儿科学教学课件：16-1 Infectious Mononucleosis (IM)

1、Infectious Mononucleosis (IM) mono 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 dis

2、ease, nasopharyngeal carcinoma ) 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 blood.

3、Case study患儿，女，6岁,因“发热、咽痛6天，颈部包块4天”入院。6天前开始发热,体温可达39.8，无畏寒，寒战，诉咽痛，吞咽时明显。2天后家人发现颈部包块，不伴疼痛。轻咳，鼻阻明显，打鼾。精神食欲尚可。院外予头孢菌素（不详）治疗4天，无明显好转。无类似病人接触史。查体：T 39.5 P 123次/分 R 30次/分 神清神可，热病容，全身未见皮疹，眼睑浮肿，双侧颈部各有3-4个肿大的淋巴结，最大者直径约2cm，质韧，咽充血明显，扁桃体度肿大，可见白色渗出物附着，心肺听诊无异常，腹软，肝脏肋下2cm,脾脏肋下2cm，质地中，边钝。门诊血常规：WBC 19.2*109/L,N 0.23

4、 L0.58 变异淋巴细胞 0.19。文献资料传染性单核细胞增多症及其相关疾病临床特点分析,中国实用儿科杂志,2006年9月第21卷9期Clinical 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

5、is enlargement of cervical lymph nodes4. hepatosplenomegaly:5. rashes： 10%6. others：stuff nose, snore, edema of the eyelids, etc suppurative tonsillitisThe tonsils are hyperemic and edematous covered with gray-white exudates. The incubation period ：515 days1. Fever2. pharyngitis: 3. generalized lymp

6、hadenopathy： 80100%. The most common lymphadenopathy is enlargement of cervical lymph nodes4. hepatosplenomegaly:5. rashes： 10%6. others：stuff nose, snore, edema of the eyelids, etc Clinical Manifestations cervical lymph nodescervical lymph nodes The incubation period ：515 days1. Fever 2. Pharyngiti

7、s IM triad3. generalized lymphadenopathy4. hepatosplenomegaly:5. rashes： 10%6. others：stuff nose, snore, edema of the eyelids, etc Clinical ManifestationsThe incubation period ：515 days1. Fever (90%)2. pharyngitis: 80%. sore throat, tonsillar enlargement, 3. generalized lymphadenopathy： 80100%. 4. h

8、epatosplenomegaly: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 Clinical ManifestationsClinical ManifestationsPolymorphous rashThe in

9、cubation period ：515 days1. Fever (90%)2. pharyngitis: 80%. sore throat, tonsillar enlargement, 3. generalized lymphadenopathy： 80100%. 4. splenohepatomegalia:5. rashes： 10%6. others：stuff nose, snore, edema of the eyelids, etc Clinical ManifestationsClinical ManifestationsThe incubation period ：515

10、 days1. Fever (90%)2. pharyngitis: 80%. sore throat, tonsillar enlargement, 3. generalized lymphadenopathy： 80100%. 4. splenohepatomegalia:5. rashes： 10%6. others：stuff nose, snore, edema of the eyelids, etc Atypical in infants Clinical ManifestationsEtiology Epstein-Barr virus(EBV) 1. Classificatio

11、n：double-stranded DNA virus -Family: Herpesviridae-Subfamily: -herpesviridae2. Characteristics of EBVLatent-reactiveLymphotropic virus just infecting B-LCcapacity to have B lymphocyte proliferate infinitely (immortalization ) Epstein-Barr virus(EBV) Epstein-Barr virus(EBV) Etiology3、Viral Antigen Sy

12、stemsviral 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 through the mouth (exchange of

13、saliva) blood transmission occasionally 3. Population susceptibilitySchool age children and adolescents 4. Epidemiological featuresPeak seasonsEpidemiological status传染性单核细胞增多症及其相关疾病临床特点分析,中国实用儿科杂志,2003年12月第18卷12期儿童传染性单核细胞增多症临床特点与发病年龄的关系附312例临床分析,临床儿科杂志,2011年6月第29卷6期 6岁以下232例，占74.4%，6-15岁80例，占25.6%Ep

14、idemiology1. 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 s

15、easonsEpidemiological 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 system viremia Activation of polyclonal B-L

16、C 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 basic pathological change is the beni

17、gn 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.Complicationsn

18、erve 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, in

19、terstitial pneumonia, etc.urinary system：nephritis, nephrotic syndrome, 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 ly

20、mphocytes account for 10% relatively or 1.0109/L absolutely 2. detection of markers of EBV3. 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; atypical lymphocytes account

21、 for 10% relatively or 1.0109/L absolutely 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 pig kidney cells after a

22、dsorption Cow red blood cells after adsorption IM + + Serum diseases + Normal or other diseases + +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 2. detection of markers of EBVheterophil agglutination test