Symptoms and treatment of Epstein-Barr virus (EBV). Clinical forms of chronic Epstein-Barr virus infection: issues of diagnosis and treatment Epstein Barr latent

Definition and description of Epstein-Barr virus

Epstein-Barr virus infection is an acute or chronic human infectious disease caused by the Epstein-Barr virus from the family of herpetic viruses (Herpesviridae). It has the peculiarity of damaging the lymphoreticular and immune systems of the body (1.6).

Epstein-Barr virus (EBV) is a DNA virus from the Family Herpesviridae (gammaherpesviruses), and is a type 4 herpesvirus.

Epstein-Barr virus is a low-contagious infection, since many people have antibodies to this virus

Particularly noteworthy is the property of the Epstein-Barr virus, such as “lifelong persistence in the body.” Thanks to infection of B-lymphocytes, in which it is present for life, these cells of the immune system acquire the ability for unlimited life activity (so-called “cellular immortality”), as well as the ability to constantly synthesize heterophilic antibodies (or autoantibodies, for example, antinuclear antibodies, rheumatoid factor, cold agglutinins) (6).

The virus has a spherical shape with a diameter of up to 180 nm. The structure consists of 4 components: the core, the capsid (the outer shell), inner and outer shell.

The core contains two strands of DNA containing up to 80 genes. The viral particle on the surface also contains dozens of glycoproteins necessary for the formation of virus-neutralizing antibodies.

The viral particle contains the following specific antigens (proteins necessary for diagnosis):

• capsid antigen (VCA);
• early antigen (EA);
• nuclear or nuclear antigen (NA or EBNA);
• membrane antigen (MA).

The significance and timing of their appearance in different forms of EBVI are not the same and have their own specific meaning in terms of assessing the phase of the disease in laboratory examination patient (6).

Epstein-Barr virus is relatively stable in external environment, quickly dies when dried out, exposed to high temperatures, as well as the action of common disinfectants.

In biological tissues and fluids, the Epstein-Barr virus can feel beneficial when it enters the blood of a patient with EBVI, brain cells are completely healthy person, cells during oncological processes (lymphoma, lecemia and others).

The sources of infection for Epstein-Barr viral infection are a patient with a clinically pronounced form and a virus carrier.

The patient becomes infectious in last days the incubation period, the initial period of the disease, the height of the disease, as well as the entire period of convalescence (up to 6 months after recovery), and up to 20% of those who have recovered from the disease retain the ability to periodically secrete the virus (that is, they remain carriers) (6,7).

Mechanisms of Epstein-Barr virus infection:

• this is an aerogenic (airborne transmission route), in which saliva and mucus from the oropharynx, which is released when sneezing, coughing, talking, kissing, is contagious;
• contact mechanism (contact-household transmission route), in which salivation of household items (dishes, toys, towels, etc.) occurs, but due to the instability of the virus in the external environment, it is of unlikely significance;
• a transfusion mechanism of infection is allowed (during the transfusion of infected blood and its preparations);
• nutritional mechanism (water-food transmission route);
• Currently, the transplacental mechanism of infection of the fetus with the possibility of developing congenital Epstein-Barr viral infection has been proven (1,6).

Despite the variety of routes of infection, there is a good immune layer among the population - up to 50% of children and 85% of adults are infected with this virus. Many become infected from carriers without developing symptoms of the disease, but with the development of immunity. That is why it is believed that if a patient is surrounded by an Epstein-Barr viral infection, the disease is less contagious, since many already have antibodies to the Epstein-Barr virus.

Infectious mononucleosis

Epstein-Barr virus can cause acute infection, chronic forms of infection, and asymptomatic carriage (7).

The classic manifestation of acute Epstein-Barr viral infection is infectious mononucleosis - this is an acute viral disease, characterized by fever, damage to the pharynx, lymph nodes, liver, spleen and peculiar changes in the clinical blood test.

The clinical picture of the disease was first described in 1885 by N. F. Filatov and was considered as idiopathic inflammation of the lymph glands.

The connection of the disease with Epstein-Barr virus was proven in the late 1960s (1, 10). The disease develops predominantly in young adults, but it can occur in all patients from children to the elderly. Incubation period is 5-12 days, but can reach 30-45 days; as a rule, it is not possible to associate the disease with contact with a patient.

The disease is accompanied by an increase in temperature to 38-39 degrees, although in some patients the disease occurs at normal temperature. The duration of the febrile period can reach 1 month or more.

Enlarged lymph nodes (viral lymphadenitis) is the most constant symptom of the disease. Increases earlier than others and most clearly The lymph nodes in the head and neck area, bilateral enlarged lymph nodes are characteristic, rarely - unilateral lesions.

Less commonly, the axillary, inguinal, ulnar lymph nodes, lymph nodes of the mediastinum and abdominal cavity are involved in the process. The most striking and characteristic sign of infectious mononucleosis is damage to the pharynx, which develops from the first days of the disease, sometimes later.

Sore throat in infectious mononucleosis can be different in form and in some cases even accompanied by the formation of fibrinous films reminiscent of diphtheria. Characterized by a pronounced enlargement of the palatine tonsils, the presence of small hemorrhages (petechiae) on the back wall of the pharynx, which distinguishes the disease from other viral pharyngitis, but not from streptococcal tonsillitis, swelling of the uvula may occur. Often the nasopharyngeal tonsil is involved in the process, causing patients to experience difficulty in nasal breathing, nasal sounds and snoring during sleep.

If you have an elevated temperature and enlarged lymph nodes, you should first consult a therapist.

An enlarged liver and spleen are natural manifestations of the disease. Liver dysfunction - moderate yellowness of the sclera, changes in biochemical blood tests are more typical for older people. Rarely (3-25% of patients) may occur skin rash- maculopapular, hemorrhagic, roseola, miliaria type rash (1.10).

Observed characteristic changes in a clinical blood test - moderate leukocytosis, a decrease in the number of neutrophils, lymphocytosis and the appearance of specific cells - atypical mononuclear cells, appearing on the 2-3rd day of the disease and persisting up to 4 weeks (1.10).

To diagnose the disease, in addition to general and biochemical blood tests, specific serological diagnostics are used - determination of IgG and IgM antibodies to the capsid proteins of the Epstein-Barr virus.

So-called heterophilic antibodies are also determined - autoantibodies that are synthesized by infected B lymphocytes. These include antinuclear antibodies, rheumatoid factor, cold agglutinins.

For treatment, antiviral drugs from the group of acyclic nucleosides, interferon preparations and interferon inducers are used. Symptomatic treatment of existing disorders is carried out internal organs.

Rarely, when there is a pronounced enlargement of the tonsils or a number of complications occur, glucocorticosteroids are used.

The patient is hospitalized according to clinical indications.

For of this disease Anti-epidemic measures are not carried out, specific prevention has not been developed (1.7, 8, 10).

Chronic forms of Epstein-Barr viral infection

Chronic EBV infection develops no earlier than 6 months after an acute infection, and in the absence of a history of acute mononucleosis - 6 or more months after infection. Often, the latent form of infection with a decrease in immunity turns into a chronic infection. Chronic EBV infection can occur in the form of: chronic active EBV infection, hemophagocytic syndrome associated with EBV, atypical forms of EBV (recurrent bacterial, fungal and other infections of the digestive system, respiratory tract, skin and mucous membranes) (7).

Chronic active EBV infection is characterized by a long course and frequent relapses.

Symptoms

• weakness,
• increased fatigue,
• excessive sweating,
• prolonged low temperature up to 37.2-37.5°,
• skin rashes,
• sometimes articular syndrome,
• pain in the muscles of the trunk and limbs,
• heaviness in the right hypochondrium,
• feeling of discomfort in the throat area,
• slight cough
• nasal congestion,
• some patients have neurological disorders - causeless headaches, memory impairment, sleep disturbances, frequent shifts mood, tendency to depression, patients are inattentive, decreased intelligence.
• Patients often complain of enlargement of one or a group of lymph nodes, and possibly enlargement of internal organs (spleen and liver).

Along with such complaints, when questioning the patient, it becomes clear that there have been frequent cold infections, fungal diseases, and other herpetic diseases recently. For example, simple herpes on the lips or genital herpes and more.

In confirmation of clinical data there will also be laboratory signs (changes in blood, immune status, specific tests for antibodies).

Hemophagocytic syndrome associated with EBV manifests itself in the form of anemia or pancytopenia (a decrease in the composition of almost all blood elements associated with inhibition of hematopoietic germs).

Patients may experience fever (wavy or intermittent, in which both sudden and gradual rises in temperature are possible with restoration to normal values), enlargement of the lymph nodes, liver and spleen, impaired liver function, laboratory changes in the blood in the form of a decrease in both red blood cells and and leukocytes and other blood elements.

Erased (atypical) forms of Epstein-Barr viral infection: most often it is a fever of unknown origin lasting for months, years, accompanied by enlarged lymph nodes, sometimes joint manifestations, muscle pain; another option is secondary immunodeficiency with frequent viral, bacterial, fungal infections (7)

Considering all of the above, doctors refer patients with prolonged fever or lymphadenopathy for consultation with an allergist-immunologist to exclude erased forms of Epstein-Barr viral infection. However, consultation with this specialist is necessary only after excluding other causes that have a more serious prognosis (oncological diseases, tuberculosis, etc.) or are more common (chronic foci bacterial infection).

In the presence of long-term increase temperature or enlarged and painful lymph nodes, the examination should begin with a consultation with a therapist (5).

One of the forms of chronic Epstein-Barr viral infection is the so-called “chronic fatigue syndrome” - a condition characterized by constant fatigue, which does not go away after a long and complete rest.

Patients with chronic fatigue syndrome are characterized by muscle weakness, periods of apathy, depressive states, mood lability, irritability, and sometimes outbursts of anger and aggression.

Patients are lethargic, complain of memory impairment, decreased intelligence. Patients sleep poorly, and both the phase of falling asleep is disrupted and interrupted sleep, possible insomnia and drowsiness during the day. At the same time, autonomic disorders are characteristic: trembling or tremor of the fingers, sweating, periodically low temperature, poor appetite, joint pain.

The disease can develop at any age, and women predominate among patients. At risk are workaholics, people with increased physical and mental work, persons who are in acute stressful situation, and in chronic stress.

There is a high prevalence of the syndrome among ethnic and racial minorities and people with low socioeconomic status.

Unfortunately, even foreign publications do not note enough serious attitude to patient complaints in this condition and non-recognition of chronic fatigue syndrome as a real problem caused by a biological process (7, 11).

To diagnose chronic forms of Epstein-Barr virus infection, in addition to the above-mentioned serological tests, determination of viral DNA by PCR in blood, saliva, oropharyngeal swabs and other biological materials, and assessment of immune status are used (8, 9).

Complications and severe forms of diseases caused by the Epstein-Barr virus

Acute and chronic forms of Epstein-Barr virus infection can lead to serious complications. In addition, the infection itself, under certain circumstances, can occur in the form of diseases with a serious prognosis for life and health.

Thus, with infectious mononucleosis, excessive enlargement of the palatine tonsils is possible, which can lead to obstruction of the upper respiratory tract, rupture of the spleen, and in rare cases, encephalitis, lymphoma.

In children, Epstein-Barr virus infection can lead to the development of a fulminant form of hepatitis with the development of acute liver failure, but the incidence of this complication is very low (13).

For older patients, liver damage from infectious mononucleosis can lead to cholestasis (10).

In countries with tropical and subtropical climates, Epstein-Barr viral infection can cause the development malignant neoplasms(Burkitt's lymphosarcoma - aggressive B-cell, nasopharyngeal carcinoma and others), often with metastases to various organs (6, 15).

In countries with temperate climates, in addition to the infectious mononucleosis and chronic forms of infection described above, the Epstein-Barr virus can cause the development of autoimmune diseases (rheumatic diseases, vasculitis, nonspecific ulcerative colitis) (6).

A rare complication of Epstein-Barr viral infection is viral arthritis, which manifests itself as polyarthralgia or, much less commonly, monoarthritis of the knee joint, the formation of a Baker's cyst with possible rupture (14).

Effect of Epstein-Barr virus on the immune system

Damage to the immune system by Epstein-Barr virus is an integral part of the pathogenesis of Epstein-Barr virus infection.

It was discovered that the Epstein-Barr virus has a large set of genes that give it the ability to evade the human immune system to a certain extent. In particular, it produces proteins that are analogues of a number of human interleukins and their receptors that modify the immune response.

During the period of active reproduction, the virus produces interleukin - a 10-like protein that suppresses T-cell immunity, the function of cytotoxic lymphocytes, macrophages, and disrupts all stages of the functioning of natural killer cells (that is, the most important antiviral defense systems).

Another viral protein (BI3) can also suppress T-cell immunity and block killer cell activity (via suppression of interleukin-12).

Another property of the Epstein-Barr virus, like other herpes viruses, is its high mutability, which allows it to avoid the effects of specific antibodies (accumulated to the virus before its mutation) and host immune system cells for a certain time (7). Thus, the reproduction of the Epstein-Barr virus in the human body can cause the occurrence of infection, manifested by the addition of other herpetic, bacterial and fungal infections. For example, herpes labialis, genital herpes, thrush, inflammatory diseases upper respiratory tract and gastrointestinal tract.

On the other hand, the course of this infection in patients with secondary immunodeficiency contributes to a more severe course of the infection, the development of chronic forms, and the occurrence of complications.

Classic examples of severe forms of Epstein-Barr virus infection in patients with secondary immunodeficiency occur in HIV-infected patients. In this group of patients, the infection occurs in the form of specific forms:

• "Hairy leukoplakia" of the tongue and mucous membrane oral cavity, in which whitish folds appear on the lateral surfaces of the tongue, as well as on the mucous membrane of the cheeks and gums, which gradually merge, forming white plaques with a heterogeneous surface, as if covered with grooves, cracks and erosive surfaces form. As a rule, there is no pain with this disease.
• Lymphoid interstitial pneumonia, which is a polyetiological disease (there is also a connection with Epstein-Barr viral infection) and is characterized by shortness of breath, unproductive cough against the background of fever and symptoms of intoxication, as well as progressive weight loss of patients. The patient has an enlarged liver and spleen, lymph nodes, and enlarged salivary glands. X-ray examination revealed bilateral lower lobe interstitial foci of inflammation lung tissue, roots are expanded, unstructured.
• In persons with severe immune deficiency, generalized forms of EBV infection may occur with damage to the central and peripheral nervous systems (development of meningitis, encephalitis, cerebellar ataxia, polyradiculoneuritis), as well as damage to other internal organs (development of myocarditis, glomerulonephritis, lymphocytic interstitial pneumonitis, severe forms of hepatitis). Generalized forms of EBV infection are often fatal (7).

Also, Epstein-Barr virus infection can cause the occurrence of lymphoproliferative diseases in transplanted organs after transplantation and subsequent immunotherapy in individuals who have not been exposed to the Epstein-Barr virus before transplantation and do not have immunity to it at the time of intervention (12).

Epstein-Barr virus infection and pregnancy

In recent years, the transplacental mechanism of infection of the fetus has been proven and a congenital Epstein-Barr virus infection has been described, which occurs in the fetus when a pregnant woman is initially infected with the Epstein-Barr virus.

It has been established that its risk with primary EBVI during pregnancy is 67%, with reactivation - 22%.

It is characterized by possible damage to the internal organs of the child in the form of interstitial pneumonia, encephalitis, myocarditis and others. Prematurity and premature birth are possible.

Both maternal antibodies to the Epstein-Barr virus (IgG to EBNA, VCA, EA antigens) and clear confirmation of intrauterine infection - the child’s own antibodies (IgM to EA, IgM to VCA antigens of the virus) can circulate in the blood of a born baby (7).

The influence of Epstein-Barr virus on the course of allergic diseases

Since the immune system is involved in the pathogenesis of Epstein-Barr viral infection, the virus may influence the occurrence of a number of allergic diseases.

A classic example of a debut allergic disease Epstein-Barr virus infection is a generalized occurrence when taking penicillin antibiotics to treat tonsillitis caused by Epstein-Barr virus.

The appearance of a rash to aminopenicillins is not an IgE-dependent reaction, therefore the use has neither preventive nor therapeutic effect. After recovery, repeated reactions to penicillin antibiotics may not be observed. It is possible to develop erythema multiforme exudate, in severe cases - Stevens-Johnson syndrome and. The latter cases are characterized by an extremely severe course and a high risk of death (2). Therefore, it is very dangerous to take penicillin antibiotics on your own for a sore throat without a prior medical examination and general analysis blood.

In recent years, the possible influence of the Epstein-Barr virus on the occurrence of chronic relapsing disease has been studied (4). The possibility of the development of exudative erythema multiforme against the background of Epstein-Barr viral infection has been shown, regardless of the use of medications (16).

Epstein-Barr virus (EBV) belongs to the herpes virus family. It is one of the most common human viruses. For example, in the United States, 90% of the population becomes infected with it during their lifetime. Most people, especially young children, have little or very mild symptomatic infection. The exception is people with weakened immune systems, who may develop diseases such as mononucleosis and lymphoma due to infection with the virus. EBV is transmitted primarily through saliva, which is why it is also called “kissing disease.” However, it can also be transmitted through other body fluids. There is no vaccine for this virus, and antiviral drugs are used only to treat severe, rapidly developing forms. In this regard, the main means of combating EBV infection are prevention and alternative treatment methods.

Steps

Part 1

How to reduce the risk of EBV infection

Make sure you have a strong immune system. Home prevention any viral, bacterial or fungal infection - a healthy and strong immune system. The task of the immune system is to recognize and destroy pathogens, including EBV, using special white blood cells. If the immune system is weakened, pathogens multiply almost unhindered and spread throughout the body. That is why, in order to prevent the development of EBV and any other infections, you need to do everything possible to ensure that you have a strong immune system that copes well with its functions.

Get plenty of vitamin C or ascorbic acid. Until now, the effect of vitamin C on the viruses that cause common colds has mainly been studied. However, it has been proven that vitamin C has significant antiviral and immunostimulating properties. It helps prevent EBV infection or reduce its consequences, as it stimulates the production and activity of leukocytes, which search for and destroy viruses. It is recommended to consume 75-125 mg of vitamin C per day. The dose depends on gender and whether you smoke tobacco products. However, recently, medical circles have begun to express concerns that even this amount may not be enough for the normal functioning of the immune system and the body as a whole.

• If your body is fighting an infection, the recommended dose is at least 1000 mg, divided into two doses.
• Vitamin C is found in large quantities in citrus fruits, kiwi, strawberries, tomatoes and broccoli.

1. Take dietary supplements that help strengthen your immune system. Not only vitamin C, but also many other vitamins, minerals and herbal preparations have antiviral and immunostimulating properties. Unfortunately, their effectiveness in preventing and combating EBV infection has not been sufficiently studied. This is because high-quality scientific research requires large amounts of money, and these funds are rarely allocated to the research of natural or “alternative” medicines. What's also special about EBV is that it can hide inside B cells, a type of white blood cell that the body produces to fight infection. This makes EBV difficult to eradicate simply by stimulating the immune system, but it is still worth a try.

   Be careful when kissing. Most often, teenagers and adults around the world become infected with EBV during a kiss. Some people's bodies cope with the virus without symptoms, others develop mild symptoms, and others may be sick for several weeks or even months. Therefore, the best prevention of EBV and other viral infections is not to kiss or have sexual contact with those who may be sick. Be careful and refrain from romantic kisses with a person who feels tired, exhausted, has a sore throat and swollen lymph nodes. However, do not forget that a person can have EBV infection asymptomatically and still be a carrier.

   Part 2

   What treatment options are there?

   1. Only severe symptoms need to be treated. Does not exist typical treatment specifically EBV infection, since very often it has no symptomatic manifestations at all. As a rule, even mononucleosis goes away on its own within a few months. If you are concerned about symptoms such as heat, sore throat and swollen lymph nodes, take acetaminophen (Tylenol) and anti-inflammatory drugs (ibuprofen, naproxen). If your throat is severely swollen, your doctor may prescribe a short course of steroid medication. No need to comply bed rest, but with mononucleosis a person may feel severe weakness.

   2. Consider taking colloidal silver. Colloidal silver is a liquid preparation containing tiny atomic clusters of electrically charged silver. IN medical literature there is evidence that a silver solution is capable of destroying a number of viruses, but its effectiveness depends on the particle size (less than 10 nm in diameter) and purity (without salt or protein impurities). Subnanometer silver particles have a strong electrical charge and are capable of destroying even rapidly mutating viral pathogens microorganisms. However, it has not yet been clarified whether silver particles specifically destroy EBV, so before making definite recommendations, additional research is necessary.

      • A silver solution, even in high concentration, is considered non-toxic, but if it is protein-based, the risk of developing argyria increases. Argyria is a disease that manifests itself as changes in skin color as a result of the accumulation of silver compounds.
      • Dietary supplements with colloidal silver can be purchased at pharmacies or specialty stores.

   3. Consult your doctor if you have a chronic infection. If EBV infection or mononucleosis does not disappear after several months, consult your doctor to prescribe effective antiviral or other potent medications. Chronic EBV infection is not common, but if it persists for many months, it negatively affects immunity and quality of life. There is evidence that treatment of chronic EBV infection with antiviral drugs such as acyclovir, ganciclovir, vidarabine and foscarnet can be effective. Keep in mind that if the disease is mild, antiviral therapy is ineffective. In case of chronic EBV infection, immunosuppressants (corticosteroids, cyclosporine) can also be used. They will help relieve symptoms for a while.

      • Immune suppressant drugs can slow the body's immune response to EBV, causing cells infected with the virus to continue to multiply. Therefore, the doctor must decide how much the expected benefit from taking these drugs outweighs the risk of undesirable consequences.
      • The following side effects may occur as a result of taking antiviral drugs: skin rash, stomach upset, diarrhea, joint pain, headache, dizziness, fatigue.
      • Despite numerous attempts to develop a vaccine against EBV, they have so far been unsuccessful.
   • If mononucleosis is suspected, a blood sample must be provided. If mononuclear cells are detected in the blood, this confirms the diagnosis of mononucleosis.
   • There are tests that detect antibodies that indicate latent infection. Antibodies are “tags” left by immune system cells to help recognize viruses and other pathogens.
   • EBV is most often contracted through saliva, but it can also be transmitted through semen during sexual intercourse or blood through transfusions and organ transplants.

   Warning

   • A doctor may mistake mononucleosis for a sore throat and prescribe an antibiotic (such as amoxicillin). In this case, a common reaction to the antibiotic is a skin rash.

Epstein-Barr virus (EBV) is the cause of chronic persistent infection from the group of herpesvirus pathogens (herpes virus type 4). The source of EBV infection is a sick person or a virus carrier. Transmission of the virus can occur by airborne droplets, sexual contact and household contact through saliva, sputum, vaginal and urethral secretions, and blood. According to available data, about 80% of the population is infected with EBV.

Diseases caused by EBV

Epstein-Barr viral infection usually occurs in children and young adults. However, they can be observed at any age. The clinical manifestations of the infection are extremely diverse and have varied symptoms, which greatly complicates diagnosis. As a rule, manifestations of EBV develop against the background of decreased immunity, which is characteristic of all herpesvirus infections. Primary forms of the disease and its relapses are always associated with congenital or acquired immunodeficiency. People with severe immunodeficiency experience generalized forms of infection affecting the central nervous system, liver, lungs and kidneys. Often, severe forms of EBV infection may be associated with HIV infection.

Attention!

It has now been established that EBV is also associated with a number of oncological, mainly lymphoproliferative and autoimmune diseases (classical rheumatic diseases, vasculitis, ulcerative colitis, etc.). In addition, EBV causes manifest and latent forms of the disease, which occur as acute and chronic mononucleosis.

Course of EBV infection

In people with normal immunity, after infection with EBV, two options are possible. The infection may be asymptomatic or manifest itself in the form of minor symptoms resembling influenza or acute respiratory viral disease (ARVI). However, in case of infection against the background of an existing immunodeficiency, the patient may develop a picture of infectious mononucleosis.

In case of development of acute infectious process There are several possible outcomes of the disease:
– recovery (virus DNA can only be detected with a special study in single B-lymphocytes or epithelial cells);
– asymptomatic virus carriage or latent infection (the virus is determined in saliva or lymphocytes in the laboratory);
– development of a chronic relapsing process:
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) erased or atypical forms EBV infections: long-term low-grade fever of unknown origin, recurrent bacterial, fungal, often mixed infections of the respiratory and gastrointestinal tract, furunculosis;
d) development of oncological diseases (Burkitt's lymphoma, nasopharyngeal carcinoma, etc.);
e) development of autoimmune diseases;
f) EBV-associated chronic fatigue syndrome.

The outcome of an acute infection caused by EBV depends on the presence and severity of immune deficiency, as well as on the presence of a number of external factors (stress, concomitant infections, surgical interventions, hyperinsolation, hypothermia, etc.) that can disrupt the functioning of the immune system.

Clinical manifestations of EBV infection

Clinical manifestations of diseases caused by EBV largely depend on the severity of the process. The primacy of the infectious process or the occurrence of clinical symptoms is also important. chronic infection. In the case of the development of an acute infectious process due to EBV infection, a picture of infectious mononucleosis is observed. It usually occurs in children and young adults.

The development of this disease leads to the appearance of the following clinical signs:
– temperature increase,
– enlargement of various groups of lymph nodes,
– damage to the tonsils and hyperemia of the pharynx.
Quite often there is swelling of the face and neck, as well as an enlargement of the liver and spleen.

In the case of chronically active EBV infection, a long-term relapsing course of the disease is observed. Patients are concerned about: weakness, sweating, often pain in muscles and joints, the presence of various skin rashes, cough, discomfort in the throat, pain and heaviness in the right hypochondrium, headaches, dizziness, emotional lability, depressive disorders, sleep disturbance, decreased memory, attention, intelligence. Often observed low-grade fever, enlarged lymph nodes and hepatosplenomegaly of varying severity. Usually this symptomatology has a wave-like character.

In patients with severe immune deficiency, generalized forms of EBV infection may occur with damage to the central and peripheral nervous systems (the development of meningitis, encephalitis, cerebellar ataxia, polyradiculoneuritis), as well as damage to other internal organs (the development of myocarditis, glomerulonephritis, lymphocytic interstitial pneumonitis, severe forms of hepatitis). Generalized forms of EBV infection can be fatal.

Quite often, chronic EBV infection proceeds silently or may resemble other chronic diseases. With erased forms of infection, the patient may be bothered by wave-like low-grade fever, pain in the muscles and lymph nodes, weakness, and sleep disturbances. In the case of an infectious process under the guise of another disease, the most important signs are: duration of symptoms and resistance to therapy.

Laboratory research

Considering that it is impossible to make a clinical diagnosis of EBV infection, laboratory diagnostic methods are leading in determining the disease.

They can be divided into two groups: screening and clarifying:

1. Screening tests include those that, along with clinical symptoms, allow one to suspect EBV infection. In a clinical blood test: slight leukocytosis, lymphomonocytosis, possibly thrombocytopenia may be observed. A biochemical blood test reveals: increased levels of transaminases and other enzymes, acute phase proteins - C-reactive protein, fibrinogen, etc. However, these changes are not strictly specific to EBV infection (they can also be detected in other viral infections).

2. An important study to determine the presence of a pathogen in the body is a serological examination: an increase in titers of antibodies to EBV is a criterion for the presence of an infectious process at the present time or evidence of contact with an infection in the past. However, the presence of antibodies does not allow us to say unambiguously that the clinical manifestations of the disease are caused by EBV.

3. To obtain the most reliable results, DNA diagnostics is used. Using the polymerase method chain reaction(PCR) determination of EBV DNA is carried out in various biological materials: saliva, blood serum, leukocytes and peripheral blood lymphocytes. If necessary, research is carried out in biopsy samples of the liver, lymph nodes, intestinal mucosa, etc. Thus, to make a diagnosis of EBV infection, in addition to general clinical examinations, serological tests (ELISA) and DNA diagnostics of infection in various materials over time are necessary.

Treatment of EBV infection

Currently, there are no generally accepted treatment regimens for EBV infection. The volume of therapy for patients with both acute and chronic active EBV infection may vary, depending on the duration of the disease, the severity of the condition and immune disorders. IN complex treatment For this disease, various groups of drugs are used, including recombinant interferons, which suppress the reproduction of the virus, protect uninfected cells, and strengthen the immune system. In addition, acyclic synthetic nucleosides and other antiviral drugs are used to stop virus replication in the affected cells, as well as glucocorticoids, the action of which is aimed at stopping inflammatory processes in organs and tissues. Depending on the severity of certain symptoms of the disease, various symptomatic therapy is prescribed (analgesics, antioxidants, non-steroidal anti-inflammatory drugs, mucolytics, etc.).

Interferon in the treatment of disease

The drug of choice in the treatment of EBV infection may be interferon-alpha, which in moderate cases is prescribed as monotherapy. The rationale for including antiviral immune agents (interferons) in the therapeutic complex is that clinical manifestations of infection are usually associated with immunodeficiency states of varying severity. With EBV infection, there is always a reduced production of its own interferon. Considering that EBV infection is a chronic, persistent disease, interferon therapy can also be recommended as a prevention of exacerbations. In this case, a course of treatment is prescribed, the duration of which depends on the severity of the disease.

A drug from the group of recombinant interferons can be prescribed. Combination of basic active substance interferon alpha-2b and highly active antioxidants: alpha-tocopherol acetate and ascorbic acid (presented in the dosage form as a mixture of ascorbic acid/sodium ascorbate) allows you to reduce the therapeutically effective concentration of interferon alpha-2b and avoid the side effects of interferon therapy. In the presence of ascorbic acid and its salt and alpha-tocopherol acetate, the specific antiviral activity of interferon increases, its immunomodulatory effect is enhanced and interferon levels are normalized.

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

Corresponding member RANS, professor A.A. Khaldin, MD, President of the Herpes-Forum NP.

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, 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 schoolchildren and adolescents usually suffer from various diseases caused by viruses.

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. The largest number of viral particles is 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 them, in addition to the salivary glands, are also found in the cells of the cervix, liver and spleen. Their main target is B-lymphocytes - cells of the immune system.

Important distinctive feature The virus is that it does not inhibit or disrupt cell reproduction, but on the contrary, it 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. However, these types of cells themselves are not affected by the Epstein-Barr virus, and therefore, in any case, play an 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, and changes in blood composition. These symptoms last for several weeks, sometimes up to a month, and then disappear.

Once suffered, infectious mononucleosis almost never bothers a person again, but the person who has been ill remains a carrier of the virus itself for 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 functioning 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 was 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. In case of serious muscle tension in this case, the patient’s spleen may rupture, and if he is not taken to surgery department, death will come.

But in general, infectious mononucleosis is not fatal. dangerous disease. Fatalities with it - an extremely rare phenomenon, 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 complicated course of the disease, the patient is prescribed antivirals: Acyclovir or Zovirax (which are 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 of the 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 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 of diseases caused by the Epstein-Barr virus will be 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 therapy cold water 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?

Epstein Barr virus (EBV) is one of the representatives of the family of herpes infections. Its symptoms, treatment and causes in adults and children are also similar to cytomegalovirus (herpes according to No. 6). EBV itself is called herpes number 4. In the human body, it can be stored for years in a dormant form, but when immunity decreases, it is activated, causes acute infectious mononucleosis and later - the formation of carcinomas (tumors). How else does the Epstein Barr virus manifest itself, how is it transmitted from a sick person to a healthy person, and how to treat the Epstein Barr virus?

What is the Epstein Barr virus?

The virus received its name in honor of the researchers - professor and virologist Michael Epstein and his graduate student Iwona Barr.

Einstein bar virus has two important differences from other herpes infections:

• It does not cause the death of host cells, but on the contrary, it initiates their division and tissue proliferation. This is how tumors (neoplasms) form. In medicine, this process is called proliferation - pathological proliferation.
• Not stored in ganglia spinal cord, and inside immune cells - in some types of lymphocytes (without their destruction).

The Epstein Barr virus is highly mutagenic. With the secondary manifestation of infection, it often does not respond to the antibodies produced earlier at the first meeting.

Manifestations of the virus: inflammation and tumors

Acute Epstein Barr disease manifests itself like flu, cold, inflammation. Long-term, low-grade inflammation initiates chronic fatigue syndrome and tumor growth. At the same time, different continents have their own characteristics of the course of inflammation and the localization of tumor processes.

In the Chinese population, the virus more often forms nasopharyngeal cancer. For the African continent - cancer of the upper jaw, ovaries and kidneys. For residents of Europe and America, acute manifestations of infection are more typical - high temperature (up to 40º for 2-3 or 4 weeks), enlarged liver and spleen.

Epstein Barr virus: how is it transmitted

Epstein bar virus is the least studied herpes infection. However, it is known that the routes of its transmission are varied and extensive:

• airborne;
• contact;
• sexual;
• placental.

People in the acute stage of the disease become a source of infection through the air(those who cough, sneeze, blow their nose - that is, they deliver the virus into the surrounding space along with saliva and mucus from the nasopharynx). During the period of acute illness, the predominant method of infection is airborne droplets.

After recovery(decrease in temperature and other symptoms of ARVI) the infection is transmitted by contact(with kisses, handshakes, shared dishes, during sex). EBV resides in the lymph and salivary glands for a long time. A person can easily transmit the virus through contact during the first 1.5 years after the disease. Over time, the likelihood of transmitting the virus decreases. However, research confirms that 30% of people have the virus in their salivary glands for the rest of their lives. In the other 70%, the body suppresses a foreign infection, while the virus is not detected in saliva or mucus, but is stored dormant in the beta lymphocytes of the blood.

If there is a virus in a person’s blood ( virus carriers) it can be transmitted from mother to child through the placenta. In the same way, the virus is spread through blood transfusions.

What happens when infected

The Epstein-Barr virus enters the body through the mucous membranes of the nasopharynx, mouth or respiratory organs. Through the mucous layer, it descends into the lymphoid tissue, penetrates beta lymphocytes, and enters the human blood.

Note: the effect of the virus in the body is twofold. Some of the infected cells die. The other part begins to divide. At the same time, different processes predominate in the acute and chronic stages (carriage).

During acute infection, the infected cells die. In case of chronic carriage, the process of cell division with the development of tumors is initiated (however, such a reaction is possible with weakened immunity, but if the protective cells are sufficiently active, tumor growth does not occur).

The initial penetration of the virus often occurs asymptomatically. Epstein Barr virus infection in children manifests itself with visible symptoms only in 8-10% of cases. Less often - signs are formed general illness(5-15 days after infection). The presence of an acute reaction to infection indicates low immunity, as well as the presence of various factors that reduce the body's protective reactions.

Epstein Barr virus: symptoms, treatment

Acute infection by a virus or its activation with decreased immunity is difficult to distinguish from a cold, acute respiratory infection or acute respiratory viral infection. The symptoms of Epstein bar are called infectious mononucleosis. This is a common group of symptoms that accompany a number of infections. Based on their presence, it is impossible to accurately diagnose the type of disease; one can only suspect the presence of an infection.

In addition to the signs of a common acute respiratory infection, Symptoms of hepatitis, sore throat, and rash may occur. The manifestations of the rash increase when the virus is treated with penicillin antibiotics (such erroneous treatment is often prescribed due to incorrect diagnosis, if instead of a diagnosis of EBV, a person is diagnosed with tonsillitis or acute respiratory infections). Epstein-Barr is a viral infection in children and adults, Treatment of viruses with antibiotics is ineffective and fraught with complications.

Epstein Barr infection symptoms

In the 19th century, this disease was called an unusual fever, in which the liver and lymph nodes become enlarged and the throat hurts. At the end of the 21st century, it received its own name - Epstein-Barr infectious mononucleosis or Epstein-Barr syndrome.

Signs of acute mononucleosis:

• Symptoms of acute respiratory infections- feeling unwell, fever, runny nose, enlarged lymph nodes.
• Symptoms of hepatitis: enlarged liver and spleen, pain in the left hypochondrium (due to an enlarged spleen), jaundice.
• Symptoms of a sore throat: soreness and redness of the throat, enlarged cervical lymph nodes.
• Signs of general intoxication: weakness, sweating, soreness in muscles and joints.
• Symptoms of inflammation of the respiratory organs: difficulty breathing, cough.
• Signs of damage to the central nervous system: headache and dizziness, depression, sleep disturbances, attention, memory.

Signs of chronic virus carriage:

• Chronic fatigue syndrome, anemia.
• Frequent recurrences of various infections- bacterial, viral, fungal. Frequent respiratory infections, digestive problems, boils, rashes.
• Autoimmune diseases - rheumatoid arthritis (joint pain), lupus erythematosus (redness and rashes on the skin), Sjogren's syndrome (inflammation of the salivary and lacrimal glands).
• Oncology(tumors).

Against the background of a sluggish infection with the Epstein Barr virus, a person often develops other types of herpes or bacterial infections. The disease becomes widespread and is difficult to diagnose and treat. Therefore, the Einstein virus often occurs under the guise of other infectious diseases. chronic diseases with wave-like manifestations - periodic exacerbations and stages of remission.

Virus carriage: chronic infection

All types of herpes viruses reside in the human body for life. Infection often occurs asymptomatically. After the initial infection, the virus remains in the body for the rest of life.(stored in beta lymphocytes). In this case, a person often does not realize that he is a carrier.

The activity of the virus is controlled by antibodies produced by the immune system. Without the opportunity to multiply and manifest itself actively, the Epstein-Barr infection sleeps as long as the immune system functions normally.

EBV activation occurs with a significant weakening of protective reactions. The reasons for this weakening may be chronic poisoning (alcoholism, industrial emissions, agricultural herbicides), vaccination, chemotherapy and radiation, tissue or organ transplantation, other operations, long-term stress. After activation, the virus spreads from lymphocytes to the mucous surfaces of hollow organs (nasopharynx, vagina, ureteral canals), from where it reaches other people and causes infection.

Medical fact: Herpes viruses are found in at least 80% of people examined. Bar infection is present in the body of the majority of the adult population of the planet.

Epstein Barr: diagnosis

Symptoms of Epstein Barr virus are similar to signs of infection cytomegalovirus(also herpetic infection No. 6, which manifests itself as a long-term acute respiratory infection). It is possible to distinguish the type of herpes and name the exact causative virus only after laboratory tests of blood, urine, and saliva.

Testing for Epstein Barr virus includes several laboratory tests:

• Blood is tested for Epstein Barr virus. This method is called ELISA (enzyme-linked immunosorbent assay) determines the presence and amount of antibodies to infection. In this case, primary antibodies of type M and secondary antibodies of type G may be present in the blood. Immunoglobulins M are formed during the first interaction of the body with an infection or when it is activated from a dormant state. Immunoglobulins G are formed to control the virus during chronic carriage. The type and quantity of immunoglobulins allows us to judge the primacy of the infection and its duration (a high titer of G bodies is diagnosed with a recent infection).
• Saliva or other biological fluid of the body (mucus from the nasopharynx, discharge from the genitals) is examined. This examination is called PCR, it is aimed at detecting viral DNA in liquid samples. The PCR method is used to detect various types of herpes viruses. However, when diagnosing the Epstein Barr virus, this method shows low sensitivity - only 70%, in contrast to the sensitivity of detecting herpes types 1, 2 and 3 - 90%. This is explained by the fact that the bara virus is not always present in biological fluids (even when infected). Because the PCR method does not provide reliable results of the presence or absence of infection; it is used as a confirmation test. Epstein-Barr in saliva - says that there is a virus. But it does not show when the infection occurred, and whether the inflammatory process is associated with the presence of the virus.

Epstein Barr virus in children: symptoms, features

Epstein-Barr virus in a child with normal (average) immunity may not cause painful symptoms. Therefore, infection of children of preschool and primary school age with the virus often occurs unnoticed, without inflammation, fever or other signs of illness.

Epstein-Barr virus often causes a painful infection in adolescent children- mononucleosis (fever, enlarged lymph nodes and spleen, sore throat). This is due to a lower protective reaction (the reason for the deterioration of immunity is hormonal changes).

Epstein-Barr disease in children has the following features:

• The incubation period of the disease is reduced - from 40-50 days it is reduced to 10-20 days after the virus penetrates the mucous membranes of the mouth and nasopharynx.
• The recovery time is determined by the state of immunity. A child’s defensive reactions often work better than an adult’s (they say bad habits, sedentary lifestyle). Therefore, children recover faster.

How to treat Epstein-Barr in children? Does treatment depend on the person's age?

Epstein Barr virus in children: treatment of acute infection

Since EBV is the least studied virus, its treatment is also under research. For children, only those drugs are prescribed that have passed the stage of long-term testing with identification of all side effects. There are currently no antiviral drugs for EBV that are recommended for the treatment of children of any age. Therefore, pediatric treatment begins with general supportive therapy, and only in cases urgent need(threats to the child’s life) use antiviral drugs. How to treat Epstein bar virus in the stage of acute infection or when chronic carriage is detected?

In acute manifestations, the Epstein-Barr virus in a child is treated symptomatically. That is, when symptoms of sore throat appear, they gargle and treat the throat; when symptoms of hepatitis appear, medications are prescribed to support the liver. Vitamin and mineral support of the body is required, in case of long-term protracted course - immunostimulating drugs. Vaccination after suffering from mononucleosis is postponed for at least 6 months.

Chronic carriage cannot be treated unless it is accompanied by frequent manifestations of other infections and inflammations. For frequent colds, measures to strengthen the immune system are necessary.- hardening procedures, walks in the fresh air, physical education, vitamin and mineral complexes.

Epstein Barr virus: treatment with antiviral drugs

Specific treatment for the virus is prescribed when the body cannot cope with the infection on its own. How to treat Epstein bar virus? Several areas of treatment are used: counteracting the virus, supporting one’s own immunity, stimulating it and creating conditions for the full development of protective reactions. Thus, the treatment of Epstein-Barr virus uses the following groups of drugs:

• Immunostimulants and modulators based on interferon (a specific protein that is produced in the human body when a virus intervenes). Interferon-alpha, IFN-alpha, reaferon.
• Drugs containing substances that inhibit the proliferation of viruses inside cells. These are valacyclovir (Valtrex), famciclovir (Famvir), ganciclovir (Cymevene), and foscarnet. The course of treatment is 14 days, with intravenous administration of drugs recommended for the first 7 days.

Important to know: the effectiveness of acyclovir and valacyclovir against the Epstein Barr virus is under research and has not been scientifically proven. Other drugs - ganciclovir, famvir - are also relatively new and insufficiently studied; they have a wide list side effects(anemia, disorders of the central nervous system, heart, digestion). Therefore, if Epstein-Barr virus is suspected, treatment with antiviral drugs is not always possible due to side effects and contraindications.

During treatment in hospitals, hormonal drugs are also prescribed:

• Corticosteroids are hormones that suppress inflammation (they do not act on the causative agent of infection, they only block the inflammatory process). For example, prednisolone.
• Immunoglobulins - to support immunity (administered intravenously).
• Thymic hormones - for prevention infectious complications(thymalin, thymogen).

If low titers of the Epstein Barr virus are detected, treatment can be restorative - vitamin s (as antioxidants) and drugs to reduce intoxication ( sorbents). This is maintenance therapy. It is prescribed for any infections, diseases, diagnoses, including those with a positive test for the Epstein-Barr virus. Treatment with vitamins and sorbents is allowed for all categories of sick people.

How to cure Epstein Barr virus

Medical research asks: is the Epstein-Barr virus a dangerous infection or a quiet neighbor? Is it worth fighting the virus or focusing on maintaining immunity? And how to cure Epstein Barr virus? The answers from doctors are mixed. And until a sufficiently effective cure for the virus is invented, we must rely on the body's immune response.

Everything is contained in a person necessary reactions protection against infections. To protect against foreign microorganisms, it is necessary to have good nutrition, limit toxic substances, as well as positive emotions and the absence of stress. Crash in immune system and infection with the virus occurs when it weakens. This becomes possible when chronic poisoning, long-term therapy medicines, after vaccination.

The best treatment for the virus is create the body healthy conditions, cleanse it of toxins, provide it with adequate nutrition, provide the opportunity to produce their own interferons against infection.