(儿科学英文课件)20 传染性单核细胞增多症

Pathology
The basic pathological change is the benign lymphadenosis
The main damage is in monocyte-macrophage system
Lymph nodes：non-pyogenic lymphadenectasis with LC and monocyte-macrophage system proliferation
The tonsils are hyperemic and edematous covered with gray-white exudates.
Manifestations
The incubation period ：5~15 days 1. Fever (>90%) 2. pharyngitis: 80%. sore throat, tonsillar enlargement,
(Burkitt lymphoma 、B cell lymphoma、Hodgkin's disease, nasopharyngeal carcinoma )
Etiology
3、Viral Antigen Systems
viral capsid antigen, VCA EB nuclear antigen, EBNA early antigen, EA lymphocyte-detected membrane antigen,
hepatomegaly： 30~50%.
Among them, 2/3 has elevated liver enzymes
Jaundice is uncommon. Liver failure may occurred in few cases.
splenomegaly：50~70%
5. rashes： 10% 6. others：stuff nose, snore, edema of the eyelids, etc
门诊血常规： WBC 19.2*109/L，N 0.23，L0.58
异型淋巴细胞 0.19。
Complications
nerve system：encephalitis,Guillain-Barrésyndrome, Reye
syndrome, Peripheral neuritis, etc.
Pathogenesis
EBV
salivary glands
infects oral epithelial cells and B-LC in pharynx
viremia
pharyngitis Lymphadenopathy
in cervical nodes
excrete EBV
B-LC in the peripheral
1. Infectious sources Patients, persons with latent infection and carriers
2. Routes of transmission ：
Contact transmission through the mouth (exchange of saliva)
Spleen: lots of atypical LC LC infiltration and limited necrotic lesions in
organs such as liver, heart, kidney, lung, CNS,etc.
Manifestations
The incubation period ：5~15 days 1. Fever (>90%) 2. pharyngitis: 80%. sore throat, tonsillar enlargement,
blood transmission occasionally
3. Population susceptibility
School age children and adolescents
4. Epidemiological features
Peak seasons Epidemiological status
hepatomegaly： 30~50%.
Among them, 2/3 has elevated liver enzymes
Jaundice is uncommon. Liver failure may occurred in few cases.
splenomegaly：50~70%
5. rashes： 10% 6. others：stuff nose, snore, edema of the eyelids, etc
Continuously or blood and the entire
intermittently lymphoreticular system
Activation of
polyclonal B-LC
Changes of antigenicity
on the surface of B-LC
polyclonal antibodies
临床表现
ቤተ መጻሕፍቲ ባይዱ
文献资料
传染性单核细胞增多症及其相关疾病临床特点分析,中国实用儿科杂志,2006年9月第 21卷9期
病例学习
患儿，女，6岁,因”发热、咽痛6天，颈部包块4天”入院。6 天前开始发热,体温可达39.8℃，无畏寒，寒战，诉咽痛，吞 咽时明显。2天后家人发现颈部包块，不伴疼痛。轻咳，鼻阻 明显，打鼾。精神食欲尚可。院外予头孢菌素（不详）治疗4 天，无明显好转。无类似病人接触史。查体：T 39.5℃ P 123 次/分 R 30次/分 神情神可，热病容，全身未见皮疹，眼睑浮 肿，双侧颈部各有3-4个肿大的淋巴结，最大者直径约2cm， 质中，咽充血明显，扁桃体Ⅱ度肿大，可见白色渗出物附着， 心肺听诊无异常，腹软，肝脏肋下2cm,脾脏肋下2cm，质地 中，边钝。
cardiovascular system：Myocarditis, pericarditis hematological system：Hemolytic anemia, Aplastic
LYDMA membrane antigen, MA
Epidemiology
1. Infectious sources Patients, persons with latent infection and carriers
2. Routes of transmission ：
Contact transmission through the mouth (exchange of saliva)
hyperemia , edema and exudates（50%）
3. generalized lymphadenopathy： 80~100%.
The most common lymphadenopathy is enlargement of cervical lymph nodes
4. splenohepatomegalia:
hyperemia , edema and exudates（50%）
3. generalized lymphadenopathy： 80~100%.
The most common lymphadenopathy is enlargement of cervical lymph nodes
4. splenohepatomegalia:
The clinical features include fever, pharyngitis , and
generalized lymphadenopathy. The characteristics of lab study is atypical
lymphocytosis in the peripheral blood.
cervical lymph nodes
cervical lymph nodes
Manifestations
The incubation period ：5~15 days 1. Fever (>90%) 2. pharyngitis: 80%. sore throat, tonsillar enlargement,
Infectious Mononucleosis (IM) mono
Huang Yanfeng, associate professor
DIVISION OF INFECTIOUS DISEASE OF CHONGQING MEDICAL UNIVERSITY
Introduction
Infectious mononucleosis(IM) is an infectious disease caused by Epstein-Barr virus(EBV) .
门诊血常规：WBC 19.2*109/L,N 0.23 L0.58 异型淋巴细
胞 0.19。
病例学习
患儿，女，6岁,因 “发热、咽痛6天，颈部包块4天”入院。6 天前开始发热,体温可达39.8℃，无畏寒，寒战，诉咽痛，吞咽 时明显。2天后家人发现颈部包块，不伴疼痛。轻咳，鼻阻明 显，打鼾。精神食欲尚可。院外诊断“扁桃体炎”予头孢菌素 （不详）治疗4天，无明显好转。无类似病人接触史。查体：T 39.5℃ P 123次/分 R 30次/分，神清神可，热病容，全身未见 皮疹，眼睑浮肿，双侧颈部各有3-4个肿大的淋巴结，最大者直 径约2cm，质中，咽充血明显，扁桃体Ⅱ度肿大，可见白色渗 出物附着，心肺听诊无异常，腹软，肝脏肋下2cm，脾脏肋下 2cm，质地中，边钝。
传染性单核细胞增多症及其相关疾病临床特点分析,中国实用儿科杂志,2003年12月第 18卷12期
儿童传染性单核细胞增多症临床特点与发病年龄的关系附312例临床分析,临床儿科 杂志,2011年6月第29卷6期