Infectious mononucleosis: symptoms

Infectious mononucleosis has a cyclic course. The incubation period, according to various data, varies from 4 to 50 days.

[1], [2], [3]

The main symptoms of infectious mononucleosis and the dynamics of their development

Allocate the initial period of the disease, the period of swelling and the period of convalescence. In most cases, infectious mononucleosis begins acutely, with an increase in body temperature, the appearance of sore throat and enlarged lymph nodes. With a gradual onset of soreness and an increase in lymph nodes precede the temperature rise for several days, then there are sore throat and fever. In any case, by the end of the week the initial period of the illness is completed and all the symptoms of infectious mononucleosis are revealed.

For the period of the height of the disease are characterized by:

• fever;
• polyadenopathy:
  • roto- and nasopharynx:
    • hepatolienal syndrome;
    • hematological syndrome.

The febrile reaction is diverse in both level and duration of fever. At the onset of the disease, the temperature is often subfebrile, in the midst it can reach 38.5-40.0 ° C for several days, then decreases to a subfebrile level. In some cases, subfebrile condition is noted throughout the disease, in rare cases, fever is absent. Duration of fever from 3-4 days to 3-4 weeks, sometimes more. With prolonged fever, its monotonous course is revealed. The peculiarity of infectious mononucleosis is a weak expression and peculiarity of the intoxication syndrome. Patients report symptoms of infectious mononucleosis, such as: loss of appetite, myasthenia gravis, fatigue, in severe cases, patients due to myasthenia can not stand and hardly sit. Intoxication persists for several days.

Polyadenopathy is a constant symptom of infectious mononucleosis. Most often the lateral cervical lymph nodes increase, they are often visible to the eye, their sizes vary from beans to chicken eggs. In some cases, there is a fibroid edema around the enlarged lymph nodes, the contours of the neck change (a symptom of the "bull's neck"). Skin over the lymph nodes is not changed, with palpation they are sensitive, dense elastic consistency, not soldered to each other and to surrounding tissues. Other groups of nodes also increase: occipital. Submaxillary, cubital. In some cases, an increase in the inguinal-femoral group predominates. In this case, pain in the sacrum, lower back, sharp weakness is noted, changes in the oropharynx are poorly expressed. Polyadenopathy regresses slowly and. Depending on the severity of the course of the disease, persists from 3-4 weeks to 2-3 months or assumes a persistent nature.

The following symptoms of infectious mononucleosis are also noted: the increase and swelling of the palatine mines of the dalin, which sometimes close together, making it harder for oral breathing. The simultaneous increase in the nasopharyngeal tonsil and the puffiness of the mucous membrane of the inferior nasal shell impede nasal breathing. At the same time, a person's pastosity, a nasal voice, appears. The patient breathes with his mouth open. Possible development of asphyxia. The posterior wall of the pharynx is also edematous, hyperemic, with hyperplasia of the lateral columns and lymphoid follicles of the posterior pharyngeal wall (granulomatous pharyngitis). Often on the palatine and nasopharyngeal tonsils appear dirty gray or yellowish-white overlays in the form of islets, strips, sometimes they completely cover the entire surface of the tonsils. The overlays are loose, easily removed with a spatula, dissolve in water. Rarely, fibrinous plaque or superficial necrosis of tonsillar tissue is noted. Scurvy can appear from the first days of the disease, but more often on the 3-7th day. In this case, the appearance of plaque is accompanied by pain in the throat and a significant increase in body temperature.

Enlargement of the liver and spleen is almost a constant symptom of infectious mononucleosis, especially in children. The liver increases from the first days of the illness, minimally in its height. It is sensitive for palpation, dense, splenomegaly persists up to 1 month. Often there is a moderate increase in ALT and ACT activity, less often - darkening of urine, mild jaundice and hyperbilirubinemia. In these cases, note nausea, a decrease in appetite. The duration of jaundice does not exceed 3-7 days, the course of hepatitis is benign.

The spleen increases on the 3-5th day of the disease, maximally to the 2nd week of the disease and ceases to be available for palpation by the end of the 3rd week of the disease. It becomes less sensitive to palpation. In some cases, splenomegaly is pronounced (the edge is determined at the navel level). In this case there is a threat of its rupture.

The picture of blood has a decisive diagnostic value. Moderate leukocytosis (12-25х10 ⁹ / l) is characteristic . Lymphoma monocyte up to 80-90%. Neutropenia with a shift to the left. Plasma cells are often found. ESR increases to 20-30 mm / h. Especially typical is the appearance of atypical mononuclears from the first days of the disease or at its height. The number of them varies from 10 to 50%, as a rule, they are detected within 10-20 days, i.e. Can be detected in two analyzes taken at an interval of 5-7 days.

Other symptoms of infectious mononucleosis: a rash, usually papular. It is observed in 10% of patients, and in the treatment with ampicillin - in 80%. Moderate tachycardia is possible.

From atypical forms describe a scraped form, in which there is no part of the main symptoms and serological tests are needed to confirm the diagnosis.

In rare cases, a visceral form of the disease with severe multi-organ lesions and an unfavorable prognosis is observed.

A chronic form of the disease that develops after acute acute infectious mononucleosis is described. It is characterized by weakness, fatigue, poor sleep, headaches, myalgia, subfebrile, pharyngitis, polyadenopatney, exanthema. The diagnosis is possible only with the use of convincing laboratory tests.

Classification of infectious mononucleosis

Infectious mononucleosis has typical and atypical forms, in severity - mild, moderate and severe forms of the disease. At present, the chronic form of infectious mononucleosis is described.

[4], [5], [6], [7], [8], [9]

Complications of infectious mononucleosis

Infectious mononucleosis rarely has complications, but they can be very difficult. Hematologic complications include autoimmune hemolytic anemia, thrombocytopenia and granulocytopenia. Neurological complications: encephalitis, paralysis of the cranial nerves, including Bell's paralysis or prozopoplegia (paralysis of facial musculature due to facial nerve damage), meningoencephalitis, Guillain-Barre syndrome, polyneuritis, transverse myelitis, psychosis. Cardiac complications (pericarditis, myocarditis) are possible. On the part of the respiratory organs, interstitial pneumonia is sometimes noted.

In rare cases, a spleen rupture occurs at the 2-3 rd week of the disease, accompanied by abrupt, sudden pain in the abdomen. The only method of treatment in this case is splenectomy.

[10], [11], [12], [13], [14], [15], [16], [17],

Mortality and causes of death

The causes of death in mononucleosis can be encephalitis, airway obstruction and rupture of the spleen.