Angina in infectious mononucleosis

As an independent infectious disease, infectious mononucleosis was first described by NF Filatov in 1885 under the name "idiopathic inflammation of the cervical lymphatic glands". In 1889 E.Pfeiffer described a clinical picture of the same disease called "glandular fever".

[1], [2], [3], [4],

The cause of angina in infectious mononucleosis

Infectious mononucleosis is caused by the Epstein-Barr virus from the herpes virus family. The source of the infectious agent is a sick person and a virus carrier. The causative agent is transmitted by airborne droplets. Contiguous factors of infection are crowding, use of shared dishes, towels, bedding, etc. The disease is not very contagious. Immunity has not been studied enough. Cases of recurrent disease are not described.

Symptoms and clinical course of angina with infectious mononucleosis

The incubation period is from 4 to 28 days, usually 7-10 days. The disease develops, as a rule, acutely with a slight chill. The temperature is subfebrile, sometimes increases to 39-40 ° C. The fever can be wavy, recurring and last from 2-3 days to 3-4 weeks, usually 6-10 days. Intoxication is moderate. Sweating is possible. In the blood - moderate leukocytosis - (10-20) x10 ⁹ / l), neutropenia, the predominance of lymphocytes and monocytes (40-80%), a shift in the leukocyte formula to the left, the appearance of atypical mononuclear cells with broad light protoplasm. Changes in the blood remain 2-4 months or more after the normalization of body temperature. Almost always the spleen is enlarged, the liver is very often.

Clinical forms of angina in infectious mononucleosis

Typical signs of infectious mononucleosis are angina, enlargement of the lymph nodes, especially the occipital cervical, submandibular (with palpation they are elastic painless), liver and spleen.

Angina in infectious mononucleosis can occur before the appearance of lymph node reaction, in other cases it may occur much later than this reaction. Clinically, it manifests itself in three forms: pseudo-ulcerative, asthenic and adenopathic

Pseudo-ulcer angina is characterized by an elevated content of leukocytes in the blood and signs of acute leukemia, which complicates the diagnosis of infectious mononucleosis, especially in the first week of the disease. In connection with this, it should be emphasized that "acute leukemias," in which complete recovery occurs, is nothing more than unidentified monocytic tonsillitis, especially if they are accompanied by bufopharyngeal bleeding and hemorrhage.

The asthenic form of monocytic angina can be accepted as manifestations of agranulocytosis, when the blood test does not detect leukocytosis, which is usual for infectious mononucleosis, but on the contrary, there is a significant decrease in the number of polynuclei that cause the appearance of elements of the asthenic syndrome - a symptom complex characterized by irritability, weakness, fatigue and unstable mood, bad sleep, various psychopathic manifestations. With infectious mononucleosis, there are no psychonuclear components.

Adenopathic form is characterized by a predominance of the reaction of the lymph nodes and often simulates adenopathic fever in children, in which, in addition to angina and regional lymphadenitis, there is polyadenopathy syndrome with an increase in distant lymph nodes, while the blood does not reveal any changes characteristic of infectious mononucleosis. The final diagnosis for this form of infectious mononucleosis is established using a specific serological response to the mononucleosis of Paul and Bünnell.

[5], [6], [7], [8], [9], [10]

Diagnosis of angina in infectious mononucleosis

Diagnosis of infectious mononucleosis is established on the basis of the clinical picture, the results of the blood test and the positive results of serological reactions. Differentiate infectious mononucleosis in asthenic form from paratyphosis, in which asthenia is accompanied by a rise in body temperature and a significant increase in the spleen. In the pseudo-ulcer form of angina with extensive filmy layers in the tonsils, it is differentiated from diphtheria of the pharynx, Simanovsky-Plaut-Vincent's angina and vulgar angina.

[11], [12], [13]

Treatment of angina with infectious mononucleosis

With a mild course of the disease and the possibility of isolation, the patient can be treated at home (bed rest, drinking tea with lemon, vitamins, nutrition, rich in protein and carbohydrates, fruit juices). In severe cases, treatment is carried out in an infectious hospital (antiviral drugs, antibiotics for the prevention of secondary bacterial complications, prednisolone).

Prevention

Prevention is the early detection and isolation of patients. Extracting them from a medical institution is made only after the disappearance of clinical symptoms (an average of 2-3 weeks from the onset of the disease).

What prognosis does angina have in infectious mononucleosis?

The outlook is usually favorable.