(儿科学英文课件)20 传染性单核细胞增多症

InfectiousMononucleosis(IM)

monoHuangYanfeng,associateprofessorDIVISIONOFINFECTIOUSDISEASEOFCHONGQINGMEDICALUNIVERSITY

InfectiousMononucleosis(IM)

1IntroductionInfectiousmononucleosis(IM)isaninfectiousdiseasecausedbyEpstein-Barrvirus(EBV).Theclinicalfeaturesincludefever,pharyngitis,andgeneralizedlymphadenopathy.Thecharacteristicsoflabstudyisatypicallymphocytosisintheperipheralblood.

IntroductionInfectiousmononuc2EBVassociateddisease

TheupperrespiratorytractinfectionInfectiousmononucleosis(IM)EBVirus-associatedhemophagocyticlymphohistiocytosis(EBV-HLH)ChronicactiveEBVinfectionEBVirus-associatedmalignanttumor(Burkittlymphoma、Bcelllymphoma、Hodgkin'sdisease,nasopharyngealcarcinoma)EBVassociateddiseaseTheupp3(儿科学英文课件)20传染性单核细胞增多症4(儿科学英文课件)20传染性单核细胞增多症5Etiology3、ViralAntigenSystemsviralcapsidantigen,VCAEBnuclearantigen,EBNAearlyantigen,EAlymphocyte-detectedmembraneantigen,LYDMAmembraneantigen,MAEtiology3、ViralAntigenSystem6Epidemiology1.Infectioussources

Patients,personswithlatentinfectionandcarriers2.Routesoftransmission：Contacttransmissionthroughthemouth(exchangeofsaliva)bloodtransmissionoccasionally

3.PopulationsusceptibilitySchoolagechildrenandadolescents

4.EpidemiologicalfeaturesPeakseasonsEpidemiologicalstatusEpidemiology1.Infectioussour7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%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8重庆医科大学感染消化教研室重庆医科大学感染消化教研室9Epidemiology1.Infectioussources

Patients,personswithlatentinfectionandcarriers2.Routesoftransmission：Contacttransmissionthroughthemouth(exchangeofsaliva)bloodtransmissionoccasionally

3.PopulationsusceptibilitySchoolagechildrenandadolescents

4.EpidemiologicalfeaturesPeakseasonsEpidemiologicalstatusEpidemiology1.Infectioussour10PathogenesisEBVsalivaryglands

infectsoralepithelialcellsandB-LCinpharynx

pharyngitisLymphadenopathyincervicalnodesexcreteEBVContinuouslyorintermittently

B-LCintheperipheralbloodandtheentirelymphoreticularsystem

viremia

ActivationofpolyclonalB-LC

polyclonalantibodiesSpecificAbsheterophilAbautoantibodyTcresponsedtotheinfectedB-LCEffectonB-LCcontainingEBVatypicalLC↑Hepatosplenomegaly,lymphadenectasis,myocarditis,pneumonia,etc.ChangesofantigenicityonthesurfaceofB-LC

TCLPathogenesisEBVsalivarygland11PathologyThebasicpathologicalchangeisthebenignlymphadenosisThemaindamageisinmonocyte-macrophagesystemLymphnodes：non-pyogeniclymphadenectasiswithLCandmonocyte-macrophagesystemproliferationSpleen:lotsofatypicalLCLCinfiltrationandlimitednecroticlesionsinorganssuchasliver,heart,kidney,lung,CNS,etc.PathologyThebasicpathologica12ManifestationsTheincubationperiod：5~15days1.Fever(>90%)2.pharyngitis:

80%.sorethroat,tonsillarenlargement,hyperemia,

edema

andexudates（50%）3.generalizedlymphadenopathy：80~100%.

Themostcommonlymphadenopathyisenlargementofcervicallymphnodes4.splenohepatomegalia:hepatomegaly：30~50%.

Amongthem,2/3haselevatedliverenzymesJaundiceisuncommon.

Liverfailuremayoccurredinfewcases.splenomegaly：50~70%5.rashes：10%6.others：stuffnose,snore,edemaoftheeyelids,etcManifestationsTheincubationp13Thetonsilsarehyperemicandedematouscoveredwithgray-whiteexudates.Thetonsilsarehyperemicand14(儿科学英文课件)20传染性单核细胞增多症15ManifestationsTheincubationperiod：5~15days1.Fever(>90%)2.pharyngitis:

80%.sorethroat,tonsillarenlargement,hyperemia,

edema

andexudates（50%）3.generalizedlymphadenopathy：80~100%.

Themostcommonlymphadenopathyisenlargementofcervicallymphnodes4.splenohepatomegalia:hepatomegaly：30~50%.

Amongthem,2/3haselevatedliverenzymesJaundiceisuncommon.

Liverfailuremayoccurredinfewcases.splenomegaly：50~70%5.rashes：10%6.others：stuffnose,snore,edemaoftheeyelids,etcManifestationsTheincubationp16

cervicallymphnodes

17cervicallymphnodes

cervicallymphnodes

18ManifestationsTheincubationperiod：5~15days1.Fever(>90%)2.pharyngitis:

80%.sorethroat,tonsillarenlargement,hyperemia,

edema

andexudates（50%）3.generalizedlymphadenopathy：80~100%.

Themostcommonlymphadenopathyisenlargementofcervicallymphnodes4.splenohepatomegalia:hepatomegaly：30~50%.

Amongthem,2/3haselevatedliverenzymesJaundiceisuncommon.

Liverfailuremayoccurredinfewcases.splenomegaly：50~70%5.rashes：10%6.others：stuffnose,snore,edemaoftheeyelids,etcManifestationsTheincubationp19临床表现临床表现20(儿科学英文课件)20传染性单核细胞增多症21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期文献资料22病例学习患儿，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：T39.5℃P123次/分R30次/分神情神可，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，质中，咽充血明显，扁桃体Ⅱ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：WBC19.2*109/L,N0.23L0.58异型淋巴细胞

0.19。病例学习患儿，女，6岁,因”发热、咽痛6天，颈部包块4天”入23病例学习患儿，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。院外诊断“扁桃体炎”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：T39.5℃P123次/分R30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，质中，咽充血明显，扁桃体Ⅱ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：WBC19.2*109/L，N0.23，L0.58

异型淋巴细胞0.19。病例学习患儿，女，6岁,因“发热、咽痛6天，颈部包块4天”24Complicationsnervesystem：encephalitis,Guillain-Barrésyndrome,Reyesyndrome,Peripheralneuritis,etc.cardiovascularsystem：Myocarditis,pericarditishematologicalsystem：Hemolyticanemia,Aplasticanemia,thrombocytopenia,neutropenia,hemophagocyticsyndrome,etc.respiratorysystem：upperairwayobstruction,interstitialpneumonia,etc.urinarysystem：nephritis,nephroticsyndrome,etc.digestivesystem：gastrointestinalbleeding,liverfailure,etc.subcapsularsplenichemorrhageorsplenicruptureComplicationsnervesystem：ence25Labstudies1.bloodroutine：thereisleukocytosisof10–20×109/L,ofwhichatleast½arelymphocytes;atypicallymphocytesaccountfor≥10%relativelyor≥1.0×109/Labsolutelynotice:2.detectionofmarkersofEBVheterophilagglutinationtest

principlelimitationsdetectionofEBVAbs:EBV-VCAIgM3.detectionofnucleicacidofEBVbyPCR4.IsolationofEBVLabstudies1.bloodroutine：26atypicallymphocytesatypicallymphocytes27Labstudies1.bloodroutine：thereisleukocytosisof10–20×109/L,ofwhichatleast½arelymphocytes;atypicallymphocytesaccountfor≥10%relativelyor≥1.0×109/Labsolutelynotice:2.detectionofmarkersofEBVheterophilagglutinationtest

principlelimitationsdetectionofEBVAbs:EBV-VCAIgM3.detectionofnucleicacidofEBVbyPCR4.IsolationofEBVLabstudies1.bloodroutine：28heterophilagglutinationtestBeforetheadsorptionGuineapigkidneycellsafteradsorption

Cowredbloodcellsafteradsorption

IM++++++++—Serum

diseases+++——Normalorotherdiseases+—+heterophilagglutinationtest29Diagnosis1.IMtriadFever,pharyngitisandenlargementofcervicallymphnodes2.atypicallymphocytesaccountfor≥10%relativelyor≥1.0×109/Labsolutely3.heterophilagglutinationtestor/andEBV-VCAIgM(+)Diagnosis1.IMtriad30DifferentialDiagnosis1.suppurativetonsillitis2.infectiousmononucleosis-likesyndrom3.viralhepatitis4.Kawasakidisease5.LeukemiaDifferentialDiagnosis1.sup31Treatment1.generaltreatment2.symptomatictreatment3.antiviraltherapy：α-interferon、Acyclovir

Ganciclovir4.theuseofglucocorticoid：indicatorTreatment1.generaltreatment32Prognosis1.mostgoodprognosis2.fewpatientsprolongedcourse3.<1%ofpatientsdiePrognosis1.mostgoodprognosis33谢谢！谢谢！34InfectiousMononucleosis(IM)

monoHuangYanfeng,associateprofessorDIVISIONOFINFECTIOUSDISEASEOFCHONGQINGMEDICALUNIVERSITY

InfectiousMononucleosis(IM)

35IntroductionInfectiousmononucleosis(IM)isaninfectiousdiseasecausedbyEpstein-Barrvirus(EBV).Theclinicalfeaturesincludefever,pharyngitis,andgeneralizedlymphadenopathy.Thecharacteristicsoflabstudyisatypicallymphocytosisintheperipheralblood.

IntroductionInfectiousmononuc36EBVassociateddisease

TheupperrespiratorytractinfectionInfectiousmononucleosis(IM)EBVirus-associatedhemophagocyticlymphohistiocytosis(EBV-HLH)ChronicactiveEBVinfectionEBVirus-associatedmalignanttumor(Burkittlymphoma、Bcelllymphoma、Hodgkin'sdisease,nasopharyngealcarcinoma)EBVassociateddiseaseTheupp37(儿科学英文课件)20传染性单核细胞增多症38(儿科学英文课件)20传染性单核细胞增多症39Etiology3、ViralAntigenSystemsviralcapsidantigen,VCAEBnuclearantigen,EBNAearlyantigen,EAlymphocyte-detectedmembraneantigen,LYDMAmembraneantigen,MAEtiology3、ViralAntigenSystem40Epidemiology1.Infectioussources

Patients,personswithlatentinfectionandcarriers2.Routesoftransmission：Contacttransmissionthroughthemouth(exchangeofsaliva)bloodtransmissionoccasionally

3.PopulationsusceptibilitySchoolagechildrenandadolescents

4.EpidemiologicalfeaturesPeakseasonsEpidemiologicalstatusEpidemiology1.Infectioussour41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%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42重庆医科大学感染消化教研室重庆医科大学感染消化教研室43Epidemiology1.Infectioussources

Patients,personswithlatentinfectionandcarriers2.Routesoftransmission：Contacttransmissionthroughthemouth(exchangeofsaliva)bloodtransmissionoccasionally

3.PopulationsusceptibilitySchoolagechildrenandadolescents

4.EpidemiologicalfeaturesPeakseasonsEpidemiologicalstatusEpidemiology1.Infectioussour44PathogenesisEBVsalivaryglands

infectsoralepithelialcellsandB-LCinpharynx

pharyngitisLymphadenopathyincervicalnodesexcreteEBVContinuouslyorintermittently

B-LCintheperipheralbloodandtheentirelymphoreticularsystem

viremia

ActivationofpolyclonalB-LC

polyclonalantibodiesSpecificAbsheterophilAbautoantibodyTcresponsedtotheinfectedB-LCEffectonB-LCcontainingEBVatypicalLC↑Hepatosplenomegaly,lymphadenectasis,myocarditis,pneumonia,etc.ChangesofantigenicityonthesurfaceofB-LC

TCLPathogenesisEBVsalivarygland45PathologyThebasicpathologicalchangeisthebenignlymphadenosisThemaindamageisinmonocyte-macrophagesystemLymphnodes：non-pyogeniclymphadenectasiswithLCandmonocyte-macrophagesystemproliferationSpleen:lotsofatypicalLCLCinfiltrationandlimitednecroticlesionsinorganssuchasliver,heart,kidney,lung,CNS,etc.PathologyThebasicpathologica46ManifestationsTheincubationperiod：5~15days1.Fever(>90%)2.pharyngitis:

80%.sorethroat,tonsillarenlargement,hyperemia,

edema

andexudates（50%）3.generalizedlymphadenopathy：80~100%.

Themostcommonlymphadenopathyisenlargementofcervicallymphnodes4.splenohepatomegalia:hepatomegaly：30~50%.

Amongthem,2/3haselevatedliverenzymesJaundiceisuncommon.

Liverfailuremayoccurredinfewcases.splenomegaly：50~70%5.rashes：10%6.others：stuffnose,snore,edemaoftheeyelids,etcManifestationsTheincubationp47Thetonsilsarehyperemicandedematouscoveredwithgray-whiteexudates.Thetonsilsarehyperemicand48(儿科学英文课件)20传染性单核细胞增多症49ManifestationsTheincubationperiod：5~15days1.Fever(>90%)2.pharyngitis:

80%.sorethroat,tonsillarenlargement,hyperemia,

edema

andexudates（50%）3.generalizedlymphadenopathy：80~100%.

Themostcommonlymphadenopathyisenlargementofcervicallymphnodes4.splenohepatomegalia:hepatomegaly：30~50%.

Amongthem,2/3haselevatedliverenzymesJaundiceisuncommon.

Liverfailuremayoccurredinfewcases.splenomegaly：50~70%5.rashes：10%6.others：stuffnose,snore,edemaoftheeyelids,etcManifestationsTheincubationp50

cervicallymphnodes

51cervicallymphnodes

cervicallymphnodes

52ManifestationsTheincubationperiod：5~15days1.Fever(>90%)2.pharyngitis:

80%.sorethroat,tonsillarenlargement,hyperemia,

edema

andexudates（50%）3.generalizedlymphadenopathy：80~100%.

Themostcommonlymphadenopathyisenlargementofcervicallymphnodes4.splenohepatomegalia:hepatomegaly：30~50%.

Amongthem,2/3haselevatedliverenzymesJaundiceisuncommon.

Liverfailuremayoccurredinfewcases.splenomegaly：50~70%5.rashes：10%6.others：stuffnose,snore,edemaoftheeyelids,etcManifestationsTheincubationp53临床表现临床表现54(儿科学英文课件)20传染性单核细胞增多症55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期文献资料56病例学习患儿，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：T39.5℃P123次/分R30次/分神情神可，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，质中，咽充血明显，扁桃体Ⅱ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：WBC19.2*109/L,N0.23L0.58异型淋巴细胞

0.19。病例学习患儿，女，6岁,因”发热、咽痛6天，颈部包块4天”入57病例学习患儿，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。院外诊断“扁桃体炎”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：T39.5℃P123次/分R30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，质中，咽充血明显，扁桃体Ⅱ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：WBC19.2*109/L，N0.23，L0.58

异型淋巴细胞0.19。病例学习患儿，女，6岁,因“发热、咽痛6天，颈部包块4天”58Complicationsnervesystem：encephalitis,Guillain-Barrésyndrome,Reyesyndrome,Peripheralneuritis,etc.cardiovascularsystem：Myocarditis,pericarditishematologicalsystem：Hemolyticanemia,Aplasticanemia,thrombocytopenia,neutropenia,hemophagocyticsyndrome,etc.respiratorysystem：upperairwayobstruction,interstitialpneumonia,etc.urinarysystem：nephritis,nephroticsyndrome,etc.digestivesystem：gastrointestinalbleeding,liverfailure,etc.subcapsularsplenichemorrhageorsplenicruptureComplicationsnervesystem：ence59Labstudies1.bloodroutine：thereisleukocytosisof10–20×109/L,ofwhichatleast½arelymphocytes;atypicallymphocytesaccountfor≥10%relativelyor≥1.0×109/Labsolutelynotic