《儿科学教学课件》17传染性单核细胞增多症(上).ppt

Infectious Mononucleosis(IM),Liu Quanbo,associate professorDIVISION 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 lymphadenopathy.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:-herpesvirinae2.Characteristics of EBVLatent-reactiveLymphotropic virus just infecting B-LCcapacity to have B lymphocyte proliferate infinitely(immortalization),Epstein-Barr virus(EBV),Etiology,3、Viral Antigen Systemsviral capsid antigen,VCAEB nuclear antigen,EBNAearly antigen,EAlymphocyte-detected membrane antigen,LYDMAmembrane antigen,MA,Epidemiology,1.Infectious sources Patients,persons with latent infection and carriers2.Routes of transmission：Contact transmission through the mouth(exchange of saliva)blood transmission occasionally 3.Population susceptibilitySchool age children and adolescents 4.Epidemiological featuresPeak seasonsEpidemiological status,Pathogenesis,EBV,salivary glands,infects oral epithelial cells and B-LC in pharynx,pharyngitisLymphadenopathy 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 antibodiesSpecific Absheterophil Abautoantibody,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 lymphadenosis The main damage is in monocyte-macrophage system Lymph nodes：non-pyogenic lymphadenectasis with LC and monocyte-macrophage system proliferationSpleen:lots of atypical LCLC infiltration and limited necrotic lesions in organs such as liver,heart,kidney,lung,CNS,etc.,Manifestations,The incubation period：515 days1.fever2.pharyngitis:80%.sore throat,tonsillar enlargement,hyperemia,edema and exudates（50%）3.generalized lymphadenopathy：80100%.The most common lymphadenopathy is enlargement of cervical lymph nodes4.splenohepatomegalia:hepatomegaly：3050%.Among them,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：515 days1.fever2.pharyngitis:80%.sore throat,tonsillar enlargement,hyperemia,edema and exudates（50%）3.generalized lymphadenopathy：80100%.The most common lymphadenopathy is enlargement of cervical lymph nodes4.splenohepatomegalia:hepatomegaly：3050%.Among them,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,cervical lymph nodes,cervical lymph nodes,Manifestations,The incubation period：515 days1.fever2.pharyngitis:80%.sore throat,tonsillar enlargement,hyperemia,edema and exudates（50%）3.generalized lymphadenopathy：80100%.The most common lymphadenopathy is enlargement of cervical lymph nodes4.splenohepatomegalia:hepatomegaly：3050%.Among them,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,临床表现,Complications,nerve system：encephalitis,Guillain-Barr syndrome,Reye syndrome,Peripheral neuritis,etc.cardiovascular system：Myocarditis,pericarditis hematological system：Hemolytic anemia,Aplastic 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 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 EBVheterophil agglutination test principlelimitationsdetection of EBV Abs:VCA IgM3.detection of nucleic acid of EBV by PCR4.Isolation of EBV,atypical lymphocytes,Diagnosis,1.IM triadFever,pharyngitis and enlargement of cervical lymph nodes2.atypical lymphocytes account for 10%relatively or 1.0109/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,Treatment,1.general treatment2.symptomatic treatment3.antiviral therapy4.the use of glucocorticoid：indicator,Prognosis,