《儿科学教学课件》17传染性单核细胞增多症(上)

1、Infectious Mononucleosis (IM),Liu Quanbo, associate professor DIVISION OF INFECTIOUS DISEASE OF CHONGQING MEDICAL UNIVERSITY,Introduction,Infectious mononucleosis(IM) is an infectious disease caused by Epstein-Barr virus(EBV) . The clinical features include fever, pharyngitis , and generalized lymph

2、adenopathy. The characteristics of lab study is atypical lymphocytosis in the peripheral blood.,Etiology,Epstein-Barr virus(EBV) 1. Classification： double-stranded DNA virus -Family: Herpesviridae -Subfamily: -herpesvirinae 2. Characteristics of EBV Latent-reactive Lymphotropic virus just infecting

3、B-LC capacity to have B lymphocyte proliferate infinitely (immortalization ),Epstein-Barr virus(EBV),Etiology,3、Viral Antigen Systems viral capsid antigen, VCA EB nuclear antigen, EBNA early antigen, EA lymphocyte-detected membrane antigen, LYDMA membrane antigen, MA,Epidemiology,1. Infectious sourc

4、es Patients, persons with latent infection and carriers 2. Routes of transmission ： Contact transmission through the mouth (exchange of saliva) blood transmission occasionally 3. Population susceptibility School age children and adolescents 4. Epidemiological features Peak seasons Epidemiological st

5、atus,Pathogenesis,EBV,salivary glands,infects oral epithelial cells and B-LC in pharynx,pharyngitis Lymphadenopathy in cervical nodes,excrete EBV Continuously or intermittently,B-LC in the peripheral blood and the entire lymphoreticular system,viremia,Activation of polyclonal B-LC,polyclonal antibod

6、ies Specific Abs heterophil Ab autoantibody,Tc responsed to the infected B-LC,Effect on B-LC containing EBV,atypical LC,Hepatosplenomegaly, lymphadenectasis, myocarditis, pneumonia, etc.,Changes of antigenicity on the surface of B-LC,Specific Abs,Pathology,The basic pathological change is the benign

7、 lymphadenosis The main damage is in monocyte-macrophage system Lymph nodes：non-pyogenic lymphadenectasis with LC and monocyte-macrophage system proliferation Spleen: lots of atypical LC LC infiltration and limited necrotic lesions in organs such as liver, heart, kidney, lung, CNS,etc.,Manifestation

8、s,The incubation period ：515 days 1. fever 2. pharyngitis: 80%. sore throat, tonsillar enlargement, hyperemia , edema and exudates（50%） 3. generalized lymphadenopathy： 80100%. The most common lymphadenopathy is enlargement of cervical lymph nodes 4. splenohepatomegalia: hepatomegaly： 3050%. Among th

9、em, 2/3 has elevated liver enzymes Jaundice is uncommon. Liver failure may occurred in few cases. 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.,Manifestations,The incubation period ：5

10、15 days 1. fever 2. pharyngitis: 80%. sore throat, tonsillar enlargement, hyperemia, edema and exudates（50%） 3. generalized lymphadenopathy： 80100%. The most common lymphadenopathy is enlargement of cervical lymph nodes 4. splenohepatomegalia: hepatomegaly： 3050%. Among them, 2/3 has elevated liver

11、enzymes Jaundice is uncommon. Liver failure may occurred in few cases. splenomegaly：5070% 5. rashes： 10% 6. others：stuff nose, snore, edema of the eyelids, etc,cervical lymph nodes,cervical lymph nodes,Manifestations,The incubation period ：515 days 1. fever 2. pharyngitis: 80%. sore throat, tonsilla

12、r enlargement, hyperemia , edema and exudates（50%） 3. generalized lymphadenopathy： 80100%. The most common lymphadenopathy is enlargement of cervical lymph nodes 4. splenohepatomegalia: hepatomegaly： 3050%. Among them, 2/3 has elevated liver enzymes Jaundice is uncommon. Liver failure may occurred i

13、n few cases. splenomegaly：5070% 5. rashes： 10% 6. others：stuff nose, snore, edema of the eyelids, etc,临床表现,Complications,nerve system：encephalitis,Guillain-Barr syndrome, Reye syndrome, Peripheral neuritis, etc. cardiovascular system：Myocarditis, pericarditis hematological system：Hemolytic anemia, A

14、plastic anemia, thrombocytopenia, neutropenia, hemophagocytic syndrome, etc. respiratory system：upper airway obstruction, interstitial pneumonia, etc. urinary system：nephritis, nephrotic syndrome, etc. digestive system：gastrointestinal bleeding, liver failure, etc. subcapsular splenic hemorrhage or

15、splenic rupture,Lab studies,1. blood routine ： there is leukocytosis of 1020109/L, of which at least are lymphocytes; atypical lymphocytes account for 10% relatively or 1.0109/L absolutely notice: 2. detection of markers of EBV heterophil agglutination test principle limitations detection of EBV Abs

16、: VCA IgM 3. detection of nucleic acid of EBV by PCR 4. Isolation of EBV,atypical lymphocytes,Diagnosis,1. IM triad Fever, pharyngitis and enlargement of cervical lymph nodes 2. atypical lymphocytes account for 10% relatively or 1.0109/L absolutely 3. heterophil agglutination test or/and VCA IgM (+),Differential Diagnosis,1. sup