Popularmente conhecida como doença do beijo ou febre do beijo, a mononucleose é uma doença infectocontagiosa causada pelo vírus do Epsthein-Barr (VEB) e que possui alta incidência em indivíduos da faixa etária entre 15-25 anos, mas podendo, também, ser adquirida nos primeiros anos de vida. Seu nome popular se dá justamente pelo seu método de transmissão, uma vez que a principal via de contágio acaba sendo a saliva, bem como objetos contaminados, transfusão sanguínea e relações sexuais.
O agente etiológico da enfermidade é um vírus da família Herpesviridae, infectando mais de 95% da população mundial e que não necessita de sazonalidades específicas para dar continuidade ao seu ciclo de vida. Por possuir alta disseminação, grande parte da população acaba por possuir anticorpos devido à infecção quando ainda criança ou posteriormente na adolescência. Quanto a sua fisiopatologia, o vírus infecta o tecido epitelial da orofaringe, principalmente as glândulas salivares e a parcela referente ao sistema linfático, alastrando-se pela região oral e fazendo alterações morfológicas nas células do sistema imune.
No que tange a sintomatologia, há a possibilidade do indivíduo infectado ser assintomático ou possuir leves sintomas facilmente confundidos com outras doenças sazonais do trato respiratório. O indivíduo sintomático costuma apresentar a tríade de febre alta, faringite e linfadenomegalia. Embora seja possível a presença de outros sintomas como artralgia, dor abdominal, esplenomegalia, exantema, hepatomegalia discreta, náuseas, vômito e tosse. Trabalha-se com um período de incubação de aproximadamente 30 a 50 dias.
Por ter uma sintomatologia facilmente compartilhada por diversas outras doenças, o diagnóstico da mononucleose infecciosa é de extrema importância para o prognóstico do indivíduo afetado. Para isso, além do exame clínico indispensável, deve ser feito o Monoteste, um exame de sangue com aglutinação rápida que busca a presença de anticorpos heterófilos característicos da MI. Quando não disponível o Monoteste, pode ser feita a Reação em Cadeia Polimerase (PCR) ou a sorologia para os anticorpos específicos da doença. Por se tratar de uma virose, não há um medicamento específico para o vírus, de modo que também não há vacinação. Logo, o tratamento se baseia em lidar com os sintomas desenvolvidos pela MI através de antitérmicos, anti-inflamatórios, analgésicos e repouso, evitando atividades físicas e contato íntimo com outras pessoas.
Pedro Armando Meneghesso
Estudante do 4º ano de medicina veterinária da FZEA/USP, aspirante a pesquisador e apaixonado pela epidemiologia de doenças infecciosas.
Referências:
DE OLIVEIRA, Juliana Linhares, et al. O vírus Epstein-Barr e a mononucleose infecciosa. Rev Bras Clin Med. São Paulo, 2012, 10.6: 535-43.
CARVALHO, Luiza Helena Falleiros R. Mononucleose infecciosa. J Pediatr (Rio J), 1999, 75.Supl 1: s115-s25.
CARDOSO, Marta, et al. Mononucleose infecciosa: estudo retrospectivo. Revista Portuguesa de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, 2010, 48.4: 195-200.
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