Infectious lymphocytosis
Introduction
Introduction to infectious lymphocytosis Infectious lymphocytosis (infectious lymphocytosis) is an infectious disease that occurs mainly in children and is rarely distributed in adults. The disease is characterized by an increase in the total number of white blood cells in the peripheral blood, which is mainly caused by lymphocytosis, long duration, mild symptoms, and non-specific, partially asymptomatic or physical signs, but only found during routine blood tests. basic knowledge The proportion of children: the incidence rate of children is about 0.005%-0.01% Susceptible people: no specific people Mode of infection: non-infectious Complications: lymphitis
Cause
Causes of infectious lymphocytosis
(1) Causes of the disease
The cause is still unknown. It is generally thought to be caused by a virus. In 1964, Olson et al. isolated adenovirus type 12 from the upper respiratory tract of 4 children. Horowitz isolated a coxsackie virus from the feces of 21% of patients in a epidemic. Subtype A is similar to enterovirus EVU-16, and most patients have a 4-fold increase in anti-intestinal antibodies against the enterovirus, but EVU-16 is inoculated to various animals including immunologically abnormal animals to induce lymphocyte proliferation. None of them were successful. They were used as Epstein-Barr virus, cytomegalovirus, and herpes simplex virus antibodies. They were negative. Cox A, Echo 7, and Cox B antibodies were detected, but it was not possible to determine which virus was caused by bone marrow. The virus isolation of blood, pharyngeal sputum and stool has not been successful. Many scholars have not shown any special significance from the bacteria cultured in the nasopharyngeal cavity of the patients. The children in Beijing have not developed pathogenic bacteria in the stool, and the literature has not Confirmed to be related to parasites.
(two) pathogenesis
Lymph node biopsy microscopic examination revealed lymphoid follicle degeneration and significant proliferation of mononuclear macrophages in the lymphatic sinus.
Prevention
Infectious lymphocytosis prevention
Pay attention to rest, work and rest, life in an orderly manner, and maintaining an optimistic, positive and upward attitude towards life can be of great help in preventing diseases.
Complication
Infectious lymphocytosis complications Complications
Red maculopapular rash is sometimes seen in the early stages of the disease, similar to infectious mononucleosis. Physical examination showed no superficial lymphadenopathy, and there may be submandibular lymphadenopathy and enlarged lymph nodes in the neck due to upper respiratory tract inflammation.
Symptom
Symptoms of Infectious Lymphocytosis Common symptoms Cervical lymphadenopathy, sore throat, papules, nausea, appetite, nasal congestion, abdominal pain, diarrhea, low fever
Many patients have asymptomatic and abnormal signs. Clinical manifestations tend to be mild or transient. About <50% have hypothermia, with an average of 38.9 °C, with fatigue, upper respiratory tract infections such as nasal congestion, runny nose, cough, sore throat, etc. Others have mild diarrhea, nausea, vomiting, abdominal pain and loss of appetite, generally only lasting 1 to 3 days, a small number of abdominal pain due to mesenteric lymphadenopathy, mistaken for acute abdomen, rare cases may have meningitis symptoms There is an increase in the number of mild cells in the cerebrospinal fluid. It is reported that red maculopapular rash is sometimes seen in the early stage of the disease, similar to infectious mononucleosis. In 45 cases reported by Peking Union Medical College Hospital, the highest incidence of symptoms is diarrhea. For example, the stool is 2 to 7 times a day, it is thin, with a small amount of mucus, usually lasting 1 to 3 weeks; followed by fever, 17 cases, the body temperature is between 38 ~ 39 ° C, up to 40 ° C, usually 1 to 3 days Immediate retreat, 6 cases of asymptomatic, physical examination without superficial lymphadenopathy, may have submandibular lymphadenopathy and cervical lymphadenopathy due to upper respiratory tract inflammation, spleen is generally small, 26 of the 45 patients in this group have Submandibular lymphadenopathy The spleen touched only 1 case and the rash was 3 cases.
Examine
Examination of infectious lymphocytosis
1. Peripheral blood: Hemoglobin and red blood cell count are in the normal range. The most characteristic of peripheral blood is the total number of white blood cells and lymphocytes. The mean white blood cell count is reported between (20 ~ 30) × 109 / L, up to 178 × 109 / L The white blood cells were highest in the first week, and continued to increase for 3 to 5 weeks. Lymphocytes accounted for 60% to 97%, and the absolute value was about (8 to 10) × 109/L. The increase was 3 months, and the percentage of lymphocytes was at the peak. Eosinophils are low, and eosinophils can be increased after lymphocyte decline, with an average of about 2.3×109/L, returning to normal within 4 to 6 weeks. The changes in blood and symptoms are not parallel, and the increased lymphocytes are mostly For mature small lymphocytes, the size is different, the nuclear chromatin is closely arranged, the cytoplasm is very little, and the Reiter staining is basophilic; also a few large mature lymphocytes or smaller than normal small lymphocytes, the dyeing is deeper. Mature small lymphocytes, Concord Hospital reported that 15 of 45 patients found abnormal lymphocytes accounted for 0.3% to 3.0%, of which Downey type III is similar in infectious mononucleosis, such cells can be Many viral diseases or It is often found in children; the other type of cytoplasm and nucleus resemble large lymphocytes, with two nuclei connected by a filamentous pedicle. This cell may be a direct dividing lymphocyte, but it can also be found in normal people, so the author believes The discovery of the above two types of cells has no special significance. Among the patients with Dodesh and Zodeh, 96% are small lymphocytes, 2% of which are B cells, 46% are T cells, and 52% are naked cells.
2. Bone marrow: The number of bone marrow cells increases, the granules and erythroids are normal, and mature small lymphocytes increase.
3. Serological examination: negative for heterophilic agglutination, even if the titer is slightly increased, it is lower than the diagnostic requirements for infectious mononucleosis.
According to clinical manifestations, symptoms, signs, chest X-ray, ECG, B-ultrasound, etc.
Diagnosis
Diagnosis and diagnosis of infectious lymphocytosis
Diagnostic criteria
The white blood cell and lymphocyte counts of children of different ages vary greatly. This feature must be paid attention to when diagnosing this disease. The mean white blood cell count is 18.1×109/L at birth, and then gradually decreases. The age of 1 to 3 years is 11.2×109/L. It is 9.1×109/L at 4 years old, 8.3×109/L at 8 years old, and 7.8×109/L at 16 years old. The average percentage of lymphocytes is 30% at birth, and the percentage of neutrophils at 4-6 days. Similar, the percentage of lymphocytes increased afterwards, up to about 60%. The percentage of lymphocytes and neutrophils was similar at 4-6 years old, about 50% each, and then gradually decreased to nearly 30% after normal age. The total number of white blood cells and small lymphocytes are higher than the certain level of this age, asymptomatic, or only mild upper respiratory tract and gastrointestinal symptoms, no systemic lymph nodes or splenomegaly, the disease should be considered.
Differential diagnosis
1. Infectious mononucleosis: The symptoms of this disease can be mild or severe, usually have 1 to 3 weeks of fever, obvious angina, systemic superficial lymph nodes can be swollen, 1/3 to 1/2 patients have liver Splenomegaly, the total number of white blood cells in the blood is increased, but generally does not exceed 20 × 109 / L, atypical lymphocytes appear 4 to 5 days after onset, to the second week of the disease often > 20%, asymptomatic lymphocytosis asymptomatic Or the symptoms are very small, no systemic lymph nodes or spleen enlargement, the average number of white blood cells (20 ~ 30) × 109 / L, mainly mature small lymphocytes, according to the above points, generally can be identified, in case of doubt Epstein -Barr virus antibody assay, the positive rate of the pneumoagglutination test in infectious mononucleosis is very low in children under 5 years old, and the identification of the two diseases is not significant.
2. Infectious diseases: such as typhoid fever, tuberculosis, brucellosis and whooping cough, although the total number of peripheral white blood cells is increased, the percentage of lymphocytes is also increased, but not as obvious as this disease, and each disease has its clinical characteristics, so the identification Not difficult.
3. Chronic non-specific infectious lymphocytosis: more than adults in children, after acute upper respiratory tract infection, low fever, 38 ~ 39 ° C, with fatigue, anorexia, pharyngeal congestion and tonsil enlargement, neck Lymph nodes can be swollen, infant spleen is sometimes available, the total number of white blood cells is increased, but more than <20 × 109 / L, lymphocytes do not exceed 60%, the duration of the disease is generally several months, showing that the symptoms are more obvious than this disease, The duration is long, and the total number of white blood cells and lymphocytes are not as high as this disease.
4. Chronic lymphocytic leukemia: mainly seen in the elderly, with liver, spleen and lymph nodes, although the total number of white blood cells in the blood is increased and small lymphocyte proliferation is the main, but there is anemia and thrombocytopenia.
