How Common Is Mononucleosis in Children?

Pediatric infectious mononucleosis is an acute proliferative infectious disease of the monocyte-macrophage system, which is mainly caused by EB virus and is an acute infectious disease mainly involving invasion of the lymphatic system. Clinical manifestations vary widely. Fever, angina, lymph nodes, and hepatosplenomegaly are common. A large number of abnormal lymphocytes appear in the blood, and EB virus antibodies can be detected in the serum.

Basic Information

Visiting department: Pediatrics
Common causes: Epstein-Barr virus

Common symptoms: Fever, enlarged lymph nodes
Contagious: Have
way for spreading: Saliva droplets

Causes of Pediatric Infectious Mononucleosis

The disease is caused by EB virus. The Epstein-Barr virus was first discovered in African child lymphoma (Burkitt lymphoma) cell culture by Epstein and Barr. It belongs to the herpes virus group and is a virus that infects humans generally. It has latent and metastatic properties.

Clinical manifestations of infectious mononucleosis in children

EB virus is transmitted through saliva droplets. The pediatric incubation period is short, about 4 to 15 days, most of which are 10 days, and the adolescent period can be as long as 30 days. The disease spreads throughout the year, and the number of cases may increase in the cold season, with occasional epidemics.

General symptoms

Acute or insidious onset, half have prodromal symptoms, followed by fever and sore throat, general discomfort, nausea, fatigue, sweating, shortness of breath, headache, and cervical lymphadenopathy.

2. Typical symptoms

Symptoms vary, juveniles are often heavier than juveniles, and the younger they are, the less typical they are. Typical symptoms usually appear one week after the onset of symptoms.

(1) Fever: Most of them have different degrees of fever, and the heat type is uncertain. It lasts for about 1 week. Although the fever is high, the symptoms of poisoning are mild.

(2) Lymph node enlargement: It is one of the main manifestations of this disease. It is more common in the posterior cervical lymph nodes, but superficial lymph nodes can be involved. Lymph nodes are generally mild, moderately swollen, and rare in diameters of 3 to 4 cm. The texture is medium, dispersed and non-adhesive, and the tenderness is not obvious. Most enlarged lymph nodes need to resolve within a few weeks after fever regression.

(3) Pharyngitis: The most common is congestion of the pharyngeal isthmus, tonsil congestion and swelling, and even a few may have difficulty breathing or swallowing. Thick tonsil-like exudate can be found on the surface of the tonsils, and a few have pseudofilm formation.

(4) Hepatosplenomegaly: About half of the children's liver and spleen can be enlarged, and the degree of swelling can vary, with occasional pain or tenderness in the spleen area. Most are accompanied by one or more abnormal liver functions, and some cases have jaundice.

(5) Rash: In a few cases, a rash of different morphology appears in 4 to 10 days after the illness, which can be pimples, maculopapular rashes, similar to measles or scarlet fever-like rash. It fades in 3 to 7 days, without desquamation and pigment. Some children have needle-point bleeding spots at the junction of the soft and hard palate. Conjunctival membrane congestion or eyelid edema.

In addition to the above typical symptoms, quite a few children with EB virus infection can often be asymptomatic or mild. Because all the organs of the disease can be affected, a large number of children have a variety of clinical symptoms and diverse manifestations.

Pediatric infectious mononucleosis test

Blood image

The white blood cell count was normal or slightly increased, mostly below 20 × 10 ⁹ / L, and a few could be decreased. In the early stage, neutrophils increased, and later lymphocytes increased, reaching 60% to 97%, and more than 10% were heterotypic lymphocytes. Atypical lymphocytes can begin to appear 4 to 5 days after the illness, and peak at 7 to 10 days. A few patients with chronic disease can still be detected after several weeks.

2. Bone marrow lymphatic system

The white blood cell count is normal or increased, and atypical lymphocytes may appear, but not as many as seen in the blood. Primitive lymphocytes do not increase.

3. Serum Heterophilic Agglutination

Mainly sheep and horse hemagglutinin, which belongs to IgM. Appeared earlier, reaching a peak within 3 to 4 weeks. When positive, a bovine erythrocyte or guinea pig kidney adsorption test must be performed to distinguish it from normal serum, serum disease, leukemia, Hodgkin's disease, and tuberculosis. Heterophilic agglutination test in children with infectious mononucleosis can be adsorbed by bovine red blood cells but not by guinea pig kidney. Heterophilic lectins in normal and serum children can turn negative after being adsorbed by bovine red blood cells and guinea pig kidneys.

4. EB virus-specific antibody assay

Including: anti-capsid antigen (VCA) antibody: VCA-IgM is often measured clinically for diagnosis; membrane antigen (MA) antibody; anti early antigen (EA) antibody; anti-core antigen (NA) antibody.

5.EB virus culture and EB virus DNA detection

There are also rheumatoid factors, antinuclear antibodies, anti-smooth muscle antibody lymphotoxic antibodies and so on.

6. Other inspections

X-ray chest X-ray, B-ultrasound, ECG, EEG, etc.

Diagnosis of Pediatric Infectious Mononucleosis

This disease should be considered when children have concurrent fever, angina, lymph nodes, and hepatosplenomegaly. The diagnosis depends on the EB virus antibody test. The diagnostic criteria are:

Clinical symptoms

At least 3 or more are positive: fever; pharyngitis and tonsillitis; cervical lymph node enlargement (more than 1cm); liver enlargement; spleen enlargement.

Blood test

(1) White blood cell classification: Lymphocytes account for more than 50% or the total number of lymphocytes is higher than 5.0 × 10 ⁹ / L.

(2) Atypical lymphocytes: more than 10% or a total of more than 1.0 × 10 ⁹ / L.

3. EB virus antibody test

Acute EBNA antibodies are negative; one of the following is positive:

(1) VCA-IgM antibody is positive in the early stage and becomes negative afterwards;

(2) The titer of VCA-IgG antibody in duplicate serum was increased more than 4 times;

(3) Transient elevation of EA antibodies;

(4) VCA-IgG antibody was positive at the initial stage.

EBNA antibodies were positive afterwards.

Pediatric infectious mononucleosis treatment

There is no specific treatment for this disease, mainly symptomatic and supportive treatment.

General treatment

The acute phase should be bed rest, intensive care to avoid serious complications. When the disease is complicated by bacterial infections, such as pharynx and sacral tonsil -hemolytic streptococcal infection, antibiotics such as penicillium G and erythromycin can be used.

2. Antiviral treatment

Use acyclovir, interleukin, etc., supplemented with vitamin B ₁ and C orally.

3. Symptomatic treatment

It can be used symptomatically for antipyretic and analgesic, sedative, cough and liver protection. For severely ill children, such as those with severe edema of the pharynx and throat, adrenal corticosteroids can be used for a short period of time. Critical conditions such as respiratory tract obstruction, hemolytic anemia, neurological complications, thrombocytopenic purpura, myocarditis, and pericarditis can be treated with corticosteroids. Use of human blood gamma globulin as appropriate can improve symptoms and eliminate inflammation. However, it should not be used in general cases.