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Infectious mononucleosis is a disease as Epstein-Barr (EB) virus caused fever, pharyngitis and lymphadenopathy characterized by acute disease.
Etiology and pathophysiology
EB virus is a herpes virus is widely distributed, and its limited human and certain primate hosts of B lymphocytes and nasopharyngeal cells, after replication in the nasopharynx, the virus will be transmitted to the B lymphocytes, and make induced secretion of immunoglobulin, which immunoglobulin includes a substance called heterophil antibodies, useful in the diagnosis of this substance (see below laboratory tests and diagnosis).
By EB virus transformation B lymphocytes, is a multi-faceted response to the target cells. Humoral immune response (heterophilic antibodies) is the EB virus infection of the primary response. Cellular immune response was partly due to CD8 T lymphocytes were induced marked activation is due to primary EB virus infection caused by atypical lymphocytosis. Therefore, the cell-mediated immune response in the prevention of primary EB virus infection is to change the B lymphocyte proliferation, and reversing the EB virus activation of polyclonal B cell responses play an important role.
After the primary infection, EB virus is still a long remain in the host body, and the intermittently emitted from the oropharynx in 15% to 20% of the EB virus seropositive healthy adults respond can be found in oropharyngeal secretions of EB virus. Immunocompromised patients (organ transplant as receptor species by HIV infected people) and its frequent oropharyngeal titer increased detoxification. With herpes simplex and herpes zoster virus in different, EB virus, the general response was subclinical.
EB virus is relatively unstable, infectious is relatively small, only about 5% of the patients had recent contact with infectious mononucleosis syndrome in patients with history of exposure to the large numbers of patients, the incubation period of 30 to 50 days.
Infectious mononucleosis syndrome can be transmitted through blood, but the EB virus susceptible and healthy carriers of oropharyngeal contact (kissing) is more common. Although the latter have no symptoms, but continue to discharge its oropharyngeal virus, in a low socio-economic groups and crowded living environment, opportunities for young persons infected are more common.
EB virus is also considered with African Burkitt (Burkitt) lymph node disease, in some immunocompromised patients (especially the same receptors in organ transplantation, HIV infection, ataxia - telangiectasia patients), B cells cancer and nasopharyngeal relevant (see 139 and 87). The association is due to EB virus in the serum of patients with increased vitality, and in tumor biopsy specimens were found to have EB virus core antigen (EBNA) and DNA. Have speculated that EB virus is by changing the B cell clones, making it easy to produce chromosome misalignment, and activate the monoclonal or polyclonal lymphocyte prolifera
In the past several years, many researchers have found that a technique called "chronic fatigue syndrome" disease, characterized by fatigue, mild dysfunction that can be felt, some cases accompanied by fever and swollen lymph nodes (see Section 287), although some speculation that EB virus and pathogenesis of chronic fatigue syndrome may be some relationship, but the objective basis to support this speculation insufficient, EB virus-specific serological test for diagnosing meaningless.
Occasional case reports support the chronic EB virus infection and a fever, interstitial pneumonia, pancytopenia, and uveitis syndrome related. These patients with chronic fatigue syndrome should be differentiated, because the latter there is no objective signs and symptoms.
About 50% of the children in the age of 5 have primary EB virus infection, most infections were subclinical. In the adolescent or adult, may be a subclinical or showed symptoms of infectious mononucleosis. By prospective college students found that primary EB virus infection, 30% to 70% have symptoms of infectious mononucleosis, but the peace and the recruitment of volunteer recruits in the team similar study showed that up to 90% No cases of clinical performance. EB virus infection even if the delay to the elderly, will produce a typical infectious mononucleosis symptoms.
Symptoms and signs
Usually occur in patients with fatigue, fever, pharyngitis and swollen lymph nodes of Fallot, or only a few of the symptoms. Patients often show lasted for many days to a week of discomfort, it follows that it fever, pharyngitis and swollen lymph nodes, in the first 2 to 3 weeks was the most tired, the body temperature is highest in the afternoon or evening, usually around 39.5 â„ƒ, a few up to 40.5 â„ƒ, fatigue and fever are prominent (so-called typhoid-like type), the onset and extinction are relatively slow. Pharyngitis can be very serious, with severe pain and exudation, similar with streptococcal pharyngitis, enlarged lymph nodes can affect any one group, but was usually symmetrical, with anterior and posterior cervical lymph nodes is most prominent, Sometimes a single or a group of lymph nodes, this time heterophilic antibody test can replace the lymph node biopsy or to help solve people feel uncertain pathological findings. Medicine. Learn all. In. Line www.med126.com
About 50% of the patients had splenomegaly, in the course of 2 and maximum 3 weeks, when the spleen tip just below the left costal margin can be touched, but also a mild hepatomegaly and liver percussion pain , rare symptoms include rash, jaundice, periorbital edema, and palatal mucosa rash.
Although the vast majority of cases will ultimately recover, but complications are still very compelling.
Central nervous system complications, including encephalitis, epilepsy, Guillain-BarrÃ© syndrome, peripheral neuropathy, aseptic meningitis, myelitis, cranial nerve paralysis and mental symptoms. EB virus-associated encephalitis, the symptoms may be associated with cerebellar damage, is also possible that the damage of whole brain, and is similar to herpes simplex encephalitis, rapid progress, but the difference is that EB virus-associated encephalitis is usually self-limiting The.
Hematological complications include neutropenia, thrombocytopenia and hemolytic anemia, and often is self-limiting and does not require special handling. About 50% of patients associated with transient neutropenia or thrombocytopenia, rare cases can have serious secondary infection or bleeding. Because the presence of specific antibodies, hemolytic anemia can occur. Edema due to spleen enlargement and capsular rupture can occur at this time require splenectomy. While most patients will feel pain, but occasionally there will be painless rupture, this time showing only low blood pressure. About half of the patients had history of trauma.
Pulmonary complications include airway obstruction or interstitial pulmonary infiltrates, due to enlarged lymph nodes around the pharynx or trachea can lead to airway obstruction, if the adrenal cortex hormones can not control require immediate hospitalization and may require surgery. Interstitial pneumonia was more common in pediatric patients, usually only on the X-ray abnormalities and lack of clinical symptoms.
Liver complications of liver dysfunction as the main performance, about 95% of the patients liver enzymes increased (up to 2 to 3 times the normal, in the course of 3 to 4 weeks come back to the baseline.) If jaundice or enzyme titer higher, will have to consider whether or not other causes of hepatitis.
Occasional sporadic overwhelming EB virus infection may be related to family history. In some families there may be X linked lymphocyte syndrome (Duncan syndrome) (see Section 147), in these families, the primary EB virus infection may be accompanied beyond the control of lymphocyte proliferation, regeneration anemia or low agammaglobulinemia.
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