How Do I Choose the Best Treatment for Mononucleosis?
Mononucleosis is called kissing disease in western countries because it is often
Mononucleosis - Infectious mononucleosis is an acute, self-limiting infectious disease caused by EBV virus (a type of infectious virus, Epstein-Barr virus). Its clinical features are fever, pharyngitis, hepatosplenic lymphadenopathy, peripheral blood lymphocytes significantly increased and abnormal lymphocytes appear. Heterotropic agglutination test is positive, and anti-EBV antibodies appear in the body after infection. Adolescents and young adults are more likely (12 to 40 years).
Introduction to mononucleosis
- Mononucleosis is called kissing disease in western countries because it is often
- Mononucleosis
Basic information on mononucleosis
- EBV belongs to the herpes virus group, and was first discovered by Epstein, Barr, and others from cell cultures of African malignant lymphoma in 1964. The virus is spherical with a diameter of about 180 nm. The surface of the capsid has a lipoprotein envelope and the core is double-stranded DNA.
- The virus has very special growth requirements, so virus isolation is difficult. However, the virus can be detected in cultured lymphocytes by immunofluorescence or electron microscopy. EBV has B-cellophilic properties and can serve as its lysogen, turning B lymphocytes into lymphoblasts.
- EBV has five antigenic components, namely the viral capsid antigen (VcA), membrane antigen (MA), early antigen (EA), complement-binding antigen (soluble antigen S), and nuclear antigen (EBNA). Various antigens can produce corresponding antibodies. eb virus is the pathogen of this disease. The morphology and structure of eb virus under electron microscope is similar to that of other viruses in herpesvirus group, but the antigenicity is different. The eb virus is a dna virus, and a complete virus particle is composed of a nucleoid, a membrane shell, a shell particle, and an envelope. Nucleoids contain viral DNA; the membrane shell is a icosahedral three-dimensional symmetrical shape composed of tubular protein subunits; the envelope is derived from the host cell membrane. eb disease has very special growth requirements, and it only reproduces in the culture of African lymphoma cells, leaflet patient blood, leukemia cells and healthy human brain cells, so virus isolation is difficult.
- eb virus has 6 kinds of antigen components, such as membrane shell antigen, membrane antigen, early antigen (can be divided into diffuse
- Mononucleosis
- 1. Infections: The carriers and patients are the source of the disease.
- 2. Transmission: more than 80% of patients have EB virus in the nasopharynx. Close contact between the nose and mouth is the main route of transmission. It can also be transmitted through droplets and blood transfusion.
- 3. Susceptible crowd: The crowd is generally susceptible.
Mononucleosis epidemiology
- (1) Sources of infection The carriers and patients are the source of infection of the disease. The rate of infection in healthy people is about 15%.
- (B) More than 80% of patients have EB virus in the nasopharynx, and 15 to 20% can recover from the throat for a long time after recovery. Oral and nasal close contact is the main route of transmission, and it can also be transmitted through droplets and blood transfusions.
- (3) Vulnerable populations are generally susceptible, but children and adolescents are more common. Most children under 6 years of age suffer from recessive or mild onset. Infection over 15 years of age is typical. Permanent immunity can be obtained after the illness, and the second incidence is uncommon. [1]
Mononucleosis pathology
- The pathogenesis of this disease has not been fully elucidated. After entering the oral cavity, the virus may first multiply in the lymphatic tissues of the pharynx, and then invade the blood to cause viremia, which subsequently affects the lymphatic system and various organs. Because B lymphocytes have EBV receptors on the surface, they are extremely vulnerable. B-lymphocytes proliferate actively after infection, and their antigenicity changes. The latter can cause a T-lymphocyte defense response, forming cytotoxic effector cells that directly destroy infected B-cells. This cellular immune response is an important factor in the course of the disease. After the B cells are destroyed, they release self-antigens, which stimulates the production of autoantibodies, which causes a series of complications.
- The main pathological feature of this disease is benign hyperplasia of lymphatic reticulum. The liver has various monocyte infiltrations, Kupffer cell hyperplasia, and focal necrosis. Splenomegaly, deformed lymphocytes in the spleen and sinus. It is brittle, bleeds easily, and even ruptures. Lymph nodes are enlarged and abscesses are not formed, and the hyperplasia of the paracortical area (T lymphocytes) is significant. Other organs throughout the body, such as the myocardium, kidneys, adrenals, lungs, skin, and central nervous system, can have hyperemia, edema, and lymphocyte infiltration. First, it invades the epithelial cells of the oropharynx and the tubular epithelium of the salivary glands. Current research suggests that EBV can also directly invade the tonsil crypt. EBV continuously proliferates, infiltrates and builds up in it, causing symptoms such as pharyngitis and tonsillitis. EBV particles that escape at the same time
- Mononucleosis
- Continuously a large number of transformations and polyclonal activation in infected B cells promote a large number of polyclonal proliferation of B cells. New virus particles escape from the periodic lysis of cells, continue to enter the bloodstream, and invade other B cells. The ratio of detectable EBV antigen (+) in B lymphocytes in the early bloodstream was about 1: 10000, which was reduced to 1: 10000000 (Cohen) during the recovery period. Infected B cells are affected by EBV, and the cell membrane undergoes antigenic changes, which can activate a large number of T cells to proliferate, that is, reactive T cells appear in the bloodstream in large numbers. This is the abnormal lymphocytes seen later in the bloodstream But it also includes increased NK cells. The presence of a large number of infected B cells and reactive T cells in the body causes a series of complex humoral and cellular immunity throughout the body.
- Infected B cells can transform to produce a variety of specific antibodies and release a variety of immunoglobulins (mainly IgM, IgG, others include IgA, IgE, etc.), which has also been confirmed by in vitro experiments. In addition, the EBNA nuclear antigen (EBNA) part can not undergo virus replication, but form episomes that attach to the nucleus of some B cells and nasopharyngeal epithelium, or integrate with the DNA of the host cell, causing genetic changes in the cells As it proliferates, it is continuously passed on to progeny cells (Jenson). B cells are also considered to be the only source of infection (Cohen) for EBV. This type of cell is also called immortalizing ell. They are important because viral antigens not only evade immune surveillance and are immune to antiviral drugs. Long-term or even life-long latent in the nucleus or under appropriate conditions, once again formed a complete virus, intermittently excreted from saliva. A few cases even show malignant proliferation or develop carcinogenic factors.
- Reactivity: T8 cells are mostly CD8 cells (T8, cytotoxic T cells), a few are CD4 cells (T4, helper-inducing T cells), and others are NK cells. The ratio of the number of normal T4 / T8 cells in the blood stream should be 2: 1, at which time severe proportion inversion occurs (Jenson). Because T8 cells have cytotoxic and inhibitory effects on target cells (infected B lymphocytes), they can kill and inhibit the proliferation of B cells and form antibodies. In addition, NK cells and neutralizing antibodies are added to make infected cells B cells gradually decrease and disappear, and reactive T cells decrease accordingly and gradually return to normal, which forms a self-healing process of IM benign circulation.
- Pathological changes: In benign lymph nodes, spleen and liver, there are a large number of benign proliferation of lymphocytes in lymphoblastoid cell lines and extensive tissue infiltration and aggregation, which causes the loss of normal structure. This is the basic of IM Pathological characteristics.
- Infiltrating cells of the liver are distributed in the manifold area and develop towards the liver sinus. Liver macrophages (<SPAN lang = EN-US> Kupffer cells) increased, but the appearance of liver cells remained normal except for individual cases of liver necrosis. Lymph node infiltration and aggregation area is mainly in the paracortical area where T cells are distributed, and less in the center of B cell distribution. The infiltration area of the spleen is in the spleen sinus and spleen marrow area, and the morphology of some cells is ambiguous.
- There may also be normal or abnormal lymphocyte infiltration, accumulation, or localized lesions around the blood vessels and lymphatic tissues in various organs throughout the body. This is the basis for multiple organs to develop into lesions. So it's worth noting.
Clinical manifestations of mononucleosis
- The incubation period is 4 to 15 days, usually 9 to 11 days. Adults can be longer. The onset was mixed. About 4
- Mononucleosis
- (1) The temperature of the fever varies from 38 to 40 ° C. Heat type is uncertain. The heat course ranges from several days to several weeks, even months. May be accompanied by chills and sweating. The symptoms of poisoning are not serious.
- (B) Lymphadenopathy is seen in 70% of patients. Cervical lymphadenopathy is the most common, followed by axillary and groin areas. The diameter is 1 ~ 4cm, the texture is medium hard, scattered, no obvious tenderness, no suppuration, bilateral asymmetry and so on. It can take weeks to months to subside. Swelling of mesenteric lymph nodes causes abdominal pain and tenderness.
- (3) Although only half of the patients complained of sore throat, pharyngeal congestion was seen in most cases, and a few patients had ulcers and pseudomembrane formation in the pharynx. The gums can also swell or have ulcers. Edema and obstruction of the larynx and trachea are rare.
- (IV) Hepatomegaly occurs in only 10% of patients with hepatosplenomegaly, and up to 2/3 of patients with abnormal liver function. Jaundice can occur in a small number of patients, but conversion to chronic and liver failure is rare. More than 50% of patients have mild splenomegaly and occasionally spleen rupture may occur. During the examination, you should press gently to prevent spleen rupture.
- (5) About 10% of cases of rash appear pleomorphic rash in the course of 1 to 2 weeks. It is a pale red maculopapular rash, and may also have measles-like, scarlet-like, or urticaria-like rashes. Retreat without scaling.
- (F) Neurological symptoms are seen in a few severe cases. Can manifest as aseptic meningitis, encephalitis and peripheral radiculitis. More than 90% can be recovered.
- Others include pneumonia (5%), myocarditis, nephritis, and conjunctival congestion.
- The course of disease is mostly 1 to 3 weeks, and a few can be delayed for several months. Occasionally recurrence, the course of disease is short and the condition is mild. The prognosis of this disease is good, with a mortality rate of only 1 to 2%. It is caused by severe complications.
Mononucleosis complications
- (1) About 30% of patients in the respiratory system may be complicated by bacterial infection of the pharynx. Interstitial pneumonia can occur in about 5% of patients.
- (B) Some patients with urinary complications may experience changes similar to nephritis such as edema, proteinuria, urinary casts, and increased blood urea nitrogen, and the lesions are mostly reversible.
- (C) Cardiovascular complications with myocarditis accounted for about 6%. ECG showed T wave inversion, low level and prolonged P-R interval.
- (D) Meningitis, meningoencephalitis, and peripheral neuropathy can occur in neurological complications, and the incidence is about 1%.
- Other complications include spleen rupture, hemolytic anemia, gastrointestinal bleeding, and parotid enlargement.
Mononucleosis diagnosis
- (1) The epidemiological data should pay attention to the local epidemic situation, and whether they have traveled to the epidemic area for business. Are there similar patients around to help with the diagnosis.
- (2) The clinical manifestations are mainly fever, sore throat, enlarged lymph nodes in the neck and other parts, hepatosplenomegaly, and pleomorphic rash. In the case of examination conditions, diagnosis is difficult.
- (Three) laboratory inspection
- 1. The total number of white blood cells in the blood is normal or slightly increased, up to 30 ~ 50 × 109 / L. Mononuclear cells (lymphocytes, monocytes, and atypical lymphocytes) can reach more than 60%, and among them, atypical lymphocytes can exceed 10%.
- Mononucleosis
- 3 EBV antibody detection Anti-EBV includes antibodies to VCA, EA, EBNA, complement-binding antibodies, and neutralizing antibodies. Among them, anti-VCAIgM and IgG are more commonly used. The former appears early, disappears quickly, has high sensitivity and specificity, and has early diagnostic value. The latter appears early, has high titers, and lasts for life. It is suitable for epidemics. Learn to investigate.
- 4 The detection of EBV is difficult, and the virus can also be detected in healthy people and patients with other diseases, so it is rarely used for clinical diagnosis.
- This disease should be related to streptococcal infections mainly characterized by pharyngitis, herpes angina, rheumatic fever, tuberculosis, lymphocytic leukemia, and lymphatic reticuloma, which are mainly represented by fever and lymphadenopathy. Viral hepatitis and laboratory changes characterized by jaundice and abnormal liver function are compared with similar infectious lymphocytosis, cytomegalovirus infection, and serum disease. In addition, the disease needs to be distinguished from myocarditis, rubella, and viral encephalitis.
Mononucleosis disease test
Mononucleosis laboratory test
- Peripheral blood. Hematological changes are an important feature of the disease. In the early stage, the total number of white blood cells is mostly in the normal range or slightly lower. After one week of onset, the total number of white blood cells increases, generally (10-20) × 109 / L, and the highest is 60 × 109 / L. Mononuclear cells increased mainly, accounting for more than 60%. An increase in abnormal lymphocytes of more than 10% or other absolute values exceeding 1.0 × 109 / L is diagnostic. Platelet counts are often reduced, which may be related to direct virus damage and immune complex effects. The total number of white blood cells in the blood is normal or slightly increased, up to 30 ~ 50 × 109 / L. Mononuclear cells (lymphocytes, monocytes, and atypical lymphocytes) can reach more than 60%, and among them, atypical lymphocytes can exceed 10%. At the beginning of the disease, the white blood cell count can be normal. The total number of white blood cells often increased 10 to 12 days after the onset, and the highest was 30,000 to 60,000 / mm3, and returned to normal by the third week. Abnormal lymphocytes (10% to 20% or more) can appear on the 1st to 21st days of the onset of disease, and they can be divided into three types: foam type, irregular type, and naive type according to their cell morphology. Such abnormal cells may originate from T cells and can also be found in other viral diseases such as viral hepatitis, epidemic hemorrhagic fever, chicken pox, mumps, etc., but the percentage is generally less than 10%. Platelet counts can be reduced. Very few patients have agranulocytosis or lymphocytopenia, which may be related to the body's abnormal immune response.
Mononucleosis serology
- (1) Heterophilic agglutination test: IgM type heterophilic antibody appears in the patient's serum, can agglutinate sheep or horse red blood cells, the positive rate is 80% -90%, and the titer is higher than 1:64 and still positive after absorption by guinea pig kidney, It has diagnostic significance. Pediatric tests under 5 years old are mostly positive. The heterophil agglutination test is a standard diagnostic test. The principle is that patient serum often contains heterophilic antibodies belonging to IgM that can agglutinate with sheep or horse red blood cells. The test was positive early in the course of the disease, about 40%, and the positive rates in the second and third weeks reached 60% and 80%, respectively, and the recovery period decreased rapidly. Normal people, patients with serum disease, lymphoid reticuloma, monocyte leukemia, and tuberculosis. Heterophilic antibodies can also appear in serum, which can be identified by guinea pig kidney and bovine erythrocyte absorption tests. It is generally considered that the titer titer after guinea pig kidney absorption is more than 1:64 is of diagnostic significance. Heterophilic agglutination test has a positive rate of 80% to 90%. The principle is that patient's serum often contains IgM heterogeneous antibodies, which can agglutinate with sheep red blood cells or horse red blood cells. The average duration of antibody in vivo is 2 to 5 months. Those who develop heterogeneous antibodies later often recover more slowly. In a few cases (about 10%), heterophilic agglutination tests have always been negative, and most of them are mild, especially in children.
- (2) EBV antibody detection: VCA IgA and EA IgG in serum are detected by immunofluorescence and enzyme immunosorbent assay. VCA IgM is a sign of recent EBV infection, and EA IgG is a sign of recent infection or active EBV replication. . Heterophilic agglutination tests of normal people, patients with serum diseases, and a few patients with lymphoid reticuloma, monocyte leukemia, tuberculosis, etc. can also have positive results (except for serum diseases, the antibody titer is lower), but they are available Guinea pig kidney and bovine erythrocyte absorption tests were identified.
- Normal people and the above-mentioned patients (except those with serum diseases), the heterophilic antibodies in the blood can be completely absorbed by the guinea pig kidney or partially absorbed by bovine erythrocytes, while the heterophilic antibodies in the blood of the patients can be absorbed by the guinea pig kidney partially and completely Absorption, and antibodies in the blood of patients with serum disease can be completely absorbed by both. Heterophilic lectins have clinical value from 1:50 to 1: 224, and generally have a diagnostic value of more than 1:80. If the titer is measured more than 4 times weekly, the significance is even greater. In recent years, the slide agglutination method has been used to replace sheep red blood cells with horse red blood cells. The results are faster and more sensitive than the test tube method. About 30% of patients can be complicated by streptococcal infection of the throat. The incidence of acute nephritis can be as high as 13%, and the clinical manifestations are similar to general nephritis. The incidence of spleen rupture is about 2%, which is usually more common within 10-21 days of the disease. Myocarditis is complicated by about 6% of patients.
- (3) EBV antigen detection: Southern blotting can detect integrated EBV DNA. The in situ hybridization department can determine the presence of EBV in oropharyngeal epithelial cells. The polymerase chain reaction can detect EBV DNA in a specimen sensitively, quickly, and specifically.
T Dynamic changes of T cell subsets in mononucleosis
- Objective To study the changes of peripheral blood T cell subsets CD3 ^ +, CD4 ^ +, and CD8 ^ + cells in children with infectious mononucleosis (IM) at different stages and their changes. Methods Peripheral blood of 30 children with IM were collected at different stages of the course of disease, and heparin was used for anticoagulation. Flow cytometry was used to detect 30 patients with IM in acute phase, 1 month course, 3 month course, 6 month course and normal controls. The expression rates of CD3 ^ +, CD4 ^ +, CD8 ^ + cells in peripheral blood lymphocytes in the group. Results In the acute phase of 1IM, CD4 ^ + (14.84 ± 5.03%) and CD4 / CD8 (0.25 ± 0.13%) were significantly decreased, and CD3 ^ + (82.55 ± 5.49%), CD8 ^ + (66.17 ± 8.10%) was significantly increased, and there were significant differences compared with the other groups (P <0.001).
- CD4 ^ + and CD4 / CD8 cells gradually increased with time and infection control, but the course of disease was 1 month (CD4 ^ +: 27.89 ± 6.04%, CD4 / CD8: 0.66 ± 0.16%) There was no significant difference with the course of disease in March (CD4 ^ +: 29.49 ± 4.49%, CD4 / CD8: 0.76 ± 0.20%) (P> 0.05), and the course of disease in June (CD4 ^ +: 32.81 ± 6.79%, CD4 / CD8: 0.93 ± 0.31%) and control group (CD4 ^ +: 65.04 ± 6.50%, CD4 / CD8: 1.18 ± 0.35%), there were significant differences (P <0.001); 3 course of January CD3 ^ + (76.25 ± 8.33%), CD8 ^ + (46.35 ± 9.43%) ) And the course of disease in March was CD3 ^ + (71.20 ± 5.32%), CD8 ^ + (37.76 ± 8.28%), and the course of disease in June CD3 ^ + (67.98 ± 8.01%), There were significant differences between CD8 ^ + (33.96 ± 7.37%) and CD3 ^ + (65.04 ± 6.50%) and CD8 ^ + (30.72 ± 16.51%) in the control group ( P <0.001);
- There was no significant difference in the duration of disease between March 3 and June in CD3 ^ +, CD4 ^ +, CD8 ^ +, and CD4 ^ + / CD8 ^ + (P> 0.05), but the March group was compared with the control group. There were significant differences in comparison (P <0.01); CD3 ^ +, CD4 ^ +, CD8 ^ +, and CD4 ^ + / CD8 ^ + were not significantly different from the control group in the course of the disease in each experimental group in June. (P> 0.05). Conclusion CD3 ^ + and CD8 ^ + increase significantly in the acute phase of IM, and CD4 ^ + and CD4 / CD8 decrease significantly. With the passage of time and infection control, CD3 ^ + and CD8 ^ + gradually decrease, and CD4 ^ + and CD4 / CD8 gradually decrease. CD3, CD4, CD8 expression and CD4 ^ + / CD8 ^ + reached normal levels in June.
Dialectical classification of mononucleosis
- 1. Exogenous wind and evil symptoms: cough, runny nose, red throat pain, swelling of milk moth, white miliary, heat ups and downs, nausea, abdominal discomfort, white tongue coating, floating pulse.
- Symptom analysis: When exogenous, the epidemic is poisonous. First, the lungs are lost. The evil heat is smoked through the meridians, so the milk moth is swollen, and there is white mime on it. The evil fights, the camp guards are not in harmony, so the body is ups and downs. Then the evil poison guilty of stomach, so I saw nausea, and abdominal discomfort. The white fur and the floating number of pulses show that the disease is still on the table.
- 2. Symptoms of yin deficiency and fire: strong body heat, thirst induced drinking, loss of appetite, low fever, night sweats, liver and splenomegaly, dark red tongue, thin white fur and thin pulse.
- Syndrome analysis: The evil poison is abundant inside and hurts the Yin points, so the body is overwhelmed, and thirst induces drinking. Yin deficiency and internal heat, low fever night sweats. Burning blood veins, blood stasis can not work, so see liver and splenomegaly.
- 3. Symptoms of fever and fever: strong heat, persistent thirst, irritability, subcutaneous bleeding, or seeing hematuria, red tongue, yellow fur, and pulse count.
- Syndrome analysis: Heat poisons thrive inside, so it is strong and hot, and thirst induces drinking. Disturbing gods, so restless. The evil heat forces blood to act in willful ways, overflows the skin, and infiltrates and scorches, and then the skin is bleeding or hematuria. The tongue is red and yellow with yellow veins and fiery veins.
- 4. Symptoms of hot and humid accumulation: yellowing, nausea and vomiting, lack of appetite, poor stool, liver and splenomegaly, greasy fur, and pulse count.
- Syndrome analysis: Insufficient endowment, spleen deficiency and dampness, re-sensation of exogenous epidemic poison, the two are combined. Damp-heat acts as a sting, which causes liver and gallbladder. Ganmu insults the spleen, so nausea and vomiting, less appetite for fruit, and unfavorable stool. Damp heat consumes yin and blood, blood stasis fails, and liver and spleen enlarge. The moss is white and greasy, and the number of pulses is succulent.
Typing for mononucleosis
- 1. The rule of exogenous wind evil: Shufeng Qingre Liyan.
- Main party: Yinqiaosan addition and subtraction.
- Addition and subtraction: milk moth with white spots, plus 10 grams of dry shoots, 6 grams of puffball; body heat fluctuations, plus 10 grams of white wei, 10 grams of confidante.
- Principal analysis: This card belongs to exogenous heat and poison when exogenous, and the disease is still on the surface.
- Examples of prescriptions:
- Silver Flower 10g Forsythia 10g Banlangen 30g Bupleurum 6g Scutellaria 10g White Flower Hedyotis 15g Grass Root 30g Red Root 10g Danpi 10g Licorice 6g
- 2, yin deficiency and fire rule: nourishing yin and clearing heat.
- Subject: Angelica Liuhuang Tang plus or minus.
- Addition and subtraction: night sweats, add 30 grams of oysters (fried first), 6 grams of Schisandra chinensis; thirst, add 30 grams of reed roots, 10 grams of Dendrobium; hepatosplenomegaly, add 10 grams of pancake decoction (including fried).
- Principal analysis: This card is evidence of heat poisoning yin, yin deficiency and fire, and its essence is to clear the heat. Therefore, the heat of the scutellaria baicalensis, Coptis chinensis and Phellodendron spp. Is used to clear the heat of the three burners, and it is supplemented with raw land, mature land, and black ginseng to nourish the Yin. With Angelica, Astragalus nourishing blood and nourishing Qi, played the function of nourishing yin and clearing heat.
- Examples of prescriptions:
- Angelica 10 g Coptis 3 g Cork 10 g Cooked land 10 g Schisandra 6 g Raw land 10 g Scutellaria baicalensis 10 g Astragalus 10 g Radix Ginseng 10 g Licorice 6 g
- 3, the rule of hot poisoning: Shengre detoxification, cooling blood to stop bleeding.
- Main party: Qingying Tonga minus.
- Addition and subtraction: subcutaneous bleeding, plus 10 grams of red scallion and 10 grams of tannin; hematuria, plus 10 grams of thistle and 30 grams of grass root.
- Principal analysis: This side has been in the camp for a long time, and the blood is forced to act indiscriminately. Rhinoceros hornifolia and Radix Rehmanniae clear heat and detoxify blood; Yinhua and Forsythia detoxify heat and detoxify; Coptis chinensis and bamboo leaves detoxify fire; Salvia miltiorrhiza clears heart and cools blood, promotes blood circulation and disperse blood stasis;
- Examples of prescriptions:
- 30 g buffalo horns (fried first) raw 10 g black ginseng 10 g bamboo leaves 6 g silver flower 10 g forsythia 10 g coptis 3 g salvia 10 g oleracea 10 g licorice 6 g
- 4, the rule of damp heat accumulation: clearing away heat and dampness.
- Main Party: Manna Disinfection Dan Plus.
- Addition and subtraction: liver and spleen enlargement, plus 15 grams of turpentine, 10 grams of salvia miltiorrhiza; nausea and vomiting, 6 grams of ginger and bamboo, 10 grams of ginger pinellia.
- Principal analysis: This card is due to the accumulation of damp and heat, and the disease is lingering. When using manna to disinfect dan, remove heat and dampness. Fang Huanghuang, Forsythia, Shegan, Fritillaria clears heat and detoxifies phlegm; Huoxiang, Cardamom, and Rhododendron are aromatic and moist; Talc, Mutong, Yinchen Qingli are hot and humid; Peppermint is cool and clear; shot on Qingli throat.
- Examples of prescriptions:
- Yinchen 10 g mountain cricket 10 g yellow fenca gram stone calamus 10 gram diarrhea 10 gram mutong 10 gram forsythia 10 gram kernel 6 gram (back) citron 10 gram licorice 6 gram
Treatments for mononucleosis
- The treatment of this disease is symptomatic, and most of the diseases can heal on their own. The acute phase, especially when complicated with hepatitis, should be bed rest. Antibiotics are not effective for this disease. They can only be added when the bacterial infection of the pharynx and tonsils is secondary. Penicillin G is generally appropriate. The course of treatment is 7-10 days. If ampicillin is administered, about 95% of patients may develop a rash, which usually occurs 1 week after administration or after discontinuation of the drug, which may be related to the immune abnormality of the disease, so ampicillin should not be used in this disease.
- It is thought that metronidazole and clindamycin may be helpful for the inflammation of the throat of this disease, suggesting the possibility of combined anaerobic infection, but clindamycin can also cause rash. Adrenal corticosteroids have indications for those with severe lesions or edema in the throat and throat, which can quickly resolve inflammation, and timely application can avoid tracheotomy. Hormones can also be used for central nervous system complications, thrombocytopenic purpura, hemolytic anemia, myocarditis, pericarditis and so on.
- Should be vigilant at any time about the possibility of spleen rupture, timely diagnosis, rapid blood volume replenishment, blood transfusion and splenectomy can often save patients.
- Acyclovir and its derivatives have antagonistic effects on EB virus in in vitro tests, but such drugs do not need to be routinely used in patients with infectious mononucleosis, but only with AIDS with oral white spot disease Patients and those who have sufficient evidence that they are chronic progressive EB virus infection may consider the use of such preparations.
Analysis of clinical characteristics of mononucleosis
- I. Materials and methods
- Data: There were 44 males and 32 females in 76 children with IM, male: female = 1.38: 1; age 2mo 14a, <1a4 patients (5.26%), 1 3a24 patients (31.6%), and 4 7a35 patients (46.1 %), 8 to 14a in 13 cases (17.1%).
- Method
- 1. Diagnostic criteria (1) Typical IM symptoms and signs: fever, angina, hepatosplenomegaly, large lymph nodes, rash, etc .; (2) peripheral blood variant lymphocytes (AL)> 0.10; (3) EB virus resistant clothing Shell antigen antibody (EBVVCAIgM) was positive. If you have any 3 of the clinical manifestations and have any of (2) and (3), you can diagnose.
- 2. The clinical manifestations were 32 cases (42.1%) with typical clinical manifestations, 71 cases (93.4%) with fever, 43 cases (56.6%) with heat course less than 7d at admission, 28 cases (36.8%) with> 7d, and 65 cases (85.5) with angina %), Cervical lymphadenopathy in 62 cases (81.6%), liver enlargement in 48 cases (63.1%), splenomegaly in 37 cases (48.7%), rash in 15 cases (19.7%), and cough in 23 cases (30.3%), Eyelid edema occurred in 2 cases (2.6%), convulsions in 3 cases (3.95%), and 1 case of thrombocytopenic purpura (1.31%).
- 3. Laboratory examination (1) Peripheral blood: Total white blood cells: minimum 2.7 × 109 · L-1, maximum 36 × 109 · L-1, of which 47 cases (61.8%)> 10 × 109 · L-1, 11 cases (14.5%) <4 × 109 · L-1, 18 cases (23.7%) were normal; white blood cell classification: lymphocytes 50% 26 cases (34.2%), monocytes + lymphocytes 60% 39 cases (51.3% ), 68 cases (89.4%) of atypical lymphocytes, of which up to 38%; 24 (31.5%) anemia, except for 7 (9.21%) moderate anemia, the rest are mild anemia ; Platelet 300 × 109 · L-122 cases (28.9%). (2) Liver function tests: The main manifestations of liver function tests in 76 cases were enzymatic changes, including 57 cases (75%) of lactate dehydrogenase (LDH) and 52 cases of aspartate aminotransferase (AST). 68.4%), 47 cases (61.8%) increased alanine aminotransferase (ALT), 34 cases (44.7%) increased total bile acid (TBA); total bilirubin, indirect bilirubin, direct bilirubin, There was no significant change in total protein and albumin. Degree of abnormal liver function. (3) EBV-specific antibody test: 61 cases of infectious mononuclear cell antibody (EBVIgM) were detected, of which 34 (55.7%) were positive; EBVVCAIgM was measured in 8 cases, of which 6 were positive. (4) Heterophilic agglutination test: 54 cases were tested, of which 31 cases were positive (57.4%). (5) Bone marrow examination: 17 cases underwent bone marrow cytology examination, of which 12 cases were proliferative bone marrow image, 3 cases were infectious bone marrow image, and 1 case was secondary thrombocytopenic purpura.
- 4. Other examinations: 43 cases of X-ray chest X-ray diagnosis showed: 11 cases of bronchial pneumonia, 19 cases of bronchitis; 3 cases of children with convulsive EEG examination showed: 2 cases of boundaries, 1 case was normal; 7 cases of ECG examination showed: 2 cases Sinus tachycardia.
- 5. After the diagnosis is confirmed, symptomatic treatment is mainly given, and intravenous acyclovir, ganciclovir or ribavirin are given; patients with combined bacterial infections are given antibiotics; those with high fever and severe symptoms are given hormones treatment. 68 cases were cured and 8 cases improved.
- Discussion
- The results of this study show that 42.1% of children with typical clinical manifestations of IM are not difficult to diagnose, but are often misdiagnosed early in the course of the disease as unexplained fever, purulent tonsillitis, lymphadenitis, bronchopneumonia, and sepsis. Especially fever patients with cervical lymphadenopathy and exudative tonsillitis are often misdiagnosed as suppurative tonsillitis, and differential diagnosis should be paid attention to.
- This group of patients is associated with liver damage, bronchial pneumonia, encephalitis, thrombocytopenic purpura, etc. The most common complication is digestive system complications, which are manifested as changes in liver function. There were no significant changes in total bilirubin, indirect bilirubin, direct bilirubin, total protein and albumin. The main manifestations are enzymatic changes, of which ALT, AST, and LDH elevations are the most common. The degree of liver enzyme elevation is mainly mild to moderate, with rapid recovery and good prognosis. The symptoms of the respiratory system are bronchitis. And bronchial pneumonia, especially in some patients without cough or cough has improved significantly, chest radiographs still show inflammation exudation. Therefore, for bronchial pneumonia with long fever and ineffective antibiotic treatment, we should be alert to the possibility of EBV infection. 2 cases of simple eyelid edema, normal urine and renal function. It is generally believed that IM eyelid edema is caused by oppression of enlarged lymph nodes in the neck, which causes venous lymphatic reflux disorder, not kidney damage. Therefore, improving the understanding of IM with eyelid edema will help reduce misdiagnosis and missed diagnosis.
- In primary hospitals, children are often seen earlier. In this group, 56.6% of the patients had a heat course 7d. At this time, the symptoms were often atypical, and peripheral blood routines had certain implications. Lymphocytes 50% in this group were 34.2%, monocytes + lymphocytes 60% were 51.3%, and the two accounted for about 85.5%. For early suspected cases, peripheral blood routine lymphocytes 50% or lymphocytes + monocytes 60% can be used for leukocyte-atypical lymphocyte detection. Because peripheral blood atypical lymphocytes are one of the main indicators for early diagnosis of infectious monocyte antibodies. Atypical lymphocytes generally appear 3 days after the disease, and can reach more than 10% within 1w, and can reach as high as 10-35% within 2 ~ 3w, and gradually decrease after 3w, and the duration is about 7w. In this group, at least 5% of the atypical lymphocytes accounted for 89.4%, and in the subsequent review, the atypical lymphocytes 10% accounted for about 90.1%. Therefore, in order to confirm the diagnosis of children's IM, peripheral blood abnormal lymphocytes must be examined multiple times, and the diagnosis of leaflets cannot be denied by relying on a single abnormal lymphocyte <10%.
- EBVVCAIgM appears in the early stage of infection and lasts for several weeks to 3 months. It is a reliable marker reflecting the recent primary infection of EBV. The positive rate is generally 66.7 to 100%. Due to the limitation of this group, only 8 cases were done, of which 6 cases were positive. The positive rates of infectious mononuclear cell antibodies (EBVIgM) and heterophilic agglutination tests were 55.7% and 57.4%, respectively, which is meaningful for diagnosis.
- For clinical manifestations similar to IM, but not caused by EBV infection, it is called infectious mononucleosis syndrome, which is mostly caused by cytomegalovirus, Toxoplasma gondii, adenovirus, hepatitis virus and so on. With the improvement of the level of medical detection, the detection rate of mononucleosis (CMVMN) caused by cytomegalovirus infection has increased in recent years. Adult patients are easier to distinguish. Adult CMVMN is less common. Severe sore throat, enlarged liver, spleen, and lymph nodes are common in IM. However, in children, the clinical manifestations of the two diseases are very similar and easily misdiagnosed. According to foreign reports, compared with the clinical manifestations of CMVMN and IM, except for IM, which has cervical lymphadenopathy, other clinical manifestations such as fever, exudative tonsillitis, hepatomegaly, splenomegaly, and sore throat are not significantly different. The results showed similar clinical manifestations. Therefore, patients with clinical manifestations similar to infectious mononucleosis, but with negative EBVVCAIgM or negative heterophile agglutination tests should be further tested for CMV virus-specific antibodies. A single serum of CMVIgM is positive, suggesting recent infection and can be confirmed.
- EBV is a herpes virus, and its human host cells are mainly B lymphocytes. EBV-infected B lymphocytes can express a series of EBV-specific antigen molecules, making the latter highly immunogenic, inducing the body's immune response, and stimulating CD4T lymphocytes to produce Th1-type cytokines, thereby activating NK cells and CD8 + T lymphocytes. Cells, producing EBV-specific cytotoxic T lymphocytes (CTL), thereby phagocytosing and destroying EBV-infected B lymphocytes, and gradually declining the clinical manifestations of IM. Because of this, most IM present benign self-limiting clinical experience. The children in this group are mainly mild and have a good prognosis. Compared with the control group of 91 children with IM, secondary lymphocytic leukemia and malignant tissue hyperplasia were significantly increased, suggesting that children with IM must be followed up for a long time.
Mononucleosis considerations
- 1. For in vitro diagnostic and professional use only.
- 2. Do not mix reagents of different batches. Do not use the kit if it expires.
- 3. All samples and control solutions are treated as infectious items.
- 4. Do not use highly hemolyzed samples.
- 5. Buffers and controls contain sodium azide. When handling these solutions, rinse with plenty of water.
- 6. Warning: Potential biohazardous substances.
- 7. The serum and plasma used for the preparation of the reference substance were verified by the FDA for HIV1 / 2, hepatitis B, and hepatitis C negative. However, in use, biosafety level 2 standards must be followed.
Mononucleosis related news
- Mononucleosis attacks Fei Tianwang announces end of dynasty prematurely Federer's legendary season continues, although points against Sampras in New York on Monday do not count towards points
- Federer
- crisis? Maybe, but now, Federer, 26, has some "unknown" stories. Last month, after a third illness in six weeks, he underwent a comprehensive examination in Switzerland and a corresponding examination during the days of his stay in Dubai. According to Federer, the test results showed that he had mononucleosis.
- Federer has said that he had food poisoning before the Australian Open, which completely disrupted his preparation plan and eventually lost to Djokovic. In the state of depression, Federer publicly stated that mononucleosis is a more serious problem. "Doctors say it will take at least 6 weeks to get back to what it was before December," Federer said in a telephone interview in Dubai. He is now ready to play after passing a medical examination.
- Mononucleosis is an infectious disease, usually caused by Epstein-Barr (EB) virus. It produces symptoms like a cold and long-lasting fatigue. Doctors usually discourage people with mononucleosis from participating in strenuous exercise, as expanding the infected area is likely to cause the spleen to rupture.
- "When I learned that it was mononucleosis, I was actually more happy to have advanced to the semifinals of the Australian Open because the doctor might say that you can't play." Federer said. Fei Tianwang also knows that mononucleosis once forced the world's top ten Croatian Ansic to miss six games in the 2007 season, including the Wimbledon Open. "At a football club in my hometown, a football player was forced to side out for two years," Federer said. "You heard it for two years, and now you hear it for another six months. So I think, my God."
- Federer said that he was unable to train for 10 days in February, and after receiving a medical report, he must resume training in the first 5 days of the Dubai Open on March 3. "They're not sure I've recovered, but I'm producing antibodies, which shows you're recovering," he said. "However, I have lost a lot of health. From December until I learned that I was sick, I felt great, but now I can't really get into training because you have to be vigilant against mononucleosis."
- Federer said he had a fever before going to Australia in December without any medical treatment. Afterwards, he felt unwell in Australia, so he accepted a long-planned two-week break, including his absence from the Super Cup. He said, however, that he was soon caught in the cold again and had to return to Switzerland for examination. Even in its heyday, Federer is entering a challenging season in his career. His struggle came from confrontation with Djokovic and his long schedule, including the Beijing Olympics. He is still pursuing to win his only missing French Open Grand Slam title, while he will attempt to break the record set by Bjorn Borg with a sixth consecutive Wimbledon title.
- Now, 2008 seems more challenging. This year is like a big theater. They have to see how a champion who is used to successfully winning will behave.
- Federer has largely avoided major injuries and has played 33 consecutive Grand Slam tournaments, winning 12 Grand Slam titles, leaving the remaining two to tie Sampras' career Record. He won three of four Grand Slam titles in 2006, and in 2007 he did the same. Although he could rule in Melbourne Park in 2008, he said it was too early to declare his dynasty over.
Mononucleosis prevention measures
- There are no effective precautions. Patients in the acute phase should be isolated from the respiratory tract. The respiratory secretions and sputum cups should be sterilized by bleaching powder or boiling. Because viremia can last for several months, you cannot participate in blood donation for at least 6 months after the illness. The vaccine is still under development.