《兒科學教學課件》傳染性單核細胞增多癥(上)

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1、Infectious Mononucleosis (IM) Liu Quanbo, associate professor IntroductionoInfectious mononucleosis(IM) is an infectious disease caused by Epstein-Barr virus(EBV) .oThe clinical features include fever, pharyngitis , and generalized lymphadenopathy.oThe characteristics of lab study is atypical lympho

2、cytosis in the peripheral blood.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 (immor

3、talization ) Epstein-Barr virus(EBV) Etiology3、Viral Antigen Systemsnviral capsid antigen, VCAnEB nuclear antigen, EBNAnearly antigen, EAnlymphocyte-detected membrane antigen, LYDMAnmembrane antigen, MA Epidemiology1. Infectious sources Patients, persons with latent infection and carriers2. Routes o

4、f transmission :nContact transmission through the mouth (exchange of saliva) nblood transmission occasionally 3. Population susceptibilitynSchool age children and adolescents 4. Epidemiological featuresnPeak seasonsnEpidemiological statusPathogenesisEBV salivary glands infects oral epithelial cells

5、and B-LC in pharynx 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 AbautoantibodyTc responsed to the infected B-LCEffect on B-LC containing EBVatypical LCH

6、epatosplenomegaly, lymphadenectasis, myocarditis, pneumonia, etc.Changes of antigenicity on the surface of B-LC Specific Abs PathologyoThe basic pathological change is the benign lymphadenosis oThe main damage is in monocyte-macrophage system nLymph nodes:non-pyogenic lymphadenectasis with LC and mo

7、nocyte-macrophage system proliferationnSpleen: lots of atypical LCnLC infiltration and limited necrotic lesions in organs such as liver, heart, kidney, lung, CNS,etc.ManifestationsThe incubation period :515 days1. fever2. pharyngitis: 80%. sore throat, tonsillar enlargement, hyperemia , edema and ex

8、udates50%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%

9、6. others:stuff nose, snore, edema of the eyelids, etc The tonsils are hyperemic and edematous covered with gray-white exudates. ManifestationsThe incubation period :515 days1. fever2. pharyngitis: 80%. sore throat, tonsillar enlargement, hyperemia, edema and exudates50%3. generalized lymphadenopath

10、y: 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

11、the eyelids, etc cervical lymph nodescervical lymph nodes ManifestationsThe incubation period :515 days1. fever2. pharyngitis: 80%. sore throat, tonsillar enlargement, hyperemia , edema and exudates50%3. generalized lymphadenopathy: 80100%. The most common lymphadenopathy is enlargement of cervical

12、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 臨床表現(xiàn)Complicationsnnerve system:encephalitis,Guillain-

13、Barr syndrome, Reye syndrome, Peripheral neuritis, etc.ncardiovascular system:Myocarditis, pericarditis nhematological system:Hemolytic anemia, Aplastic anemia, thrombocytopenia, neutropenia, hemophagocytic syndrome, etc.nrespiratory system:upper airway obstruction, interstitial pneumonia, etc.nurin

14、ary system:nephritis, nephrotic syndrome, etc.ndigestive system:gastrointestinal bleeding, 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; n109/L absolutely notice:2. detection

15、of markers of EBVnheterophil agglutination test oprincipleolimitationsndetection of EBV Abs: VCA IgM3. detection of nucleic acid of EBV by PCR4. Isolation of EBV atypical lymphocytesNoImageDiagnosis1. IM triadnFever, pharyngitis and enlargement of cervical lymph nodes2. 109/L absolutely 3. heterophi

16、l agglutination test or/and VCA IgM (+)Differential Diagnosis 1. suppurative tonsillitis 2. infectious mononucleosis-like syndrom 3. viral hepatitis 4. Kawasaki disease 5. malignant histocytosisTreatment1. general treatment2. symptomatic treatment3. antiviral therapy4. the use of glucocorticoid:n indicatorPrognosis

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