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1、Infectious Mononucleosis (IM) Liu Quanbo, associate professor Introductiono Infectious mononucleosis(IM) is an infectious disease caused by Epstein-Barr virus(EBV) .o The clinical features include fever, pharyngitis , and generalized lymphadenopathy.o The characteristics of lab study is atypical lym
2、phocytosis in the peripheral blood. Etiology Epstein-Barr virus(EBV) 1. Classification：n double-stranded DNA virus n -Family: Herpesviridaen -Subfamily: -herpesvirinae2. Characteristics of EBVn Latent-reactiven Lymphotropic virus just infecting B-LCn capacity to have B lymphocyte proliferate infinit
3、ely (immortalization ) Epstein-Barr virus(EBV) Etiology3、 Viral Antigen Systemsn viral capsid antigen, VCAn EB nuclear antigen, EBNAn early antigen, EAn lymphocyte-detected membrane antigen, LYDMAn membrane antigen, MA Epidemiology1. Infectious sources Patients, persons with latent infection and car
4、riers2. Routes of transmission ：n Contact transmission through the mouth (exchange of saliva) n blood transmission occasionally 3. Population susceptibilityn School age children and adolescents 4. Epidemiological featuresn Peak seasonsn Epidemiological status PathogenesisEBV salivary glands infects
5、oral epithelial cells and B-LC in pharynx excrete EBV Continuously or intermittently B-LC in the peripheral blood and the entire lymphoreticular system viremia Activation of polyclonal B-LC polyclonal antibodiesSpecific Abs heterophil AbautoantibodyTc responsed to the infected B-LCEffect on B-LC con
6、taining EBVatypical LCHepatosplenomegaly, lymphadenectasis, myocarditis, pneumonia, etc.Changes of antigenicity on the surface of B-LC Specific Abs Pathologyo The basic pathological change is the benign lymphadenosis o The main damage is in monocyte-macrophage system n Lymph nodes： non-pyogenic lymp
7、hadenectasis with LC and monocyte-macrophage system proliferationn Spleen: lots of atypical LCn LC infiltration and limited necrotic lesions in organs such as liver, heart, kidney, lung, CNS,etc. ManifestationsThe incubation period ： 515 days1. fever2. pharyngitis: 80%. sore throat, tonsillar enlarg
8、ement, n hyperemia , edema and exudates（ 50%）3. generalized lymphadenopathy： 80100%. n The most common lymphadenopathy is enlargement of cervical lymph nodes4. splenohepatomegalia:n hepatomegaly： 3050%. Among them, 2/3 has elevated liver enzymes Jaundice is uncommon. Liver failure may occurred in fe
9、w cases.n splenomegaly： 5070%5. rashes： 10%6. others： stuff nose, snore, edema of the eyelids, etc The tonsils are hyperemic and edematous covered with gray-white exudates. ManifestationsThe incubation period ： 515 days1. fever2. pharyngitis: 80%. sore throat, tonsillar enlargement, n hyperemia, ede
10、ma and exudates（ 50%）3. generalized lymphadenopathy： 80100%. n The most common lymphadenopathy is enlargement of cervical lymph nodes4. splenohepatomegalia:n hepatomegaly： 3050%. Among them, 2/3 has elevated liver enzymes Jaundice is uncommon. Liver failure may occurred in few cases.n splenomegaly：
11、5070%5. rashes： 10%6. others： stuff nose, snore, edema of the eyelids, etc cervical lymph nodes cervical lymph nodes ManifestationsThe incubation period ： 515 days1. fever2. pharyngitis: 80%. sore throat, tonsillar enlargement, n hyperemia , edema and exudates（ 50%）3. generalized lymphadenopathy： 80
12、100%. n The most common lymphadenopathy is enlargement of cervical lymph nodes4. splenohepatomegalia:n hepatomegaly： 3050%. Among them, 2/3 has elevated liver enzymes Jaundice is uncommon. Liver failure may occurred in few cases.n splenomegaly： 5070%5. rashes： 10%6. others： stuff nose, snore, edema
13、of the eyelids, etc 臨 床 表 現(xiàn) Complicationsn nerve system： encephalitis,Guillain-Barr syndrome, Reye syndrome, Peripheral neuritis, etc.n cardiovascular system： Myocarditis, pericarditis n hematological system： Hemolytic anemia, Aplastic anemia, thrombocytopenia, neutropenia, hemophagocytic syndrome,
14、etc.n respiratory system： upper airway obstruction, interstitial pneumonia, etc.n urinary system： nephritis, nephrotic syndrome, etc. n digestive system： gastrointestinal bleeding, liver failure, etc.n subcapsular splenic hemorrhage or splenic rupture Lab studies1. blood routine ：n there is leukocyt
15、osis of 1020 109/L, of which at least are lymphocytes; n atypical lymphocytes account for 10% relatively or 1.0 109/L absolutely notice:2. detection of markers of EBVn heterophil agglutination test o principle o limitationsn detection of EBV Abs: VCA IgM3. detection of nucleic acid of EBV by PCR4. I
16、solation of EBV atypical lymphocytes Diagnosis1. IM triadnFever, pharyngitis and enlargement of cervical lymph nodes2. atypical lymphocytes account for 10% relatively or 1.0 109/L absolutely 3. heterophil agglutination test or/and VCA IgM (+) Differential Diagnosis 1. suppurative tonsillitis 2. infectious mononucleosis-like syndrom 3. viral hepatitis 4. Kawasaki disease 5. malignant histocytosis Treatment1. general treatment2. symptomatic treatment3. antiviral therapy4. the use of glucocorticoid：n indicator Prognosis
《兒科學(xué)教學(xué)課件》17傳染性單核細(xì)胞增多癥(上)
