Infectious mononucleosis in children

Infectious mononucleosis in children is a polyetiological disease caused by viruses from the Herpesviridae family, which occurs with fever, sore throat, 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 gammaherpes virus.
• B27.1 Cytomegalovirus mononucleosis.
• B27.8 Infectious mononucleosis of other etiology.
• B27.9 Infectious mononucleosis, unspecified.

In half of all patients admitted to the clinic with a diagnosis of infectious mononucleosis, the disease is associated with Epstein-Barr virus infection, in other cases - with cytomegalovirus and herpes virus type 6. Clinical manifestations of the disease depend on the etiology.

Epidemiology

The source of infection is patients with asymptomatic and manifest (absent and typical) forms of the disease, as well as virus excretors; 70-90% of those who have had infectious mononucleosis periodically excrete viruses with oropharyngeal secretions. The virus is excreted from nasopharyngeal washes for 2-16 months after the disease. The main route of transmission of the pathogen is airborne, often infection occurs through infected saliva, which is why infectious mononucleosis was called the "kissing disease". Children often become infected through toys contaminated with the saliva of a sick child or virus carrier. Blood transfusion (with donor blood) and sexual transmission of the infection are possible.

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Pathogenesis of infectious mononucleosis

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

Symptoms of infectious mononucleosis in children

In most cases, the disease begins acutely, with a rise in body temperature, nasal congestion, sore throat, swelling of the cervical lymph nodes, enlargement of the liver and spleen, and the appearance of atypical mononuclear cells in the blood.

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

Very often (up to 85%) with infectious mononucleosis, various deposits in the form of islands and stripes appear on the palatine and nasopharyngeal tonsils; they completely cover the palatine tonsils. The deposits are whitish-yellowish or dirty-gray in color, loose, bumpy, rough, easily removed, the tonsil tissue usually does not bleed after removing the plaque.

Moderate leukocytosis is observed in the blood (up to 15-30 • 10 ⁹ /l), the number of mononuclear blood elements is increased, 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 a round or oval shape, ranging in size from an average lymphocyte to a large monocyte. The nuclei of the cells are of a spongy structure with remnants of nucleoli. The cytoplasm is wide, with a light belt around the nucleus and significant basophilia towards the periphery, vacuoles are found in the cytoplasm. Due to the structural features, atypical mononuclear cells are called "broad-plasma lymphocytes" or "monolymphocytes".

Classification of infectious mononucleosis

Infectious mononucleosis is divided by type, severity and course.

• Typical cases include cases of the disease accompanied by the main symptoms (enlarged lymph nodes, liver, spleen, tonsillitis, atypical mononuclear cells). Typical forms are divided by severity into mild, moderate and severe.
• Atypical forms include latent, asymptomatic and visceral forms of the disease. Atypical forms are always considered mild, and visceral forms are considered severe.

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

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Diagnosis of infectious mononucleosis in children

In typical cases, diagnostics is not difficult. For laboratory confirmation, it is important to detect DNA of the corresponding virus by PCR in blood, nasopharyngeal washes, urine, and cerebrospinal fluid. Serological diagnostics of Epstein-Barr mononucleosis is based on the detection of heterophilic antibodies in the blood serum of patients in relation to the erythrocytes of various animals (erythrocytes of a sheep, bull, horse, etc.). Heterophilic antibodies are IgM. To detect heterophilic antibodies, the Paul-Bunnell reaction or LAIM test, the Tomchik reaction or the Gough-Baur reaction, etc. are used. In addition, the ELISA method determines specific antibodies of the IgM and IgG classes to viruses.

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Treatment of infectious mononucleosis in children

There is no specific treatment for infectious mononucleosis in children. Symptomatic and pathogenetic therapy is prescribed in the form of antipyretic, desensitizing agents, antiseptics to stop the local process, vitamin therapy, and, in case of functional changes in the liver, choleretic drugs.

Antibacterial therapy is prescribed for severe deposits in the oropharynx, as well as for 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 its use is accompanied by severe allergic reactions (rash, Quincke's edema, toxic-allergic condition). There are reports of the positive effect of imudon, arbidol, children's anaferon, metronidazole (flagil, trichopolum). It makes sense to use wobenzym, which has an immunomodulatory, anti-inflammatory effect. The effect of cycloferon (meglumine acridonacetate) in a dose of 6-10 mg / kg is substantiated and shown in the literature. The most effective is a combination of antiviral and immunomodulatory drugs. For the purposes of local non-specific immunotherapy, especially in cases of severe inflammatory process in the oropharynx, drugs from the group of topical bacterial lysates are prescribed - Imudon and IRS 19.

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

How to prevent infectious mononucleosis in children?

Specific prevention of infectious mononucleosis has not been developed.