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Mononucleosis in children: symptoms and consequences. Infectious mononucleosis

Data 02 May ● Comments 0 ● Views

Doctor Maria Nikolaeva

Infectious mononucleosis is a disease of viral etiology that is transmitted primarily by airborne droplets. Children aged 3 to 10 years are most often infected. Although the symptoms are similar to the common cold, mononucleosis has its own characteristics. The effectiveness of treatment for infectious mononucleosis in children largely depends on the correct diagnosis of the disease, the state of the child’s immune system and adherence to a special diet.

In most cases, treatment of mononucleosis in children is carried out on an outpatient basis, under the supervision of a local pediatrician. For an accurate diagnosis, a number of tests are required, usually these are:

General or clinical blood test.
PCR (polymerase chain reaction) - to identify a specific pathogen.
Biochemical blood test - its results allow you to determine how well the child’s internal organs are functioning.
ELISA (enzyme-linked immunosorbent assay) - determines the presence of antibodies to the causative virus in the blood.

In a hospital setting, treatment can be managed by a pediatrician, infectious disease specialist or other specialized specialist, depending on the characteristics of the disease.

Medical practice shows that a local pediatrician does not always correctly diagnose mononucleosis, attributing symptoms to a common sore throat or cold (ARI, ARVI). But the disease is more complicated: the infection affects internal organs (spleen, liver), respiratory tract, provokes enlargement of lymph nodes in the abdominal cavity and neck, and rashes on the skin.

Improper treatment can lead to a deterioration in the child’s condition and the development of serious complications. If there is no improvement and there are doubts about the correctness of the diagnosis, it is advisable to request tests, call an ambulance, or seek advice from an infectious disease specialist.

Mononucleosis, unlike tonsillitis, occurs with special symptoms. A visually detectable sign is enlarged lymph nodes. Changes in the child's condition become noticeable a few days or weeks after infection. Diagnosis is complicated by the fact that there are typical and atypical forms of infectious mononucleosis. In the second case, one or more characteristic signs of pathology are completely absent from the clinical picture.

In what cases is hospitalization necessary?

The advisability of outpatient treatment for mononucleosis in children depends on the form of the disease. Indications for urgent hospitalization are the patient’s serious condition:

severe swelling of the respiratory tract (can lead to death from suffocation);
severe intoxication – accompanied by vomiting, diarrhea, prolonged fever and fainting;
high temperature – 390 C or more;
development of complications, including severe disturbances in the functioning of internal organs, secondary bacterial and viral infections.

If infection with infectious mononucleosis is diagnosed in a child of the first year of life, treatment in a hospital is also recommended. This will allow you to receive timely medical care in the event of a sharp deterioration in the baby’s condition, and prevent the development of severe complications and consequences.

How to treat mononucleosis in children

The causative agent of the disease is the Epstein-Barr virus (EBV) or cytomegalovirus. There are no effective drugs to suppress the activity of these infectious agents, so therapy is aimed at relieving symptoms and shortening the acute period of the disease. Infectious mononucleosis in children should be treated by selecting medications according to age restrictions. None of the available methods eliminates the presence of this virus in the body. A person who has recovered from the disease remains a carrier of the infection for the rest of his life.

Dr. Komarovsky - how to treat mononucleosis

General treatment regimen

Infectious mononucleosis simultaneously affects different organs and systems, so combating it requires an integrated approach. The treatment regimen usually includes:

bed rest, rest;
drug relief of symptoms (antipyretics, vasoconstrictors, antihistamines);
special diet;
strengthening and stimulating the immune system;
normalization and maintenance of the functioning of internal organs;
in case of severe complications, surgery may be required (in particular, removal of the spleen if it ruptures).

The acute period of the disease is 14-20 days; in some children it may last longer. After completing the course of therapy, it is time for rehabilitation; it can last up to a year.

Drug therapy

Modern pharmacology does not have drugs to destroy the virus that causes mononucleosis, but it can alleviate the patient’s condition and speed up recovery. Depending on the individual clinical picture of the disease, the following are used for these purposes:

Antipyretic drugs based on paracetamol or ibuprofen - at elevated temperatures.
Vitamin complexes to strengthen the body.
Furacilin, soda, medicinal herbs - for gargling (to relieve inflammation and reduce pain).
Vasoconstrictor drops for nasal congestion.
Antiallergic drugs (including glucocorticosteroids) according to indications. They help prevent bronchospasm, cope with skin rashes, and reduce reactions to toxins and medications.
To stimulate the body's immunity, Anaferon, Imudon, Cycloferon and other immunomodulators are prescribed.
In the case of the development of a secondary bacterial infection, in the presence of a pronounced inflammatory process, antibiotics are used.
To restore the intestinal microflora, probiotics (Normobact, Linex, Bifiform) are simultaneously prescribed.
To protect internal organs and improve their functioning, drugs with a hepatoprotective effect (“Karsil”) and choleretic drugs are prescribed.

It is permissible to treat mononucleosis only under the guidance of a qualified doctor; self-medication can provoke serious consequences for the life and health of the child.

Traditional medicine

Traditional methods of treating mononucleosis in a child can give good results, but only as an addition to the main course. Their use must be agreed with your doctor. As part of complex therapy, the use of herbal infusions accelerates recovery and strengthens the body's defenses. It is recommended to take decoctions of the following plants:

calendula flowers;
yarrow;
coltsfoot leaves;
chamomile flowers;
sequences;
elecampane;
Echinacea purpurea.

The effect is based on the antibacterial, immunostimulating and restorative properties of these herbs. They can be brewed either individually or in various combinations. An important requirement is the absence of an allergic reaction to the components of the herbal collection.

How long does treatment last?

The duration of the course of therapy depends on the characteristics of the disease and the state of the immune system. On average, treatment for infectious mononucleosis in a child lasts 2-3 weeks, until the acute phase is completed. During this period it is necessary:

maintain bed rest;
limit contact with healthy people as much as possible;
drink more fluids, adhere to the prescribed diet;
strictly follow the recommendations and prescriptions of the attending physician.

In severe cases, it may take longer to relieve the main symptoms.

Acute mononucleosis is curable, but complete recovery of a child’s body after an illness takes from several months to a year. During this period, it is necessary to carefully monitor the child’s condition, adhere to the prescribed diet, and pay attention to strengthening the immune system.

Diet for mononucleosis in children

In the fight against infection, adherence to a certain diet plays an important role. The Epstein-Barr virus affects the spleen, liver and other organs, making it difficult for them to function. This explains the need for a diet for mononucleosis - both in the acute phase of the disease and during the rehabilitation period.

The patient's diet should be complete, but at the same time gentle, not burdening the liver with additional work. The following rules must be adhered to:

Meals should be “fractional” - 4-6 times a day, in small portions.
The patient needs to drink more fluids, this helps reduce intoxication of the body.
Reduce fat consumption to a minimum - their breakdown creates additional stress on the liver. Preference should be given to vegetable oils (olive, sunflower), and the use of butter should be limited. A little sour cream and mild cheese are allowed. Egg yolk – 1-2 times a week.
The menu must include fermented milk and dairy products, vegetables and fruits, lean meats and fish. Soups, porridges and soft wheat bread are healthy. Berries and fruits that are not sour are allowed.
You should strictly exclude confectionery products, fatty, fried, smoked foods, and pickled foods. Spicy seasonings, canned food, fatty meat and poultry (including broths), mushrooms, cocoa and coffee are prohibited.

Following these recommendations will speed up recovery and help the body recover faster from illness. It is necessary to adhere to a diet during treatment for infectious mononucleosis and during the rehabilitation period, since restoration of normal liver function can take up to six months.

If infectious mononucleosis is diagnosed, it is possible to cure the baby. The virus will remain in the body even after completion of therapy, but usually the medical prognosis for this disease is positive. With adequate treatment and compliance with all recommendations, the child’s health will be fully restored, and he will be able to lead a normal life without restrictions.

Andrey Duiko - treatment, symptoms and prevention of mononucleosis

Causes of infectious mononucleosis and routes of infection

N.F. Filatov was the first to announce the viral etiology of infectious mononucleosis at the end of the 19th century, calling it idiopathic inflammation of the lymph nodes. Subsequently, the disease was called Filatov's disease, monocytic tonsillitis, benign lymphoblastosis, glandular fever. In modern science, the name “infectious mononucleosis” is accepted, often referred to by non-specialists as “immunocleosis”. The herpetic type virus responsible for the development of the disease was isolated by M.A. Epstein and I. Barr in the middle of the 20th century.

Mononucleosis is a disease that is transmitted by airborne droplets, contact and hemolytic means (in utero and during transfusion of blood and tissue from donor to recipient). The source of infection is not only patients with severe symptoms, but also people whose disease is asymptomatic, as well as virus carriers. The pathology belongs to the group of so-called “kissing diseases”, since transmission of the virus with saliva particles during a kiss is the most likely contact between the virus carrier and the child.

The development of exacerbation of mononucleosis in children is a period when the immune system is weakened. There are two age stages of infection reactivation: in childhood under five years of age and in adolescence (about 50% of cases). Both periods are characterized by physiological changes, immune tension, and an increased number of bodily contacts.

Among male children, the development of infectious mononucleosis is observed twice as often as in girls. The main peak of diseases occurs in the autumn and winter periods due to a decrease in general immunity and an increased number of contacts in enclosed spaces (kindergartens, schools, transport, etc.).

The virus is not stable in the external environment, dying when drops of saliva dry out, are exposed to UV rays, or are disinfected. Most often, infection occurs through close or prolonged contact with a sick person or a carrier of the causative agent of the virus.

After the causative agent of the virus enters the human body, the development of symptoms similar to infectious mononucleosis occurs on average in 1 in 20 children. After clinical recovery, the virus remains in the tissues and can provoke relapses when the activity of the immune system drops, manifesting itself in a blurred picture of the infectious process, as well as chronic tonsillitis, chronic fatigue syndrome, Burkitt's lymphoma, nasopharyngeal carcinoma. Relapses are especially dangerous against the background of immunodeficiency states caused by taking certain medications (immunosuppressants), living conditions or other diseases accompanied by severe immunosuppression.

Infectious mononucleosis in children: symptoms and treatment

Diagnosis of infectious mononucleosis is often complicated by the variability in the manifestation of symptoms and their time of occurrence; in mild and atypical forms, characteristic and most striking signs may be absent, which appear depending on the activity of resistance of the body's defenses. The course of the disease can have a wave-like character with alternating intensification and weakening of the severity of symptoms.

Symptoms

The incubation period of the disease averages from 7 to 21 days. The onset can be either gradual or acute. With the gradual development of infection in the initial stage, this process is marked by a general deterioration in health, an increase in body temperature to subfebrile levels, and catarrhal manifestations (congestion, swelling of the nasal passages, hyperemia of the nasopharyngeal mucosa, swelling, redness of the tonsils).

Acute onset of illness characterized by a sharp increase in temperature (38-39°C), fever, chills, increased sweating, headache, a feeling of aching in the skeletal muscles, severe sore throat when swallowing. The febrile state can last up to a month (sometimes longer), accompanied by periods of rising and falling body temperature.

A characteristic symptom is swelling of the lymph nodes (occipital, submandibular, posterior cervical) in the absence of pain or mild pain upon palpation in the early stages of the disease. With the development of the disease and lack of therapy, not only long-term (up to several years) pain in the lymph nodes is possible, but also an increase in their number.

Other symptoms of infectious mononucleosis include:

manifestations: redness, follicular hyperplasia, granularity of the oropharyngeal mucosa, possible superficial hemorrhages;
an increase in the volume of the liver and spleen (more typical for adults, but also occurs in children);
characteristic mononucleosis rash.

The rash is observed in the patient as a consequence of the inflammatory process in the mesentery and appears 3-5 days from the onset of the disease, as pigment spots with color variability from pink to burgundy. The rash can be localized or distributed throughout the body (face, limbs, torso). This symptom does not require treatment or care. The rash persists for several days and then disappears on its own. There is normally no itching; the addition of skin itching during antibiotic therapy means the onset of an allergic reaction and the need to prescribe an antibacterial agent from a different group.

The disease may be accompanied by the development of polyadenitis, nasopharyngitis, tonsillitis, tracheitis, interstitial pneumonia, hypoplasia of bone marrow tissue, uveitis, and the clinical picture of jaundice as a consequence of hepatosplenomegaly. There is a serious danger that a significant enlargement of the spleen during infectious mononucleosis can lead to rupture of the organ.

There is no uniform systematization of symptoms; the manifestations of the disease vary depending on age, the body’s immune response, the presence of concomitant diseases and the form of development of the disease. Individual symptoms may be absent or predominant (for example, jaundice in the icteric form of mononucleosis), so this sign of the disease causes erroneous primary diagnosis.

The clinical picture also includes worsening sleep, nausea, diarrhea, dizziness and headaches, pain in the peritoneum (with enlarged lymph nodes and the occurrence of lymphomas in the peritoneum leads to the characteristic clinical picture of an “acute abdomen” and incorrect diagnosis).

The period of convalescence begins 2-4 weeks after the manifestation of the disease. In some cases, there is a chronic course of infection lasting up to one and a half years.

Treatment

There is no specific antiviral therapy for Epstein-Barr virus infection; treatment in adults and children is symptomatic and supportive.

During therapy, especially in childhood, the use of acetylsalicylic acid (aspirin) is prohibited due to the high likelihood of developing Reye's syndrome and paracetamol-containing drugs that negatively affect the liver (this disease makes the liver vulnerable).

Treatment takes place mainly at home, but in severe cases and complications, hospitalization in a hospital is recommended. Signs of the need for hospitalization include:

hyperthermia with readings from 39.5°C;
severe symptoms of intoxication (prolonged febrile fever, migraine pain, fainting, vomiting, diarrhea, etc.);
the onset of complications, the addition of other infectious diseases;
pronounced polyadenitis with the threat of asphyxia.

In all other cases, strict adherence to bed rest at home is prescribed.

Directions for treatment of children with infectious mononucleosis

Type of therapy	Goal of treatment
Symptomatic	Reducing and stopping symptoms of the disease
Pathogenetic	Reducing hyperthermia (ibuprofen-based drugs are recommended, for example, children's)
Local antiseptic	Reducing the severity of inflammatory processes in the nasopharynx
Desensitizing	Reducing the body's allergic reaction to pathogens and toxins
General strengthening	Increasing the body's resistance (vitamin therapy)
Immunomodulatory, immunostimulating	Increased systemic and local resistance (antiviral, systemic and local immunomodulatory drugs)
Therapy for lesions of the liver and spleen	Support of organ functioning (hepatoprotective drugs, choleretic medications, gentle diet)
Prescribing antibiotics	When a bacterial infection occurs in the nasopharynx (preparations without penicillin are preferred due to the high likelihood of developing an allergy to the penicillin group in this disease)
Antitoxic treatment	If there are signs of a hypertoxic course of the disease, glucocorticosteroids (Prednisolone) are indicated
Surgical treatment	Surgical intervention (splenectomy) for splenic rupture, tracheotomy for laryngeal edema interfering with respiratory function

Bed rest and rest are required. A patient with infectious mononucleosis is prescribed fractional (4-5 times a day), complete, dietary meals. Products high in fat (butter, fried foods), spicy, salted, pickled, smoked foods, canned foods, semi-finished products, and mushrooms are excluded.

The diet is based on dairy products, vegetable dishes, lean meats, fish, poultry, grains (porridges, whole grain breads), fruits, and berries. Vegetable soups and weak meat broths, plenty of drink (water, compote, fruit drinks, juices, rosehip infusions, etc.) are recommended.

With a mild form of the disease and acceptable health, children suffering from infectious mononucleosis are recommended to walk in the fresh air without high physical activity and hypothermia.

Diagnosis of infectious mononucleosis

Accurate diagnosis of infectious mononucleosis in its erased or atypical form is complicated by distortions in the characteristic clinical picture of the disease. The acute form can also have different symptoms, so to confirm the diagnosis, a blood test is prescribed for infectious mononucleosis in children and adults.

Most often, clinically significant signs that determine the need for a hemolytic study are considered to be the presence of a complex of manifestations of infection: tonsillitis, enlarged lymph nodes, liver, spleen, and fever.

The main diagnostic value for infectious mononucleosis is a laboratory blood test for specific antibodies to the Epstein-Barr virus (the presence of IgM antibodies indicates an acute infection, IgG - a history of contact with infection and the absence of an acute process). It is possible to prescribe a monospot test that detects the presence of the virus in the patient’s saliva, although its content in biological fluid is detected within six months after clinical recovery.

Other studies prescribed to diagnose the disease and determine the patient’s condition and prognosis of therapy include hemolytic and instrumental tests.

This diagnosis requires differentiation from acute respiratory viral infections, bacterial diseases, sore throat, viral hepatitis, Botkin's disease, listeriosis, tularemia, diphtheria, rubella, pseudotuberculosis, lymphogranulomatosis, acute leukemia, immunodeficiency states during infection. An extensive list of diseases indicates a variety of symptoms in infectious mononucleosis both in adulthood and in childhood.

Clinical and serological blood tests are also prescribed after recovery, which makes it possible to determine the effectiveness of therapy and the progress of health restoration, and to monitor the development of possible complications of the disease, including long-term complications.

Complications and consequences of infectious mononucleosis in children

Common complications include the addition of a bacterial infection of the nasopharynx, which causes severe forms of sore throat, and the development of icteric syndrome against the background of an inflammatory process in the liver.

Much less frequently, this virus develops otitis media, paratonsillitis, sinusitis, and inflammatory processes in the lungs (pneumonia) as a complication.
Splenic rupture is one of the most dangerous complications of infectious mononucleosis. This pathological process is observed in 0.1% of patients, but it entails a life-threatening condition - extensive hemorrhage in the abdominal cavity and requires immediate surgical intervention.

The development of a secondary infectious process against the background of the underlying disease is most often provoked by pathogenic microorganisms of the staphylococcal and streptococcal groups. Other types of complications include meningoencephalitis, interstitial pneumonia with the formation of infiltrates in the lung tissue, liver failure, severe hepatitis, hemolytic type of anemia, neuritis, polyneuritis, cardiac complications, etc.

The overall prognosis for recovery is favorable with appropriate and timely therapy. In the absence of treatment, incorrect diagnosis or distortion of doctor’s prescriptions, it is possible not only for the development of serious complications and consequences of the disease, but also for the transition of the acute form to a chronic viral infection.

Among the long-term consequences of infection with the Epstein-Barr virus, the development of cancer (lymphomas) is also distinguished. This disease can occur against the background of a sharp decrease in immunity, however, a history of infectious mononucleosis, according to research, does not play a significant role; the presence of the virus in the body (virus carriage) is sufficient. However, clinicians state that the chances of such a consequence are extremely small.

For 6 months or more, depending on the severity of the disease, increased fatigue and the need for more frequent and longer rest may be observed. Children are recommended to have a daytime or “quiet hour”, regardless of age, a gentle diet, the absence of significant physical and psycho-emotional stress, and observation by a hepatologist. During the recovery period, routine vaccination is prohibited.

Prevention of infection during contact with a patient with infectious mononucleosis

The release of the virus into the environment by a sick child or adult does not end with recovery, therefore quarantine and additional means of protection during the acute period of mononucleosis are not recommended. It goes without saying that you should avoid visiting houses where the presence of infection has been recorded, but specific means and measures that reduce the likelihood of infection with the Epstein-Barr virus do not yet exist.

General preventive principles include strengthening the body's defenses: proper balanced nutrition, exercise, hardening, adherence to a daily routine, reasonable alternation of stress and periods of rest, reducing the amount of stress, supportive vitamin therapy (if necessary).

Preventive consultations with a pediatrician and specialized specialists will allow timely detection of disorders and deviations in the functioning of organs and systems, which reduces the likelihood of developing severe complications and consequences of any disease.

Contents of the article

Infectious mononucleosis(Filatov's disease) is an acute infectious disease of a viral nature, characterized by damage to the reticuloendothelial system with lymphadenopathy, an increase in the size of the liver, spleen and peculiar changes in white blood.

Historical data

Infectious mononucleosis was first isolated by N. F. Filatov from acute adenitis in 1885 under the name idiopathic lymphadenitis. Pfeiffer in 1889 described it as glandular fever.
Subsequently, characteristic changes in the blood were discovered (Turk, 1907; Bums, 1909). Subsequently, laboratory diagnostic methods were developed, which contributed to in-depth, comprehensive research. In our country, such research is carried out by many scientists: I. A. Kassirsky, N. M. Chireshkina, N. I. Nisevich, V. S. Kazarin, M. O. Gasparyan and others.

Etiology of infectious mononucleosis in children

The causative agent, according to most researchers, is a virus, but until it has been isolated, its properties are unknown.
The causative agents described were diphtheria bacteria, coccal flora, spirochetes, Listerella, and rickettsia. The hypothesis about the viral nature of the disease arose in 1939 (Wising) and subsequently took a dominant position.
There are reports of immunological responses in patients with infectious mononucleosis to various viruses or the isolation of various viruses from them, especially from the group of myxoviruses and cytomegaly virus. In recent years, much attention has been drawn to the Epstein-Barr virus (EBV). It was discovered in 1964-1965. in Burkitt's lymphoma cells. Later, there were reports that patients with infectious mononucleosis developed EBV antibodies. This gives grounds for a number of authors to speculate about the etiological role of this virus. The question of the specificity of EBV in infectious mononucleosis is being intensively studied.

Epidemiology of infectious mononucleosis in children

Epidemiology is extremely insufficiently studied. The source of infection is the patient, including erased forms, and possibly the virus carrier. Transmission is primarily airborne, but can also occur through contact. The possibility of infection through food is also suspected. Diseases occur primarily in sporadic cases, but small epidemic outbreaks have also been described. Children of preschool and school age and young people are more often affected. Contagiousness is low.

Pathogenesis and pathological anatomy of infectious mononucleosis in children

The virus, according to most researchers, has a tropism for lymphoid-reticular tissue. It enters the body through the mucous membrane of the oropharynx and upper respiratory tract.
The site of virus replication and changes in the incubation period are unclear. Viremia probably occurs at the end of incubation. Due to viremia, as well as lymphogenous spread, the virus penetrates the lymph nodes, liver, spleen, and other organs, where it causes proliferation of lymphoid and reticulohistiocytic elements. Tissue monocytic cells flood the blood, which determines the peculiar hematological changes.
Pathomorphological changes known on the basis of intravital studies of material obtained during biopsy, as well as in rare deaths (E. N. Ter-Grigorova). Under microscopy, the proliferation of mononuclear cells is especially pronounced in the lymph nodes, tonsils, and spleen. In some cases, necrosis is observed in the lymph nodes. In the liver, in addition to proliferation, moderately pronounced degenerative changes may occur. The mesenchymal process predominates, but disturbances can also occur in the parenchyma; subsequently they disappear without disturbing the structure of the organ. Changes are also described in other organs (lungs, heart, kidneys, central nervous system), where predominantly focal, mainly perivascular, infiltrates are observed - accumulations of mononuclear cells. Thus, all organs and systems are involved in the pathological process.
In addition to viral effects, microbial infection often occurs and the process occurs in the form of a viral-microbial association (N. I. Nisevich, V. S. Kazarin, M. O. Gasparyan). This contributes to the formation of more severe forms of tonsillitis with effusion, with more pronounced symptoms of intoxication, and can have an effect on the blood, contributing to the appearance of neutrophilia and an increase in ESR.
Infectious mononucleosis is usually considered benign reticulosis. However, severe lesions of the central nervous system (meningitis, meningoencephalitis, encephalomyelitis) resulting from regiculohistiocytic and lymphoid infiltration in different parts of the nervous system have been described. There are reports of severe liver damage, even necrotic and fatal due to hepatodystrophy. The development of hemolytic syndrome, hemolytic anemia, and thrombocytopenic purpura is possible. The pathogenesis and pathological anatomy of infectious mononucleosis require further study.

Clinic of infectious mononucleosis in children

The incubation period ranges from a few days to 30 or more. The disease begins acutely, with an increase in temperature usually to high numbers (38-39 ° C), the state of health is disturbed, pain when swallowing often appears, then difficulty in nasal breathing due to swelling of the lymphoid tissue of the nasopharynx and enlargement of the lymph nodes. The disease usually reaches full development in 2-3 days. Against the background of persistent temperature of a continuous or remitting type, polyadenitis develops: enlargement of the axillary, inguinal, ulnar, mediastinal, mesenteric lymph nodes, but the most pronounced is multiple enlargement of the cervical and posterior cervical nodes. They reach the size of a bean, a walnut, and even large ones; they are not sharply contoured, rather dense, elastic, not welded together, and almost painless. There may be a slight swelling of the surrounding tissue.
By this time, many patients develop catarrhal tonsillitis or with effusion in the lacunae. Microbial flora usually plays a role in the etiology, mainly hemolytic streptococcus and staphylococcus. In the pharynx, there is a rather bright hyperemia, swelling, looseness of the mucous membranes, plaques are usually loose, but sometimes they are filmy, as in diphtheria. Sometimes a rash appears without a specific location and morphology.
By this time, the size of the liver and spleen increases. The liver can protrude 3-4 cm or more from under the edge of the costal arch. In some cases, functional liver disorders are observed due to the development of so-called mononucleosis hepatitis, characterized by a predominance of the mesenchymal reaction and slight damage to the parenchyma; its course is benign.
Slight icterus of the skin and sclera appears, and the level of bilirubin in serum increases slightly. blood flow and enzyme activity; the changes are short-lived.
The main manifestations of mononucleosis, which determine its essence and name, are changes in the peripheral blood that occur in the first days of the disease and reach a maximum at its height, but are often somewhat delayed. Characterized by the appearance of leukocytosis, often significant (up to 15-15-10-20-103 in 1 μl or more), an increase in the number of lymphocytes and monocytes. In addition, atypical mononuclear cells with wide basophilic protoplasm are found, called wide-plasma lymphocytes, lymphomonocytes, mononuclear cells, ESR is moderately increased.
There are mild, moderate and severe forms of mononucleosis. Atypical forms are also observed, occurring without clinical manifestations, only with a characteristic hematological picture.
The course of the disease is quite long (up to 1-2 weeks or more). The high temperature lasts for several days (often 7-8 days or more); Other changes with very little dynamics also persist. Then the temperature gradually decreases without any specific patterns; sometimes a second temperature wave occurs. Simultaneously with the decrease in temperature, plaque in the pharynx disappears.
The lymph nodes shrink more slowly. When the patient’s condition is completely satisfactory, the size of the spleen and especially the liver normalize extremely slowly, often within weeks and even months. Normalization of blood also often occurs over several weeks or even months.
Complications are rare (pneumonia, otitis, stomatitis, etc.).

Diagnosis of infectious mononucleosis in children

Diagnosis of mononucleosis in most cases is not difficult. Fever, damage to the nasopharynx, tonsillitis, mainly with effusion on the palatine and nasopharyngeal tonsils and swelling, enlarged lymph nodes, liver, and spleen are sufficient to establish a clinical diagnosis. This is confirmed by characteristic hematological changes. Sometimes it is necessary to differentiate from diphtheria of the pharynx, Botkin's disease, acute leukemia, lymphogranulomatosis. The distinctive signs of diphtheria and Botkin's disease are given in the corresponding chapters. The diagnosis of leukemia and lymphogranulomatosis is clarified based on the dynamics of changes. Sometimes it is necessary to perform a sternal puncture or puncture of a lymph node.
Diagnostic assistance is provided by serological examination methods, based on the fact that the blood serum of patients acquires the ability of heteroagglutination. The Paul-Bunnel agglutination reaction with sheep erythrocytes has been proposed for use in practice, but it is not specific enough, so it was replaced by the modified Paul-Bunnell-Davidson reaction, which is highly accurate. Currently, the Hoff and Bauer agglutination reaction with horse erythrocytes is usually used, which is fast, easy to perform and highly accurate; it becomes positive at the end of the 1st - beginning of the 2nd week.

Prognosis of infectious mononucleosis in children

The prognosis is usually favorable. However, given the importance of timely diagnosis of leukemia, it is necessary to closely monitor changes in the blood and not release children from observation until final recovery.

Treatment and prevention of infectious mononucleosis in children

Treatment is symptomatic. In severe forms, a short course of treatment with glucocorticoids is carried out. Due to the frequent addition of secondary microbial flora, antibiotics are used.
Prevention. Patients are hospitalized in boxed units. There are no special events held in the outbreak.

On the neck.

In this article we will talk about the symptoms and treatment of infectious mononucleosis in children.

Pathogens

There are many hypotheses about pathogens that can cause infectious mononucleosis in a child. Currently, the proven cause of the disease is the Epstein-Barr virus (herpes virus type VI, EBV infection) and. In addition to mononucleosis, the role of EBV infection has been proven in other pathologies (Burkitt's lymphoma, carcinomas, oral tumors, etc.).

The disease has a spring-autumn seasonality, and is characterized by peak incidence rates every 5-7 years.

Ways of infection of a child

The virus can enter the baby’s body from a sick person or from a carrier. Those who have had mononucleosis can actively release the pathogen into the environment for several months. Subsequently, a lifelong carriage of the virus is formed, which does not manifest itself with any symptoms.

There are several possible ways the virus can enter a child’s body:

Airborne. This is the most common variant of infection with infectious mononucleosis. The virus spreads with saliva over long distances when talking, coughing or sneezing, reaching the mucous membranes of the respiratory tract.
Contact and household. The pathogen remains viable outside the human body for several hours. When using dishes, individual towels, or toys contaminated with the Epstein-Barr virus, there is a high probability that a child may become infected with it.
Blood transfusion. The herpes virus actively multiplies in blood culture, so when transfusion of infected donor blood or organ transplant occurs, an acute disease process occurs with a pronounced clinical picture.

In half of the sick children, the disease does not clinically manifest itself with bright and clear symptoms; the infectious process occurs in an erased form. If the immune system is functioning well, the disease may be asymptomatic.

Clinic of the disease

From the moment the pathogen is introduced into the child’s body until the first clinical manifestations, it can take from 1 week to several months. There are several main symptoms, the appearance of which indicates infectious mononucleosis in children:

High persistent fever.
Enlarged cervical lymph nodes, especially the posterior group.
Sore throat or bright hyperemia of the oropharynx.
Increased size of the spleen and.
The appearance of altered monocytes (mononuclear cells) in the peripheral blood.

Among the secondary symptoms, children may develop a rash on the body or hard palate, swelling of the eyelids, face, catarrhal phenomena (nasal congestion, runny nose, sneezing), in rare cases it is noted.
The acute process begins suddenly, against the background of absolute health, the temperature rises to high levels, and the traditional set of symptoms of infectious mononucleosis fully manifests itself within one week.

From the first days of illness, the doctor can see or palpate enlarged lymph nodes in the neck, and when examining the oropharynx, detect purulent plaque on the tonsils. By the end of the first week of illness, atypical mononuclear cells are detected in a general blood test.

There is a variant of the development of infectious mononucleosis with a gradual increase in body temperature, general weakness, and minor catarrhal symptoms. At the peak of the disease, high fever, soreness of the lymph nodes and swelling of the tissue around them appear. When the virus spreads through the bloodstream, nodes in other parts of the body (abdomen, chest) enlarge.

With an increase in the size of the liver in children, sometimes there is an icteric staining of the skin and sclera, and in the peripheral blood the ALT level also increases. The spleen enlarges simultaneously with the liver, but the decrease in its parameters occurs somewhat earlier.

Older children with infectious mononucleosis may experience pain in the knee joints.

Classification of pathology

Depending on the severity of specific symptoms, infectious mononucleosis can occur:

typical: the disease is characterized by a full-fledged, detailed picture of the disease;
asymptomatic: there are completely no clinical symptoms of pathology, and only special laboratory tests help establish the diagnosis;
with erased symptoms: the main manifestations of the disease are minimally expressed or are more reminiscent of a respiratory tract disease;
with predominant damage to internal organs (visceral form): changes in the nervous, cardiovascular, urinary, endocrine and other systems or organs come to the fore in clinical manifestations.

Depending on the duration of clinical manifestations, the disease can be acute, protracted or chronic. Infectious mononucleosis is considered acute from the first day of the disease until 3 months, from 3 to 6 months - a protracted course, chronic - the presence of pathological symptoms for more than 6 months.

Complications and consequences of mononucleosis

Regardless of the severity of a child's symptoms, infectious mononucleosis can cause certain serious complications:

suffocation (asphyxia): the condition develops due to the blocking of the airway lumen by a package of enlarged lymph nodes;
rupture of the splenic capsule with significant enlargement;
changes in the blood (, hematopoietic disorders);
damage to the nervous system (serous meningitis, impaired coordination of movements);
infectious-toxic shock (severe disruption of the functioning of important organs when the virus enters the blood in large quantities);
suppuration of the lymph nodes and surrounding tissue (lymphadenitis, peritonsillar abscess);
damage to the ENT organs (sinusitis, mastoiditis), etc.

After suffering an acute form of infectious mononucleosis, children can fully recover, become virus carriers, or the process will become chronic with periodic exacerbations.

Diagnosis of mononucleosis

With infectious mononucleosis, characteristic changes in the blood are detected.

To identify infectious mononucleosis, the child must undergo a complete laboratory examination. At the first stage of diagnosis, a general blood test is performed. It shows signs of inflammation (leukocytosis, accelerated ESR), altered mononuclear cells appear, their number exceeds 10%. If the disease is caused not by EBV infection, but by a different type of herpes virus, then there will be no atypical monocytes in the blood.

In addition to a general blood test, heterophilic antibodies in the patient’s serum are determined in the laboratory using sheep erythrocytes. The LA-IM test is also performed, its effectiveness is about 80%.

Using an enzyme immunoassay, the level of antibodies to various types of herpes is determined in a sick baby. The PCR method allows you to detect pathogen DNA not only in the blood, but also in saliva or urine.

Principles of treatment

Viferon suppositories - an antiviral agent for children

Treatment of most typical cases of infectious mononucleosis is carried out in an infectious diseases department. In mild cases, treatment can be carried out on an outpatient basis, but under the supervision of a local doctor and an infectious disease specialist.

During the height of the pathology, the child must comply with bed rest, a chemically and mechanically gentle diet and water and drinking regime.

Symptomatic therapy includes antipyretic drugs, local antiseptics for the throat (Hexoral, Tandum Verde, Strepsils, Bioparox), analgesics, rinsing the mouth with herbal decoctions, furatsilin. Etiotropic treatment (the action is aimed at destroying the pathogen) has not been definitively determined. In children, it is recommended to use interferon (Viferon suppositories), (isoprinosine, arbidol).

In small or weakened children, the prescription of antibacterial drugs with a wide spectrum of action is justified, especially in the presence of purulent complications (pneumonia, otitis media, meningitis). When the central nervous system is involved in the process, symptoms of asphyxia, decreased bone marrow function (

Most parents have not even heard of such a childhood disease as infectious mononucleosis. Although with a 9 to 10 probability they themselves, when they were children, successfully recovered from this disease. But since their babies are yet to face this “fate”, it makes sense to find out how infectious mononucleosis in children progresses and how it is treated, more details...

The “favorite” area of infection for infectious mononucleosis in children is lymphoid tissue. This means that not only the lymph nodes increase in size and suffer (especially noticeably in the neck), but also the liver and spleen.

Infectious mononucleosis in children: aka Goga, aka Zhora, aka Georgy Ivanovich...

Infectious mononucleosis is not a rare disease and is very common among children. However, in the vast majority of cases it occurs in mild forms, which are often not even diagnosed. The child “imperceptibly” gets sick, without causing any special worries in the hearts of the parents about his well-being, and gradually recovers on his own. In such cases, only a blood test can tell about the presence of the mononucleosis virus in a child’s body... What kind of “sore” is this strange?

In the old days, there was a popular synonym for infectious mononucleosis - “kissing disease”. It was believed that children “catch” this “infection” through kisses. Which, in general, is very close to the truth.

The fact is that the infectious mononucleosis virus is present in all secretions of a sick person (including saliva), but it cannot “fly” through the air. Thus, you can only become infected through close physical contact, the most common and familiar variant of which in the case of children is kissing.

And if in ordinary circles infectious mononucleosis was called “kissing disease” in earlier times, then doctors in the late 19th and early 20th centuries called it differently - “glandular fever,” most likely because the most striking symptom of the disease is enlarged lymph nodes in the neck. Later, medical scientists noticed that the blood leukocytes of patients with glandular fever specifically change, turning into atypical mononuclear cells - hence the modern name “infectious mononucleosis”.

In 1964, English virologist Michael Epstein and his assistant Yvonne Barr isolated the virus itself that causes infectious mononucleosis - it belongs to the group of herpes viruses of the so-called type 4. Since then, the infectious mononucleosis virus has received their names - Epstein-Barr virus (sometimes simply EBV). Thus, the disease received another name - EBV infection.

The last name is especially important for parents, because when testing a blood for infectious mononucleosis, the answers usually state “result for EBV infection.”

Despite the fact that infectious mononucleosis, having an impressive list of synonymous names, seems at first glance to be a terribly dangerous “infection”, it can be cured in the vast majority of cases. Children under 2 years of age get sick extremely rarely, and most of all, infectious mononucleosis “loves” children 3 years of age and older, as well as adults 35 years of age and younger. But no matter how much and for a long time both adults and children get sick, everyone gets better in the end!

The incubation period of infectious mononucleosis in children can last from 5-10 days to 2 months, and the acute period of the disease itself, as a rule, does not exceed 2-3 weeks.

Symptoms of infectious mononucleosis in children

In the vast majority of cases, children and adolescents “suffer” from this disease, but adults almost never.

In almost half of cases of infectious mononucleosis, the disease is asymptomatic. Moreover, often parents do not even notice that their baby has already suffered from the “kissing disease.” But there is also the other half - those who have obvious symptoms.

The main and main and most characteristic symptom of infectious mononucleosis is damage to lymphoid tissue, which is part of the immune system. Lymphoid tissue consists of tonsils (one of which - the nasopharyngeal - often makes itself known to parents in the form of adenoids in their children), lymph nodes, liver and spleen. Accordingly, all these organs suffer (to varying degrees) if a child becomes ill with infectious mononucleosis.

Doctors cannot explain the nature of the existing phenomenon: boys get infectious mononucleosis almost twice as often as girls.

Typical symptoms of infectious mononucleosis in children:

Difficulty in nasal breathing ();
Inflammation of the tonsils as in “classic”;
(which means adult-like snoring and shortness of breath during sleep, loss of appetite, potential ear pain);
Enlarged lymph nodes (the cervical lymph nodes increase in size the most - you will notice and feel it to the touch);
Enlarged liver and spleen;
Chronic fatigue and lethargy.

In addition, there are also less frequent and less typical manifestations of the disease:

As a rule, the final diagnosis of “infectious mononucleosis” is made after a clinical blood test, when those same atypical mononuclear cells are detected in it.

Treatment of infectious mononucleosis in children

Treatment of infectious mononucleosis is exclusively symptomatic - these are the symptoms that are observed, then you should try to alleviate and normalize:

1 If the child has a fever, you can give an antipyretic (paracetamol).
2 If your throat hurts, give your child gargles (at home, it is best to use a decoction of sage and chamomile, as well as soda or saline solutions as a gargle).

Soda solution: 1 tsp. baking soda per glass of water;
Saline solution: 1 tsp. table salt per 500 ml of water;

3 If your nose is stuffy, you should rinse it with saline as often as possible; in addition, you can use vasoconstrictor drugs.

In addition, a light diet, a fresh and cool indoor climate, rest and plenty of fluids will help improve the health of a sick baby.

Infectious mononucleosis in children: symptoms and treatment

Important facts about infectious mononucleosis in children and its complications

Despite the fact that the disease itself can occur easily and almost imperceptibly in a child, it is extremely useful for parents to know some important nuances regarding infectious mononucleosis in children:

1 Lymphoid tissue, affected by infectious mononucleosis, is an important part of the immune system. And therefore, often, against the background of this disease, a child may be vulnerable to the “face” of many other ailments, especially bacterial ones. The most common complications of infectious mononucleosis are: sore throat, and others.
2 No matter how much the child suffers during the acute period of infectious mononucleosis, which can last 2-3 weeks, he will recover in any case. The only thing you should really be wary of is possible complications.
3 When a child experiences one or another bacterial complication against the background of infectious mononucleosis, antibiotics are usually prescribed as medications. Which (and doctors always warn parents about this) in 90-95% of cases cause a mild short-term rash on the child’s skin. This is not considered a side effect, but is considered a somewhat benign feature of using antibiotics (usually ampicillin or amoxicillin) to combat bacterial infections associated with infectious mononucleosis.
4 A weakened immune system of the child, who remains vulnerable for quite a long time - up to 12 months after recovery, can also be considered a kind of complication of the disease. Therefore, it is “useful” for children after suffering from infectious mononucleosis to reschedule all scheduled vaccinations, as well as to limit the child’s contact with a large number of people and not.
5 The most important and serious point that parents should know: unfortunately, the infectious mononucleosis virus in children is oncogenic. In other words, it may have a stimulating effect on the occurrence of cancer. Therefore, it is very important, after recovery, to donate the baby’s blood for a second test in order to monitor the rate at which the child’s blood is restored (gradually, atypical mononuclear cells should disappear). And if recovery does not occur for a long time, seek help from a hematologist (that is, a specialist in blood diseases).