Infectious mononucleosis in children

Infectious mononucleosis in children is a polyethological disease caused by viruses from the Herpesviridae family, which occurs with fever, angina, polyadenitis, enlargement of the liver and spleen, and the appearance of atypical mononuclear cells in the peripheral blood.

ICD-10 code

• B27 Mononucleosis caused by gamma-herpetic virus.
• B27.1 Cytomegalovirus mononucleosis.
• B27.8 Infectious mononucleosis of another etiology.
• B27.9 Infectious mononucleosis, unspecified.

At half of all patients entering the clinic with the diagnosis of infectious mononucleosis, the disease is associated with Epstein-Barr virus infection, in the remaining cases - with cytomegalovirus and herpesvirus of the 6th type. Clinical manifestations of the disease depend on the etiology.

Epidemiology

The source of infection are patients with asymptomatic and manifest (erased and typical) forms of the disease, as well as viruses; 70-90% of infected infectious mononucleosis periodically secrete viruses with oropharyngeal secretions. From nasopharyngeal swabs the virus is secreted within 2-16 months after the transferred disease. The main pathway for the transmission of the pathogen is airborne, often infection occurs through infected saliva, which is why infectious mononucleosis was called a "kiss disease". Children are often infected through toys that are contaminated with the saliva of a sick child or a virus carrier. Possible blood transfusion (with donor blood) and sexual transmission of infection.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10]

Pathogenesis of infectious mononucleosis

The entrance gates are the lymphoid formations of the oropharynx. Primary reproduction and accumulation of viral material take place here, from which the virus can be hematogenous (possibly, lymphogenous) by entering other organs, primarily in the peripheral lymph nodes and liver. B- and T-lymphocytes, spleen. The pathological process in these organs begins almost simultaneously. In the oropharynx there are inflammatory changes with hyperemia and edema of the mucous membrane, hyperplasia of all lymphoid formations, leading to a sharp increase in palatine and nasopharyngeal tonsils, as well as of all lymphoid accumulations on the posterior pharyngeal wall ("granular" pharyngitis). Similar changes occur in all organs containing lymphoid-reticular tissue, but the lymph nodes, as well as the liver, spleen, and B-lymphocytes are especially characteristic.

Symptoms of infectious mononucleosis in children

The disease in most cases begins acutely, with rising body temperature, nasal congestion, sore throat, swelling of the cervical lymph nodes, enlargement of the liver and spleen, in the blood there are atypical mononuclears.

Polyadenopathy  is the most important symptom of infectious mononucleosis, the result of lymphoid tissue hyperplasia in response to generalization of the virus.

Very often (up to 85%) with infectious mononucleosis on the palatine and nasopharyngeal tonsils there are various overlapping in the form of islets and strips; they completely cover the palatine tonsils. Overlays of a whitish-yellowish or dirty-gray color, loose, bumpy, rough, easily removed, the tissue of the amygdala after removal of the plaque usually does not bleed.

In the blood, moderate leukocytosis is noted (up to 15-30 × 10 ⁹ / L), the number of mononuclear elements of blood is increased, the ESR is moderately elevated (up to 20-30 mm / h).

The most characteristic sign of infectious mononucleosis is atypical mononuclear cells in the blood - elements of round or oval shape, ranging in size from an average lymphocyte to a large monocyte. Cell nuclei are spongy with nucleolus residues. The cytoplasm is wide, with a light belt around the nucleus and a significant basophilia to the periphery, and vacuoles are found in the cytoplasm. In connection with the peculiarities of the structure, atypical mononuclear cells have been called "broad-plasma lymphocytes" or "monolymphocytes".

Classification of infectious mononucleosis

Infectious mononucleosis is divided by type, severity and flow.

• Typical cases are cases of the disease, accompanied by the main symptoms (enlarged lymph nodes, liver, spleen, tonsillitis, atypical mononuclears). Typical forms of severity are divided into light, medium and heavy.
• Atypical include the erased, asymptomatic and visceral forms of the disease. Atypical forms are always regarded as light, and visceral - as heavy.

The course of infectious mononucleosis can be smooth, uncomplicated, complicated and protracted.

[11], [12], [13], [14], [15], [16], [17], [18]

Diagnosis of infectious mononucleosis in children

In typical cases, diagnosis is not difficult. For laboratory confirmation, it is important to detect DNA of the corresponding virus by PCR in the blood, nasopharyngeal washings, urine, cerebrospinal fluid. The serological diagnosis of Epstein-Barr mononucleosis is based on the detection of heterophile antibodies in the blood serum of patients with erythrocytes of various animals (erythrocytes of ram, bull, horse, etc.). Heterophilic antibodies refer to IgM. To detect heterophilic antibodies, the Paul-Bunnell reaction or the LAIM test, the Tomczyk reaction or the Gof-Baur reaction, etc. Are also put in. In addition, the ELISA method is used to determine the specific antibodies of classes IgM and IgG against viruses.

[19], [20], [21], [22]

Treatment of infectious mononucleosis in children

There is no specific treatment for infectious mononucleosis in children. Assign symptomatic and pathogenetic therapy in the form of antipyretic, desensitizing agents, antiseptics for relief of the local process, vitamin therapy, with functional changes in the liver - cholagogue preparations.

Antibiotic therapy is prescribed with pronounced overlays in the oropharynx, as well as with complications. When choosing an antibacterial drug, it should be remembered that the penicillin series and especially ampicillin are contraindicated in infectious mononucleosis, since in 70% of cases it is accompanied by severe allergic reactions (rash, Quinck edema, toxic-allergic condition). There are reports of a positive effect of imudon, arbidol, anaferon, metronidazole (flagel, trichopolum). It makes sense to use vobenzim, which has an immunomodulatory, anti-inflammatory effect. In the literature, the effect of using cycloferon (meglumine acridon acetate) at a dose of 6-10 mg / kg is justified and shown. The most effective combination of antiviral and immunomodulating drugs. For the purposes of local nonspecific immunotherapy, especially with a pronounced inflammatory process in the oropharynx, prescribe drugs from the group of topical bacterial lysates - imudon and IRS 19.

In severe cases, appoint glucocorticoids (prednisolone, dexamethasone) from the calculation of 2-2.5 mg / kg, a short course (no more than 5-7 days), as well as probiotics (acipol, bifidumbacterin, etc.), the dose of cycloferon can be increased to 15 mg / kg body weight.

How to prevent infectious mononucleosis in children?

Specific prophylaxis of infectious mononucleosis is not developed.