Update: December 2018
A disease called infectious mononucleosis was first
described N.F. Filatov in 1885 and became known as
idiopathic lymphadenitis. it острое инфекционное вирусное
a disease that is characterized by an increase in the size of the spleen
and liver, white blood change and disorder
reticuloendothelial system complicated by lymphadenopathy.
It has been established that this disease causes a particular herpetic virus.
Epstein-Barr (4 types), affecting the lymphoid-reticular
the cloth. When it enters the body by airborne droplets it affects
the epithelium of the oropharynx, then with blood and regional lymph nodes.
Epstein-Barr virus remains in the human body for life, and
with a decrease in immunity can periodically recur.
Причины инфекционного mononucleosis у детей
Most of all, children under 10 are predisposed to this disease.
years old. As a rule, the child is often in a closed team,
for example, in kindergarten or in a school where transmission is possible
by airborne droplets. The virus dies very quickly when hit
into the environment, therefore contamination occurs only when close
contacts, so it can not be called very contagious. Virus
Epstein-Barr in a sick person is in particles of saliva,
therefore, infectious mononucleosis can be transmitted from person to person.
- use of common utensils
It is noteworthy that boys suffer from infectious mononucleosis in
two times more often than girls. Thus, there is a possibility of easy
заразиться при sneeze или coughing, особенно весной и в осенне-зимний
period. Some people do not experience any symptoms.
diseases, however, are virus carriers and represent
potential danger to others. Virus проникает в организм
through the respiratory tract, and the incubation period of the disease is
about 5-15 days. In some cases, it can last up to one and a half
Virus Эпштейна-Барр очень распространенная инфекция, до
At 5 years of age, over 50% of children become infected with this type and
большинства он не вызывает серьезной симптоматики и diseases.
Moreover, the infection of the adult population according to various data
is 85-90% and only in some children or adults is this
the virus is expressed by symptoms called infectious
Симптомы mononucleosis у ребенка
Since today there is practically no infection from viruses.
prevention, if the child has been in contact with an infectious patient
mononucleosis, parents should closely monitor the health
baby in the next 2-3 months. Если симптомов mononucleosis не
will appear, therefore, either the child is infected, or immunity
coped with the virus and the infection passed safely.
If the child has symptoms of general intoxication – chills,
fever, weakness, rash, swollen lymph nodes – to
which doctor to contact? First to the district pediatrician or
to the family doctor, then to the infectious disease specialist.
Симптомы инфекционного mononucleosis разнообразны. Sometimes
common phenomena of a prodromal nature, such as
malaise, weakness and catarrhal symptoms. Gradually
the state of health worsens, the temperature rises to subfebrile,
there is constant sore throat and difficulty breathing
due to nasal congestion. A characteristic phenomenon can also be called
hyperemia of the mucous membrane of the oropharynx, as well as pathological
overgrowth of tonsils.
Sometimes заболевание начинается внезапно, и его симптомы ярко
are expressed. In this situation, it is not excluded:
- fever, it proceeds differently (usually 38 -39C) and
lasts a few days or even a month
- increased sweating, chills, drowsiness, weakness
- signs of intoxication – headache, aching muscles and
pain when swallowing
Then comes the culmination of the disease, that is, manifest
the main features of the clinical picture of infectious
mononucleosis, в том числе:
- sore throat – there is a granularity of the posterior wall of the pharyngeal mucosa,
her hyperemia, follicular hyperplasia, probably hemorrhage
- hepatosplenomegaly – enlarged liver and spleen
- lymphadenopathy – lymphadenopathy
- total body intoxication
- appearance of a rash on the body
A rash with mononucleosis most often occurs at the onset of the disease,
simultaneously with fever and lymphadenopathy, it can also
be quite intense, localized on the legs, hands, face,
stomach and back in the form of small red or pale pink spots.
The rash does not require treatment, because it does not itch, it can not be anything
smear, it is independently eliminated as the struggle intensifies
immunity with the virus. But, если ребенку назначили антибиотик и
the rash began to itch – this indicates an allergic reaction to
antibiotic (most often it is a penicillin series of antibiotics –
ampicillin, amoxicillin), because the rash in mononucleosis does not
But, наиболее важным симптомом инфекционного mononucleosis,
traditionally considered polyadenitis. It arises as a result.
hyperplasia of lymphoid tissue. In most cases on the tonsils
nasopharynx and palate develop islet overlays of gray or
whitish-yellowish. Their consistency is loose and lumpy,
they are easily removed.
Besides того, увеличиваются периферические лимфатические узлы. AT
they are delayed actively breeding virus. Especially intense
lymph nodes grow on the back of the neck: they become very
noticeable when the child turns his head to the side. Beside
located lymph nodes are interconnected, and almost always their
the lesion is bilateral in nature.
Palpation of the lymph nodes is not very painful, they are mobile
and not tightly in contact with the skin. Sometimes увеличиваются и лимфоузлы,
in the abdominal cavity – they squeeze the nerves in
this area and provoke the occurrence of signs of acute abdomen.
it может привести к постановке неточного диагноза и проведению
Для инфекционного mononucleosis характерна гепатоспленомегалия,
that is, a pathological enlargement of the spleen and liver. These bodies
very sensitive to the disease, so changes in them begin
occur in the first days after infection. Spleen can
increase so much that its tissues do not withstand pressure, and she
The first 2-4 weeks there is a continuous increase in the size of these
organs, to some extent it continues after recovery
baby When body temperature returns to physiological
values, normalization of the state of the spleen and
Diagnosis of the disease
Для начала, чтобы подтвердить диагноз инфекционного mononucleosis
in a child, the doctor usually prescribes the following tests:
- Blood test for antibodies IgM, IgG to Epstein-Barr virus
- General and biochemical blood test
- Ultrasound of the internal organs, especially the liver and
Диагностика детского инфекционного mononucleosis довольна
difficult. The main signs of the development of the disease is considered
tonsillitis, enlarged lymph nodes, liver and spleen,
fever. Eye doctor can not determine a sore throat in a child or
infectious mononucleosis, therefore serological
research. Hematologic changes serve as a secondary symptom.
Анализ крови при мононуклеозе у children:
- According to the results of the general blood test can be judged by the number
leukocytes, lymphocytes and monocytes.
- ESR is also increased.
- Of course, the indicator of the presence of atypical
mononuclear cells – cells with large basophilic cytoplasm. ABOUT
развитии инфекционного mononucleosis говорит увеличение их
content in the blood up to 10%. It should be borne in mind that atypical
elements do not appear in the blood immediately, and sometimes only after 2-3
weeks after infection. Atypical mononuclear cells are
oval or round elements whose size can reach to
sizes of large monocyte. These atypical elements are also called
�”Monolymphocytes” or “wide plasma lymphocytes”.
When differentiating the diagnosis, first of all, you need to distinguish
tonsillitis from sore throat, eliminate Botkin’s disease, acute leukemia,
lymphogranulomatosis and pharyngeal diphtheria, which have similar symptoms.
For the most accurate diagnosis in difficult cases, analyze
determination of antibody titer to a specific Epstein-Barr virus.
There are also fast modern laboratory techniques.
studies that allow you to get results through
as short as possible, for example PCR.
Persons with infectious mononucleosis undergo
several serological studies conducted every few
месяцев, на предмет определения наличия ATИЧ-инфекции, поскольку она
also provokes high blood levels of mononuclears.
Also, if you experience symptoms of angina, you should visit
otolaryngologist and pharyngoscopy to correctly identify
the cause of this disease, since it can be different
How not to get infected from a sick child to adults and others
If the family has a child or an adult who is sick
infectious mononucleosis, do not get infected with the rest of the family
It will be difficult enough, not because the virus is very contagious, but
because even after recovery, the ill child or
An adult may periodically excrete a virus with particles of saliva in
environment and remains a virus carrier for life.
Therefore, the need for quarantine with infectious mononucleosis
нет, даже если здоровые члены семьи в период болезни ребенка
for sure, infection will occur later, during
when the patient has already recovered and will return to normal routine
of life. With a slight course of the disease, it is not necessary to isolate
child and set quarantine, he can return to school as
just get better.
How to treat infectious mononucleosis in children
To date, there is no specific treatment for infectious diseases.
mononucleosis у детей, нет единой схемы терапии, нет
an antiviral drug that would effectively suppress
virus activity. ABOUTбычно заболевание лечится в домашних conditions
in severe cases in the inpatient setting and recommended
only bed rest.
Clinical indications for hospitalization:
- High temperature 39, 5 and above
- severe symptoms of intoxication
- development of complications
- threat of asphyxia
There are several ways to treat mononucleosis in
- Therapy is mainly aimed at relieving the symptoms of infectious
- Pathogenetic therapy in the form of antipyretics for
children (ibuprofen, paracetamol in syrup)
- Antiseptic local preparations for the relief of angina, and
also as a local non-specific immunotherapy, prescribed
drugs Imudon and IRS 19.
- Desensitizing agents
- Restorative therapy – vitamin therapy, including vitamins
groups B, C and R.
- If changes in liver function are detected, a special
diet, choleretic drugs, hepatoprotectors
- Immunomodulators in conjunction with antiviral drugs
have the greatest effect. Imudon, Child may be appointed.
Anaferon, Viferon, and Cycloferon at a dose of 6-10 mg / kg. Sometimes
has a positive effect metronidazole (Trichopol,
- Since the secondary microbial flora does not rarely join,
antibiotics that are prescribed only in case of complications are shown
and intense inflammation in the oropharynx (except
antibiotics of the penicillin series, which are precisely in infectious
mononucleosis in 70% of cases cause severe allergic
- When antibiotic therapy is prescribed at the same time probiotics
(Acipol, Narine, Primadophilus Children, etc., see the entire list
probiotics with prices and composition)
- In case of severe hypertoxic course, a short-term
course of prednisolone (20-60 mg per day for 5-7 days), he
used at risk of asphyxiation
- Installation of tracheostoma and transfer to artificial ventilation
the lung is carried out with a strong swelling of the larynx and with difficulties with
breathing in children
- When the spleen ruptures, an emergency procedure is performed.
Прогноз и последствия mononucleosis
Infectious mononucleosis in children usually has a fairly
favorable prognosis. However, the main condition for the absence
consequences and complications is timely diagnosis
leukemia and regular monitoring of changes in the composition of the blood. Besides
In addition, it is very important to monitor the condition of children until their final
In one clinical study that was conducted with
find out the duration of the recovery process of children and adults,
who have suffered mononucleosis, attended by 150 people. Within half a year
after the transfer of the virus, the patients were watched by doctors,
their health condition. The results of the study are as follows:
- Normally, if the body temperature in infectious mononucleosis
above 37.5 lasts the first few weeks from the start
diseases. Also, the temperature is less than 37.5, that is subfebrile
can be considered normal.
- Angina with infectious mononucleosis or sore throat lasts
1-2 weeks on average
- Lymph nodes return to normal in
during the first month of the disease
- Drowsiness, fatigue, weakness persist after
болезни достаточно долго – от нескольких месяцев до
half a year.
Therefore, the ill children need medical examination.
over the next 6-12 months to monitor residual
phenomena in the blood.
ABOUTсложнения инфекционного mononucleosis возникают достаточно
rarely however the most common among them is
inflammation of the liver causing jaundice and characterized by
darkening of the urine and yellowing of the skin.
ABOUTдним из серьезнейших последствий mononucleosis у детей является
rupture of the spleen, but it occurs in 1 case out of a thousand. it
occurs when thrombocytopenia and overdrain develop
lienal capsule, leading to rupture of the spleen. it
extremely dangerous condition in which from the internal
bleeding a child may die.
Other complications, the consequences are mainly associated with the development of
фоне mononucleosis вторичной инфекции, преимущественно
streptococcal and staphylococcal. May also appear
meningoencephalitis, manifested in airway obstruction and
enlarged tonsils, severe hepatitis and bilateral
interstitial infiltration of the lungs.
There are a number of scientific studies that have established a link
Epstein-Barr virus, with the development of certain cancers that
quite rare – these are different types of lymphoma. But,
This does not mean at all that if a child has had an infectious disease
mononucleosis, as a consequence he may develop cancer. Lymphomas
rare disease and for the development of oncology usually provoking
factor is a sharp decrease in immunity for various
It is worth noting that the activities for specific and effective
профилактике инфекционного mononucleosis в настоящий момент не