Which doctor treats infectious mononucleosis in a child. Infectious mononucleosis - symptoms (photos) in children and adults, treatment

Symptoms of mononucleosis

The duration of the incubation period varies, according to different authors, from 5 to 21 days, more often it is 7-10 days.

The onset of the disease is often acute, with a rise in body temperature to high numbers, but the entire clinical symptom complex usually develops by the end of the first week. The earliest symptoms are fever, difficulty in nasal breathing, swelling of the cervical lymph nodes, and sore throat.

By the end of the first week from the onset of the disease, most patients already have an enlarged liver and spleen, and atypical mononuclear cells appear in the blood.

With a gradual onset of the disease over 2-5 days, general malaise, a slight increase in temperature are noted, and there may be moderate catarrhal symptoms in the upper respiratory tract. In some patients, the initial temperature may even be normal, and only by the end of the first week does it become high, rising to 39-40o at the height of the disease. Rarely, infectious mononucleosis can proceed from beginning to end at normal temperatures. There is no typical temperature curve. Usually it decreases lytically. The decrease in temperature coincides with an improvement in general condition and the disappearance of other symptoms of the disease.

An important symptom of infectious mononucleosis is an enlargement of all groups of lymph nodes, mainly the cervical ones. They are visible to the eye, upon palpation they are dense, elastic, low-painful, and not fused to each other and the surrounding tissue. The skin over them is not changed. Their sizes vary from a pea to a walnut or a chicken egg. Their suppuration does not occur in infectious mononucleosis. Often, swollen lymph nodes are the first symptom of the disease. There is no parallelism in the degree of damage to the oropharynx: with mild angina there may be a significant enlargement of the cervical lymph nodes and with massive overlays on the tonsils it can be moderate. Enlargement of other groups of lymph nodes is rarely significant.

A constant symptom of infectious mononucleosis is damage to the oropharynx. There is always an increase and swelling of the palatine tonsils, the nasopharyngeal tonsil is affected, and therefore there is severe nasal congestion, difficulty in nasal breathing, constriction of the voice and “snoring” breathing with a half-open mouth. Despite severe nasal congestion, there is usually no nasal discharge in the acute period of the disease; sometimes they appear after nasal breathing is restored, because infectious mononucleosis affects the mucous membrane of the inferior turbinate at the entrance to the nasopharynx (posterior rhinitis). The posterior wall of the pharynx is also swollen, hyperemic in the hyperplasm of lymphoid tissue (granulosa pharyngitis), and covered with thick mucus. Hyperemia of the pharynx is moderate, sore throat is minor.

In almost 85% of children with infectious mononucleosis, plaque in the form of islands and stripes appears on the palatine and nasopharyngeal tonsils, sometimes solid in the first days of the disease, sometimes after 3-4 days. When they appear, the body temperature usually rises even more and the general condition worsens significantly.

An increase in the size of the liver and spleen in infectious mononucleosis is observed almost constantly (97-98% of cases). The liver begins to enlarge from the first days of the disease and reaches its maximum by the 4-10th day. Sometimes moderate yellowness of the skin and sclera appears. Jaundice usually occurs at the height of infectious mononucleosis and disappears along with the disappearance of other manifestations of the disease. The incidence of jaundice does not depend on the intensity of the increase in liver size. There are no severe hepatitis. The size of the liver is normalized only at the end of the first - beginning of the second month from the moment of the disease, remaining in some cases increased for three months.

One of the early symptoms of infectious mononucleosis is an enlargement of the spleen in the first days of the disease, reaching its maximum size on the 4th-10th day. In 1/2 of the patients, by the end of the third week from the onset of the disease, the spleen is no longer palpable.

Puffiness of the face and swelling of the eyelids often appear.

At the height of the disease, various skin rashes are common. The rash can be morbilliform, urticarial, scarlet-like, hemorrhagic. Exanthema and petechiae appear on the oral mucosa.

From the cardiovascular system, tachycardia, muffled heart sounds, and sometimes systolic murmur are noted, which usually disappear with recovery. There are no serious changes on the ECG.

A general blood test revealed moderate leukocytosis, atypical mononuclear cells (they are also called wide-plasma lymphocytes). In most cases, they are detected in the first days of the illness, especially at its height; in most children, within 2-3 weeks from the onset of the illness. The number of atypical mononuclear cells in infectious mononucleosis ranges from 5-10 to 50% and higher. There is a clear connection between the number of atypical mononuclear cells and the severity of the disease.

There are typical and atypical forms of infectious mononucleosis. In atypical (erased and asymptomatic) forms, the leading symptoms characteristic of infectious mononucleosis are weakly expressed or completely absent, and diagnosis is carried out on the basis of hematological and serological data.

Indicators of severity in typical forms are: the severity of general intoxication, the degree of enlargement of the lymph nodes, the nature of changes in the oropharynx, the degree of difficulty in nasal breathing, the severity of enlargement of the liver and spleen and changes in the general blood test.

The course of infectious mononucleosis in most cases ends after 2-4 weeks, sometimes after 1-1.5 weeks. Normalization of the size of the liver, spleen, and lymph nodes may be delayed for 1.5–2 months. Atypical mononuclear cells can also be detected in the blood for a long time.

There are no relapses or chronic course of infectious mononucleosis in children.

Complications are usually associated with the activation of microbial flora and especially with the accumulation of ARVI - an acute respiratory viral infection (bronchitis, pneumonia, otitis media).

The prognosis is favorable. The disease ends in recovery in 80% of cases within 2-3 weeks. In some cases, changes in the blood may persist for a long time - up to 6 months or more.

The world literature describes isolated cases of deaths from splenic rupture or damage to the nervous system in the form of bulbar or encephalitic forms.

The differential diagnosis of infectious mononucleosis is carried out with oropharyngeal diphtheria, acute respiratory viral diseases, especially adenoviral etiology, acute leukemia, and viral hepatitis.

Infectious mononucleosis, accompanied by sore throat, differs from diphtheria of the oropharynx in the nature and color of plaque, the discrepancy between the lesions of the pharynx and the enlargement of the lymph nodes (changes in the pharynx can be insignificant, and the enlargement of the lymph nodes is pronounced), enlargement of the liver and spleen, the presence of polyadenitis, typical blood changes (atypical mononuclear cells ).

The general condition of infectious mononucleosis usually suffers only slightly, despite severe difficulty in nasal breathing and high body temperature. With infectious mononucleosis, the febrile period is longer, in contrast to diphtheria, in which the elevated body temperature lasts no more than 3-4 days, and then decreases, despite the progression of local changes in the oropharynx.

Great difficulties arise in the differential diagnosis of infectious mononucleosis and ARVI, especially adenoviral etiology, in which a mononucleosis-like syndrome can be expressed. Differences: pronounced catarrhal symptoms (runny nose, cough, wheezing in the lungs) are not characteristic of infectious mononucleosis; If the liver and spleen increase during ARVI, then only slightly and mainly with adenoviral infection in young children. Atypical mononuclear cells in ARVI are detected rarely, once and in small quantities, not exceeding 5-10%. Conjunctivitis does not occur with infectious mononucleosis.

The issue is finally resolved after serological tests are carried out.

Cases of infectious mononucleosis, accompanied by high leukocytosis (30-60 g/l) and lymphocytosis (80-90%), must be differentiated from acute leukemia, which is characterized by severe pallor of the skin, a decrease in the number of red blood cells and hemoglobin, and a significantly accelerated ESR. The final diagnosis is established based on the results of sterile puncture.

In the differentiated diagnosis of infectious mononucleosis and lymphogranulomatosis, the duration of the disease (months), the wavy nature of the temperature curve, the absence of lesions of the oropharynx and nasopharynx, and neutrophilic leukocytosis indicate lymphogranulomatosis. In doubtful cases, lymph node puncture should be used. The presence of Berezovsky-Sternberg cells in the lymph node confirms the diagnosis of lymphogranulomatosis.

Infectious mononucleosis, accompanied by jaundice, should be differentiated from viral hepatitis. Long-term elevated body temperature and the presence of atypical mononuclear cells in the blood are not characteristic of viral hepatitis. The presence of pronounced biochemical changes in the blood serum (increased bilirubin, transaminase activity, thymol test, etc.) and negative serological reactions exclude the diagnosis of infectious mononucleosis.

Infectious mononucleosis in children of the first year of life has some features. At the onset of the disease, young children experience a runny nose and sometimes a cough in almost half of the cases. Often, from the first days of illness, snoring breathing, puffiness of the face, pastiness of the eyelids, cervical tissue, and polyadenia occur. Early (in the first three days) a sore throat appears with overlays on the tonsils. More often there are rashes on the skin. In the blood of young children, an increase in band and segmented neutrophils is often observed in the first days of illness.

Positive results of serological reactions occur less frequently and in lower titers than in older children. It is especially difficult to differentiate infectious mononucleosis in children of the first three years of life from acute respiratory viral infections, which are often accompanied by mononucleosis syndrome.

The course of the disease in young children is favorable and ends with complete recovery.

What is mononucleosis in adults

Mononucleosis in adults

Mononucleosis is a rather dangerous disease, although it is very rare.

Synonyms for infectious mononucleosis are glandular fever, Filatov's disease, Pfeiffer's disease, monocytic tonsillitis, and there are many other names for this disease.

Causes of mononucleosis

This disease is provoked by the Epstein-Barr virus, and it manifests itself in the form of fever, tonsillitis, generalized lymphadenopathy, certain changes in the hemogram, enlargement of the spleen and liver, the disease can also take a chronic form.

Epstein-Barr virus belongs to the group of herpes viruses type 4.

The source of infection in mononucleosis is a sick person, but the disease is less contagious, due to the high percentage of immune individuals. Although transmission of infection occurs through airborne droplets, it most often occurs through saliva (in particular, through kissing). In addition, there is a possibility of transmission of infection through blood transfusions.

People over forty years of age rarely get mononucleosis, but in HIV-infected people, reactivation of the Epstein-Barr virus can occur at any age.

During infection, some of the affected cells die, and the released virus infects new cells, as a result of which cellular and humoral immunity is impaired.

Against the background of lymphadenitis and enlargement of the liver and spleen, dyspepsia and abdominal pain are often observed. Every tenth patient has noticeable yellowness (icterus) of the skin and sclera.

Routine laboratory tests may show some abnormal liver function. A rash of a maculopapular, urticarial, or hemorrhagic nature is likely to occur. Quite characteristic are changes in the blood, which can be detected from the very first days of the disease, but in some cases these changes can be noticed much later.

Leukocytosis and an increase in the number of monocytes and lymphocytes are very often determined; ESR increases moderately. In addition to ordinary lymphocytes, atypical mononuclear lymphocytes of a larger size are also observed - atypical mononuclear cells.

Infectious mononucleosis is characterized by lesions of the lymphoid tissue of the nasal pharynx and tonsils. Over time, growth is noticeable not only in the submandibular, but also in the elbow, axillary, inguinal, especially posterior cervical, and in some cases, tracheobronchial lymph nodes. A well-known triad of symptoms manifests itself in the form of lymphadenopathy, fever and tonsillitis. Sore throat and dysphagia are present, but nasal breathing is not difficult. Speech with a nasal tone is detected. The tonsils are inflamed and enlarged. There are symptoms of catarrhal, follicular, membranous, ulcerative necrotizing tonsillitis, in some cases with peritosillitis. There is a sweetish-sweet smell from the mouth.

Diagnostics

Mononucleosis can be determined by a finger prick blood test for mononuclear cells. The peripheral blood of this disease contains a large number of wide-plasma mononuclear cells

In mild cases of the disease, therapeutic measures can be carried out at home; in mild cases of the disease and the possibility of isolating the patient, they can be carried out at home. However, severe conditions require hospitalization in the infectious diseases department. Bed rest is mandatory, treatment is carried out in accordance with the symptoms.

Antibiotics are prescribed only in the presence of bacterial complications, however, ampicillin and oxacillin are strictly contraindicated for this disease. Quite often a short course of glucocorticoid therapy is prescribed.

In the treatment of mononucleosis, human immunoglobulin against the Epstein-Barr virus is used.

Traditional methods include treating the liver with hophytol or milk thistle, and immunity should be improved with the help of echinacea.

Signs and symptoms of chronic mononucleosis in adults

Mononucleosis or glandular fever, monocytic tonsillitis, Pfeiffer disease, etc. - a disease caused by the Epstein-Barr virus. Clinical characteristics include fever, generalized lymphadenopathy, and tonsillitis. enlarged liver and spleen, characteristic changes in the blood count. In some cases, the disease can take a chronic form.

Epstein-Barr virus is a human B-lymphotropic virus that belongs to the group of herpes viruses. It can hide for a long time in the cells of an infected person in the form of a dormant infection, so the source of infection is a sick person or a carrier of the virus. Mostly people under 40 years of age get sick; after suffering from the disease, everyone develops a strong immunity to mononucleosis.

The virus is released into the environment starting from the last days of the incubation period. Duration – 6-18 months. The transmission mechanism of the Epstein-Barr virus is airborne, through a kiss, dirty hands, dishes, and hygiene items. During blood transfusion and during childbirth from an infected mother.

There is a high degree of susceptibility to infection, but when infected, both mild and erased clinical forms can develop. The spread of infection occurs everywhere, there are no epidemic outbreaks, and there is an increased incidence in girls aged 14-16 years and in boys aged 16-18. In case of infection with the virus at an older age, the disease does not have pronounced symptoms.

Since most adults usually have developed specific immunity by the age of 30-35, the clinical course of the disease is rare. When air containing the virus is inhaled, epithelial cells of the upper respiratory tract and pharynx are damaged in humans. Moderate inflammation of the mucous membrane develops; with the flow of lymph, the infection enters nearby lymph nodes, which contributes to the appearance of lymphadenitis.

In the blood, the virus hijacks B-lymphocytes and begins to actively spread. As a result, specific reactions are formed and pathological cell damage occurs. The pathogen is transported through the blood vessels throughout the body, reaching important organs. The Epstein-Barr virus lives in the human body throughout life; if immunity decreases, it manifests its negative impact.

Sometimes weakness, malaise, catarrhal symptoms may be observed, and if measures are not taken and an accurate diagnosis is not established, in such cases there is a gradual increase in symptoms. Weakness increases, the temperature rises, nasal congestion, difficulty breathing, sore throat and sore throat appear. In the acute period, increased sweating and intoxication are observed.

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Patients complain of muscle aches and headaches. pain when swallowing. Fever torments the patient for several days, and even a month; the course may vary. After a week, the disease should go into an exacerbation phase. General intoxication and sore throat appear. swelling of the lymph nodes, enlargement of the liver and spleen.

The patient's condition may worsen significantly. You can find catarrhal, ulcerative-necrotic processes, membranous or follicular sore throat with intense redness of the mucous membrane of the tonsils, yellowish and loose plaque in the throat. Examination reveals granularity of the posterior pharyngeal wall and mucosal hemorrhages.

From the first days of the disease, multiple lesions of the glands (polyadenopathy) occur. Enlarged lymph nodes are easily detected in almost any area accessible for examination by palpation. The occipital and submandibular nodes are most often affected. During palpation, the density of the lymph nodes is determined; usually they are dense, mobile, painless or with mild pain.

There is swelling of the surrounding tissue, yellowness of the sclera and skin, dark urine is released and dyspepsia appears. Spots, papules and various rashes are common, the location of which varies. The rash goes away quickly, there is no itching or burning of the skin. The acute period lasts about 2-3 weeks. Then comes the time for the gradual subsidence of clinical symptoms and the process of restoring normal functioning of the body begins.

Body temperature normalizes, signs of sore throat disappear, the liver and spleen acquire their natural size. It happens that for several weeks there are signs of adenopathy and low-grade fever. In a chronic relapsing course, the period of illness is prolonged.

Consequences of mononucleosis in adults

Complications from mononucleosis may be absent or very severe, sometimes the disease ends in death. One of the causes of death is splenic rupture. There are known cases of the development of severe hepatitis and tachycardia. psychosis, kidney inflammation.

Paralysis of facial muscles and cranial nerves occurs.

Sometimes you have to simultaneously treat pneumonia and fight swelling of the eyelids. Possible narrowing of the lumen of the larynx (airway obstruction), requiring emergency surgical intervention. Treatment should be carried out in a timely manner; if you seek help from a doctor at the first signs of the disease, the consequences of mononucleosis can be avoided.

Mononucliosis in children and adults. Symptoms, treatment, consequences

The virus appears in the patient’s saliva during the height of the disease, and can rarely persist for up to six months after recovery. During the latent course of the disease, the pathogen can settle in the epithelium lining the mucous membrane of the oropharynx and infect B-lymphocytes responsible for humoral immunity.

Mononucleosis in adults: symptoms and signs

Infectious mononucleosis is characterized by the following symptoms:

Angina;
Fever;
Damage to the lymph nodes;
Damage to the spleen and liver;
Changes in the blood picture.

Signs of mononucleosis. The disease begins with an increase in body temperature. The temperature during mononucleosis can rise to 40 C and drop to normal levels in the morning. Fever is accompanied by weakness, joint and muscle pain, lack of appetite, headaches, dizziness and migraines.

Fever with mononucleosis can last from several days to several months and is accompanied by enlarged lymph nodes. The axillary, inguinal, mediastinal and lymph nodes located along the posterior edge of the sternocleidomastoid muscle are mainly affected.

They are capable of increasing in size up to 3 cm in diameter, which is striking upon examination; palpation reveals mobility and pain. The affected lymph nodes are not fused with the surrounding tissues and do not cause changes in the overlying skin.

Sore throat, which occurs with infectious mononucleosis, can be of several types:

1. Lacunar;
2. Catarrhal;
3. Follicular;
4. Ulcerative-necrotic.

Almost from the first days of the disease, due to severe intoxication, an enlargement of the spleen and liver (hepatosplenomegaly) is detected, reaching a maximum by the 4-10th day of the disease. Due to damage to the liver parenchyma, additional symptoms of mononucleosis may develop:

- yellowness of the skin;
- icterus of the sclera of the eyes;
- increased activity of liver transaminases in the blood.

Often, mononucleosis symptoms are expressed in the form of a skin rash (urticarial, maculopapular or hemorrhagic), which appears after antibiotic therapy. Changes in the blood picture are characterized by the presence of atypical mononuclear cells and an increase in mononuclear cells - monocytes and lymphocytes.

Infectious mononucleosis in children

If a child comes into contact with a patient with mononucleosis, it is necessary to carefully monitor his condition for 2-3 months. If during this time no manifestations appear, then we can assume that the child has not become infected.

The clinical picture of mononucleosis in children is identical to that in adults. The disease begins with signs of intoxication, and the temperature during mononucleosis depends on the severity of the disease. Childhood mononucleosis can begin with bright and obvious symptoms, or it can occur in the form of mild malaise and low fever.

The appearance of a rash is not associated with the use of antibiotics and also appears at the onset of the disease. The spilled elements do not itch and therefore do not require any treatment. But if the rash is accompanied by itching, then this indicates an allergy to any drug being taken.

Enlargement of the lymph nodes in a child (polyadenitis) manifests itself quite clearly and occurs in symmetrical lymph nodes. The hyperplasia is so significant that it is noticeable upon examination. With enlarged lymph nodes in the abdominal cavity, compression of nearby nerve endings may occur, which will lead to the appearance of symptoms of an “acute abdomen.”

The presence of such manifestations often leads to misdiagnosis. Active proliferation of lymphoid tissue in the oropharynx can lead to difficulty in nasal breathing. But visible rhinitis is not accompanied by mucus secretion, unlike typical inflammatory processes.

Hepatosplenomegaly appears already in the first days of the disease and progresses over 2-4 weeks. Even with recovery, enlargement of the liver and spleen may continue for some time, which requires constant monitoring due to the risk of organ rupture.

Treatment and diagnosis

Diagnosis of the disease is not difficult. 4 studies are enough to confidently make a diagnosis:

1. Blood test - presence of IgM, IgG;
2. General blood test – shift of the leukogram to the left, presence of atypical mononuclear cells;
3. Blood biochemistry – increase in liver transaminases;
4. Ultrasound – hepatosplenomegaly.

The therapeutic tactics for treating mononucleosis are determined by the attending physician. Immunoglobulin against the Epstein-Barr virus and supportive drugs for the liver and spleen are mainly used. If a bacterial infection develops, antibacterial therapy is added. In severe cases, glucocorticoid therapy is administered to prevent the development of serious complications.

Consequences and complications

The development of complications of mononucleosis is explained by the addition of other infections or activation of the existing bacterial flora. As a result, the following pathologies and consequences of mononucleosis may develop:

Infection from the oropharynx can spread to nearby tissues and organs and cause sinusitis, tonsillitis, paratonsillitis, otitis media, bronchitis, pneumonia, etc.

Due to the heavy load on the liver, there is a risk of developing liver failure and hemolytic anemia.

In isolated cases, an enlarged spleen can rupture.

Antibiotic treatment may cause a rash that may leave scars on the skin.

Infectious mononucleosis in children - symptoms, treatment, complications

A disease called infectious mononucleosis was first described by N.F. Filatov in 1885 and became known as idiopathic lymphadenitis. This is an acute infectious viral disease that is characterized by an increase in the size of the spleen and liver, changes in white blood and a disorder of the reticuloendothelial system, complicated by lymphadenopathy.

It has been established that this disease is caused by a special herpetic virus, Epstein-Barr (type 4), which affects lymphoid-reticular tissue. Entering the body by airborne droplets, it affects the epithelium of the oropharynx, then through the bloodstream and regional lymph nodes. The Epstein-Barr virus remains in the human body for life, and with a decrease in immunity it can periodically recur.

Causes of infectious mononucleosis in children

Children under 10 years of age are most susceptible to this disease. As a rule, the child is often in a closed group, for example, in a kindergarten or school, where transmission of the virus by airborne droplets is possible. The virus dies very quickly when released into the environment, so infection occurs only through close contact, so it cannot be called very contagious. The Epstein-Barr virus in a sick person is found in particles of saliva, so infectious mononucleosis can be transmitted from person to person when:

• kiss
• cough
• sneeze
• sharing utensils

It is noteworthy that boys suffer from infectious mononucleosis twice as often as girls. Thus, there is a chance of easily becoming infected by sneezing or coughing, especially in spring and autumn-winter. Some people do not experience any symptoms of the disease, but are carriers of the virus and pose a potential danger to others. The virus enters the body through the respiratory tract, and the incubation period of the disease is approximately 5-15 days. In some cases it can last up to one and a half months.

Epstein-Barr virus is a very common infection; before the age of 5, over 50% of children become infected with this type and for the majority it does not cause serious symptoms or illness. Moreover, according to various sources, the infection rate of the adult population is 85-90%, and only in some children or adults this virus is expressed by symptoms that are commonly called infectious mononucleosis.

Symptoms of mononucleosis in a child

Since today there is practically no prevention from viral infection, if a child has been in contact with a patient with infectious mononucleosis, parents should closely monitor the child’s health in the next 2-3 months. If no symptoms of mononucleosis appear, then either the child has not become infected, or the immune system has coped with the virus and the infection is safe.

If a child develops symptoms of general intoxication - chills, fever, weakness, rash, enlarged lymph nodes - which doctor should he contact? First, see a local pediatrician or family doctor, then an infectious disease specialist.

The symptoms of infectious mononucleosis are varied. Sometimes general prodromal phenomena appear, such as malaise, weakness and catarrhal symptoms. Gradually, the state of health worsens, the temperature rises to low-grade fever, there is a constant sore throat and difficulty breathing due to nasal congestion. A characteristic phenomenon can also be called hyperemia of the mucous membrane of the oropharynx, as well as pathological proliferation of the tonsils.

Sometimes the disease begins suddenly and its symptoms are pronounced. In such a situation it is possible:

• fever, it occurs in different ways (usually 38 -39C) and lasts several days or even a month
• increased sweating, chills, drowsiness, weakness
• signs of intoxication - headache, muscle aches and pain when swallowing

• sore throat - granularity of the posterior wall of the pharyngeal mucosa occurs, its hyperemia, follicular hyperplasia, and possible mucosal hemorrhage
• hepatosplenomegaly - enlargement of the liver and spleen
• lymphadenopathy - enlarged lymph nodes
• general intoxication of the body
• the appearance of a rash on the body

The rash in mononucleosis most often occurs at the onset of the disease, simultaneously with fever and lymphadenopathy, and it can be quite intense, localized on the legs, arms, face, abdomen and back in the form of small red or pale pink spots. The rash does not require treatment, since it does not itch, cannot be smeared with anything, and will disappear on its own as the immune system strengthens its fight against the virus. However, if a child is prescribed an antibiotic and the rash begins to itch, this indicates an allergic reaction to the antibiotic (most often it is a penicillin series of antibiotics - ampicillin, amoxicillin), since the rash with mononucleosis does not itch.

However, polyadenitis is traditionally considered the most important symptom of infectious mononucleosis. It occurs as a result of hyperplasia of lymphoid tissue. In most cases, island-like deposits of a gray or whitish-yellowish hue develop on the tonsils of the nasopharynx and palate. Their consistency is loose and lumpy, they are easily removed.

In addition, peripheral lymph nodes enlarge. The actively reproducing virus is retained in them. The lymph nodes on the back of the neck grow especially rapidly: they become very noticeable when the child turns his head to the sides. Nearby lymph nodes are interconnected, and almost always their damage is bilateral.

Palpation of the lymph nodes is not very painful; they are mobile and do not come into close contact with the skin. Sometimes the lymph nodes located in the abdominal cavity also enlarge - they compress the nerve endings in this area and provoke the appearance of signs of an acute abdomen. This may lead to an inaccurate diagnosis and surgery.

Infectious mononucleosis is characterized by hepatosplenomegaly, that is, pathological enlargement of the spleen and liver. These organs are very sensitive to the disease, so changes in them begin to occur in the first days after infection. The spleen may become so enlarged that its tissues cannot withstand the pressure and it ruptures.

During the first 2-4 weeks, there is a continuous increase in the size of these organs, and to some extent it continues after the child’s recovery. When body temperature returns to physiological values, the condition of the spleen and liver normalizes.

Diagnosis of the disease

To begin with, to confirm the diagnosis of infectious mononucleosis in a child, the doctor usually prescribes the following tests:

• Blood test for IgM, IgG antibodies to Epstein-Barr virus
• General and biochemical blood test
• Ultrasound of internal organs, primarily the liver and spleen

Diagnosis of childhood infectious mononucleosis is quite difficult. The main signs of the development of the disease are tonsillitis, enlarged lymph nodes, liver and spleen, and fever. A doctor cannot detect a child’s sore throat or infectious mononucleosis by eye, so serological tests are required. Hematological changes are a secondary symptom of infectious mononucleosis.

Blood test for mononucleosis in children:

• Based on the results of a general blood test, one can judge by the number of leukocytes, lymphocytes and monocytes.
• ESR is also increased.
• Of course, the presence of atypical mononuclear cells – cells with large basophilic cytoplasm – is also important. The development of infectious mononucleosis is indicated by an increase in their content in the blood to 10%. It should be borne in mind that atypical elements do not appear in the blood immediately, and sometimes only 2-3 weeks after infection. Atypical mononuclear cells are oval or round elements, the size of which can reach the size of a large monocyte. These atypical elements are also called "monolymphocytes" or "wide-plasma lymphocytes."

When differentiating the diagnosis, first of all, it is necessary to distinguish tonsillitis from tonsillitis, to exclude Botkin's disease, acute leukemia, lymphogranulomatosis and diphtheria of the pharynx, which have similar symptoms. For the most accurate diagnosis in difficult cases, an analysis is performed to determine the titer of antibodies to the specific Epstein-Barr virus. There are also fast modern laboratory research methods that allow you to get results in the shortest possible time, for example PCR.

Persons with infectious mononucleosis undergo several serological tests every few months to determine the presence of HIV infection, since it also provokes an increased level of mononuclear cells in the blood.

Also, if symptoms of tonsillitis appear, it is necessary to visit an otolaryngologist and perform a pharyngoscopy in order to correctly determine the cause of this disease, since it can be of different etiologies.

How can adults and other children not get infected from a sick child?

If there is a child or adult in the family who has contracted infectious mononucleosis, it will be quite difficult not to infect the rest of the family members, not because the virus is very contagious, but because even after recovery, the ill child or adult can periodically release the virus with particles of saliva in environment and remains a virus carrier for life.

Therefore, there is no need for quarantine in case of infectious mononucleosis, even if healthy family members do not become infected during the child’s illness, the infection will most likely occur later, during the period when the patient has already recovered and returned to his normal routine. If the disease is mild, there is no need to isolate the child and establish quarantine; he can return to school as soon as he recovers.

How to treat infectious mononucleosis in children

To date, there is no specific treatment for infectious mononucleosis in children, there is no single treatment regimen, and there is no antiviral drug that would effectively suppress the activity of the virus. Usually the disease is treated at home, in severe cases in a hospital setting and only bed rest is recommended.

Clinical indications for hospitalization:

• High temperature 39.5 or higher
• severe symptoms of intoxication
• development of complications
• threat of asphyxia

There are several areas of treatment for mononucleosis in children:

• Therapy is mainly aimed at relieving the symptoms of infectious mononucleosis
• Pathogenetic therapy in the form of antipyretics for children (Ibuprofen, Paracetamol in syrup)
• Antiseptic local drugs for the relief of sore throat, as well as local nonspecific immunotherapy, are prescribed the drugs Imudon and IRS 19.
• Desensitizing agents
• General strengthening therapy - vitamin therapy, including vitamins B, C and P.
• If changes in liver function are detected, a special diet, choleretic drugs, hepatoprotectors are prescribed
• Immunomodulators together with antiviral drugs have the greatest effect. Imudon, Children's Anaferon, Viferon, as well as Cycloferon at a dose of 6-10 mg/kg can be prescribed. Sometimes metronidazole (Trichopol, Flagyl) has a positive effect.
• Since secondary microbial flora is often associated, antibiotics are indicated, which are prescribed only in case of complications and intense inflammatory process in the oropharynx (except for penicillin antibiotics, which cause severe allergic reactions in 70% of cases in infectious mononucleosis)
• During antibiotic therapy, probiotics are simultaneously prescribed (Acipol, Narine, Primadophilus for Children, etc. see the entire list of probiotic preparations with prices and composition)
• In case of severe hypertoxicity, a short-term course of prednisolone is indicated (20-60 mg per day for 5-7 days), it is used if there is a risk of asphyxia
• Installation of a tracheostomy and transfer to artificial ventilation is carried out in case of severe swelling of the larynx and difficulty breathing in children
• If the spleen ruptures, a splenectomy is performed as an emergency.

Prognosis and consequences of mononucleosis

Infectious mononucleosis in children, as a rule, has a fairly favorable prognosis. However, the main condition for the absence of consequences and complications is timely diagnosis of leukemia and regular monitoring of changes in blood composition. In addition, it is very important to monitor the condition of children until their final recovery.

One clinical study, which was conducted to find out the duration of the recovery process in children and adults who had suffered mononucleosis, involved 150 people. For six months after contracting the virus, patients were monitored by doctors to monitor their health. The results of the study are as follows:

• It is normal if the body temperature during infectious mononucleosis is above 37.5 and persists for the first few weeks from the onset of the disease. Also, the temperature is less than 37.5, that is, low-grade fever can be considered normal.
• Sore throat with infectious mononucleosis or sore throat lasts on average 1-2 weeks
• Lymph nodes return to normal within the first month of the disease
• Drowsiness, increased fatigue, and weakness persist after illness for quite a long time - from several months to six months.

Therefore, children who have recovered from the disease need a clinical examination over the next 6-12 months to monitor residual effects in the blood.

Complications of infectious mononucleosis occur quite rarely, but the most common among them is inflammation of the liver, causing jaundice and characterized by darkening of the urine and yellowing of the skin.

One of the most serious consequences of mononucleosis in children is splenic rupture, but this occurs in 1 case out of a thousand. This occurs when thrombocytopenia develops and overstretching of the lienal capsule leads to rupture of the spleen. This is an extremely dangerous condition in which the child can die from internal bleeding.

Other complications and consequences are mainly associated with the development of a secondary infection against the background of mononucleosis, mainly streptococcal and staphylococcal. Meningoencephalitis may also appear, manifested by airway obstruction and enlarged tonsils, severe forms of hepatitis and bilateral interstitial infiltration of the lungs.

There are a number of scientific studies that have established a connection between the Epstein-Barr virus and the development of certain types of cancer that are quite rare - these are various types of lymphoma. However, this does not mean at all that if a child has had infectious mononucleosis, he or she may develop cancer as a consequence. Lymphoma is a rare disease and the development of cancer is usually triggered by a sharp decrease in immunity for various reasons.

It is worth noting that there are currently no measures for specific and effective prevention of infectious mononucleosis.

Mononucleosis

Causes, symptoms and diagnosis of mononucleosis, consequences

Definition of mononucleosis

Infectious mononucleosis (mononary tonsillitis or glandular fever) is a disease caused by the filtering Epstein-Barr virus (human B-lymphotropic virus), which belongs to the group of herpes viruses. It can be present in human cells for a long time as a latent infection.

Children are most often affected by the disease; outbreaks of the disease occur throughout the year, but the highest incidence rate is reached in the autumn months. People get sick with mononucleosis once, after which lifelong immunity is developed.

Causes of mononucleosis

The disease is transmitted from a sick person in the acute period, and with erased forms of the disease, the source is also the virus carrier. Typically, infection occurs through close contact, when the virus is spread by airborne droplets, through kissing, transmission is possible through blood transfusions, while traveling on public transport, or when using other people's hygiene products.

Mononucleosis affects children with weak immunity, after suffering stress, under severe mental and physical stress. After the initial infection, the virus is released into the external space for 18 months. The duration of the incubation period ranges from 5 to 20 days. Half of the adult population experiences an infectious disease during adolescence.

In girls, infectious mononucleosis occurs at the age of 14-16 years, and boys are exposed to the disease at 16-18 years. The disease rarely affects people over 40 years of age, since antibodies to the virus are present in the blood of adults. What causes the rapid development of infection in an infected body? During the acute phase of the disease, some of the affected cells die, and when released, the virus infects new, healthy cells.

When cellular and humoral immunity is impaired, superinfection develops and a layer of secondary infection occurs. It has been noted that the Epstein-Barr Virus is capable of infecting lymphoid and reticular tissue, resulting in the appearance of generalized lymphadenopathy, enlargement of the liver and spleen.

Symptoms of mononucleosis

Mononucleosis is characterized by fever, damage to the pharynx (tonsillitis) and lymph nodes, enlarged tonsils, severe sore throat, enlarged liver and spleen, changes in blood composition, and can sometimes take a chronic course. From the first days, mild malaise, weakness, headaches and muscle pain, painful sensations in the joints, a slight increase in temperature and mild changes in the lymph nodes and pharynx appear.

Later, pain appears when swallowing. Body temperature rises to 38-40°C, may have a wave-like character, such temperature changes persist throughout the day and can last 1-3 weeks. Tonsillitis appears immediately or after a few days, it can be catarrhal with mild swelling of the tonsils, lacunar with a more severe manifestation of inflammation in both tonsils, or ulcerative-necrotic with a fibrinous film as in diphtheria.

Severe difficulty breathing and copious mucous discharge, mild nasal congestion, soreness and mucous discharge on the back wall of the pharynx mean the development of nasopharyngitis. In patients, a lance-shaped plaque may hang from the nasopharynx, and massive, loose, curd-like white-yellow deposits on the tonsils are observed.

The disease is accompanied by damage to the angular jaw and posterior cervical lymph nodes; they swell most clearly in the cervical group, along the posterior edge of the sternocleidomastoid muscle in the form of a chain or package. The diameter of the nodes can be up to 2-3 cm. Less commonly, the axillary, inguinal, and cubital lymph nodes become enlarged.

The infection affects the lymph flow of the intestinal mesentery, causes inflammation, and provokes pathological rashes on the skin in the form of spots, papules, and age spots. The time frame for the appearance of the rash is from 3 to 5 days; after three days it disappears without a trace. Recurrence of rashes usually does not occur.

There is no uniform systematization of the clinical forms of infectious mononucleosis; there can be not only typical (with symptoms), but also atypical (without symptoms) forms of the disease. Histological examination confirms the involvement of several important organs in the process. Inflammation of the interstitial tissue of the lung (interstitial pneumonia), a decrease in the number of cellular elements of the bone marrow (hypoplasia), and inflammation of the choroid (uveitis) develops.

Clinical manifestations of the disease are poor sleep, nausea, abdominal pain, diarrhea, and sometimes vomiting. Mononucleosis is characterized by the appearance of intraperitoneal tumors; it is also associated with the occurrence of lymphatic lymphomas in patients with reduced immunity.

Diagnosis of mononucleosis

Infectious mononucleosis is quite widespread, its mild forms are difficult to diagnose. The peculiarity of this virus is that it prefers to infect lymphoid tissue, which is found in the tonsils, lymph nodes, spleen and liver, so these organs suffer the most.

During the initial examination, the doctor determines the main symptoms of the disease based on complaints. If mononucleosis is suspected, blood tests (monospot test) are prescribed to rule out other diseases that can cause similar symptoms. Accurate diagnosis is only possible by collecting clinical and laboratory data.

The blood count usually reveals an increase in lymphocytes and the presence of atypical mononuclear cells in the blood. Serological studies can detect heterophilic antibodies to the erythrocytes of various animals.

The virus is found in saliva:

• after the incubation period of the infection has passed;
• during the period of its development;
• 6 months after recovery;

Epstein-Barr viruses persist in latent form in B-lymphocytes and in the mucous tissue of the oropharynx. Isolation of the virus is observed in 10-20% of patients who have had infectious mononucleosis in the past. In modern laboratories, laboratory diagnosis of the disease is performed on modern equipment using disposable sterile instruments when collecting biomaterial.

A positive result clarifies the presence of infection in the body, the transition of the disease to a chronic form, as well as the period of activation of the infectious process. Negative results mean absence of infection early in the course of the disease. To monitor the progress of the infection, blood tests should be done every three days.

Consequences of mononucleosis

Complications from infectious mononucleosis are very rare, but if they occur, they can be very dangerous. Hematologic complications include increased destruction of red blood cells (autoimmune hemolytic anemia), decreased platelet counts in the peripheral blood (thrombocytopenia), and decreased granulocyte counts (granulocytopenia).

In patients with mononucleosis, splenic rupture and airway obstruction can occur, which sometimes leads to death. There is a danger from a variety of neurological complications - from encephalitis, cranial nerve palsy, damage to the facial nerve and, as a result, paralysis of facial muscles. Meningoencephalitis, Guillain-Barré syndrome, multiple nerve lesions (polyneuritis), transverse myelitis, psychosis, cardiac complications, interstitial pneumonia are also considered complications of mononucleosis.

After an illness, children usually feel tired for about six months; they need to sleep more, including during the daytime. Such students should be given less workload at school.

Treatment of mononucleosis and prevention of mononucleosis

Symptomatic therapy is used in the treatment of mononucleosis. During the period of fever, antipyretic drugs and plenty of fluids are used. With the help of vasoconstrictor drugs, for example ephedrine, galazolin, etc., difficulty in nasal breathing is relieved.

They use desensitizing drugs that prevent or weaken allergic reactions, interferon, various immunostimulants or other effective antiviral drugs that are in the arsenal of doctors. Patients are prescribed gargling with warm solutions of furatsilin, soda solution and salt water.

To relieve headaches and reduce fever, ibuprofen and acetaminophen are recommended. To eliminate pain and reduce swelling of the tonsils, throat and spleen, it is advisable to take corticosteroids, always under the constant supervision of the attending physician. Special preventive measures for mononucleosis are the same as for ARVI. An important role is played by increasing immunity and mobilizing the internal forces of the human body.

It is believed that for the treatment of mild and moderate forms of the disease, the patient remains at rest, i.e., bed rest, moderate nutrition. It is necessary to select dietary products so as not to overload the damaged liver. Meals should be fractional (4-5 times a day) with a complete content of proteins, vegetable fats, carbohydrates, and vitamins.

Therefore, preference is given to dairy products, lean fish and meat, fruits, sweet berries, vegetables and soups made from them. You can eat porridge and wholemeal bread. The child is prohibited from butter, fried, smoked, pickled foods, canned food, pickles, and hot seasonings. Walks in the fresh air, a calm, joyful atmosphere in the house, and a good mood will be beneficial.

Regular consultations with a hepatologist and exemption from preventive vaccinations will not interfere with the child. Hypothermia and overheating, physical activity, sports are contraindicated; it is useful to engage in physical therapy.

Expert editor: Mochalov Pavel Alexandrovich | Doctor of Medical Sciences general practitioner

Education: Moscow Medical Institute named after. I. M. Sechenov, specialty - “General Medicine” in 1991, in 1993 “Occupational diseases”, in 1996 “Therapy”.

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Infectious mononucleosis

Infectious mononucleosis is an acute viral disease characterized by fever, sore throat and swollen lymph nodes. Certain changes in blood tests are also characteristic.

What it is?

The disease is caused by the human herpes virus type IV, also called the Epstein-Barr virus, after the names of the scientists who discovered it. Infectious mononucleosis is also called the “kissing disease”, since transmission of the virus in young people can occur through saliva during a kiss.

Infection with the Epstein-Barr virus is quite high, in all age categories, but the virus itself is not very contagious; infection requires prolonged contact with the carrier. In young children, the disease, as a rule, proceeds easily and unnoticed; the clinical picture of infectious mononucleosis develops in adolescence and young adulthood. The vast majority of adults are already infected with this virus.

What's happening?

After an initial invasion of the cells lining the nasal cavity, the virus penetrates the nasopharyngeal mucosa and then spreads to B lymphocytes. In these cells it actively multiplies, which causes the appearance of characteristic symptoms.

The incubation period averages from 30 to 50 days (variations from 4 days to 2 months are possible). There are four main symptoms:

• fatigue,
• increase in body temperature,
• a sore throat
• enlargement of regional (usually cervical) lymph nodes.

Usually the disease begins with a feeling of general malaise, which can last up to a week, then the body temperature rises to 38-39°C. There is an increase in lymph nodes up to 2-3 centimeters. The liver is always involved in the process, which can be manifested by a feeling of heaviness in the right hypochondrium, as well as darkening of the urine. In addition, the spleen is affected, which increases in size.

If the sick person has received the antibiotic ampicillin, a skin rash is almost always observed. Other complications described include encephalitis, seizures, various lesions of the nervous system, meningitis and behavioral disorders. A possible but fortunately rare complication is splenic rupture. This condition requires emergency surgery!

The illness lasts one to two weeks, then gradual recovery begins. Enlarged lymph nodes and general weakness may persist for three weeks.

Diagnosis and treatment

The doctor makes a diagnosis taking into account the characteristics of the clinical picture, but it is not strictly specific. For example, similar symptoms are observed in cytomegalovirus infection. Infectious mononucleosis can mimic side effects from certain medications, as well as some infectious diseases.

The diagnosis is made based on the determination of antibodies to the Epstein-Barr virus in the blood. In addition, to replace the affected B lymphocytes, the body produces new ones that have a very characteristic appearance (mononuclear cells). Their detection during microscopy of a blood smear also speaks in favor of infectious mononucleosis. In addition, to exclude streptococcal tonsillitis and other bacterial infections, a culture of tonsil discharge is done.

Most patients with infectious mononucleosis recover completely. In rare cases (less than 1%), death is possible due to the development of severe complications. Those recovering are advised to rest completely until the temperature normalizes and the sore throat disappears. To avoid rupture of the spleen, lifting weights and playing sports is prohibited for 6-8 days, even in cases where there is no noticeable enlargement of the spleen.

Paracetamol is used to reduce body temperature in infectious mononucleosis. Aspirin is not recommended due to the possibility of developing Reye's syndrome.

The disease leaves behind a strong immunity.

Infectious mononucleosis - symptoms (photos) in children and adults, treatment

Infectious diseases, of which there are more than two hundred, have a variety of names. Some of them have been known for many centuries, some appeared in the modern era after the development of medicine, and reflect some of the features of clinical manifestations.

For example, scarlet fever is so named because of the pink color of the skin rash, and typhoid is so named because the patient’s state of consciousness is disturbed by the type of toxic “prostration”, and resembles fog, or smoke (translated from Greek).

But mononucleosis stands apart: perhaps this is the only case when the name of the disease reflects a laboratory syndrome that is “not visible to the naked eye.” What kind of disease is this? How does it affect blood cells, how does it progress and how is it treated?

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Infectious mononucleosis - what is it?

the onset of the disease may be similar to a cold

First of all, this disease has several other names. If you hear terms such as “glandular fever”, “Filatov’s disease”, or “monocytic tonsillitis”, then you know that we are talking about mononucleosis.

If we decipher the name “mononucleosis”, then this term means an increase in the content of mononuclear, or mononuclear cells in the blood. These cells include special types of leukocytes, or white blood cells, which perform a protective function. These are monocytes and lymphocytes. Their content in the blood is not just increased during mononucleosis: they become altered, or atypical - this is easy to detect when examining a stained blood smear under a microscope.

Infectious mononucleosis is a viral disease. Since it is caused by a virus and not a bacterium, it must be said right away that the use of any antibiotics is completely pointless. But this is often done because the disease is often confused with sore throat.

After all, the transmission mechanism of mononucleosis is aerosol, that is, airborne droplets, and the disease itself occurs with damage to lymphoid tissue: pharyngitis and tonsillitis (angina) occur, hepatosplenomegaly appears, or an enlargement of the liver and spleen, and the content of lymphocytes and monocytes in the blood increases, which become atypical.

Who is guilty?

Infectious mononucleosis is caused by the Epstein-Barr virus, which belongs to the herpes viruses. In total, there are almost a dozen families of herpes viruses and even more of their types, but only this type of virus is so sensitive to lymphocytes, since on their membrane they have receptors for the envelope protein of this virus.

The virus is unstable in the external environment and quickly dies with any available methods of disinfection, including ultraviolet irradiation.

A characteristic feature of this virus is its special effect on cells. If ordinary viruses of the same herpes and chickenpox exhibit a pronounced cytopathic effect (that is, leading to cell death), then EBV (Epstein-Barr virus) does not kill cells, but causes their proliferation, that is, active growth. It is this fact that lies in the development of the clinical picture of mononucleosis.

Epidemiology and routes of infection

Since only people get sick with infectious mononucleosis, a sick person can infect a healthy person, and not only with the bright form of the disease, but also with the erased form of the disease, as well as an asymptomatic carrier of the virus. It is through healthy carriers that the “virus cycle” in nature is maintained.

In most cases of the disease, the infection is transmitted by airborne droplets: when talking, screaming, crying, sneezing and coughing. But there are other ways through which infected saliva and body fluids can enter the body:

• kissing, sexual intercourse;
• through toys, especially those that have been in the mouth of a virus-carrying child;
• through donor blood transfusion, if donors are carriers of the virus.

Susceptibility to infectious mononucleosis is universal. It may seem incredible, but most healthy people are infected with this virus and are carriers. In underdeveloped countries, where the population is very crowded, this occurs in children, and in developed countries - in adolescence and young adulthood.

Upon reaching 30–40 years of age, the majority of the population is infected. It is known that men are more likely to get infectious mononucleosis, and people over 40 years of age get sick very rarely: infectious mononucleosis is a disease of young people. True, there is one exception: if a patient is sick with HIV infection, then at any age he can not only develop mononucleosis, but also recur. How does this disease develop?

Pathogenesis

Infectious mononucleosis in adults and children begins with the fact that infected saliva enters the oropharynx, and there the virus replicates, that is, its primary reproduction occurs. It is the lymphocytes that are the target of the virus attack and quickly become infected. After this, they begin to transform into plasma cells and synthesize various and unnecessary antibodies, for example, hemagglutinins, which can glue foreign blood cells together.

A complex cascade of activation and suppression of various parts of the immune system is launched, and this leads to the accumulation of young and immature B lymphocytes in the blood, which are called “atypical mononuclear cells”. Despite the fact that these are its own cells, albeit immature, the body begins to destroy them because they contain viruses.

As a result, the body weakens, trying to destroy a large number of its own cells, and this contributes to the addition of microbial and bacterial infections, since the body and its immunity are “busy with other things.”

All this manifests itself as a generalized process in lymphoid tissue. Proliferation of immune cells causes hypertrophy of all regional lymph nodes, enlargement of the spleen and liver, and in the case of severe disease, necrosis in the lymphoid tissue and the appearance of various infiltrates in organs and tissues are possible.

Symptoms of infectious mononucleosis in children and adults

High temperature up to 40 is a symptom of mononucleosis (photo 2)

Infectious mononucleosis has a “vague” incubation period, which can last from 5 to 60 days, depending on age, immune status and the number of viruses that have entered the body. The clinical picture of symptoms in children and adults is approximately the same, only in children an enlargement of the liver and spleen manifests early, which in adults, especially with erased forms, may not be detected at all.

As with most diseases, infectious mononucleosis has a period of onset, peak and recovery, or convalescence.

Initial period

The disease is characterized by an acute onset. Almost on the same day, the temperature rises, chills occur, then a sore throat and regional lymph nodes become enlarged. If the onset is subacute, then lymphadenopathy occurs first, and only then fever and catarrhal syndrome develop.

Usually the initial period lasts no more than a week, and people often think that this is the “flu” or another “cold”, but then the height of the disease occurs.

Clinic at the height of the disease

Symptoms of infectious mononucleosis photo 3

The classic signs of “apotheosis of mononucleosis” are:

• High fever up to 40 degrees, and even higher, which can remain at this level for several days, and at lower numbers - up to a month.
• A kind of “mononucleosis” intoxication, which is not similar to ordinary viral intoxication. Patients get tired, have difficulty standing and sitting, but usually maintain an active lifestyle. They do not have the desire, as with ordinary infections, to go to bed even with a high temperature.
• Polyadenopathy syndrome.

The lymph nodes close to the “entrance gate” become enlarged. More often than others, the nodes on the lateral surface of the neck are affected, which remain mobile and painful, but are enlarged, sometimes to the size of a chicken egg. In some cases, the neck becomes bullish and mobility when rotating the head is limited. The damage to the inguinal and axillary nodes is somewhat less pronounced.

This symptom of infectious mononucleosis persists for a long time and disappears slowly: sometimes 3-5 months after recovery.

• Enlargement and severe swelling of the palatine tonsils, with the appearance of loose plaque, or sore throat. They even close together, making breathing difficult. The patient's mouth is open, there is a nasal tone, and swelling of the back of the throat (pharyngitis).
• The spleen and liver are almost always enlarged. This symptom of infectious mononucleosis in children is observed quite often, and can be well expressed. Sometimes there is pain in the side and right hypochondrium, mild jaundice and increased enzyme activity: ALT, AST. This is nothing more than benign hepatitis, which soon goes away.
• Peripheral blood picture. Of course, the patient does not complain about this, but the exceptional originality of the test results requires indicating this sign as the main symptom: against the background of moderate or high leukocytosis (15-30), the number of lymphocytes and monocytes increases to 90%, of which almost half are atypical mononuclear cells. This sign gradually disappears, and after a month the blood “calms down.”
• Approximately 25% of patients experience various rashes: bumps, dots, spots, small hemorrhages. The rash does not bother you, it appears towards the end of the period of initial appearance, and after 3-6 days it disappears without a trace.

rash due to infectious mononucleosis photo 4

About the diagnosis of mononucleosis

Infectious mononucleosis is a disease with a characteristic clinical picture, and it is always possible to identify atypical mononuclear cells in peripheral blood. This is a pathognomonic symptom, just like fever, enlarged lymph nodes, hepatosplenomegaly and tonsillitis combined.

Additional research methods are:

• Hoffa-Bauer reaction (positive in 90% of patients). Based on the detection of hemagglutinating antibodies, with an increase in their titer by 4 or more times;
• ELISA methods. Allows you to determine marker antibodies that confirm the presence of virus antigens (to capsid and nuclear antigens);
• PCR to detect the virus in blood and saliva. It is often used in newborns, since it is difficult to focus on the immune response in them, since the immunity is not yet formed.

Treatment of infectious mononucleosis, drugs

Uncomplicated and mild forms of infectious mononucleosis are treated at home by both children and adults. Patients with jaundice, significant enlargement of the liver and spleen, and an unclear diagnosis are hospitalized. The principles of treatment of infectious mononucleosis are:

• “Liver” table No. 5. The diet requires giving up spicy, smoked, fatty and fried foods to facilitate the functioning of the liver;
• Semi-bed rest, plenty of vitamin drinks are recommended;
• It is necessary to rinse the oropharynx with antiseptic solutions (Miramistin, Chlorhexidine, Chlorophyllipt) to avoid secondary infection;
• Antipyretic drugs from the NSAID group are indicated.

Attention! How to treat infectious mononucleosis in children, and what drugs should not be used? All parents should remember that taking aspirin in any type and dose is strictly prohibited in children until they reach the age of at least 12-13 years, since a serious complication may develop - Reye's syndrome. Only paracetamol and ibuprofen are used as antipyretic drugs.

• Antiviral therapy: interferons and their inducers. "Neovir", Cycloferon, Acyclovir. They are used, although their effectiveness has been proven only in laboratory studies;
• Antibiotics are prescribed when suppuration appears on the tonsils or other purulent-necrotic complications. Fluoroquinolones are used most often, but ampicillin can cause a rash in most patients;
• If a splenic rupture is suspected, the patient should be urgently operated on, according to vital indications. And the attending physician should always draw the attention of patients who are being treated at home that if jaundice increases, acute pain appears in the left side, severe weakness, or decreased blood pressure, it is necessary to urgently call an ambulance and hospitalize the patient in a surgical hospital.

How long to treat infectious mononucleosis? It is known that in 80% of cases, significant improvement occurs between 2 and 3 weeks of illness, so active treatment should be carried out for at least 14 days from the moment of the first signs of the disease.

But, even after improving your health, you need to limit your physical activity and sports for 1 to 2 months after discharge. This is necessary because the spleen is enlarged for a long time, and there is a significant risk of rupture.

If severe jaundice has been diagnosed, the diet must be followed for 6 months after recovery.

Consequences of mononucleosis

After infectious mononucleosis, persistent immunity remains. There are no recurrent cases of the disease. In rare exceptions, death can occur with mononucleosis, but it can be caused by complications that have little to do with the development of the virus in the body: this may be obstruction and swelling of the airways, bleeding due to rupture of the liver or spleen, or the development of encephalitis.

In conclusion, it must be said that EBV is not at all as simple as it seems: remaining persistent in the body for life, it often tries to “show its ability” to proliferate cells in other ways. It causes Burkitt's lymphoma, and is considered a possible cause of some carcinomas, since it has been proven to be oncogenic, or the ability to “tend” the body to develop cancer.

Its role in the rapid course of HIV infection is also possible. Of particular concern is the fact that the hereditary material of EBV is firmly integrated in the affected cells with the human genome.

Currently, studies of this phenomenon are being carried out, and it is possible that the Epstein-Barr virus will provide a solution to the creation of a vaccine against cancer and other malignant neoplasms.

Infectious mononucleosis - treatment, symptoms, causes, diagnosis and recovery

Infectious mononucleosis is caused by Epstein-Barr virus(DNA-containing virus of the genus Lymphocryptovirus). The virus belongs to the herpesvirus family, but unlike them, it does not cause the death of the host cell (the virus mainly multiplies in B lymphocytes), but stimulates its growth.

Becomes a reservoir and source of infection sick person or carrier of infection. An infectious disease specialist treats mononucleosis. Epstein-Barr viruses persist in latent form in B lymphocytes and in the epithelium of the oropharyngeal mucosa.

What is mononucleosis

Infectious mononucleosis occurs everywhere, affecting people of all age groups. In developed countries, the disease is registered mainly among adolescents and young adults, peak incidence falls on 14-16 years for girls and 16-18 years for boys. In developing countries, children of younger age groups are more often affected.

Rarely, infectious mononucleosis occurs in adults over 40 years of age, because most people at this age are immune to this infection. In children under 2 years of age, the disease is usually not diagnosed due to its latent course. Infectious mononucleosis slightly contagious: Mainly sporadic cases, occasionally small epidemic outbreaks.

Symptoms of mononucleosis

The cervical, axillary and inguinal lymph nodes gradually enlarge and swelling becomes visible. Inflammation of the cervical lymph nodes(cervical lymphadenitis), as well as tonsillitis, are typical signs of infectious mononucleosis.

Enlarged lymph nodes are elastic and painful on palpation. Sometimes body temperature reaches 39.4–40°. The temperature remains at a constant level or changes in waves throughout the day, dropping at times (in the morning) to normal. When the temperature rises, headaches are observed, sometimes severe.

From the first days of illness sizes increase liver and spleen, reaching a maximum at 4-10 days. Sometimes dyspeptic symptoms and abdominal pain are observed. In 5-10% of patients, mild icterus of the skin and sclera occurs.

Other symptoms also appear:

• jaundice;
• skin rash;
• stomach ache;
• pneumonia;
• myocarditis;
• neurological disorders.

In some cases, an increase in transaminase activity in the blood is detected, which indicates liver dysfunction. At the height of the disease or at the beginning of the convalescence period, patients receiving antibiotics develop an allergic rash (maculopapular, urticarial or hemorrhagic). This happens most often when prescribed penicillin drugs, as a rule, ampicillin and oxacillin (antibodies to them are found in the blood of patients).

The disease continues 2-4 weeks, sometimes longer. At first, fever and plaque on the tonsils gradually disappear, later the hemogram, the size of the lymph nodes, spleen and liver normalize.

In some patients, a few days after a decrease in body temperature, it rises again. Changes in the hemogram persist for weeks and even months.

Symptoms of mononucleosis in children

Children complain of the following symptoms:

• lack of appetite;
• nausea;
• headache;
• chills;
• pain in the sacral region, in the joints.

Then laryngitis appears, dry cough, sore throat, and fever. During this early period, the disease is diagnosed as influenza. In some children, these symptoms disappear after a few days. Careful clinical observation reveals enlargement and tenderness of the cervical lymph nodes. Other children develop the classic picture of the disease after this period.

The latter in some children occurs without any peculiarities (catarrh of the nose or throat), in others - tonsillitis, which sometimes takes on an ulcerative and even diphtheria character. Changes in the throat and tonsils become the gateway to secondary infection, sometimes occurring septically.

A typical symptom of mononucleosis is rash on the roof of the mouth. In addition, in addition to the symptoms of sore throat, some children experience swelling of the soft palate, uvula and larynx, as well as swelling of the oral mucosa. The gums soften, bleed, and ulcerate.

Sometimes inflammation of the cornea and mucous membrane of the eyelids occurs. Temperature stays 10-17 days, in some cases up to a month. Sometimes low-grade fever lasts for months.

A characteristic sign of this syndrome is enlargement of the lymph nodes, mainly in the cervical and nodes located behind the sternocleidomastoid and submandibular muscles (75% of cases), less often in the inguinal and axillary (30% of cases), sometimes in the occipital and elbow. The mesenteric nodes and mediastinal nodes may also enlarge.

Nodes enlarge either singly or in groups. As a rule, the nodes are small, elastic, painful when pressed, which often occurs in the cervical nodes and then only if there are large changes in the tonsils. Rarely does symmetrical enlargement of nodes occur. Abdominal pain, nausea, vomiting and diarrhea are associated with enlarged mesenteric nodes.

Descriptions of mononucleosis symptoms

Diagnosis of mononucleosis

Infectious mononucleosis is diagnosed based on several tests:

It is also considered a prerequisite for the development of mononucleosis presence of mononuclear cells. These cells are found in the blood during mononucleosis and their number is increased by 10% of normal. However, mononuclear cells are not detected immediately after the onset of the disease - usually 2 weeks after infection.

When one blood test fails to identify the cause of symptoms, the presence of antibodies to the Epstein-Barr virus is determined. Tests are often ordered PCR, which helps to get results quickly. Sometimes diagnostics are performed to determine HIV infection, which manifests itself as mononucleosis.

To determine the causes of a sore throat and differentiate it from other diseases, a consultation with an otolaryngologist is scheduled, who performs a pharyngoscopy, which helps determine the cause of the disease.

Treatment of mononucleosis

Which doctors should I contact if I have mononucleosis?

Treatment of mononucleosis is symptomatic. Antiviral, antipyretic, anti-inflammatory drugs are used drugs and means to enhance immunity. Application shown local antiseptics to disinfect the mucous membrane of the throat.

It is allowed to use anesthetic spray and solutions for rinsing the throat. If you are not allergic to bee products, use honey. This remedy strengthens the immune system, softens the throat and fights bacteria.

Infectious mononucleosis is often complicated by viral infections; in this case, antibiotic therapy is carried out. Patients need to be provided with plenty of fortified drinks, dry and clean clothes, and attentive care. Due to liver damage not recommended often take antipyretics, such as paracetamol.

In case of severe hypertrophy of the tonsils and the threat of asphyxia, a short-term course of prednisolone is prescribed. During treatment worth giving up from fatty, fried foods, hot sauces and seasonings, carbonated drinks, too hot food.

Medications

As a rule, the following medications are prescribed for mononucleosis:

• antipyretics (Ibuprofen, Paracetamol);
• vitamin complexes;
• local antiseptics;
• immunomodulators;
• hepatoprotectors;
• choleretic;
• antiviral;
• antibiotics;
• probiotics.

Treatment of mononucleosis in children

In the acute period of the disease, in order to avoid injury to the enlarged spleen (or its ruptures), it is important to observe bed rest. Treatment of mononucleosis in children is combined with herbal medicine. In this case, decoctions are effective.

Take equal parts of chamomile, calendula and immortelle flowers, coltsfoot leaves, yarrow grass and strings. Grind the herbs in a meat grinder. Next, take two tablespoons of the mixture and pour a liter of boiling water. The broth is infused in a thermos overnight. Take the infusion half an hour before meals, 100 ml.

Children are prescribed a special diet that must be followed six months to a year. At this time, nothing fatty, smoked, or sweet is allowed. The patient should consume as often as possible:

• dairy products;
• fish;
• lean meat;
• soups (preferably vegetable);
• puree;
• porridge;
• fresh vegetables;
• fruits.

At the same time, you will have to reduce the consumption of butter and vegetable oil, sour cream, cheese, and sausages.

After recovery, the child is monitored by an infectious disease specialist for 6 months so as not to miss blood complications. The disease leaves behind a strong immunity.

Instructions for the use of drugs for mononucleosis

Recovery from mononucleosis

When children have a fever, they are reluctant to eat, mainly drink a lot - even if it is sweet tea with lemon, non-acidic fruit drinks and compotes, natural juices without preservatives. When the temperature returns to normal, the child's appetite improves. You need to follow a proper diet for six months so as not to overload the liver.

Child after mononucleosis, gets tired quickly, feels overwhelmed and weak, and needs more time to sleep. You should not overload your child with home and school chores.

To prevent complications mononucleosis children need to follow some recommendations for six months:

The child needs leisurely walks in the fresh air; staying in the countryside or in the country has a beneficial effect on recovery from illness.

Complications of mononucleosis

As a rule, mononucleosis ends full recovery.

But sometimes serious complications occur:

Neurological complications

• polyneuropathy;
• encephalitis;
• meningitis;
• mental disorders.

Hematological complications

• decreased platelet count;
• death of red blood cells;
• decrease in the number of white blood cells.

Splenic rupture

A serious complication of mononucleosis, accompanied by a decrease in blood pressure, severe abdominal pain and fainting.

Causes of mononucleosis

The virus is detected in saliva at the end of the incubation period of the disease, during the peak period and sometimes 6 months after recovery. Isolation of the virus is observed in 10-20% of people who have had infectious mononucleosis in the past.

How can you become infected with mononucleosis?

Even after suffering from the disease, the patient continues to release the Epstein-Barr virus into the external environment for a long time (up to 18 months!). This has been proven by numerous studies.

Half of people experience infectious mononucleosis in adolescence: boys at 16-18 years old, girls at 14-16 years old, and then the incidence rate drops.

Persons over 40 years of age suffer from infectious mononucleosis extremely rarely. This does not apply to patients with AIDS or HIV infected; they suffer from mononucleosis at any age, in severe forms and with severe symptoms.

How to avoid getting mononucleosis

To improve immunity, regularly do a set of hardening activities. Wash your face with cool water, walk around the house barefoot, take a contrast shower, gradually increasing the duration of the cold part of the procedure and reducing the water temperature. If doctors do not prohibit it, douse yourself with cold water in winter.

Try to lead a healthy lifestyle, give up bad habits. Include easily digestible foods with vitamins and microelements in your diet: citrus fruits, dairy and other products. Physical education classes, walks in the fresh air, and morning exercises are required.

In consultation with the doctor, take medications that enhance immunity. It is better to be of plant origin, for example, tincture of eleutherococcus, ginseng, and Schisandra chinensis.

Since mononucleosis is transmitted by airborne droplets, it is necessary to avoid contact with a sick person. People who interacted with him become ill within twenty days, counting from the day of last contact.

If a child visiting is sick kindergarten, it is required to carry out a thorough wet cleaning of the group premises using disinfectants. Shared items (dishes, toys) are also subject to disinfection.

To other children who attended the same group, as prescribed by the pediatrician, specific immunoglobulin is administered to prevent the disease.

Questions and answers on the topic “Mononucleosis”

Hello, a one and a half year old child has elevated monocytes and atypical mononuclear cells in the blood. Enlarged tonsils and lymph nodes. No rash. The liver and spleen are not enlarged. Could this be infectious mononucleosis? Thank you.

The child suffered from mononucleosis a month ago, and his lymph nodes are still enlarged. Temperature is either 37 or 36.8

Daughter is 11 years old. I got sick with mononucleosis a month ago, and the cervical lymph node is going away very slowly, I don’t know how to deal with it. Help me please!

My son is 5 years old. We get sick very often, sometimes more than once a month. A month ago we were discharged from the hospital after suffering from infectious mononucleosis. Today my temperature rose again to 37.3 and my throat turned red. Throughout the month they took Cecloferon and Viferon. What to do for treatment now? Please tell me.

Lymph nodes sometimes remain enlarged (not inflamed) for quite a long time. If the child feels normal, everything is fine. They will pass with time. Continue to monitor your child's temperature and take your child to the doctor if the temperature rises above 38.5 C.

Tell me, what tests are needed to detect mononucleosis?

I’m 29. Three weeks ago the lymph node on the right side of my neck became enlarged and painful, the next day the same thing happened to the left and my throat became very swollen. After 4 days, the sore throat went away, a severe cough began and the temperature rose to low-grade. After another 3 days, the temperature rose to 38, ceftriaxone was prescribed, the temperature rose every day, on the sixth day of the antibiotic it began to drop to normal values, the lymph nodes returned to normal. After 4 days, low-grade fever again, after another 2 days, severe swelling of the throat and enlarged lymph nodes throughout the body. At the same time, severe sweating at night for two weeks and a dry cough. Could this be mononucleosis?

The diagnosis of mononucleosis is made on the basis of laboratory tests.

I am 62 years old. At the end of July I had a sore throat that I still can’t cure. I visited the ENT doctor. I took tests - BARRA virus - 650. The doctor said that she had once had mononucleosis and had very low immunity. Having found your site, I read that recurrent mononucleosis is impossible, so why can’t I cure my throat. And which doctor should I contact (at the moment I am rinsing alternately with chamomile, diluted alcoholic infusion of propolis, tanzelgone and lugol) or is it all about immunity? And what do YOU ​​recommend?

If the ENT specialist has not prescribed treatment and paid attention to immunity, you need to contact an immunologist.

Can there be complications in the joints after having mononucleosis a month ago?

On the seventh day, the child (daughter, almost 9 years old) had a fever; for the first 4 days it rose to 39.5. For the first 2 days, the child complained that it was painful to look at and had a headache, which usually happens with the flu, nothing else bothered him, they started taking Ingoverine. My throat turned red on the 4th day, but there was no plaque or pain, the doctor examined me and diagnosed ARV. However, in the evening on the 4th day they called an ambulance, the doctor suspected mononucleosis, the child was taking an antibiotic, they took a general blood test, a large number of leukocytes, mononuclear cells were within normal limits (as the pediatrician said), the lymph nodes were enlarged. On day 7 (today) we donated blood to detect early antibodies and the virus itself, the result will be ready in 2 days. The doctor gave me a referral for hospitalization and this worries us very much, because of course I don’t want to be in the infectious diseases department with my child. Please tell me how long is hospitalization necessary? My nose is bothering me (difficulty breathing), I don’t have much of a runny nose!

Patients are hospitalized according to clinical indications. The main indications for hospitalization and treatment of a patient in a hospital are: prolonged high fever, jaundice, complications, diagnostic difficulties.

My child is 1.6 months old. We went to the nursery for 4 days and fell ill with mononucleosis. For 7 days the temperature was below 40. We were admitted to the hospital. We injected her with antibiotics for 7 days and continue to take acyclovir. Now he's breaking out in pimples. Is this an allergy or is this how the disease manifests itself? What to do?

At the height of the disease, patients receiving antibiotics often develop an allergic rash. This is most often observed when prescribing penicillin drugs. Tell your doctor about this.

A 3-year-old child suffered from infectious mononucleosis and subsequently suffers from ARVI every month. How does mononucleosis affect the immune system, what is the most effective treatment and prevention of consequences?

In our opinion, the cause of frequent episodes of ARVI in a child is not mononucleosis, but another reason (decreased immunity), which may have led to the child developing mononucleosis. Infectious mononucleosis does not have a long-term effect on the immune system and does not cause late complications. To prevent ARVI, it is necessary to strengthen the immune system.

Please tell me, a 14-year-old child suffered from mononucleosis. How to determine whether there are complications? Our friends advised us to donate blood for AST and ALT. is this necessary? And is it necessary to test for antibodies to mononuclear cells?

How long has it been since your child had mononucleosis? Was the child examined by a doctor? If the child has no complaints, no yellowing of the sclera of the eyes or skin, then the presence of complications of mononucleosis is practically excluded. You do not need to take any additional tests.

My granddaughter will be 6 years old in December. A diagnosis of mononucleosis was made. There was no high temperature. Now they said that the liver is enlarged by +1.5-2 cm. What should the diet be?

The diet for mononucleosis is as follows: good nutrition, inclusion of boiled meat, low-fat fish, vegetables, fruits, dairy products, and cereals in the diet. Fried, fatty, spicy foods are excluded.

A 15-year-old boy suspected of infectious mononucleosis has been ill for 5 days: severe sore throat, nasal congestion, lack of appetite, severe weakness, headache, high fever has been present for 4 days (38.7-39.1). I knock it down with Nurofen (2 days), take Zinnat (2 days), Tantum Verde, Nazivin, Aqualor, rinse. Before Nurofen I beat it with Panadol (2 days). On palpation, the liver is enlarged, white plaque on the tonsils (fol. sore throat). Why does the temperature continue to persist? Is it harmful to take Nurofen for more than 3 days? And how long can a high temperature last? Tomorrow we will take a general urine and blood test.

Elevated temperature with infectious mononucleosis can last for quite a long time (up to several weeks). Taking Nurofen for more than 3 days is not dangerous, but we recommend that you additionally consult your doctor about this.

Six months ago I suffered from infectious mononucleosis. I carried it on my feet because I didn’t know. Then I just got tested for infections and found that I had it. There was a high temperature, the cervical and occipital lymph nodes were enlarged. After that I felt fine. The infectious disease specialist said that I no longer needed her treatment, and why I had a fever - let other doctors find out. Now I have had long-term sovereignty for six months. Malaise. Weakness. In the morning the temperature is 35.8, in the evening it rises. None of the doctors can say anything. And literally 3 days ago I also caught a cold. Regular ODS. But it is impossible to sleep at night, the lymph nodes on the back of the head and in the ears have enlarged. Now I don't know what it is. What is this connected with? Help me please!!

As a rule, infectious mononucleosis does not require specific treatment and always ends in recovery. The disease almost never recurs. After recovery, a person often has a weakened immune system and an increased susceptibility to other infections. There are many reasons for increased body temperature, so diagnosis is only possible through direct contact with a doctor, who will determine the presence of other symptoms and also prescribe additional tests.

Please tell me whether it is possible to vaccinate children (3 and 6 years old) with DPT and polymelitis if they are diagnosed with “infectious mononucleosis” or “cytomegalovirus”. We have been treating these infections for 2 years now, but to no avail. There is no acute phase now. Before this, the immunologist gave medical advice only once, when there was an acute phase, but the hematologist gives medical advice all the time. They require either medical clearance or vaccination from kindergarten. I know that it is practically impossible to cure these infections; I only poison the children’s bodies with medications. The last time the youngest was prescribed vitamins (his lymph nodes in his neck are constantly inflamed). A re-examination is now necessary. But I don’t want to go, because I know that the analysis will show the same thing, and the treatment will be the same.

In this case, vaccinations can be done.

How can you quickly and effectively increase a child’s immunity after mononucleosis?

The immune system is too complex and finely structured, and therefore it can be upset by any too sharp and active influences.

My 12-year-old son suffered from a severe form of mononucleosis in June. We are currently taking cycloferon. Recently the child began to complain of strong, rapid heartbeats. In a calm state, without physical activity, the pulse can reach 120 beats per minute with blood pressure in the range of 120/76 - 110/90. Cases of such strong heart palpitations occur even at night. Could these symptoms indicate any complication after an illness? Or is it something else? And which doctor should I contact?

You should take your child to a pediatrician and a cardiologist. Despite the fact that heart damage in mononucleosis is practically excluded, consultation with a cardiologist in this case is still necessary.

Is it possible to get infectious mononucleosis again?

My 12 year old son has mononucleosis. The acute stage of the disease has passed. Now we are recovering at home. I was constantly next to him, almost never left. I am 41 years old. Now I felt bad too. The temperature stays at 37.3 - 37.8. Severe weakness. Sore throat, the nose periodically does not breathe. The feeling that this pain and discomfort wants to move into the ears. My eyes were very red. Can I now become a carrier of this virus or get mononucleosis myself?

The symptoms you described are not typical for mononucleosis and it is generally unlikely that you contracted this disease from a child. you may have an episode of a common ARVI, common at this time of year (adenovirosis). We recommend symptomatic treatment of colds with folk remedies. If you notice pain in the liver area, swollen lymph nodes, or any other signs of mononucleosis, be sure to consult a doctor.

My 12 year old son was diagnosed with mononucleosis. The disease is difficult. The temperature reached 40.4. We relieve the symptoms of this disease using traditional means. At this point in time it is the 6th day of illness. The temperature stays within 38.3 - 39.5. I refuse hospitalization due to the fact that the child eats exclusively homemade food. Maintaining this condition in the hospital is not possible, due to the fact that appetite can occur at any time of the day when the temperature drops, even at night. Can I treat this disease while staying at home? What are the possible risks associated with this disease?

In most cases, infectious mononucleosis in children progresses favorably, which makes treatment at home possible, but despite this you should keep your child under medical supervision. The most dangerous complication of mononucleosis is splenic rupture, so make sure that for some time after recovery the child refrains from active games that could lead to a fall or abdominal injury.

What kind of disease is mononucleosis and how to treat it

Infectious mononucleosis is encountered everywhere. Even in developed European countries this disease is registered. It mainly affects young people and adolescents aged 14-18 years. Mononucleosis is much less common in adults, since people over 40 years of age, as a rule, have immunity to this infection. Let's figure out mononucleosis - what kind of disease it is and how to deal with it.

What is mononucleosis

Mononucleosis is an acute infectious disease accompanied by high fever, damage to the lymph nodes and oropharynx. The spleen and liver are involved in the painful process, and the composition of the blood changes. Mononucleosis (ICD code 10) has several other names: monocytic tonsillitis, Filatov's disease, benign lymphoblastosis. The source of infection and reservoir of mononucleosis is a person with a mild disease or a carrier of the pathogen.

The causative agent of infectious mononucleosis is the Epstein-Barr virus of the Herpesviridae family. Its difference from other herpes viruses is that the cells are activated rather than killed. The pathogen is unstable to the external environment, therefore it quickly dies when exposed to disinfectants, high temperature or when dried out. People infected with the virus excrete it in their saliva for 6-18 months after recovery.

Why is Epstein-Barr virus dangerous?

Viral mononucleosis is dangerous because immediately after entering the bloodstream it attacks B-lymphocytes - the cells of the immune system. Once it gets into the cells of the mucous membrane during primary infection, the virus remains in them for life, because it cannot be completely destroyed, like all herpes viruses. An infected person, due to the lifelong presence of the Epstein-Barr infection in him, is its carrier until his death.

After penetrating the immune cells, the virus causes them to transform, due to which they, multiplying, begin to produce antibodies to themselves and to the infection. The intensity of reproduction leads to the fact that the cells fill the spleen and lymph nodes, causing them to enlarge. Antibodies to the virus are very aggressive compounds that, once they enter a tissue or organ of the human body, provoke diseases such as:

• Lupus erythematosus.
• Diabetes.
• Rheumatoid arthritis.
• Hashimoto's thyroiditis.

How is mononucleosis transmitted to humans?

Often, infectious mononucleosis is transmitted from a human carrier to a healthy person through airborne droplets or saliva. The virus can be transmitted through hands, through sexual intercourse or kissing, through toys or household items. Doctors do not exclude the possibility of transmission of mononucleosis during labor or blood transfusion.

People are very susceptible to the Epstein-Barr virus, but erased or atypical mononucleosis (mild form) predominates. Only in a state of immunodeficiency does infection contribute to the generalization of the virus, when the disease becomes visceral (severe) form.

Symptoms and signs of the disease

Characteristic criteria for the first days of infection with mononucleosis are an increase in the size of the spleen and liver. Sometimes during illness there is a rash on the body, abdominal pain, and chronic fatigue syndrome. In some cases, with mononucleosis, liver function is impaired, and the temperature persists for the first few days.

The disease develops gradually, starting with a sore throat and high fever. Then the fever and rash due to mononucleosis disappear, and the plaque on the tonsils disappears. Some time after starting treatment for mononucleosis, all symptoms may return. Poor health, loss of strength, enlarged lymph nodes, loss of appetite sometimes lasts for several weeks (up to 4 or more).

Diagnosis of the disease

Recognition of the disease is carried out after a thorough laboratory diagnosis of infectious mononucleosis. The doctor examines the general clinical picture and analyzes the patient’s blood for CPR (polymerase chain reaction). Modern medicine is able to detect the virus without analyzing nasopharyngeal secretions. The doctor knows how to diagnose and treat mononucleosis by the presence of antibodies in the blood serum even at the stage of the incubation period of the disease.

To make a diagnosis of mononucleosis, serological methods are also used, which are aimed at identifying antibodies to the virus. When a diagnosis of infectious mononucleosis is made, a three-time blood test is required to determine the presence of antibodies to HIV antigens, since this infection at the initial stage of development also sometimes gives symptoms of mononucleosis.

How to treat mononucleosis

A disease with a mild or moderate stage can be completely treated at home, but the patient is isolated from others. In severe forms of mononucleosis, hospitalization is required, which takes into account the degree of intoxication of the body. If the disease occurs against the background of liver damage, then the hospital prescribes therapeutic diet No. 5.

There are currently no specific treatments for mononucleosis of any etiology. Doctors, after studying the medical history, carry out symptomatic therapy, in which antiviral drugs, antibiotics, detoxification and restorative drugs are prescribed. Rinsing the oropharynx with antiseptics is mandatory.

If there are no bacterial complications during mononucleosis, then antibiotic treatment is contraindicated. If there are signs of asphyxia, if the tonsils are greatly enlarged, a course of treatment with glucocorticoids is indicated. After the body has recovered, children are prohibited from receiving preventive vaccinations for another six months to avoid complications of mononucleosis.

Drug treatment: drugs

Infectious mononucleosis, even if completely untreated, can go away on its own over time. But to prevent the disease from becoming chronic, patients are recommended to undergo therapy not only with folk remedies, but also with medications. After consulting a doctor, a patient with mononucleosis is prescribed a pastel regime, a special diet and the following medications:

1. Acyclovir. An antiviral drug that reduces the manifestation of the Epstein-Barr virus. For mononucleosis in adults, the drug is prescribed 5 times a day, 200 mg. It should be taken for 5 days. The pediatric dose is exactly half of the adult dose. During pregnancy, treatment with the drug is prescribed in rare cases under strict medical supervision.
2. Amoxiclav. For infectious mononucleosis, this antibiotic is prescribed if the patient has an acute or chronic form of the disease. Adults need to take up to 2 grams of medication per day, teenagers - up to 1.3 g. For children under 12 years of age, the dosage is prescribed by a pediatrician individually.
3. Suprax. A semisynthetic antibiotic that is prescribed for infectious mononucleosis once a day. Adults are prescribed a single dose of 400 mg (capsules). The course of taking the medicine during illness lasts from 7 to 10 days. For children (6 months - 2 years) with mononucleosis, a suspension is used at a dose of 8 mg per 1 kg of weight.
4. Viferon. Antiviral immunomodulator that enhances immunity. At the first signs of mononucleosis, a gel or ointment is prescribed for use (externally) on the mucous membranes. During illness, the drug is applied to the affected area for a week, up to 3 times a day.
5. Paracetamol. An analgesic that has antipyretic and anti-inflammatory effects. Prescribed for acute form of mononucleosis to patients of all ages (headache, fever) 1-2 tablets. 3 times/day 3-4 days. (See detailed instructions for use of Paracetamol).
6. Faringosept. An anesthetic that helps relieve sore throat due to mononucleosis. Prescribe, regardless of age, 4 absorbable tablets per day. Take the drug for no more than five days in a row.
7. Cycloferon. Immunomodulatory and antiviral medicine, effective against the herpes virus. Suppresses its reproduction in the earliest stages of mononucleosis (from 1 day). Children under 12 years of age and adult patients are prescribed 450/600 mg daily dose orally. For children over 4 years of age, the daily intake is 150 mg.

Treatment of mononucleosis with folk remedies

It is also possible to cure mononucleosis with natural remedies, but there is a risk of various complications. The following folk recipes will help shorten the course of the disease and alleviate symptoms:

• Flower decoction. Take freshly picked or dried chamomile, sage, and calendula flowers in equal doses. After stirring, pour boiling water and leave for 15-20 minutes. To increase immunity and reduce liver intoxication during infectious mononucleosis, drink 1 glass (150-200 ml) of the decoction 3 times a day until the condition improves.
• Herbal decoction. To reduce a sore throat during an infection, gargle every 2 hours with a decoction of crushed rose hips (1 tablespoon) and dry chamomile (150 g). Brew the ingredients in a thermos for 2 hours, then gargle until completely cured.
• Cabbage broth. Vitamin C, which is found in large quantities in white cabbage, will help speed up your recovery and relieve fever. Boil the cabbage leaves for about 5 minutes, then leave the broth until it cools. Take 100 ml of cabbage broth every hour until the fever stops.

Therapeutic diet

As already mentioned, infectious mononucleosis affects the liver, so you should eat right during illness. The foods that the patient should consume during this period should be enriched with fats, proteins, carbohydrates and vitamins. Meals are prescribed in fractional doses (5-6 times/day). During a therapeutic diet, the following products are needed:

• low-fat dairy products;
• lean meat;
• vegetable purees;
• fresh vegetables;
• sweet fruits;
• fish soups;
• lean sea fish;
• seafood;
• some wheat bread;
• porridge, pasta.

During a therapeutic diet, give up butter and vegetable oil, hard cheese, fatty sour cream, sausages, sausages, and smoked meats. You cannot eat marinades, pickles, or canned food. Eat less mushrooms, pastries, cakes, horseradish. It is strictly forbidden to eat ice cream, onions, coffee, beans, peas, and garlic.

Possible complications and consequences

Mononucleosis infection is very rarely fatal, but the disease is dangerous due to its complications. The Epstein-Barr virus has oncological activity for another 3-4 months after recovery, so you should not be in the sun during this period. After the illness, brain damage and pneumonia (bilateral) sometimes develop with severe oxygen deprivation. It is possible that the spleen may rupture during illness. If a child has a weakened immune system, mononucleosis can lead to jaundice (hepatitis).

Prevention of mononucleosis

As a rule, the prognosis of the disease is always favorable, but the symptoms of mononucleosis are similar to many viruses: hepatitis, sore throat and even HIV, so consult a doctor at the first signs of the disease. To avoid infection, try not to eat from someone else’s dishes, and if possible, avoid kissing on the lips again, so as not to swallow infectious saliva. However, the main prevention of the disease is good immunity. Lead a healthy lifestyle, exercise your body physically, eat healthy food, and then no infection will defeat you.

Content

Weakness, sore throat, fever are signs reminiscent of flu or sore throat. Mononucleosis in children is a viral disease that occurs in an acute form and is characterized by an enlargement of the spleen, liver, and lymph nodes throughout the body (lymphadenopathy). A characteristic sign of the disease is a change in blood composition. For what reasons does the disease develop, how is it treated? Parents should know the symptoms of the disease and its consequences in order to consult a doctor in time.

Pathogen

Infectious mononucleosis in children is caused by the Epstein-Barr virus (herpes type 4), which belongs to the genus Limphocryptovirus, subfamily Gammaherpesvirinae, family Herpesviridae. The action of the infectious agent is aimed at damaging the body's lymphatic system. The virus has the following features:

• captures lymphocytes - cells of the immune system that resist infection;
• penetrates their DNA, changes genetic information, disrupts functions;
• does not cause the death of lymphocytes, but stimulates cell growth, unlike other herpes viruses.

The infectious agent quickly dies in the external environment from drying out, the action of disinfectants (antimicrobial drugs), and high temperatures. The Epstein-Barr virus is dangerous for humans because it has the following properties:

• remains in the body;
• within 18 months after infection, it is released into the external environment from the oropharynx;
• disrupts liver function;
• damages the pharyngeal and palatine tonsils;
• increases the risk of developing cancer pathologies.

How is it transmitted?

Viral mononucleosis in children is transmitted in several ways. The source of infection is a patient or a virus carrier (a person who has been ill and recovered). Children and teenagers get sick more often. Infection often occurs where sick and healthy people come into close contact - in schools, kindergartens, and dormitories. There are several ways of infection:

• Intrauterine. The fetus becomes infected through the general bloodstream from a sick mother during pregnancy.
• Airborne. Physiological fluids - mucus, saliva get to a healthy child from a sick child when coughing or sneezing.

Most people who have had an infection in childhood or adolescence develop antibodies to the virus. In this case, a person remains a carrier of the pathogen for the rest of his life and can transmit it during a blood transfusion, during an organ or bone marrow transplant operation. Doctors identify a contact and household method of infectious infection. The virus is transmitted through saliva through kissing. The causative agent of mononucleosis comes from a sick child as a result of using:

• shared toys in kindergarten;
• someone else's bed linen, clothes;
• shared dishes, towels;
• someone else's nipples.

Forms

Doctors distinguish several types of mononucleosis. They differ in the course of the disease and symptoms. The following forms of infection cannot be ruled out:

• Typical – characterized by fever, sore throat, enlarged spleen and liver. Blood tests indicate the presence of mononuclear cells (a type of white blood cell) and heterophilic antibodies.
• Atypical form. Its symptoms are smoothed out or have a strong severity. The child may develop a high temperature, and damage to the nervous system, heart, kidneys, and lungs may begin. The infection has a tendency to develop complications.

Often the disease occurs in an acute form with pronounced symptoms. In the absence of treatment and the presence of a large number of viruses in the body, the infection becomes chronic. Depending on the symptoms, the degree of enlargement of the lymph nodes, spleen, liver, the amount of mononuclear cells in the blood, the stage of the disease is divided into severe, moderate and mild. According to the nature of the course of mononucleosis in children, the following forms are distinguished:

• smooth;
• uncomplicated;
• complicated;
• protracted

Symptoms in children

If the baby has a strong immune system, the infectious agent, once in the body, can live in it asymptomatically for a long time. The incubation period lasts 21 days, but with weakened protection, the infection develops after 5 days. The symptoms of mononucleosis are similar to other diseases; pediatricians must differentiate them from the following pathologies:

• lymphogranulomatosis;
• viral hepatitis;
• rubella;
• acute leukemia;
• diphtheria;
• angina;

The very first symptom of the development of an infectious disease is enlarged lymph nodes. The cervical, occipital, and submandibular peripheral organs are most affected; inflammation is accompanied by severe pain. As the infection develops, the inguinal, abdominal, and axillary lymph nodes enlarge. Then inflammation of the tonsils and swelling of the tissues in the nose appear. The following signs of mononucleosis in children are observed:

• sore throat when swallowing;
• white plaque on the tonsils;
• bad breath;
• difficulty in nasal breathing;
• night snoring;
• runny nose;
• cough.

When infected with the Epstein-Barr virus, the body becomes intoxicated with waste products. At the same time, the temperature rises to 39 degrees, fever, chills, aches in the bones and muscles are observed. Symptoms of mononucleosis include:

• pink rash all over the body, without itching, which goes away on its own;
• enlarged spleen, liver;
• darkening of urine;
• headache;
• high fatigue;
• refusal to eat;
• weakness;
• lethargy.

Infection increases sensitivity to the development of respiratory pathologies. There is a disturbance in the functioning of the heart - murmurs, rapid heartbeat. The disease is accompanied by the following symptoms:

• development of sore throat, bronchitis;
• changes in blood counts;
• damage to the lips by the herpes simplex virus;
• swelling of the eyelids, face;
• dizziness;
• migraine;
• insomnia;
• fatigue syndrome.

Chronic mononucleosis

The danger is posed by late diagnosis of infection and lack of timely treatment. The disease becomes chronic. The temperature during mononucleosis in children in this case remains normal, the following symptoms are present:

• constant enlargement of lymph nodes;
• fast fatiguability;
• drowsiness;
• decreased activity;
• bowel dysfunction - constipation, diarrhea;
• stomach ache;
• nausea;
• weakness;
• vomit.

Symptoms of the chronic form of infection are often similar to the acute form, but are less severe. Enlargement of the spleen and liver occurs rarely. The disease is dangerous due to the development of the following complications in a child:

• hemophagocytic syndrome - destruction of the body's own blood cells;
• damage to nerve centers, brain;
• changes in heart function;
• blood clotting problems;
• violation of facial expressions;
• development of migraine;
• psychoses;
• anemia.

Spicy

More often, the infection occurs in an acute form, which lasts up to two months. Lymphadenopathy develops - damage to the lymph nodes, accompanied by an increase in size and pain. Swelling of the mucous membranes of the oral cavity provokes breathing problems and throat hyperemia. The child complains of the appearance of:

• general weakness;
• sore throat, especially when swallowing;
• nasal congestion;
• runny nose;
• severe chills;
• lack of appetite.

The acute form of mononucleosis is characterized by fever, nausea, aches in the muscles, joints, and fever. When children develop an infection, they may:

• hepatomegaly – enlarged liver;
• small rash on the chest, back, face, neck;
• white plaque on the tonsils, palate, tongue, back of the throat;
• splenomegaly - an increase in the size of the spleen;
• photophobia;
• swelling of the eyelids

Laboratory tests play an important role in the differential diagnosis of infectious mononucleosis. Based on their results, pediatricians prescribe treatment. Blood tests are performed:

• General – determines ESR (erythrocyte sedimentation rate), the content of monocytes, leukocytes, lymphocytes. When sick, their number increases 1.5 times. Mononuclear cells appear in the blood only a few days after infection. The more there are, the more severe the disease.
• Biochemical - reveals the content of urea, protein, glucose, characterizing the condition of the kidneys and liver.

The presence of a large number of mononuclear cells in the child’s blood confirms the infection. Considering that this situation is possible in other pathologies, for example, in the case of HIV, doctors prescribe additional studies. Executed:

• ELISA – enzyme-linked immunosorbent assay for antibodies to the Epstein-Barr virus;
• PCR - polymerase chain reaction - a highly accurate, fast diagnostic method using the DNA of the infectious agent;
• Ultrasound of the liver and spleen for changes.

Treatment

When mononucleosis is diagnosed, the child is prescribed treatment at home with bed rest. If high temperature, fever, and signs of intoxication are observed during infection, hospitalization is performed. Indications for it are:

• damage to the respiratory tract, causing asphyxia (suffocation);
• disruption of internal organs;
• development of complications;
• repeated vomiting.

Uncomplicated mononucleosis in a child does not require special treatment. Pediatricians only recommend drinking plenty of fluids. In the acute stage of infection it is necessary:

• humidify the air in the room where the child is;
• avoid hypothermia;
• provide warm drinks;
• regularly carry out wet cleaning;
• use medications for treatment.

The treatment regimen for the disease is aimed at relieving the symptoms of the pathology and strengthening the immune system. Treatment of infectious mononucleosis in children solves several problems:

• reduction of hyperthermia (overheating of the body at high temperatures);
• reducing inflammation in the nasopharynx with antiseptic agents;
• activation of the immune system using immunomodulators, immunostimulants;
• increasing the body's resistance with the help of vitamin complexes;
• restoration of the functioning of the spleen and liver with choleretic agents and hepatoprotectors.

When treating an infection, much attention is paid to reducing allergic reactions to pathogens and toxins. The treatment regimen includes the use of:

• antibiotics in case of secondary infection;
• glucocorticosteroids for complicated hypertoxic disease, risk of asphyxia;
• probiotics to restore intestinal microflora after antibiotic therapy;
• artificial lung ventilation;
• surgical intervention: splenectomy (removal of the spleen in case of rupture), tracheotomy (opening of the trachea) in case of laryngeal edema.

Drug treatment

The use of medications is aimed at weakening and eliminating the symptoms of an infectious lesion. Doctors use several groups of medications to combat mononucleosis in children. For treatment the following is prescribed:

• Antipyretic drugs – Ibuprofen, Paracetamol. Aspirin is not recommended due to the risk of acute liver failure.
• Antiseptic Furacilin for gargling an inflamed throat.
• Antihistamines - Claritin, Zyrtec to eliminate allergic reactions, bronchospasm, symptoms of intoxication.

Antibiotics for mononucleosis in children are used only when a secondary bacterial infection develops. The drugs Clatrimycin, Azithromycin, Metronidazole are used with the simultaneous administration of probiotics Acipol, Linex to prevent disturbances of the intestinal microflora. The following medications are used to treat infectious diseases:

• hepatoprotectors – Essentiale, Galstena;
• choleretic – Allohol, Karsil;
• immunomodulators – Viferon, Imudon;
• glucocorticosteroids - Prednisolone - if there is a threat of asphyxia in case of laryngeal edema.

To treat the infection, homeopathic Galsten drops are used. The drug contains plant components: greater celandine, dandelion, milk thistle. Characteristics of the drug:

• action – hepatoprotective, choleretic, anti-inflammatory, antispasmodic;
• indications – liver pathologies in acute, chronic form;
• dosage – 5 drops, 3 times a day;
• contraindications – sensitivity to components;
• side effects - increased salivation.

Viferon is used in the form of rectal suppositories. The drug has an active substance – human interferon. Characteristics of the medicine:

• indications – infectious viral diseases complicated by the bacterial activity of microorganisms;
• dosage - set by the pediatrician depending on the severity of the pathology;
• contraindications – hypersensitivity to components;
• side effects - rarely skin rashes, itching.

Diet

To quickly restore health during mononucleosis, it is important to organize nutrition in such a way as to strengthen the immune system, eliminate unpleasant symptoms, and speed up recovery. There are dietary rules for treating infection:

• daily calorie content of food is 1.5 times higher than normal - the body spends energy fighting the disease;
• The presence of animal and plant proteins is mandatory - the basis for cells that provide immunity.

Since the disease is accompanied by a sore throat and problems with swallowing, doctors recommend preparing liquid soups, viscous porridges, and purees for mononucleosis in children. Required for dietary nutrition are:

• obtaining vitamins, microelements, antioxidants from fresh vegetables, berries, fruits;
• eating whole grains to provide energy to the body.

During an infection, it is important to maintain a drinking regime - drink large amounts of water, fruit drinks, compotes, and rosehip decoction to remove toxins. The child’s diet requires the presence of:

• rice, wheat, oatmeal, buckwheat porridge;
• dried rye bread;
• low-fat dairy products - cottage cheese, sour cream, hard cheese;
• vegetable oil, butter;
• poultry, rabbit, veal;
• fish - cod, hake, pike perch, pike;
• durum pasta;
• greens - lettuce, parsley, dill;
• vegetables and fruits rich in fiber;
• berries;
• eggs - one per day;
• jam;
• honey

In case of mononucleosis, limit the consumption of fatty foods, smoked foods, and pickles, so as not to overload the liver. Sweets, sour and spicy foods are prohibited. Exclude from the diet:

• fatty meat - duck, lamb, beef, pork;
• confectionery products;
• sparkling water;
• concentrated meat broths;
• dairy products with a high percentage of fat;
• hot spices;
• fatty fish;
• fast food;
• canned food;
• chocolate;
• mayonnaise;
• ketchup;
• mushrooms;
• legumes;
• garlic.

Folk remedies

Recipes using herbal ingredients are part of the treatment regimen for mononucleosis, but do not replace it. The use of any folk remedies must be agreed with a doctor to exclude complications and allergic reactions in children. The main goal of treatment is to eliminate the symptoms of the disease. To maintain immunity, it is recommended to drink healing teas with honey three times a day. To prepare them, add dry herbs (in spoons) to half a liter of boiling water:

• infusion of birch, currants, lingonberries - one at a time, aged for 30 minutes;
• echinacea decoction – 3;
• lemon balm tea – 2.

• eliminate fever - tea made from mint, chamomile, raspberry leaves with honey, lemon juice;
• counteract the symptoms of intoxication of the body - headache, body aches, nausea - linden blossom decoction, lingonberry juice;
• to alleviate the condition of illness - tea from the collection of oregano, motherwort, mint, rose hips.

To reduce inflammation of the lymph nodes, it is useful to make a compress with an infusion of medicinal plants. A napkin soaked in the composition is applied every other day for 20 minutes to the area of ​​the nodes. To prepare the infusion, pour 5 tablespoons of the mixture into a liter of boiling water and leave for half an hour. The collection includes equal parts:

• currant, willow, birch leaves;
• chamomile flowers, calendula;
• pine buds.

Consequences

Complications after contracting mononucleosis occur in rare cases. Their cause is a weakened immune system, in which pathogenic microflora are activated and staphylococcal and streptococcal infections develop. The child may experience:

• pneumonia;
• sinusitis;
• follicular tonsillitis;
• meningoencephalitis (inflammation of the substance, membranes of the brain);
• sinusitis;
• paratonsillitis;
• bronchial obstruction;
• asphyxia (suffocation, oxygen starvation);
• myocarditis (damage to the heart muscle);
• neuritis (inflammation of peripheral nerves);
• otitis media of the middle ear.

Since viral mononucleosis in children is accompanied by damage to the liver and spleen, the consequences of infection are associated with these organs. Development is possible:

• hemolytic anemia;
• acute liver failure;
• rupture of the spleen as a result of excessive stretching of the organ capsule - urgent surgical intervention is required;
• hepatitis A.

Relapse of mononucleosis in a child

After an infection, the body has a strong immunity to mononucleosis throughout its life. Unfortunately, in medical practice there are cases of recurrent infection in a child. These include situations associated with a sharp decrease in the body’s defenses:

• AIDS, in which the lymphatic system is destroyed and immunodeficiency develops;
• chemotherapy administered to patients with cancer pathologies;
• taking immunosuppressants in preparation for transplantation of tissues and organs to prevent their rejection.

Prevention

To avoid complications after mononucleosis, it is important to avoid contact with sick people. Increased monitoring of the child’s health is required for a year after treatment. Doctors conduct periodic blood tests. In addition, to exclude the development of inflammatory processes, the condition of the organs is checked:

• respiratory systems;
• liver;
• spleen.

Prevention of mononucleosis involves measures aimed at maintaining and strengthening the immune system. Attention is paid to maintaining a balance of educational, physical activity and rest. Among the preventive measures:

• healthy, long sleep;
• maintaining personal hygiene;
• high physical activity with regular exercise;
• frequent exposure to fresh air;
• healthy, proper nutrition, rich in protein, slow carbohydrates, fiber;
• exclusion of psychological, physical, mental overload.

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Infectious diseases, of which there are more than two hundred, have a variety of names. Some of them have been known for many centuries, some appeared in the modern era after the development of medicine, and reflect some of the features of clinical manifestations.

For example, it is so called because of the pink color of the skin rash, and typhus is so named because the patient’s state of consciousness is disturbed by the type of toxic “prostration”, and resembles fog, or smoke (translated from Greek).

But mononucleosis stands apart: perhaps this is the only case when the name of the disease reflects a laboratory syndrome that is “not visible to the naked eye.” What kind of disease is this? How does it affect blood cells, how does it progress and how is it treated?

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Infectious mononucleosis - what is it?

the onset of the disease may be similar to a cold

First of all, this disease has several other names. If you hear terms such as “glandular fever”, “Filatov’s disease”, or “monocytic tonsillitis”, then you know that we are talking about mononucleosis.

If we decipher the name “mononucleosis”, then this term means an increase in the content of mononuclear, or mononuclear cells in the blood. These cells include special types of leukocytes, or white blood cells, which perform a protective function. These are monocytes and lymphocytes. Their content in the blood is not just increased during mononucleosis: they become altered, or atypical - this is easy to detect when examining a stained blood smear under a microscope.

Infectious mononucleosis is a viral disease. Since it is caused by a virus and not a bacterium, it must be said right away that the use of any antibiotics is completely pointless. But this is often done because the disease is often confused with sore throat.

After all, the transmission mechanism of mononucleosis is aerosol, that is, airborne droplets, and the disease itself occurs with damage to lymphoid tissue: pharyngitis and tonsillitis (angina) occur, hepatosplenomegaly appears, or an enlargement of the liver and spleen, and the content of lymphocytes and monocytes in the blood increases, which become atypical.

Who is guilty?

Causes infectious mononucleosis, which belongs to the herpes viruses. In total, there are almost a dozen families of herpes viruses and even more of their types, but only this type of virus is so sensitive to lymphocytes, since on their membrane they have receptors for the envelope protein of this virus.

The virus is unstable in the external environment and quickly dies with any available methods of disinfection, including ultraviolet irradiation.

A characteristic feature of this virus is its special effect on cells. If ordinary viruses of the same herpes and chickenpox exhibit a pronounced cytopathic effect (that is, leading to cell death), then EBV (Epstein-Barr virus) does not kill cells, but causes their proliferation, that is, active growth. It is this fact that lies in the development of the clinical picture of mononucleosis.

Epidemiology and routes of infection

Since only people get sick with infectious mononucleosis, a sick person can infect a healthy person, and not only with the bright form of the disease, but also with the erased form of the disease, as well as an asymptomatic carrier of the virus. It is through healthy carriers that the “virus cycle” in nature is maintained.

In most cases of the disease, the infection is transmitted by airborne droplets: when talking, screaming, crying, sneezing and coughing. But there are other ways through which infected saliva and body fluids can enter the body:

• kissing, sexual intercourse;
• through toys, especially those that have been in the mouth of a virus-carrying child;
• through donor blood transfusion, if donors are carriers of the virus.

Susceptibility to infectious mononucleosis is universal. It may seem incredible, but most healthy people are infected with this virus and are carriers. In underdeveloped countries, where the population is very crowded, this occurs in children, and in developed countries - in adolescence and young adulthood.

Upon reaching 30–40 years of age, the majority of the population is infected. It is known that men are more likely to get infectious mononucleosis, and people over 40 years of age get sick very rarely: infectious mononucleosis is a disease of young people. True, there is one exception: if a patient is sick with HIV infection, then at any age he can not only develop mononucleosis, but also recur. How does this disease develop?

Pathogenesis

Infectious mononucleosis in adults and children begins with the fact that infected saliva enters the oropharynx, and there the virus replicates, that is, its primary reproduction occurs. It is the lymphocytes that are the target of the virus attack and quickly become infected. After this, they begin to transform into plasma cells and synthesize various and unnecessary antibodies, for example, hemagglutinins, which can glue foreign blood cells together.

A complex cascade of activation and suppression of various parts of the immune system is launched, and this leads to the accumulation of young and immature B lymphocytes in the blood, which are called “atypical mononuclear cells”. Despite the fact that these are its own cells, albeit immature, the body begins to destroy them because they contain viruses.

As a result, the body weakens, trying to destroy a large number of its own cells, and this contributes to the addition of microbial and bacterial infections, since the body and its immunity are “busy with other things.”

All this manifests itself as a generalized process in lymphoid tissue. Proliferation of immune cells causes hypertrophy of all regional lymph nodes, enlargement of the spleen and liver, and in the case of severe disease, necrosis in the lymphoid tissue and the appearance of various infiltrates in organs and tissues are possible.

Symptoms of infectious mononucleosis in children and adults

High temperature up to 40 is a symptom of mononucleosis (photo 2)

Infectious mononucleosis has a “vague” incubation period, which can last from 5 to 60 days, depending on age, immune status and the number of viruses that have entered the body. The clinical picture of symptoms in children and adults is approximately the same, only in children an enlargement of the liver and spleen manifests early, which in adults, especially with erased forms, may not be detected at all.

As with most diseases, infectious mononucleosis has a period of onset, peak and recovery, or convalescence.

Initial period

The disease is characterized by an acute onset. Almost on the same day, the temperature rises, chills occur, then a sore throat and regional lymph nodes become enlarged. If the onset is subacute, then lymphadenopathy occurs first, and only then fever and catarrhal syndrome develop.

Usually the initial period lasts no more than a week, and people often think that this is the “flu” or another “cold”, but then the height of the disease occurs.

Clinic at the height of the disease

The classic signs of “apotheosis of mononucleosis” are:

• High fever up to 40 degrees, and even higher, which can remain at this level for several days, and at lower numbers - up to a month.
• A kind of “mononucleosis” intoxication, which is not similar to ordinary viral intoxication. Patients get tired, have difficulty standing and sitting, but usually maintain an active lifestyle. They do not have the desire, as with ordinary infections, to go to bed even with a high temperature.
• Polyadenopathy syndrome.

The lymph nodes close to the “entrance gate” become enlarged. More often than others, the nodes on the lateral surface of the neck are affected, which remain mobile and painful, but are enlarged, sometimes to the size of a chicken egg. In some cases, the neck becomes bullish and mobility when rotating the head is limited. The damage to the inguinal and axillary nodes is somewhat less pronounced.

This symptom of infectious mononucleosis persists for a long time and disappears slowly: sometimes 3-5 months after recovery.

• Enlargement and severe swelling of the palatine tonsils, with the appearance of loose plaque, or sore throat. They even close together, making breathing difficult. The patient's mouth is open, there is a nasal tone, and swelling of the back of the throat (pharyngitis).
• The spleen and liver are almost always enlarged. This symptom of infectious mononucleosis in children is observed quite often, and can be well expressed. Sometimes there is pain in the side and right hypochondrium, mild jaundice and increased enzyme activity: ALT, AST. This is nothing more than benign hepatitis, which soon goes away.
• Peripheral blood picture. Of course, the patient does not complain about this, but the exceptional originality of the test results requires indicating this sign as the main symptom: against the background of moderate or high leukocytosis (15-30), the number of lymphocytes and monocytes increases to 90%, of which almost half are atypical mononuclear cells. This sign gradually disappears, and after a month the blood “calms down.”
• Approximately 25% of patients experience various rashes: bumps, dots, spots, small hemorrhages. The rash does not bother you, it appears towards the end of the period of initial appearance, and after 3-6 days it disappears without a trace.

About the diagnosis of mononucleosis

Infectious mononucleosis is a disease with a characteristic clinical picture, and it is always possible to identify atypical mononuclear cells in peripheral blood. This is a pathognomonic symptom, just like fever, enlarged lymph nodes, hepatosplenomegaly and tonsillitis combined.

Additional research methods are:

• Hoffa-Bauer reaction (positive in 90% of patients). Based on the detection of hemagglutinating antibodies, with an increase in their titer by 4 or more times;
• ELISA methods. Allows you to determine marker antibodies that confirm the presence of virus antigens (to capsid and nuclear antigens);
• PCR to detect the virus in blood and saliva. It is often used in newborns, since it is difficult to focus on the immune response in them, since the immunity is not yet formed.

Treatment of infectious mononucleosis, drugs

Uncomplicated and mild forms of infectious mononucleosis are treated at home by both children and adults. Patients with jaundice, significant enlargement of the liver and spleen, and an unclear diagnosis are hospitalized. The principles of treatment of infectious mononucleosis are:

• The diet requires giving up spicy, smoked, fatty and fried foods to ease the work of the liver;
• Semi-bed rest, plenty of vitamin drinks are recommended;
• It is necessary to rinse the oropharynx with antiseptic solutions (Miramistin, Chlorhexidine, Chlorophyllipt) to avoid secondary infection;
• Antipyretic drugs from the NSAID group are indicated.

Attention! How to treat infectious mononucleosis in children, and what drugs should not be used? All parents should remember that taking aspirin in any type and dose is strictly prohibited in children until they reach the age of at least 12-13 years, since a serious complication may develop - Reye's syndrome. Only paracetamol and ibuprofen are used as antipyretic drugs.

• Antiviral therapy: interferons and their inducers. "Neovir", Acyclovir. They are used, although their effectiveness has been proven only in laboratory studies;
• Antibiotics are prescribed when suppuration appears on the tonsils or other purulent-necrotic complications. Fluoroquinolones are used most often, but ampicillin can cause a rash in most patients;
• If a rupture is suspected, the patient should be urgently operated on, for health reasons. And the attending physician should always draw the attention of patients who are being treated at home that if jaundice increases, acute pain appears in the left side, severe weakness, or decreased blood pressure, it is necessary to urgently call an ambulance and hospitalize the patient in a surgical hospital.

How long to treat infectious mononucleosis? It is known that in 80% of cases, significant improvement occurs between 2 and 3 weeks of illness, so active treatment should be carried out for at least 14 days from the moment of the first signs of the disease.

But, even after improving your health, you need to limit your physical activity and sports for 1 to 2 months after discharge. This is necessary because the spleen is enlarged for a long time, and there is a significant risk of rupture.

If severe jaundice has been diagnosed, the diet must be followed for 6 months after recovery.

Consequences of mononucleosis

After infectious mononucleosis, persistent immunity remains. There are no recurrent cases of the disease. In rare exceptions, death can occur with mononucleosis, but it can be caused by complications that have little to do with the development of the virus in the body: this may be obstruction and swelling of the airways, bleeding due to rupture of the liver or spleen, or the development of encephalitis.

In conclusion, it must be said that EBV is not at all as simple as it seems: remaining persistent in the body for life, it often tries to “show its ability” to proliferate cells in other ways. It causes Burkitt's lymphoma, and is considered a possible cause of some carcinomas, since it has been proven to be oncogenic, or the ability to “tend” the body to develop cancer.

Its role in the rapid course of HIV infection is also possible. Of particular concern is the fact that the hereditary material of EBV is firmly integrated in the affected cells with the human genome.

Infectious mononucleosis is an infectious disease of a viral nature that affects the liver, spleen and lymphoid tissue. Children aged 3 to 10 years are most prone to this type of infection, but adults can also get sick.

Infectious mononucleosis in most cases is mild, and its symptoms resemble a sore throat or a cold, so it is not always possible to make a timely diagnosis. But the most difficult in terms of diagnosis is atypical mononucleosis in children, since its symptoms can be disguised as other diseases.

The danger of infectious mononucleosis lies in its complications, which, if not detected in time, can lead to death.

To help you protect your child from this disease, we suggest taking a closer look at its first signs, symptoms, treatment and effective methods of prevention. We will also demonstrate educational photos and videos on this topic.

Epstein-Barr virus type 4 belongs to the herpesvirus family and is the causative agent of infectious mononucleosis.

This virus contains genetic material, which is represented by double-stranded DNA. The virus multiplies in human B lymphocytes.

Antigens of the pathogen are represented by capsid, nuclear, early and membrane types. In the early stages of the disease, capsid antigens can be detected in the child’s blood, since other antigens appear during the height of the infectious process.

The Epstein-Barr virus is adversely affected by direct sunlight, heat and disinfectants.

How is mononucleosis transmitted?

The source of infection in mononucleosis is a patient with a typical or atypical form, as well as an asymptomatic carrier of Epstein-Barr virus type 4.

Infectious mononucleosis is characterized by airborne droplet spread, that is, it expands its presence when sneezing, coughing, or kissing.

The virus can also be transmitted through household and hematogenous routes.

Since the causative agent of infectious mononucleosis is transmitted mainly through saliva, this disease is often called the “kissing disease”.

More often children who live in dormitories, boarding schools, orphanages, as well as those who go to kindergarten get sick.

What is the mechanism of development of infectious mononucleosis?

The infection enters the human body through the mucous membrane of the upper respiratory tract (mouth, nose and throat), which leads to swelling of the tonsils and local lymph nodes. After this, the pathogen spreads throughout the body.

Infectious mononucleosis is characterized by hyperplasia of lymphoid and connective tissues, as well as the appearance of atypical mononuclear cells in the blood, which are a specific marker of this disease. In addition, there is an enlargement of the liver, spleen and lymph nodes.

Infectious mononucleosis can be cured, but even after recovery, the virus remains in the child’s body and can, under unfavorable conditions, begin to multiply again, which can lead to a relapse of the disease.

Infectious mononucleosis can have an acute and chronic course. It is also customary to distinguish between typical and atypical forms of the disease. Typical mononucleosis, in turn, is divided by severity: mild, moderate and severe.

Atypical mononucleosis can occur with mild symptoms, asymptomatic, or only with signs of damage to internal organs.

If we classify the disease depending on the presence of complications, then infectious mononucleosis can be uncomplicated and complicated.

How long is the incubation period for infectious mononucleosis?

The incubation period is the initial stage of infectious mononucleosis, which generally takes from 1 to 4 weeks in the acute course and from 1 to 2 months in the chronic course of the disease. This stage is necessary for virus replication, which occurs in B lymphocytes.

It is impossible to say exactly how long this stage of the disease will last in a particular child, since the duration directly depends on the state of the patient’s immunity.

How does infectious mononucleosis manifest in children?

The clinical manifestations of infectious mononucleosis depend on its course, so we will consider each form of the disease separately.

In children, symptoms of acute mononucleosis appear abruptly. The incubation period of the disease ends with a rise in body temperature to high numbers (38-39 °C).

With mononucleosis in children there are the following symptoms:

• lymphadenopathy, primarily of the cervical postauricular lymph nodes;
• pain in the area of ​​enlarged lymph nodes;
• swelling of the throat mucosa, which is expressed by difficulty breathing;
• throat hyperemia;
• sore throat;
• nasal congestion;
• general weakness;
• chills;
• loss of appetite;
• pain in muscles and joints;
• white plaque on the mucous membranes of the tongue, palate, tonsils and back of the pharynx;
• splenomegaly (enlarged spleen);
• hepatomegaly (enlarged liver);
• a small, red, thick rash on the face, neck, chest, or back;
• swelling of the eyelids;
• photophobia and others.

Answering the question of how dangerous the patient is to others in this case, we can say that the release of the virus into the external environment occurs during the incubation period and in the first 5 days of the height of the disease. That is, a child is contagious even when he does not yet show symptoms of infectious mononucleosis.

Experts have not yet been able to reliably determine the cause of chronic mononucleosis.

But a number of factors can be identified which contribute to this:

• immunodeficiency;
• unhealthy diet;
• harmful;
• sedentary lifestyle;
• frequent psycho-emotional shocks;
• hormonal changes during puberty;
• mental and physical fatigue and others.

Chronic mononucleosis in children is characterized by symptoms of the acute course of the disease, only their severity is less intense.

Fever during chronic infection is rare, and the spleen and liver, if hypertrophied, are insignificant.

Children experience a deterioration in their general condition, which is expressed by general weakness, drowsiness, fatigue, decreased activity, etc. Abnormal bowel habits in the form of constipation or diarrhea, nausea, and rarely, vomiting may also occur.

How dangerous is mononucleosis?

In general, the course of infectious mononucleosis is mild and uncomplicated. But in rare cases there may be the following complications:

• bronchial obstruction;
• myocarditis;
• inflammation of the meninges and brain tissue;
• addition of bacterial flora (bacterial tonsillitis, pneumonia and others);
• hepatitis;
• immunodeficiency and others.

But the most dangerous complication of infectious mononucleosis is rupture of the splenic capsule, which is characterized by the following symptoms:

• nausea;
• vomit;
• dizziness;
• loss of consciousness;
• severe general weakness;
• severe abdominal pain.

Treatment of this complication consists of emergency hospitalization and surgical intervention - removal of the spleen.

Algorithm for diagnosing infectious mononucleosis in children consists of several steps.

Subjective diagnostic methods:

• interviewing the patient;
• collection of anamnesis of illness and life.

Objective methods of examining the patient:

• examination of the patient;
• palpation of the lymph nodes and abdomen;
• percussion of the abdomen.

Additional diagnostic methods:

• laboratory diagnostics (complete blood count, biochemical blood test, blood test to determine antibodies to the Epstein-Barr virus);
• instrumental diagnostics (ultrasound examination of the abdominal organs, including the liver and spleen).

When interviewing the patient, they pay attention to symptoms of intoxication, pain in the throat and behind the jaw, and also clarify whether there has been contact with children with infectious mononucleosis.

When examining patients with mononucleosis, an enlargement of the postauricular lymph nodes is often observed, and in young children an enlarged liver or even spleen is clearly visible. When examining the throat, its granularity, redness and swollen mucous membrane are determined.

Palpation reveals enlarged and painful lymph nodes, liver and spleen.

In the patient’s blood, indicators such as slight leukocytosis, an increase in erythrocyte sedimentation rate, and the presence of wide-plasma lymphocytes can be detected.

A specific sign of infectious mononucleosis is the appearance in the blood of atypical mononuclear cells - giant cells with a large nucleus, which consists of many nucleoli. Atypical mononuclear cells can remain in the blood of a recovered child for up to four months, and sometimes longer.

But the most informative blood test for mononucleosis is the detection of antibodies to the pathogen or the determination of the genetic material of the virus itself. To do this, enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR) are performed.

Why do you need to carry out and decipher ELISA and PCR? Deciphering the listed blood tests is necessary to identify the virus and confirm the diagnosis.

The diagnosis and treatment of infectious mononucleosis is carried out by an infectious disease specialist. But patients can also be referred for consultation to related specialists, for example, an otolaryngologist, an immunologist and others.

If the diagnosis is unclear, the attending physician will consider the need for an HIV test, since this disease can cause the growth of atypical mononuclear cells in the blood.

Ultrasound examination of the abdominal organs allows us to determine the degree of hepato- and splenomegaly.

In his book, Komarovsky dedicated an article to infectious mononucleosis in children, where he describes in detail the symptoms and treatment of this disease.

The well-known TV doctor, like most specialists, claims that a specific treatment for mononucleosis has not yet been developed and, in principle, it is not necessary, since the body is able to cope with the infection on its own. In this case, adequate prevention of complications, symptomatic treatment, limitation of exercise and nutrition play an important role.

Infectious mononucleosis in children can be treated at home under the guidance of a pediatrician and an infectious disease specialist. In severe cases, the patient is hospitalized in the infectious diseases department or hospital.

Indications for inpatient treatment is:

• temperature above 39.5°C;
• severe swelling of the upper respiratory tract;
• severe intoxication;
• the appearance of complications.

In the treatment of infectious mononucleosis, Komarovsky recommends following the following principles:

• bed rest;
• diet;
• antipyretic therapy for body temperatures above 38.5 degrees, as well as if the child does not tolerate fever well. In such cases, Nurofen, Efferalgan, Ibuprofen and others are prescribed;
• in case of severe inflammation in the throat, local antiseptics are used - Septefril, Lisobakt, Orosept, Lugol, as well as local immunotherapy drugs, such as Immudon, IRS-19 and others;
• vitamin therapy with complex vitamin preparations, which necessarily contain B vitamins, as well as ascorbic acid;
• in case of liver dysfunction, choleretic agents and hepatoprotectors are used;
• immunotherapy, which consists of prescribing interferons or their inducers, namely: Viferon, Cycloferon, Imudon, human interferon, Anaferon and others;
• antiviral therapy: Acyclovir, Vidabarin, Foscarnet and others. Acyclovir for mononucleosis is prescribed at a dose of 5 mg/kg body weight every 8 hours, Vidabarin - 8-15 mg/kg/day, Foscarnet - 60 mg/kg every 8 hours;
• Antibiotics for a child with mononucleosis can only be prescribed if a secondary bacterial flora is present (streptococcal tonsillitis, pneumonia, meningitis, etc.). It is prohibited to use penicillin antibiotics for mononucleosis, since they cause allergies in many children. Also, the child must be prescribed probiotics, such as Linex, Bifi-form, Acipol, Bifidumbacterin and others;
• Hormone therapy is indicated for children with severe intoxication. Prednisolone is used for this.

The period of convalescence for infectious mononucleosis takes from two weeks to several months, its duration depends on the severity of the disease and whether there were consequences.

The patient's condition improves literally a week after body temperature normalizes.

During treatment and 1.5 months after recovery, the child is freed from any physical activity in order to prevent the development of such consequences as rupture of the spleen capsule.

If the temperature persists during mononucleosis, this may indicate the addition of secondary bacterial flora, since during the recovery period it should not exceed 37.0 ° C.

You can visit kindergarten after mononucleosis when blood levels return to normal, that is, atypical mononuclear cells disappear.

Both during treatment for infectious mononucleosis and after recovery, patients should adhere to a diet, especially if the liver has been affected.

Nutrition should be balanced and easily digestible so as not to overload the liver. For hepatomegaly, table No. 5 according to Pevzner is prescribed, which involves limiting animal fats, excluding hot seasonings, spices, marinades, sweets and chocolate.

The patient's menu should consist of liquid soups, semi-liquid cereals, lean meats, poultry and fish. When preparing food, it is recommended to use gentle heat treatment methods, such as boiling, baking or steaming.

The diet after infectious mononucleosis should be followed for 3 to 6 months, depending on the severity of the disease. After this period, the menu can be expanded and diversified.

Medicinal herbs such as chamomile, milk thistle, corn silk, lemongrass and others, which are consumed in the form of tea, help restore liver cells.

It is also important for infectious mononucleosis to maintain adequate drinking regimen according to age.

What methods exist for preventing infectious mononucleosis in children?

Specific prevention of infectious mononucleosis has not been developed. The development of the disease can be prevented by strengthening the immune system using the following methods:

• active and ;
• the child’s adherence to a rational daily routine;
• elimination of mental and physical overload;
• dosed sports loads;
• sufficient time in the fresh air;
• healthy and balanced diet.

Despite the fact that infectious mononucleosis does not cause death, it should not be taken lightly. The disease itself is not fatal, but can cause life-threatening consequences - meningitis, pneumonia, bronchial obstruction, splenic rupture, etc.

Therefore, at the first signs of infectious mononucleosis in your child, we strongly recommend that you consult a pediatrician at the nearest clinic or immediately see an infectious disease doctor and under no circumstances self-medicate.

Mononucleosis- an infectious disease characterized by many different symptoms, which is why treatment in children differs.
It is very important not to miss the development of complications, which distinguish this disease from the common cold.

Dietary immunostimulating nutrition plays a special role in healing.

Therapist: Azalia Solntseva ✓ Article checked by doctor

Symptoms and treatment of mononucleosis in children

The pathology is often called the kissing disease, due to the typical route of entry. The Epstein-Barr virus, which causes this disease, is transmitted through saliva, so you can become infected through coughing or sneezing, or by sharing utensils with a sick person. However, mononucleosis in a child is not as contagious as some common infections such as the flu and tonsillitis.

Epstein-Barr viral disease usually begins in infancy and remains latent throughout life.

Teenagers are more likely to develop the disease. Young children usually have fewer symptoms and the infection often goes unrecognized.

In the presence of pathology, it is important to be careful with some complications, such as enlargement of the spleen and liver. Rest and adequate fluid intake are key to recovery.

Symptoms and signs of pathology

Signs and symptoms of mononucleosis in children may include:

• a sore throat;
• it is possible to develop streptococcal infection (angina), which does not go away with the use of antibiotics;
• headache;
• skin rash;
• fever;
• soft and enlarged spleen;
• swelling of the lymph nodes in the neck and armpits;
• fatigue.

The incubation period for the virus is approximately four to six weeks, although it may be shorter in young children. Signs and symptoms such as fever and sore throat usually improve within 12 to 14 days, but other symptoms such as fatigue, swollen lymph nodes and a swollen spleen may persist for several weeks longer.

How to treat the disease

Infectious mononucleosis is a disease that usually does not require specific therapy in patients with mild to moderate severity. However, if the tonsils are noticeably enlarged or the child has persistent symptoms (severe thrombocytopenia or anemia), most doctors recommend a short course of steroids (1-2 mg/kg prednisolone daily for 3-7 days).

Due to the low contagiousness of the Epstein-Barr virus, isolation of the patient is not necessary. Since most patients can be treated on an outpatient basis, i.e. in the clinic, then therapy in the clinic is required only if there are complications.

Nonsteroidal anti-inflammatory drugs (diclofenac) are used to treat fever and discomfort. New therapies are being explored, including the use of interferon-alpha and infusion of donor T cells.

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Viral mononucleosis - manifestations

This infectious process was first described in the late 19th century as acute glandular fever, a disease that includes lymphadenopathy, fever, enlarged liver and spleen, malaise and abdominal discomfort.

Epstein-Barr virus is a type of herpes virus that affects more than 95% of the world's population. The most common manifestation of primary infection is mononucleosis.

Classic symptoms include sore throat, fever, and lymphadenopathy (inflammation of the lymph nodes). Infection in young children is usually asymptomatic or mild. Epstein-Barr virus is also a tumor factor associated with human malignancies (oncological pathologies).

The incidence of acute infectious mononucleosis was approximately 45 cases per 100,000 people per year in the early 1970s, with the highest incidence in persons aged 15–24 years. However, changes in economic status have led to the disease appearing at an earlier age.

The incubation period for adolescents is 30-50 days, and less for young children. The course of acute infectious mononucleosis is 1-2 weeks of fatigue and malaise; however, the onset may be acute.

Viral mononucleosis in children manifests itself in the form of pain in the throat, abdomen, head, fever, myalgia, and nausea. The severity of manifestations depends on many factors. Sore throat is the most common symptom.

The patient's condition gradually worsens over seven days and is described by patients as the most unpleasant illness in life. The headache usually occurs during the first week and is felt behind the eye sockets.

Discomfort in the left upper abdomen may be caused by an enlarged spleen. Symptoms usually last for 2-3 weeks, but fatigue lasts longer.

The disease often goes away without any symptoms in infants and young children. Upon examination, there may be inflammation of the throat (pharyngitis), enlargement of the spleen, liver, cervical and axillary lymph nodes. In children under 4 years of age, abdominal inflammation, rash, and symptoms of upper respiratory tract infection are observed.

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Consequences and complications

Most primary Epstein-Barr virus infections are asymptomatic. This is the most common cause of fever of unknown origin in young children. Fever may be isolated or accompanied by symptoms such as lymphadenopathy (swelling of the lymph nodes), fatigue, or malaise.

Deaths are uncommon but may occur due to neurological complications, upper airway obstruction, or splenic rupture.

The infection is associated with numerous tumors. Burkitt's lymphoma, the most common childhood malignancy in Africa, is associated with Epstein-Barr virus and malaria. In Asia, this virus is associated with the development of nasopharyngeal carcinoma (cancer).

Mononucleosis often leads to an enlarged spleen. In extreme cases, the organ can rupture, causing sharp, sudden pain in the left upper abdomen. If this occurs, you should consult a doctor immediately, as surgery may be required.

Liver problems are also possible: hepatitis (inflammation of the liver tissue) and jaundice.

Consequences of mononucleosis in children and possible complications:

• anemia – a decrease in the number of red blood cells and hemoglobin levels;
• inflammation of the tonsils, which can cause obstruction (obstruction) of the airways;
• meningitis and encephalitis;
• heart problems - inflammation of the heart muscle (myocarditis);
• thrombocytopenia - low content of cells - platelets, which are involved in blood clotting.

The virus can cause a much more serious condition in children with weakened immune systems.

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Rash due to mononucleosis in children

Usually mild, widely scattered. The rashes generally appear as flat spots with small red areas. The rash develops first on the torso and shoulders, soon spreading to the face and forearms, mainly to the flexor surfaces of the arms. It quickly appears and disappears similarly.

Occurs in 3-15% of patients and is more common in young children. There is usually minor itching.

Treatment of mononucleosis in children with amoxicillin or ampicillin causes a rash in about 80% of infants. It often occurs when a primary Epstein-Barr virus infection is initially misdiagnosed and treated as strep throat.

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Blood test in babies

The three classic criteria for laboratory confirmation of an infectious process include: leukocytosis, the presence of more than 10% abnormal lymphocytes in the smear, and a positive serological test for Epstein-Barr virus.

Antibody tests. This test provides results within a day. But it cannot detect infection during the first week of illness. If further confirmation is needed, a mononuclear stain test can be performed to test the blood for antibodies to the Epstein-Barr virus.

The result takes longer to obtain, but can detect the disease even within the first week after the onset of symptoms.

The doctor may use other blood tests to look for increased numbers of cells or abnormal-looking lymphocytes. These studies do not confirm mononucleosis, but may suggest its presence.

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How the disease is transmitted

Epstein-Barr virus is the cause of 90% of cases of acute infectious mononucleosis. Other pathogens can also cause this disease. Viruses typically spread through body fluids, especially saliva. However, they can also be transmitted through blood transfusions and organ transplants.

The only predisposing risk factor for pathology is close contact with a person infected with the virus.

It usually persists in nasopharyngeal secretions for several months after the symptoms of the disease disappear. Patients with congenital immunodeficiencies (especially children) are predisposed to the development of malignant tumors.

The virus can be spread by sharing objects such as a toothbrush or drinking glass. Since the virus is transmitted through bodily fluids, it survives on an object as long as its surface remains wet.

When a child is first infected, they can spread the virus for several weeks, even before symptoms appear. When an infection stays in the body for a long time, it remains latent (inactive). If the virus wakes up, the child becomes a spreader of the disease, no matter how much time has passed since the initial infection.

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Proper healing diet

Diet is one of the first things to change after contracting Epstein-Barr virus to prevent symptoms from worsening.

Foods with fatty acids should be added to the diet to help reduce inflammation: avocados, nuts, seeds and fish.

Drink plenty of fluids. Fever is one of the first symptoms of mononucleosis and can lead to dehydration, especially in infants. Make sure your child drinks enough water, juices and compotes. Drinking lemon can help relieve the sore throat that usually accompanies mononucleosis.

Fruits and vegetables contain large amounts of antioxidants, which can help the immune system fight viruses and infections and flush toxins from the body.

Protein-rich foods support cellular health and stimulate body repair. These include: chicken, fish, eggs, lean meats and tofu. The diet should not concentrate on one product; for example, too much protein in the diet can lead to other problems.

There are certain foods that should be avoided due to possible negative effects on the body:

1. Excessive amounts of sugar and carbohydrates. Excess glucose in the diet increases inflammation. You should also avoid refined foods such as white bread because they are also converted into glucose in the intestines.
2. Caffeine can increase fatigue, slowing down the body's recovery.
3. Alcohol. Epstein-Barr virus directly affects the liver. Remember that drinking alcohol while you have symptoms of mononucleosis can damage the gland.

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How do antibiotics work?

There is no specific therapy for infectious mononucleosis. Antibiotics do not work against such viral diseases. Treatment mainly involves bed rest, good nutrition and plenty of fluids.

Sometimes streptococcal infection accompanies the underlying disease. Sinusitis (inflammation of the paranasal and frontal sinuses) or infection of the tonsils (tonsillitis) may develop. In this case, the child may need antibiotic treatment.

Amoxicillin and other penicillin derivatives are not recommended for children with mononucleosis because they may develop a rash. However, this does not always mean that they are allergic to the antibiotic. Other antimicrobial agents that are approved to treat pathology are less likely to cause changes in the skin.

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Symptoms without fever

It is possible to have the disease without fever and noticeable enlargement of the lymph nodes. The most common symptom in this case is fatigue, but even this is not always present. Thus, the diagnosis cannot be excluded due to the absence of any specific manifestation.

Mononucleosis will often present like a common viral infection early in the illness and without fever. Significant symptoms gradually develop that help differentiate the condition.

The key feature of the pathology is that it lasts longer than ordinary sore throat or tonsillitis.

Traditional blood tests are usually negative during the first week of illness. Specific antibody tests may show a positive result earlier, but most doctors usually do not perform such tests during the first week of illness.

If symptoms improve within 2-5 days, it is a common cold. Otherwise, most likely it is mononucleosis.

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Atypical type of pathology

The disease can occur in an unusual form. In this case, the child does not experience typical symptoms of the disease, such as sore throat, fever and lymphadenopathy (enlarged lymph nodes). Manifestations that are not specific come to the fore: pain in the chest during inhalation, discomfort in the abdomen, especially in its upper half, jaundice, which is characteristic of calculous cholecystitis.

There may be a different combination of symptoms, which makes diagnosis and treatment of the disease difficult. In older children, atypical mononucleosis may manifest as hepatitis or myocarditis (inflammation of the heart muscle).