Saturday, December 15, 2012

Kissing disease


To kiss is not so innocent, proving the existence of infectious mononucleosis. In fact, the disease caused by the Epstein Barr virus (EBV short-, B lymphotropic herpesvirus which, besides causing infectious mononucleosis, is associated with cancer of the throat and certain B-cell lymphomas) is transmitted via droplets, esspecialy oral contact. In addition to the aforementioned virus, the disease can cause and cytomegalovirus (CMV).


Distinguishing between CMV and EBV mononucleosis is based on the fact that the elderly more susceptible mononukelozi caused by cytomegalovirus, a disease usually characterized by sore throat and fever. Insidious disease occurs more slowly and stops than a disease caused by the Epstein-Barr virus.The diagnosis is made by isolating the virus in the blood or specific antibodies to CMV.

More than 90% of cases the disease has a course without major complications. The disease is rarely fatal.Risky sexual condition called (x) associated limfoproliferacijski syndrome (XLP) or Duncan's syndrome occurs in males. A total of 40% of men affected by the condition dies after EBV infection.

Transmission of the disease:

The virus is found in saliva and mucous membrane of the mouth, and is transmitted by coughing, sneezing or kissing;
most people are just an infection, and that are most susceptible to between 15 and 35 years;
Mononucleosis is usually no cure, she goes alone. Antibiotics are not credited as a virus, not a bacteria.

The first symptoms
body temperature of 38-40   C, which takes 7-10 days;
general symptoms of infection, such as: headache, sore throat, physical weakness, muscle pain and joint pain, fever, loss of appetite and nausea;
generalized increase in lymph glands, especially in the neck, where are grouped into "packages";
almost always leads to an increase of liver and spleen, a very common symptom of lacunar angina and minor bleeding at the border of the soft palate;
extreme fatigue.
High fever usually lasts an average of 7 - 10 days, as its normal drop is located in the throat and gradually lose the general symptoms of the disease. However, enlarged lymph glands, liver and spleen decreased slowly, and the disease takes an average of about six weeks. Laryngitis is an intensive 5 - 7 days, and then subside in the next 7 - 10 days. Lymph nodes are usually lower during the 3 weeks.

Infectious mononucleosis is characterized by changes in the blood picture, which consist of a marked increase in the number of lymphocytes and the occurrence of so-called atypical lymphocytes. In over 90% of cases significantly elevated levels of liver enzymes, indicating transient liver damage. In addition, there may be damage (complications) in the nervous system, heart and lungs, and very rarely come to a complete spleen destruction and death.

Diagnosis is based on:
three symptoms: high fever, sore throat, enlarged lymph glands packages;
pratećenja changes in the blood picture of patients;
heterophile antibody titer rise ...
As well as confirming the findings:
elevated white blood cell count;
increased number of atypical lymphocytes (in 75% of patients);
presence of heterophile antibodies (in 50% of children and up to 95% of adults);
mild granulocytopenia (reduction in the number of granulocytic white blood cells);
mild thrombocytopenia (platelets);
slight increase in immunoglobulin IgM, IgG and IgA;
slight increase in liver enzymes;
the presence of EBV-specific antibodies.
Possible complications:
autoimmune hemolytic anemia, which usually ends in 1-2 months;
mild thrombocytopenia (platelets) in 50% of cases - stop for 3-6 weeks;
severe thrombocytopenia - very rare;
mild granulocytopenia (reduction in the number of granulocytic leukocytes) - usually subsides in 3-6 weeks;
severe granulocytopenia - an extremely rare, severe infection associated with the death;
Shooting spleen - a rare complication that occurs in the second or third week of illness-symptoms are insidious or sudden stomach pain, rapid heart rate, low blood pressure, cold sweat;
nerve complications - paralysis of cerebral nerves, inflammation of the brain and the meninges (meningoencephalitis), Guillain-Barre syndrome, cerebral seizures, psychosis;
Hepatitis - is a common component of infectious mononucleosis, nearly 90% of patients had a slight increase in liver enzymes, but severe or permanent liver disorder is extremely rare;
cardiac abnormalities - very rare (inflammation of the heart muscle, coronary artery constriction, changes in ECG);
airway obstruction due to enlarged lymph nodes ...
Treatment, which is symptomatic because no conventional medicine:
rest;
drink large quantities of liquids;
taking drugs for downloading temperature, with children under 12 should avoid aspirin, andol, and other medications that contain aspirin. Otherwise, it can cause complications (Reye's syndrome);
taking lozenges for sore throat;
Avoiding sports 6-8 weeks.
Application of specific drugs in certain situations:
Corticosteroids may help relieve symptoms of sore throat, but the side effects are usually given only if there are complications - obstruction of the respiratory tract and haematological disorders (anemia, granulocytopenia, thrombocytopenia);
alpha-interferon - has antiviral effects and may reduce the spread of EBV, but because of the high cost usually applied in patients with immunological disorders;
Acyclovir - in high doses stops the spread of EBV in the throat, however, its clinical benefit is minimal.


Prevention

To prevent the spread of mononucleosis is recommended to avoid contact with the saliva of people who have recently recovered from mononucleosis, and maintaining a high level of hygiene, especially toys and objects that children put in their mouths.

Epidemiology

Infectious mononucleosis is an acute viral disease caused by Epstein-Barr's herpes virus (human herpes virus 4), spread throughout the world. Since it affects people of all ages, but most commonly the disease affects mostly school children and adolescents aged 15 to 25 years. It can occur in sporadic form, such as outbreaks.

The disease is spread by droplets through saliva (oral contact). Incubation period (the period from the entry of the virus into the body and the first signs of illness) lasts between 5 and 15 days. How ill from the disease mainly young people, and because of its oral transmission, in the vernacular, and gave the name of "kissing disease.


Clinical manifestations of the disease and diagnosis

In most cases, the disease begins with fever, 38-40 C, which takes 7-10 days, and other general symptoms of infection, such as: headache, sore throat, weakness, muscle pain and joint pain, chills, loss of appetite and nausea. On this general symptoms can be followed typical, special symptoms in the form of a generalized increase in the lymph nodes in all regions, especially in the neck (especially the last group), which are grouped into "packages". Almost regular occurrence spleen is enlarged, a very common symptom of lacunar angina (angina pharyngeal) and minor bleeding at the border of the soft and hard palate.

Frequent manifestations of infectious mononucleosis and hepatitis accompanied by enlargement of the liver, nausea, vomiting, loss of appetite and jaundice. Quite rare, the disease can be manifested by symptoms of central nervous system (encephalitis) in the form of a severe headache, neck stiffness, photophobia (sensitivity to light) and signs of peripheral neuritis. Very rarely possible and pulmonary manifestations in the form of chest pain, shortness of breath and coughing.

Colorfulness and diversity of the symptoms of this disease especially inflammation of the throat, hepatitis, rash and enlargement of glands linfnih really make the differential diagnosis.

In the course of infectious mononucleosis are regular changes in the blood picture, which consist of a marked increase in the number of lymphocytes (lymphocytosis) screen and so-called atypical lymphocytes. In over 90% of cases were significantly elevated values ​​of liver enzymes (transaminases), indicating transient liver damage.

The diagnosis of infectious mononucleosis is made based on clinical findings (three symptoms: high fever, sore throat, enlarged lymph glands packages), the accompanying changes in the blood picture of the patient and increasing titer of heterophile antibodies in mononucleosis (the result is obtained in a few days).
There are rapid diagnostic test for the detection of mononucleosis so. Mono-test to the diagnosis comes within 30-60 minutes.

The course of the disease and its complications

High fever usually lasts for 7-10 days, and with its normalization, normalization and finding the throat and gradually lose the common symptoms of the disease. Enlarged lymph nodes, enlarged liver and spleen decreased slowly, and the disease takes an average of about six weeks. In exceptional cases, the symptoms of the disease there may be 2-3 months.

The most common complications of infectious mononucleosis are secondary bacterial infection pharynx and larynx, usually by streptococcal bacteria.

In addition to the transient liver damage in the disease, there may be damage (complications) ing, the system, the heart and lungs, and rarely may rupture the spleen, and in severe physical exertion or in the case of blunt, sometimes innocuous trauma in the left upper abdominal quadrant. Rupture of the spleen if not detected on time can lead to death.

A rare infection with EB virus can cause malignant lymphoma originating from B-cells.
In Burkitt's linfoma jaw, which occurs in children in Africa, generally in the serum of patients still are Epstein-Barr virus.
Also, infection with this virus is associated with nasopharyngeal carcinoma in certain populations. The etiological role of EB virus in these neoplasms is not precisely defined.


Treatment

There is no specific treatment of this disease.
Essentially symptomatic and disease in the vast majority of cases goes without complications and consequences.

Relative quiescence is necessary as long as the general symptoms (fever, headache, malaise).

In the acute phase, the patient will need to drink a large amount of fluid in the body, diet should be light, and the room in which the patient resides to be ventilated and regularly maintained by the percentage of increased humidity.

To reduce body temperature above 38 C, antipyretics should be used, especially from a group of paracetamol, avoiding Acetilisalicilnu acid (Aspirin and related derivatives), especially in young children, for presence of the so-called. Ray's syndrome, and the possible association of thrombocytopenia (reduced platelet count in the blood count) with the disease, which can have the effect of an increased tendency to bleeding.

In over 20% of cases there is no association of this disease and lacunar angina (faringo-tonsilitis/zapaljenje pharyngitis and tonsillitis) caused by the bacterium Streptococcus beta-hemolytic, which requires the use of antibiotics, preferably from the group of macrolides antibiotics (Azithromycin, Roxythromicin, Erythromicin, clarithromycin), avoiding antibiotics penicillin-ampicillin groups who quite often in patients with mononucleosis leads to a very nasty skin rash.

The use of cortisone drugs is limited to complicated cases of infectious mononucleosis, where there are complications from the respiratory tract, heart, central nervous system or septic persistent high temperature and 7 days after the start of the first signs of the disease, as in the case of complications from the haematopoietic tissue (hemolytic Anemia, Thrombocytopenia expressed).

In the next month or two, pack drives by acute illness, it is necessary to avoid hard physical exertion and sports, especially martial arts, because of the risk of possible injury to the spleen.



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

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

Transmission of the disease
EBV is primarily transmitted through saliva, and less blood transfusion. It is usually transmitted by kissing and touching body parts and objects imbued with infected saliva. Since the droplets unlikely, isolation of patients does not make sense. Virus host stays for life; first 18 months after the infection is eliminated in the saliva, and periodically thereafter. People weaker 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 first symptoms: fatigue, loss of appetite and fever for several days that precede the beginning of a sore throat, temperature, and enlarged lymph nodes.
Severe sore throat usually compel patients to seek medical help. Occasionally, patients will notice only a fever or enlarged lymph nodes, or they will be present in only one of the complications. Most patients complain of headache and malaise.

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

Complications
Complications of infectious mononucleosis are uncommon, but can be very dramatic and become dominant manifestation of the disease. It includes:
- Autoimmune hemolytic anemia, which usually ends in 1-2 months
- Mild thrombocytopenia (platelets) in 50% of cases - the stops for 3-6 weeks
- Severe thrombocytopenia - a very rare
- Mild granulocytopenia (reduction in 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 of the illness, the symptoms are insidious or sudden stomach pain, rapid heart rate, low blood pressure, cold sweat
- Neurological complications - paralysis of cerebral nerves, inflammation of the brain and the meninges (meningoencephalitis), Guillain-Barre syndrome, cerebral seizures, inflammation of the spinal cord, psychosis
- Hepatitis - is a common component of infectious mononucleosis, nearly 90% of patients had a slight increase in liver enzymes, but severe or permanent liver disorder is very rare
- Cardiac abnormalities - very rare (inflammation of the heart muscle, coronary artery constriction, changes in the ECG)
- Obstruction of the airway due to enlarged lymph nodes

Is it possible to die of infectious mononucleosis?
More than 90% of cases the disease has a benign course.
The disease is rarely fatal, neurological disease, respiratory obstruction and rupture of the spleen are the most common cause of death in previously healthy people.
Sexually risky condition called (x) associated limfoproliferacijski syndrome (XLP) or Duncan's syndrome occurs in males. 40% of men affected by the condition dies after EBV infection. This is a disease for which is not yet sufficiently known, reflected the enormous proliferation of lymphatic tissues with severe immunologic and hematologic 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
- An increased number of atypical lymphocytes (in 75% of patients). Lymphocytes are a type of white blood cell that is in this disease differ from normal - increased and changed their core
- Presence of heterophile antibodies (in 50% of children and up to 95% of adults). These are antibodies to sheep red blood cells that are proving so. Monospot test.
- Mild granulocytopenia (reduction in the number of granulocytic leukocytes)
- Mild thrombocytopenia (platelets)
- A slight increase of immunoglobulin IgM, IgG and IgA
- A slight increase in liver enzymes
- The presence of EBV-specific antibodies - these serological tests to diagnose EBV infection safely, and can be done 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 the disease is usually characterized by inflammation of the throat, and fever. Sore throat and enlarged lymph nodes occur less frequently. Insidious disease occurs more slowly and stops than a disease caused by the Epstein-Barr virus. The diagnosis is made by isolating the virus in the blood or specific antibodies against CMV.

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

Certain drugs used in rare situations:
- Corticosteroids may help relieve symptoms of sore throat, but because of the side effects usually given only if there are complications - obstruction of the respiratory tract and haematological disorders (anemia, granulocytopenia, thrombocytopenia)
- Alpha-interferon - has antiviral effects and may reduce the spread of EBV, but due to high prices usually applied in patients with immunological disorders
- Acyclovir - in high doses stops the spread of EBV in the throat, however, its clinical benefit is minimal or unnoticeable

Prevention
To prevent the spread of mononucleosis recommended izbegavnjei contact with the saliva of people who have recently suffered a mononucleosis and maintain a high level of hygiene, especially children's toys and objects that children put in their mouths.


Also known as "glandular fever" Mononucleosis infectiosa. Epstein-Barr virus (EBV), a widespread virus from group B human herpesvirus-specific limfotropnih, causes an acute infection of lymphoid and reticuloendothelial system, infectious mononucleosis labeled (IMN). In childhood infection caused by EBV is usually asymptomatic or nonspecific, and young people (adolescents, teens) and adults occurs with symptoms of infectious mononucleosis or "glandular fever" (fever, enlarged lymph nodes, sore throat).

Epidemiology

Infected people excrete and periodically transmitting the virus to another person directly or indirectly (by hand) contact, mainly through saliva. Due to the very strong sensitivity of the virus to external factors, with consequent loss of infectivity outside the human body, for the transmission of the virus it is necessary to close and direct contact, usually kissing ("kissing disease"). Although the virus is found in the epithelial cells of the cervix, the semen and urethral swabs and urine, to date there is no conclusive evidence of transmission EBV through sexual contact or urine. Transmission of the virus and blood transfusion bone marrow transplant can be reported as a rare occurrence.



The clinical picture

The disease is most commonly seen form of infectious mononucleosis, sometimes only one or painless enlarged lymph node groups in the neck with no fever and only rare clinical form of extended duration marked by high fever accompanied by fatigue and general weakness.
Incubation period (time from exposure to infection and the appearance of symptoms) is from two to six weeks. Depending on the age of the disease can manifest itself differently severe clinical forms, from very lightweight, clinically unrecognized (subclinical) at the age of a small child with a severe form of fever in adolescents and adults.

In infancy and early childhood are the most infected, even more than 90%, the disease goes clinically imperceptible or only with mild symptoms, which is attributed to the immaturity of the immune response and low dose infekcijskoj which children usually indirect infection via droplets of saliva on toys.Infectious mononucleosis is possible, but quite rare occurrence in adults, even in people over the age of sixty years, and expressed the prolonged duration of fever, and long-term (chronic) fatigue. In total, the disease usually manifests infectious mononucleosis form, sometimes only one or painless enlarged lymph node groups in the neck with no fever and only rarely marked clinical form extended (weeks) duration of high temperatures accompanied by fatigue and general weakness.

Fatigue, headache, and reluctance often precedes the appearance of major symptoms such as fever, sore throat, and enlarged cervical lymph nodes.

Such common infectious mononucleosis, the clinical picture was more common in patients aged 15 to 24 years and is reflected in the high temperature for 1 to 3 weeks, the layers of the tonsils (tonsillitis), generalized enlarged lymph nodes (lymph "glands") and liver enlargement and spleen.

The increase was most pronounced lymph nodes in the neck and the back edge prsnoključnosisastog muscle (m. sternocleidomastoideus). Lymph nodes are usually less painful and bilaterally enlarged, often with distinct islands. Also, although less often and less expressive, there are enlarged lymph nodes in the armpits and groin.

Rash is a common occurrence in patients receiving antibiotics, particularly those taking amoxycillin and ampicillin. Rash is the result of a temporary and transient response hiperalergijske, and not due to actual allergies to antibiotics applied.

In most patients, performs a complete cure, and few complications may arise as obstruction of the pharynx and trachea, hemolytic anemia, thrombocytopenia, encephalitis, splenic rupture, severe hepatitis, myocarditis, pneumonia, chronic fatigue. EBV infection leaves a lasting immunity, and the return of symptoms is only the exceptional phenomenon.

Diagnostic

The diagnosis of infectious mononucleosis is based on the incidence of clinical signs and symptoms (fever, enlarged lymph nodes, tonsillitis, enlarged spleen) and the results of laboratory tests (increased number of white blood cells, atypical lymphocytes, pathological values ​​aminotrasferaza), and to confirm the diagnosis performed serology (nonspecific heterophile and EBV-specific antibodies).

Treatment

Treatment consists in lowering high temperatures and rest. In patients with symptoms of respiratory obstruction, due to the island of mucosa and tonsils throat, applied corticosteroids. Also, the use of corticosteroids is recommended in patients with severe thrombocytopenia and hemolytic anemia.



Prevention

The prevention of the spread of EBV infection apply general hygienic measures. It has not produced an effective vaccine. Isolation of patients is challenging.

No comments:

Post a Comment