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Mononucleosis infectious — the acute infectious disease which is shown fever, a lymphadenopathy, a hepatolienal syndrome and mononuclear reaction of peripheral blood.
Etiology. According to data of the last years, the etiological role in development of an infectious mononucleosis belongs to Epstein's virus — Burra similar in the antigenic relation with viruses of a herpes simplex and cytomegaly.
Epidemiology. The disease meets in the form of sporadic cases. Individual group diseases in families and collectives are described. The infectious mononucleosis is registered everywhere during the whole year, but higher incidence is noted in the fall and in the spring. More often children are ill.
Pathogeny. The activator gets into an organism through upper respiratory tracts, striking first of all an adenoid tissue of nasal part of a throat. Further it gets into blood what confirm a generalized lymphadenopathy, spleno-and a hepatomegalia, and also a possibility of a transmission of infection at hemotransfusion of donors at whom the disease is in an incubation interval. Selective defeat of adenoid and reticuloendothelial tissue leads to generalized hyperplastic reaction with dominance of proliferation of lymphoid cells and is expressed by emergence in blood of a large number of mononuklear, a hypergammaglobulinemia, increase of a caption of the heterophyllous antibodies synthesized by mononukleara. At the same time there are also intersticial, nonspecific inflammatory changes in pulmonary fabric, a muscle of heart, a liver, kidneys, a nervous system which are localized mainly perivaskulyarno. They explain polymorphism of clinical manifestations and emphasize the general character of a disease. In development specified, and also secondary parenchymatous changes an important role is played by an organism sensitization first of all to various microbes which quite often are an origin of complications (otitis, tonsillitis, a cholangitis, etc.).
Clinic. The incubation interval lasts from 4 to 15 days, on average week. The disease, as a rule, begins sharply though at part of patients the onset of the illness remains an imperceptible, and first sign to which pays attention of the patient, the hyperadenosis is. Manifest forms of an illness are clinically usually shown by a triad of symptoms: fever, adenopathy and tonsillitis. From here and allocation of 3 main clinical forms of a mononucleosis — ferruterous, anginous and septic though it is sometimes difficult to define the leading symptom complex, and at establishment of the diagnosis are limited to the indication of a nosological form in general. Usually the disease begins with an indisposition, a headache, a mialgiya, a joint pain, temperature increase, is more often to high. Several days later the increased lymph nodes are defined, patients complain of a dysphagy and a pharyngalgia, catarral, lacunary, follicular, filmy, ulcer and necrotic tonsillitis, in some cases with the peritonsillitis phenomena is found. Submandibular and zadnesheyny lymph nodes increase more often the first and reach the big sizes, than axillary, inguinal, elbow, tracheobronchial, etc. They reach the size of haricot, forest, a walnut, rarely it is more, have a resilient-elastic consistence, are not soldered among themselves and to skin, without periadenitis signs, are moderately painful. Usually the sizes of lymph nodes become normal in several weeks, is more rare in several months and in exceptional cases — in a year. Temperature is observed within 1 — 3 weeks, rarely longer. In character the temperature curve can be various: remittiruyushchy, intermittent, gektichesky, constant type, wavy, two-wave, sometimes — subfebrile. Are observed a case, proceeding with a normal temperature. Such symptoms of the general intoxication as a headache, the general weakness, in hard cases nausea, vomiting, have no diagnostic value and die away usually with normalization of temperature though the adynamy can last several weeks and even months.
At an infectious mononucleosis; an enanthesis is possible. Rash can be various, remains within several days. But rash can sometimes be late is long, to have hemorrhagic character, in a clinical picture of an illness to act into the forefront, as gave the grounds to allocate a clinical form of an infectious mononucleosis with a dieback.
In some cases conjunctivitis and damage of mucous membranes can prevail over other symptoms of an illness. Such course of a disease is allocated in an independent clinical form with damage of mucous membranes. Unilateral granulosa or catarral conjunctivitis, aphthous or ulcer and vesicular stomatitis and an ulitis is characteristic of this form. Cases of vesicular stomatitis in combination with vesicular rash on palms and soles are described.
Clinical forms of an infectious mononucleosis at which the leading symptoms are signs of defeat of this or that body or any system are carried to visceral. Distinguish the respiratory forms caused by defeat of bronchopulmonary, peribronchial, mediastinal lymph nodes with manifestation of the corresponding signs of functional character from them. Sometimes such forms come to light only radiological, but more often at them the nasopharyngitis, laryngitis, tracheitis, bronchitis or an acute pneumonia are observed. Also cordial forms when at the patient arise mio-, endo-or a pericardis with the expressed clinical signs or coming to light only by means of an ECG belong to visceral. Changes in heart arise in the 1st week of an illness or 5 — 6 weeks later. The current is usually favorable. If at an infectious mononucleosis; there are various abdominal symptoms — the abdominal pain, a diarrhea, a meteorism, nausea, vomiting, at an appendicular syndrome and the expressed mesadenitis demanding surgical intervention, then speak about a digestivny form of an illness.
Quite often the disease proceeds with jaundice, in such cases allocate a hepatic form of an infectious mononucleosis. Cases when in a clinical picture of an illness syndromes of meningitis, an encephalomeningitis, mono - or a polyradiculoneuritis or reactive psychosis are leading are known. Most often meningeal syndromes come to light on 3 — the 4th day of an illness, but happen later, usually differ in a favorable current though also lethal outcomes are known.
The eye form of a mononucleosis is especially allocated. At it diseases in combination with other symptoms of defeat of a nervous system or without them catarral, follicular, granulosa or filmy unilateral conjunctivitis, a sclerite or an episcleritis, a dacryadenitis, a uveitis, an iridocyclitis are defined, the periphlebitis of a retina and hemorrhage in it, hypostasis of a nipple of an optic nerve are possible.
More rare are renal also other forms with the corresponding symptomatology (nephrite, pancreatitis, an orchitis, etc.). The latent forms of an illness, without clinical manifestations, but with the expressed hematologic serological changes are possible; the erased forms when clinical displays of an illness are a little expressed, or atypical — with the isolated defeat of mesenteric and bronchopulmonary lymph nodes or atypical hematologic forms (lozhnoleykemichesky — with sharp increase in number of leukocytes, leykopenichesky — with the expressed reduction of quantity of leukocytes, granulocytopoietic or agralotsitarny, anemic, trombopenichesky, etc.) . At patients with an infectious mononucleosis aggravations and recurrence, in some cases perhaps chronic disease can be observed. Complications are observed seldom. More often they are connected with bacterial superinfection. In such cases secondary tonsillitis, a peritonsillitis, otitis, sepsis develop. It is necessary to carry ruptures of a spleen to the most terrible complications (spontaneous or from physical tension). In diagnosis of a disease these researches of peripheral blood are of great importance. In most cases they are defined from the first days and reach a maximum in the period of an illness heat. Total quantity of leukocytes at an infectious mononucleosis; exceeds normal indicators, reaching in a week 15 — 30 * 109/l. At the beginning of a disease a leukocytosis and normotsitoz are registered equally often. Much less often the leukopenia or tendency to it is defined. On 3 — the 4th week the total quantity of leukocytes usually comes to norm. The number of erythrocytes, thrombocytes, amount of hemoglobin, SOE are changed slightly and have no, diagnostic value. Thrombocytopenia and the phenomena of hemolitic anemia meet seldom. In an onset of the illness the deviation to the left to 0,08 — 0,11 band neutrocytes at the low level of segmentoyaderny neutrocytes (0,2 — 0,3) and the raised indicators of mononuklear is noted. On the 2nd week the quantity of segmentoyaderny neutrocytes decreases to 0,05 — 015 at significant increase in maintenance of mononuklear: to 0,3 — 0,4 lymphocytes, 0,1 — 0,12 monocytes. Plasmocytes, limfoidnoretikulyarny elements are found. From 3rd week of an illness the leukocytic composition of blood begins to be recovered, but full normalization drags on sometimes before half a year and longer. At all options of a clinical current of a mononucleosis from the first days in blood the maintenance of small lymphocytes to 0,06 — 0,12, sometimes to 0,02 — 0,04 decreases at norm 0,47 — 0,52. Along with it increase in maintenance of limfotsitopodobny mononuklear to 0,25 — 0,35 at norm 0,1 — 0,12 is defined, of monocytosimilar — to 0,06 — 0,1 at norm 0,01 — 0,02 and plazmotsitopodobny to 0,03 — 0,04 in the absence of them is normal. On 4 — the 5th week of an illness in a leykogramma average and big lymphocytes (0,3 — 0,4) still prevail at decrease in level of small lymphocytes.