Infectious mononucleosis in children is called glandular fever. This is a viral disease, which is characterized by prolonged fever, sore throat, an increase in various groups of lymph nodes, specific changes in peripheral blood. This disease is relevant for all age groups, but more so for young children.
For the first time infectious mononucleosis was described as early as 1885 by Filatov, but then it was supplemented with the study of blood changes and the detection of a specific pathogen. Due to all this, this disease got its official name of infectious mononucleosis. The causative agent was later identified by two scientists - and in honor of them the virus was named the Ebstein-Barr virus.
What kind of disease mononucleosis: the causative agent of the disease
To understand correctly what kind of disease is infectious mononucleosis, and why this disease requires a certain attention, it is necessary to know some features of the virus itself.
Epstein-Barr virus is the immediate cause, that is, the infectious agent of this disease in children and adults. This member of the herpesvirus family is prone to prolonged circulation in the human body, and also has a carcinogenic effect, which can lead to irreversible consequences. It may cause the development of not only infectious mononucleosis, but also the formation of nasopharyngeal carcinoma and Burkitt's lymphoma. The Epstein-Barr virus, like most other viruses, is transmitted by airborne droplets, through common utensils, kisses, toys, and other items that have an infection carrier’s saliva. The disease is very common.
Once in the child's body, the virus immediately begins to actively multiply in the mucous membrane of the nasopharynx, from where it enters the bloodstream and infects type B lymphocytes responsible for the production of antibodies. In these cells, the virus remains its entire subsequent life.
There are statistics according to which by the age of 5, a little more than 50% of children are infected with this infection. More than 90% of the population by the age of 35 years, a blood test shows the presence of antibodies to EBV. This fact gives the right to assert that the majority of the adult population has already suffered infectious mononucleosis. In 80-85% of cases, its development occurs in an erased form, i.e., its characteristic symptoms either do not manifest at all, or appear weak, and the disease is mistakenly diagnosed as SARS or angina.
This is the time from the time Epstein-Barr virus enters the child’s body and until the first signs of illness appear. The incubation period varies widely from several days to two months, on average it is a period of 30 days. At this time, the virus multiplies and accumulates in sufficient quantity for massive expansion.
It is possible to develop a prodromal period that does not have specific manifestations and is typical for all infectious diseases. In such cases, the disease will develop gradually - for several days, low, low-grade body temperature, general malaise and weakness, increased fatigue, the presence of catarrhal phenomena from the upper respiratory tract in the form of nasal congestion, redness in the mucous membranes of the oropharynx, as well as gradual increase and redness of the tonsils.
Symptoms of mononucleosis
From the first days there is a slight indisposition, weakness, headache and muscle pain, pain in the joints, a slight fever and mild changes in the lymph nodes and pharynx.
Later there is pain when swallowing. The body temperature rises to 38-40 ° C, may have a wave-like character, such temperature drops persist throughout the day and can last 1-3 weeks. Tonsillitis occurs immediately or after a few days, it is catarrhal with mild swelling of the tonsils, lacunar with a more severe manifestation of inflammation in both tonsils, or ulcerative necrotic with a fibrinous film like with diphtheria.
The spleen and liver are also enlarged. Quite often, the skin becomes yellow. There is a so-called jaundice. With mononucleosis, there is no heavy hepatitis. The liver for a long time remains enlarged. The body accepts normal size only 1-2 months after the moment of infection.
A rash in mononucleosis appears on average at 5-10 days of illness and in 80% percent of cases is associated with the intake of the antibacterial drug ampicillin. It is spotty-papular in nature, the elements of its bright red color, located on the skin of the face, torso and limbs. The rash on the skin lasts about a week after which it fades and disappears without a trace.
Mononucleosis in children is often asymptomatic or with an erased clinical picture in the form of SARS. The disease is dangerous for babies with congenital immunodeficiency or atopic reactions. In the first case, the virus exacerbates the lack of immune protection and contributes to the accession of a bacterial infection. In the second, it enhances the manifestation of diathesis, initiates the formation of autoimmune antibodies, and may become a provoking factor for the development of tumors of the immune system.
The main features of mononucleosis include:
- high temperature;
- mononuclear sore throat (dirty-gray films are marked on the tonsils, which are easily removed with tweezers);
- pains in muscles, joints;
- weakness, sore throat, nasal congestion;
- high susceptibility to other infectious agents;
- frequent skin lesions with herpes;
- bleeding gums;
- loss of appetite;
- enlarged liver and spleen;
- lymphadenopathy (as a rule, lymph nodes increase along the posterolateral surface of the neck, they are intertwined into conglomerates or chains, painless on palpation, not soldered to surrounding tissues and sometimes increase to the size of an egg).
Leukocytosis is noted in peripheral blood (9-10 o109 per liter, sometimes it may be more). The number of mononuclear elements (monocytes, lymphocytes, atypical mononuclear cells) closer to the end of the 1st week reaches about 80% -90%. In the early days of the disease, clear neutrophilia can be observed with a stab shift. The mononuclear response (mainly due to lymphocytes) can last from 3-6 months and even up to several years. Convalescents after a period of infection with mononucleosis can cause another disease, for example, acute influenza or dysentery, etc., and can also be accompanied by a quite significant increase in the number of mononuclear elements.
The illness proceeds from one and more weeks. During the course of the disease, a high temperature is maintained throughout the week. Saving other changes occur with little dynamics. Then there is a gradual decrease in temperature. In some cases, the next wave of temperature rises. During a decrease in temperature, the raids in the throat disappear. Lymph nodes gradually decrease. The liver and spleen generally normalize within a few weeks or months. In the same way, the state of blood is normalized. Rarely, there are complications such as stomatitis, pneumonia, otitis media and others.
How does the defeat of the nasopharynx with mononucleosis look? Photo
The first time you visit a medical institution, the doctor examines and ascertains the symptoms. If infectious mononucleosis is suspected, a blood test is submitted. It is necessary not only to confirm this disease, but also to exclude other health problems.
If atypical mononuclears are detected in the blood, this confirms the diagnosis of "mononucleosis". The more such cells are found in the blood, the more difficult the disease will be.
Complications are rare. The most important are otitis, paratonzillitis, sinusitis, pneumonia. In isolated cases, there are ruptures of the spleen, liver failure, acute liver failure, hemolytic anemia, acute hemolytic anemia, neuritis, follicular angina. Patients with antibiotics ampicillin and amoxicillin almost always have a skin rash.
How to treat infectious mononucleosis in children
To date, the specific treatment of infectious mononucleosis in children has not been developed, there is no single treatment regimen, there is no antiviral drug that would effectively suppress the activity of the virus. Mononucleosis is usually treated at home, in severe cases in a hospital, and only bed rest, a chemically and mechanically-sparing diet and a water-drinking regimen are recommended.
To reduce the high temperature used children's antipyretic drugs such as paracetamol, ibuprofen. Good result gives mefinaminova acid due to the fact that stimulated the production of interferon. We must refrain from lowering the temperature in children with aspirin, since Ray's syndrome may develop.
The throat is treated the same way as with sore throat. You can apply tantumverde, various aerosols, rinsing with infusions of herbs, furatsilinom etc. Close attention should be paid to the oral cavity, brushing your teeth, rinsing the mouth should be after each meal. When expressed signs of rhinitis used vasoconstrictor droplets. But they should not get involved in more than five days. The symptoms of the disease are eliminated, this is the supportive treatment by which the infection is eliminated.
When a change in liver function is detected, a special diet, choleretic drugs, and hepatoprotectors are prescribed. Immunomodulators together with antiviral drugs have the greatest effect. Imudon, Children's Anaferon, Viferon, and Cycloferon at a dose of 6-10 mg / kg can be prescribed. Sometimes it has a positive effect metronidazole (Trihopol, Flagil). Since the secondary microbial flora does not rarely join, antibiotics are indicated, which are prescribed only in case of complications and an intensive inflammatory process in the oropharynx (except for penicillin antibiotics, which in 70% of cases cause severe allergic reactions)
The spleen of a child can be enlarged during the illness, and even minor injuries to the abdomen can lead to its rupture. Thus, all children with mononucleosis should avoid contact sports and strenuous activities for 4 weeks. Athletes especially need to limit their activities until the spleen returns to normal size.
In general, the treatment of infectious mononucleosis in children and adults is exclusively symptomatic (drinking, lowering the temperature, pain relief, relief of nasal breathing, etc.). Prescription of antibiotics, hormonal drugs is carried out only with the development of appropriate complications.
Infectious mononucleosis in children, as a rule, has a rather favorable prognosis. However, the main condition for the absence of consequences and complications is the timely diagnosis of leukemia and regular monitoring of changes in the composition of the blood. In addition, it is very important to monitor the condition of children until their final recovery.
Also, ill children need a follow-up examination over the next 6-12 months to control residual effects in the blood. It should be noted that measures for the specific and effective prophylaxis of infectious mononucleosis do not currently exist.