Author: Zhang Xing
Unit: Department of Clinical Laboratory, The Third Affiliated Hospital of Chongqing Medical University
"Flyer" (kissing disease) point memory
Kissing disease is all around, and EB infection is the root cause;
Keeping in mind the symptoms "triptych",
Hepatosplenomegaly is possible;
Complications of the heart, lungs, kidneys and other organs should also be concerned.
Although there are numbers ten and five, you still have to look at the scatter chart;
How to find EBV virus?
Antigens, antibodies, and DNA can all be done.
Supportive treatment should be the mainstay, and then antiviral;
Antipyretic commonly used ibuprofen,
Loway, Loway antiviral.
Kissing others is risky, and oral transmission is key;
Oral feeding of babies is not good, personal hygiene is very important,
Vaccine prevention is solid, but it has not yet been developed.
Note: "Triptymy" i.e., fever, pharyngitis, and large lymph nodes; "ten and five" i.e., the percentage of heterotypical lymphocytes in the classification count of leukocytes ≥ 10%, and the percentage of lymphocytes > 50%,; "lovir, lovir" refers to acyclovir and ganciclovir.
One
Case after
The seasonal changes in Chongqing come somewhat suddenly, with temperatures changing dramatically in a short period of time. If the child does not increase or decrease clothing in time, it is easy to get sick and feverish.
4-year-old boy Sensen, fever for 4 days, the highest body temperature of 39.7 ° C, nose blockage breathing is not smooth, sore throat, no appetite, eyelid puffiness, is very uncomfortable. Before coming to our hospital for medical treatment, after oral administration of ibuprofen suspension and oral administration of cefixime and pediatric chaigui granules for 2 days, the sore throat was relieved but the fever was repeated.
On this day, the fever clinic is full, and if you want to go to the pediatric department or other departments, you have to get a negative COVID-19 nucleic acid result before you can leave. At this time, it is particularly important that a blood routine report is issued in a timely and accurate manner and communicated with the clinic in a timely manner to prompt it.
On this day, a long row of peripheral blood was waiting for me to report on the machine as always, and Sensen's peripheral blood was also in this queue. The percentage of lymphocytes (Lym%) >50% and the leukocyte classification scatterplot is abnormal, in which lymphocytes are inseparable from monocyte clusters (vertical coordinate FS: forward light scatter, that is, the volume size of cells in the forward scattering light signal response).
Leukocyte scatter plot
Pushing, staining, microscopy, manual classification of white blood cells: neutrophil percentage (Neu%) 36%, lymphocyte percentage (Lym%) 45.0%, monocyte percentage (Mon%) 8.0%, eosinophil percentage (Eos%) 0%, basophil percentage (Bas%) 0%, atypical lymphocyte percentage 11.0%.
Microscopic atypical lymphocytes (× 1000, as shown by arrows)
Communicate with the doctor who sent for examination that the patient has symptoms of fever and sore throat, elevated lymphocytes classified as white blood cells, and artificially counts 11.0% of dysysmal lymphocytes. Abnormal lymphocytes may also occur in other viral diseases, but the percentage is generally less than 10 percent [1], and EBV-related testing is recommended to rule out infectious mononucleosis ("leaflets").
After the nucleic acid test result of the new crown virus is negative , it is recommended to be admitted to the hospital to diagnose "infectious mononucleosis?" "Admitted to the pediatric ward.
Subsequently, other test results were issued, including alanine aminotransferase (ALT) 31U/L, aspartate aminotransferase (AST) 54U/L, EB virus nucleic acid quantitative detection (EB DNA) 3.22E+05 copies/mL, positive EB virus shell antigen IgM antibody (+), EB virus shell antigen IgG antibody positive (+).
After a definitive diagnosis of "flyers", symptomatic treatment with glucose, vitamin C, ibuprofen suspension, pediatric chaigui, gall wood extract syrup, budesonide suspension during hospitalization, and interferon antiebrenvirus therapy. After 5 days, his condition improved and he was discharged from the hospital.
Two
Anatomy of a case
Once you look at the "flyers", you will find a particularly large number of "flyers". 24-year-old Xiao Jiang, 19-year-old Xiao Hao, 4-year-old Xiao Kai, 22-year-old Wen Wen, 3-year-old Si Si, 19-year-old Xiao Yi... A sense of accomplishment was born.
Epstein-Barr viruses proliferate in oropharyngeal epithelial cells, so saliva contains a large amount of virus that can last from weeks to months [1].
Epstein-Barr virus infection is a self-limiting disease, as long as it is detected early, diagnosed early, and treated early, it is generally mild and will get better in about 1 week.
Early treatment requires vigilance against complications, if the delay in treatment for a long time, the EBV will damage the heart, liver, spleen, lungs, kidneys and other important organs, causing many complications, which is fatal.
Because in addition to "leaflets", some malignant diseases, including nasopharyngeal carcinoma and Hodgkin's disease, are also related to Epstein-Barr virus infection [2]. Therefore, in recent years, EBV vaccines are being studied at home and abroad, and in addition to being used to prevent "flyers", they are still considered for immunoprophylaxis of children with malignant lymphoma and nasopharyngeal carcinoma associated with EPV [3].
【Reference】
[1] Infectious mononucleosis, in: Yang Shaoji, Ren Hong, editor-in-chief. Infectious Diseases. Seventh Edition, Beijing: People's Medical Publishing House, 2008, 103-106.
[2] Aguayo-Hiraldo P, Arasaratnam R, Rouce R. Recent advances in the risk factors, diagnosis and management of Epstein-Barr virus post-transplant lymphoproliferative disease. Bol Med Hosp Infant Mex. 2016; 73(1):31-40.
Infectious mononucleosis, in: Xiaoming Shen, Weiping Wang, editors- pedology. Seventh Edition, Beijing: People's Medical Publishing House, 1979, 196-199.
Edited by: Yeah Reviewer: Xiao Ran