MONONUCLEOZA INFECŢIOASĂ - boală infecţioasă acută, - puţin contagioasă, - febră neregulată,
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Transcript of mononucleoza
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Patogenie
Calea de transmitere
- aeriană,
- parenterală (transfuzie de sânge infectat, transplant de organe).
Multiplicarea - la poarta de intrare,
Viremie,
- localizare în ţesuturile limfatice (ganglioni, splină, amigdale).
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Virusul- se integrează în genomul limfocitului B ,
- produce o limfoproliferare autolimitată,
- apar infiltrate cu celule mononucleare în
- ganglionii limfatici,
- splină,
- ficat,
- măduvă osoasă.
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Manifestări clinice Incubaţia – 30-50 de zile.
Debutul -insidios
- astenie,
- cefalee,
- febră,
- disfagie.
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Perioada de stare - durează 2-4 săptămâni- febra -10-14 zile,
- angina - eritematoasă,
- eritemato-pultacee,
- pseudomembranoasă , peteşii,
- adenomegalia,
- hepatosplenomegalia, icter,
- exantemul - scarlatiniform, rubeoliform, hemoragic.
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Convalescenţa
- dispar semnele bolii,
- persistă hepatomegalia,
- poate persista astenia.
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Diagnostic pozitiv
Diagnostic hematologic
- hiperleucocitoză, chiar reacţie leucemoidă,
- creşterea limfomonocitelor până la 60%,
- celulele Downey cu citoplasmă bazofilă, nuclei ovalari,
fragmentaţi, situaţi excentric.
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Diagnostic pozitiv
Diagnostic serologic
a)anticorpi heterofili (IgM care aglutinează hematiile de berbec)
b)anticorpi specifici faţă de virusul Epstein-Barr:
- anti-antigenul capsidic viral (VCA) - apar în faza acută
- anticorpi faţă de antigenul precoce (EA)
- anti- antigenul nuclear asociat virusului EBNA, apar tardiv
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Diagnostic diferenţial
- sindromul mononuclezic (CMV, HIV, T. gondi),
- rubeolă,
- leucoză acută,
- TBC,
- angine ulceronecrotice,
- hepatite acute virale.
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Complicaţii
- determinate de virus,
- suprainfecţie bacteriană,
- anemie hemolitică, trombocitopenie,
- mecanice (ruptura splinei).
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Tratament- izolare la domiciliu sau în spital,
- regimul alimentar normocaloric,
- repaus la pat în perioada febrilă,
- igiena riguroasă a mucoaselor
- antipiretice, antialgice, antiinflamatorii,
- vitamine de grup B şi C,
- corticoterapia (prednison 1 mg/kg/zi) în formele severe.