EBウイルス（伝染性単核球症）と新型コロナウイルス感染症の違い
EBウイルス（伝染性単核球症）と新型コロナウイルス感染症の違い
◆初期症状が、のどの痛み
＊ウイルスではアデノウイルスが咽頭痛をおこしやすい。
細菌で急性咽頭炎が最も重症になるのはA群β溶血性レンサ球菌。
伝染性単核球症と新型コロナウイルス感染症でも
初期症状が咽頭痛のことが多い。
◆医師国家試験 第１０１回 G 33
12歳の女児。5日前からの38～39℃の発熱と咽頭痛とを主訴に来院した。咽頭は発赤し、扁桃は腫大し白苔の付着を認める。
両側頸部に示指頭大から母指頭大のリンパ節を数個触知する。右肋骨弓下に肝を2cm、左肋骨弓下に脾を2cm触知する。
血液所見:赤血球502万、Hb 12.6g/dL、Ht 43％、白血球14,000（桿状核好中球3％、分葉核好中球20％、単球3％、
リンパ球57％、異型リンパ球17％）、血小板21万。
血清生化学所見:総ビリルビン0.8mg/dL、AST 120U/L、ALT 140U/L、LDH 480U/L（基準176～353）。CRP 2.3mg/dL。
最も考えられるのはどれか。
ａ 敗血症
ｂ 川崎病
ｃ 伝染性単核症
ｄ A群レンサ球菌感染症
ｅ 急性リンパ性白血病
※近未来の医師国家試験では、６番目に
f 新型コロナウイルス感染症
の選択肢を追加することも考えられます。
◆EBウイルスについて
初感染の潜伏期は４～６週。
唾液で感染。
大人は９５％以上感染し、無症状のまま一生涯、潜伏感染となる。
Bリンパ球に感染する。
感染細胞であるBリンパ球に特異的な細胞障害性T細胞（キラーT細胞）の出現。
そのT細胞活性化による幼若化が異型リンパ球。
EBウイルスには感染したBリンパ球を腫瘍性に増殖させる作用がある。
キラーT細胞が感染したB細胞を破壊する。
他のウイルス感染症よりリンパ節が大きく腫れやすい。
◆伝染性単核球症の血液検査
VCA-IgM抗体： 初感染 急性期
VCA-IgG抗体： 回復期
EBNA抗体： 初感染の急性期は陰性。６～１２週後から陽性。
★リンパ球は血管の血液の中から感染部位の咽頭の細胞へ移動できる。
ウイルスは細胞の中に遺伝子の状態で入ることで
感染部位から血管の中に移動できるようになる。
※アニメ「はたらく細胞」では登場人物（細胞）が壁をすりぬける。
◆関連疾患
バーキットリンパ腫
ホジキンリンパ腫
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