兒科學(xué)英文課件：20 傳染性單核細(xì)胞增多癥

1、Infectious Mononucleosis (IM) mono IntroductionInfectious 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 bloo

2、d.EBV associated disease The upper respiratory tract infection Infectious mononucleosis(IM)EB Virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH)Chronic active EBV infection EB Virus-associated malignant tumor (Burkitt lymphoma 、B cell lymphoma、Hodgkins disease, nasopharyngeal carcinoma )

3、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) E

4、tiology3、Viral Antigen Systemsviral capsid antigen, VCAEB nuclear antigen, EBNAearly antigen, EAlymphocyte-detected membrane antigen, LYDMAmembrane antigen, MA Epidemiology1. Infectious sources Patients, persons with latent infection and carriers2. Routes of transmission ：Contact transmission throug

5、h the mouth (exchange of saliva) blood transmission occasionally 3. Population susceptibilitySchool age children and adolescents 4. Epidemiological featuresPeak seasonsEpidemiological status傳染性單核細(xì)胞增多癥及其相關(guān)疾病臨床特點(diǎn)分析,中國(guó)實(shí)用兒科雜志,2003年12月第18卷12期兒童傳染性單核細(xì)胞增多癥臨床特點(diǎn)與發(fā)病年齡的關(guān)系附312例臨床分析,臨床兒科雜志,2011年6月第29卷6期 6歲以下232例

6、，占74.4%，6-15歲80例，占25.6%重慶醫(yī)科大學(xué)感染消化教研室Epidemiology1. 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 adolesc

7、ents 4. Epidemiological featuresPeak seasonsEpidemiological statusPathogenesisEBV salivary glands infects oral epithelial cells and B-LC in pharynx pharyngitisLymphadenopathy in cervical nodesexcrete EBV Continuously or intermittently B-LC in the peripheral blood and the entire lymphoreticular syste

8、m viremia Activation of polyclonal B-LC polyclonal antibodies Specific Absheterophil AbautoantibodyTc responsed to the infected B-LCEffect on B-LC containing EBVatypical LCHepatosplenomegaly, lymphadenectasis, myocarditis, pneumonia, etc.Changes of antigenicity on the surface of B-LC TCLPathologyThe

9、 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

10、, kidney, lung, CNS,etc.ManifestationsThe incubation period ：515 days1. Fever (90%)2. 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. splenohepato

11、megalia: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. Manif

12、estationsThe incubation period ：515 days1. Fever (90%)2. 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%.

13、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 nodescervical lymph nodes ManifestationsThe incubation period ：515 days1. Fever (90%)2. phary

14、ngitis: 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 uncommo

15、n. 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)文獻(xiàn)資料傳染性單核細(xì)胞增多癥及其相關(guān)疾病臨床特點(diǎn)分析,中國(guó)實(shí)用兒科雜志,2006年9月第21卷9期病例學(xué)習(xí)患兒，女，6歲,因”發(fā)熱、咽痛6天，頸部包塊4天”入院。6天前開(kāi)始發(fā)熱,體溫可達(dá)39.8，無(wú)畏寒，寒戰(zhàn)，訴咽痛，吞咽時(shí)明顯。2天后家人發(fā)現(xiàn)頸部包塊，不伴疼痛。輕咳，鼻阻明顯，打鼾。精神食欲尚可。院外予頭孢菌素（不詳）治療4天，

16、無(wú)明顯好轉(zhuǎn)。無(wú)類(lèi)似病人接觸史。查體：T 39.5 P 123次/分 R 30次/分 神情神可，熱病容，全身未見(jiàn)皮疹，眼瞼浮腫，雙側(cè)頸部各有3-4個(gè)腫大的淋巴結(jié)，最大者直徑約2cm，質(zhì)中，咽充血明顯，扁桃體度腫大，可見(jiàn)白色滲出物附著，心肺聽(tīng)診無(wú)異常，腹軟，肝臟肋下2cm,脾臟肋下2cm，質(zhì)地中，邊鈍。門(mén)診血常規(guī)：WBC 19.2*109/L,N 0.23 L0.58 異型淋巴細(xì)胞 0.19。病例學(xué)習(xí)患兒，女，6歲,因 “發(fā)熱、咽痛6天，頸部包塊4天”入院。6天前開(kāi)始發(fā)熱,體溫可達(dá)39.8，無(wú)畏寒，寒戰(zhàn)，訴咽痛，吞咽時(shí)明顯。2天后家人發(fā)現(xiàn)頸部包塊，不伴疼痛。輕咳，鼻阻明顯，打鼾。精神食欲尚可。院外

17、診斷“扁桃體炎”予頭孢菌素（不詳）治療4天，無(wú)明顯好轉(zhuǎn)。無(wú)類(lèi)似病人接觸史。查體：T 39.5 P 123次/分 R 30次/分，神清神可，熱病容，全身未見(jiàn)皮疹，眼瞼浮腫，雙側(cè)頸部各有3-4個(gè)腫大的淋巴結(jié)，最大者直徑約2cm，質(zhì)中，咽充血明顯，扁桃體度腫大，可見(jiàn)白色滲出物附著，心肺聽(tīng)診無(wú)異常，腹軟，肝臟肋下2cm，脾臟肋下2cm，質(zhì)地中，邊鈍。門(mén)診血常規(guī)： WBC 19.2*109/L，N 0.23，L0.58 異型淋巴細(xì)胞 0.19。Complicationsnerve system：encephalitis,Guillain-Barr syndrome, Reye syndrome, Per

18、ipheral 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 syndr

19、ome, etc.digestive system：gastrointestinal bleeding, liver failure, etc.subcapsular splenic hemorrhage or splenic rupture Lab studies1. 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:

20、2. detection of markers of EBVheterophil agglutination test principlelimitationsdetection of EBV Abs: EBV-VCA IgM3. detection of nucleic acid of EBV by PCR4. Isolation of EBV atypical lymphocytesLab studies1. blood routine ：there is leukocytosis of 1020109/L, of which at least are lymphocytes; atypi

21、cal lymphocytes account for 10% relatively or 1.0109/L absolutely notice:2. detection of markers of EBVheterophil agglutination test principlelimitationsdetection of EBV Abs: EBV-VCA IgM3. detection of nucleic acid of EBV by PCR4. Isolation of EBV heterophil agglutination testBefore the adsorption Guinea pi