传染性单核细胞增多症：快速证据综述
Infectious Mononucleosis: Rapid Evidence Review
影响因子:3.50000
分区:医学3区 / 医学：内科3区 初级卫生保健3区
发表日期:2023 Jan
作者:
Jillian E Sylvester, Benjamin K Buchanan, Taran W Silva
摘要
传染性单核细胞增多症是一种病毒综合征，其特征是发烧，咽炎和后宫颈淋巴结肿大。它通常是由爱泼斯坦 - 巴尔病毒引起的，通常会影响青少年和年轻人15至24岁。主要传播是通过与感染者，尤其是其唾液的人进行亲密接触。急性传染性单核细胞增多症的成本效益，有效的初始实验室测试包括具有差异的完全血细胞计数（评估超过40％的淋巴细胞和大于10％的非典型淋巴细胞）和快速的杂毒抗体测试。杂抗抗体测试的敏感性为87％，特异性为91％，但在五岁以下的儿童和成人疾病的第一周可能会产生错误的阴性。肝酶升高的存在增加了在杂型抗体测试结果阴性的情况下，对感染性单核细胞增多症的临床怀疑。 Epstein-Barr病毒capsid抗原抗体测试更敏感和特异性，但比快速的杂抗抗体测试需要更长的过程。传染性单核细胞增多症的治疗是支持的。不建议常规使用抗病毒药和皮质类固醇。当前的指南建议，从症状发作后三周内，感染性单核细胞增多症患者不参加运动活动。共同的决策应用于确定活动的返回时间。免疫抑制人群的严重疾病风险更高，发病率明显。爱泼斯坦 - 巴尔病毒感染与九种类型的癌症有关，包括霍奇金淋巴瘤，非霍奇金淋巴瘤和鼻咽癌以及一些自身免疫性疾病。
Abstract
Infectious mononucleosis is a viral syndrome characterized by fever, pharyngitis, and posterior cervical lymphadenopathy. It is usually caused by Epstein-Barr virus and most often affects adolescents and young adults 15 to 24 years of age. Primary transmission is through close personal contact with a person who is infected, particularly their saliva. Cost-effective, efficient initial laboratory testing for acute infectious mononucleosis includes complete blood count with differential (to assess for greater than 40% lymphocytes and greater than 10% atypical lymphocytes) and a rapid heterophile antibody test. The heterophile antibody test has a sensitivity of 87% and specificity of 91% but can have a false-negative result in children younger than five years and in adults during the first week of illness. The presence of elevated liver enzymes increases clinical suspicion for infectious mononucleosis in the setting of a negative heterophile antibody test result. Epstein-Barr viral capsid antigen-antibody testing is more sensitive and specific but more expensive and takes longer to process than the rapid heterophile antibody test. Treatment of infectious mononucleosis is supportive; routine use of antivirals and corticosteroids is not recommended. Current guidelines recommend that patients with infectious mononucleosis not participate in athletic activity for three weeks from onset of symptoms. Shared decision-making should be used to determine the timing of return to activity. Immunosuppressed populations are at higher risk of severe disease and significant morbidity. Epstein-Barr virus infection has been linked to nine types of cancer, including Hodgkin lymphoma, non-Hodgkin lymphoma, and nasopharyngeal carcinoma, and some autoimmune diseases.