Angina with infectious mononucleosis

As an independent infectious disease, infectious mononucleosis was first described by N.F. Filatov in 1885 under the name "idiopathic inflammation of the cervical lymph nodes". In 1889, E. Pfeiffer described the clinical picture of the same disease under the name "glandular fever".

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Cause of sore throat in infectious mononucleosis

Infectious mononucleosis is caused by the Epstein-Barr virus from the herpes virus family. The source of the infectious agent is a sick person and a virus carrier. The pathogen is transmitted by airborne droplets. Contributing factors to infection are crowding, using common dishes, towels, bedding, etc. The disease is slightly contagious. Immunity has not been sufficiently studied. No cases of recurrent disease have been described.

Symptoms and clinical course of angina in infectious mononucleosis

The incubation period is from 4 to 28 days, more often 7-10 days. The disease usually develops acutely with slight chills. The temperature is subfebrile, sometimes rising to 39-40 ° C. The fever can be undulating, recurrent and last from 2-3 days to 3-4 weeks, more often 6-10 days. Intoxication is moderate. Pronounced sweating is possible. In the blood - moderate leukocytosis - (10-20) x 10 ⁹ / l), neutropenia, predominance of lymphocytes and monocytes (40-80%), a shift in the leukocyte formula to the left, the appearance of atypical mononuclear cells with wide light protoplasm. Changes in the blood persist for 2-4 months or more after normalization of body temperature. The spleen is almost always enlarged, the liver - very often.

Clinical forms of angina in infectious mononucleosis

Typical signs of infectious mononucleosis are sore throat, enlarged lymph nodes, especially the occipital, cervical, submandibular (they are elastic and painless when palpated), liver and spleen.

Angina in infectious mononucleosis can occur before the lymph nodes react, in other cases it can occur much later than this reaction. Clinically, it manifests itself in three forms: pseudoulcer, asthenic and adenopathic

Pseudoulcer angina is characterized by an increased content of leukocytes in the blood and signs of acute leukemia, which complicates the diagnosis of infectious mononucleosis, especially in the first week of the disease. In this regard, it should be emphasized that "acute leukemias", in which complete recovery occurs, are nothing more than unspecified monocytic angina, especially if they are accompanied by bucopharyngeal bleeding and hemorrhages.

The asthenic form of monocytic angina can be accepted as a manifestation of agranulocytosis, when the blood test does not reveal the usual leukocytosis for infectious mononucleosis, but on the contrary, a significant decrease in the number of polynuclears is revealed, causing the occurrence of elements of the asthenic syndrome - a symptom complex characterized by irritability, weakness, increased fatigue and unstable mood, poor sleep, various psychopathic manifestations. In infectious mononucleosis, psychonatic components are absent.

The adenopathic form is characterized by a predominance of the lymph node reaction and often simulates childhood adenopathy fever, in which, in addition to angina and regional lymphadenitis, there is a polyadenopathy syndrome with an increase in distant lymph nodes, while no changes characteristic of infectious mononucleosis are detected in the blood. The final diagnosis for this form of infectious mononucleosis is established using a specific serological reaction to Paul and Bunnell mononucleosis.

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Diagnosis of sore throat in infectious mononucleosis

The diagnosis of infectious mononucleosis is established on the basis of the clinical picture, blood test results and positive serological test results. Infectious mononucleosis in the asthenic form is differentiated from paratyphoid fever, in which asthenia is accompanied by a rise in body temperature and a significant increase in the spleen. In the pseudoulcer form of tonsillitis with extensive filmy deposits on the tonsils, it is differentiated from diphtheria of the pharynx, Simanovsky-Plaut-Vincent angina and vulgar angina.

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Treatment of sore throat in infectious mononucleosis

In mild cases of the disease and the possibility of isolating the patient, treatment can be carried out at home (bed rest, drinking tea with lemon, vitamins, food rich in proteins and carbohydrates, fruit juices). In severe cases, treatment is carried out in an infectious diseases hospital (antiviral drugs, antibiotics to prevent secondary bacterial complications, prednisolone).

Prevention

Prevention consists of early detection and isolation of patients. They are discharged from the medical institution only after the disappearance of clinical symptoms (on average, 2-3 weeks from the onset of the disease).

What is the prognosis for tonsillitis in infectious mononucleosis?

The prognosis is usually favorable.