Infectious mononucleosis in children is called glandular fever. It is a viral disease that is characterized by a prolonged rise in temperature, angina, an increase in various groups of lymph nodes, specific changes in peripheral blood. This disease is relevant for all age groups, but more for young children.
Infectious mononucleosis was first described as far back as 1885 by Filatov, but was later supplemented by a study of blood changes and the identification of a specific pathogen. Due to all this, this disease also received its official name for infectious mononucleosis. The causative agent was later identified by two scientists - and in honor of them the virus was called the Ebstein-Barr virus.
What a disease mononucleosis: causative agent of the disease
To correctly understand what a disease is infectious mononucleosis, and why this disease requires some attention, you need to know some features of the virus itself.
The Epstein-Barr virus is an immediate cause, that is, an infectious agent of this disease in children and adults. This representative of the herpesvirus family is prone to prolonged circulation in the human body, and also has a carcinogenic effect, which can lead to irreversible consequences. It can cause the development of not only infectious mononucleosis, but also the formation of nasopharyngeal carcinoma and Burkitt's lymphoma. The Epstein-Barr virus is transmitted, like most other viruses, by airborne droplets, through general utensils, kisses, toys and other items on which there is a saliva of the carrier of infection. The disease is very common.
Once in the body of the child, the virus immediately begins to multiply actively in the mucous membrane of the nasopharynx, from which it then enters the bloodstream and infects lymphocytes of type B, responsible for the production of antibodies. In these cells, the virus remains its entire subsequent life.
There are statistics on which by the age of 5 this infection is infected with just over 50% of children. In more than 90% of the population, by the age of 35, a blood test shows the presence of antibodies to EBV.This fact gives the right to assert that the majority of the adult population has already had an infectious mononucleosis. In 80-85% of cases, its development occurs in an erased form, that is, its characteristic symptoms either do not manifest at all, or manifest weakly, and the disease is mistakenly diagnosed as an acute respiratory viral infection or a sore throat.
Incubation period
This is the time interval from the Epstein-Barr virus entry through the pharynx into the baby's body and until the first signs of the disease appear. The incubation period varies widely from several days to two months, with an average of 30 days. At this time, the virus multiplies and accumulates in a quantity sufficient for a massive expansion.
It is possible to develop a prodromal period that does not have specific manifestations and is typical for all infectious diseases. In such cases, the disease will develop gradually - for several days, low, subfebrile body temperature, general malaise and weakness, fatigue, catarrhal phenomena from the upper respiratory tract in the form of nasal congestion, redness in the mucous membranes of the oropharynx can be observed, as well asgradual increase and reddening of the tonsils.
Symptoms of mononucleosis
From the first days there are slight malaise, weakness, head and muscle pains, pain in the joints, a slight increase in temperature and mild changes in the lymph nodes and pharynx.
Later, soreness appears when swallowing. The body temperature rises to 38-40 ° C, it can have undulating character, such temperature differences persist for 24 hours and can last 1-3 weeks. Tonsillitis manifests itself immediately or after a few days, is catarrhal with a slight swelling of the tonsils, lacunar with a more severe manifestation of inflammation in both tonsils or ulcerative necrotic with fibrinous film as in diphtheria.
The spleen and liver also increase. Quite often the skin becomes yellow. There is a so-called jaundice. When mononucleosis of severe hepatitis does not happen. The liver remains enlarged for a long time. The body takes normal sizes only 1-2 months after the time of infection.
The rash with mononucleosis appears on average on day 5-10 of the disease and in 80% of cases is associated with the use of an antibacterial drug - ampicillin. It has a patchy-papular character, elements of its bright red color, located on the skin of the face, trunk and extremities. The rash remains on the skin for about a week after which it fades and disappears completely.
Mononucleosis in children often occurs asymptomatically or with an erased clinical picture in the form of ARVI.The disease is dangerous for children with congenital immunodeficiency or atopic reactions. In the first case, the virus exacerbates the deficiency of immune defense and promotes the attachment of a bacterial infection. In the second - strengthens the manifestations of diathesis, initiates the formation of autoimmune antibodies and can become a provoking factor for the development of tumors of the immune system.
The main signs of mononucleosis include:
- the appearance of a headache;
- heat;
- mononuclear angina( on the tonsils there are dirty gray films, which are easily removed with tweezers);
- pain in muscles, joints;
- weakness, sore throat, nasal congestion;
- high susceptibility to other infectious agents;
- frequent skin lesions with herpes;
- bleeding gums;
- loss of appetite;
- enlargement of the liver and spleen;
- enlargement of the lymph nodes( usually enlarged lymph nodes on the posterolateral surface of the neck, they are weaved into conglomerates or chains, painless on palpation, not soldered to surrounding tissues and sometimes increase to the size of the egg).
In peripheral blood there is leukocytosis( 9-10o109 per liter, sometimes there may be more).The number of mononuclear elements( monocytes, lymphocytes, atypical mononuclears) is closer to the end of the first week of about 80% -90%.In the first days of the disease, there can be obvious neutrophilia with a stab-shift. Mononuclear reaction( mainly due to lymphocytes) can persist for 3-6 months and even up to several years. In convalescents after the period of infectious mononucleosis disease, another disease may appear, for example, acute influenza or dysentery, etc., as well as a quite significant increase in the number of mononuclear elements.
The disease lasts for one or more weeks. During the course of the illness, the high temperature is held for a week. Preservation of other changes proceed with small dynamics. Then there is a gradual decrease in temperature. In some cases, the next wave of temperature rise takes place. During the temperature drop, the raids in the throat disappear. Gradually diminished lymph nodes. The liver and spleen are mostly normal for several weeks or months. In the same way, the blood state is normalized. Rarely complications occur, such as stomatitis, pneumonia, otitis and others.
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How does nasopharynx damage occur in mononucleosis - photo
Diagnosis
When a doctor visits a medical institution for the first time, he or she performs an examination and finds out the symptoms. If a suspected infectious mononucleosis is given a blood test. It is necessary not only to confirm this disease, but also to exclude other health problems.
If atypical mononuclears are detected in the blood, then this confirms the diagnosis of "mononucleosis".The more such cells are found in the blood, the more severe the disease will be.
Consequences of
Complications are rare. The greatest importance is otitis, paratonzillitis, sinusitis, pneumonia. In isolated cases, there are ruptures of the spleen, hepatic insufficiency, acute liver failure, hemolytic anemia, acute hemolytic anemia, neuritis, follicular angina. When treating antibiotics with ampicillin and amoxicillin, skin rash is almost always observed in patients.
How to treat infectious mononucleosis in children
To date, there has not been developed a specific treatment for infectious mononucleosis in children, there is no single regimen for therapy, there is no antiviral drug that effectively suppresses the activity of the virus. Usually mononucleosis is treated at home, in severe cases in a hospital environment and recommended exclusively bed rest, chemically and mechanically sparing diet and water-drinking regime.
To reduce the heat, children's antipyretic drugs such as paracetamol, ibuprofen are used. A good result is mefaminamic acid due to the fact that the production of interferon is stimulated. It is necessary to refrain from lowering the temperature in children with aspirin, since Reye's syndrome can develop.
The throat is treated in the same way as with angina. You can apply tantumverde, various aerosols, rinse infusions of herbs, furatsilinom etc. Careful attention should be paid to the oral cavity, brushing your teeth, rinsing your mouth after each meal. With pronounced signs of rhinitis, vasoconstrictive droplets are used. But they should not get involved more than five days. The symptoms of the disease are eliminated, this is the supporting treatment, which eliminates the infection.
If a change in liver function is detected, a special diet, choleretic preparations, hepatoprotectors are prescribed. Immunomodulators together with antiviral drugs have the greatest effect. Imudon, Pediatric anaferon, Viferon, and also Cycloferon in a dose of 6-10 mg / kg may be prescribed. Sometimes has a positive effect metronidazole( Trichopol, Flagil).Since secondary microbial flora is rarely attached, antibiotics are indicated, which are prescribed only in case of complications and intense inflammatory process in the oropharynx( except antibiotics of the penicillin line, which in case of infectious mononucleosis in 70% of cases cause severe allergic reactions)
The spleen of the child can be increased intime of illness, and even minor injuries in the abdomen can lead to its rupture. Therefore, all children with mononucleosis should avoid contact sports and strenuous activity for 4 weeks. Athletes should especially limit their activities until the spleen returns to normal size.
In general, the treatment of infectious mononucleosis in children and adults is exceptionally symptomatic( drinking, reducing temperature, anesthetizing, alleviating nasal breathing, etc.).The appointment of antibiotics, hormonal drugs is carried out only with the development of appropriate complications.
Forecast
Infectious mononucleosis in children, as a rule, has a rather favorable prognosis. However, the main condition for the absence of consequences and complications is the timely diagnosis of leukemia and regular monitoring of changes in blood composition. In addition, it is very important to monitor the condition of the children until their final recovery.
Also, the sick children need a follow-up examination for the next 6-12 months to monitor residual events in the blood. It should be noted that there are no measures for specific and effective prophylaxis of infectious mononucleosis at the moment.