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(兒科學英文課件)20傳染性單核細胞增多癥4(兒科學英文課件)20傳染性單核細胞增多癥5Etiology3、ViralAntigenSystemsviralcapsidantigen,VCAEBnuclearantigen,EBNAearlyantigen,EAlymphocyte-detectedmembraneantigen,LYDMAmembraneantigen,MAEtiology3、ViralAntigenSystem6Epidemiology1.Infectioussources

Patients,personswithlatentinfectionandcarriers2.Routesoftransmission：Contacttransmissionthroughthemouth(exchangeofsaliva)bloodtransmissionoccasionally

3.PopulationsusceptibilitySchoolagechildrenandadolescents

4.EpidemiologicalfeaturesPeakseasonsEpidemiologicalstatusEpidemiology1.Infectioussour7傳染性單核細胞增多癥及其相關疾病臨床特點分析,中國實用兒科雜志,2003年12月第18卷12期兒童傳染性單核細胞增多癥臨床特點與發病年齡的關系附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，占74.4%，6-15歲80例，占25.6%傳染性單核細胞增多癥及其相關疾病臨床特點分析,中國實用兒科雜8重慶醫科大學感染消化教研室重慶醫科大學感染消化教研室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(兒科學英文課件)20傳染性單核細胞增多癥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臨床表現臨床表現20(兒科學英文課件)20傳染性單核細胞增多癥21文獻資料傳染性單核細胞增多癥及其相關疾病臨床特點分析,中國實用兒科雜志,2006年9月第21卷9期文獻資料22病例學習患兒，女，6歲,因”發熱、咽痛6天，頸部包塊4天”入院。6天前開始發熱,體溫可達39.8℃，無畏寒，寒戰，訴咽痛，吞咽時明顯。2天后家人發現頸部包塊，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，無明顯好轉。無類似病人接觸史。查體：T39.5℃P123次/分R30次/分神情神可，熱病容，全身未見皮疹，眼瞼浮腫，雙側頸部各有3-4個腫大的淋巴結，最大者直徑約2cm，質中，咽充血明顯，扁桃體Ⅱ度腫大，可見白色滲出物附著，心肺聽診無異常，腹軟，肝臟肋下2cm,脾臟肋下2cm，質地中，邊鈍。門診血常規：WBC19.2*109/L,N0.23L0.58異型淋巴細胞

0.19。病例學習患兒，女，6歲,因”發熱、咽痛6天，頸部包塊4天”入23病例學習患兒，女，6歲,因“發熱、咽痛6天，頸部包塊4天”入院。6天前開始發熱,體溫可達39.8℃，無畏寒，寒戰，訴咽痛，吞咽時明顯。2天后家人發現頸部包塊，不伴疼痛。輕咳，鼻阻明顯，打鼾。精神食欲尚可。院外診斷“扁桃體炎”予頭孢菌素（不詳）治療4天，無明顯好轉。無類似病人接觸史。查體：T39.5℃P123次/分R30次/分，神清神可，熱病容，全身未見皮疹，眼瞼浮腫，雙側頸部各有3-4個腫大的淋巴結，最大者直徑約2cm，質中，咽充血明顯，扁桃體Ⅱ度腫大，可見白色滲出物附著，心肺聽診無異常，腹軟，肝臟肋下2cm，脾臟肋下2cm，質地中，邊鈍。門診血常規：WBC19.2*109/L，N0.23，L0.58

異型淋巴細胞0.19。病例學習患兒，女，6歲,因“發熱、咽痛6天，頸部包塊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,ofwhichatleast?arelymphocytes;atypicallymphocytesaccountfor≥10%relativelyor≥1.0×109/Labsolutelynotice:2.detectionofmarkersofEBVheterophilagglutinationtest

principlelimitationsdetectionofEBVAbs:EBV-VCAIgM3.detectionofnucleicacidofEBVbyPCR4.IsolationofEBVLabstudies1.bloodroutine：26atypicallymphocytesatypicallymphocytes27Labstudies1.bloodroutine：thereisleukocytosisof10–20×109/L,ofwhichatleast?arelymphocytes;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謝謝！謝謝！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(兒科學英文課件)20傳染性單核細胞增多癥38(兒科學英文課件)20傳染性單核細胞增多癥39Etiology3、ViralAntigenSystemsviralcapsidantigen,VCAEBnuclearantigen,EBNAearlyantigen,EAlymphocyte-detectedmembraneantigen,LYDMAmembraneantigen,MAEtiology3、ViralAntigenSystem40Epidemiology1.Infectioussources

Patients,personswithlatentinfectionandcarriers2.Routesoftransmission：Contacttransmissionthroughthemouth(exchangeofsaliva)bloodtransmissionoccasionally

3.PopulationsusceptibilitySchoolagechildrenandadolescents

4.EpidemiologicalfeaturesPeakseasonsEpidemiologicalstatusEpidemiology1.Infectioussour41傳染性單核細胞增多癥及其相關疾病臨床特點分析,中國實用兒科雜志,2003年12月第18卷12期兒童傳染性單核細胞增多癥臨床特點與發病年齡的關系附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，占74.4%，6-15歲80例，占25.6%傳染性單核細胞增多癥及其相關疾病臨床特點分析,中國實用兒科雜42重慶醫科大學感染消化教研室重慶醫科大學感染消化教研室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(兒科學英文課件)20傳染性單核細胞增多癥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臨床表現臨床表現54(兒科學英文課件)20傳染性單核細胞增多癥55文獻資料傳染性單核細胞增多癥及其相關疾病臨床特點分析,中國實用兒科雜志,2006年9月第21卷9期文獻資料56病例學習患兒，女，6歲,因”發熱、咽痛6天，頸部包塊4天”入院。6天前開始發熱,體溫可達39.8℃，無畏寒，寒戰，訴咽痛，吞咽時明顯。2天后家人發現頸部包塊，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，無明顯好轉。無類似病人接觸史。查體：T39.5℃P123次/分R30次/分神情神可，熱病容，全身未見皮疹，眼瞼浮腫，雙側頸部各有3-4個腫大的淋巴結，最大者直徑約2cm，質中，咽充血明顯，扁桃體Ⅱ度腫大，可見白色滲出物附著，心肺聽診無異常，腹軟，肝臟肋下2cm,脾臟肋下2cm，質地中，邊鈍。門診血常規：WBC19.2*109/L,N0.23L0.58異型淋巴細胞

0.19。病例學習患兒，女，6歲,因”發熱、咽痛6天，頸部包塊4天”入57病例學習患兒，女，6歲,因“發熱、咽痛6天，頸部包塊4天”入院。6天前開始發熱,體溫可達39.8℃，無畏寒，寒戰，訴咽痛，吞咽時明顯。2天后家人發現頸部包塊，不伴疼痛。輕咳，鼻阻明顯，打鼾。精神食欲尚可。院外診斷“扁桃體炎”予頭孢菌素（不詳）治療4天，無明顯好轉。無類似病人接觸史。查體：T39.5℃P123次/分R30次/分，神清神可，熱病容，全身未見皮疹，眼瞼浮腫，雙側頸部各有3-4個腫大的淋巴結，最大者直徑約2cm，質中，咽充血明顯，扁桃體Ⅱ度腫大，可見白色滲出物附著，心肺聽診無異常，腹軟，肝臟肋下2cm，脾臟肋下2cm，質地中，邊鈍。門診血常規：WBC19.2*109/L，N0.23，L0.58

異型淋巴細胞0.19。病例學習患兒，女，6歲,因“發熱、咽痛6天，頸部包塊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,ofwhichatleast?arelymphocytes;atypicallymphocytesaccountfor≥10%relativelyor≥1.0×109/Labsolutelynotic