Infectious mononucleosis in children - a viral disease caused in the vast majority of episodes by EBV (Epstein-Barr virus). This nature determines the symptomatic treatment of the disease (antipyretic and analgesic drugs, vasoconstrictors, etc.). Despite the duration of the disease, antibiotics are prescribed only when a bacterial infection is proven. In this case, taking medications is prohibited penicillin group due to the high risk of developing a reaction in the form of a characteristic rash.
Signs and causes of the disease
Infectious mononucleosis is caused by viruses:
- Epstein-Barr (human herpes virus type 4) - in 9 out of 10 cases;
- cytomegalovirus – up to 10% of all episodes;
- others (rubella, adenovirus, etc.) - extremely rare.
The disease is transmitted as a result of close contact with a healthy virus carrier or a sick person (through saliva from kissing, on toys, dishes) or through transfusion (through blood transfusion, organ transplantation, etc.). The specificity of the infection dictates a different name. pathology - “kissing disease”.
After infection, it may take up to 8 weeks for the first signs of infection to appear.
The main group susceptible to the disease are young people aged between 10 and 30 years. People over 40 years of age practically do not suffer from infectious mononucleosis due to the presence of immunity.
“Atypical” mononucleosis is possible in young children, with symptoms reminiscent of a mild cold (the so-called erased form).
After an illness, the virus can be released in external environment throughout life, therefore no special quarantine and isolation measures are required. 90% of the adult population have antibodies to EBV in their blood, which indicates that they had this infection in childhood or adolescence. Post-infectious immunity is lifelong.
Symptoms in children
Suspicion of infectious mononucleosis (symptoms in children may be subtle) requires confirmation by laboratory methods, but in most cases, the signs of the disease are quite typical and include:
- fever (38 – 40 degrees), long-term persistent or with an irregular wave-like course;
- enlarged lymph nodes (mainly submandibular and posterior cervical localization, less often - axillary and inguinal groups);
- pharyngitis of viral origin;
- severe nasal congestion (snoring during sleep, impaired nasal breathing during the day);
- drowsiness;
- significantly expressed fatigue and a feeling of tiredness (can persist for up to 6 months after the disappearance of other manifestations);
- an increase in the size of the spleen and/or liver (not always);
- occasionally, a measles-like rash, which is localized on the face, torso and buttocks, and is especially pronounced when taking penicillin antibiotics due to erroneous diagnosis of sore throat (what this characteristic rash looks like with mononucleosis in children can be found at the request: “Mononucleosis in children photo " - on the Internet).
The average duration of the disease is is two weeks.
Diagnostic methods
If there are clinical signs to confirm the diagnosis, it is prescribed specific analysis for mononucleosis in children - heterophile antibody test. If the result is positive, it is concluded that there is an infection.
A general blood test reveals:
- increase in the number of leukocytes;
- the appearance of atypical mononuclear cells (more than 10% of the total number of leukocytes).
According to international standards, routine serological examination (determination of antibodies in blood serum) is not required, since its result does not affect treatment tactics.
Diagnosis involves the determination of specific antibodies to EBV - IgM (indicates an acute process, high values persist for about two months) and IgG (a sign of a previous infection, detected throughout a person’s life).
Diagnostics PCR method saliva and blood to detect infection are not recommended due to the high probability false positive result(in healthy carriers, the virus persists for life in the epithelial cells of the oropharynx, as well as B-lymphocytes).
Infectious mononucleosis in children: consequences and complications
Parents are especially concerned about the dangers of mononucleosis in children. The fact is that some researchers claim a connection between EBV and cancer.
Are you sure you know for sure? If not, then we suggest you read the article at the link.
About the symptoms and causes of lacunar tonsillitis in children. Perhaps it is this, and not mononucleosis, that the child is suffering from.
In fact, everything is not so critical. Epstein-Barr virus can cause some forms of malignant neoplasms, but this is in no way a variant of the course of infectious mononucleosis (that is, the pathogen is the same, but the pathologies are different).
Such independent oncopathologies are distinguished by their strict geographical distribution and include:
- Burkitt's lymphoma (found in Africa in young representatives of the Negroid race);
- nasopharyngeal cancer (in Southeast Asia in the Chinese);
- some others.
Thus, since EBV infection is observed in the vast majority of adults, and there are no serious pathologies, then for the development malignant tumors additional factors required:
The main, extremely rare complications of mononucleosis include:
- addition of a bacterial infection;
- obstruction of the upper respiratory tract by enlarged tonsils (about the removal of tonsils for chronic tonsillitis);
- thrombocytopenia;
- meningoencephalitis;
- hepatitis (in most cases, an increase in the corresponding biochemical parameters disappears independently after recovery);
- splenic rupture.
The main recommendation in the post-infection period is to limit physical activity due to the risk of rupture of the enlarged spleen during three weeks, for example, when playing contact sports (dynamic assessment of the size of this organ, as well as the liver, using ultrasound is recommended).
For six months, weakness and a feeling of fatigue may be noted, which raises suspicion of a relationship between EBV and the syndrome chronic fatigue(this assumption was not confirmed in subsequent clinical studies).
As for routine vaccination, in a situation with a mild course of the disease it can be carried out immediately after the disappearance of all clinical manifestations, and with severe ones - after about a month from recovery.
Treatment of viral pathology
Treatment of mononucleosis in a child, like any viral disease, is exclusively symptomatic and involves:
- taking antipyretics for fever (based on paracetamol, ibuprofen, the use of aspirin-containing products in children is prohibited medications due to the highest risk of developing fatal dangerous pathology– Reye's syndrome);
- taking painkillers for sore throats (for example, warm drinks, Anti-angin lozenges), information on this is on the link page;
- usage vasoconstrictor drops into the nose in an age-appropriate dosage (based on oxymetazoline, xylometazoline, such as Nazivin, Otrivin, etc.);
- restriction of physical activity;
- drinking enough fluid.
There are no specific antiviral drugs for the treatment of infectious mononucleosis. The use of , prescribed to children for herpes sore throat, reduces the amount of virus detected in saliva, but does not affect the intensity and duration of the disease.
Antibacterial agents are prescribed when a bacterial infection is confirmed by analysis (otitis media, streptococcal sore throat, etc.). Treatment is carried out with drugs from the macrolide group (based on Azithromycin, Clarithromycin, etc.) or cephalosporins (Cephalexin, Cefuroxime, etc.).
Sometimes they may be prescribed antihistamines(Suprastin, etc.) to eliminate swelling, itching and other allergic manifestations.
In severe cases (especially with airway obstruction), treatment with glucocorticoid hormones (for example, Prednisolone) is carried out in a hospital setting.
Treatment folk remedies(in consultation with the pediatrician!) involves gargling with infusions of chamomile, sage, calendula and other herbs, drinking raspberry tea to reduce fever, etc.
Thus, how to treat mononucleosis in children can only be determined by a doctor based on a thorough examination (reliable confirmation of the diagnosis, identification of complications, etc.).
Medicines and their approximate cost
Medicines for the symptomatic treatment of infectious mononucleosis are available over-the-counter (specific ones are sold by prescription) in any pharmacies, including on the Internet, on Yandex.Market.
Cost of individual funds:
- paracetamol containing – 2 – 280 rub.;
- based on oxymetazoline - 50 – 380 rubles;
- Anti-Angin – 74 – 163 rubles;
- based on azithromycin (Sumamed, etc.) – 21 – 580 rubles;
- Suprastin - 92 - 151 rubles;
- Prednisolone – 25 – 180 rub.
Infectious mononucleosis is a common viral disease in children. younger age often occurring in an erased form, resembling a cold (as a result of which it is not diagnosed).
Characteristic signs (high temperature, swollen lymph nodes, nasal congestion, sore throat, etc.) allow one to suspect pathology. Treatment of the disease is exclusively symptomatic(drinking, reducing temperature, pain relief, facilitating nasal breathing, etc.). Prescription of antibiotics and hormonal drugs is carried out only when the corresponding complications develop.
The symptoms and signs of the “Kissing Disease” and how to deal with it are described in the video of the “Live Healthy” program. We recommend mandatory viewing.
Mononucleosis in children most often appears between the ages of two and fifteen years. This is an infectious disease that resembles the flu or sore throat in its symptoms, but it also affects internal organs. It is transmitted by airborne droplets, and the pathology persists for life, and with a decrease in immunity, it is capable of relapse. In severe cases, when the infection cannot be detected, it can be fatal.
Course and forms of the disease
The virus originates in the mucous membrane oral cavity , then it attacks the tonsils and throat. After which, through the circulation of blood and lymph, the infection enters the internal organs, affecting many internal organs. As a rule, the pathology proceeds without complications; they arise only when a relapse occurs when the immune system is weakened. Symptoms of mononucleosis in children, with repeated pathogenic microflora, occur with pneumonia, sinusitis and swelling of the middle ear begin.
At the first infection, the incubation period lasts from five days to three weeks, and when the disease becomes severe, the duration increases from 2 to 4 weeks. If not treated in a timely manner, the mononucleosis virus becomes chronic form. Then the child’s lymph nodes become constantly enlarged, damage to the heart, brain and nerve centers, as a result, facial expressions are disrupted and frequent psychoses occur.
Komarovsky divides infectious mononucleosis in children into forms:
- Typical. It occurs with pronounced symptoms. The child develops a sore throat, fever, and the liver and spleen become enlarged.
- Atypical. Symptoms of the disease are either completely absent or manifest themselves in the form of heart disease, nervous system disease, and also damage to the lungs and kidneys.
The pathology can occur in a smooth form, uncomplicated, complicated or protracted. In order to prevent a child from becoming infected, it is necessary to strengthen the immune system from birth.
Etiology of the disease
The main cause of the disease is infection. The main routes of infection with mononucleosis:
- Occurs after kissing an infectious person.
- Contact with the patient.
- Sharing the same dishes, clothes, bedding with an infected person.
In addition, the disease is transmitted by airborne droplets; a person only needs to sneeze or cough, and the causative agent of the disease enters the environment. Most often, infection occurs in schoolchildren and preschool children; mononucleosis occurs less frequently in infants. If the infection appears in a newborn, it means that the disease was transmitted from the mother during pregnancy through the blood. Based on statistics, boys are much more likely to be affected by the disease than girls.
Symptoms and signs of the disease
After contact with an infected person, it is necessary to monitor the baby’s condition for the next three months. If the disease does not manifest itself, then it is considered that no infection occurred, the immune system overcame the virus, or the disease was asymptomatic. To the main Symptoms of infectious mononucleosis in children include:
Mononucleosis-like syndrome is similar to the symptoms of a sore throat, but the main difference is that a runny nose is also added to the sore throat. In addition, an increased level of mononuclear cells occurs in the blood, which can only be determined using a medical test.
In very young children, mononucleosis-like syndrome manifests itself weakly, and it is quite difficult to distinguish it from ARVI. Home distinctive feature In one-year-old children, a rash appears; it occurs more often in them than in older children.
In children from six to fifteen years of age, the syndrome manifests itself more clearly. Typically, when children show only signs of fever, it means the body is fighting an infection.
Diagnostic measures
In order to distinguish mononucleosis from another disease and prescribe the correct treatment, a specialist prescribes a diagnosis. Blood is drawn to perform the following types of analysis:
Since mononuclear cells appear in the blood of children and other diseases, it is necessary to test for antibodies to other types of infections. In addition to the basic tests, the specialist will prescribe a referral for an ultrasound of the internal organs to exclude their enlargement.
They found out in 1887. A description of febrile pathology in children was compiled by the Russian scientist N. F. Filatov. And to this day, interest in Filatov’s illness does not fade.
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 develop similar Clinical signs: enlarged peripheral lymph nodes, frequent headaches or dizziness, pain in joints and muscles when walking. Filatov called this condition glandular fever.
Currently, science has made great strides forward. Using various diagnostic tests and high-precision devices, scientists have obtained modern information about what causes the disease. In the 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 means that a person with infectious mononucleosis is potentially dangerous and contagious to others. Throughout acute period diseases he can infect other people.
Most often, this infectious pathology occurs in young people, as well as in children. Scientists note that sporadic cases may occur. Large and massive outbreaks of infectious mononucleosis are recorded extremely rarely. Basically, all epidemics associated with this disease occur during the cold season. The peak incidence is autumn.
Typically, viruses that enter the mucous membranes settle in the body and trigger an inflammatory process. Their favorite primary location is 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 peculiarities of the physiological structure of the 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 consequences. Some babies, especially those who are often sick or suffering from immunodeficiency diseases, are at risk of 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 herpes 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 lymphoid-reticular tissue. They are actively striking The lymph nodes and spleen. Once viruses enter the body, they can also cause damage to internal organs.
Infection with pathogenic microbes can be in different ways:
- Contact and household. Most often, children become infected when personal hygiene rules are violated. Someone else's dishes, especially those that are not well processed and pre-cleaned, can become a source of infection. The smallest components of a sick person's saliva can remain on a plate or mug for quite a long time. By violating hygiene rules and eating food from the same container with an infected person, you can easily become infected.
- Airborne. Enough common option transmission of viruses from a sick child to a healthy one. Viruses are the smallest microorganisms. They easily enter a healthy body from a carrier through the air. Typically, infection occurs during conversation, as well as through sneezing.
- Parenteral. In pediatric practice, this variant of infection is extremely rare. It is more typical for adults. In this case, infection is possible during various surgical operations or during blood transfusions. Violation of safety precautions for medical procedures leads to infection.
- Transplacental. In this case, the source of infection for the baby is the mother. The child becomes infected from it in utero. During pregnancy, an infected mother can transmit 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 the baby becoming infected with infectious mononucleosis increases several times.
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 pathogenic microorganisms, including herpes Epstein-Barr viruses.
Typically, clinical signs of the disease appear in children older than one year. This infectious pathology is extremely rare in infants. This feature is due to the presence of specific passive immunoglobulins. They protect the child’s body from various infections, including dangerous herpes viruses. Babies receive these protective immunoglobulins from their mother through breast milk during breastfeeding.
Many parents ask questions about whether a child can get infectious mononucleosis several times in his life. The opinions of scientists and doctors are divided. Some experts believe that after an illness, a baby develops a strong immune system. Their opponents say that herpes viruses cannot be cured. Microbes remain in the child’s body and can remain there throughout life, and if immunity decreases, the disease can return again.
How many days does the incubation period of the disease last? Usually it ranges 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 baby's behavior. During incubation period The child may experience some slowness and absent-mindedness, and sometimes sleep is disturbed. However, these signs appear so faintly that they do not cause any concern for fathers and mothers.
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 provides a description of the pathological symptoms that have developed in the child.
Doctors distinguish several forms of infectious mononucleosis:
- Manifest. Usually occurs with the development of various unfavorable symptoms. It shows up quite clearly. To eliminate adverse symptoms, special treatment is required.
- Subclinical. Some scientists also call this form carrier state. In this case, adverse symptoms of the disease do not appear. A child may be a carrier of infectious mononucleosis, but not even know it. Usually, the disease can be detected in this situation only after the use of special diagnostic tests.
Taking into account the severity of symptoms, several types of disease are distinguished:
- Mild or uncomplicated. Some experts also call it smooth. This clinical variant occurs in a relatively mild form. It is not characterized by the appearance of complications. Usually, the right treatment is enough for the baby to recover.
- Complicated. In this case, the child may develop dangerous consequences diseases. Their treatment requires mandatory hospitalization of the baby in a hospital. Therapy in this case is complex with the appointment of various groups medicines.
- Protracted. It is characterized by a persistent and long-lasting course. Typically, this clinical variant does not respond well 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 children. Only in some cases is rapid acute development illness with the development of numerous complications.
The very first period of the disease is initial. On average, it lasts 1-1.5 months. Most clinical cases are accompanied by an increase in body temperature to 39.5-40 degrees. The severity of the condition causes headaches. It can be of varying intensity: from moderate to unbearable. Against the background of high fever and headache, the child develops severe nausea and even vomits once.
During the acute period of the illness, the baby feels extremely unwell. He develops severe joint pain and muscle weakness. He gets tired very quickly. Even everyday activities that are familiar to a child lead to rapid fatigue. The child eats poorly and refuses his most favorite treats. The loss of appetite is also aggravated by the presence of severe nausea.
These signs are easy to identify yourself. Their appearance causes a real shock among mothers. There is no need to panic! If unfavorable symptoms of the disease appear, be sure to call a doctor. You should not go to the clinic with your child. The serious condition of the baby requires consultation with a specialist at home.
In some cases, children have less severe symptoms. In this case, body temperature does not increase so rapidly. It usually rises to low-grade or febrile levels within a few days. Characteristic 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 simultaneously. These include: an increase in temperature to febrile levels, damage to the lymph nodes and signs of acute tonsillitis. This course is usually quite severe.
Duration initial period illness usually lasts from 4 days to a week.
The next stage of the disease is the time of height. Typically, the height of the disease occurs within a week from the moment the first adverse symptoms appear. By this time, the child’s general well-being is noticeably deteriorating. He also continues to have a fever. An extremely specific symptom at this time is mononucleosis tonsillitis.
The mononuclear form of acute tonsillitis (tonsillitis) is quite severe. It is accompanied by the appearance of numerous symptoms in the throat. Typically, sore throat occurs in catarrhal form. The tonsils become bright red and hyperemic. In some cases, plaque appears on them. It is usually white or with a gray tint. More often, the overlays on the tonsils are quite loose and can be removed relatively well with a spatula or a regular 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 unfavorable signs of the disease disappear.
The course of the height of the disease is often accompanied by severe symptoms of intoxication. The child continues to have severe or moderate headache, decreased appetite, disturbed sleep. A sick baby becomes more capricious. The child's sleep duration is disrupted. Typically, sick babies sleep longer during the daytime and experience significant problems falling asleep at night.
One of the characteristic signs of the height of the disease is the appearance of symptoms of lymphadenopathy. Typically, the nearest peripheral lymphatic collectors are involved in this inflammatory process. In this disease, these are the cervical lymph nodes. They increase in size several times. Sometimes the swollen lymph nodes reach 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 during the acute period of the disease is unacceptable! Applying warm compresses to 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 notice from the outside with the naked eye. Changes appearance baby. Severe swelling of the subcutaneous fat surrounding swollen lymph nodes, leads to the development of a “bull 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 develops clinical signs of involvement of the spleen in the inflammatory process. This is manifested by an increase in its size. Doctors call this condition splenomegaly. In 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 transient and passes by the end of the period of the height of the disease.
On days 5-7 from the onset of the disease, children develop another characteristic feature- rash. It occurs in approximately 6% of cases. The rash is maculopapular. Clear localization of occurrence skin rashes No. They can appear on almost the entire body. The rash does not itch and practically does not cause any discomfort to the child.
The rash usually goes away on its own. The skin elements disappear sequentially and do not leave any traces of hyper- or depigmentation on the skin. After the rash disappears, the baby’s skin becomes its usual physiological color and is not changed in any way. There is also no residual peeling left on the skin. By the end of the high period, the baby begins to feel much better.
By the end of the second week of the disease, his nasal congestion disappears and his breathing normalizes, the elevated body temperature decreases, and the swelling of the face goes away. On average, the total duration of this period of the disease is 2-3 weeks. This time may vary and depends on the initial condition of the baby.
Children with multiple chronic diseases of internal organs tolerate the peak period much worse. They may have it for 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 unfavorable symptoms. In children, the body temperature normalizes, plaque on the tonsils completely disappears, and the normal size of the cervical lymph nodes is restored. The child feels significantly better at this time: appetite returns and weakness decreases. The baby begins to recover.
It usually takes enough time for all symptoms to disappear completely. Thus, the period of convalescence in babies is usually 3-4 weeks. After this, recovery begins. Some children who have had 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 baby’s well-being so that the disease does not develop into a protracted form.
Diagnostics
When the first signs of illness appear, be sure to show your baby to the doctor. The doctor will conduct the necessary clinical examination, during which he will certainly examine the inflamed throat, 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 allowing further clarification of the diagnosis.
To determine the source of the disease, doctors resort to a blood test to determine specific immunoglobulins of class M and G for the Eptation-Barr virus. This simple test can differentiate mononucleosis sore throat from other viral or bacterial sore throats. This analysis- highly sensitive and in most cases gives a real idea of whether the virus is in the blood.
To establish functional disorders that occur in internal organs, a biochemical blood test is required. If a child has signs of mononucleosis hepatitis, then liver transaminases and bilirubin levels will be elevated in the blood. General analysis blood will help identify all deviations from the norm that occur during viral diseases. The severity of these changes may vary.
In the general analysis, blood increases total leukocytes, monocytes, lymphocytes. An 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 disease development, various signs appear in the general blood test. pathological changes, which change over the course of the disease.
A characteristic feature is the appearance of specific cells in the analysis - atypical mononuclear cells. They have large cytoplasm inside. If their number exceeds 10%, then this indicates the presence of the disease. Typically, these cells do not appear immediately after the onset of the disease, but after several days or even weeks. In size they resemble large monocytes with a changed structure.
Laboratory tests allow differential diagnosis to be made quite accurately. Infectious mononucleosis can masquerade as diphtheria, various types acute tonsillitis, acute leukemia, lymphogranulomatosis and other dangerous childhood diseases. In some difficult clinical cases, a whole complex of diagnostic measures, which includes performing 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 changes that occur in the liver and spleen during the development of infectious mononucleosis. The method is quite accurate and highly informative.
An undoubted advantage of the study is the safety and absence of any pain in the child during it.
Consequences and complications
The course of the disease may not always be easy. In some cases, health-threatening complications arise. They can significantly affect the child’s well-being 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 baby’s quality of life in the future.
The disease can be dangerous due to the development of the following negative complications:
- Splenic rupture. Quite a rare option. Occurs in no more than 1% of cases. Severe splenomegaly causes the outer capsule of the spleen to rupture and the organ ruptures. If not done on time surgery, then coma and even death may occur.
- Anemic condition. This hemorrhagic anemia is associated with dysfunction of the spleen. Signs of immune thrombocytopenia are also observed 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 states, sudden cerebellar syndrome, paresis of peripheral nerve trunks, Guillain-Barré syndrome (polyneuritis).
- Various heart disorders. They manifest themselves as altered heart rhythm. The baby develops various types of arrhythmia or tachycardia. When the heart muscle and its membranes are involved in the inflammatory process, very dangerous condition- infectious pericarditis.
- Inflammation of the lungs - pneumonia. Develops as a result of the addition of a secondary bacterial infection. Most often, staphylococci or streptococci are the culprits of pneumonia. Much less often, anaerobic microorganisms lead to the development of the disease.
- Necrosis of liver cells. This is an extremely unfavorable condition. The death of liver cells leads to disruption of its functions. The flow of many processes in the body is disrupted: hemostasis, the formation of sex hormones, the disposal of waste metabolic products and toxic substances, and the formation of bile. Liver failure develops. The condition requires immediate intensive treatment.
- Development of acute renal failure. This complication is quite rare. Typically, kidney problems occur in children who have anatomical defects in the structure of the urinary organs or chronic diseases of the genitourinary system. This condition is manifested by a violation of urine excretion. Treatment of this clinical condition is carried out only in a hospital setting.
- Asphyxia. In this acute condition, breathing is completely impaired. Severe acute mononucleosis tonsillitis often leads to the development of asphyxia. The abundance of plaque on the tonsils also contributes to breathing problems. 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: to eliminate all unfavorable 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 kids who have severe symptoms intoxication, fever, with the threat of developing various complications, must be taken 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.
The following are used in the treatment of the disease:
- Non-pharmacological means. These include: bed rest during the acute period of the disease and therapeutic nutrition. The daily routine for a sick child should be clearly planned. The baby must sleep at least three hours during the daytime. Reviews from parents indicate that following a diet and proper daily routine help the baby recover faster and significantly improve the child’s well-being.
- Local treatment. To carry it out, various rinses are used. As medicines, you can use a solution of furatsilin, baking soda, as well as various herbs (sage, calendula, chamomile). Rinsing should be done 30-40 minutes before or after meals. All solutions and decoctions for these procedures should be at a comfortable, warm temperature.
- Antihistamines. They help eliminate severe tissue swelling, 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 of treatment. The dosage, frequency and duration of treatment is determined by the attending physician.
- Antipyretic. Help normalize elevated temperature bodies. The duration of taking these medications must be discussed with your doctor, since long-term use can cause numerous side effects. In pediatric practice, medications based on paracetamol or ibuprofen.
- Antibacterial therapy. Prescribed only in case of bacterial infection. The choice of antibiotic depends on the pathogen that caused the infection. Currently, doctors prefer modern antibacterial agents that have wide range actions. They try not to use penicillin drugs in children, since taking these drugs is accompanied by the development of numerous side effects.
- Hormonal drugs. Medicines based on prednisone 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. Self-use of hormones is unacceptable! The products are used only after prescription by the attending physician.
- Multivitamin complexes. Biologically included in these medicinal products active ingredients help improve the course of the disease and also help the baby recover from the infection faster. You should take vitamins for several months. Typically, the course of multivitamin therapy is 60-90 days.
- Surgery. Prescribed when there is a risk of splenic rupture. Such operations are carried out exclusively for health reasons.
It is important to note that currently specific antiviral treatment against infectious mononucleosis do not exist. Antiviral drugs can only have an indirect effect on Epstein-Barr viruses. TO complete cure against viral infection data reception medicines, unfortunately, does not lead. Treatment of the disease is mainly symptomatic and pathogenetic.
If complications develop, antibiotics and hormonal agents are prescribed. Hormones can 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 airway, leading to asphyxia. Prescribing hormonal drugs helps eliminate this unfavorable and very dangerous symptom. The treatment package is chosen by the attending physician. During the development of the disease, it may change taking into account the baby’s well-being.
The severity of adverse symptoms depends on the initial severity of the disease. To eliminate them, adequate selection of drug dosages and determination of the correct duration of treatment is required.
Diet
The nutrition of children 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. Following a diet in this case allows you to reduce the severity of all negative manifestations.
Medical nutrition includes the mandatory consumption of protein foods. Lean beef, chicken, turkey and white fish are excellent options for protein. All dishes should be prepared in a gentle manner. Such nutrition is important especially during the height of infectious mononucleosis, when inflammation in the oral cavity develops. Crushed products will not have a traumatic effect on the tonsils, and will not provoke increased pain when swallowing.
Any cereal can be used as complex carbohydrates. Try to keep the cooked porridge as well-cooked as possible. The diet should be supplemented with various vegetables and fruits. Such a varied diet helps saturate the body with all the necessary substances needed to fight infection.
Rehabilitation
Recovery from infectious mononucleosis is a rather long process. It takes at least six months for the baby to return to his usual lifestyle. Rehabilitation measures will require compliance with the postulates healthy image life. Full balanced diet, regular physical exercise, optimal alternation of active pastime and rest will help improve immunity weakened during the acute period of the disease.
For several months after suffering from infectious mononucleosis, the baby must be observed by doctors. Clinical observation allows for timely detection of long-term consequences of the disease. A child who has suffered a severe infection must be under medical supervision.
Parents should also be careful. Any suspicion of changes in the baby’s well-being should be a good reason to consult a doctor.
Disease prevention
There is currently no universal vaccination against infectious mononucleosis. Specific prevention has not yet been developed. Nonspecific preventive measures to prevent this disease include avoiding any contact with feverish or sick children. Children's body A baby who has just recovered from infectious mononucleosis is very susceptible to various infections.
Maintaining 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 in children.
During the acute period of the disease, all sick children should stay at home. Visit educational institutions at this time it is strictly prohibited!
Compliance with quarantine will help prevent mass outbreaks of diseases in children's groups. If a child has had contact with a child sick with infectious mononucleosis, then he is subject to mandatory medical observation for 20 days. If signs of the disease are detected, the necessary treatment is prescribed.
Infectious mononucleosis in children is an acute infectious disease that occurs with damage to the lymphatic and reticuloendothelial systems and is manifested by fever, polyadenitis, tonsillitis, hepatosplenomegaly, leukocytosis with a predominance of basophilic mononuclear cells.
Source: razvitierebenka.info
The infection is widespread, no seasonality has been identified. Infectious mononucleosis is practically not observed in children in the first two years of life. With age, the incidence rate increases and reaches a maximum in puberty, then gradually decreases again. Boys get sick twice as often as girls.
Death in infectious mononucleosis is extremely rare. It can be caused by splenic rupture and airway obstruction.
Synonyms: glandular fever, Filatov's disease, benign lymphoblastosis, “kissing disease.”
Causes and risk factors
The causative agent of infectious mononucleosis is the Epstein–Barr virus (EBV), one of the members of the herpevirus family. Unlike other herpes viruses, it stimulates the growth of host cells (mainly B lymphocytes) rather than causing their death. It is this factor that experts explain the carcinogenicity of the Epstein-Barr virus, i.e. its ability to provoke the development oncological diseases, for example, nasopharyngeal carcinoma or Burkitt's lymphoma.
Source: okeydoc.ru
The only reservoir of infection is the carrier of the infection or a sick person. The virus is released into the spring environment within 18 months after the initial infection. The main route of transmission is airborne (through coughing, sneezing, kissing), in addition, sexual, intrapartum (from mother to child) and transmissible (through blood transfusion) are possible.
Natural susceptibility to infection is high, but infection usually results in erased or light form diseases. The low incidence of infectious mononucleosis in children in the first two years of life is explained by passive immunity received from the mother during intrauterine development and breastfeeding.
Infectious mononucleosis in children with immunodeficiency conditions can be severe, with generalization of the infectious process.
Once in the human body, the virus infects the epithelial cells of the upper respiratory tract and oropharynx, contributing to the occurrence of moderate inflammation. Then, with the current of lymph, it penetrates into the nearest lymph nodes, leading to the development of lymphadenitis. After this, it enters the blood and invades B-lymphocytes, where it replicates (multiplies), leading to cell deformation. The Epstein-Barr virus persists in the body for a long time; when general immunity decreases, it is reactivated.
Preventive measures aimed at reducing the incidence of infectious mononucleosis in children are similar to those for acute respiratory viral infections.
Symptoms of infectious mononucleosis in children
The incubation period can vary widely (from 3 to 45 days), but more often it is 4–15 days.
In most cases, the disease begins acutely, but sometimes it develops clinical picture may be preceded by a prodromal period, the signs of which are:
- sore throat;
- nasal congestion;
- general malaise, weakness;
- low-grade fever;
The most dangerous complication is splenic rupture. It occurs in approximately 0.5% of cases and is accompanied by massive internal bleeding.
The height phase lasts an average of 2-3 weeks, after which the body temperature decreases, the size of the liver and spleen returns to normal, and the symptoms of tonsillitis disappear. Low-grade fever and adenopathy persist for several weeks.
Acute infectious mononucleosis in children in some cases can become chronic. Most often, chronic active course of the disease is observed in children with weakened immune systems (transplant recipients, HIV-infected patients). The chronic active course of the disease is characterized by a high titer of antibodies to capsid antigens of the Epstein-Barr virus and histologically confirmed changes in a number of organs (persistent hepatitis, lymphadenopathy, uveitis, hypoplasia of bone marrow elements, interstitial pneumonia).
Symptoms of chronic infectious mononucleosis in children:
- exanthema;
- low-grade fever;
- signs of damage to the central nervous system.
The congenital form of infectious mononucleosis in children is characterized by multiple malformations (cryptorchidism, micrognathia, etc.).
Diagnostics
Laboratory diagnosis of infectious mononucleosis in children includes the following methods:
- general blood test - leukocytosis, lymphocytosis, monocytosis, thrombocytopenia, the appearance of atypical mononuclear cells (lymphoblast precursors of cytotoxic T cells that are actively involved in the removal of B-lymphocytes affected by the Epstein-Barr virus) are detected;
- biochemical blood test - hypergammaglobulinemia, hyperbilirubinemia, appearance of cryoglobulins in the serum;
- detection of specific antibodies to viral proteins (indirect immunofluorescence reaction, drop test);
- virological study - detection of Epstein-Barr virus in swabs from the oropharynx. IN clinical practice used extremely rarely due to the complexity and high cost of this study.
Acetylsalicylic acid should not be prescribed to children to reduce fever, since its use is accompanied by high risk development of Reye's syndrome.
The presence of infectious mononuclear cells in the blood can be detected in children not only with infectious mononucleosis, but also with HIV infection. Therefore, when they are detected, the child must undergo an enzyme immunoassay for HIV infection, and then repeat this test twice more with an interval of three months.
Infectious mononucleosis in children requires differential diagnosis with listeriosis, leukemia, lymphoma, toxoplasmosis, viral hepatitis, viral tonsillitis of other etiology, streptococcal pharyngitis, adenoviral infection, rubella, diphtheria, cytomegalovirus infection, side effects from medications.
Treatment of infectious mononucleosis in children
In most cases, the disease is treated on an outpatient basis. In the acute phase, bed rest is prescribed; as the sick child’s condition improves and the severity of intoxication decreases, the regime is gradually expanded.
Since etiotropic treatment of infectious mononucleosis in children has not been developed, symptomatic therapy is carried out. At high fever non-steroidal anti-inflammatory drugs are prescribed. Acetylsalicylic acid should not be prescribed to children to reduce fever, since its use is accompanied by a high risk of developing Reye's syndrome.
When a secondary bacterial infection occurs, penicillin antibiotics (penicillin, oxamp, ampicillin, oxacillin) are prescribed. Levomycetin and sulfonamide drugs are not prescribed to children with infectious mononucleosis, as they have an inhibitory effect on the red bone marrow.
With the development of specific complications of infectious mononucleosis (obstruction of the airways by hyperplastic tonsils), short-course glucocorticosteroids are indicated.
One of the main symptoms of infectious mononucleosis in children is tonsillitis, which occurs from the first days of the disease.
If the spleen ruptures, emergency surgery is required - splenectomy.
In the complex treatment of infectious mononucleosis in children, diet therapy is of no small importance. Since the disease occurs with dysfunction of the liver and spleen, optimal mode food is table No. 5 according to Pevzner. Main characteristics of this diet:
- the content of proteins and carbohydrates corresponds to the needs of the child’s body;
- restriction in the diet of fats, especially of animal origin;
- preparing dishes using dietary methods: boiling, baking, stewing;
- exclusion from the diet of foods rich in oxalic acid, purines, extractives, and coarse fiber;
- eating 5-6 times a day in small portions at regular intervals.
Sample menu for one day
- first breakfast - oatmeal, curd pudding, tea with milk;
- second breakfast - fruit, grated carrots and apple, tea with lemon;
- lunch - vegetarian potato soup with a teaspoon of sour cream, baked meat with white sauce, stewed zucchini, rye bread, apple jelly;
- afternoon snack – biscuits, rose hip decoction;
- dinner - mashed potatoes with boiled fish, white bread, tea with lemon.
Possible complications and consequences of infectious mononucleosis in children
The most dangerous complication is splenic rupture. It occurs in approximately 0.5% of cases, is accompanied by massive internal bleeding and requires immediate attention. surgical intervention according to vital indications.
Other consequences of infectious mononucleosis in children may include:
- monoarthritis;
- mild hemolytic anemia;
Prevention
Preventive measures aimed at reducing the incidence of infectious mononucleosis in children are similar to those for acute respiratory viral infections. The sick child is isolated in a separate room. Wet cleaning is carried out daily using disinfectants, the room is often ventilated.
A vaccine for specific prevention of Filatov's disease has not been developed. Nonspecific measures to prevent infectious mononucleosis in children consist of increasing general defenses (prescribing adaptogens, mild immunoregulators, carrying out health-improving measures).
Emergency prevention of infectious mononucleosis in children who have been in contact with patients is rarely carried out. Indications for the use of specific immunoglobulin are immunodeficiency states.
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(otherwise called benign lymphoblastosis, Filatov's disease) is an acute viral infection, characterized by predominant damage to the oropharynx and lymph nodes, spleen and liver. Specific sign The disease is the appearance in the blood of characteristic cells - atypical mononuclear cells. The causative agent of infectious mononucleosis is the Epstein-Barr virus, which belongs to the herpesvirus family. Its transmission from the patient is carried out by aerosol. Typical symptoms infectious mononucleosis includes general infectious phenomena, tonsillitis, polyadenopathy, hepatosplenomegaly; maculopapular rashes are possible on various areas of the skin.
ICD-10
B27
General information
Infectious mononucleosis (otherwise called benign lymphoblastosis, Filatov's disease) is an acute viral infection characterized by predominant damage to the oropharynx and lymph nodes, spleen and liver. A specific sign of the disease is the appearance of characteristic cells in the blood - atypical mononuclear cells. The spread of infection is widespread, no seasonality has 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 individuals, who may develop a latent manifestation existing infection any age. In case of early infection with the virus childhood the disease proceeds as an acute respiratory infection, at an older age - without severe symptoms. In adults clinical course The disease is practically not observed, since the majority have developed specific immunity by the age of 30-35.
Causes
Infectious mononucleosis is caused by the Epstein-Barr virus (a DNA virus of the Lymphocryptovirus genus). 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, the Epstein-Barr virus causes Burkitt's lymphoma and nasopharyngeal carcinoma.
The reservoir and source of infection is a sick person or a carrier of infection. The virus is shed by sick people starting from last days incubation period, and lasts 6-18 months. The virus is released in saliva. In 15-25% healthy people with a positive test for specific antibodies, the pathogen is detected in swabs from the oropharynx.
The transmission mechanism of the Epstein-Barr virus is aerosol, the predominant route of transmission is airborne droplets, it can be transmitted by contact (kissing, sexual contact, 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 indolent clinical forms predominantly develop. The insignificant incidence among children under one year of age indicates the presence of innate passive immunity. Severe course and generalization of infection is facilitated by immunodeficiency.
Pathogenesis
The Epstein-Barr virus is inhaled by a person 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 the virus enters the blood, it invades B lymphocytes, where it begins active replication. Damage to B lymphocytes leads to the formation of specific immune reactions and pathological deformation of cells. The pathogen spreads throughout the body through the bloodstream. Due to the fact that the virus invades 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 being activated 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 nonspecific prodromal phenomena (weakness, malaise, catarrhal symptoms) may be observed. Such cases goes a gradual increase in symptoms, malaise intensifies, the temperature rises to low-grade levels, nasal congestion and sore throat are noted. On examination, hyperemia of the oropharyngeal mucosa is revealed, and the tonsils may be enlarged.
In case of acute onset of the disease, fever, chills, increased sweating develop, symptoms of intoxication are noted (muscle aches, headache), patients complain of a sore throat when swallowing. Fever can persist from several days to a month, and the course (type of fever) can vary.
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), the throat has a characteristic picture of catarrhal, ulcerative-necrotic, membranous or follicular sore throat: intense hyperemia of the mucous membrane of the tonsils, yellowish, loose plaque (sometimes like diphtheria). Hyperemia and granularity back wall pharynx, follicular hyperplasia, possible mucosal hemorrhages.
In the first days of the disease, polyadenopathy occurs. Enlarged lymph nodes can be detected in almost any group accessible to palpation; the occipital, posterior cervical and submandibular nodes are most often affected. To the touch, the lymph nodes are dense, mobile, painless (or the pain is mild). Sometimes there may be 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 and skin, dyspepsia, and darkening of urine may occur. In some cases, maculopapular rashes of various localizations are observed. The rash is short-lived and 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 the clinical symptoms gradually subside 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 function. 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 severe 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, obstruction of the upper respiratory tract by hypertrophied tonsils, may occur. Children may experience severe hepatitis, and sometimes (rarely) interstitial bilateral infiltration of the lungs develops. Rare complications also include thrombocytopenia; overstretching of the lienal capsule can cause rupture of the spleen.
Diagnostics
Nonspecific laboratory diagnostics includes a thorough examination of the cellular composition of the blood. A general blood test shows moderate leukocytosis with a predominance of lymphocytes and monocytes and relative neutropenia, a shift in the leukocyte formula to the left. Large cells of various shapes with 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 white blood elements. When examining blood in the first days, mononuclear cells may be absent, which, however, does not exclude the diagnosis. Sometimes these cells can take 2-3 weeks to form. The blood picture usually gradually returns to normal during the period of convalescence, while atypical mononuclear cells often persist.
Specific virological diagnostics are not used due to laboriousness and irrationality, although it is possible to isolate the virus in swabs 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 detected during the incubation period, and at the height of the disease they are observed in all patients and disappear no earlier than 2-3 days after recovery. The detection of these antibodies serves as a sufficient diagnostic criterion for infectious mononucleosis. After an infection, specific immunoglobulins G are present in the blood and remain for life.
Patients with infectious mononucleosis (or persons suspected of having this infection) undergo serological testing three times (the first time during an acute infection, and twice more at an interval of three months) to detect HIV infection, since it may also be accompanied by the presence of mononuclear cells in the blood. To differentiate a sore throat in infectious mononucleosis from tonsillitis of other etiologies, consultation with an otolaryngologist and pharyngoscopy is necessary.
Treatment of infectious mononucleosis
Mild and moderate infectious mononucleosis is treated on an outpatient basis; bed rest is recommended in cases of severe intoxication and severe fever. If there are signs of liver dysfunction, 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 remedies, depending on the available clinic. Severe hypertoxic course, threat of asphyxia when the larynx is compressed by hyperplastic tonsils are an indication for short-term prescription 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.). The drugs of choice are penicillins, ampicillin and oxacillin, and tetracycline antibiotics. Sulfonamide drugs and chloramphenicol are contraindicated due to the side inhibitory effect on the hematopoietic system. Splenic rupture is an indication for emergency splenectomy.
Prognosis and prevention
Uncomplicated infectious mononucleosis has a favorable prognosis; dangerous complications that can significantly aggravate it occur quite rarely in this disease. Residual effects in the blood are a reason for clinical observation for 6-12 months.
Preventive measures aimed at reducing the incidence of infectious mononucleosis are similar to those for acute respiratory infectious diseases; individual measures of nonspecific prevention consist of increasing immunity, both with the help of general health measures and with the use of mild immunoregulators and adaptogens in the absence of contraindications. Specific prevention (vaccination) for mononucleosis has not been developed. Emergency preventive measures are applied to children who have been in contact with the patient and consist of prescribing a specific immunoglobulin. The area where the disease is occurring is thoroughly cleaned and personal belongings are disinfected.
