Friday, July 27, 2012

Infectious mononucleosis - "kissing disease"


Definition
Infectious mononucleosis, also called "kissing disease", an infectious disease caused by Epstein - Barr virus (EBV) in 90% of cases, while the remaining 10% of the cytomegalovirus (CMV). When children are infected by the virus, the infection usually resolves without symptoms. If adults are infected, 25-75% will develop symptoms of the disease that are typical of three symptoms: fever, enlarged lymph nodes and sore throat.


Cause
Epstein Barr virus (EBV) is a B limfotropni (a great tendency to attack B lymphocytes) herpesvirus which is widespread throughout the world. In addition to causing infectious mononucleosis, the virus is associated with throat cancer and certain B-cell lymphomas.

Transmission of disease
EBV is primarily transmitted through saliva, a rare blood transfusion. It is usually spread by kissing and touching body parts and items soaked with infected saliva. Because the droplets is unlikely, isolation of patients does not make sense. Virus host stays for life; first 18 months after infection excreted in saliva, and periodically thereafter. People of lower immune status (virtually all patients with HIV, 25-50% of people with transplanted organs) often spread the virus.

Symptoms
4-8 weeks after infection appear the first symptoms: fatigue, loss of appetite and fever for several days that precede the beginning of a sore throat, temperature increase and lymph nodes.
Severe sore throat often compel patients to seek medical help. Occasionally, patients notice only fever and enlarged lymph nodes, or will they be present in only one of the complications. Most patients complain of headache and malaise.

The course of disease
Infectious mononucleosis is a disease in most cases naturally limited duration.
Sore throat is an intense 5-7 days and then subside over the next 7-10 days.
Fever usually lasts for 7-14 days, but can sometimes take a little longer.
Lymph nodes are usually reduced during 3 weeks.
Fatigue is a persistent symptom. Most of the patients for 3-4 weeks feels well enough to return to school or work, but some patients may experience fatigue for months, disturbances of concentration and inability to perform everyday activities. Usually these are patients who have had mild disease onset, without a severe form of sore throat and high fever.

Complications
Complications of infectious mononucleosis are uncommon but can be very dramatic and become the dominant manifestation of the disease. These include:
- Autoimmune hemolytic anemia, which usually ends in 1-2 months
- Mild thrombocytopenia (platelet) in 50% of - ceases for 3-6 weeks
- Severe thrombocytopenia - a very rare
- Mild granulocytopenia (reducing the number of granulocytic leukocytes) - usually subsides in 3-6 weeks
- Severe granulocytopenia - very rare, is associated with severe infection or death
- Rupture of the spleen - a rare complication that occurs in the second or third week, the symptoms are insidious or sudden stomach pain, rapid heartbeat, low blood pressure, cold sweat
- Neurological complications - paralysis of cerebral nerves, inflammation of the brain and meninges (meningoencephalitis), Guillain-Barre syndrome, cerebral seizures, inflammation of the spinal cord, psychosis
- Hepatitis - a common component of infectious mononucleosis, nearly 90% of patients have a mild increase in liver enzymes, but severe or permanent disorder of the liver is very rare
- Cardiac abnormalities - very rare (inflammation of heart muscle contraction of the coronary arteries, changes in the ECG)
- Obstruction of the airways due to increased lymph node

Can you die from infectious mononucleosis?
More than 90% of cases the disease has a benign course.
This disease is rarely fatal, neurological disease, airway obstruction and rupture of the spleen are the most common cause of death in previously healthy individuals.
Sexually risky condition called (x) associated limfoproliferacijski syndrome (XLP) or Duncan's syndrome occurs in males. 40% of men affected by this condition died after EBV infection. This disease, of whom still do not know enough, manifested by an enormous proliferation of lymphoid tissue with possible severe immunological or hematological effects such as agammaglobulinemia, aplastic anemia or lymphocytic lymphoma.

Diagnosis
In addition to the listed symptoms, diagnosis is confirmed by the following laboratory findings:
- Increased number of leukocytes
- Increased number of atypical lymphocytes (75% of patients). Lymphocytes are a type of white blood cells that are in this disease different from normal - increased and changed their core
- The existence of heterophilic antibodies (in 50% of children up to 95% of adults). These are antibodies to sheep erythrocytes, which is proving so. Monospot test.
- Mild granulocytopenia (reducing the number of granulocytic leukocytes)
- Mild thrombocytopenia (platelet)
- A slight increase in immunoglobulin IgM, IgG and IgA
- A slight increase in liver enzymes
- The presence of EBV-specific antibodies - these serological tests to safely diagnose EBV infection, and can be made immediately or if the above is inconsistent

Distinguishing between CMV and EBV mononucleosis
Patients with mononucleosis caused by cytomegalovirus (CMV) on average are older and usually is a disease characterized by sore throat and fever. Inflammation of the throat and increase lymph nodes rarely occur. The disease occurs more insidious and stops slower than a disease caused by Epstein-Barr virus. Diagnosis is made by isolating the virus in the blood or specific antibodies to CMV.

Treatment
Treatment is symptomatic, because there is no cure against pathogens. Patients are recommended:
- Waiting - patients should rest, which does not mean that they should strictly lie in bed because there is no evidence that strict rest improves recovery
- Drinking large amounts of fluid during the temperature
- If necessary, take drugs for lowering high temperatures which will recommend a doctor. Children under 12 should avoid aspirin (Aspirin. Andol) due to the risk of complications (Reye syndrome).
- Hard candy can be taken for sore throats because their chewing stimulates the secretion of saliva and swallowing collected secretion
- Avoid sports for 6-8 weeks - because of rare complications such as rupture of the spleen

Certain drugs used in rare situations:
- Corticosteroids may relieve symptoms of sore throat, but the side effects are usually given only if there are complications - obstruction of the airways and haematological disorders (anemia, granulocytopenia, thrombocytopenia)
- Alpha interferon - have antiviral activity and can reduce the spread of EBV, but due to the high cost typically used in people with immunity disorders
- Acyclovir - in high doses stops the spread of EBV in the throat, however, its clinical benefit is minimal or inconspicuous

Prevention
To prevent the spread of mononucleosis recommended izbegavnjei contact with the saliva of people who recently overcame mononucleosis and maintain a high level of hygiene, especially children's toys and objects that children put into the mouth.

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