1、Infectious Mononucleosis(IM)monoHuang Yanfeng,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 lymp
2、hocytosis in the peripheral blood.EBV associated disease oThe upper respiratory tract infection oInfectious mononucleosis(IM)oEB Virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH)oChronic active EBV infection oEB Virus-associated malignant tumor (Burkitt lymphoma、B cell lymphoma、Hodgkins
3、disease,nasopharyngeal carcinoma)Etiology Epstein-Barr virus(EBV)1.Classification：ndouble-stranded DNA virus n-Family:Herpesviridaen-Subfamily:-herpesvirinae2.Characteristics of EBVnLatent-reactivenLymphotropic virus just infecting B-LCncapacity to have B lymphocyte proliferate infinitely(immortaliz
4、ation)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 carriers2.Routes of transmiss
5、ion：nContact transmission through the mouth (exchange of saliva)nblood transmission occasionally 3.Population susceptibilitynSchool age children and adolescents 4.Epidemiological featuresnPeak seasonsnEpidemiological status传染性单核细胞增多症及其相关疾病临床特点分析,中国实用儿科杂志,2003年12月第18卷12期儿童传染性单核细胞增多症临床特点与发病年龄的关系附312例临
6、床分析,临床儿科杂志,2011年6月第29卷6期 6 6岁以下岁以下232232例，占例，占74.4%74.4%，6-156-15岁岁8080例，占例，占25.6%25.6%重庆医科大学感染消化教研室Epidemiology1.Infectious sources Patients,persons with latent infection and carriers2.Routes of transmission：nContact transmission through the mouth (exchange of saliva)nblood transmission occasionall
7、y 3.Population susceptibilitynSchool age children and adolescents 4.Epidemiological featuresnPeak seasonsnEpidemiological statusPathogenesisEBV salivary glands infects oral epithelial cells and B-LC in pharynx excrete EBV Continuously or intermittently B-LC in the peripheral blood and the entire lym
8、phoreticular system viremia Activation of polyclonal B-LC polyclonal antibodies Specific Absheterophil AbautoantibodyTc responsed to the infected B-LCEffect on B-LC containing EBVatypical LCHepatosplenomegaly,lymphadenectasis,myocarditis,pneumonia,etc.Changes of antigenicity on the surface of B-LC T
9、CLPathologyo The basic pathological change is the benign lymphadenosis o The main damage is in monocyte-macrophage system nLymph nodes：non-pyogenic lymphadenectasis with LC and monocyte-macrophage system proliferationnSpleen:lots of atypical LCnLC infiltration and limited necrotic lesions in organs
10、such as liver,heart,kidney,lung,CNS,etc.ManifestationsThe incubation period：515 days1.Fever(90%)2.pharyngitis:80%.sore throat,tonsillar enlargement,nhyperemia,edema and exudates（50%）3.generalized lymphadenopathy：80100%.nThe most common lymphadenopathy is enlargement of cervical lymph nodes4.splenohe
11、patomegalia:nhepatomegaly：3050%.Among them,2/3 has elevated liver enzymes Jaundice is uncommon.Liver failure may occurred in few cases.nsplenomegaly：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.Manifestat
12、ionsThe incubation period：515 days1.Fever(90%)2.pharyngitis:80%.sore throat,tonsillar enlargement,nhyperemia,edema and exudates（50%）3.generalized lymphadenopathy：80100%.nThe most common lymphadenopathy is enlargement of cervical lymph nodes4.splenohepatomegalia:nhepatomegaly：3050%.Among them,2/3 has
13、 elevated liver enzymes Jaundice is uncommon.Liver failure may occurred in few cases.nsplenomegaly：5070%5.rashes：10%6.others：stuff nose,snore,edema of the eyelids,etc cervical lymph nodescervical lymph nodes ManifestationsThe incubation period：515 days1.Fever(90%)2.pharyngitis:80%.sore throat,tonsil
14、lar enlargement,nhyperemia,edema and exudates（50%）3.generalized lymphadenopathy：80100%.nThe most common lymphadenopathy is enlargement of cervical lymph nodes4.splenohepatomegalia:nhepatomegaly：3050%.Among them,2/3 has elevated liver enzymes Jaundice is uncommon.Liver failure may occurred in few cas
15、es.nsplenomegaly：5070%5.rashes：10%6.others：stuff nose,snore,edema of the eyelids,etc 临床表现o 文献资料传染性单核细胞增多症及其相关疾病临床特点分析,中国实用儿科杂志,2006年9月第21卷9期病例学习o 患儿，女，6岁,因”发热、咽痛6天，颈部包块4天”入院。6天前开始发热,体温可达39.8，无畏寒，寒战，诉咽痛，吞咽时明显。2天后家人发现颈部包块，不伴疼痛。轻咳，鼻阻明显，打鼾。精神食欲尚可。院外予头孢菌素（不详）治疗4天，无明显好转。无类似病人接触史。查体：T 39.5 P 123次/分 R 30次/分
16、 神情神可，热病容，全身未见皮疹，眼睑浮肿，双侧颈部各有3-4个肿大的淋巴结，最大者直径约2cm，质中，咽充血明显，扁桃体度肿大，可见白色渗出物附着，心肺听诊无异常，腹软，肝脏肋下2cm,脾脏肋下2cm，质地中，边钝。o 门诊血常规：WBC 19.2*109/L,N 0.23 L0.58 异型淋巴细胞 0.19。病例学习o 患儿，女，6岁,因“发热、咽痛6天，颈部包块4天”入院。6天前开始发热,体温可达39.8，无畏寒，寒战，诉咽痛，吞咽时明显。2天后家人发现颈部包块，不伴疼痛。轻咳，鼻阻明显，打鼾。精神食欲尚可。院外诊断“扁桃体炎”予头孢菌素（不详）治疗4天，无明显好转。无类似病人接触史。查
17、体：T 39.5 P 123次/分 R 30次/分，神清神可，热病容，全身未见皮疹，眼睑浮肿，双侧颈部各有3-4个肿大的淋巴结，最大者直径约2cm，质中，咽充血明显，扁桃体度肿大，可见白色渗出物附着，心肺听诊无异常，腹软，肝脏肋下2cm，脾脏肋下2cm，质地中，边钝。o 门诊血常规：WBC 19.2*109/L，N 0.23，L0.58 异型淋巴细胞 0.19。Complicationsnnerve system：encephalitis,Guillain-Barr syndrome,Reye syndrome,Peripheral neuritis,etc.ncardiovascular s
18、ystem：Myocarditis,pericarditis nhematological system：Hemolytic anemia,Aplastic anemia,thrombocytopenia,neutropenia,hemophagocytic syndrome,etc.nrespiratory system：upper airway obstruction,interstitial pneumonia,etc.nurinary system：nephritis,nephrotic syndrome,etc.ndigestive system：gastrointestinal b
19、leeding,liver failure,etc.nsubcapsular splenic hemorrhage or splenic rupture Lab studies1.blood routine：nthere is leukocytosis of 1020109/L,of which at least are lymphocytes;natypical lymphocytes account for 10%relatively or 1.0109/L absolutely notice:2.detection of markers of EBVnheterophil aggluti
20、nation test oprincipleolimitationsndetection of EBV Abs:EBV-VCA IgM3.detection of nucleic acid of EBV by PCR4.Isolation of EBV atypical lymphocytesLab studies1.blood routine：nthere is leukocytosis of 1020109/L,of which at least are lymphocytes;natypical lymphocytes account for 10%relatively or 1.010
21、9/L absolutely notice:2.detection of markers of EBVnheterophil agglutination test oprincipleolimitationsndetection of EBV Abs:EBV-VCA IgM3.detection of nucleic acid of EBV by PCR4.Isolation of EBV heterophil agglutination testBefore the adsorption Guinea pig kidney cells after adsorption Cow red blo
22、od cells after adsorption IM +Serum diseases +Normal or other diseases +Diagnosis1.IM triadn Fever,pharyngitis and enlargement of cervical lymph nodes2.atypical lymphocytes account for 10%relatively or 1.0109/L absolutely 3.heterophil agglutination test or/and EBV-VCA IgM(+)Differential Diagnosis 1.
23、suppurative tonsillitis 2.infectious mononucleosis-like syndrom 3.viral hepatitis 4.Kawasaki disease 5.Leukemia Treatment1.general treatment2.symptomatic treatment3.antiviral therapy：-interferon、Acyclovir Ganciclovir4.the use of glucocorticoid：n indicatorPrognosis1.most good prognosis2.few patients prolonged course3.1%of patients die
