What Is Infectious Mononucleosis?

Infectious mononucleosis is an acute self-limiting infectious disease caused by EB infection. The typical clinical triad is fever, angina, and lymphadenopathy, which can be accompanied by hepatosplenomegaly, and peripheral lymphocytes and atypical lymphocytes increase. The course of the disease is often self-limiting. Most have a good prognosis, and a few can have serious complications such as hemophagocytic syndrome. Close oral contact is the main route of transmission of the disease, such as kissing, sharing tableware or chewing food to feed the baby; droplet transmission is also possible.

Basic Information

nickname

Glandular fever

English name

infectious mononucleosis

Visiting department

Pediatrics, Infectious Diseases

Multiple groups

Preschool and school age children

Common locations

Common causes

Caused by EB virus infection

Common symptoms

Fever, lymphadenopathy, sore throat, tonsil enlargement, rash, etc.

Contagious

Have

way for spreading

Oral contact

Causes of infectious mononucleosis

EB virus infection, virus carriers and patients are the source of the disease.

Clinical manifestations of infectious mononucleosis

The incubation period of this disease is uncertain, mostly 10 days, 4 to 15 days for children, and 30 days for young people. Most patients have varying degrees of fever, generally fluctuating around 39 ° C, and occasionally 40 ° C. Fever lasted about a week, but symptoms of poisoning were mild. Lymph node enlargement is one of the characteristics of this disease, so it is also called "glandular fever". Superficial lymph nodes throughout the body can be involved, and cervical lymphadenopathy is the most common. It usually occurs in the first week and gradually decreases in the third week. Lymph nodes are generally scattered without adhesion, tenderness, and suppuration. Mesenteric lymphadenopathy can cause corresponding symptoms such as abdominal pain. Most children have sore throat, tonsil enlargement, white exudation in the pit, and occasionally a pseudomembrane.

Splenomegaly is common and is generally accessible 2 to 3 cm below the ribs, accompanied by pain or tenderness in the spleen. The liver is mostly within 2cm below the ribs, often accompanied by liver dysfunction, and some patients have jaundice.

Some patients develop rashes of various forms, such as pimples, maculopapular or measles-like and scarlet rash.

Infectious mononucleosis test

The total number of white blood cells is normal, increased or decreased. It can be normal or decreased first. After 1 weekend, the number of lymphocytes increases. The proportion of atypical lymphocytes in the blood smear is 10%. Serum EB virus antibody determination, early antigen (EA) -IgG titer 1:20, viral capsid antigen (VCA) -IgM positive or titer 1:10, VCA-IgG titer 1: 160, or VCA -IgG was more than 4 times higher in the recovery phase than in the acute phase, and EB nuclear antigen was positive in the course of 3 to 4 weeks. Molecular methods were used to detect EB virus DNA in blood, saliva, oral epithelial cells, and urine. Bone marrow examination was almost normal.

In addition, liver and spleen B-ultrasound can be performed. When complications occur, corresponding examinations such as chest X-rays and electrocardiograms can be performed.

Diagnosis of infectious mononucleosis

Clinical symptoms

At least 3 or more of the following symptoms are positive: fever; pharyngitis and tonsillitis; enlarged neck lymph nodes (greater than 1cm); liver enlargement; splenomegaly.

Blood test

(1) Leukocyte classification: lymphocytes> 50% or total lymphocytes 5.0 × 10 ⁹ / L;

(2) Amorphous lymphocytes 10% or total 1.0 × 10 ⁹ / L.

3. EB virus antibody test

Acute EB nuclear antigen is negative and has one of the following:

(1) The anti-VCA-IgM antibody is positive at the initial stage and then becomes negative;

(2) The titer of anti-VCA-IgG antibody in duplicates increased more than 4 times;

(3) Transient elevation of EA antibodies;

(4) VCA-IgG antibody is positive at the initial stage; EB virus nuclear antigen antibody is positive at the later stage.

4.EB virus DNA test

Epstein-Barr virus DNA is positive in blood, saliva, oropharyngeal epithelial cells, urine, or tissue.

5.EB virus antigen check

Nasopharyngeal swab

Meet the above clinical symptoms and haematological examination, and have one of 3 to 5 at the same time, can confirm the diagnosis.

Infectious mononucleosis treatment

General treatment

The acute phase should be bed rest, intensive care to avoid serious complications. When the spleen is significantly enlarged, vigorous exercise should be avoided to prevent rupture. Antibiotics are not effective, and antibiotics can be used if secondary bacterial infections occur.

2. Drug treatment

(1) Antipyretics are available for symptomatic treatment of patients with high fever. Those who have sore throat are given oral saline or watermelon cream throat tablets. For those with high fever and severe sore throat, pay attention to the secondary bacterial infection of the pharynx, and use antibiotics for pharyngeal swab culture. Glucocorticoids may be considered in patients with myocarditis, severe hepatitis, hemolytic anemia, or bleeding due to thrombocytopenia.

(2) Antiviral treatment of ganciclovir and early interferon treatment can relieve symptoms and reduce oropharyngeal detoxification, but it is not effective for latent infection of EB virus. Acyclovir or EB virus-specific immunoglobulin can also be used for treatment.

Prognosis of infectious mononucleosis

The prognosis of this disease is mostly good, and the course of the disease is generally 2 to 4 weeks. Some patients have low fever, enlarged lymph nodes, fatigue, and weakness after the disease, which can last for weeks or months, and the duration of the disease can last for several years. There are fewer deaths due to this disease, including spleen rupture, meningitis, and myocarditis.