《儿科学教学》17传染性单核细胞增多症（上）

1、编辑pptInfectious Mononucleosis (IM) Liu Quanbo, associate professor 编辑pptIntroductionoInfectious 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 atypi

2、cal lymphocytosis in the peripheral blood.编辑pptEtiology 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 in

3、finitely (immortalization )编辑ppt Epstein-Barr virus(EBV) 编辑pptEtiology3、Viral Antigen Systemsnviral capsid antigen, VCAnEB nuclear antigen, EBNAnearly antigen, EAnlymphocyte-detected membrane antigen, LYDMAnmembrane antigen, MA 编辑pptEpidemiology1. Infectious sources Patients, persons with latent inf

4、ection and carriers2. Routes of transmission ：nContact transmission through the mouth (exchange of saliva) nblood transmission occasionally 3. Population susceptibilitynSchool age children and adolescents 4. Epidemiological featuresnPeak seasonsnEpidemiological status编辑pptPathogenesisEBV salivary gl

5、ands infects oral epithelial cells 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

6、 on B-LC containing EBVatypical LCHepatosplenomegaly, lymphadenectasis, myocarditis, pneumonia, etc.Changes of antigenicity on the surface of B-LC Specific Abs 编辑pptPathologyoThe basic pathological change is the benign lymphadenosis oThe main damage is in monocyte-macrophage system nLymph nodes：non-

7、pyogenic lymphadenectasis with LC and monocyte-macrophage system proliferationnSpleen: lots of atypical LCnLC infiltration and limited necrotic lesions in organs such as liver, heart, kidney, lung, CNS,etc.编辑pptManifestationsThe incubation period ：515 days1. fever2. pharyngitis: 80%. sore throat, to

8、nsillar enlargement, nhyperemia , edema and exudates（50%）3. generalized lymphadenopathy： 80100%. nThe most common lymphadenopathy is enlargement of cervical lymph nodes4. splenohepatomegalia:nhepatomegaly： 3050%. Among them, 2/3 has elevated liver enzymes Jaundice is uncommon. Liver failure may occu

9、rred in few cases.nsplenomegaly：5070%5. rashes： 10%6. others：stuff nose, snore, edema of the eyelids, etc 编辑pptThe tonsils are hyperemic and edematous covered with gray-white exudates. 编辑pptManifestationsThe incubation period ：515 days1. fever2. pharyngitis: 80%. sore throat, tonsillar enlargement,

10、nhyperemia, edema and exudates（50%）3. generalized lymphadenopathy： 80100%. nThe most common lymphadenopathy is enlargement of cervical lymph nodes4. splenohepatomegalia:nhepatomegaly： 3050%. Among them, 2/3 has elevated liver enzymes Jaundice is uncommon. Liver failure may occurred in few cases.nspl

11、enomegaly：5070%5. rashes： 10%6. others：stuff nose, snore, edema of the eyelids, etc 编辑ppt cervical lymph nodes编辑pptcervical lymph nodes 编辑pptManifestationsThe incubation period ：515 days1. fever2. pharyngitis: 80%. sore throat, tonsillar enlargement, nhyperemia , edema and exudates（50%）3. generalize

12、d lymphadenopathy： 80100%. nThe most common lymphadenopathy is enlargement of cervical lymph nodes4. splenohepatomegalia:nhepatomegaly： 3050%. Among them, 2/3 has elevated liver enzymes Jaundice is uncommon. Liver failure may occurred in few cases.nsplenomegaly：5070%5. rashes： 10%6. others：stuff nos

13、e, snore, edema of the eyelids, etc 编辑ppt临床表现编辑ppt编辑pptComplicationsnnerve system：encephalitis,Guillain-Barr syndrome, Reye syndrome, Peripheral neuritis, etc.ncardiovascular system：Myocarditis, pericarditis nhematological system：Hemolytic anemia, Aplastic anemia, thrombocytopenia, neutropenia, hemo

14、phagocytic syndrome, etc.nrespiratory system：upper airway obstruction, interstitial pneumonia, etc.nurinary system：nephritis, nephrotic syndrome, etc.ndigestive system：gastrointestinal bleeding, liver failure, etc.nsubcapsular splenic hemorrhage or splenic rupture 编辑pptLab studies1. blood routine ：n

15、there is leukocytosis of 1020109/L, of which at least are lymphocytes; n109/L absolutely notice:2. detection of markers of EBVnheterophil agglutination test oprincipleolimitationsndetection of EBV Abs: VCA IgM3. detection of nucleic acid of EBV by PCR4. Isolation of EBV 编辑ppt atypical lymphocytesNoImage编辑pptDiagnosis1. IM triadnFever, pharyngitis and enlargement of cervical lymph nodes109/L absolutely 3. heterophil agglutination test or/and VCA IgM (+)编辑pptDifferential Diagnosis 1. suppurative to