The present review examines the modern view on the problem of infectious mononucleosis. It is noted that this disease is a polyetiological entity and is usually caused by various lymphotropic infections that are often representatives of the Негреsviridae family. Etiological factors, pathogenesis, and the most typical clinical manifestations are described. Clinical and laboratory features depending on the type of pathogen are presented. Differential diagnosis complications are discussed. The authors present comparative analysis of different approaches to this issue reported by other investigators. The authors have made the following conclusions: 1. Infectious mononucleosis presents a variety of clinical manifestations, from asymptomatic to life-threatening, can have a chronic course and form a contingent of sickly children. 2. On the basis of using only routine clinical and laboratory methods of examination, it doesn’t always possible to diagnose the disease. 3. Today there is no single opinion about the treatment infectious mononucleosis, are clearly not designed clinical examination doesn’t clearly developed. 4. Currently, there is no doubt as to the urgency of the threat of infectious mononucleosis in pediatric practice and the need for more detailed study.
infectious mononucleosis, etiological factors, diagnosis, treatment, children, herpes viruses
1. Issledovanie mikrobiotsenoza rotoglotki metodom mass- spektrometrii mikrobnykh markerov u detey s infektsionnym mononukleozom / Adeishvili P.S., Polesko I.V., Osipov G.A., Fedosova N.F., Guseva N.A., Koltunov I.E. [i dr.]// Detskie infektsii. 2012. T. 11. №1. S. 12–16.
2. Bazhanova E.D. Tsikloferon: mekhanizm deystviya, funktsii i primenenie v klinike. Eksperimental´naya i klinicheskaya farmakologiya. 2012. T. 75. №7. S. 40–44.
3. Barycheva L.Yu., Golubeva M.V., Volkova A.V. Pokazateli adaptivnogo immuniteta u detey s infektsionnym mononukleozom, obuslovlennym virusom Epshteyna-Barra. Kubanskiy nauchnyy meditsinskiy vestnik. 2012. №2. S. 30–33.
4. Belan Yu.B., Mikhaylova T.A.Znachenie klinicheskikh i laboratornykh dannykh v differentsial´noy diagnostike infektsionnogo mononukleoza. Detskie infektsii. 2008. T. 7. №1. S. 32–35.
5. Bokovoy A.G. Gerpesvirusnaya infektsiya u detey. M.: MAKS Press, 2008.
6. Egorova N.Yu., Guseva L.N., Rakhalina E.V., Novosad A.A., Rogova L.A., Uchaykin V.F. Znachenie markerov gerpeticheskikh virusov dlya otsenki sostoyaniya zdorov´ya detey. Detskie infektsii. 2008. T. 7. №2. S. 16–22.
7. Infektsionnyy mononukleoz: klinika, patogenez, novoe v diagnostike i terapii / Ivanova V.V., Zheleznikova G.F., Aksenov O.A. [i dr.]// Infektsionnye bolezni. 2004. №4. S. 5–12.
8. Isakov V.A., Rybalkin S.B., Romantsov M.G. Gerpeticheskaya infektsiya. Rekomendatsii dlya vrachey. SPb.: OOO «Taktik - Studio», 2006.
9. Kan N.Yu. Znachenie persistiruyushchey gerpesvirusnoy infektsii v formirovanii vtorichnogo immunodefitsita u chasto boleyushchikh detey. Detskie infektsii. 2008. №2. S. 64–66.
10. Kasymova E.B., Bashkina O.A., Galimzyanov X.M., Netalieva S.Zh. Infektsionnyy mononukleoz u detey, assotsiirovannyy s virusami gerpesa 4-go i 5-go tipov. Detskie infektsii. 2012. T. 10. №3. S. 44–47.
11. Opyt primeneniya Reaferon-ES-lipinta v terapii detey s infektsionnym mononukleozom / Klimanova E.M., Guseva G.D., Kurnosenok E.N., Zotova O.S., Gay S.A., Targonskiy S.N. [i dr.]// Poliklinika. 2009. №2. S. 76.
12. Kramar´ L.B., Arova A.A., Karpukhina O.A. Kliniko-immunologicheskie kharakteristiki mononukleozopodobnogo sindroma u detey. Vestnik Volgogradskogo gosudarstvennogo meditsinskogo universiteta. 2012. №1(41). S. 72–74.
13. Kramar´ L.V., Karpukhina O.A.. Arova A.A. Kompleksnaya otsenka funktsional´nogo sostoyaniya pecheni v ostrom periode infektsionnogo mononukleoza u detey. Volgogradskiy nauchno-meditsinskiy zhurnal. 2011. №1. S. 21–24.
14. Kramar´ L.V., Karpukhina O.A., Arova A.A. Etiologicheskaya struktura i kliniko-laboratornaya kharakteristika mononukleozopodobnogo sindroma u detey. Fundamental´nye issledovaniya. 2012. T. 7. № 1. S. 92–95.
15. Kramar´ L.B., Karpukhina O.A. Otsenka pokazateley obshchego analiza krovi u detey pri infektsionnom mononukleoze razlichnoy etiologii. Sovremennye problemy nauki i obrazovaniya. 2012. № 6(44). URL: www.science-education.ru/106-7904.
16. Krasnov V.V., Kotlyarova E.V., Obryadina A.P., Kuzenkova L.A., Shcherbakova L.I. Etiopatogeneticheskie osobennosti infektsionnogo mononukleoza u detey, effektivnost´ immunotropnoy terapii. Profilakticheskaya i klinicheskaya meditsina. 2009. №3. S. 202–206.
17. Nisevich N.I., Kazarin B.C., Gasparyan M.O. Infektsionnyy mononukleoz u detey. M.: Meditsina, 1975.
18. Novitskiy V.V., Urazova O.I., Pomogaeva A.P. Tsitogeneticheskaya kharakteristika limfotsitov krovi u detey raznykh vozrastnykh grupp pri infektsionnom mononukleoze razlichnoy etiologii. Gematologiya i transfuziologiya. 2005. №50(3). S. 20–24.
19. Novosad E.V. Infektsionnyy mononukleoz, assotsiirovannyy s virusom gerpesa 6 tipa: Diss. M., 2010.
20. Pomogaeva A.P., Urazova O.I., Novitskiy V.V. Infektsionnyy mononukleoz u detey. Kliniko-laboratornaya kharakteristika razlichnykh etiologicheskikh variantov bolezni. Tomsk, 2005.
21. Romantsov G.A., Goryacheva L.G., Kovalenko A.L. Tsikloferon – opyt primeneniya v detskoy praktike. Detskie infektsii. 2008. №7(4). S. 62–68.
22. Romantsov M.G., Ershov F.I. Chasto boleyushchie deti. Sovremennaya farmakoterapiya: Rukovodstvo dlya vrachey. 2-e izd. M.: GEOTAR-Media, 2009.
23. Roslyy I.M., Abramov S.V. Biokhimicheskie pokazateli v otsenke tsitoliticheskikh mekhanizmov i metabolicheskikh protsessov na primere infektsionnogo mononukleoza. Epidemiologiya i infektsionnye bolezni. 2005. №5. S. 33–41.
24. Spiridovich V.I., Kastusik S.V., Kudin A.P. Otsenka effektivnosti raznykh metodov terapii infektsionnogo mononukleoza u detey. Meditsinskiy zhurnal. 2012. №3. S. 148–151.
25. Uchaykin V.F., Kharlamova F.S., Shashmeva O.V., Polesko I.V. Infektsionnye bolezni: atlas-rukovodstvo. M.: GEOTAR-Media, 2010.
26. Khmilevskaya S.A., Zaytseva E.V., Mikhaylova E.V. Infektsionnyy mononukleoz u detey. Uchebnoe posobie dlya vrachey-pediatrov, infektsionistov. Saratov: SMU, 2009.
27. Khmilevskaya S.A., Zaytseva I.A., Mikhaylova E.V. Osobennosti funktsional´nogo sostoyaniya pecheni pri razlichnykh variantakh Epshteyna-Barr virusnoy infektsii u detey. Infektsionnye bolezni. 2010. №2. S. 30–35.
28. Ahmad U.A., Anari S. Infectious mononucleosis screening in quinsy patients. Eur Arch Otorhinolaryngol. 2010. №267(l). P. 113–115.
29. Auwaerter P.G. Infectious mononucleosis: return to play. Clin. Sports Med. 2004. №23. R. 485–497.
30. Carra-Dalliere C., Mernes R., Juntas-Morales R. Iso-lated palsy of the hypoglossal nerve complicating infectious mononucleosis. Rev Neurol (Paris). 2011. №167(8-9). R. 635–637.
31. Chovel-Sella A., Ben Tov A., Lahav E., Mog O., Ru-dich H., Paret G., Reif S. Incidence of rash after amoxicillin treatment in children with infectious mononucleosis. Pedia-trics. 2013. № 131(5). S. 1424-1427.
32. Should you use steroids to treat infectious mono-nucleosis / Dickens K.P. [et al.]// J. Fam. Pract. 2008. №57(ll). R. 754–755.
33. Feigin R.D. ed. Textbook of pediatric infectious diseases, 6rd ed. Philadelphia, PA: Saunders, 2009.
34. Candidosis of the pharyngeal mucosa: in patients with infectious mononucleosis / Fota-Markowska H. [et al.]// Ann Univ Mariae Curie Sklodowska. 2004. №59(1). R. 200–203.
35. Gordeets A.V., Savina O.G., Beniova S.N., Chernikova A.A. Infectious mononucleosis: etiology, immunological variants, methods of correction. Eksp Klin Farmakol. 2011. №74(11). R. 29–32.
36. Jappe U. Amoxicillin-induced exanthema in patients with infectious mononucleosis: allergy or transient immunostimulation. Allergy. 2007. №62(2). R. 1474–1475.
37. Kliegman R.M., ed. Nelson textbook of pediatrics.18nd ed. Philadelphia, PA: Elsevier Science Health Science Division, 2008.
38. Epstein-Barr virus hepatitis / Kofteridis D.P. [et al.]// European Journal of Internal Medicine. 2011. N22. P. 73–76.
39. Luzuriaga K., Sullivan J.L. Infectious mononucleosis. NEJM. 2010. N362 (21). P. 1993–2000.
40. Dexamethasone for the treatment of sore throat in children with suspected infectious mononucleosis: a rando-mized, double-blind, placebo-controlled trial / M. Roy T. [et al.]// Arch. Pediatr.Adolesc.Med. 2004. N58(3). P. 250–254.
41. Odumade O.A., Hogquist K.A., Balfour H.H. Jr. Progress and problems in understanding and managing primary Epstein-Barr virus infections. Clin. Microbiol.Rev. 2011. N24(1). P. 193–209.
42. Mononucleosis and athletic participation: an evidence-based subject review / Putukian M. [et al.]// Clin. J. Sport Med. 2008. N18. P. 309–315.
43. Randall R.E., Goodbourn S. Interferons and viruses: an interplay between induction, signalling, antiviral responses and virus countermeasures. J. Gen. Virol. 2008. N89. P. 41–47.
44. Rinderknecht A.S, Pomerantz W.J. Spontaneous splenic rupture in infectious mononucleosis: case report and review of the literature. Pediatr Emerg Care. 2012. N28(12). P. 1377–1379.
45. Stock I. Infectious mononucleosis- a "childhood dis-ease" of great medical concern. Med Monatsschr Pharm. 2013. N36(10). P. 364–368.
46. Ulug M., Celen M.K., Ayaz C.,Geyik M.F., Hosoglu S. Acute hepatitis: a rare complication of Epstein-Barr virus (EBV) infection. J Infect Dev Ctries. 2010. N.28:4(10). P. 668–673.
47. Agranulocytosis after infectious mononucleosis / Yokoyama T., Tokuhisa Y., Toga A., Fujiki T., Sakakibara Y., Mase S. [et al.]// J Clin Virol. 2013. N56(3). P. 271–273.
48. Zhu M.H., Liang M,, Wang Z.J,, Wen H,Y. Value of antiviral therapy for infectious monocytosis in children. Zhongguo Dang Dai Er Ke Za Zhi. 2012. №14(3). R. 198–201.