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Infectious lymphocytosis - Practical hematology of children's age

Table of contents
Practical hematology of children's age
Embryonal hemopoiesis
Morfofunktsionalny characteristic of cells of marrow and peripheral blood
Marrow parenchyma cells
Peripheral blood of children of different age
The system of a hemostasis is normal
Etiology and pathogeny of leukoses
Acute leukoses
Acute leukoses - a preleukosis
Possibilities of a predictive assessment of a course of an acute lymphoblastoid leukosis at children
General principles of treatment of an acute leukosis
Chemotherapeutic drugs
Treatment of an acute lymphoblastoid leukosis
Treatment of myeloid forms of an acute leukosis
Infectious complications and symptomatic therapy of an acute leukosis
Consolidation and maintenance therapy of an acute leukosis
Immunotherapy
Remission and recurrence of an acute leukosis
Inborn leukosis
Neuroleukosis
Myelosis
Lymphogranulomatosis
Gematosarkoma
Macrofollicular lymphoma
Angioimmunoblastny lymphadenopathy
Leukemoid tests
Infectious lymphocytosis
Infectious mononucleosis
Leukemoid tests of different types
Dysfunctions of granulocytes
Leukopenias
Histiocytoses
Histiocytoses - an eosinophilic granuloma
Malignant histiocytosis
Family erythrophagocytal histiocytosis
Accumulation diseases
Nimann's illness — Peak
Angiopathies
Hemorrhagic vasculitis (Shenleyn's illness — Genokh)
Mayokki's purpura
Ataxy teleangiectasia
Entsefalotrigeminalny angiomatosis
Kortiko-meningealny diffusion angiomatosis
Cerebroretinal angiomatosis
Hypertrophic gemangiektaziya
Multiple and huge hemangiomas
Elastic fibrodisplaziya
Coagulopathies
Hereditary coagulopathies
Hemophilia And
Clinic of hemophilia
Treatment of hemophilia
Angiohemophilia
Cristmas disease (Kristmas's illness)
Hereditary deficit of factors of XI, XII, XIII and I
Dysfibrinogenemias
Hereditary deficit of factors of VII, X, V and II
Deficit K-vitaminozavisimykh of factors of coagulation
Syndrome of the disseminated intravascular coagulation
Clinic and diagnosis of the IDCS
Treatment of the IDCS
Thrombocytopenia
Idiopathic Werlhof's disease
Clinic and diagnosis of an idiopathic Werlhof's disease
Treatment of an idiopathic Werlhof's disease
Isoimmune Werlhof's disease
Transimmune Werlhof's disease of newborns
Trombogemolitichesky Werlhof's disease (syndrome Moshkovich)
Hereditary Werlhof's diseases
Trobotsitopatiya
Anemias
The anemias connected with blood loss
Chronic posthemorrhagic anemia
Iron deficiency anemias
Clinic and diagnosis of an iron deficiency anemia
Treatment of iron deficiency anemias
Sideroakhrestichesky, sideroblastny anemias
Megaloblastny anemias
Foliyevodefitsitny anemia
Hereditary forms of megaloblastny anemias
Hereditary dizeritropoetichesky anemias
The anemias connected with oppression of proliferation of cells of marrow
Hereditary hypoplastic anemias
Hemolitic anemias
Hemolitic anemias - an ovalocytosis, a hereditary stomatocytosis
Acanthocytosis, piknotsitoz
The hereditary hemolitic anemias connected with disturbance of activity of enzymes of erythrocytes
The hereditary hemolitic anemias connected with disturbance of structure or synthesis of hemoglobin
The acquired immune hemolitic anemias
Isoimmune hemolitic anemias
Treatment of a hemolitic illness of newborns
Autoimmune hemolitic anemias
List of references

The infectious lymphocytosis is allocated as a separate nosological form. The disease occurs very seldom, generally only at children though cases and at adults are described. The first message on an infectious lymphocytosis was made by I. A. Kassirsky in 1938 on hematologic section of the Moscow therapeutic society. The disease was in detail described by A. Smith in 1941 I. A. Kassirsky "the oligosymptomatic infectious lymphocytosis" as the basic and quite often only clinical symptom is the high lymphocytosis offered the name of an illness. It was at the same time noted that the illness is not asymptomatic and the careful analysis helps to reveal a number of clinical signs. Now the infectious lymphocytosis is considered as a disease of infectious and allergic genesis. As the most probable consider a virus etiology of a disease. Children of the first years of life and advanced age are ill seldom. The main incidence is registered in group of children from 3 to 6 years. An infectious lymphocytosis — a contagious disease. In children's collectives the flashes sometimes gaining mass character are noted.
The incubation interval lasts 2 — 3 weeks. The disease most often begins asymptomatically, the general state is not broken, small subfebrile temperature can be observed. At some patients loss of appetite, weakness, fatigue are noted. In the developed stage it is possible to allocate a number of the general clinical signs, however they not specific to this disease — it can proceed and asymptomatically. Most often at an infectious lymphocyte the easy catarral phenomena are observed: conjunctivitis, rhinitis, faringotrakheit. The disease can be shown by dispepsichesky frustration: loss of appetite, nausea, vomiting, diarrhea, abdominal pain. Cases with accurate localization of pain in the right ileal area caused by increase in retrocecal lymph nodes are described. It led to wrong diagnosis of appendicitis and unjustified surgical intervention. Children can have a rash of makulo-papular character with preferential localization on a face and extremities. At an infectious lymphocyte cervical or bronkhopulmonalny lymph nodes increase. In rare instances the nervous system is surprised — the headache, dizziness, easy meningeal signs are noted. Some patients complain of a joint pain. Despite the lack of typical signs, the clinical picture at an infectious lymphocytosis is various though each symptom can be the only display of a disease. On this basis the following forms of an infectious lymphocytosis are allocated: respiratory, belly, ferruterous (adenopatichesky), artralgichesky, nervous, skin, asthenic, mixed.
The most reliable information about existence of a disease is given by the analysis of composition of peripheral blood. Are found in all patients a high leukocytosis — from 30 X 109/l to 80 X 109/l and above. In a leykogramma lymphocytes — to 80 — 90% prevail, the relative neutropenia is noted. At most of patients moderate increase in quantity of eosinophilic granulocytes — to 10% is observed. In drugs of peripheral blood it is possible to meet nuclear shadows of Gumprekht.

The bulk of lymphocytes is provided by mature small forms of normal morphology, however at cytochemical research nevertheless a number of features is revealed. N. S. Kislyak and R. V. Lenskaya (1978) note that at an infectious lymphocytosis the quantity of CHIC-positive lymphoid cells is increased, activity of acid phosphatase and and-naftilatsetat esterases is increased. Authors regard it as manifestation of a sensitization. Miyelogramma has no characteristics. Moderate increase in number of lymphocytes without metaplasia can be found. The puncture of lymph nodes and a breast is a little informative for diagnosis of an infectious lymphocytosis. Punctates consist of usual lymphatic and reticular macrophages. The relative rarity of a disease can serve as the reason of diagnostic mistakes. Hematologic data — a high leukocytosis with a lymphocytosis, existence of nuclear shadows of Gumprekht give to a disease similarity to a chronic lymphoid leukosis, however at children's age the chronic lymphoid leukosis practically does not meet. Besides, there are no characteristic signs of tumoral process — a hyperadenosis, spleens that allows to establish the correct diagnosis. High degree of a leukocytosis can become a reason for suspicion of an acute leukosis. However the general condition of patients is broken a little, there is no hemorrhagic syndrome, anemia, a hyperplasia of bodies. Lack of blast cells in peripheral blood has crucial importance for the final diagnosis. Resort to a diagnostic sternal puncture extremely seldom. The infectious lymphocytosis differs from an infectious mononucleosis in lack of specific clinical symptoms — quinsies, a hyperadenosis, a liver, a spleen. The infectious lymphocytosis proceeding with the respiratory phenomena can be regarded as the catarral period of whooping cough at which the leukocytosis with a lymphocytosis is also noted. However hematologic changes at whooping cough are, as a rule, expressed to a lesser extent. Further dynamics of a disease (absence of spasmodic cough) promotes right diagnosis of a disease. Increase in retrocecal lymph nodes against an abdominal pain syndrome at an infectious lymphocytosis can simulate an attack of an acute appendicitis. In diagnosis hematologic data as at appendicitis there is only a neutrocytosis have crucial importance.
The current of an infectious lymphocytosis is good-quality. The disease does not demand special treatment. In the presence of these or those clinical signs use symptomatic means. The forecast is favorable. Patients do not need hospitalization. If the disease is registered in children's collective, patients are subject to dissociation. Clinical recovery comes quickly, within 7 — 10 days. Is longer hematologic changes keep. The composition of peripheral blood is normalized in 3 — 8 weeks; in certain cases changes of blood remain till 3 months and more.



 
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