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Infectious mononucleosis

Infectious mononucleosis (Filatov's illness) — the viral disease which is characterized by the expressed blasttransformation of lymphocytes, emergence of these peculiar cells in blood, reactive lymphadenitis, a hyperadenosis and spleens.

Epidemiology

The infectious mononucleosis meets most often at teenage age in the first 10 years of life, is more rare — at persons 30 years are more senior. In distribution it patients with the developed clinical picture how many with the erased and abortal forms are of great importance probably not so much. The Kontagioziost is rather low.

Etiology and pathogeny

The activator of an infectious mononucleosis is Epstein's virus — Barrel. Healthy people can often be carriers of this virus, the high antiserum capacity to its antigen is almost always found in the diseased. The leading way of defeat — airborne, a disease is transferred also in the peroral way (at drink from one ware, kisses), is very rare — at hemotransfusions.

The virus origin of an infectious mononucleosis is spoken well by the following facts: the disease meets both in the form of sporadic cases, and in the form of epidemic flashes, at patients proliferative and infiltrative trials of necrotic prevail and there is no effect of treatment by antibiotics and streptocides.

Classification

Allocate the erased, abortal, subclinical forms, a form of an infectious mononucleosis with the developed kliniko-hematologic picture of a disease.

Approximate formulation of the diagnosis:
1. An infectious mononucleosis, a subclinical form with insignificant quantity of shirokoprotoplazmenny lymphocytes in blood, marrow, the small sizes of cervical lymph nodes and hardly increased spleen.
2. An infectious mononucleosis with fever, quinsy, anorexia, increase
occipital, cervical lymph nodes and a liver with development of jaundice, a low leukocytosis, with a significant amount of shirokoprotoplazmeniy lymphocytes in blood and marrow.

Clinic

Early symptoms of a disease are the expressed fatigue, an indisposition and perspiration, oznoba with temperature increase to 38 °C and above; pharyngalgias, a hyperemia of a pharynx, the phenomenon of pharyngitis and quinsy, considerable hypostasis of almonds and a mucous membrane of a throat is possible, separate elements or groups dot hemorrhages on border of a hard and soft palate, sometimes on a mucous membrane of cheeks, an enantema in the form of the spots appearing on the 2nd week of a disease can be found, in 48 h gains brown color and in 4 — 5 days disappears.

Anorexia is observed usually on 2 — the 3rd week of an illness. Its intensity is often connected with throat pains; quite often there is nausea and vomiting. At some patients the specified symptoms can be the only symptom of a disease. The headache develops early and usually abates on the first week. Certain patients note a photophobia, eye muscle pain, cough, mialgiya.
8 current of the 1st week of an illness lymph nodes which, since 3rd week, gradually decrease in sizes quickly increase. Most often occipital and cervical lymph nodes are surprised, axillary and inguinal increase changeably. They usually dense consistence, are mobile, not soldered among themselves and painful at a palpation. The hyperplasia of intrathoracic lymph nodes meets seldom and is usually slightly expressed.
The spleen is increased in all cases, but in different degree, reaches the maximum sizes usually to 7 — to the 10th day of an illness. It an elastic consistence, with a smooth surface, is painless. Small increase in a liver of a plotnovaty consistence with development of jaundice or chronic hepatitis is sometimes noted.

Moderate increase of bilirubin in blood serum, activities of an alkaline phosphatase, zymohexase and other enzymes, and also a thymol turbidity test is found in many patients. Urine is usually normal, the proteinuria, a hamaturia, an insignificant pyuria is only sometimes observed. Existence in peripheral blood along with end-stage lymphocytes and monocytes of 60 — 70% of mononuklear, the majority of which make shirokoprotoplazmenny lymphocytes of various sizes, is characteristic. Their kernels can be a various form, nukleola, cytoplasm basphilic, sometimes vacuolated usually contain. Mononuclear cells represent the V-lymphocytes which underwent blast transformation in response to an antigen challenge of viruses.

The quantity of leukocytes increases on the 1st week of a disease (to 10 — 12*109/l), reaching the highest figures on the 2nd week (20 — 25*109/l), then the leukocytosis begins to decrease, but can keep within several weeks. Sometimes within 1 week the leykotsitopeniya, an agranulocytosis are noted. The leukocytosis is caused by absolute increase in quantity of the normal or atypical lymphocytes which are usually making more than 60% of total number of leukocytes. Sometimes the quantity of eosinophils increases, existence of plasmocytes (from 4 — 5 to 20 — 25%) is characteristic. With recovery the composition of blood is normalized, but for a long time there can be a lymphocytosis and a monocytosis which in some cases remain from several weeks and months to 1 — 1,5. The blood sedimentation rate usually does not exceed 30 mm/h.

Marrow punctate cellular with a hyperplasia of erythroidal, granulotsitarny and megakariotsitarny elements. As well as in peripheral blood, in it shirokoprotoplazmenny mononukleara can come to light.

The disease proceeds favorably more often, however the atypical current reminding a typhoid or infectious hepatitis in some cases takes place. From the hematologic complications which are found at an infectious mononucleosis autoimmune hemolitic anemia, a Werlhof's disease, cases of fatal aplastic anemia are observed. In some cases diagnose a pericardis, neurologic complications in the form of quickly passing paralyzes of cranial and spinal nerves, a polyradiculoneuritis, cerebellar frustration and defeats of a facial nerve; the myelitis, meningitis, an encephalomeningitis can lead to death. Also mental disturbances meet. Very seldom the rupture of a spleen can be observed.

Verification of the diagnosis

At atypical forms of an infectious mononucleosis it is reasonable to use serological researches as serum of these patients often (80%) contains agglutinins against erythrocytes of a ram (Paul's test — Bunnelya in Davidson's modification). The caption of agglutinins also serves higher of 1:28 confirmation of the diagnosis an infectious mononucleosis. This test is positive within the first 2 weeks of a disease. Also Tomchik's reaction has diagnostic value.
Differential diagnosis is carried out with the diphtheria proceeding with acute streptococcal damage of a pharynx, lymphoma, acute leukoses, epidemic parotitis, a tularemia, a salmonellosis, a brucellosis and other diseases.

Treatment

Treatment of an infectious mononucleosis includes use of antibiotics at development of infectious complications, corticosteroids at autoimmune hemolitic anemia. The forecast is usually favorable, the disease comes to an end with an absolute recovery, however there are not numerous messages on deaths owing to a rupture of a spleen, accession of consecutive infection, a liver failure, neurologic and other disturbances. Palindromias within the next years are known.

 
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