Epstein Barr virus chronic associated. Latent infection. Epstein-Barr virus

The Epstein-Barr virus is capable of being dormant for many years, and appearing when the body's immune forces are weakened. If the cervical or axillary lymph nodes are enlarged, there is soreness in the throat, there are frequent relapses pharyngitis and all this is combined with impotence, it is worth learning more about the symptoms and treatment of herpes caused by type 4 virus.

Epstein-Barr virus - what is it?

Epstein-Barr virus - EBV for short or as it is also called Epstein Barr virus, Human herpes virus type 4 (EBV, HHV-4) - representative herpetic infection. According to WHO, this type of virus is considered common, out of 10 people 9 are its carrier. Viral infection of strain 4 is poorly understood, it began to be investigated not so long ago, about 40 years ago.

Form and structure

The shape of the virus particle is specific, within a radius of 90 nm (nanometers). The virus consists of an inner and outer shell, a capsid and a core. On its surface are glycoproteins.

The Epstein-Barr virus particle includes antigens (capsid protein, early, nuclear antigen or nuclear and membrane).

The structure of the herpes virus particle type 4

Causes of Epstein Barr virus

Type 4 herpes is such a common disease that many people experience it in childhood.

Carriers of viruses and sources of infection are considered to be:

• a person with an active form of the disease, in the last days after the microbial agent enters the body, before the manifestation of pronounced symptoms and after;
• six months after infection;
• 1 in 5 who once had the disease remains a carrier of the virus for the rest of their lives.

How is the Epstein-Barr virus transmitted:

1. Contact household way. Use common utensils and things intended for the care of the body, hair and teeth, a less common way than kissing or oral sex.
2. Airborne route. Occurs when talking with a carrier of the virus, when coughing or sneezing.
3. Infection through blood. Blood transfusion can become a source of infection for a healthy person. In drug addicts, infection occurs through a syringe.
4. Infection from mother to child. Dangerous periods are pregnancy, breastfeeding and childbirth itself.

EBV infection can occur through kissing

There is an alimentary way of transmission of herpesvirus (through food and water), but this theory does not play a special role in the spread.

The risk group includes:

• children from 2 to 10 years old (a child who has not reached the age of one is less likely to be infected due to the maternal antibodies received);
• people with HIV and AIDS;
• women during pregnancy;
• with immunodeficiency.

The development of the virus in the body

Active reproduction of EBV begins with its contact with the mucous membranes of the oral cavity and larynx (tonsils and adenoids). Through the capillaries, the viral particle enters the bloodstream and spreads throughout the human body. Available affected immune cells are destroyed, which is the reason for the enlargement of the lymph nodes.

If the body's defenses are weak, it cannot block the reproduction of a herpes infection and the disease becomes chronic form. With high immunity, the disease can be bypassed.

EBV enters the blood through the capillaries

Why is EBV dangerous for humans?

The most common danger posed by the Epstein-Barr virus is infectious mononucleosis (Filatov's disease). With strong immunity, the disease may not be diagnosed. But if the disease is detected in time, correct treatment is given, then we can expect not only recovery, but also the development of lifelong immunity at this stage.

If we allow the development of the virus and do not detect EBV in time:

• inflammatory processes in the liver (toxic hepatitis);
• accession of a bacterial infection and the development of purulent;
• inflammation of the brain and spinal cord;
• violation of the integrity of the spleen (its rupture);
• hypocoagulation;
• inflammation of the lungs (viral, bacterial).

Other consequences, which lead to infection with herpesvirus type 4, have also been recorded:

• chronic fatigue syndrome (CFS) occurs when the autonomic nervous system is affected;
• generalized forms of VEB;
• oncological diseases (lymphoma, Burkitt's lymphoma, cancer of the nasopharynx, tonsils, adenoids, esophagus, stomach and small intestine;
• change in immunity;
• blood diseases;
• appearance autoimmune diseases.

Type 4 herpes infection leads to hepatitis and infectious mononucleosis

Symptoms of Epstein Barr virus

The clinical manifestations of the disease differ depending on the climate. In a temperate climate, many of the complications develop asymptomatically (have a subclinical form of the disease), for example, mononucleosis.

How does infectious mononucleosis manifest?

1. Signs characteristic of ARI. Deterioration of general well-being, loss of strength, fever, runny nose and nasal congestion, inflammation of the lymph nodes.
2. Symptoms accompanying hepatitis. Pain in the hypochondrium on the left side due to enlargement of the spleen and liver, jaundice is possible.
3. Signs of angina. The throat becomes red, there is pain, cervical The lymph nodes increase.
4. Symptoms characteristic of intoxication. Increased sweating, weakness, pain in muscles and joints.

Other symptoms of EBV are also noted:

• have breathing problems;
• a person is tormented by a cough;
• concerned about frequent headaches and dizziness;
• it becomes difficult to fall asleep, and the dream itself is restless;
• distracted attention;
• memory impairment;
• aggression;
• irritability.

Sore throat, inflammation of the lymph nodes, fever may indicate infection

Clinical manifestations of acute and chronic stage are different.

Symptoms of chronic viral infection:

• the number of red blood cells and hemoglobin in the blood decreases, which leads to anemia;
• increased fatigue is noted, which does not go away even after a long rest, in medicine this is called chronic fatigue syndrome;
• skin and mucous membranes are susceptible to fungi, bacteria and viruses much more often than in healthy people - this is caused by a weakening of the body's immune forces;
• the risk of the appearance and development of benign and malignant tumors becomes higher - oncology;
• chronic virus carriers have autoimmune diseases - rheumatoid arthritis (connective tissue disease affecting small joints), lupus erythematosus (a pathology that affects both connective tissues and blood vessels), "dry syndrome" or Sjögren's disease ( inflammatory processes and dryness of the mucous membranes of the eyes and mouth).

Features of manifestation in children

In children preschool age, as well as up to 12 years, the disease is often asymptomatic. After infection, there is no fever, inflammation and other characteristics. This is due to a stronger immune system.

Due to age characteristics in adolescents after 12 years of age, the immune system weakens. It happens in the background hormonal disorders. Therefore, the symptoms of the disease have a vivid character: the temperature rises, the lymph nodes and spleen increase, the throat hurts a lot.

If the virus entered the body through the nasopharynx or the mucous membrane of the mouth, then the incubation period becomes shorter (from 10 to 20 days). But recovery in children usually occurs faster than in the older generation.

In adolescence, the disease is more difficult

Which doctor should I contact?

If you find yourself with most of the above symptoms, you should consult a doctor.

An infectious disease specialist and an immunologist will help to deal with the resulting problem. If there are no such specialists in the hospital, then they will be able to collect an anamnesis, send for further examination and conduct an examination:

• pediatrician - in children;
• therapist - in adults.

You can also get advice from an ENT specialist, a hematologist and an oncologist.

Timely access to a doctor eliminates the possibility of serious complications

Diagnosis of the disease

It is impossible to determine type 4 herpes infection solely after examination and history taking, as it is similar to cytomegalovirus (herpes 6 strain). To get the correct treatment, several tests are taken that help to identify not only the type, but also help to distinguish the acute stage from the chronic one.

1. General blood analysis. They talk about the presence of VEB elevated white blood cells, lymphocytes, monocytes and erythrocyte sedimentation rate, detection of virocytes (white blood cells). Deviations from the norm of platelets and hemoglobin are not excluded.
2. Blood chemistry. The presence of the virus is indicated by an increase in enzymes from the group of transferases (AST and ALT), lactate dehydrogenase (LDH), the presence of c-reactive protein and fibrinogen, and an increase in bilirubin.
3. Immunogram. This research method allows assessing the state immune system.
4. Serological reactions (enzymatic immunoassay, ELISA). Determine the number and class of immunoglobulins. In the acute stage, IgM dominates, after about 3 months it becomes higher than IgG.
5. PCR diagnostics. hypersensitive laboratory method studies to detect any DNA and RNA. Almost any biomaterial can be used: saliva, cerebrospinal fluid, smear from upper respiratory tract, biopsy internal organs.

Any material is used to conduct PCR studies

Epstein-Barr virus treatment

Specially selected drugs will reduce the risk of developing the virus and eliminate the unpleasant manifestations of the disease.

Medical therapy

For EBV treatment pharmaceutical drugs are prescribed:

1. medicines with antiviral action- to block the synthesis of DNA, a multiplying virus. Valtrex, Famvir, Tsimeven, Foscarnet - the duration of treatment is up to 2 weeks.
2. Immunostimulating and immunomodulating agents of the interferon group (Interferon-alpha, Reaferon, Imunofan).
3. Corticosteroids are highly effective anti-inflammatory drugs, hormones (Prednisolone).
4. Immunoglobulins - for the ability to increase the body's defenses to strengthen the immune system. The drug is administered intravenously.
5. Thymus hormones - help prevent possible infectious complications.

The effectiveness of antiviral treatment has not been proven. The use of other drugs in this group may also not always be useful due to the presence of a large number of side effects.

Immunostimulants are administered intramuscularly

Treatment of herpesvirus type 4 folk remedies

It will be effective if the treatment with medicines is combined in combination with non-traditional methods of medicine. Therapy by folk methods is mostly aimed at increasing immunity.

echinacea tincture

Help improve metabolic processes, in the body, increase efficiency, relieve fatigue, act as an immunostimulant and increase resistance to various colds.

A medicinal extract can be bought inexpensively at a pharmacy (it costs about 40 rubles) or prepared independently at home:

• 50 g of chopped grass pour 1 liter of vodka;
• put in a dark place for 3 weeks and let it brew, shake the remedy periodically;
• strain after 3 weeks.

Tincture is taken 25 drops three times a day for half an hour before meals.

Tincture is contraindicated for hypertension, insomnia and AIDS

Ginseng tincture

To avoid diarrhea, insomnia, vomiting, nosebleeds, the dosage should be strictly observed. It is not recommended to use a prescription for the treatment of EBV in people with hypertension, hyperexcitability and individual intolerance to ginseng. Also, the tincture is contraindicated for pregnant women and children under the age of 12 years.

You can purchase a ready-made pharmacy package with medicine at a price of 50 rubles or use a recipe for making at home:

• grind dry ginseng root into powder;
• 30 g of the resulting powder pour 1 liter of vodka;
• let the product brew for 4 weeks, periodically shaking the container with the contents;
• after 4 weeks, strain the finished product.

Take 5-10 drops of ginseng-based medicine twice a day 30 minutes before meals.

The root of the plant is used in dry form.

fir essential oil

Intended for external treatment. Fir oil lubricates the skin over the inflamed lymph nodes.

Teas to increase the body's defenses

For brewing healthy tea you will need additional components that have medicinal properties and contain vitamins.

1. Green tea, honey, ginger and lemon. In 1 tsp. tea, add 7 grams of peeled and sliced ​​ginger, pour all 250 boiling water, after 10 minutes add a slice of lemon and let it brew for 5 minutes, and only then put 1 tsp. honey.
2. Tea with mahonia root and Oregon grapes. 1 tsp. dry raw materials add to the drink.

Daily intake of tea strengthens and heals the body

The famous doctor Komarovsky draws a parallel between herpesvirus 4 strains and chickenpox - both diseases are easier to tolerate in childhood. The later the infection occurs, the more likely the risk of severe complications.

Prevention

It will not be possible to get rid of the virus forever, it will remain in B-lymphocytes for life, this is beyond the power of even the best modern means. Herpesivrus will always be able to remind of itself with a decrease in immunity. To prevent this from happening, you can support your body:

• compliance with the daily routine;
• maintaining healthy lifestyle life;
• adjusting your diet
• vitamin intake.

Avoid casual sex, limit contact with sick people and surround yourself with positive emotions.

During the period of the disease, the patient should observe bed rest, limit physical activity, eat small portions, but often, exclude spicy, salty and sweet foods that are difficult for the stomach, liver, spicy, salty and sweet foods from the menu. Enrich your body with a complex of vitamins and nutrients. Compliance with all recommendations contributes to a speedy recovery.

And etc.). Each of the species has its own characteristics of manifestation and the degree of danger to human health. Epstein-Barr virus belongs to the fourth type, its symptoms and treatment will be discussed by us today.

Features of the disease

The type of virus is one of the most common. It is known that most often the acquisition of the virus occurs in childhood. According to statistics, half of the child population has had an infection and have antibodies in their blood.

In adulthood, the virus covers the remaining fifty percent of the population, and almost everyone, under some circumstances, came into contact with an infected patient and also suffered the disease.

Therefore, despite the fact that the infection is highly contagious, infection between people does not happen very often, because in adulthood, almost everyone already has antibodies developed in the blood.

The disease is often insidious and may also have symptoms. colds.The manifestation inherent in this diagnosis is an increase in lymph nodes. Features that distinguish the course of the disease in different population groups are not observed.

Doctor Komarovsky will tell about the features of the Epstein-Barr virus in this video:

Classification

Diseases caused by the virus have a variety of forms of manifestations. Classification of the disease according to various criteria:

• the activity phase can be:
  • active,
  • inactive;
• signs indicating when infection occurred:
  • acquired form,
  • infection in the womb;
• the disease is caused by:
  • Epstein-Barr virus only
  • in combination with other viruses, for example,;
• manifestation form:
  • atypical:
    • causes organ disease
    • erased,
    • asymptomatic;
  • typical,
• aspect expressing the duration of the disease:
  • chronic course,
  • acute form,
  • protracted illness;
• according to the severity of the manifestation:
  • heavy
  • medium severity,
  • light form.

Causes

It is possible to become infected with the virus under the following circumstances:

• by airborne droplets,
• the child can get the virus from the mother during fetal development,
• transmission of the virus is possible when kissing a sick person,
• as well as through personal hygiene items,
• by transfusion of blood from an infected donor.

Epstein-Barr virus symptoms in children and adults

A person infected with the virus may not experience any discomfort, that is, the disease in this case is asymptomatic. The most common manifestation of the virus is infectious mononucleosis. The symptoms of the disease are similar to those of a cold.

• fatigue,
• pharyngitis,
• diarrhea,
• poor health,
• pain in the muscles,
• pneumonia,
• lymph nodes are enlarged
• stomach ache,
• may be ,
• vomit,
• sometimes - herpetic eruptions,
• tests can reveal:
  • thrombocytopenia,
  • leukopenia;
• an increase is rarely observed:
  • spleen,
  • liver.

You already know about the symptoms, but read below about tests for the Epstein-Barr virus in children and adults and its treatment.

Diagnostics

The specialist examines the patient, listens to complaints. For an accurate diagnosis, laboratory tests are carried out. The presence of virus infection is determined by the following actions:

• DNA diagnostics. Since the herpes virus of the fourth type is DNA-containing, its determination is possible using the method of searching for its DNA. To do this, collect biological material:
  • biopsy taken from internal organs
  • saliva
  • samples taken from the mucous surface of the respiratory tract,
  • cerebrospinal fluid.

The study is performed by conducting a polymerase chain reaction. In addition, attention is drawn to the level of bilirubin, as well as alkaline phosphatase.

• . The presence of enzymes and certain proteins is determined, the presence of which in the blood provides information about the infection of the body with a virus.
• Examine the blood for a general analysis. The result of the study shows whether there are dangerous deviations from the norm in the indicators, which corresponds to healthy state organism.
• An immunological study is underway. The method involves determining the state of interferon production, assessing the ability to create immunoglobulins and other parameters.
• Serological reactions. This test uses an enzyme-linked immunosorbent assay to detect the presence of antibodies to the Epstein-Barr virus. The study is able to answer the question of how long ago the infection occurred, and at what stage the process is.
  • If the analysis determined the presence of antibodies of the IgG class, then experts conclude that the infection was some time ago, the exacerbation stage has passed.
  • Antibodies of the IgM type indicate an actively ongoing process of the body's fight against infection. This may be a primary infection or the onset of an exacerbation stage.

This video will tell you how to treat the Epstein-Barr virus in children and adults:

Treatment

Relief measures are the same as for other types of virus. If the virus is in a latent state, then treatment is not carried out.

Therapeutic

Important actions in viral diseases are the maintenance of immunity.

• Special therapeutic measures are carried out if the virus has initiated a concomitant disease.
• The medical assistance necessary for the manifestation of a particular disease is provided in accordance with accepted methods.
• After the reproduction of the virus can be stopped, the patient is recommended to undergo a sanatorium course.

Drug treatment of Epstein-Barr virus in children and adults is discussed below.

Medical

If it is necessary to weaken the effect of the virus, then conventional drugs are used for herpes infection:

• valaciclovir,
• ganciclovir.

In the chronic course of the disease, they have shown themselves effectively:

• interferon preparations,
• glucocorticoids,
• thymic hormone analogues.

gene therapy

For the virus of the fourth type (including the first and fifth types), a method of struggle at the genetic level has been developed. It has already shown its effectiveness.

• In a cell, an NRK molecule is inserted at a certain stretch of DNA, which enables the immune system to recognize viral DNA. The mechanism involves cutting the viral DNA.
• One incision significantly reduces the level of infection of healthy cells (by 2 times). This method achieves complete removal of the virus if two cuts are made.

Disease prevention

Measures that can to some extent prevent the disease include:

• personal hygiene:
  • frequent hand washing, especially before eating and after visiting public places,
  • do not use other people's hygiene items;
• increasing the body's defenses:
  • healthy daily routine
  • exclusion from habitual actions that are harmful,
  • useful exercise,
• exception .

The virus at each stage of its stay has a composition in relation to the protein, which varies and does not repeat. In this regard, there are difficulties with the creation of a vaccine. Experts are testing and working on a solution to the problem.

What diseases can be caused by the Epstein-Barr virus? What are the typical symptoms of EBV infection?

Are there strictly specific for EBV changes in laboratory parameters?

What does complex therapy for EBV infection include?

In recent years, there has been an increase in the number of patients suffering from chronic recurrent infections, which in many cases are accompanied by a pronounced violation of general well-being and a number of therapeutic complaints. The most common in clinical practice (most often caused by Herpes Simplex I), (Herpes zoster) and (more often caused by Herpes simplex II); in transplantology and gynecology, diseases and syndromes caused by cytomegalovirus (Cytomegalovirus) are common. However, general practitioners are clearly not well aware of the chronic infection caused by the Epstein-Barr virus (EBV) and its forms.

EBV was first isolated from Burkett's lymphoma cells 35 years ago. It soon became known that the virus can cause acute and acute in humans. It has now been established that EBV is associated with a number of oncological, mainly lymphoproliferative and autoimmune diseases (classic, etc.). In addition, EBV can cause chronic manifest and erased forms of the disease, proceeding according to the type of chronic mononucleosis. The Epstein-Barr virus belongs to the family of herpes viruses, the subfamily of gamma-herpes viruses and the genus of lymphocriptoviruses, contains two DNA molecules and has the ability, like other viruses of this group, to persist for life in the human body. In some patients, against the background of immune dysfunction and hereditary predisposition to a particular pathology, EBV can cause various diseases, which were mentioned above. EBV infects a person by penetrating through intact epithelial layers by transcytosis into the underlying lymphoid tissue of the tonsils, in particular B-lymphocytes. The penetration of EBV into B-lymphocytes is carried out through the receptor of these cells CD21 - the receptor for the C3d component of complement. After infection, the number of affected cells increases through virus-dependent cell proliferation. Infected B-lymphocytes can reside in tonsillar crypts for a significant time, which allows the virus to be released into the external environment with saliva.

With infected cells, EBV spreads to other lymphoid tissues and peripheral blood. The maturation of B-lymphocytes into plasma cells (which normally occurs when they encounter the corresponding antigen, infection) stimulates the reproduction of the virus, and the subsequent death (apoptosis) of these cells leads to the release of viral particles into crypts and saliva. In virus-infected cells, two types of reproduction are possible: lytic, that is, leading to death, lysis, of the host cell, and latent, when the number of viral copies is small and the cell is not destroyed. EBV can be present in B-lymphocytes and epithelial cells of the nasopharyngeal region and salivary glands for a long time. In addition, it is able to infect other cells: T-lymphocytes, NK cells, macrophages, neutrophils, vascular epithelial cells. In the nucleus of the host cell, EBV DNA can form a circular structure, the episome, or integrate into the genome, causing chromosomal abnormalities.

In acute or active infection, lytic viral replication predominates.

Active reproduction of the virus can occur as a result of a weakening of immunological control, as well as stimulation of the reproduction of cells infected with the virus under the influence of a number of reasons: acute bacterial or viral infection, vaccination, stress, etc.

According to most researchers, today approximately 80-90% of the population is infected with EBV. Primary infection often occurs in childhood or young age. The ways of transmission of the virus are different: airborne, contact-household, transfusion, sexual, transplacental. After infection with EBV, virus replication in the human body and the formation of an immune response can be asymptomatic or manifest as minor signs of SARS. But if a large amount of infection gets in and / or the presence of given period significant weakening of the immune system, the patient may develop a picture of infectious mononucleosis. There are several options for the outcome of acute infectious process:

• recovery (DNA of the virus can be detected only with a special study in single B-lymphocytes or epithelial cells);
• asymptomatic virus carrying or latent infection (the virus is detected in saliva or lymphocytes with a sensitivity of the PCR method of 10 copies per sample);
• chronic recurrent infection: a) chronic active EBV infection of the type of chronic infectious mononucleosis; b) a generalized form of chronic active EBV infection with damage to the central nervous system, myocardium, kidneys, etc.; c) EBV-associated hemophagocytic syndrome; d) erased or atypical forms of EBV infection: prolonged subfebrile condition of unknown origin, clinic - recurrent bacterial, fungal, often mixed infections of the respiratory and gastrointestinal tract, and other manifestations;
• development of an oncological (lymphoproliferative) process (multiple polyclonal, nasopharyngeal carcinoma, leukoplakia of the tongue and mucous membranes of the oral cavity, and intestines, etc.);
• the development of an autoimmune disease -, etc. (it should be noted that the last two groups of diseases can develop over a long period of time after infection);
• according to the results of our laboratory research (and based on a number of foreign publications), we concluded that VEB can play important role in occurrence .

The immediate and long-term prognosis for a patient with an acute infection caused by EBV depends on the presence and severity of immune dysfunction, genetic predisposition to certain EBV-associated diseases (see above), as well as on the presence of a number of external factors (stress, infection, surgical interventions, adverse environmental effects), damaging the immune system. EBV has been found to have a large set of genes that enable it to elude the human immune system to some extent. In particular, EBV produces proteins that are analogues of a number of human interleukins and their receptors that change the immune response. During the period of active reproduction, the virus produces an IL-10-like protein that suppresses T-cell immunity, the function of cytotoxic lymphocytes, macrophages, and disrupts all stages of the functioning of natural killers (that is, the most important antiviral defense systems). Another viral protein (BI3) can also suppress T-cell immunity and block the activity of killer cells (through downregulation of interleukin-12). Another property of EBV, as well as other herpes viruses, is its high mutability, which allows it to avoid the effects of specific immunoglobulins (which were produced for the virus before its mutation) and cells of the host's immune system for a certain time. Thus, the reproduction of EBV in the human body can cause aggravation (occurrence) secondary immunodeficiency.

Clinical forms of chronic infection caused by the Epstein-Barr virus

Chronic active EBV infection (HA EBV) is characterized by a long relapsing course and the presence of clinical and laboratory signs of viral activity. Patients are concerned about weakness, sweating, often pain in muscles and joints, the presence of skin rashes, cough, difficulty in nasal breathing, discomfort in the throat, pain, heaviness in the right hypochondrium, headaches previously uncharacteristic for this patient, dizziness, emotional lability, depressive disorders, sleep disturbance, memory loss, attention, intelligence. Often seen subfebrile temperature, swollen lymph nodes, hepatosplenomegaly of varying severity. Often this symptomatology has a wave-like character. Sometimes patients describe their condition as a chronic flu.

In a significant proportion of patients with HA VEBI, the addition of other herpetic, bacterial and fungal infections is observed (, inflammatory diseases upper respiratory and gastrointestinal tract).

HA VEBI is characterized by laboratory (indirect) signs of viral activity, namely relative and absolute lymphomonocytosis, the presence of atypical mononuclear cells, less often monocytosis and lymphopenia, in some cases anemia and thrombocytosis. When researching immune status in patients with HA VEBI, there are changes in the content and function of specific cytotoxic lymphocytes, natural killers, a violation of a specific humoral response (dysimmunoglobulinemia, a long-term absence of immunoglobulin G (IgG) production or the so-called lack of seroconversion to the late nuclear antigen of the virus - EBNA, which reflects the failure of the immunological control of reproduction In addition, according to our data, more than half of the patients have reduced ability to stimulated production of interferon (IFN), elevated serum IFN, dysimmunoglobulinemia, impaired avidity of antibodies (their ability to bind strongly to the antigen), and reduced content of DR + lymphocytes , indicators of circulating immune complexes and antibodies to DNA are often increased.

In persons with severe immune deficiency, generalized forms of EBV infection may occur with damage to the central and peripheral nervous systems (development, encephalitis, cerebellar ataxia, polyradiculoneuritis), as well as damage to other internal organs (development, lymphocytic interstitial pneumonitis, severe forms). Generalized forms of EBV infection often end in death.

EBV-associated hemophagocytic syndrome is characterized by the development of anemia or pancytopenia. Often combined with HA VEBI, infectious mononucleosis and lymphoproliferative diseases. The clinical picture is dominated by intermittent fever, hepatosplenomegaly, lymphadenopathy, pancytopenia or severe anemia, hepatic dysfunction, coagulopathy. Hemophagocytic syndrome, which develops against the background of infectious mononucleosis, is characterized by high mortality (up to 35%). The above changes are explained by hyperproduction of pro-inflammatory cytokines (TNF, IL1 and a number of others) by T-cells infected with the virus. These cytokines activate the phagocyte system (reproduction, differentiation and functional activity) in bone marrow, peripheral blood, liver, spleen, lymph nodes. Activated monocytes and histiocytes begin to absorb blood cells, which leads to their destruction. More subtle mechanisms of these changes are under study.

Erased variants of chronic EBV infection

According to our data, HA VEBI often proceeds in a subtle way or under the guise of other chronic diseases.

There are two most common forms of latent flaccid EBV infection. In the first case, patients are concerned about prolonged low-grade fever of unknown origin, weakness, pain in the peripheral lymph nodes, myalgia, arthralgia. The undulation of symptoms is also characteristic. In another category of patients, in addition to the complaints described above, there are markers of secondary immunodeficiency in the form of frequent infections of the respiratory tract, skin, gastrointestinal tract, and genitals that were previously uncharacteristic for them, which do not completely disappear during therapy or quickly recur. Most often in the anamnesis of these patients there are long-term stressful situations, excessive mental and physical overload, less often - fasting, trendy diets, etc. Often, the above condition developed after suffering a sore throat, acute respiratory infections, influenza-like illness. Characteristic for this variant of infection are also the stability and duration of symptoms - from six months to 10 years or more. Repeated examinations detect EBV in saliva and/or peripheral blood lymphocytes. As a rule, repeated in-depth examinations conducted in most of these patients do not allow us to detect other causes of prolonged subfebrile condition and the development of secondary immunodeficiency.

Very important for the diagnosis of HA VEBI is the fact that in the case of stable suppression of viral replication, it is possible to achieve long-term remission in most patients. Diagnosis of CA VEBI is difficult due to the lack of specific clinical markers of the disease. A certain “contribution” to underdiagnosis is also made by the lack of awareness of practitioners about this pathology. However, given the progressive nature of CA VEBI, as well as the severity of the prognosis (the risk of developing lymphoproliferative and autoimmune diseases, high mortality in the development of hemophagocytic syndrome), if CA VEBI is suspected, it is necessary to conduct an appropriate examination. The most characteristic clinical symptom complex in HA VEBI is prolonged subfebrile condition, weakness and decreased performance, sore throat, lymphadenopathy, hepatosplenomegaly, hepatic dysfunction, mental disorders. An important symptom is the lack of complete clinical effect from holding conventional therapy asthenic syndrome, restorative therapy, as well as from the appointment of antibacterial drugs.

When conducting a differential diagnosis of HA VEBI, the following diseases should be excluded first of all:

• other intracellular, including viral infections: HIV, viral hepatitis, cytomegalovirus infection, toxoplasmosis, etc.;
• rheumatic diseases, including those associated with EBV infection;
• oncological diseases.

Laboratory studies in the diagnosis of EBV infection

• Clinical blood test: there may be a slight leukocytosis, lymphomonocytosis with atypical mononuclear cells, in some cases hemolytic anemia due to hemophagocytic syndrome or autoimmune anemia possibly thrombocytopenia or thrombocytosis.
• Biochemical analysis of blood: an increase in the level of transaminases, LDH and other enzymes, acute phase proteins, such as CRP, fibrinogen, etc., are detected.

As mentioned above, all of these changes are not strictly specific for EBV infection (they can be found in other viral infections as well).

• Immunological examination: it is desirable to assess the main indicators of antiviral protection: the state of the interferon system, the level of immunoglobulins of the main classes, the content of cytotoxic lymphocytes (CD8+), T-helpers (CD4+).

According to our data, there are two types of changes in the immune status in EBV infection: increased activity of certain parts of the immune system and/or imbalance and insufficiency of others. Signs of tension of antiviral immunity can be elevated levels Serum IFN, IgA, IgM, IgE, CEC, often - the appearance of antibodies to DNA, an increase in the content of natural killers (CD16+), T-helpers (CD4+) and / or cytotoxic lymphocytes (CD8+). The phagocyte system can be activated.

In turn, immune dysfunction/deficiency in this infection is manifested by a decrease in the ability to stimulate the production of IFN alpha and/or gamma, dysimmunoglobulinemia (decrease in the content of IgG, less often IgA, an increase in the content of Ig M), a decrease in the avidity of antibodies (their ability to bind strongly to the antigen) , a decrease in the content of DR + lymphocytes, CD25 + lymphocytes, that is, activated T cells, a decrease in the number and functional activity of natural killers (CD16+), T-helpers (CD4+), cytotoxic T-lymphocytes (CD8+), a decrease in the functional activity of phagocytes and / or change (perversion) of their response to stimuli, including immunocorrectors.

• Serological studies: an increase in antibody titers (AT) to antigens (AG) of the virus is a criterion for the presence of an infectious process at the present time or evidence of contact with the infection in the past. In acute EBV infection, depending on the stage of the disease, different classes of antibodies to the antigen of the virus are determined in the blood, and “early” antibodies change to “late” ones.

Specific IgM antibodies appear in the acute phase of the disease or during an exacerbation and usually disappear after four to six weeks. IgG-AT to EA (early) also appear in the acute phase, are markers of active viral replication, and decrease during recovery in three to six months. IgG-AT to VCA (early) are determined in acute period with a maximum by the second or fourth week, then their number decreases, and the threshold level remains for a long time. IgG-AT to EBNA are detected two to four months after the acute phase, and their production persists throughout life.

According to our data, with HA EBV in more than half of patients, "early" IgG-Abs are detected in the blood, while specific IgM-Abs are determined much less frequently, while the content of late IgG-Abs to EBNA varies depending on the stage of exacerbation and state of immunity.

It should be noted that a serological study in dynamics helps in assessing the state of the humoral response and the effectiveness of antiviral and immunocorrective therapy.

• DNA diagnostics of CA VEBI. Using the polymerase chain reaction (PCR) method, the determination of EBV DNA is carried out in various biological materials: saliva, blood serum, leukocytes and lymphocytes of peripheral blood. If necessary, a study is carried out in biopsy specimens of the liver, lymph nodes, intestinal mucosa, etc. The PCR diagnostic method, characterized by high sensitivity, has found application in many areas, for example, in forensics: in particular, in cases where it is necessary to identify minimal trace amounts of DNA .

The use of this method in clinical practice to detect one or another intracellular agent is often difficult due to its too high sensitivity, since it is not possible to distinguish healthy carriage (the minimum amount of infection) from the manifestations of an infectious process with active virus reproduction. Therefore, for clinical research use a PCR method with a given, lower sensitivity. As our studies have shown, the use of the technique with a sensitivity of 10 copies per sample (1000 GE/ml in 1 ml of the sample) makes it possible to detect healthy carriers of EBV, while reducing the sensitivity of the method to 100 copies (10000 GE/ml in 1 ml of the sample) gives the ability to diagnose individuals with clinical and immunological signs of HA VEBI.

We observed patients with clinical and laboratory data (including the results of serological studies) characteristic of a viral infection, in whom, at the initial examination, the analysis for EBV DNA in saliva and blood cells was negative. It is important to note that in these cases it is impossible to exclude the replication of the virus in the gastrointestinal tract, bone marrow, skin, lymph nodes, etc. Only a repeated examination in dynamics can confirm or exclude the presence or absence of HA EBV.

Thus, in order to make a diagnosis of HA EBV, in addition to a general clinical examination, it is necessary to study the immune status (antiviral immunity), DNA, diagnosis of infection in various materials over time, serological studies(IFA).

Treatment of chronic Epstein-Barr virus infection

Currently, there are no generally accepted treatment regimens for HA VEBI. However, modern ideas about the effect of EBV on the human body and data on the existing risk of developing serious, often fatal diseases show the need for therapy and dispensary observation in patients suffering from HA VEBI.

The literature data and the experience of our work allow us to give pathogenetically substantiated recommendations for the treatment of CA VEBI. AT complex treatment this disease use the following drugs:

• , in some cases in combination with IFN inducers - (creation of an antiviral state of uninfected cells, suppression of virus reproduction, stimulation of natural killers, phagocytes);
• abnormal nucleotides (suppress the reproduction of the virus in the cell);
• immunoglobulins for intravenous administration(blockade of "free" viruses in the intercellular fluid, lymph and blood);
• analogs of thymic hormones (contribute to the functioning of the T-link, in addition, stimulates phagocytosis);
• glucocorticoids and cytostatics (reduce viral replication, inflammatory response and organ damage).

Other groups of drugs, as a rule, play a supporting role.

Prior to the start of treatment, it is desirable to examine the patient's family members for the isolation of viruses (with saliva) and the possibility of re-infection of the patient, if necessary, the suppression of viral replication is also carried out in family members.

• The volume of therapy for patients with chronic active EBV infection (HA EBV) may be different, depending on the duration of the disease, the severity of the condition and immune disorders. Treatment begins with the appointment of antioxidants and detoxification. In moderate and severe cases, it is desirable to carry out the initial stages of therapy in a hospital setting.

The drug of choice is interferon-alpha, in moderate cases prescribed as monotherapy. The domestic recombinant drug reaferon has proven itself well (in terms of biological activity and tolerability), while its cost is significantly lower than that of foreign analogues. Used doses of IFN-alpha vary depending on weight, age, tolerability of the drug. The minimum dose is 2 million units per day (1 million units twice a day intramuscularly), the first week daily, then three times a week for three to six months. Optimal doses - 4-6 million units (2-3 million units twice a day).

IFN-alpha, as a pro-inflammatory cytokine, can cause flu-like symptoms (fever, headaches, dizziness, myalgia, arthralgia, autonomic disorders - changes in blood pressure, heart rate, less often dyspepsia).

The severity of these symptoms depends on the dose and individual tolerability of the drug. These are transient symptoms (disappear after 2-5 days from the start of treatment), and some of them are controlled by the appointment of non-steroidal anti-inflammatory drugs. Reversible thrombocytopenia, neutropenia, skin reactions(itching, rashes of various nature), rarely - alopecia. Long-term use of IFN-alpha in large doses ah can lead to immune dysfunction, clinically manifested by furunculosis, other pustular and viral skin lesions.

In moderate and severe cases, as well as with the ineffectiveness of IFN-alpha preparations, it is necessary to connect abnormal nucleodites - valacyclovir (Valtrex), ganciclovir (Cymeven) or famciclovir (Famvir) to the treatment.

The course of treatment with abnormal nucleotides should be at least 14 days, the first seven days, intravenous administration of the drug is desirable.

In cases of severe CA VEBI, immunoglobulin preparations for intravenous administration at a dose of 10–15 g are also included in the complex therapy. etc.) within one to two months with gradual withdrawal or transition to maintenance doses (twice a week).

Treatment of EBV infection should be carried out under the control of a clinical blood test (once every 7-14 days), biochemical analysis (once a month, more often if necessary), immunological studies - after one to two months.

• Treatment of patients with generalized EBV infection is carried out in a hospital, together with a neuropathologist.

First of all, systemic corticosteroids are connected to antiviral therapy with IFN-alpha and abnormal nucleotides in doses: parenterally (in terms of prednisolone) 120-180 mg per day, or 1.5-3 mg/kg, it is possible to use metipred 500 pulse therapy mg IV drip, or orally 60-100 mg per day. Plasma and/or immunoglobulin preparations for intravenous administration are administered intravenously. With severe intoxication, the introduction of detoxifying solutions, plasmapheresis, hemosorption, and the appointment of antioxidants are indicated. In severe cases, cytostatics are used: etoposide, cyclosporine (sandimmun or consupren).

• Treatment of patients with EBV infection complicated by HPS should be carried out in a hospital. If HPS is leading in the clinical picture and life prognosis, therapy begins with the appointment of large doses of corticosteroids (blockade of the production of pro-inflammatory cytokines and phagocytic activity), in the most severe cases with cytostatics (etoposide, cyclosporine) against the background of the use of abnormal nucleotides.
• Patients with latent erased EBV infection can be treated on an outpatient basis; therapy includes the appointment of interferon-alpha (alternation with IFN inducer drugs is possible). With insufficient efficiency, abnormal nucleotides are connected, immunoglobulin preparations for intravenous administration; based on the results of an immunological examination, immunocorrectors (T-activators) are prescribed. In cases of the so-called "carriage", or "asymptomatic latent infection" with the presence of a specific immune response to the reproduction of the virus, observation and laboratory control are carried out ( clinical analysis blood tests, biochemistry, PCR diagnostics, immunological examination) after three to four months.

Treatment is prescribed when a clinic of EBV infection appears or when signs of VID develop.

Holding complex therapy with the inclusion of the above drugs allows to achieve remission of the disease in some patients with a generalized form of the disease and with hemophagocytic syndrome. In patients with moderate manifestations of HA EBV and in cases of an erased course of the disease, the effectiveness of therapy is higher (70-80%), in addition to the clinical effect, it is often possible to achieve suppression of virus replication.

After the suppression of the virus multiplication and obtaining a clinical effect, it is important to prolong the remission. Conducting sanatorium-and-spa treatment is shown.

Patients should be informed about the importance of observing the regime of work and rest, good nutrition, limiting / stopping alcohol intake; in the presence of stressful situations the help of a psychotherapist is needed. In addition, if necessary, supportive immunocorrective therapy is carried out.

Thus, the treatment of patients with chronic Epstein-Barr virus infection is complex, carried out under laboratory control and includes the use of interferon-alpha preparations, abnormal nucleotides, immunocorrectors, immunotropic replacement drugs, glucocorticoid hormones, and symptomatic agents.

Literature

1. Gurtsevich V. E., Afanasyeva T. A. Genes of latent Epstein-Barr infection (EBV) and their role in the occurrence of neoplasia // Russian Journal<ВИЧ/СПИД и родственные проблемы>. 1998; Vol. 2, No. 1: 68-75.
2. Didkovsky N. A., Malashenkova I. K., Tazulakhova E. B. Interferon inductors — a new promising class of immunomodulators // Allergology. 1998. No. 4. S. 26-32.
3. Egorova O. N., Balabanova R. M., Chuvirov G. N. The significance of antibodies to herpetic viruses detected in patients with rheumatic diseases// Therapeutic archive. 1998. No. 70(5). pp. 41-45.
4. Malashenkova I. K., Didkovsky N. A., Govorun V. M., Ilyina E. N., Tazulakhova E. B., Belikova M. M., Shchepetkova I. N. On the role of the Epstein-Barr virus in development of chronic fatigue syndrome and immune dysfunction.
5. Christian Brander and Bruce D Walker Modulation of host immune responses by clinically relevant human DNA and RNA viruses // Current Opinion in Microbiology 2000, 3:379-386.
6. Cruchley A. T., Williams D. M., Niedobitek G. Epstein-Barr virus: biology and disease // Oral Dis 1997 May; 3 Suppl 1: S153-S156.
7. Glenda C. Faulkner, Andrew S. Krajewski and Dorothy H. CrawfordA The ins and outs of EBV infection // Trends in Microbiology. 2000, 8:185-189.
8. Jeffrey I. Cohen The biology of Epstein-Barr virus: lessons learned from the virus and the host // Current Opinion in Immunology. 1999. 11: 365-370.
9. Kragsbjerg P. Chronic active mononucleosis // Scand. J. Infect. Dis. 1997. 29(5): 517-518.
10. Kuwahara S., Kawada M., Uga S., Mori K. A case of cerebellar meningo-encephalitis caused by Epstein-Barr virus (EBV): usefulness of Gd-enhanced MRI for detection of the lesions // No To Shinkei. 2000 Jan. 52(1): 37-42.
11. Lekstron-Himes J. A., Dale J. K., Kingma D. W. Periodic illness assotiated with Epstein-Barr virus infection // Clin. Infect. Dis. Jan. 22(1): 22-27.
12. Okano M. Epstein-Barr virus infection and its role in the expanding spectrum of human diseases // Acta Paediatr. 1998 Jan; 87(1): 11-18.
13. Okuda T., Yumoto Y. Reactive hemophagocytic syndromeresponded to combination chemotherapy with steroid pulse therapy // Rinsho Ketsueki. 1997. Aug; 38(8): 657-62.
14. Sakai Y., Ohga S., Tonegawa Y. Interferon-alpha therapy for chronic active Epstein-Barr virus infection // Leuk. Res. 1997 Oct; 21(10): 941-50.
15. Yamashita S., Murakami C., Izumi Y. Severe chronic active Epstein-Barr virus infection accompanied by virus-associated hemophagocytic syndrome, cerebellar ataxia and encephalitis // Psychiatry Clin. neurosci. 1998. Aug; 52(4): 449-52.

I. K. Malashenkova, candidate medical sciences

N. A. Didkovsky,doctor of medical sciences, professor

J. Sh. Sarsania, Candidate of Medical Sciences

M. A. Zharova, E. N. Litvinenko, I. N. Shchepetkova, L. I. Chistova, O. V. Pichuzhkina

Research Institute of Physical and Chemical Medicine of the Ministry of Health of the Russian Federation

T. S. Guseva, O. V. Parshina

GUNII epidemiology and microbiology them. N. F. Gamalei RAMS, Moscow

Clinical illustration of a case of chronic active EBV infection with hemophagocytic syndrome

Patient I. L., 33 years old, turned to the laboratory of clinical immunology of the Research Institute of Physical Chemistry on March 20, 1997 with complaints of prolonged subfebrile condition, severe weakness, sweating, sore throat, dry cough, headaches, shortness of breath on movement, palpitations, sleep disturbances, emotional lability (increased irritability, touchiness, tearfulness), forgetfulness.

From the anamnesis: in the fall of 1996, after severe tonsillitis (accompanied by severe fever, intoxication, lymphadenopathy), the above complaints arose, an increase in ESR persisted for a long time, changes leukocyte formula(monocytosis, leukocytosis), anemia was detected. Outpatient treatment (antibiotic therapy, sulfonamides, iron preparations, etc.) proved to be ineffective. The condition progressively worsened.

Upon admission: t of the body - 37.8 ° C, skin of high humidity, severe pallor of the skin and mucous membranes. Lymph nodes (submandibular, cervical, axillary) are enlarged up to 1-2 cm, dense elastic consistency, painful, not soldered to the surrounding tissues. The pharynx is hyperemic, edematous, pharyngitis phenomena, tonsils are enlarged, loose, moderately hyperemic, the tongue is coated with a white-gray coating, hyperemic. In the lungs, breathing with a hard tone, scattered dry rales on inspiration. Borders of the heart: the left one is enlarged by 0.5 cm to the left of the midclavicular line, heart sounds are preserved, a short systolic murmur over the apex, irregular rhythm, extrasystole (5-7 per minute), heart rate - 112 per minute, blood pressure - 115/70 mm Hg Art. The abdomen is swollen, moderately painful on palpation in the right hypochondrium and along the colon. According to the ultrasound of the abdominal organs, a slight increase in the size of the liver and, to a slightly greater extent, the spleen.

Of the laboratory tests, attention was drawn to normochromic anemia with a decrease in Hb to 80 g/l with anisocytosis, poikilocytosis, polychromatophilia of erythrocytes; reticulocytosis, normal serum iron content (18.6 µm/l), backlash Coombs. In addition, leukocytosis, thrombocytosis and monocytosis were observed with a large number of atypical mononuclear cells, and ESR acceleration. In biochemical blood tests, there was a moderate increase in transaminases, CPK. ECG: sinus rhythm, irregular, atrial and ventricular extrasystole, heart rate up to 120 per minute. The electrical axis of the heart is deviated to the left. Violation of intraventricular conduction. Decreased voltage in standard leads, diffuse changes in the myocardium, in chest leads observed changes characteristic of myocardial hypoxia. The immune status was also significantly impaired - the content of immunoglobulin M (IgM) was increased and immunoglobulins A and G (IgA and IgG) were reduced, there was a predominance of the production of low-avid, that is, functionally defective antibodies, dysfunction of the T-link of immunity, an increase in the level of serum IFN, a decrease in the ability to to IFN production in response to many stimuli.

In the blood, titers of IgG antibodies to early and late viral antigens (VCA, EA EBV) were increased. At virological study(in dynamics) EBV DNA was detected in peripheral blood leukocytes by polymerase chain reaction (PCR).

During this and subsequent hospitalizations, an in-depth rheumatological examination and oncological search were carried out, other somatic and infectious diseases were also excluded.

The patient was diagnosed with the following diagnoses: chronic active EBV infection, moderate hepatosplenomegaly, focal myocarditis, somatogenically conditioned persistent; virus-associated hemophagocytic syndrome. immunodeficiency state; chronic pharyngitis, bronchitis of mixed viral and bacterial etiology; , enteritis, intestinal flora dysbiosis.

Despite the conversation, the patient categorically refused the introduction of glucocorticoids and interferon-alpha preparations. Treatment was carried out, including antiviral therapy (Virolex intravenously for a week, with the transition to Zovirax 800 mg 5 times a day per os), immunocorrective therapy (thymogen according to the scheme, cycloferon 500 mg according to the scheme, immunofan according to the scheme), substitution therapy (octagam 2.5 g twice intravenously drip), detoxification measures (gemodez infusions, enterosorption), antioxidant therapy (tocoferrol, ascorbic acid), metabolic preparations (Essentiale, Riboxin), vitamin therapy (multivitamins with microelements) was prescribed.

After the treatment, the patient's temperature returned to normal, weakness, sweating decreased, and some indicators of the immune status improved. However, it was not possible to completely suppress the replication of the virus (EBV continued to be detected in leukocytes). Clinical remission did not last long - after a month and a half there was a second exacerbation. In the study, in addition to signs of activation of a viral infection, anemia, and acceleration of ESR, high titers of antibodies to Salmonella were detected. Outpatient treatment of the main and concomitant disease. A severe exacerbation began in January 1998 after acute bronchitis and pharyngitis. According to laboratory research during this period, there was an increase in anemia (up to 76 g/l) and an increase in the number of atypical mononuclear cells in the blood. An increase in hepatosplenomegaly was noted, Chlamidia Trachomatis was found in a throat swab, Staphylococcus aureus, streptococcus, in the urine - Ureaplasma Urealiticum, in the blood a significant increase in antibody titers to EBV, CMV, virus herpes simplex Type 1 (HSV 1). Thus, the number of concomitant infections increased in the patient, which also indicated an increase in immunity deficiency. Therapy with interferon inducers, replacement therapy with T-activators, antioxidants, metabolic agents, and long-term detoxification were carried out. A noticeable clinical and laboratory effect was achieved by June 1998, the patient was recommended to continue metabolic, antioxidant, immunoreplacement therapy (thymogen, etc.). When re-examined in the fall of 1998, EBV was not detected in saliva and lymphocytes, although moderate anemia and immune dysfunction persisted.

Thus, in patient I., 33 years old, acute EBV infection took on a chronic course, complicated by the development of hemophagocytic syndrome. Despite the fact that it was possible to achieve clinical remission, the patient needs dynamic monitoring in order to both control EBV replication and timely diagnosis of lymphoproliferative processes (given the high risk of their development).

Note!

• EBV was first isolated from Burkett's lymphoma cells 35 years ago.
• Epstein-Barr virus belongs to the herpesvirus family.
• Today, approximately 80-90% of the population is infected with EBV.
• Reproduction of EBV in the human body can cause aggravation (occurrence) of secondary immunodeficiency.

Epstein-Barr virus often masquerades as other diseases, and doctors lose valuable time trying to make a correct diagnosis. Anna Levadnaya (@doctor_annamama) - a new generation doctor, pediatrician, candidate of medical sciences and mother of two children - dedicated her new post on Instagram to this topic. "Letidor" gives its full version.

The number of patients who want to treat their children with the Epstein-Barr virus (hereinafter referred to as EBV) or who are trying to link all their problems with the carriage of EBV is off scale. So this post is about him!

Epstein-Barr virus: what is this virus

• EBV is a virus of the herpes family. As with herpes, it is enough to meet him once, as he remains in the body for life.
• More than 90-95% of all people on the planet are VEB carriers. But carriage of EBV does not require treatment.
• The virus enters the body in childhood (in most cases from 2 to 6 years) through saliva, blood or by contact (with kisses, through dishes, toys, underwear), penetrating the body through the oropharyngeal mucosa, then the virus lives in lymphoid tissue and saliva .

The very first encounter with the virus can be asymptomatic - under the guise of a common ARVI or manifests itself in the form of infectious mononucleosis.

Epstein-Barr virus: symptoms

• An increase in temperature (more than 38.5⁰C, sometimes poorly controlled, sometimes prolonged, up to several weeks), sometimes severe intoxication (malaise, chills, nausea, vomiting, headache).
• Snoring and difficulty in nasal breathing.

iconmonstr-quote-5 (1)

The reason is an increase in adenoid tissue, so vasoconstrictor nasal drops will not help!

• Sore throat, tonsillitis: white-gray plaques on the tonsils, loose, bumpy, often in the form of islets and stripes (how to distinguish viral from bacterial tonsillitis, you can read here).
• Painless enlargement of lymph nodes (usually cervical and occipital), liver, spleen.
• Swelling around the eyes, jaundice, sometimes a rash on the body or on the palate.

Epstein-Barr virus: additional diagnostics

Additional tests that can help make a diagnosis but are not needed if the clinical picture is obvious:

In a blood test: increase in monocytes (more than 10%) with the appearance of atypical mononuclear cells, as well as leukocytes, lymphocytes, in biochemical analysis- increase in ALT, AST, alkaline phosphatase, bilirubin; decrease in neutrophils, platelets.

IgM to capsid a/g EBV they talk about an acute infection (the child first encountered the virus) and persist for 1-3 months.

On ultrasound there is an increase in the spleen, liver and lymph nodes of the mesentery of the intestine.

Test "for heterophile antibodies"- positive since the end of the second week of illness.

Methods that won't talk about acute illness (can be determined after the illness throughout life):

• PCR virus in saliva and blood
• IgG to EBV

How to treat mononucleosis

In most cases, the prognosis for infectious mononucleosis is favorable, it resolves on its own, complications are rare. Treatment for infectious mononucleosis is reduced to alleviating the symptoms of the disease: rinse the nose, ventilate the room, give plentiful drink, provide peace, pick up antipyretics and so on.

One of the most common latent infections is the Epstein-Barr virus.

The Epstein-Barr virus, discovered in 1964 by scientists Michael Epstein and Yvonne Barr, belongs to the fourth type of herpes viruses. However, people are clearly not well aware of the chronic infection caused by the Epstein-Barr virus (EBV) and its forms.

The Epstein-Barr virus belongs to the herpesvirus family. Short name: VEB, HHV-4, EBV, HHV-4.

Virus Epstein - BARR (Epstein-Barr virus, Human Herpes Virus type 4). It was first described in 1964 and named after its authors, virologist Michael Anthony Epstein, and his graduate student Yvonne Barr from the UK. This virus is one of the most common viruses found in humans. He is credited with participating in the formation of tumor cells in the human body. Many people infected with the virus carry the disease with little or no symptoms. At the initial stage, the virus does not pose a particular threat, because it does not affect important organs, the circulatory system. But when complications occur, the virus can destroy brain cells.

Antibodies (Abs) to the Epstein-Barr virus (EBV) are found in 60% of children in the first two years of life and in 80-100% of adults.

Epstein-Barr virus is transmitted primarily through saliva, sometimes through blood transfusion, and is highly contagious (it is easy to get infected).

Diseases caused by the virus

Epstein-Barr virus causes diseases such as infectious mononucleosis and Burkitt's lymphoma. Burkitt's lymphoma is diagnosed among residents of African countries (Uganda, Nigeria, Guinea-Bissau). The disease affects mainly children aged 4-8 years. The tumor, the appearance of which provokes a virus, affects the lymph nodes, kidneys and adrenal glands, ovaries, lower or upper jaws.

Regarding infectious mononucleosis, which is also called the “kissing disease”, it infects, as a rule, children and young people. In developing countries, up to half of the child population, whose age does not exceed 5 years, are carriers of the virus received from their mothers. In developed countries, this rate of infection is typical for people over the age of 18.

You can become infected with the virus through saliva, objects, during a blood transfusion, with a handshake. After an incubation period, which can last up to 1 or 2 months, the virus multiplies rapidly. Moreover, this happens in the lymph nodes and cells of the membranes of the pharynx and nose.

Symptoms of the virus are manifested in chills, a sharp jump in temperature (up to 38 degrees and above). Infected patients note severe headache, pain during swallowing, excessive sweating. In general, the development of the virus is disguised as symptoms of acute respiratory infections, fever, tonsillitis or pharyngitis. More complete information on this issue can be found in the article “Epstein-Barr virus. Symptoms and treatment.

After getting into the blood after reproduction, the virus spreads throughout the body. Its particles begin to spread into the environment along with the secretions of the human body (saliva, cervical mucus). During the examination of a sick person, enlarged lymph nodes are found in different parts of the body. At the same time, they are painless and for this reason do not cause tangible discomfort to a person. The course of the disease ends with a change in the blood formula due to a decrease in the number and properties of white blood cells. The body usually fights the virus on its own, and improvement occurs after a few weeks (up to 2 months).

Varieties of the Epstein-Barr virus

This virus (abbreviated as EBV, EBV) infects B-lymphocytes in human blood. Depending on what disease provokes its reproduction, There are several antigens to the virus:

1. EBV-VCA (capsid antigen). Viral capsid IgG antigens and IgM provoke the production of antibodies to them only in the acute stage. IgM levels decrease after 1-3 months, but low level IgG can persist throughout life. High performance IgG of the viral capsid antigen is diagnosed in cases of Burkitt's lymphoma, nasopharyngeal carcinoma, and immunosuppression. Positive titers of both antigen classes indicate an acute infection.
2. EBV-EA (early antigen). Antibodies to this antigen begin to be produced during the acute stage, however, an increase in their number occurs much more slowly. Their level decreases two months after infection with the virus. Perhaps their complete disappearance after a year.
3. EBV-EBNA. This is the core antigen of the virus. Antibodies to it are produced only a month after infection with the virus. They are characterized by high rates and can remain in the blood throughout a person's life as indicators of immunity.

Epstein-Barr virus symptoms

Many manifestations and symptoms of the Epstein-Barr virus are observed over time. A person feels weak, sometimes his sleep is disturbed, body temperature rises, lymph nodes increase. If these symptoms recur, we can confidently talk about the transition of the disease to a chronic form. The virus leads to chronic fatigue syndrome - a person constantly feels weakened, and even a ten-hour sleep does not restore strength. Vacation also does not give a person a feeling of relaxation and a surge of energy.

To accurately determine the presence of this virus in the body, it is not enough to know its main symptoms; modern diagnostic methods are needed, for example, an enzyme immunoassay. If 90% of the adult population are already carriers of the Epstein-Barr virus, then the number of adolescents is less - about 50%.

To detect the virus, a blood or saliva test is done. When confirming its presence in the body, it is quite difficult for doctors to determine at what stage the disease is. It is little studied, so all the work of physicians is aimed mainly at eliminating its symptoms. Medicines for the treatment of the disease in the chronic stage have not yet been developed. Immunomodulators are used, a special nutritious diet, physiotherapy, optimal physical activity are prescribed.

There are signs of a sore throat, sometimes a rash appears. In most cases, everything ends happily. Severe course occurs only with HIV infection and other severe immunodeficiencies. The Epstein-Barr virus has receptors that allow it to penetrate one of the types of human protective cells - B-lymphocytes. This allows it to stay in the body for a long time and get into almost all organs and tissues. But such a neighborhood is often bad for health, and immune cells begin to attack a person's own tissues. These diseases are called autoimmune diseases.

Examples are rheumatoid arthritis, systemic lupus erythematosus and others. In addition, B-cells can lose their normal structure, acquire the properties of tumor tissues and lead to malignant processes - lymphomas, lymphosarcomas, lymphogranulomatosis. Epstein-Barr virus is also considered responsible for the manifestations of chronic fatigue syndrome. Some doctors blame him for the occurrence of multiple sclerosis, causeless liver damage.

Treatment of Epstein-Barr virus infection

There is no specific treatment for Epstein-Barr virus. The patient is provided with peace, given a lot to drink, if necessary, antipyretic drugs are prescribed. In some cases, it is necessary to prescribe hormones, antiviral drugs, interferon. Infectious mononucleosis requires treatment of the patient in a hospital. To suppress the virus, a course of antibiotics, antihistamines and immunomodulators is prescribed. At its core, treatment is aimed at eliminating the symptoms of the disease. If the Epstein-Barr virus caused the development of a tumor, the patient is prescribed a course of anticancer drugs.

To diagnose the disease, you should be examined by an infectious disease specialist and a pediatrician (children). You will also need to take a blood test that will show the presence of antibodies. Additionally, an immunological examination may be prescribed.

Therapy for an infection caused by the Epstein-Barr virus is guided by several principles:

1. use of the complex medicines aimed at eliminating symptoms and treating developed diseases;
2. non-drug methods of treatment;
3. long-term and continuous treatment of a successive nature in a hospital, clinic and rehabilitation center;
4. drawing up an individual treatment program that takes into account the patient's age, stage of infection, immunological, clinical and other indicators.

It is far from always necessary to have treatment, since in children the infection is often hidden, the symptoms are blurred and it is not possible to clearly recognize the disease. In this case, they are limited to observation by the attending physician and use drugs that relieve inflammation and help remove toxins from the body. It would be appropriate to use traditional medicine to eliminate the symptoms of the disease.

Serious hospital treatment is required for chronic infections, as well as if there are complications on other organs.