异型淋巴细胞IM课件.pptVIP

传染性单核细胞增多症 Infectious mononucleosis 一、概述 1. 定义 2. Infectious MononucleosisTransmission 2. 发病情况 传染源：患者、隐性感染者 传播途径:唾液传播，偶尔输血感染,器官移植，性关系。 感染类型： 1.初次感染 幼儿潜伏感染（隐性感染） 多见。 2.青春期原发性感染 50%引起传染性单核细胞增多症（增殖性感染） 3.非增殖性感染：潜伏感染→引起细胞转化→恶性转化 传染性单核细胞增多症 青春期初次感染 非洲儿童恶性淋巴瘤（Burkitt瘤） 发病前有重度EBV感染 EBV引起细胞转化 血清学证据：患儿体内EBV-Ab水平高 瘤组织中EBV DNA和EBNA 鼻咽癌：见于我国广东，广西，湖南 瘤组织中有EBV-DNA，EBNA 血清中EBV抗体增高 鼻咽癌治疗好转后，EBV抗体水平↓ 3. 发病机理： 唾液 EB 咽喉部 淋巴组织 病毒 淋巴结 良性增生 B细胞 T细胞 自制 3. Infectious MononucleosisPathogenesis EBV infects the epithelium of the oropharynx and salivary glands. Lymphocytes in the tonsilar crypts are directly infected - BLOODSTREAM. Infected B cells and activated T cells proliferate and expand. Polyclonal B cells produce antibodies to host and viral proteins. Infectious MononucleosisPathogenesis Memory B cells (not epithelial cells) are reservoir for EBV. EBV receptor is CD21 (found on B cell surface) Cellular immunity (suppressor T cells, NK cells, cytotoxic T cells) more important than humoral immunity in controlling infection Infectious MononucleosisPathogenesis Infectious MononucleosisPathogenesis IM World Distribution Maculopapular EBV Rash with Amoxicillin Eyelid edema,Pharyngitis,Rash Exudative pharyngotonsillitis Lymphadenopathy Clinical manifestation of IM in children and adults Frequency (%) Sign or symptom Age 4 yr Age 4 – 16 yr Adults (range) Lymphadenopathy 94 95 93 – 100 Fever 92 100 63 – 100 Sore throat or 67 75 70 – 91 tonsillopharyngitis Exudative 45 59 40 – 74 tonsillopharyngitis Splenomegaly 82 53 32 – 51 Hepatomegaly 63 30 6 – 24 Cough or rhinitis 51 15 5 – 31 Rash 34 17 0 – 15 Abdominal pain or 17 0 2 – 14 discomfort Eyelid edem