With all the variety of viral diseases, there is a group of infections that become our companions for life. Infectious mononucleosis belongs to these diseases (synonyms - monocytic tonsillitis, Filatov’s disease). This is a disease that is difficult to distinguish from a normal respiratory viral infection, but which can lead to serious complications. And since it is precisely in children that infectious mononucleosis is more common than in adults, this article may be useful to parents.
Many-Faced Herpesvirus
The causative agent of this disease belongs to the family Herpesviridae, which includes 8 serotypes of human viruses. Infectious mononucleosis causes the herpes simplex virus serotype 4 (Human gammaherpesvirus 4). The original name - Epstein virus - Barr - he received in honor of his discoverers, virologists from England Michael Epstein and Yvonne Barr, they described it in 1964.
According to statistics, 90-95% of the adult population have antibodies to this disease in their blood, which indicates an infection. Epstein-Barr virus, like all herpes viruses, contains hereditary information in the form of a double-stranded DNA helix, which causes lifelong virus carrier in humans. This virus has a complex membrane - a supercapsid, which consists of glycoproteins and lipids that form peculiar spikes on its surface. And he looks like a multifaceted cube with a diameter of up to 200 nanometers.
Target cells and virions
The extracellular form of the virus - the virion - is quite stable in the external environment. At normal environmental conditions, the virus retains virulence for 2-12 hours. On different surfaces, these terms may vary. It is resistant to freezing, but dies when boiled, it takes less than half an hour. The virus that causes infectious mononucleosis (photo below) is clearly tropical - this means that it especially “loves” the cells of the lymphatic system and affects its organs (oropharyngeal lymph nodes, tonsils, spleen).
Unlike other herpetic viruses, the interaction of the Epstein-Barr virus with target cells (group B lymphocytes) proceeds according to a conciliatory scenario. Penetrating into the cells of the lymphatic tissue, the virus embeds its DNA into the DNA of the host cell. After that, the process of replication (doubling) of the virus genome begins. But the parasite does not kill lymphocytes, but leads to their proliferation - the proliferation of tissues due to an increase in host cells. In addition, recently there has been evidence of the involvement of this pathogen in the formation of various types of tumor cells in the human body. The danger of the virus lies in the fact that the virus carrier, although asymptomatic, can nevertheless lead to damage to internal organs.
Etiology and reservoir
Statistics show that out of every 100 thousand people, only 45 experience mononucleosis. The causative agent of the disease is ubiquitous. A weak seasonality of the disease was detected: the virus is more active in the autumn-winter and spring period. Infectious mononucleosis in children under 2 years of age is a very rare occurrence; older children are more likely to get sick. The peak incidence occurs in the puberty period (10-14 years). Boys are more likely to become infected than girls, with the latter being sick more often at 12-14 years old, and the former at 14-16 years old.
The nature of this pattern is not completely clear, but it can also be seen in adults. Infectious mononucleosis in childhood has symptoms of respiratory inflammation. In adults, it is often asymptomatic, and it can only be determined by the presence of antibodies in the blood. The reservoir of infection is both patients with a pronounced clinic and virus carriers. Patients are especially contagious (contagious) during the period of clinical manifestations of the disease and from the 4th to the 24th week after convalescence (recovery). In virus carriers, the virus is released into the environment periodically.
How does it enter our body?
This ailment is sometimes called the "disease of kisses." The most likely way a pathogen enters the body is direct contact with the saliva of the patient or the virus carrier. They can be infected by inhalation of sputum that the patient exudes when coughing or sneezing. Possible infection through food and household items. The ingress of the virus into the respiratory tract leads to damage to the epithelium and lymphoid tissues of the oropharynx. Then the virus invades the lymphocytes, stimulates their growth and runs through the body, leading to edema and enlargement of the tonsils, liver and spleen. Possible transmission of the pathogen through the bloodstream and at the time of delivery.
Infectious Mononucleosis: Symptoms
The terms of the incubation period of the development of the disease are blurred - from 3 to 45 days. Most often, the disease begins acutely. Sometimes before the acute period there is a sore throat, rhinitis, weakness and headaches at subfebrile temperature. During the period of infection activation (on the 4th day), the temperature can rise to 40 ° C.
The main symptom of infectious mononucleosis is tonsillitis (enlargement and inflammation of the tonsils). Fibrous films appear on the tonsils, and the disease is very similar to a sore throat. Sometimes deeper inflammation appears, affecting the gaps of the tonsils, the contents of which are removed and exposes the wounded surface.
Damage to the cervical and maxillary lymph nodes leads to lymphadenopathy, lymph outflow is difficult, and the bovine neck syndrome appears. A fourth of patients have rashes that do not cause itching and disappear within 2 days. The increase in the liver and spleen, which persists in infectious mononucleosis in children and adults up to 4 weeks, leads to darkening of the urine, yellowness of the integument, yellowing of the sclera of the eyes and the appearance of dyspepsia.
General clinical picture
Symptoms of infectious mononucleosis in children with acute course are diverse. With this option, the following periods are distinguished during the course of the disease:
- Initial phase. More often, the acute phase begins with fever, aches throughout the body and weakness. Sometimes it is accompanied by the simultaneous appearance of all three main symptoms of infectious mononucleosis - fever, tonsillitis and lymphadenopathy. Duration from 4 to 6 days.
- The peak phase. By the end of the first week of illness, health is getting worse. There are signs of a sore throat, often catarrhal. The cervical group of lymph nodes reaches its maximum size (sometimes the size of a chicken egg). From the 10th day, the painful clinical manifestations of infectious mononucleosis disappear. By the beginning of the second week, an increase in the spleen is observed, by the third week, the liver increases. With a benign course, by 12-14 days all the symptoms of infectious mononucleosis disappear. And treatment in this period will be most effective. Its duration is 2-3 weeks.
- The period of reconvalescence (recovery). During this period, the spleen and liver come back to normal, but the patient is still contagious. Duration - up to 4 weeks. Up to 90% of patients by the end of the 2nd week already feel a surge of strength. But sometimes a feeling of fatigue and weakness accompanies the patient for six months or more.
Features of the course in adults
The disease practically does not occur in people over 35 years old. From 14 to 29 years - this is the age category most susceptible to infectious mononucleosis. Symptoms in adults begin with a fever lasting up to 2 weeks. The maxillary lymph nodes and tonsils are less affected than in children. But the liver is often involved, which is manifested by yellowness of the integument and sclera of the eyes. These atypical forms of the disease are diagnosed exclusively according to laboratory tests.
A feature of this disease in adults is often an asymptomatic course, and women simply do not pay attention to it during pregnancy planning, bearing a child and childbirth. Doctors unanimously claim that pregnancy is undesirable for 6 months or even a year after a mononucleosis infection. And not only the mother of the child, but also the future father. The infection during pregnancy harms the well-being of a woman, harms the development of the fetus, and can lead to a pregnancy failure. Doctors often advise artificially terminating a pregnancy if there is a chance of a fetal pathology.
Transition to a chronic form
The acute form of the course of the disease can become chronic with a low immune status. In chronic infectious mononucleosis in children, the symptoms are as follows: first of all, long and persistent anginal manifestations, leukopenia, exanthema, prolonged low-grade fever. A high titer of antibodies to virus antigens is observed, accompanied by histologically confirmed pathologies in organs (uveitis, hepatitis, lymphadenopathy, pneumonia, hypoplasia of the bone marrow). A fatal outcome can only occur in the case of rupture of the spleen and obstruction of the airways, which is extremely rare.
With congenital infectious mononucleosis in children, the symptoms and treatment are often severe. In intrauterine development of the fetus, severe pathologies of bone tissues and the nervous system (cryptorchidism and micrognathia) are noted.
Danger of complications
It is the danger of organ damage, as a consequence of the disease, that the Epstein-Barr virus is famous. It provokes cancer of the lymphatic organs, herpetic infections, hepatitis, damage to the liver, spleen and nervous system. The following complications may develop:
- Rupture of the spleen. It occurs in 1% of cases. Without surgery, it is fatal.
- Hemolytic complications (anemia, thrombocytopenia).
- Neurological disorders (meningitis, cranial nerve paresis, encephalitis, polyneuritis, psychosis).
- Cardiac abnormalities (arrhythmia, pacemaker blockade, pericarditis).
- Pneumonia.
- Disorders in the liver (necrosis, encephalopathy).
- Asphyxia.
This list is scary. But the patient does not need to worry in advance, most infected people recover quite quickly and avoid complications.
Diagnostics
The success of treatment of infectious mononucleosis largely depends on a complete and high-quality diagnosis. Laboratory methods are as follows:
- A general blood test will show the presence of atypical mononuclear cells - the precursors of T-lymphocytes, which are involved in the destruction of Epstein-Barr B-lymphocytes infected with the virus.
- Blood biochemistry provides information on hyperglobulinemia, hyperbilirubinia, the appearance of cryoglobulin proteins.
- An indirect immunofluorescence reaction or a drip test reveals the presence of specific antibodies.
- Virological research is carried out on swabs from the patient's throat. They determine the presence of the Epstein-Barr virus, but they are very expensive and rarely used in domestic practice.
The presence of infectious mononuclear cells in the blood is the main indicator of mononucleosis. However, they can also be detected with HIV infection. Therefore, simultaneously with this analysis, an enzyme-linked immunosorbent assay for the human immunodeficiency virus is prescribed, which is repeated two more times with interruptions per month.
How to treat infectious mononucleosis
The treatment is outpatient. In the acute phase of the disease, bed rest and heavy drinking, sleeping at least 9 hours a day, a balanced diet, excluding alcohol and caffeinated drinks are recommended. There is no special treatment for infectious mononucleosis in children and adults. To date, there are no drugs that will rid the body of this virus. But to alleviate the course of the disease and prevent relapse is quite possible.
Treatment of infectious mononucleosis in children is symptomatic, with the addition of secondary infections, penicillin antibiotics can be prescribed. Non-steroidal anti-inflammatory drugs are prescribed to reduce fever. In case of rupture of the spleen - the most dangerous complication of mononucleosis - emergency surgical intervention is necessary.
Treatment of infectious mononucleosis in adults is similar. The main thing to remember is that self-medication is not an option, but consultation with a competent specialist in combination with high-quality diagnostics is the key to a quick recovery.
Symptoms of infectious mononucleosis in children and treatment require a comprehensive analysis and approach. And dietotherapy is of no small importance. A diet for mononucleosis is necessary in connection with a violation of the liver and spleen, recommended table number 5 according to Pevzner (table below).
What does traditional medicine advise
The list of the most effective fighters against viral diseases includes astragalus root, echinacea and garlic. But proponents of traditional medicine warn of the dangers of self-medication and the use of folk remedies. Sometimes they can do a disservice.
So, astragalus root has a doubtful strengthening effect, but can be dangerous for hypertensive patients and patients with all forms of diabetes.
Echinacea even today causes controversy among doctors about its immunostimulating effect. Almost every year, various laboratories in the world publish rather controversial reports on the effects of echinacea on the human body.
From ancient times, garlic was famous for its bactericidal properties. Thanks to the presence of allicin, it really helps in the fight against viral infections. One caveat - it will show its properties in raw and crushed form. But when consumed in large quantities, garlic is toxic and adversely affects the gastrointestinal tract.
So it’s up to you to throw away money to purchase magical biological supplements and herbal remedies, which in the best case will not harm the body, and in the worst they can be put in a hospital bed or not.
Preventive measures
Special preventive measures to prevent infectious mononucleosis have not been developed. In this case, a prophylaxis scheme for respiratory viral infections is used. There is no vaccine, but non-specific methods of prevention are aimed primarily at strengthening the body's immune forces. Every second, up to three thousand different pathogens are destroyed in our body - the immune system of a healthy person copes with this. So with mononucleosis - a strong immune status will not allow to "unblock" this unpleasant infection.
As preventive measures, child care facilities are quarantined for a minimum of 14 days. Conduct a standard anti-epidemic treatment of the room and all items with disinfectant solutions.
Viral Oncogenesis, or Cancer That Can Be Infected
To date, a correlation between a viral infection and malignant tumors has been reliably established. Evidence has been obtained regarding seven viral pathogens:
- Hepatitis B and C. virus
- Epstein Virus - Barr.
- T-lymphotropic human virus.
- Some serotypes of the papilloma virus.
- Herpes simplex virus type 8 (Kaposi's sarcoma).
The fact that oncology can be a contagious disease is both scary and encouraging. Medicine does not stand still. We already have 10 diseases of an infectious nature, finally defeated by vaccines. This is smallpox, bubonic and pulmonary plague, leprosy, cholera, rabies, and some forms of polio. As the proverb says, a person is more ferocious in dealing with an infection than an infection in dealing with a person. And the invention of new vaccines is likely to save our descendants from infectious mononucleosis and cancer. After all, this is only a virus against which the entire industry of human pharmacology!