Mononucleosis Kardz Med传染性单核细胞增多症kardz医学课件.pptVIP

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 edema 14 14 5 – 34 Infectious Mononucleosis Infectious Mononucleosis Exudative pharyngotonsillitis Infectious Mononucleosis Hepatosplenomegaly Cervical lymphadnopathy Infectious Mononucleosis : Lab The 3 classic criteria for laboratory confirmation 1 lymphocytosis 2 the presence of at least 10% atypical lymphocytes on peripheral smear 3 a positive serologic test for Epstein-Barr virus (EBV). Infectious Mononucleosis : Lab Complete blood count 40-70%, Leukocytosis (WBC 10,000-20,000 cells per cm3) By the second week of illness, approximately 10% have a WBC count 25,000 per cm3. 80-90% of patients have lymphocytosis, with greater than 50% lymphocytes. Lymphocytosis is greatest during 2-3 weeks of illness and lasts for 2-6 weeks. 20-40% of the lymphocytes : atypical lymphocytes 10% ; Downey types 25-50%, Mild thrombocytopenia Infectious Mononucleosis atypical lymphocytes : Downey types Infectious Mononucleosis : Lab Liver function tests 80-100% of patients : elevated LFT Alkaline phosphatase, AST and bilirubin peak 5-14 days after onset GGT peaks at 1-3 weeks. Occasionally, GGT remains mildly elevated for up to 12 months 95% of patients : elevated LDH most liver function test results are normal by 3 months. Infectious Mononucleosi