Infectious mononucleosis is an acute proliferative infectious disease of the monocyte-macrophage system caused by EBV infection and is common in the pediatric period.
I. Clinical manifestations
1. Fever: The majority of children have varying degrees of fever, with body temperature fluctuating from 38 to 40, with variable fever pattern and a fever duration of several days to weeks or even up to several months. Although the fever is high, the symptoms of toxicity are lighter than those of bacterial pharyngitis.
2. Lymph node enlargement: Every case has it, which is characteristic of the disease, mainly accumulating bilateral cervical lymph nodes, which may not be symmetrical bilaterally. Other lymph nodes may also be enlarged.
3. Pharyngitis: 80% of children have sore throat or inflammation of the throat and cheeks, congestion of the pharynx, enlarged tonsils, and exudation or pseudomembranes. 4. Hepatosplenomegaly: seen in 70% of cases, mostly in the first week of illness, and may have abnormal liver function, jaundice is rare, heavy hepatitis and liver failure may occur in severe cases.
5, rash: can appear maculopapular rash, mostly in the course of 4-10 days of the disease, the application of ampicillin sodium rash appearance rate up to 90%.
Second, auxiliary examination
1.Blood picture: the total number of white blood cells is increased, mainly lymphocytes, abnormal lymphocytes 10-90%, foamy, irregular and naive type, hemolytic anemia occurs when the red blood cells decrease, reticulocytes increase, immune abnormalities can lead to granulocyte deficiency or thrombocytopenia.
2. EBV antibody assay: one or more of the following results are indicative of acute infection: 1) anti-VCA-IgM antibody titers with potency 1:10 or higher; 2) anti-VCA-IgG antibody with potency 1:320 or higher; 3) anti-EA-D antibody with potency 1:10 or higher; 4) no anti-EBNA antibody in the serum.
3. Serum heterophilic agglutination reaction: Generally, a positive reaction is considered to be above 1:40, and above 1:80 is more valuable. A positive reaction can be seen 5 days after the onset of the disease, with a peak in 2-3 weeks and can last for 2-5 months. However, 10% of patients are always negative, especially in children under 5 years old.
Complications: The disease is a systemic viral infection, and a variety of complications can occur, affecting the prognosis.
1. Hematologic system: autoimmune hemolytic anemia with positive Coomb’s test may appear in 1-2 weeks of the course of the disease, and most of them can stop developing within 1 month, and granulocytopenia, eosinophilia, complete blood cytopenia or immune thrombocytopenic purpura may also occur.
2. Neurological system: 0.37%-7.3% of children may develop such comorbidities, and the symptoms vary greatly.
3, digestive system: liver function abnormalities are not serious, jaundice, hepatic necrosis, spontaneous splenic rupture, esophageal varices have been reported.
4, respiratory system: upper respiratory tract obstruction, peri-tonsillar abscess, pharyngeal edema, pneumonia, pleurisy or pleural effusion, etc.
5.Heart: non-specific T-wave changes in ECG or mild conduction abnormalities, myocarditis and pericarditis are rare.
6.Eye: Conjunctivitis, optic neuritis, hemianopia, strabismus, ptosis, etc. may be complicated.
7.Urological system: hematuria, proteinuria, nephritis, nephropathy, acute renal failure, etc.
8.Other: chronic fatigue syndrome, otitis media, mumps, etc.
IV. Treatment
The disease is often self-limiting, if there are no complications, the prognosis is mostly good, the course of the disease is about 1-2 weeks, but it can also be repeated, a few patients have a slow recovery, which can be several weeks or even months long. At present, there is a lack of specific treatment for this disease.
1.General treatment: bed rest for 2-3 weeks during the acute period, strengthen care and avoid serious complications.
2, antiviral treatment: virazole 10-15mg/kg.d, divided into 2 intravenous drips, the course of 5-7 days; acyclovir 5-10mg/kg.d, dissolved in 10% glucose 100ml in the static point, the course of 5-7 days; severe cases can be used a-interferon 1 millionμ intramuscular injection or dissolved in 10% glucose 100ml in the static point, the course of 5-7 days.
3, symptomatic: antipyretic, anti-stunning, sedation, hepatoprotective treatment. For severe complications of myocarditis, severe hepatitis, hemolytic anemia or thrombocytopenic purpura, short-term application of hormones, good economic conditions can be used gammaglobulin, 400mg/kg.d for 5 days. When accompanied by bacterial infection, antibiotics can be used, avoid using ampicillin, (because the incidence of rash after using up to 95%), penicillin can be used.