Mononucleosis treatment in children. Infectious mononucleosis in children

Infectious mononucleosis in children is a viral disease with a primary lesion of the organs of the reticuloendothelial system (including the spleen and liver), generalized lymphadenopathy and changes in white blood cells (lymphocytes). The disease has been known since the 19th century. The second name of the infection is "Filatov's disease", named after the doctor who first described it.

Cause and prevalence of the disease

It has been established that infectious mononucleosis in children is caused by the herpetic virus type 4 (its other name is the Epstein-Barr virus). Once entering the body, the virus remains in it forever. This does not depend on whether Clinical signs mononucleosis in children after infection or an infected child became an asymptomatic virus carrier.

It has been established that among children under 5 years old, every second child is infected with the Epstein-Barr virus. And the infection rate of the adult population is about 90%.

At rest, the virus is located in the lymph nodes, and with a decrease in immunity under the influence of any adverse factors, the virus is activated and causes a relapse of the disease.

Outside the body, the virus is not stable, quickly dies, it cannot be called highly contagious. Therefore, for infection, close enough contact with a sick person or a virus carrier, which is the source of a viral infection, is necessary.

Infectious mononucleosis in children often occurs before 10 years of age. the incidence is higher in the autumn-winter-spring period. Girls get sick at 2 p. less than boys.

The isolation of the virus occurs with droplets of saliva or nasopharyngeal secretions. The infection is spread by airborne droplets when sneezing, coughing, kissing. Infection through the used common utensils is possible. Once in the oropharynx, the virus infects epithelial cells, penetrates into the bloodstream and enters the lymph nodes.

Is quarantine necessary?

When a patient with infectious mononucleosis appears in the family (adult or child), it is quite difficult to avoid infection to other people. This is due to the fact that those who have been ill, even after recovery, remain forever virus carriers, and can periodically secrete into environment virus. Therefore, there is no point in isolating the child, he can attend school or kindergarten after recovery.

Symptoms

With mononucleosis in a child, the incubation period lasts more often than 5-15 days (but can last up to 3 months). Just up to 3 months. you should carefully monitor the condition of the child if the fact of his contact with a patient with mononucleosis has become known. The absence of signs of infection during this period may mean that there was no infection, or an asymptomatic form of the disease occurred.

Symptoms of mononucleosis in children at the beginning of the disease reflect the general intoxication of the body in combination with catarrhal manifestations.

These include:

• general weakness;
• nasal congestion,
• fever;
• sore throat;
• redness and enlargement of the tonsils.

Then, against the background of intoxication, the main clinical manifestations mononucleosis:

• rashes on the skin;
• damage to the tonsils of the peripharyngeal ring;
• enlarged lymph nodes;
• enlarged spleen and liver.

The nature of the fever and its duration depend on the individual characteristics of the organism. It can be subfebrile (within 37.5 0 С), but it can also reach high numbers (up to 39 0 С). The fever period can last for several days, and can last up to 6 weeks.

Rashes on the body often appear simultaneously with the onset of fever and swollen lymph nodes.

The rash spreads throughout the body. By nature, the rash is small-spotted, reddish in color, without itching. The appearance of itching may indicate an allergic nature of the rash. The rash disappears on its own, without treatment, as the child recovers.

An important symptom for diagnosis is an increase in all groups of lymph nodes, especially the cervical ones. When probing, the lymph nodes are sensitive, but there is no particular pain. Lymph nodes are enlarged on both sides. They are mobile, not soldered to the skin.

In some cases, enlarged lymph nodes in abdominal cavity cause pain in the abdomen due to compression of the nerves, and a symptom complex develops, called " acute abdomen". In some cases, children even end up on the operating table for a diagnostic laparotomy.

A constant symptom of mononucleosis is the defeat of the tonsils.. They are enlarged, loose, bumpy. On the surface of the tonsils, against the background of redness, plaques (islands or films) of a whitish-yellow or grayish color are formed, which are easily removed with a spatula. The mucosa does not bleed after removal.

Equally important symptoms of mononucleosis are enlarged liver and spleen. At the same time, unpleasant sensations are noted in the left hypochondrium, pain when feeling the abdomen to determine the size of the spleen.

The size of the spleen and liver continues to increase continuously during 2-4 weeks of the disease, but may remain enlarged after the child feels better and clinically recovers. After the disappearance of fever, the liver and spleen gradually return to normal in size.

In a severe case, the spleen capsule cannot withstand stress when the organ is enlarged and ruptures, which is a severe complication of the disease.

When the spleen ruptures, the following symptoms appear:

• nausea;
• darkening in the eyes;
• dizziness;
• vomit;
• severe weakness;
• increasing diffuse pain in the abdomen.

In addition to the typical development and manifestations of the disease, atypical forms of mononucleosis may occur:

1. With atypical mononucleosis in children, the signs of the disease may be more pronounced than usual, or, conversely, some signs are completely absent (for example, temperature). Atypical forms often cause severe complications and consequences of the disease in children.
2. One of the atypical forms is fulminant, in which the manifestations of the disease, the symptoms of intoxication appear suddenly and grow rapidly over several days. There is a high fever with chills, headache, severe weakness, muscle pain, sore throat.
3. Chronic mononucleosis with periodic relapses develops with a decrease in immunity in a child.

The diagnosis is established with the following data:

• transferred within the last 6 months. primary mononucleosis, confirmed by high titers of specific antiviral antibodies;
• detection of Epstein-Barr virus particles in affected tissues using an immunofluorescent method;
• characteristic manifestations of the disease (enlargement of the spleen, persistent hepatitis, generalized enlargement of the lymph nodes).

Diagnosis of mononucleosis

The key features for the clinical diagnosis of mononucleosis are lymph node hyperplasia, spleen and liver, fever. Diagnosis of mononucleosis is quite difficult. It is necessary to exclude a number of other serious diseases with similar symptoms (leukemia, lymphogranulomatosis, bacterial tonsillitis, diphtheria, viral hepatitis).

For the differential diagnosis of the manifestations of tonsillitis in mononucleosis from bacterial tonsillitis, laboratory research throat swab for pathogenic flora (by bacteriological and bacterioscopic examination) and for diphtheria.

Important hematological changes in the clinical study of blood. Confirmation of mononucleosis is the detection of more than 10% of atypical mononuclear cells in the blood. But they appear only at 2-3 weeks of illness.

In some cases, it is necessary to consult a hematologist and analyze a sternal puncture to exclude blood diseases (leukemia, lymphogranulomatosis). A blood test for HIV is also carried out, since it can also provoke the appearance of mononuclear cells in the peripheral blood.

A serological blood test helps to clarify the diagnosis to determine the titer of class M antibodies (in early dates) and class G (in a later period). to the Epstein-Barr virus in dynamics.

Accurate and highly sensitive (and fast) is the detection of Epstein-Barr virus using PCR.

Biochemical blood test, linked immunosorbent assay blood for antibodies to hepatitis viruses, ultrasound will help to exclude viral hepatitis.

How to treat mononucleosis in children?

In infectious mononucleosis in children, the symptoms and their treatment depend on the severity. More often, the treatment of infectious mononucleosis in children is carried out at home. Only children with a severe form of the disease are hospitalized.

Indications for hospitalization are:

• high fever;
• pronounced intoxication syndrome;
• risk of developing complications.

Antiviral drugs (Acyclovir, Cycloferon, Interferon, Viferon) do not have a pronounced therapeutic effect, do not affect the severity and duration of the disease. No tangible therapeutic effect and from the use of immunomodulators (IRS 19, Imudon, etc.).

Symptomatic treatment is carried out:

1. Antipyretic drugs: NSAIDs are more often used, which will not only lower the temperature, but also have an anti-inflammatory effect (Paracetamol, Ibuprofen, Nurofen).
2. Antibiotics to treat sore throat or an associated bacterial infection. It is better to use macrolides or cephalosporins, since antibiotics penicillin series with mononucleosis cause in 70% of cases. allergic reactions.
3. During antibiotic therapy, probiotics and prebiotics are prescribed simultaneously to prevent the development of dysbacteriosis (Acipol, Lactobacterin, Bifiform, Narine, etc.).
4. Desensitizing drugs that relieve the body's allergic mood (Loratadin, Tavegil, Diazolin).
5. In severe mononucleosis, hypertoxic forms, a short course of treatment with corticosteroids (Prednisolone for 5-7 days) is carried out.
6. With severe intoxication, with the development of hepatitis, detoxification therapy is carried out - the introduction of solutions in the form of intravenous infusions.
7. Hepatoprotectors (Essentiale forte, Enerliv, Geparsil) are used in the development of hepatitis. Diet No. 5 is prescribed (exclusion of spicy, fried, fatty foods, rich broths, smoked, seasonings and gravy, sauces, pickles, canned foods, fresh pastries, drinks with gas).
8. Vitamin therapy (C, PP, group B).

In case of a threat of asphyxia and laryngeal edema, a tracheotomy is performed, transfer to mechanical ventilation. A ruptured spleen requires emergency surgical treatment(splenectomy).

Forecast and outcome

With timely treatment and examination to exclude blood diseases (leukemia), the outcome of mononucleosis in children is favorable. But children need follow-up and control of blood tests.

Possible consequences after mononucleosis in children:

1. long subfebrile temperature(JPY 37.5 0 C) within a few weeks.
2. Lymph nodes normalize in size within a month.
3. Weakness and increased fatigue can be observed up to six months.

Children who have been ill need to be observed by a pediatrician or infectious disease specialist for 6-12 months. with obligatory blood test control.

Complications from mononucleosis are rare.

The most frequent of them are:

• hepatitis (inflammation of the liver), which, in addition to an increase in the size of the liver, is characterized by the appearance of icteric staining of the skin and mucous membranes, dark urine, increased activity liver enzymes in a blood test;
• rupture of the spleen (develops in 1 case out of a thousand) is dangerous for internal bleeding, which can be fatal;
• serous meningoencephalitis (inflammation of the substance of the brain with membranes);
• asphyxia due to severe laryngeal edema;
• interstitial pneumonia (pneumonia).

There is evidence of a tendency after mononucleosis to develop oncopathology (lymphomas), but these are quite rare diseases that develop when the immune system is disturbed.

Specific prevention of mononucleosis has not been developed.

Infectious mononucleosis often occurs in mild form which is not always diagnosed. In moderate and severe cases, a thorough examination of the child (including a mandatory consultation with a hematologist) and long-term follow-up by a doctor after the disease is required in order not to miss the development of complications and long-term consequences.

Found out in 1887. The description of febrile pathology in children was compiled by the Russian scientist N. F. Filatov. And to this day, interest in Filatov's disease does not fade away.

What it is?

For a long time, especially in Russian medical practice, infectious mononucleosis was called Filatov's disease. This zemstvo doctor drew attention to the fact that many babies have similar clinical signs: an increase in peripheral lymph nodes, frequent headaches or dizziness, pain in the joints and muscles when walking. Filatov called this condition glandular fever.

At present, science has stepped far forward. With the help of various diagnostic tests and high-precision devices, scientists have received modern knowledge about what causes the disease. IN medical world a decision was made to change the name of the disease. Now it is simply called infectious mononucleosis.

There is a reliable hypothesis that the disease has a viral cause. Viruses lead to the development of this pathology. This leads to the fact that a person with infectious mononucleosis is potentially dangerous and contagious to others. During the entire acute period of the disease, he can infect other people with the infection.

Most often, this infectious pathology occurs in young people, as well as in babies. Scientists note that sporadic cases can occur. Large and massive outbreaks of infectious mononucleosis are extremely rare. Basically, all epidemics associated with this disease occur during the cold season. Peak incidence - autumn.

Usually, viruses that enter the mucous membranes settle in the body and start inflammatory process. Their favorite primary site is the epithelial cells lining outer surface nasal passages and oral cavity. Over time, pathogenic microbes penetrate the lymph and rapidly spread throughout the body along with the bloodstream.

In a child, all processes in the body proceed rapidly. This feature is due to the features physiological structure child's body.

The baby needs fast processes for active growth and development. The blood flow in babies is quite rapid. Pathogenic viruses, entering the body, usually spread within a few hours or days and activate the inflammatory infectious process.

Infectious mononucleosis can be dangerous. The disease is characterized by the development of long-term complications or adverse effects. Some babies, especially those with frequent illnesses or immunodeficiencies, are at risk for a more severe course. It is impossible to predict how the disease will develop in a particular child. To prevent potential long-term consequences of the disease, the baby must be closely monitored throughout the acute period of the disease and during recovery.

Causes

The herpetic virus leads to the development of the disease. It has its own name - Epstein - Barr. The favorite localization for exerting its destructive effect on these viruses is the lymphoid-reticular tissue. They actively affect the lymph nodes and spleen. Penetrating into the body, viruses can also cause damage to internal organs.

Infection with pathogenic microbes can be in different ways:

• Contact household. Most often, babies become infected when they violate the rules of personal hygiene. Other people's dishes, especially those that are not well processed and pre-cleaned, can become a source of infection. The smallest components of the saliva of a sick person can remain on a plate or mug for quite a long time. Violating the rules of hygiene and eating from the same dishes with an infected person, you can easily become infected.
• Airborne. A fairly common variant of the transmission of viruses from a sick child to a healthy one. Viruses are the smallest microorganisms. They easily enter a healthy body from the carrier through the air. Usually infection occurs during a conversation, as well as when sneezing.

• Parenteral. In pediatric practice, this variant of infection is extremely rare. It is more typical for adults. Infection in this case is possible during various surgical operations or during blood transfusion. Violation of safety precautions of medical manipulations leads to infection.
• Transplacentally. In this case, the source of infection for the baby is the mother. The child becomes infected from it even in utero. During pregnancy, an infected mother can pass viruses that can cross the placenta to her baby. If a pregnant woman has various anomalies and pathologies associated with placental insufficiency, then the risk of infection of the baby with infectious mononucleosis increases several times.

The development of this disease contributes to a strong decrease in immunity. This usually happens after frequent colds or as a result of exposure to severe psycho-emotional stress.

Severe hypothermia also significantly reduces the functioning of the immune system. The baby's body becomes very sensitive to the penetration of any pathogens, including herpes Epstein-Barr viruses.

Usually, clinical signs of the disease appear in babies older than one year. In infants, this infectious pathology is extremely rare. This feature is due to the presence of specific passive immunoglobulins. They protect the children's body from various infections, including dangerous herpes viruses. Babies receive these protective immunoglobulins from their mother with mother's milk during breastfeeding.

Many parents ask questions about whether a child can get infectious mononucleosis several times in a lifetime. Opinions of scientists and doctors are divided. Some experts believe that after the illness, the baby develops strong immunity. Their opponents say that herpes viruses cannot be cured. Microbes remain in the child's body and can remain there throughout life, and with a decrease in immunity, the disease may return again.

How many days is the incubation period of the disease? Usually it is from 4 days to one month. At this time, the child is practically not bothered by anything. Some very attentive parents will be able to notice small changes in the behavior of the baby. During the incubation period, the child may experience some slowness and distraction of attention, sometimes sleep is disturbed. However, these signs are so dimly manifested that they do not cause any concern in dads and moms.

Classification

There are various clinical variants of the disease. This led to the creation of a separate classification of infectious mononucleosis. It indicates all the main clinical variants of the disease, and also describes the pathological symptoms that have developed in the child.

Doctors distinguish several forms of infectious mononucleosis:

• Manifesto. Usually occurs with the development of various adverse symptoms. It shows up quite clearly. To eliminate adverse symptoms, special treatment is required.
• Subclinical. Some scientists also call this form a carrier. In this case, adverse symptoms of the disease do not appear. A child may be a carrier of infectious mononucleosis without even knowing it. Usually, it is possible to detect the disease in this situation only after the use of special diagnostic tests.

Depending on the severity of the manifestation of symptoms, several types of the disease are distinguished:

• Easy or uncomplicated. Some experts call it also smooth. This clinical variant proceeds in a relatively mild form. It is not characterized by the appearance of complications. Usually, properly selected treatment is enough for the baby to recover.
• Complicated. In this case, the child may develop dangerous consequences diseases. For their treatment, mandatory hospitalization of the baby in the hospital is required. Therapy in this case is complex with the appointment of various groups medicines.
• Protracted. It is characterized by a persistent and long-lasting course. This clinical variant usually responds poorly to drug therapy.

Symptoms

The development of infectious mononucleosis is usually gradual. One clinical stage successively replaces another. Typically, this course occurs in most sick babies. Only in some cases, a rapid acute development of the disease with the development of numerous complications is possible.

The very first period of the disease is the initial one. On average, it lasts 1-1.5 months. Most clinical cases are accompanied by an increase in body temperature up to 39.5-40 degrees. The severity of the condition causes the appearance of a headache. It can be of different intensity: from moderate to unbearable. Against the background of high fever and headache, the child develops severe nausea and even a single vomiting occurs.

In the acute period of the disease, the baby feels extremely ill. He develops severe pain in the joints and muscle weakness. He gets tired very quickly. Even everyday activities familiar to the baby lead to his fatigue. The child does not eat well, refuses his favorite treats. The presence of severe nausea also aggravates the loss of appetite.

These signs are easy to identify and independently. Their appearance causes a real shock in mothers. Don't panic! If adverse symptoms of the disease appear, be sure to call a doctor. Do not take your child to the clinic. The serious condition of the baby requires a consultation with a specialist at home.

In some cases, children have less severe symptoms. In this case, the body temperature does not increase so rapidly. Usually it rises to subfebrile or febrile numbers in a few days. Typical symptoms during this period: general malaise, severe weakness, congestion and impaired nasal breathing, swelling of the eyelids, as well as some swelling and puffiness of the face.

In 10% of babies, the disease can begin with the appearance of three characteristic symptoms at once. These include: an increase in temperature to febrile numbers, defeat lymph nodes and signs of acute tonsillitis. This course is usually quite severe.

The duration of the initial period of the disease is usually from 4 days to a week.

The next stage of the disease is the peak time. Usually the peak occurs a week after the onset of the first adverse symptoms. The general well-being of the child by this time is noticeably deteriorating. He also has a fever. An extremely specific symptom at this time is mononucleosis angina.

The mononuclear form of acute tonsillitis (tonsillitis) is quite difficult. It is accompanied by the appearance of numerous symptoms in the throat. Usually angina proceeds in a catarrhal form. Tonsils become bright red, hyperemic. In some cases, they appear plaque. It is usually white or with a gray tint. More often, the overlays on the tonsils are rather loose and are relatively well removed with a spatula or an ordinary spoon.

The duration of acute tonsillitis in infectious mononucleosis usually does not exceed 10-14 days. Over time, the tonsils are cleared of plaque and all adverse signs of the disease disappear.

The course of the height of the disease is often accompanied by severe symptoms of intoxication. The child has a severe or moderate headache, reduced appetite, disturbed sleep. A sick baby becomes more capricious. The child has sleep disturbance. Usually sick babies sleep longer in daytime, and at night experience significant problems with falling asleep.

One of the characteristic signs of the height of the disease is the appearance of symptoms of lymphadenopathy. Usually, the nearest peripheral lymphatic collectors are involved in this inflammatory process. With this disease, it cervical lymph nodes. They increase in size several times. Sometimes the swollen lymph nodes are the size of a walnut.

When palpated, they are quite painful and mobile. Any movement of the head and neck leads to increased pain. Overheating of the lymph nodes in the acute period of the disease is unacceptable! The imposition of warm compresses on the neck can only aggravate the course of the disease and contribute to the development of dangerous complications.

Cervical lymphadenopathy in infectious mononucleosis is usually symmetrical. This is easy to see from the naked eye as well. changing appearance baby. Severe swelling of the subcutaneous fat surrounding the inflamed lymph nodes leads to the development of a "bull's neck" in the child. This symptom is associated with a violation of the general configuration of the neck and is unfavorable.

By the end of 12-14 days from the onset of the disease, the child has clinical signs of involvement in the inflammatory process of the spleen. This is manifested by an increase in its size. Doctors call this condition splenomegaly. With an uncomplicated course of the disease, the size of the spleen completely returns to normal by the end of the third week from the onset of the disease.

Also, by the end of the second week, the baby shows signs of liver damage. Hepatitis is manifested by an increase in the size of this organ. Visually, this is manifested by the appearance of yellowing of the skin - jaundice develops. In some babies, the sclera of the eyes also turn yellow. Usually this symptom is transient and disappears by the end of the peak period of the disease.

On the 5-7th day from the moment of the onset of the disease, children have another feature- rash. It occurs in about 6% of cases. The rash is maculopapular. There is no clear localization of the occurrence of skin rashes. They can appear almost all over the body. Loose elements do not itch and practically do not bring any anxiety to the child.

The rash usually goes away on its own. Skin elements disappear consistently and do not leave any traces of hyper- or depigmentation on the skin. After the rash disappears, the baby's skin becomes the usual physiological color and is not changed in any way. There is also no residual peeling on the skin. By the end of the peak period, the baby begins to feel much better.

By the end of the second week of the disease, nasal congestion disappears and breathing normalizes, elevated body temperature decreases, and swelling of the face also disappears. On average, the total duration of this period of the disease is 2-3 weeks. This time can be different and depends on the initial state of the baby.

Babies with multiple chronic diseases internal organs, tolerate the peak period much worse. They may have more than a month.

The final period of the disease is convalescence. This time is characterized by the complete completion of the disease and the disappearance of all adverse symptoms. In babies, body temperature normalizes, plaque on the tonsils completely disappears, and the normal size of the cervical lymph nodes is restored. The child feels much better at this time: appetite returns and weakness decreases. The baby is starting to get better.

Usually enough time is required for the complete disappearance of all symptoms. So, the period of convalescence in babies is usually 3-4 weeks. After that comes recovery. Some children who recover from infectious mononucleosis may have residual symptoms for a longer time. During this period, it is very important to carry out regular medical monitoring of the well-being of the baby so that the disease does not turn into a protracted form.

Diagnostics

When the first signs of the disease appear, be sure to show the baby to the doctor. The doctor will conduct the necessary clinical examination, during which he will definitely examine the inflamed neck, feel the lymph nodes, and will also be able to determine the size of the liver and spleen. After such an examination, the pediatrician usually prescribes several additional laboratory tests to further clarify the diagnosis.

To determine the source of the disease, doctors resort to a blood test to determine specific immunoglobulins of class M and G to the Aptation-Barr virus. This simple test distinguishes mononuclear angina from another viral or bacterial angina. This analysis- highly sensitive and in most cases gives a real idea of ​​whether there is a virus in the blood.

To establish functional disorders arising in the internal organs, it is required to carry out biochemical research blood. If a child has signs of mononucleosis hepatitis, then liver transaminases and bilirubin levels will be increased in the blood. General analysis blood will help to identify all deviations from the norm that occur during viral diseases. The severity of these changes may vary.

In the general analysis of the blood, the total number of leukocytes, monocytes, and lymphocytes increases. Accelerated ESR indicates the presence of a pronounced inflammatory process. A change in the leukocyte formula indicates the presence of a viral infection in the body. At different stages of the development of the disease in the general blood test, various pathological changes that change with the course of the disease.

A characteristic feature is the appearance in the analysis of specific cells - atypical mononuclear cells. They have a large cytoplasm inside. If their number exceeds 10%, then this indicates the presence of the disease. Usually, these cells do not appear immediately after the onset of the disease, but after a few days or even weeks. In size, they resemble large monocytes with a modified structure.

Laboratory tests allow differential diagnosis to be made fairly accurately. Infectious mononucleosis can masquerade as diphtheria, different kinds acute tonsillitis, acute leukemia, lymphogranulomatosis and other dangerous childhood diseases. In some difficult clinical cases, a whole complex is required diagnostic measures, which includes the performance of various laboratory tests.

In order to accurately determine the size of internal organs, ultrasound is used. Using a special sensor, a specialist examines the surface of organs and determines their parameters. Ultrasound diagnostics helps to identify all the changes that occur in the liver and spleen during the development of infectious mononucleosis. The method is quite accurate and highly informative.

An unconditional plus of the study is the safety and absence of any pain during its implementation.

Consequences and complications

The course of the disease may not always be easy. In some cases, there are health-threatening complications. They can significantly disrupt the well-being of the child and lead to a deterioration in his condition. If timely assistance is not provided, such consequences of infectious mononucleosis have a significant impact on the quality of life of the baby in the future.

The disease can be dangerous by the development of the following negative complications:

• Rupture of the spleen. Pretty rare option. Occurs in less than 1% of cases. Severe splenomegaly causes the outer capsule of the spleen to rupture and rupture of the organ occurs. If surgery is not performed on time, then coma and even death.
• anemic condition. Such hemorrhagic anemia is associated with disruption of the spleen. There are also signs of immune thrombocytopenia in the blood. This condition occurs due to impaired functioning of the spleen, as a hematopoietic organ.
• neurological pathologies. These include: various clinical variants of meningitis and encephalitis, acute psychotic conditions, sudden cerebellar syndrome, paresis of peripheral nerve trunks, Guillain-Barré syndrome (polyneuritis).

• Various disorders of the heart. They are manifested by an altered heart rhythm. The baby has various options for arrhythmia or tachycardia. When the heart muscle and its membranes are involved in the inflammatory process, a very dangerous condition arises - infectious pericarditis.
• Inflammation of the lungs - pneumonia. It develops as a result of the addition of a secondary bacterial infection. Most often, the culprits of pneumonia are staphylococci or streptococci. Much less often, anaerobic microorganisms lead to the development of the disease.
• Necrosis of liver cells. This is an extremely unfortunate condition. The death of liver cells leads to a violation of its functions. The course of many processes is disturbed in the body: hemostasis, the formation of sex hormones, the utilization of waste products of metabolism and toxic substances, the formation of bile. Liver failure develops. The condition requires urgent intensive treatment.

• development of acute renal failure. This complication is quite rare. Usually, kidney disorders occur in babies with anatomical defects in the structure of the urinary organs or chronic diseases of the genitourinary system. This condition is manifested by a violation of the excretion of urine. Treatment for this clinical condition carried out only in a hospital setting.
• Asphyxia. In this acute condition, breathing is completely disturbed. Severe acute mononuclear tonsillitis often leads to the development of asphyxia. The abundance of raids on the tonsils also contributes to respiratory failure. This condition requires emergency medical care.

Treatment

Infectious mononucleosis should be treated as soon as the first clinical signs appear. Delayed therapy only contributes to the development of complications in the future. The goal of treatment is to eliminate all adverse symptoms of the disease, as well as to prevent possible secondary infection with a bacterial infection.

Hospitalization of a child in a hospital is carried out taking into account strict indications. All babies with severe symptoms of intoxication, fever, with the threat of developing various complications, must be delivered to the hospital department. Treatment at home is unacceptable for them. The decision on hospitalization is made by the attending physician after examining the child and conducting an examination.

In the treatment of the disease are used:

• Non-drug remedies. These include: adherence to bed rest during the acute period of the disease and therapeutic nutrition. The daily regimen for a sick child should be clearly planned. The baby should definitely sleep in the daytime for at least three hours. Parental feedback indicates that diet and correct mode days help the baby recover faster and significantly improve the well-being of the child.
• local treatment. For its implementation, various rinses are used. As medicines, you can use a solution of furacilin, baking soda, as well as various herbs (sage, calendula, chamomile). Rinsing should be done 30-40 minutes before or after a meal. All solutions and decoctions for these procedures should be at a comfortable, warm temperature.

• Antihistamines. They help eliminate pronounced swelling of tissues, eliminate inflammation and help normalize the size of the lymph nodes. As antihistamines are used: Tavegil, Suprastin, Peritol, Claritin and others. Drugs are prescribed for a course. Dosage, frequency and duration of treatment is determined by the attending physician.
• Antipyretic. Help to normalize elevated temperature body. The duration of taking these drugs must be discussed with your doctor, since with prolonged use they can cause numerous side effects. In pediatric practice, medicines based on paracetamol or ibuprofen.
• Antibacterial therapy. It is prescribed only in case of accession of a bacterial infection. The choice of antibiotic depends on the pathogen that caused the infection. Currently, doctors prefer modern antibacterial agents with a wide spectrum of action. They try not to use penicillin preparations in babies, since taking these drugs is accompanied by the development of numerous side effects.

• Hormonal preparations. The drugs used are mainly based on prednisolone or dexamethasone. They are used in short courses, up to 3-4 days. The average dosage per course is 1-1.5 mg / kg and is calculated individually by the attending physician. Independent use of hormones is unacceptable! Means are used only after the appointment of the attending physician.
• Multivitamin complexes. The biologically active components that make up these medicines help to improve the course of the disease, and also help the baby recover from the infection sooner. Vitamins should be taken for several months. Usually the course of multivitamin therapy is 60-90 days.
• Surgery. It is prescribed for the danger of rupture of the spleen. Such operations are carried out exclusively for health reasons.

It is important to note that there is currently no specific antiviral treatment for infectious mononucleosis. Antiviral agents can only have an indirect effect on Epstein-Barr viruses. To a complete cure for a viral infection data reception medicines, unfortunately, does not. Basically, the treatment of the disease is symptomatic and pathogenetic.

With the development of complications, antibiotics and hormonal agents are prescribed. Hormones allow you to eliminate severe hyperplasia of inflamed lymph nodes. Severe lymphoid hyperplasia (enlargement) of the lymph nodes in the nasopharynx and larynx can lead to the development of blockage of the lumen respiratory tract leading to asphyxia. The appointment of hormonal drugs helps to eliminate this unfavorable and very dangerous symptom. The complex of treatment is chosen by the attending physician. During the development of the disease, it can change, taking into account the well-being of the baby.

The severity of adverse symptoms depends on the initial severity of the disease. To eliminate them, an adequate selection of dosages of drugs and the determination of the correct duration of treatment are required.

Diet

The nutrition of babies in the acute period of the disease should be high-calorie and balanced. Following the recommendations can prevent many complications of the disease. An enlarged liver provokes a violation of the outflow of bile and contributes to the development of digestive disorders. Compliance with the diet in this case allows you to reduce the severity of all negative manifestations.

Health food includes the mandatory use of protein products. Lean beef, chicken, turkey, and white fish are great for protein. All meals should be prepared in a gentle manner. Such nutrition is important especially during the peak of infectious mononucleosis, when inflammation develops in oral cavity. The crushed products will not have a traumatic effect on the tonsils, and will not provoke an increase in pain when swallowing.

As complex carbohydrates, you can use any cereal. Try to keep the cooked cereals as boiled as possible. The diet should be supplemented with various vegetables and fruits. Such a varied diet helps to saturate the body with all the necessary substances necessary in the fight against infection.

Rehabilitation

Recovery from infectious mononucleosis is a rather lengthy process. It takes at least six months for the baby to return to his usual way of life. As rehabilitation measures, compliance with the postulates healthy lifestyle life. Complete balanced diet, regular physical exercise, the optimal alternation of active pastime and rest will help improve immunity, weakened during the acute period of the disease.

Within a few months after suffering infectious mononucleosis, the baby must be observed by doctors. Dispensary observation allows timely detection of long-term consequences of the disease. For a baby who has had a severe infection, there must be medical supervision.

Parents should also be careful. Any suspicion of changes in the well-being of the baby should be a good reason to see a doctor.

Disease prevention

There is currently no universal vaccine against infectious mononucleosis. Specific prevention has not yet been developed. Non-specific preventive measures prevention of this disease is to avoid any contact with febrile or sick children. The child's body of a baby who has just recovered from infectious mononucleosis is very susceptible to infection with various infections.

Good personal hygiene also helps reduce the risk of possible infection. Each child should have their own dishes. Using someone else's is strictly prohibited! When washing dishes, it is very important to use hot water and special detergents approved for use on children.

During the acute period of the disease, all sick babies should stay at home. visit educational institutions during this time is strictly prohibited!

Compliance with quarantine will help prevent mass outbreaks of diseases in children's groups. If the child had contact with a baby with infectious mononucleosis, then he is subject to mandatory medical supervision for 20 days. If signs of the disease are detected, the necessary treatment is prescribed.

Infectious mononucleosis usually occurs in children and adolescents. In rare cases, this pathology worries adults. The disease progresses from characteristic symptoms tonsillitis, lymphadenopathy and enlargement of the liver and spleen.

With normal immunity, after a month or a little more, the symptoms of the disease disappear without a trace and the patient returns to his usual life.

What it is?

Infectious mononucleosis is a viral infectious disease accompanied by damage to the lymph nodes, oral cavity and pharynx, an increase in the size of the liver and spleen, as well as characteristic changes in the hemogram (blood test).

The causative agent of the disease is a virus from the herpes virus family (one of the forms of Epstein-Barr virus infection), which settles in other cells and causes their active reproduction.

The virus is practically non-viable in the external environment and quickly dies under the influence of high and low temperatures, sunlight or antiseptics.

• The source of infection is a person in the midst of an illness or at the stage of recovery. There is a latent carriage of the virus.

The disease is transmitted mainly by airborne droplets. The virus actively accumulates in saliva, so a contact route of transmission is possible during kissing, through personal items, during sexual intercourse. Cases of infection transmission during childbirth and blood transfusion have been recorded.

The susceptibility of people to the virus is very high, but due to immune protection, mild severity of the disease prevails. In the presence of immunodeficiencies, generalization of infection and the development of severe consequences are observed.

The disease is predominantly found in children - it usually affects adolescents aged 12-15 years. Less commonly, the infection affects young children.

Infectious mononucleosis in adults is practically not found, with the exception of people suffering from severe immunodeficiency, for example, with HIV infection or after taking cytostatics.

Outbreaks of infection increase in the autumn-winter period. Contribute to the spread of the virus close household contacts, the use of shared toys, dishes, hygiene items.

The incubation period of infectious mononucleosis (the time from the moment the virus enters until the first signs of the disease appear) ranges from several days to one and a half months. At the same time, the first symptoms of infectious mononucleosis in children develop gradually: weakness, subfebrile temperature, nasal congestion and discomfort in the mouth appear.

In the most acute period of the disease, the symptoms are aggravated:

1. Rise in temperature to febrile values.
2. Sore throat, which is aggravated by eating and swallowing saliva. Because of this symptom, the disease is often confused with a sore throat.
3. Severe headaches.
4. Signs of intoxication of the body: aching muscles and joints, weakness, loss of appetite.
5. Enlarged lymph nodes. The patient can find enlarged lymph nodes in almost all areas available for examination. Most often it is noticeable on the submandibular, cervical and occipital lymph nodes.
6. Enlargement of the liver and spleen. In this case, the patient may develop icteric syndrome: urine darkens, the sclera of the eyes turn yellow, less often a rash appears throughout the body associated with impaired liver function.

The acute period lasts for several weeks. The temperature can rise for another month, after which a period of recovery begins. The patient's well-being gradually improves, the lymph nodes return to normal size, and the temperature curve stabilizes.

Important! A feature of the course of infectious mononucleosis in adults is the predominance of symptoms associated with liver damage (jaundice, dyspeptic disorders, etc.). The size of the lymph nodes increase little, unlike in children.

Clinical signs of infectious mononucleosis are quite easy to confuse with tonsillitis, diphtheria, Hodgkin's disease and some other diseases. by the most typical sign is a specific change in the composition of the blood. With this disease, atypical mononuclear cells and an increase in the number of leukocytes and monocytes are found in the blood.

These atypical cells appear immediately or at 2-3 weeks of illness. During the recovery period, a small amount of them can also be found in the blood.

Important! Adults with infectious mononucleosis are often recommended to have additional tests for HIV infection, since similar blood changes and symptoms are observed at the stage of initial manifestations of HIV infection.

Treatment of infectious mononucleosis, drugs

Treatment of infectious mononucleosis in children takes place at home, however, as in adults (with some exceptions). Patients with severe liver disorders may be hospitalized.

Specific therapy for this virus has not been developed, so parents are very concerned about how to treat infectious mononucleosis in children. For therapy, various groups of drugs are used to eliminate the main symptoms of the disease:

1. Local rinses with antiseptic solutions and decoctions of medicinal herbs.
2. Antihistamines.
3. Antipyretic and anti-inflammatory (Ibuprofen). In children, it is not recommended to use aspirin to bring down the temperature due to the risk of developing Reye's syndrome.
4. Hepatoprotectors.
5. Antibacterial therapy is indicated only in case of secondary infection.
6. With severe swelling of the pharynx and tonsils, short courses of glucocorticosteroids are used.

Physical activity should be limited for the entire period of illness (1-2 months) - there is a risk of rupture of the spleen.

In parallel, the patient is prescribed a sparing chemical and thermal diet rich in vitamins and microelements. Exclude fatty, fried and smoked foods so as not to overload the liver.

How long to treat infectious mononucleosis?

Acute manifestations of the disease last several weeks, during this period the patient receives symptomatic and anti-inflammatory drugs.

Additionally, detoxification therapy is carried out, the use of immunomodulators is possible. At the stage of convalescence, the patient continues to adhere to the diet, limits physical activity and, if necessary, undergoes local treatment throats.

Full recovery occurs only after a month and a half. An infectious disease specialist treats such patients.

Forecast

Most patients have a favorable prognosis. The disease proceeds in mild and erased forms and is easily amenable to symptomatic treatment.
Problems occur in patients with low immunity, in which the virus begins to actively multiply, which leads to the spread of infection.

There are no preventive measures against infectious mononucleosis, with the exception of the general strengthening of the body's immune system through a balanced diet, hardening and physical activity. In addition, crowded places should be avoided, the room should be ventilated and such patients should be isolated, especially from children.

Consequences

The most common complication of the disease is the addition of a secondary bacterial infection. Immune-compromised patients with infectious mononucleosis may develop bronchitis, pneumonia, and inflammation of other organs.

Failure to comply with bed rest can cause rupture of the spleen. In rare cases, severe hepatitis and bleeding develop due to disorders of the blood coagulation system (platelet count drops sharply).

These complications are more typical for patients with weakened immune system and severe comorbidities. In most cases, the symptoms disappear without a trace, but the virus remains in the body even after treatment for infectious mononucleosis throughout life, and can reappear when immunity is reduced.

(otherwise called benign lymphoblastosis, Filatov's disease) is an acute viral infection, characterized by a predominant lesion of the oropharynx and lymph nodes, spleen and liver. A specific symptom of the disease is the appearance in the blood characteristic cells- atypical mononuclear cells. The causative agent of infectious mononucleosis is the Epstein-Barr virus, belonging to the herpesvirus family. Its transmission from the patient is carried out by aerosol. Typical symptoms of infectious mononucleosis are general infectious phenomena, tonsillitis, polyadenopathy, hepatosplenomegaly; maculopapular rashes are possible on various parts of the skin.

ICD-10

B27

General information

Infectious mononucleosis (otherwise called benign lymphoblastosis, Filatov's disease) is an acute viral infection characterized by a predominant lesion of the oropharynx and lymph nodes, spleen and liver. A specific sign of the disease is the appearance in the blood of characteristic cells - atypical mononuclear cells. The spread of infection is ubiquitous, seasonality has not been identified, there is an increased incidence during puberty (girls 14-16 years old and boys 16-18 years old). The incidence after 40 years is extremely rare, with the exception of HIV-infected persons who may develop a manifestation of a latent infection at any age. In case of infection with the virus in the early childhood the disease proceeds according to the type of acute respiratory infection, at an older age - without severe symptoms. In adults, the clinical course of the disease is practically not observed, since in the majority, by the age of 30-35, specific immunity.

Causes

Infectious mononucleosis is caused by the Epstein-Barr virus (a DNA-containing virus of the genus Lymphocryptovirus). The virus belongs to the herpesvirus family, but unlike them, it does not cause the death of the host cell (the virus mainly multiplies in B-lymphocytes), but stimulates its growth. In addition to infectious mononucleosis, Epstein-Barr virus causes Burkitt's lymphoma and nasopharyngeal carcinoma.

The reservoir and source of infection is a sick person or a carrier of the infection. Isolation of the virus by sick people occurs from last days incubation period, and lasts 6-18 months. The virus is shed in saliva. 15-25% healthy people with a positive test for specific antibodies, the pathogen is detected in swabs from the oropharynx.

The mechanism of transmission of the Epstein-Barr virus is aerosol, the predominant route of transmission is airborne, contact is possible (kissing, sexual intercourse, dirty hands, dishes, household items). In addition, the virus can be transmitted through blood transfusion and intrapartum from mother to child. People have a high natural susceptibility to infection, but when infected, mild and blurred clinical forms are predominantly developed. A slight incidence among children under one year old indicates the presence of innate passive immunity. Severe course and generalization of infection contributes to immunodeficiency.

Pathogenesis

The Epstein-Barr virus is inhaled by humans and infects the epithelial cells of the upper respiratory tract, oropharynx (promoting the development of moderate inflammation in the mucous membrane), from there the pathogen enters the regional lymph nodes with the lymph flow, causing lymphadenitis. When it enters the bloodstream, the virus invades B-lymphocytes, where it begins active replication. The defeat of B-lymphocytes leads to the formation of specific immune reactions, pathological deformation of cells. With the blood flow, the pathogen spreads throughout the body. Due to the fact that the introduction of the virus occurs in immune cells and immune processes play a significant role in pathogenesis, the disease is classified as AIDS-associated. The Epstein-Barr virus persists in the human body for life, periodically activating against the background of a general decrease in immunity.

Symptoms of infectious mononucleosis

The incubation period varies widely: from 5 days to one and a half months. Sometimes there may be non-specific prodromal phenomena (weakness, malaise, catarrhal symptoms). In such cases, there is a gradual increase in symptoms, malaise intensifies, the temperature rises to subfebrile values, nasal congestion, and sore throat are noted. On examination, hyperemia of the oropharyngeal mucosa is revealed, the tonsils can be enlarged.

In the case of an acute onset of the disease, fever, chills, increased sweating develop, symptoms of intoxication (muscle aches, headache) are noted, patients complain of sore throat when swallowing. Fever can persist from several days to a month, the course (type of fever) can become different.

A week later, the disease usually enters the peak phase: all the main clinical symptoms appear (general intoxication, tonsillitis, lymphadenopathy, hepatosplenomegaly). The patient's condition usually worsens (symptoms of general intoxication worsen), in the throat there is a characteristic picture of catarrhal, ulcerative-necrotic, membranous or follicular tonsillitis: intense hyperemia of the mucous membrane of the tonsils, yellowish, loose plaques (sometimes like diphtheria). Hyperemia and granularity of the posterior pharyngeal wall, follicular hyperplasia, mucosal hemorrhages are possible.

In the first days of the disease, polyadenopathy occurs. An increase in lymph nodes can be detected in almost any group accessible for palpation, most often the occipital, posterior cervical and submandibular nodes are affected. To the touch, the lymph nodes are dense, mobile, painless (or pain is mild). Sometimes there may be a moderate swelling of the surrounding tissue.

At the height of the disease, most patients develop hepatolienal syndrome - the liver and spleen are enlarged, yellowness of the sclera, skin, dyspepsia, and darkening of the urine may appear. In some cases, maculopapular rashes of various localization are noted. The rash is short-term, not accompanied subjective feelings(itching, burning) and does not leave behind any residual effects.

The height of the disease usually takes about 2-3 weeks, after which there is a gradual subsidence of clinical symptoms and a period of convalescence begins. The body temperature returns to normal, the signs of sore throat disappear, the liver and spleen return to their normal size. In some cases, signs of adenopathy and low-grade fever may persist for several weeks.

Infectious mononucleosis can acquire a chronic relapsing course, as a result of which the duration of the disease increases to one and a half years or more. The course of mononucleosis in adults is usually gradual, with a prodromal period and less clinical symptoms. Fever rarely lasts more than 2 weeks, lymphadenopathy and tonsil hyperplasia are mild, but symptoms associated with functional disorder liver function (jaundice, dyspepsia).

Complications

Complications of infectious mononucleosis are mainly associated with the development of an associated secondary infection (staphylococcal and streptococcal lesions). Meningoencephalitis, an obstruction of the upper airways by hypertrophied tonsils, may occur. Children may have severe hepatitis, sometimes (rarely) bilateral interstitial infiltration of the lungs. Also rare complications include thrombocytopenia, overstretching of the lienal capsule can provoke rupture of the spleen.

Diagnostics

Nonspecific laboratory diagnostics includes a thorough study of the cellular composition of the blood. A complete blood count shows moderate leukocytosis with a predominance of lymphocytes and monocytes and relative neutropenia, a shift of the leukocyte formula to the left. Large cells of various shapes with a wide basophilic cytoplasm appear in the blood - atypical mononuclear cells. For the diagnosis of mononucleosis, it is significant to increase the content of these cells in the blood to 10-12%, often their number exceeds 80% of all elements of white blood. When examining blood in the first days, mononuclear cells may be absent, which, however, does not exclude the diagnosis. Sometimes the formation of these cells can take 2-3 weeks. The blood picture usually gradually returns to normal during the period of convalescence, while atypical mononuclear cells often persist.

Specific virological diagnostics is not used due to laboriousness and irrationality, although it is possible to isolate the virus in the swab from the oropharynx and identify its DNA using PCR. Exist serological methods diagnostics: antibodies to VCA antigens of the Epstein-Barr virus are detected. Serum immunoglobulins type M are often determined during the period of incubation, and at the height of the disease are noted in all patients and disappear no earlier than 2-3 days after recovery. The detection of these antibodies is sufficient diagnostic criterion infectious mononucleosis. After the infection has been transferred, specific immunoglobulins G are present in the blood, which persist for life.

Patients with infectious mononucleosis (or persons suspected of having this infection) are subjected to a three-time (first time during the period of acute infection, and twice more at intervals of three months) serological examination to detect HIV infection, since it may also indicate the presence mononuclear cells in the blood. For the differential diagnosis of tonsillitis in infectious mononucleosis from tonsillitis of another etiology, consultation with an otolaryngologist and pharyngoscopy is necessary.

Treatment of infectious mononucleosis

Infectious mononucleosis of mild and moderate course is treated on an outpatient basis, bed rest is recommended in case of severe intoxication, severe fever. If there are signs of impaired liver function, diet No. 5 according to Pevzner is prescribed.

There is currently no etiotropic treatment, the complex of indicated measures includes detoxification, desensitization, restorative therapy and symptomatic agents, depending on the available clinic. Severe hypertoxic course, the threat of asphyxia when the larynx is clamped by hyperplastic tonsils are an indication for the short-term appointment of prednisolone.

Antibiotic therapy is prescribed for necrotizing processes in the pharynx in order to suppress the local bacterial flora and prevent secondary bacterial infections, as well as in case of existing complications (secondary pneumonia, etc.). Penicillins, ampicillin and oxacillin, tetracycline antibiotics are prescribed as drugs of choice. Sulfanilamide preparations and chloramphenicol are contraindicated due to the side inhibitory effect on the hematopoietic system. A ruptured spleen is an indication for emergency splenectomy.

Forecast and prevention

Uncomplicated infectious mononucleosis has a favorable prognosis, dangerous complications that can significantly aggravate it, with this disease occurring quite rarely. Residual effects in the blood are the reason for dispensary observation for 6-12 months.

Preventive measures aimed at reducing the incidence of infectious mononucleosis are similar to those for acute respiratory infections. infectious diseases, individual measures of non-specific prevention are to increase immunity, both with the help of general recreational activities, and with the use of mild immunoregulators and adaptogens in the absence of contraindications. Specific prophylaxis (vaccination) for mononucleosis has not been developed. Measures of emergency prevention are applied in relation to children who communicated with the patient, they consist in the appointment of a specific immunoglobulin. In the focus of the disease, a thorough wet cleaning is carried out, personal belongings are disinfected.

When a child is born, his immunity begins to "study" all the surrounding dangers. So, gradually, faced with certain viruses, of which there are several hundred on the planet, protection is developed in the form of antibodies to viruses.

Infection with some agents is difficult to miss, and some diseases go unnoticed or almost unnoticed by the parents of the crumbs. Quite often, many mothers and fathers do not even suspect that the child has had infectious mononucleosis. The authoritative doctor Evgeny Komarovsky tells whether it is possible to determine the symptoms of this disease in a child, and what to do if the diagnosis is confirmed.

About the disease

Infectious mononucleosis is a viral disease. It is caused by the Epstein-Barr virus, which is one of the common agents and is, in fact, a fourth type of herpes virus. This "elusive" virus comes into contact with the world's population much more often than people themselves might think, as a result, more than 90% of adults have ever been infected with it. This is evidenced by the presence of antibodies in the blood.

Similar antibodies, indicating that there was an infection, immunity has developed, are found in approximately 45-50% of children aged 5-7 years.

The virus feels great in certain cells of the human body - lymphocytes. There, it quickly replicates under appropriate favorable circumstances, which include weakened immunity. Most often, the virus is transmitted with bodily fluids - saliva, for example, for this, its infectious mononucleosis is often called "kissing disease." Less commonly, the virus is transmitted by airborne droplets.

The pathogen is transmitted during blood transfusion, organ and bone marrow transplantation, as well as from a pregnant mother to the fetus through the general bloodstream.

Infectious mononucleosis refers to acute viral diseases, it does not happen chronic form. From the affected lymph nodes, the virus quickly spreads throughout the body, affecting internal organs having lymphoid tissue in their structure.

Symptoms

Komarovsky about treatment

The disease cannot be called fleeting. The acute phase lasts from 2 to 3 weeks, in some - a little longer. The child's well-being, of course, at this time will not be the best, and sometimes quite difficult. You need to be patient, because infectious mononucleosis goes away in all children without exception.

Uncomplicated mononucleosis does not require any special treatment. If the child feels well, then nothing but a plentiful drink should not be given. If the condition of the crumbs is disappointing, then the doctor may prescribe hormonal anti-inflammatory drugs. There is no cure for mononucleosis, as such, therefore, treatment should be exclusively symptomatic: sore throat - rinse, nose does not breathe - instill saline solution, moisturize the mucous membranes of the bronchi to avoid complications from the respiratory system.

At the reception antiviral agents Komarovsky does not see the expediency, since they will not have any effect on the type 4 herpes virus, but they will significantly "hit" the parents' pocket. In addition, with clinically proven efficacy in antiviral drugs everything is pretty bad. For the same reason, it makes no sense to give a child homeopathic remedies with the declared antiviral action. Of course, there will be no harm from them, but you should not expect any benefit either.

Treatment should be based on the creation of favorable conditions conducive to the speedy self-recovery of the child:

• In the acute stage of the disease, the baby needs rest, bed rest;
• The child should breathe humidified air (relative humidity in the room - 50-70%);
• It is necessary to provide a plentiful warm drink throughout the acute period;
• Do wet cleaning in the child’s room more often, while not using household chemicals that contain chlorine;
• At high temperature the child can be given "Paracetamol" or "Ibuprofen".

When the temperature becomes normal, you can and should walk more often in the fresh air, while refraining from visiting playgrounds, crowded places, so that the child does not infect others and does not "catch" another infection on a weakened immune system himself.

During treatment, it is worth adhering to a therapeutic diet, excluding all fatty, fried, smoked and salty foods, as well as spicy, sour and sweet foods from the child's diet. In the acute stage, with difficulty swallowing, it is best to give vegetable soups, mashed potatoes, milk porridge-smear, cottage cheese. In the recovery phase, it is not necessary to puree all food, but the ban on the above products remains in force.

If bacterial complications have “joined” mononucleosis, they can and should be treated exclusively with antibiotics. Parents should be aware that if the doctor prescribes Ampicillin or Amoxicillin, popular in pediatrics, then the child will have a rash with a 97% probability. Why such a reaction occurs is currently unknown to medicine. We can only say with certainty that this rash will not be an allergy to an antibiotic, nor a symptom of a separate disease, nor a complication. It just appears and then goes away on its own. It shouldn't be scary.

Parents must report the fact of infectious mononucleosis to the preschool institution that the child attends, or to the school. But this disease does not require the introduction of quarantine. Just the premises will require more frequent wet cleaning.

Recovery after infectious mononucleosis is a rather long process, immunity is greatly weakened. For the next year (sometimes for six months), the attending pediatrician cancels all calendar vaccinations for such a child. The child is not recommended to stay in close children's groups for a long time. The baby should not be taken to the sea in order to “correct” his immunity, since severe acclimatization after a viral illness is guaranteed. During the year, it is not recommended to walk in the sun, visit sections where there is a strong physical activity.

Support the body in the recovery process vitamin complexes allowed by age.

A child after an illness should be shown to the doctor more often. The virus has oncogenic activity, that is, it can contribute to the development of oncological tumor diseases. If, after an illness, for a long time, the same modified mononuclear cells continue to be found in the blood tests of the baby, the child will definitely need to be shown and registered with a hematologist.

To the virus that causes infectious mononucleosis, after the illness, persistent lifelong immunity is developed. It is impossible to get sick again. The only exceptions are HIV-infected, they can have any number of episodes of acute illness.