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1、傳染性單核細胞增多癥InfectiousmononucleosisYongfuHuangChunxiaLiuThe4thClinicalMedicalCollegeofYangzhouUniversity,LaboratoryMedicineCentreofNantongRichHospital,JiangsuNantong226010,China一、概述1.定義由EB病毒引起的一種急性或亞急性淋巴細胞良性增生的傳染病。Self-limitingdisorderoflymphoidtissuecausedbyinfectionwithEpsteinBarrvirus(infectio
2、usmononucleosis).Characterisedbytheappearanceofmanylargelymphoblastsinthecirculation.EB病毒（Epstein-Barrvirus，EBV）Epstein和Barr于1964年從非洲兒童惡性淋巴瘤(Burkitt’slymphoma)細胞培養(yǎng)中最早發(fā)現(xiàn)主要侵犯B細胞.EBV屬皰疹病毒γ亞科，外層有囊膜,囊膜內(nèi)是核衣殼，它是20面體，有160個殼粒，最內(nèi)層為大分子的雙鏈DNA。EpsteinBarrVirus(EBV):HerpesFamily–(linearDNAvirusHHV4),Surround
3、edbynucleocapsidandglycoproteinenvelope.EBV生物學(xué)性狀2.InfectiousMononucleosis Transmission“TheKissingDisease”2.發(fā)病情況傳染源：患者、隱性感染者傳播途徑:唾液傳播，偶爾輸血感染,器官移植，性關(guān)系。感染類型：1.初次感染幼兒潛伏感染（隱性感染）多見。2.青春期原發(fā)性感染50%引起傳染性單核細胞增多癥（增殖性感染）3.非增殖性感染：潛伏感染→引起細胞轉(zhuǎn)化→惡性轉(zhuǎn)化傳染性單核細胞增多癥青春期初次感染非洲兒童惡性淋巴瘤（Burkitt瘤）發(fā)病前有重度EBV感染EBV引起細胞轉(zhuǎn)化血清學(xué)證據(jù)：患
4、兒體內(nèi)EBV-Ab水平高瘤組織中EBVDNA和EBNA鼻咽癌：見于我國廣東，廣西，湖南瘤組織中有EBV-DNA，EBNA血清中EBV抗體增高鼻咽癌治療好轉(zhuǎn)后，EBV抗體水平↓EB病毒感染所致疾病3.發(fā)病機理：唾液EB咽喉部淋巴組織病毒淋巴結(jié)良性增生B細胞T細胞自制3.InfectiousMononucleosis PathogenesisEBVinfectstheepitheliumoftheoropharynxandsalivaryglands.Lymphocytesinthetonsilarcryptsaredirectlyinfected->BLOODSTREAM.Infect
5、edBcellsandactivatedTcellsproliferateandexpand.PolyclonalBcellsproduceantibodiestohostandviralproteins.InfectiousMononucleosis PathogenesisMemoryBcells(notepithelialcells)arereservoirforEBV.EBVreceptorisCD21(foundonBcellsurface)Cellularimmunity(suppressorTcells,NKcells,cytotoxicTcells)moreimpor
6、tantthanhumoralimmunityincontrollinginfectionInfectiousMononucleosis PathogenesisInfectiousMononucleosis PathogenesisIMWorldDistribution4.MaculopapularEBVRashwithAmoxicillinEyelidedema,Pharyngitis,RashExudativepharyngotonsillitisLymphadenopathyCervicallymphadnopathyHepatosplenomegalyClinicalman
7、ifestationofIMinchildrenandadultsFrequency(%)SignorsymptomAge<4yrAge4–16yrAdults(range)Lymphadenopathy949593–100Fever9210063–100Sorethroator677570–91tonsillopharyngitisExudative455940–74tonsillopharyngitisSplenomegaly825332–51Hepa
