Infectious mononucleosis in children and ways of improvement the treatment of patients

Abstract

Introduction. The beginning of this century is characterized by an epidemic of herpesvirus infections, whose frequency and spread continue to rise. Infection by the herpes virus group occurs mainly during the first five years of life and leads to life-long persistence. Despite the similarity of clinical features of the syndrome of infectious mononucleosis (IM) caused by cytomegalovirus, human herpes virus type 6 and Epstein-Barr virus (EBV), pathogenic differences occurring in the body should be realized. Despite the presence of specific antiviral drugs up to the date, scientists haven’t managed to reduce pathogen circulation in the human population and to achieve absolute elimination of the virus from the body of an infected person. Questions about the use of nonspecific antiviral and «immunomodulatory» drugs against herpes virus infections get a mixed response. The purpose of the study was to examine the efficacy of interferon in the treatment of children with ІМ.
Materials and methods. At the Regional Children's Hospital of Infectious Diseases, Kharkiv the comparison of the dynamics of clinical and laboratory parameters of 102 children in the age 1-5 years with moderate tonsillar-glandular form of IM was conducted. The diseases were caused by EBV. The control group consisted of 58 children whose treatment was performed in accordance with generally accepted schemes of existing protocols for diagnosis and treatment of infectious diseases in children. The main group contained 44 patients, which had a complex therapy with the combination of recombinant interferon alpha-2 Viferon-Fearon at doses of 500 000 IU, 2 times a day during 5 days. Our choice of this particular drug was due to the form of drug release - suppositories. In addition, the product contains ascorbic acid and tocopherol acetate, which are powerful antioxidants and membrane-stabilizing factors. Results and discussion. In the majority of children the disease started acutely with fever, symptoms of intoxication, tonsillitis (lacunar tonsillitis), and the increase in size of submandibular and cervical lymph nodes, difficulty in nasal breathing. At the same time, 22 (21,6%) children had slow onset, which was characterized by catarrhal symptoms and gradual rise in temperature. Serous discharges from the nose, nasal congestion, dry cough that gradually became moist, appearance of "snoring" during sleep were the main catarral symptoms. An acute respiratory disease was diagnosed for children at the first visit to the pediatrician, and symptomatic therapy was used during three to five days as a primary treatment. However, the fever persisted, catarrhal manifestations and signs of intoxication intensified, and parents started to pay attention on the neck lumps of. Prolonged fever and swollen lymph nodes were a major cause of hospitalization. Clinical examination of children, who proceeded to the hospital, had revealed the symptoms of tonsillitis. But membranes on the tonsils were found only in 10 patients; the other patients had hyperaemia or "looseness" of the oropharynx mucosa. The ultrasound of the abdomen was conducted for all patients during the hospital stay, which showed an increase in the size of the liver, signs of parenchymal reaction of liver. At the same time, increasing the size of the spleen was observed in 67 patients (65,7%), and in 36 patients (35,3%) signs of hepatosplenitis were found. An increase in aminotransferase levels was found in biochemical analysis of liver samples in 21 children (20,6%), but these figures decreased to physiological norms at the time of discharge from the hospital. Despite the known contraindications on the use of Ampicillin in the treatment for IM, this drug was prescribed for 11 patients (10,8%) in the outpatient basis, which led to appearance of immunocomplex rash with the hemorrhagic component in 2 (1,9%) of them. In peripheral blood leucocytosis (15,48±2,78*109 /L) and lymphocytosis (72,66±3,58%), monocytosis (13,06±2,31%), accelerated ESR (18,96±3,22 mm/h) were found. Only 57 children (55,9%) had abnormal blood mononuclear cells (virocytes), whose number was not high and reached 6,84±1,67%. Patients had thrombocytopenia to 155,49 ± 13,22*109 /L in 15 cases (14,7%) and anaemia in 19 (18,6%) patients. We analyzed the efficiency of the use of the recombinant interferon in complex treatment, based on a comparative analysis of the dynamics of basic clinical and laboratory parameters of the two groups of patients. Accelerated regression of clinical symptoms and laboratory parameters was found in children, to whom complex therapy with recombinant interferon alpha 2 (Viferon-Fearon) was used. Significant differences in clinical parameters were found in terms of normalization of body temperature (5,18 ± 1,12 vs 7,96 ± 0,77 days, p˂0,05), elimination of nasal breathing difficulty (4,06 ± 0,98 vs 6 68 ± 0,82, p˂0,05), reducing the size of the regional lymph nodes (4,98 ± 1,11 vs 7,95 ± 0,87, p˂0,05) and liver (7,65 ± 1, 16 vs 10,98 ± 1,15 days, p˂0,05). The positive effect of interferon on peripheral blood caused an early normalization of leukocytes and ESR, the last one occurred significantly faster (7,19 ± 1,06 vs 10,42 ± 1,17 days, p˂0,05). The duration of treatment of the main group in hospital was 9,02 ± 1,21 days while the treatment of the control group lasted 12,84 ± 1,43 days, p˂0,05. Prescription of Viferon made it possible to shorten the hospital stays of patients in approximately 3-4 days. Conclusions. Thus, one of the most perspective ways to improve the treatment for EBV IM in children is the use of recombinant interferon alpha-2. In addition to positive effects on the clinical course of the disease, the advisability of appointing this drug is due to its probability of development IM in young children alike to respiratory infections. Prescribing Viferon in first hours of the appearing of catarrhal symptoms in children is appropriate, regardless of the results of further definition of the ethology of the disease, because there are many studies that prove the efficacy of interferon for acute respiratory viral infections in children also.