Epstein Barr - viral infection, symptoms, treatment. Epstein-Barr virus and related diseases: mononucleosis, chronic fatigue, and even immunodeficiency Epstein-Barr virus what does it mean

According to statistics, about ninety percent of people are diagnosed with the Epstein-Barr virus. It happens that some even develop immunity to it, and they don’t even suspect it. But, unfortunately, it is also possible that in some situations the disease in question has an extremely negative effect on the functioning of the organs of the human body, and direct acquaintance with it ends not in the standard development of immunity, but in extreme and severe complications that can even become a threat to life. So, this article will discuss the symptoms of the Epstein-Barr virus.

What do patients complain about?

Thus, patients often present complaints such as:

When examining such a patient, the doctor will certainly note an enlarged spleen and liver, and laboratory research The patient's tests will reflect the appearance of atypical mononuclear cells - these are young blood cells that have a general resemblance to both monocytes and lymphocytes. Symptoms of Epstein-Barr virus vary from person to person.

Is there a specific treatment?

There is no definite and specific treatment in the fight against infectious mononucleosis. Science has proven that various antiviral drugs are absolutely ineffective, and any antibiotics are best used exclusively in situations where fungal and bacterial infection. The patient should stay in bed for a long time, gargle regularly, drink plenty of fluids and, of course, take antipyretic medications. As practice shows, body temperature stabilizes within five to seven days after the onset of the disease, and enlarged lymph nodes return to their previous state within a month. It will take about six months for your blood counts to become normal.

You should pay attention to the fact that if a person is faced with infectious mononucleosis, then certain antibodies, called class G immunoglobulins, will form in his body and remain for the rest of his life; they will subsequently ensure complete ignorance of the virus.

Symptoms of Epstein-Barr virus in chronic form

In situations where there is a complete lack of response from the human immune system, the infection can develop into a chronic condition. Doctors distinguish four types of these forms of EBV infection:

Atypical. In this case, the patient experiences quite frequent relapses infectious diseases of the intestines and genitourinary tract, and, in addition, acute respiratory illnesses. Treatment of this pathology is very difficult, and its course is almost always very protracted.
Generalized infection. In such a situation, the nervous system comes under attack from the virus, which can lead to the development of encephalitis, meningitis, or radiculoneuritis. The heart may also be affected, as there is a possibility of diagnosing myocarditis. The lungs are also at risk, because pneumonia can progress as a result of infection. The development of hepatitis is dangerous for the liver. Symptoms and treatment for Epstein-Barr virus in adults are often interrelated.

special instructions

It is important to pay attention to the fact that against the background of chronic EBV infection, doctors can find the virus itself in the patient’s saliva using the polymerase chain reaction method. They can be detected, but the latter are formed only 3-4 months after the virus enters the body. Be that as it may, this will be absolutely not enough to determine an accurate diagnosis. That is why immunologists and virologists conduct examinations of the general spectrum of antibodies.

What is the danger of the Epstein-Barr virus?

Above were cases of the Epstein-Barr virus (symptoms and treatment discussed) in quite mild form, and now let’s try to figure out what the most dangerous and severe manifestations of this pathology are.

Genital ulcers

Doctors diagnose this disease quite rarely and mainly among the female half of the population. Symptoms of genital ulcers developing against the background of the Epstein-Barr virus include the following cases:

in the armpit area and groin area increase noticeably;
small ulcers form on the mucous membrane of the external sides of the genital organs;
as the infection progresses, the ulcers can increase even more and become very painful, acquiring an erosive appearance;
There is an increase in body temperature with the Epstein-Barr virus.

Symptoms and treatment in adults are closely related.

When does therapy not help?

It is noteworthy that genital ulcers within the framework of the virus in question are not subject to absolutely any treatment. Even a drug such as Acyclovir, which can help with type 2 herpes, turns out to be ineffective in a particular situation. But, nevertheless, as practice shows, ulcers disappear on their own without relapse.

It is important to pay attention to the fact that the main danger lies in the high risk of fusion of fungal and bacterial infections, since the ulcers themselves represent a kind of open gate. In this situation, it is imperative to undergo a course of antibacterial and antifungal therapy.

Oncological diseases against the background of the virus

Symptoms of Epstein-Barr virus in adults may include the following.

There are a number of oncological diseases associated with it, the direct participation of which there are many scientifically proven facts. So to similar diseases can be attributed:

Hodgkin's disease or in other words lymphogranulomatosis. This disease manifests itself through weakness, sharp decline weight, dizziness and gain lymph nodes absolutely in all places of the human body. Diagnosis in this case is complex, and the final point in this can only be determined by a biopsy of the lymph node, during which giant Hodgkin cells will most likely be found in it. The treatment process consists of following a course of radiation therapy. According to statistics, remission can be observed in seventy percent of cases. What else can Epstein-Barr virus cause? Symptoms and treatment are also given.
Burkitt's lymphoma. This disease is diagnosed mainly among school-age children and only in African countries. The resulting tumor usually affects the kidneys, ovaries, lymph nodes and adrenal glands. In addition, the lower or upper jaw. An effective and successful treatment method for this moment does not exist. What other symptoms could there be of Epstein-Barr virus?
Lymphoproliferative disease. This type of disease is characterized by a general proliferation of lymphoid tissue, which is malignant. This pathology manifests itself only through enlarged lymph nodes, and the diagnosis can only be made after a biopsy method. Treatment is carried out according to the principle of chemotherapy. True, give any general forecasts in this case it is impossible, since everything directly depends on the individual characteristics of the course of the disease itself and the human body as a whole.
Nasopharyngeal carcinoma. This tumor is malignant and is usually located in the nasopharynx, in its upper part. This cancer is most often diagnosed in African countries. Its symptoms are considered painful sensations in the throat area, hearing loss, constant nosebleeds, prolonged and persistent headache.

What other symptoms do children have of the Epstein-Barr virus (there are plenty of photos).

Autoimmune diseases due to Epstein-Barr virus

Science has already proven that this virus is capable of exerting its influence on the immune system of the human body, as it causes the rejection of native cells, which soon leads to autoimmune diseases. Very often, the disease in question provokes the occurrence of chronic glomerulonephritis, autoimmune hepatitis, rheumatoid arthritis and Sjogren's syndrome.

Chronic fatigue

In addition to the above diseases, the appearance of which can be provoked by the Epstein-Barr virus, it is necessary to mention the syndrome of constant and chronic fatigue, which is quite often associated with herpes and occurs not only in the form of general weakness and rapid fatigue, but also the presence of headaches, apathy and all kinds of disorders of psycho-emotional well-being. Quite often in this regard, relapses associated with acute respiratory diseases. This is how mononucleosis, provoked by the Epstein-Barr virus, manifests itself (pictured).

Symptoms and treatment in children

There is currently no general unified scheme for the treatment of pathology. Of course, in the arsenal of doctors and specialists there are all kinds of specific medicines, such as, for example, Cycloferon, Acyclovir, Polygam, Alfaglobin, Reaferon, Famciclovir and others. But the advisability of their prescription, as well as the duration of administration and dosage volume should be determined exclusively by the attending physician after undergoing a full examination of the patient, including laboratory examination. It confirms pediatrician Komarovsky.

Symptoms and treatment of the Epstein-Barr virus can be limited to the prescription of currently existing medicinal complexes, as well as symptomatic therapy, but only if such a disease is still in the initial stage of its development. In addition, treatment with special corticosteroid medications is used, which can significantly reduce fever and alleviate various inflammations. In some cases, such drugs are used, usually for acute diseases if complications arise.

Malignant formations that are associated with the Epstein-Barr virus cannot be classified as standard forms of mononucleosis. These are completely independent diseases, even though they are caused by the same pathogen. For example, Burkitt's lymphoma is characterized by the appearance of tumors in the area inside abdominal cavity.

Conclusion

Thus, it is clear that it is best if the virus is treated and diagnosed in adult patients before it has a chance to become active. Otherwise, you will most likely have to treat concomitant diseases.

We examined the Epstein-Barr virus. Symptoms and treatment for children and adults are described.

Epstein-Barr virus is one of the most common viruses in the human population. Like most herpes viruses, the Epstein-Barr virus is practically impossible to completely destroy in the body, and therefore everyone infected remains a carrier and potential source of infection for life.

It is not surprising that almost 90% of people on Earth are carriers of the virus in latent or active form. Human infection most often occurs in childhood: every nine out of ten people in contact with a child are potentially capable of infecting him. According to statistics, 50% of children in developing countries receive this virus from their mother in infancy.

However, despite this prevalence of infection, it was studied in detail only relatively recently...

The history of the discovery of the virus and its features

The Epstein-Barr virus was discovered and described in 1964 by two English virologists - Michael Epstein and Yvonne Barr. Epstein was then a professor at a British institute, and Barr worked as his assistant.

Back in 1960, Epstein became interested in the report of the English surgeon Denis Burkitt, who worked in equatorial Africa, about a specific local cancer disease, later called Burkitt's lymphoma. This tumor appeared mainly in children under 7 years of age in Kenya, Uganda, Malawi and Nigeria - countries with hot and relatively humid climates.

After Epstein received a grant from the US National Cancer Institute to study the disease, Burkitt sent him tumor samples. In images using electron microscope a virus was discovered, previously unknown to science, and named “Epstein-Barr virus” after the names of its discoverers.

The virus turned out to belong to the herpesvirus family, the average size of the virion is about 150 nanometers. Unlike many other herpes viruses, the genome of the Epstein-Barr virus encodes approximately 85 proteins - for the herpes simplex virus, for example, this number barely exceeds 20.

Each virion is a spherical capsid containing genetic information. On the surface of the capsid there is a large number of glycoproteins that serve to attach the virus to the surface of the cell and introduce DNA inside it. This mechanism of infection is quite simple and effective, which makes the infection highly contagious: after the virus reaches the surface of a person’s mucous membranes, it is likely to penetrate the cell and begin to multiply there.

Epidemiology and main modes of transmission

Most adults around the world have a strong immunity to the Epstein-Barr virus due to the fact that they were already infected in childhood or adolescence.

The main risk group for infection are children aged 1 year and older, when they already begin to actively communicate with other children and adults. However, in children younger three years infection almost always occurs asymptomatically, and various diseases caused by viruses, usually affects schoolchildren and teenagers.

There are practically no known cases of the consequences of infection with the Epstein-Barr virus in elderly people over 35-40 years of age. Although in rare cases, primary infection may occur at this age, the immune response of the body, which has already encountered related herpes viruses, allows the disease to be transferred in a blurred and very mild form.

The main route of infection with the Epstein-Barr virus is through kissing. Largest quantity viral particles are found in epithelial cells near the salivary glands. It is not surprising that infectious mononucleosis, the most common disease caused by the Epstein-Barr virus, is also called the kissing disease.

The infection can also be transmitted in the following ways:

by airborne droplets;
during blood transfusion;
during bone marrow transplantation.

The important thing is that in a quarter of virus carriers, the particles themselves are constantly found in their saliva. This means that throughout their lives, even in the absence of any symptoms of the disease, such people are active sources of infection.

Virus activity in the body

Unlike many other herpes viruses, Epstein-Barr virus primarily affects epithelial cells of the mouth, pharynx, tonsils, and salivary glands. Here it reproduces most actively.

During primary infection, after an active increase in the number of virions in epithelial tissue they enter the blood and spread throughout the body. A large number of In addition to the salivary glands, they are also found in the cells of the cervix, liver and spleen. Their main target is B-lymphocytes - cells of the immune system.

An important distinguishing feature of the virus is that it does not inhibit or disrupt cell reproduction, but rather stimulates their cloning. As a result, in the acute phase of infection, the number of lymphocytes increases like an avalanche; they fill the lymph nodes, causing them to swell and harden.

Since B lymphocytes themselves are the body’s protective cells, infection of them with a virus leads to a weakening of the immune system. However, the infected lymphocytes themselves are quickly and effectively destroyed by cellular defense systems - T-lymphocytes, T-suppressors and NK-lymphocytes. At the same time, these types of cells themselves are not affected by the Epstein-Barr virus, and therefore, in any case, play important role in the fight against infection. However, in case of immunodeficiency, their number is so small that they cannot restrain the development of the disease.

Note: in the acute phase of infection, for every thousand healthy B-lymphocytes there is one infected. After the body recovers, the carrier of the virus is one B-lymphocyte in a million.

In the case of weakened immunity, an active increase in the number of infected B-lymphocytes leads to the launch of processes of malignant transformation of both the B-lymphocytes themselves and those organs in which the number of viral particles is especially high. The virus itself, without a reliable immune response, attacks the cells of the heart and brain, and in patients with immunodeficiencies it can lead to serious disruptions in the functioning of the central nervous system, heart muscle, and even death.

Diseases associated with Epstein-Barr virus

The best known disease caused by the Epstein-Barr virus is infectious mononucleosis, or Filatov's disease. This disease is characterized by symptoms of fever, elevated temperature, inflammation of the tissues of the pharynx, liver, lymph nodes and spleen, pain in the throat and muscles, changes in blood composition. These symptoms last for several weeks, sometimes up to a month, and then disappear.

Once experienced, infectious mononucleosis is almost never more than a person does not bother you, but the person who has been ill remains a carrier of the virus itself for the rest of his life.

Epstein-Barr virus also causes other diseases. For example:

A proliferative syndrome, characteristic mainly of patients with immunodeficiencies. With this disease, in a short time the number of B-lymphocytes increases so much that it leads to disruptions in the work of many internal organs. With congenital immunodeficiency, many children die from proliferative syndrome before they can be seen by a doctor. Those whom doctors manage to save often develop various forms of anemia, lymphoma, hypogammaglobulinemia, agranulocytosis;
Oral hairy leukoplakia, characterized by appearance on the tongue and inner surface cheeks small tubercles. This disease is one of the first symptoms of HIV infection;
Malignant tumors. This is primarily Burkitt's lymphoma, as well as undifferentiated nasopharyngeal cancer, tonsil cancer and most CNS lymphomas in AIDS.

In addition to these diseases, scientists associate many other types of cancer with the Epstein-Barr virus, but it is not yet possible to speak unequivocally about their etiological connection with it. Viral DNA is often found in cells and cultures of malignant tumors, and therefore experts, at a minimum, accept the possibility that the infection supports the development of a cancerous tumor.

The Epstein-Barr virus is most dangerous for patients with immunodeficiencies, congenital and acquired. For them, most diseases caused by infection or their complications can be fatal.

Infectious mononucleosis

In three out of four cases, infection of the body with the Epstein-Barr virus is accompanied by the development of infectious mononucleosis.

The clinical picture of this disease is quite diverse, and therefore in many cases it can be confused with symptomatically similar diseases.

The incubation period of the disease lasts 1-1.5 months. Only after this the first symptoms appear:

fever;
angina;
swollen lymph nodes;
sore throat;
enlarged spleen and liver;
general malaise;
headache;
chills;
digestive disorders;
jaundice;
periorbital edema;
rash on the body.

The temperature during mononucleosis increases slightly, but lasts for two to four weeks. During the disease, mainly the lymph nodes on the back of the head and neck become inflamed, and in especially severe cases, they enlarge throughout the body.

In the first weeks of the disease, most of its symptoms resemble those of streptococcal sore throat. To distinguish them, it is necessary to carry out special diagnostics. In addition, in medical practice there are often cases when mononucleosis is mistaken for rubella, acute respiratory infections, pseudotuberculosis, diphtheria, hepatitis, leukemia and even HIV.

With an atypical course of the disease, many symptoms may not appear at all, while others may be expressed in an excessively hypertrophied form. Sometimes with mononucleosis, patients develop a severe rash on the body. When taking antibiotics, these rashes are most pronounced.

During laboratory examination of patients with mononucleosis, they are diagnosed with leukocytosis, lymphocytosis, neutropenia and thrombocytopenia. Almost half of the patients experience an increase in bilirubin concentration, and 90% of patients are diagnosed with changes in biochemical parameters of liver function.

Note: due to the increase in the size of the spleen, which is the main depot of lymphocytes in the body, patients with mononucleosis are strictly prohibited from exposing themselves to physical activity. With serious muscle tension, in this case the patient’s spleen may rupture, and if he is not taken to the hospital within half an hour or an hour surgery department, death will come.

But in general, infectious mononucleosis is not fatal. dangerous disease. Fatal outcomes with it are an extremely rare occurrence, occurring mainly in patients with immunodeficiencies.

Typically, three to four weeks after symptoms appear, the disease goes away on its own, even without treatment. Relapses almost never occur, but in some cases, after mononucleosis itself, various complications may appear. Among them:

Lesions of the nervous system - encephalitis and meningitis. Most often found in children;
Damage to the cranial nerves leading to the development of Bell's syndrome, neuropathy, Guillain-Barré syndrome and myelitis;
Autoimmune hemolytic anemia, sometimes accompanied by jaundice and hemoglobinuria;
Obstructive airway disease;
Hepatitis, sometimes with lightning-fast progression;
Myocarditis and pericarditis.

The last three diseases rarely accompany mononucleosis, but lead to quite serious consequences.

Identification of the pathogen in the body

To differentiate mononucleosis from similar diseases, as well as to detect the Epstein-Barr virus in the body in the early stages of its development, several basic diagnostic methods are used:

Serological diagnosis, in which in the vast majority of cases the titer is determined IgM antibodies. A titer of 1:40 is already diagnostically significant, especially with the symptomatic picture characteristic of mononucleosis;
Determination of the titer of specific antibodies to the virus. This method is especially relevant for children who do not have heterophilic antibodies. After suffering from mononucleosis, the titer of specific IgG remains high for life;
Linked immunosorbent assay;
Polymerase chain reaction;
Culture method.

The last three methods make it possible to find viral DNA or viral particles themselves in the blood or individual tissues. In the culture method, virions are grown on a culture of brain cells, Burkitt's lymphoma, or the blood of leukemia patients.

Fighting the virus and treating associated diseases

Today there is no specific treatment for Epstein-Barr infection. With strong immunity, the disease usually goes away on its own without consequences.

In case of a complicated course of the disease, the patient is prescribed antiviral drugs: Acyclovir or Zovirax (which is practically the same thing). Children under 2 years old - 200 mg, from 2 to 6 years old - 400 mg, and over 6 years old - 800 mg 4 times a day for 7-10 days.

IN complex treatment Interferon-type drugs are most often used. Of them:

Viferon-1 is prescribed in rectal suppositories at a dose of 150,000 IU for children under 7 years of age;
Viferon-2 - 500,000 IU for children from 7 to 12 years old;
Viferon-3 1,000,000 IU for children over 12 years of age and adults in the morning and evening for 10 days.

Additionally, patients are prescribed interferon inducers: Arbidol and Cycloferon. The latter is given to children from 4 to 7 years old 150 mg, from 7 to 14 years old - 300 mg, children over 14 years old and adults - 450 mg once on 1, 3, 5, 8, 11, 14, 17, 20. 23 and 26 days of illness. In addition, 5% Cycloferon ointment is effective for treating purulent plaque.

For children under 4 years of age, Cycloferon is administered parenterally at a dose of 6–10 mg/kg.

Human immunoglobulin is traditionally used in therapy against the Epstein-Barr virus. For children over 3 years old, it is administered intramuscularly at 3 ml, for adults - at 4.5 ml 4-5 times with an interval of 48 hours. Polyoxidonium, which has a detoxifying and immunomodulatory effect, is prescribed 6-12 grams intramuscularly for adults, 0.1-0.15 mg/kg for children once a day. Usually 5-7 injections are enough.

During the period of convalescence, Lykopid is indicated - a modern immunomodulator latest generation, as well as natural adaptogens: echinacea, eleutherococcus, Rhodiola rosea and nootropics. In case of a protracted course of the disease, continue taking Cycloferon for 2-3 months with an interval of 5 days.

For the treatment of chronic active infection, they begin to use recombinant alpha interferons: Intron A, Roferon-A, Reaferon-EC.

The management of a patient with infectious mononucleosis depends on the severity of the disease. For mild forms, treatment is carried out on an outpatient basis. During the period of rising temperature it is necessary:

bed rest;
plenty of warm, fortified drinks;
vasoconstrictor nasal drops - Furacilin with adrenaline, Sofradex, Naphthyzin, Sanorin;
gargling with antiseptic solutions - the same Furacilin, as well as Iodinol, chamomile or sage decoctions;
taking vitamins B, C, P, antipyretic and painkillers (Nurofen, Panadol, Paracetamol, Brufen);
use of antihistamines - Claritina for children from 2 to 12 years old, 5 ml of syrup once a day, for children over 12 years old - 10 mg per day, as well as Fenistil, Tavegil, Diazolin, Zyrtek.

In rare cases, with mononucleosis, there is a need for hospitalization of the patient. Indications for this are high fever, severe intoxication, threat of asphyxia, and the development of complications. In the hospital, infusion therapy is carried out with 0.9% sodium chloride solution, 5% glucose solution with vitamins C and B1. If necessary, hepatoprotectors are prescribed: for children over 5 years old, Karsil at the rate of 5 mg/kg of body weight per day, as well as Essential, Galstena.

In case of complications or the addition of a secondary bacterial infection, the use of 3rd generation cephalosporin antibiotics is indicated:

Cefotaxime for children weighing up to 50 kg – intravenously or intramuscularly 50–180 mg/kg for 4–6 injections;
Ceftriaxone for children at the rate of 50–80 mg/kg body weight per day for 2 administrations;
antiprotozoal drugs Metronidazole.

Patients with hematological complications and airway obstruction are prescribed glucocorticoids: Prednisone, Dexamethasone, Prednisolone at a dose of 0.14 mg per kg of body weight per day in 3-4 doses in a short course.

Prevention of complications

It is almost impossible to avoid infection with the Epstein-Barr virus. There is no need to worry about this either: adults almost always already manage to become infected with it and develop immunity.

You should not try too hard to protect a child with a normal immune system from infection with the virus. Moreover: the sooner a child gets sick with mononucleosis, the weaker the disease will develop. Perhaps the baby won’t even notice it. And his immunity will remain with him for life.

For those who suffer from immunodeficiencies, a special vaccine is being developed today, which, according to its creators, will protect the body from infection with the Epstein-Barr virus. This vaccine will also be aimed at children living in third world countries in whom the virus causes the development of lymphomas.

In other cases reliable prevention diseases caused by the Epstein-Barr virus, there will be a systematic and diligent strengthening of the immune system. This is especially true for children of any age. Measures to prevent the development of such diseases must include:

Hardening, starting from infancy, when the child is accustomed to bathing in water at room temperature and staying on fresh air, and systemic cold water therapy throughout life;
Vitamin support for the body, which consists of proper planning of the diet, an abundance of fresh fruits, vegetables and berries in it, as well as taking specialized multivitamin complexes;
Fast and effective fight with any somatic diseases (they weaken the immune system);
Avoidance of stress, both physical and psychological;
Lots of movement, especially in the fresh air.

All these measures will increase the body’s resistance and chances of surviving infection with the Epstein-Barr virus with minimal consequences.

Why is Epstein-Barr virus dangerous?

Tests for Epstein-Barr virus are aimed at searching and isolating the DNA of the herpes virus in the blood, as well as identifying heterophilic antibodies, the presence of which will confirm infection with a 90% probability. In cases where the disease is detected in a child, testing for viral infection is carried out on family members living with the baby. For Epstein-Barr virus, tests - the only way detect the development of mononucleosis.

Institutes of epidemiology have identified the scale of EBV infection, and the data obtained during the study put a figure that fluctuates around 100%. This means that out of ten people on the planet, nine are carriers of altered DNA.

Barra virus, which has oncogenic properties, contains four antigens:

nuclear;
early;
capsid;
membrane

The values of antigens are not equal and a clear understanding of their properties and timing of manifestation makes it possible to establish the clinic of each individual case of detection of the virus.

Infected people rarely realize that the virus is present in their body, and at the same time they transmit it for another year and a half from the moment of infection. Like respiratory infections EBV is airborne with droplets of mucous secretions from the nasopharynx, but since the disease is not accompanied by a cough syndrome, the range of transmission of bacteria is small.

Methods of transmission of the Epstein virus are:

intimate contacts, kisses;
use shared utensils, bed linen, personal hygiene items;
during dental procedures;
by perinatal infection;
during surgical operations, during soft tissue transplantation, infusion of donor blood;
through household items, toys.

EBV is a social disease, and when the virus is detected in young children under three years of age who were born healthy, this indicates poor living conditions in which the child lives. The peak of the disease occurs during puberty in adolescents and varies between 15 and 18 years, more often in young men. Activation of the virus in adults indicates a weakening of the immune defense.

Tests for Epstein-Barr virus

If the basis for research to detect the virus is not a person’s complaints of feeling unwell, then the infection is more often discovered by chance - during preparation for surgery or undergoing a medical examination. The data obtained by collecting information about the state of health speaks only about existing deviations, but only specific tests for mononucleosis can determine the type of viral infection, the level of antibodies in the blood and the stage of the disease.

Biological material is submitted for study in the morning, on an empty stomach. It is not recommended to have a heavy dinner the evening before the procedure - it is better to limit yourself to a light snack no later than 9 hours before the appointed time. 72 hours before the analysis, alcoholic beverages, energy drinks, fatty and sweet flour foods are prohibited. 24 hours before the analysis, strong tea and coffee, highly carbonated water and drinks are prohibited.

In the case of taking vital medications, complete information about them, along with the treatment regimen, is provided to the doctor who will interpret the tests. Medicines that can be discontinued should be stopped 14-12 days before the collection of the study material.

Complete blood test for Epstein Barr virus

EBV, which is in a state of activity, is detected in altered levels of the following important indicators:

the leukocyte level is elevated, up to values greater than 9 G/l. Leukocytosis is considered the main reason for suspicion of Barr virus;
red blood cells remain normal (in men 4-5.1 million per µl and in women 3.7-4.7 million per µl), however, with a prolonged course of infection, these elements become characterized by rapid sedimentation;
hemoglobin drops to 90 g/l or lower, which already indicates an anemic state;
monocytes change not only quantitatively, upward, but also in external deformation. With the typical development of the Epstein virus, up to 40% of the elements of altered monocytes are detected in the blood. But, even if the percentage is less than ten, but other signs indicating EBV are present, the diagnosis is not considered refuted.

Biochemical analysis

The analysis for biochemical research is more detailed than general and shows the presence of acute phase protein substances, alkaline phosphatase (more than 90 units/l), the amount of bilirubin, aldolase (3 times more than normal), the actual presence of AST, LDH, ALT.

Bilirubin of the indirect fraction is already an indicator of such a viral complication as autoimmune anemia.

Heterophilic test

A test that detects heterophilic antibodies with almost 100% probability indicates Epstein already a month after infection, when the presence of substances in the blood reaches its highest concentration.

If testing for heterophile antibodies was preceded by a course of antibiotics or complex antiviral drugs, you should stop taking them 14 days before the examination. Also, the result is distorted if there is a history of hepatitis, leukemia, or chronic lymphoma.

Serological studies

The serological diagnostic method involves collecting biological material from the mucous membrane of the nasopharynx - the sample sample can be saliva. In rare cases, cerebrospinal fluid is taken as a sample.

Upon infection, antibodies with a characteristic-specific value are produced and mature in the patient’s blood.

IgG to early hypertension (EA)

The presence of cells is characteristic of the acute course of virus barr, since when obvious symptoms are relieved, these elements are not detected in the body. If the transcript repeatedly notes the presence of antibodies, this indicates that the disease has entered a chronic phase, which is characterized by periods of remission and relapse.

IgM antibodies to capsid protein (VCA)

Antibodies are characterized by early occurrence and are an indicator of the acute clinical picture of the disease. Cells of this type are found during secondary infection, and determination of the titer over a long period indicates the transition of the virus to a chronic state.

IgG antibodies to capsid antigen (VCA)

These antibodies are observed in the blood many years after infection, and residual titers are present in infected person to death. When introduced into the body for the first time, these elements manifest themselves immediately, but their highest activity and abundance are noted at 9-10 weeks from the moment of infection.

IgM antibodies to early hypertension (EA)

Antigens of this type are detected in the blood long before the disease manifests itself as symptoms, but the antigens reach their highest value in the first two weeks after production. Towards the end of the first month, their values gradually decline. After 2-5 months, elements of this type eliminate themselves.

IgG antibodies to nuclear or core Ag (EBNA)

Cells of this value reach their maximum expression later - at 5-6 weeks after infection, but titers of these elements are observed for another 2-3 years after recovery.

PCR diagnostics

Polymer chain reaction(PCR), does not identify the specific sample on which the analysis is taken. As prescribed by the doctor, an appropriate option is selected, which is most often whole blood taken into a flask with an EDTA solution (6%). The DNA of the virus found confirms the presence of EBR (Epstein-Barr virus).

In the early stages of the disease, when the virus has not yet begun to spread throughout the body, PCR does not show deviations from the norm, but this result refers to the misunderstood.

The method is used in children whose immune system is not established and does not allow relying on serological examinations. When decrypting, the data obtained is differentiated for the purpose of comparison with other viruses.

Prevention

Since primary EBV infection occurs in childhood or adolescence, it is the observance of the rules of personal hygiene and culture of communication with the opposite sex that helps reduce the threat of infection.

The only effective preventive measure is to instill in a child from early childhood a set of life axioms:

items by hygienic care, cosmetics must be individual;
fidelity to one sexual partner is the principle of health for both;
distance must be maintained from people who are obviously sick, with signs of respiratory or other diseases;
You can’t ignore food and mineral supplements, natural vitamins and everything that improves immunity;
a balanced diet, a daily routine with eight hours of sleep - this is 70% of a person’s health.

If the virus does enter the family, the patient is isolated in a separate room, the room is often ventilated and the doctor’s recommendations are followed.

The Epstein-Barr virus is in a dormant state in 90-97% (according to various sources) of people on the planet, but this does not mean that everyone will have to face severe symptoms of complications associated with the activation of altered cells. Immune protection The body constantly monitors the composition of the blood and the presence of foreign antigens in it, and in the event of the development of harmful activities, it immediately signals a deterioration in well-being. Not to miss the first signs of the disease and to protect yourself and your children from provoking factors of infection is a task that every adult can do.

Epstein-Barr infection is caused by a virus that belongs to the herpes family of viruses. The most common manifestation of this infection is mononucleosis. However, Epstein-Barr virus can also cause tumors such as Burkitt's lymphoma and nasopharyngeal cancer.

Epstein-Barr virus. Photo from ru.wikipedia.org

Even in the scientific literature you can find many readings of the name of the disease: Epstein-Barr infection, Epstein-Barr infection, etc. However, there should be no disagreement here. Sir Michael Epstein, the famous British virology researcher, is a man. Virologist Yvonne Barr is a woman. That's why the disease is called Epstein-Barr infection.

History of discovery and study

Infectious mononucleosis was first described at the end of the 19th century. Doctors of that time knew this disease as an acute glandular fever, occurring with symptoms of lymphadenopathy (enlarged lymph nodes), enlarged liver and spleen against a background of increased body temperature.

However, many more years passed before the causative agent of infectious mononucleosis was identified. This is largely due to the fact that scientists did not take into account the widespread prevalence of the disease, which is why most people are seropositive, i.e. have antibodies to the virus in their blood.

In 1964, Epstein and Barr described a virus they found in Burkitt's lymphoma cells. This infectious agent was later named Epstein-Barr (EBV).

In 1968, Henle reported a possible connection between mononucleosis and the Epstein-Barr virus. This assumption was confirmed in 1971 in a study by Sawyer et al.

Prevalence of the disease

It is believed that by the age of 25, 90% of the population are carriers of the Epstein-Barr virus. Infection can take the form of acute mononucleosis, but is often completely asymptomatic.

Both women and men suffer from EBV at the same frequency. The likelihood of the disease does not depend on race. Among people with low incomes, the prevalence of EBV carriage is higher, but their disease is more often latent.

After the acute phase of the disease, the person remains a carrier, which is typical for the entire family of herpes viruses.

How is EBV transmitted?

The virus is transmitted only from person to person and is contained in the oropharyngeal mucus and saliva of newly infected people for 12-18 months. In 20-30% of them, EBV can be detected in saliva throughout life.

The virus is transmitted by airborne droplets with saliva and through household objects, but is not very contagious.

Based on the results of epidemiological studies, it is known that the frequency of the appearance of antibodies to EBV in previously uninfected students whose roommates are carriers of the virus does not differ from the average figures in the student environment.

The virus can also enter the body of a previously unaffected person during a blood transfusion or bone marrow transplant.

The incubation period of the disease ranges from 30 to 50 days, but can be greatly reduced in young children.

Symptoms of infectious mononucleosis

The acute phase of the disease usually lasts 2-3 weeks, but can drag on for a longer period.

Complaints

Typically, patients with acute infection complain of sore throat and abdominal pain, headaches, muscle pain, fever, difficulty in nasal breathing, and nausea.

Sore throat is the most common symptom mononucleosis. Gradually intensifying during the first week, the pain can be very pronounced.

The headache also appears in the first week and may be felt behind the eyes.

Abdominal pain is usually associated with an enlarged spleen, and is therefore felt in the left upper quadrant of the abdomen. Nasal breathing may worsen due to enlargement of the nasopharyngeal tonsil (adenoids).

Body temperature rises to 38-39 degrees.

Objective symptoms

Objectively, infectious mononucleosis is manifested by tonsillopharyngitis (tonsillitis), enlarged lymph nodes throughout the body, and enlarged liver and spleen. A rash may also appear.

When examining the throat, you can see enlargement and redness of the palatine tonsils. In about a third of cases, a thick yellowish inflammatory fluid is found in the lacunae of the tonsils. Often on the border between soft and hard palate small submucosal hemorrhages are visible. The picture of inflammation in the throat with mononucleosis is similar to ordinary lacunar tonsillitis and is often mistaken for it.

When examining the nasopharynx through the nose or through the mouth with a special mirror, the doctor may note an enlargement and redness of the nasopharyngeal tonsil.

Lymph nodes in mononucleosis enlarge symmetrically. The posterior cervical, anterior cervical, submandibular, axillary, inguinal, and ulnar groups of lymph nodes are affected. When palpated (feeling), they are slightly painful and mobile.

Enlargement of the liver and spleen is common. However, jaundice in patients with mononucleosis is relatively rare.

The spleen rapidly enlarges in the first week of illness. This carries the risk of organ rupture with minimal trauma. Cases of spontaneous splenic rupture have been described.

In a small number of cases (up to 15%), a pale maculopapular rash may appear on the skin throughout the body. The likelihood of a rash increases significantly if mononucleosis is mistakenly treated with penicillin antibiotics. This treatment is relatively often prescribed when a mononuclear throat infection is mistaken for a common streptococcal sore throat.

Diagnostics

Diagnosis of infectious mononucleosis is based on the clinical picture and laboratory tests.

The three classic laboratory symptoms of mononucleosis are:

lymphocytosis (an increase in the number of lymphocytes in a blood test - blood cells responsible for fighting viruses);
the presence in the blood test of at least 10% mononuclear cells - atypical lymphocytes;
positive serological tests (detection of antibodies to EBV in the blood).

General blood analysis

In a general blood test, you can usually see leukocytosis - an increase in the number of white blood cells in the blood. This is not specific sign the presence of infection in the body, along with an increase in ESR.

Lymphocytosis is observed in 80-90% of people with mononucleosis. Typically, with EBV infection, up to 20-40% of atypical mononuclear cells can be detected in the blood. But sometimes these cells can be less than 10%. Their absence does not exclude the diagnosis of mononucleosis.

Liver tests

Almost all patients with mononucleosis experience a temporary increase in the level of bilirubin and liver enzymes - aminotransferases. Changes in the biochemical characteristics of liver function can be observed for up to 3 months. However, this is not a specific sign of the disease.

Serological method

In practice, most often it is enough to make an accurate diagnosis. clinical picture and general blood test. In some cases, it may be necessary to determine antibodies to EBV.

Already in the incubation period of mononucleosis, acute phase IgM antibodies to the Epstein-Barr virus can be detected in the blood serum. A few months after the symptoms of the disease disappear, IgM ceases to be detected in the blood.

A person who has had Epstein-Barr virus infection retains IgG antibodies for life. .

PCR for EBV infection

PCR (polymerase chain reaction) is of limited value in mononucleosis. The method can detect the presence of viral genetic material in blood serum. In the case of asymptomatic carriage of the Epstein-Barr virus, detection of viral DNA in the blood often indicates reactivation of the infectious process. PCR can also act as a means of monitoring the effectiveness of treatment in complicated cases.

How to treat Epstein-Barr virus infection

With Epstein-Barr virus the immune system A person usually copes independently and does not need specific treatment. All that is necessary is to provide the body with optimal conditions for recovery (rest, sufficient fluid intake).

Drug treatment for mononucleosis is aimed at relieving symptoms. The patient is given painkillers and antipyretics.

In rare cases, when the enlargement of the tonsils is so pronounced that it causes a narrowing of the airway, steroid hormones are prescribed for anti-inflammatory and decongestant purposes.

Diet changes for mononucleosis are not required, except in cases where a person does not swallow food due to a sore throat and enlarged tonsils.

There is no need to isolate the patient during treatment due to the low contagiousness of the infection.

A patient suffering from mononucleosis can be treated on an outpatient basis (without hospitalization). In rare cases (when the spleen ruptures), surgical treatment is necessary.

It is precisely because of the risk of splenic rupture during the treatment of mononucleosis that restrictions are imposed on physical activity patient. Heavy lifting and contact sports should be avoided for 2-3 weeks. Some doctors consider longer periods justified - up to 2 months after recovery.

Prognosis, complications, danger of chronic form

The prognosis for infectious mononucleosis in people without immunodeficiency is favorable. Sometimes patients (usually women) feel uneasy for up to 2 years after treatment chronic fatigue.

Complications of EBV infection include narrowing of the airways, rupture of the spleen, meningitis, hepatitis, thrombocytopenia (a decrease in the number of blood cells responsible for stopping bleeding), hemolytic anemia(anemia). However, they are rare.

More often there are complications such as otitis media and sinusitis.

In addition to infectious mononucleosis, the virus can cause the development of certain types of lymphoma, as well as nasopharyngeal carcinoma. However, given the almost universal prevalence of EBV in the population, this risk is small. Specific mechanisms, which determine tumor development only in some carriers of the virus, are not clear.

The Epstein-Barr virus from the herpes virus family (herpes type four) is called the most highly contagious and common viral infection. According to statistics world organization health care, up to 60% of all children and almost 100% of adults are infected with this virus. However, research on this virus began relatively recently and therefore it cannot be said that the virus has been fully studied.

What is EBV infection?

Epstein-Barr virus is transmitted in the following ways:

The source of EBV infection is only people who most often suffer from an asymptomatic and latent form. Moreover, a person who has recovered from this virus remains infectious to others for many more years. The virus enters the body through the respiratory tract.

The following categories of people are most susceptible to infection with the Epstein-Barr virus:

children under 10 years old;
people with immunodeficiency;
HIV patients, especially AIDS category;
pregnant women.

Classification of EBV infections

Acute infection with the virus is not very dangerous for humans. Great danger represents a tendency to form tumor processes. A unified classification of viral infection (VIEB) has not yet been invented and therefore practical medicine offers the following:

Diseases caused by EBV:

chronic fatigue syndrome;
lymphogranulomatosis;
immune deficiency;
Infectious mononucleosis;
intestinal and stomach tumors, salivary glands;
malignant formations in the nasopharynx;
systemic hepatitis;
lymphomas;
lesions of the spinal cord and brain (or otherwise multiple sclerosis);
herpes.

Epstein-Barr virus: symptoms of the disease

Polyadenopathy is the main symptom of EBV in acute form. The symptom is characterized by an increase in the anterior and posterior cervical lymph nodes, as well as occipital, submandibular, supraclavicular, subclavian, axillary, ulnar, femoral and inguinal lymph nodes.

Their diameter is about 0.5–2 cm, they are doughy to the touch, slightly painful or moderately painful. The maximum stage of polyadenopathy is observed on days 5–7 of the disease, and after two weeks, the lymph nodes gradually decrease.

Infectious mononucleosis - acute infection or abbreviated as OVIEB, the incubation period of which ranges from two days to 2 months. The disease begins gradually: the patient experiences increased fatigue, malaise, and sore throat. The temperature rises slightly or remains normal. A few days later, the temperature reaches 39–40 °C, and intoxication syndrome begins.
The symptom of polyadenopathy also affects the palatine tonsils, as a result of which signs of tonsillitis appear and the nasal breathing, the voice becomes nasal, pus forms in the back of the throat.
Splenomegaly, or enlargement of the spleen, is one of the late symptoms. After 2–3 weeks, sometimes after 2 months, the size of the spleen returns to its original state.
The symptom of hepatomegaly (or enlarged liver) is less common. This symptom is characterized by dark urine and mild jaundice.
Nervous system also suffers from acute Epstein-Barr virus. Serous meningitis may develop, sometimes meningoencephalitis, encephalomyelitis, polyradiculoneuritis, but, as a rule, focal lesions regress.
Other symptoms are possible in the form of various rashes, spots, papules, roseolas, spots or hemorrhages. Exanthema lasts about 10 days.

Diagnosis of Epstein-Barr virus

The diagnosis of chronic or acute EBV is made based on clinical manifestations, complaints and laboratory data.

General blood analysis. An increase in leukocytes, ESR, an increase in monocytes and lymphocytes, and the appearance of atypical mononuclear cells are diagnosed. An increase or decrease in the level of platelets and hemoglobin is possible (autoimmune or hemolytic anemia).

Based biochemical analysis blood, an increase in ALT, AST, LDH and other enzymes is detected, acute phase proteins (fibrinogen, CRP), an increase in bilirubin, and alkaline phosphatase are detected.

Immunological study- assess the level of interferon, immunoglobulins, etc.

Serological reactions . Serological tests help determine the immune response to EBV, but the virus content in the blood is not determined. Serological tests can detect antibodies to EBV infection:

M-class antibodies (IgM) to the capsid antigen (VCA) - are formed during the acute phase from the very beginning of infection until six months from the onset of the disease or during exacerbation chronic infection VEB.
G-class antibodies (IgG) to antigen (VCA) - these immunoglobulins are formed after the acute stage of the disease (three weeks after infection), during convalescence their number increases, in addition, they are detected after the disease throughout life.
Antibodies G (IgG) to early antigen (EA) - similar to the M-class, these antibodies are produced during the acute phase of EBV infection (in the interval from one week to six months from the moment of infection).
Late G-class antibodies (IgG) to nuclear antigen (EBNA) - occur with complete recovery, usually six months later, and characterize persistent immunity to EBV infection. Let's explain what a positive result for EBV antibodies means.
A positive result determines the level of immunoglobulins above the established norm. Each laboratory has its own standard indicators, which depend on determination methods, types of equipment and units of measurement. For convenience, the norm indicators are indicated in the columns of the results obtained.

PCR diagnostics of Epstein-Barr virus

Diagnostics using the polymerase chain reaction method is laboratory method research not aimed at identifying immune reaction, but to determine the presence of the virus itself, its DNA, in the body. This diagnostic method is modern and has an accuracy of 99.9%.

The PCR method allows examine blood, sputum, washings from the nasopharynx, biopsy formations various tumors. PCR for the Epstein-Barr virus is prescribed if there is a suspicion of a generalized EBV infection, in immunodeficiencies such as HIV, in complex or questionable clinical cases.

The method is also widely used to detect various cancer diseases. PCR is not used to study the Epstein-Barr virus as the first analysis, since this kind of analysis is very complex and very expensive.

Only 2 PCR results for EBV differ: positive and negative results. The first indicates the presence of EBV DNA in the body and active process Epstein-Barr virus. A negative result, on the contrary, indicates the absence of the virus in the body.

According to indications, it is possible to carry out other research and consultations. Consultations with an immunologist and ENT doctor, radiography paranasal sinuses nose and chest, Ultrasound of the abdominal cavity, blood clotting tests, consultations with a hematologist and oncologist.

Epstein-Barr virus: treatment methods

Completely recover from herpetic viruses impossible, even using the most modern methods treatment, since EBV, although not in an active state, still remains in B lymphocytes and other cells for life.

If the immune system weakens, the virus may become active again and the EBV infection may worsen. Neither scientists nor doctors still have a common opinion on how to treat EBV, and therefore in our time a lot of research is being carried out in the field antiviral treatment. There are still no effective specific drugs to combat EBV infection.

In the acute course of infectious mononucleosis, it is necessary maintain a gentle diet and regimen: limit physical activity, maintain semi-bed rest, drink plenty of fluids, eat frequently, in a balanced manner and in small portions, while excluding spicy, fried, salty, sweet, and smoked foods from the diet.

Have a beneficial effect on the course of the disease dairy products. It is important that the diet contained many vitamins and proteins. It is better to avoid those products that contain chemical preservatives, flavor enhancers, and dyes. It is necessary to remove allergenic foods from the diet: citrus fruits, chocolate, honey, legumes, some fruits and berries.

When treating chronic fatigue syndrome, it will be useful to adhere to a normal schedule of work, rest and sleep, active physical activity, positive emotions, doing what you love, good nutrition and a multivitamin complex.

Drug treatment for EBV infection

The principles of treatment for EBV in adults and children are the same, the only difference is in dosages. Antiviral drugs inhibit the activity of EBV DNA polymerase. This group includes: Pacyclovir, Acyclovir, Cidofovir, Gerpevir, Foscavir.

These medications are only effective when oncological diseases, generalized EBV infection, chronic course of the disease and the appearance of complications.

Other drugs have nonspecific immunostimulating and antiviral effect , among which are: Viferon, Interferon, Cycloferon, Laferobion, Arbidol, Isoprinosine (Isoprinosine), Remantadine, Uracil, IRS-19, Polyoxidonium and others. These drugs are prescribed only for severe course diseases.

Immunoglobulins such as Polygam, Pentaglobin, Bioven recommended for exacerbations chronic EBV, as well as for recovery after acute period infectious mononucleosis.

These immunoglobulins contain ready-made antibodies that bind to Epstein-Barr virus virions and remove them from the body. Highly effective in the treatment of chronic and acute VEB. They are used only in stationary clinics in the form of intravenous drips.

Antibacterial drugs include: Lincomycin, Azithromycin, Cefadox, Ceftriaxone and others. But antibiotics are prescribed exclusively when a bacterial infection is attached, for example, when bacterial pneumonia, purulent sore throat.

Treatment of the disease selected individually based on the severity of the disease, the presence of relevant pathologies and the patient’s immunity status.

Chronic fatigue syndrome is possible treat antiviral drugs : Herpevir, Acyclovir, Interferons; vascular drugs: Cerebrolysin, Actovegin; drugs that protect nerve cells from the virus: Encephabol, Glycine, Instenon, as well as antidepressants, sedatives and multivitamins.

The use of folk remedies in the treatment of Epstein-Barr virus

Drug therapy is effectively complemented traditional methods treatment. Nature has a large arsenal for strengthening the immune system.

Herbal collection cannot be used children under 12 years of age and pregnant women. The collection includes: peppermint, chamomile flowers, coltsfoot, calendula flowers, ginseng.

Herbs are taken in equal proportions, stir and brew tea: per 1 tablespoon herbal collection 200.0 ml boiling water. Wait for brewing for 10–15 minutes. Take this infusion three times a day.

Green tea with honey, lemon and ginger increases the body's defenses. Fir oil is used externally. And also use raw egg yolks: on an empty stomach every morning for 2–3 weeks. They promote good liver function and contain many useful substances.