms of respiratory inflammation. In adults, it is often asymptomatic and can only be identified by the presence of antibodies in the blood. The reservoir of infection are both patients with severe symptoms and virus carriers. Patients are especially contagious (contagious) during the period of clinical manifestations of the disease and from the 4th to the 24th week after convalescence (recovery). In virus carriers, the virus is released into the environment periodically.
How it penetrates ourorganism
This ailment is sometimes referred to as the "kissing disease". The most likely way for a pathogen to enter the body is direct contact with the saliva of a patient or virus carrier. They can be contracted by inhaling sputum that the patient exudes when coughing or sneezing. Possible infection through food and household items. The entry of the virus into the respiratory tract leads to damage to the epithelium and lymphoid tissues of the oropharynx. Then the virus invades lymphocytes, stimulates their growth and travels through the body, leading to swelling and enlargement of the tonsils, liver and spleen. Transmission of the pathogen through the blood and at the time of childbirth is possible.
Infectious mononucleosis symptoms
The timing of the incubation period for the development of the disease is blurred - from 3 to 45 days. Most often, the disease begins acutely. Sometimes, before an acute period, a sore throat, rhinitis, weakness and headaches appear at subfebrile temperature. During the period of activation of the infection (on the 4th day), the temperature can rise to 40 ° C.
The main symptom of infectious mononucleosis is tonsillitis (enlarged and inflamed tonsils). Fibrous films appear on the tonsils, and the disease is very similar to a sore throat. Sometimes there are deeper inflammations affecting the lacunae of the tonsils, the contents of which are removed and expose the wounded surface.
The defeat of the cervical and jaw lymph nodes leads to lymphadenopathy, the outflow of lymph is difficult, and there is a syndrome of "bull neck". A fourth of patients develop rashes that do not cause itching and disappear within 2 days. Enlargement of the liver andof the spleen, which persists with infectious mononucleosis in children and adults up to 4 weeks, leads to dark urine, yellowness of the integument, yellowing of the sclera of the eyes and the appearance of dyspepsia.
General clinical picture
Symptoms of infectious mononucleosis in children with acute course are varied. With this option, the following periods are distinguished during the course of the disease:
- Initial phase. More often, the acute phase begins with fever, body aches and weakness. Sometimes accompanied by the simultaneous appearance of all three main symptoms of infectious mononucleosis - fever, tonsillitis and lymphadenopathy. Duration from 4 to 6 days.
- The peak phase. By the end of the first week of illness, the state of he alth worsens. There are signs of angina, often catarrhal. The cervical group of lymph nodes reaches its maximum size (sometimes the size of a chicken egg). From the 10th day, the painful clinical manifestations of infectious mononucleosis disappear. By the beginning of the second week there is an increase in the spleen, by the third week the liver is enlarged. With a benign course, by 12-14 days, all symptoms of infectious mononucleosis disappear. And the treatment in this period will be the most effective. Its duration is 2-3 weeks.
- The period of convalescence (recovery). During this period, the spleen and liver return to normal, but the patient is still contagious. Duration - up to 4 weeks. Up to 90% of patients by the end of the 2nd week already feel a surge of strength. But sometimes a feeling of fatigue and weakness accompanies the patient for six months or more.
Features of the flowadults
The disease in people over 35 years of age is almost never found. From 14 to 29 years old - this is the age category most susceptible to infectious mononucleosis. Symptoms in adults begin with a fever that lasts up to 2 weeks. The jaw lymph nodes and tonsils are less affected than in children. But the liver is often involved, which is manifested by yellowness of the integument and sclera of the eyes. These atypical forms of the disease are diagnosed solely by laboratory tests.
The peculiarity of this disease in adults is often asymptomatic, and during the period of pregnancy planning, childbearing and childbirth, women simply do not pay attention to it. Doctors unanimously state that pregnancy is undesirable within 6 months or even a year after suffering a mononucleosis infection. And not only the mother of the child, but also the future father. The transferred infection during pregnancy harms the well-being of a woman, damages the development of the fetus, and can lead to a miscarriage. Often, doctors advise to artificially terminate a pregnancy if there is a possibility of fetal pathology.
Transition to chronic form
The acute form of the course of the disease can become chronic with a low immune status. In chronic infectious mononucleosis in children, the symptoms are as follows: first of all, long and not passing anginal manifestations, leukopenia, exanthema, prolonged subfebrile temperature. There is a high titer of antibodies to the antigens of the virus, accompanied by histologically confirmedpathologies in the organs (uveitis, hepatitis, lymphadenopathy, pneumonia, hypoplasia of the bone marrow). Fatal outcome can only be in the case of rupture of the spleen and airway obstruction, which is extremely rare.
Children with congenital infectious mononucleosis often have severe symptoms and treatment. In fetal development of the fetus, severe pathologies of bone tissues and the nervous system (cryptorchidism and micrognathia) are noted.
Danger of complications
It is the danger of organ damage, as a consequence of the disease, that the Epstein-Barr virus is famous for. It provokes oncological diseases of the lymphatic organs, herpetic infections, hepatitis, damage to the liver, spleen and nervous system. The following complications may develop:
- Rupture of the spleen. Occurs in 1% of cases. Without surgery leads to death.
- Hemolytic complications (anemia, thrombocytopenia).
- Neurological disorders (meningitis, cranial nerve paresis, encephalitis, polyneuritis, psychosis).
- Cardiac disorders (arrhythmia, pacemaker block, pericarditis).
- Pneumonia.
- Liver disorders (necrosis, encephalopathy).
- Asphyxia.
This list is scary. But the patient should not worry in advance, most infected people recover quite quickly and avoid complications.
Diagnosis
The success of the treatment of infectious mononucleosis largely dependsfrom a complete and high-quality diagnosis. The laboratory methods are as follows:
- A complete blood count will show the presence of atypical mononuclear cells - precursors of T-lymphocytes that are involved in the destruction of Epstein-Barr B-lymphocytes affected.
- Blood biochemistry provides information on hyperglobulinemia, hyperbilirubinia, the appearance of cryoglobulin proteins.
- An indirect immunofluorescence test or drop test detects the presence of specific antibodies.
- Virological research is carried out on swabs from the patient's pharynx. They determine the presence of the Epstein-Barr virus, but they are very expensive and rarely used in domestic practice.
The presence of infectious mononuclear cells in the blood is the main indicator of mononucleosis. However, they can also be found in HIV infection. Therefore, simultaneously with this analysis, an enzyme immunoassay for the human immunodeficiency virus is prescribed, which is repeated two more times with breaks in a month.
How to treat infectious mononucleosis
Treatment is on an outpatient basis. In the acute phase of the disease, bed rest and heavy drinking, sleep for at least 9 hours a day, a balanced diet are recommended, alcohol and caffeinated drinks are excluded. There is no specific treatment for infectious mononucleosis in children and adults. To date, there are no drugs that will rid the body of this virus. But it is quite possible to alleviate the course of the disease and prevent relapses.
Treatment of infectious mononucleosis in children is symptomatic,when secondary infections are attached, penicillin antibiotics may be prescribed. Non-steroidal anti-inflammatory drugs are prescribed to reduce high fever. A ruptured spleen, the most dangerous complication of mononucleosis, requires emergency surgery.
Treatment for infectious mononucleosis in adults is similar. The main thing to remember is that self-treatment is not an option, but the consultation of a competent specialist in combination with high-quality diagnostics is the key to a quick recovery.
Symptoms of infectious mononucleosis in children and treatment require a comprehensive analysis and approach. And diet therapy is of no small importance. A diet for mononucleosis is necessary due to disruption of the liver and spleen, table No. 5 according to Pevzner is recommended (table below).
What traditional medicine advises
The list of the most effective fighters against viral diseases includes astragalus root, echinacea and garlic. But supporters of traditional medicine warn of the dangers of self-medication and the use of folk remedies. Sometimes they can do a disservice.
Thus, astragalus root has a dubious strengthening effect, but can be dangerous for hypertensive patients and patients with all forms of diabetes.
Echinacea still causes controversy among doctors about its immunostimulating effect. Almost every year, various laboratories around the world publish rather conflicting reports on the effects of echinacea on the human body.
Garlic has been famous since ancient timesfor its bactericidal properties. Thanks to the presence of allicin, it really helps in the fight against viral infections. One caveat - it will show its properties in raw and crushed form. But when consumed in large quantities, garlic is toxic and negatively affects the gastrointestinal tract.
So it's up to you to throw away money for the purchase of magical biological supplements and medicinal herbal preparations that, at best, will not harm the body, and at worst, they will put you in a hospital bed or not.
Preventive measures
Special preventive measures to prevent infectious mononucleosis have not been developed. In this case, a prophylaxis scheme is used for respiratory viral infections. There is no vaccine, but non-specific methods of prevention are aimed primarily at strengthening the body's immune forces. Every second, up to three thousand different pathogens are destroyed in our body - the immune system of a he althy person copes with this. So it is with mononucleosis - a strong immune status will not allow this unpleasant infection to “unbelt”.
As a preventive measure, children's institutions are quarantined for at least 14 days. Carry out standard anti-epidemic treatment of the premises and all items with disinfectant solutions.
Viral oncogenesis, or Cancer that can be contracted
Today, a correlation between viral infection and malignant tumors has been reliably established. Evidence obtained for seven pathogensviral nature:
- Hepatitis B and C virus.
- Epstein Virus - Barr.
- T-lymphotropic human virus.
- Some papillomavirus serotypes.
- Herpes simplex virus type 8 (Kaposi's sarcoma).
The fact that cancer can be a contagious disease is both frightening and reassuring. Medicine does not stand still. We already have 10 diseases of an infectious nature, finally defeated by vaccines. These are smallpox, bubonic and pneumonic plague, leprosy, cholera, rabies and some forms of polio. As the proverb says, a person is more ferocious in dealing with an infection than an infection is in dealing with a person. And the invention of new vaccines is likely to save our descendants from infectious mononucleosis and cancer. After all, this is just a virus against which the entire pharmacology industry of mankind!
