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46. Epstein-Barr virus infection (infectious mononucleosis)
Infectious mononucleosis is an acute infectious disease caused by the Epstein-Barr virus from the herpetiform group.
Etiology. The virus in its morphological structure does not differ from the herpes simplex virus.
Epidemiology. EBV is ubiquitous. Infection proceeds differently depending on age.
The source of infection is patients with asymptomatic and manifest (erased and typical) forms of the disease, as well as virus carriers. The main route of transmission is airborne, often through infected saliva, less often vertically (from mother to fetus).
Clinical manifestations. The incubation period in adolescents and young men is 30-50 days, in children it is shorter, but the exact timing has not been established. The disease begins imperceptibly and gradually. The patient complains of weakness, fatigue, headaches, nausea, sore throat. The prodromal period can last 1-2 weeks. Gradually, the pain in the throat intensifies, the body temperature rises, which makes the patient consult a doctor. During the examination, signs of moderate or severe pharyngitis are found, a significant increase in the tonsils, sometimes covered with plaque. In some patients, enanthema is often detected in the form of petechiae, localized mainly on the border of the hard and soft palate. Body temperature rises to 39 ° C in 85% of patients.
The characteristic signs include an increase in lymph nodes, liver and spleen. Most often, nodes on the back of the neck increase.
Atypical lymphocytosis in children is usually absent, but antibodies in the blood appear much later, often only during the period of convalescence. Before the age of 2 years, infectious mononucleosis is usually asymptomatic.
Oncogenic activity of the Epstein-Barr virus. The causative agent of infectious mononucleosis is one of the factors contributing to the development of Burkitt's lymphoma (BL).
Burkitt's lymphoma is a malignant disease of lymphoid tissue localized outside the lymph nodes - in the upper jaw, kidneys, and ovaries.
Recently, an association of polyclonal B-cell lymphomas with Epstein-Barr virus has been found in immunocompromised patients.
Diagnosis. The diagnosis is confirmed using laboratory research methods, in particular, using serological diagnostic methods that make it possible to identify heterophilic antibodies in the blood serum of patients with respect to the erythrocytes of various animals.
Treatment. There is no specific treatment. Assign symptomatic and pathogenetic therapy depending on the form of the disease. In all forms of the disease, antipyretics, desensitizing drugs, antiseptics for stopping the local process, vitamin therapy are used as basic therapy, and choleretic agents for functional changes in the liver. Antibacterial therapy is prescribed in the presence of pronounced overlays in the oropharynx, the occurrence of complications.
Author: Pavlova N.V.
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