Leaflets, or infectious mononucleosis, are infectious diseases mainly caused by EB virus. The main symptoms are fever, pharynx, tonsillitis, cervical lymphadenopathy and hepatosplenomegaly. Because close contact with patients’ oral saliva can cause infection, the disease is also called [kissing disease].
Very rarely, I also used the theme party this time, Therefore, I am worried that this article will give readers who like serious popular science articles a preconceived and unreliable impression. Although the current articles are not eternal (in fact, they are mostly decadent), But I have always refused to say anything without evidence. Just as this somewhat playful title was drawn up, We must also find evidence. Not just according to the common name of infectious mononucleosis [kissing disease], Just take it for granted and make some associations as the name implies. The U.S. Centers for Disease Control and Prevention reminds everyone not to kiss people with leaflets in order to prevent the disease. However, when you face the red lips of a lovely person you like, will you suddenly come to a sudden stop? Girl, wait a minute, are you infected with infectious mononucleosis? Well, it’s a beautiful picture, I dare not continue to think about it. Probably because the Chinese are more subtle, China’s classic pediatrics textbook < < Zhu Futang Practical Pediatrics > > really does not seriously count the rule of not kissing leaflet patients as a preventive measure, Nelson Pediatrics, on the other hand, clearly wrote that both deep kissing and sexual intercourse can lead to the infection of leaflets (foreigners’ pediatrics are so unethical, Not only sexual intercourse, There is also a special chapter on pregnancy). In fact, EB virus infection is indeed impossible to prevent, Because 95% of the world’s people are infected with EB virus, In the United States, Almost all human EB virus serological tests are positive, It is everywhere. But not all people infected with EB virus will develop into [leaflets], Most primary infections in children are asymptomatic or very mild, For example, in the case of fever alone, It is impossible to distinguish it from fever caused by other viruses. Children who are usually clinically diagnosed as leaflets, In addition to the common symptoms of fever and pharyngeal tonsillitis, It also includes cervical lymph node enlargement or hepatosplenomegaly, The auxiliary examination should also be supported by corresponding blood examination and evidence of EB virus infection. Compared with the common cold or upper respiratory tract infection, which is a well-known disease name, The relatively uncommon diagnosis of infectious mononucleosis often scares parents who hear the name of the disease on the first day of the junior high school. Modern medicine has developed to a flourishing day. Not to say that the average person basically lacks sufficient understanding of most diseases, Even if doctors leave their profession, it is often a mess. The social division of labor is so, Paste is not a big deal outside the profession, But if you are also stuck in your own field of expertise, It’s scary. For example, in the treatment of infectious mononucleosis, Some pediatricians are quite paste, I was in a famous forum (well, In fact, it is the paediatrics section of Clove Garden. I saw several pediatricians seriously discussing how effective the use of certain antiviral drugs is for infectious mononucleosis. Some of them are not very effective, and only a few netizens pointed out doubtfully that the instructions of the drug you mentioned only said that it can be used for cytomegalovirus infection. Can it be used to treat leaflets? Unfortunately, instead of facing up to his doubts, some people rightfully fought back. If all the patients are treated according to the instructions, what other drugs are available in our pediatrics? Seeing such discussions, I just had a headache, It seems that the treatment of leaflets, Pediatrician paste is a very common state, otherwise in such discussions, at least whether to use antiviral drugs, the discussion will form two camps, instead of obviously overwhelmingly supporting the use of antiviral drugs. Under such a bad ecology, if you happen to be the one who does not paste, do you dare to express your opinions publicly? Do you have the courage to make your treatment plan obviously different from other peers? It should be noted that infectious mononucleosis is a self-limited disease, If there is no complication, The prognosis is mostly good, The course of the disease is about 1 ~ 2 weeks. If during the course of the disease, The doctor used some kind of antiviral drug, The gradual improvement of the symptoms will naturally be observed, From generation to generation, Non-essential antiviral therapy has also become the so-called [routine]… Yesterday, our hospital held a meeting on [three basics and three strict] training. The dean mentioned that old doctors should bring young doctors well, but some confused old doctors have no ability to bring young doctors well. They do not know that what is right. They are immersed in the shackles of empirical medicine and do not know it. They do not have the scientific spirit and learning ability that evidence-based medicine should have in the era. How can they bring young doctors well? Take it into the ditch! Both Chinese and foreign classic pediatric textbooks believe that the use of antiviral drugs has no obvious effect on improving symptoms and shortening the course of disease, so how do clinicians observe that some antiviral drugs are effective and some are not effective without strict control? I believe some doctors understand the mystery, But there must be some doctors who are really confused. Otherwise, they will not openly express such views in the professional discussions of the forum. In the treatment of almost all self-limited diseases, Without rigorous test design, In fact, it is difficult for clinicians to judge which drug or treatment plan is better based on very limited cases. That is, lack of experience. Some people once said that a doctor’s level cannot exceed the average level around you. This view was in ancient times when information was blocked and information exchange was not smooth. There may be some reason, However, if anyone uses this reason today as an excuse for not making progress, It is bound to become a laughing stock. Through literature retrieval, We can easily find that, At present, the mainstream view is that there is no good way to deal with the disease except rest and symptomatic treatment. Even if some antiviral drugs are used, they cannot reduce the severity of symptoms, shorten the duration of symptoms or change the final result of the disease. In this case, should doctors still use antiviral drugs to the patients on the flyer after weighing the pros and cons? Is it just to let these drugs exert their side effects in the human body (for example, when patients with kidney damage receive acyclovir treatment, they can cause acute renal failure and death)? However, I also found a large number of Chinese literatures that firmly claimed that certain antiviral drugs were safe and effective. Some reviews say that there is still international controversy over the use of antiviral drugs. This is probably the drive of a large number of Chinese doctors to use antiviral drugs. In addition, What is even more absurd is the combination of traditional Chinese and western medicine with some traditional Chinese medicine on the basis of antiviral drugs. It is said to be very effective and so on (in China, Almost all the known treatment of self-limited diseases has the shadow of traditional Chinese medicine). However, in this fog, there is also an exception. It is a research published by Zhu Meihua and others in the Department of Pediatrics of the Second Affiliated Hospital of Guangzhou Medical College in < < Chinese Journal of Contemporary Pediatrics > >, and the original summary is transcribed as follows. I believe you can understand it if you are not studying medicine:
According to the treatment plan for children, They were divided into ganciclovir group (49 cases), aciclovir group (72 cases) and control group (51 cases). The indexes such as heat course, improvement of angina symptoms, retraction time of liver and spleen lymph nodes, descent time of atypical lymphocytes and changes of granulocyte number after medication were observed in each group. Long-term follow-up included reexamination of blood routine, liver function, liver and spleen B ultrasound, Results There were no significant differences among the three groups in terms of heat course, improvement of angina, time of retraction of liver and spleen lymph nodes, and time when the number of atypical lymphocytes decreased to less than 10% in acute phase (P > 0.05). Follow-up for 1 to 8 years and 10 months was conducted. The results showed that there was no significant difference in indexes such as heat course, improvement of angina, time when the number of atypical lymphocytes decreased to less than 10% in acute phase among the three groups (P > 0.05). There was no significant difference in cure rate, recurrence rate and mortality rate among the three groups (P > 0.05). Conclusion: There is no significant difference in curative effect between antiviral therapy and non-antiviral therapy on infectious mononucleosis in children.
The work still needs to continue. Since the law does not blame the public, it is also easy to muddle through to deal with leaflets and continue to use antiviral drugs. Since leaflets are caused by EB virus, is it not a matter of course to use antiviral drugs? This explanation will certainly be very harmonious to the children’s families, doctors and patients, but I have to remind you, please hide the drug instructions.
Excerpts from the instructions for some antiviral drugs are attached:Ganciclovir [Indications]: This product is only used for: 1. Preventing cytomegalovirus disease that may occur in organ transplant recipients at risk of cytomegalovirus infection. 2. Treating cytomegalovirus retinitis in immune deficit patients (including AIDS patients).Adenosine monophosphate [Indication]: Antiviral drug. It can be used for herpes virus stomatitis, dermatitis, viral herpes zoster, etc.[Indications] of aciclovir: 1. Herpes simplex virus infection: used for the treatment of primary and recurrent mucosal skin infection of immunodeficiency and the prevention of recurrent cases; It is also used for the treatment of herpes simplex encephalitis. 2. Herpes zoster: it is used for the treatment of diffuse herpes zoster in immunocompromised patients with severe bagged herpes or immunocompromised patients. 3. The treatment of varicella in immunocompromised patients.(The above is recorded from the medication assistant)
Note *: More than 90% of infectious mononucleosis cases whose clinical symptoms are difficult to identify are caused by EB virus, while the rest may be caused by cytomegalovirus, Toxoplasma gondii, adenovirus, etc. Strictly speaking, this part of cases should be called infectious mononucleosis-like.