LYMPHOCYTOSIS ACUTE INFECTIOUS (lymphocytosis; a lymphocyte[s] + - osis; late lat. infectio infection; synonym oligosymptomatic infectious lymphocytosis) — the infectious disease caused by a virus and which is characterized by variety a wedge, symptoms, a leukocytosis and a hyper lymphocytosis in blood and marrow.
First message on L. lake and. it was made I. A. Kassirsky in 1938. The significant contribution to studying of a disease was made an amer. scientist Smith (S. N. of Smith, 1941) and Romanian scientist Marinesku (G. Marinescu, 1961).
the Source of a contagium are sick children, and also children with the erased and asymptomatic forms of a disease. L. lake and. meets everywhere and it is characterized by the expressed contageousness. It is more often observed at children from 4 to 15 years in autumn and spring months in a look epid, flashes in the closed collectives. After recovery there is a long immunity, however cases of a recurrent disease are described 2 — 3 later.
The etiology and a pathogeny
Consider that a disease-producing factor is the lymphotropic virus, to-ry through a mucous membrane of a nasal part of a throat or went. - kish. a path with current of a lymph gets to the next limf, nodes and it is localized in cells of reticuloendothelial system. The virus can be localized also in a reticuloendothelium of sine of almonds, spleens, intestines. Development patol, process depends on a condition of reactivity of an organism and its protective properties.
The clinical picture
the Clinical picture of a disease varies from hardly noticeable, erased forms, to pronounced symptomatology. An incubation interval — from 12 to 21 days. The onset of the illness is gradual, in the form of an indisposition, temperature increase to subfebrile figures and insignificant Qatar of upper respiratory tracts. It is a so-called oligosymptomatic form, at a cut of further increase of symptoms it is not observed. Perhaps acute (grippopodobny) beginning with the expressed Qatar of upper respiratory tracts; quite often the disease is complicated by pneumonia (a respiratory form). Bodies and systems of an organism can be involved in process, at the same time there are symptoms defining other forms of a disease: 1) the adenopatichesky form which is characterized by moderate increase cervical limf, nodes, almonds, a spleen; 2) a nervous form, at a cut symptoms of meningitis or encephalitis are observed; 3) the skin form which is characterized by emergence of korepodobny or scarlatiniform rash; 4) an abdominal form, at a cut there can be abdominal pains or the phenomena of a coloenteritis.
The picture of blood is characterized by a leukocytosis to 20 000 — 120 000 in 1 mkl with dominance in a formula of lymphocytes — to 60 — 97% (see. Leukocytosis ), generally meso - and mikrogeneration of lymphocytes. Quite often single limforetikulyarny cells meet the extended cytoplasm, polysegmentation of neutrophils is observed; the moderate eosinophilia to 10 — 15% is noted (see. Eosinophilia ). These changes come to light already in an onset of the illness, reaching a maximum in the period of the most high temperature. Level of hemoglobin, quantity of erythrocytes, thrombocytes usually normal, ROE normal or is a little accelerated (see. Gemogramma , Leukocytic formula ). Cases of a disease from moderate are described anemia (see) and nek-eye reduction of quantity of thrombocytes.
A marrowy hemopoiesis does not change: total quantity of myelocariocytes, a ratio of erythroidal and myeloid sprouts remain within norm. However in to a miyelogramma (see) increase in quantity of lymphocytes at the expense of their impurity from blood is observed.
The diagnosis and the differential diagnosis
the Diagnosis is complicated because of diversity a wedge, displays of a disease. The correct diagnosis is possible only taking into account data of a blood analysis. Differential diagnosis of L. lake and. it is necessary to carry out with diseases, for to-rykh the leukocytosis with a hyper lymphocytosis is characteristic: inf. a mononucleosis (see. Mononucleosis infectious ), an acute lymphoblastoid leukosis (see. Leukoses ), whooping cough (see). It is necessary to distinguish L. lake and. from diseases, in a wedge, a picture to-rykh there are symptoms similar to symptoms of various forms L. lake and. — lymphogranulomatosis (see), flu (see), pneumonia (see), a coloenteritis (see. Enteritis, coloenteritis ), appendicitis (see). The differential diagnosis with various inf is carried out. the diseases (measles, a rubella, chicken pox, scarlet fever) which are followed by leukemoid tests (see. Leukemoid tests ) lymphoid type.
the Bed rest, symptomatic means desensibilizing drugs, vitamins; antibiotics are shown at emergence of signs of consecutive infection.
Current and forecast favorable. A wedge, manifestations stick to 4 — 5 days, 10 — 14 is more rare. Changes in blood remain much longer (2 — 6 months).
Prevention: isolation of the patient, carrying out current disinfection (see); for the children who were in contact with the patient establish observation, at them investigate blood.
Bibliography: Kassirsky I. A. and Alekseev G. A. Clinical hematology, page 626, M., 1970; Marinesku E. An acute infectious lymphocytosis and an infectious mononucleosis, the lane from Romanians., Bucharest, 1962; Tyurina N. S. and Menshikova N. L. An infectious lymphocytosis at children, Chelyabinsk, 1973, bibliogr.; Smith of Page H. Infections lymphocytosis, Amer. J. Dis. Child., v. 62, p. 231, 1941.
H. A. Aksenov, A. V. Papayan.