Epstein-Barr virus infection and its impact on allergic diseases. Epstein-barr virus infection in children and adults Epstein-barr virus causes pulmonary edema

Definition of the concept and description of the Epstein-Barr virus

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

Epstein-Barr virus (EBV) is a DNA-containing virus from the Herpesviridae family (gamma-herpesviruses), is a type 4 herpesvirus.

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

Particular attention is drawn to such a property of the Epstein-Barr virus as "lifelong persistence in the body." Due to the infection of B-lymphocytes, in which it is present for life, these cells of the immune system acquire the ability to unlimited life activity (the so-called "cellular immortality"), as well as the ability to constantly synthesize heterophile 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: core, capsid (the outermost shell), inner and outer shell.

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

The virus particle contains the following specific antigens (proteins required for diagnosis):

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

The significance, timing of their appearance in various forms of EBVI is not the same and has its own specific significance in terms of assessing the phase of the course of the disease during a laboratory examination of a patient (6).

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

In biological tissues and fluids, the Epstein-Barr virus is able to feel favorably when it enters the blood of a patient with EBVI, brain cells of a completely healthy person, cells during oncological processes (lymphoma, leukemia, and others).

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

The patient becomes contagious in the last days of 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 been ill retain the ability to periodically secrete the virus (that is, remain carriers) (6.7) .

Mechanisms of Epstein-Barr virus infection:

• it is aerogenic (airborne transmission), in which saliva and mucus from the oropharynx are contagious, which is released when sneezing, coughing, talking, kissing;
• a contact mechanism (contact-household transmission), in which salivation of household items (dishes, toys, towels, etc.) takes place, however, due to the instability of the virus in the external environment, it is unlikely to be important;
• the transfusion mechanism of infection is allowed (during the transfusion of infected blood and its preparations);
• alimentary mechanism (water-food transmission route);
• currently proven transplacental mechanism of infection of the fetus with the possibility of congenital Epstein-Barr virus infection (1,6).

Despite the variety of ways 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 for the environment of a patient with an Epstein-Barr virus infection, the disease is not very contagious, since many already have antibodies to the Epstein-Barr virus.

Infectious mononucleosis

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

The classic manifestation of an acute Epstein-Barr virus infection is infectious mononucleosis - 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 an idiopathic inflammation of the lymph glands.

The association of the disease with the Epstein-Barr virus was proven in the late 1960s (1, 10). The disease develops mainly in young adults, but it can occur in all patients from children to the elderly. The 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 the 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.

Enlargement of lymph nodes (viral lymphadenitis) is the most constant symptom of the disease. Earlier than others, and most clearly, the lymph nodes in the head and neck are enlarged, a bilateral enlargement of the lymph nodes is characteristic, and rarely, unilateral lesions.

Less often, 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 the defeat of the pharynx, which develops from the first days of the disease, sometimes later.

Angina with infectious mononucleosis can be of various shapes and in some cases even be accompanied by the formation of fibrinous films resembling diphtheria. A pronounced increase in the palatine tonsils, the presence of small hemorrhages (petechiae) on the back of the pharynx, which distinguishes the disease from other viral pharyngitis, but not from streptococcal tonsillitis, may be accompanied by swelling of the palatine uvula. Often, the nasopharyngeal tonsil is involved in the process, in connection with which patients develop difficulty in nasal breathing, nasality and snoring in their sleep.

At elevated temperature and enlarged lymph nodes, first of all, you need to consult a therapist

Enlargement of the liver and spleen are natural manifestations of the disease. Liver dysfunction - moderate icterus of the sclera, changes in the biochemical analysis of blood are more typical for older people. Rarely (in 3-25% of patients), a skin rash may occur - maculopapular, hemorrhagic, roseolous, prickly heat-type rash (1,10).

There are characteristic changes in the clinical analysis of blood - moderate leukocytosis, a decrease in the number of neutrophils, lymphocytosis and the appearance of specific cells - atypical mononuclear cells that appear on the 2nd-3rd day of illness and last up to 4 weeks (1.10).

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

The so-called heterophile 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 therapy of existing disorders of internal organs is carried out.

Rarely, with a pronounced increase in the tonsils, the occurrence of a number of complications, glucocorticosteroids are used.

Hospitalization of the patient is carried out according to clinical indications.

For this disease, no anti-epidemic measures are taken, and specific prevention has not been developed (1,7, 8, 10).

Chronic forms of Epstein-Barr virus infection

Chronic EBV infection is formed no earlier than 6 months after an acute infection, and in the absence of acute mononucleosis in history - 6 or more months after infection. Often, a 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, EBV-associated hemophagocytic syndrome, 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,
• 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,
• slight cough,
• nasal congestion,
• some patients have neurological disorders - causeless headaches, memory impairment, sleep disturbances, frequent mood swings, a tendency to depression, patients are inattentive, decreased intelligence.
• Often, patients complain of an increase in one or a group of lymph nodes, an increase in internal organs (spleen and liver) is possible.

Along with such complaints, when questioning the patient, the presence of recent frequent colds, fungal diseases, and the addition of other herpetic diseases is revealed. For example, herpes simplex 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 (decrease in the composition of almost all blood elements associated with inhibition of hematopoietic sprouts).

Patients may experience fever (wave-like or intermittent, in which both sharp and gradual rises in temperature are possible with recovery to normal values), swollen lymph nodes, liver and spleen, abnormal 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 virus infection: most often it is a fever of unknown origin lasting for months, years, accompanied by an increase in lymph nodes, sometimes joint manifestations, muscle pain; another option is secondary immunodeficiency with frequent viral, bacterial, fungal infections (7)

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

In the presence of a prolonged fever or enlargement and soreness of the lymph nodes, the examination should begin with a consultation with a therapist (5).

One of the forms of chronic Epstein-Barr virus infection is the so-called "chronic fatigue syndrome" - a condition characterized by constant fatigue that does not go away after a long and proper 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 do not sleep well, and both the falling asleep phase is disturbed, and intermittent sleep is observed, insomnia and drowsiness during the day are possible. At the same time, vegetative disorders are characteristic: trembling or tremor of the fingers, sweating, periodically low temperature, poor appetite, joint pain.

The disease can develop at any age, women predominate among patients. At risk are workaholics, people with increased physical and mental work, people who are both in acute stressful situations 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 note an insufficiently serious attitude to the patient's complaints in this condition and the 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 serological tests, the determination of virus DNA by PCR in blood, saliva, oropharyngeal swabs and other biological materials, and assessment of the 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.

So with infectious mononucleosis, an excessive increase in the palatine tonsils is possible, which can lead to obstruction of the upper respiratory tract, rupture of the spleen, 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 elderly patients, liver damage from infectious mononucleosis can lead to cholestasis (10).

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

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

A rare complication of Epstein-Barr virus 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

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

Epstein-Barr virus has been found to have a large set of genes that enable it to elude the human immune system to some extent. In particular, it produces proteins - analogues of a number of human interleukins and their receptors that change the immune response.

During the period of active reproduction, the virus produces interleukin - 10-like protein, which suppresses T-cell immunity, the function of cytotoxic lymphocytes, macrophages, 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 the Epstein-Barr virus, like other herpes viruses, is its high mutability, which allows it to avoid the effects of specific antibodies (produced against the virus before its mutation) and cells of the host's immune system for a certain time (7). Thus, the reproduction of the Epstein-Barr virus in the human body can be the cause of the occurrence, manifested by the addition of other herpetic, bacterial and fungal infections. For example, herpes labialis, genital herpes, thrush, inflammatory diseases of the 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.

Classical 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 oral mucosa, in which whitish folds appear on the lateral surfaces of the tongue, as well as on the mucous membrane of the cheeks, gums, which gradually merge, forming white plaques with a heterogeneous surface, as if covered with furrows, cracks, erosive surfaces. As a rule, there is no pain in this disease.
• Lymphoid interstitial pneumonia, which is a polyetiological disease (there is also a connection with the Epstein-Barr virus infection) and is characterized by shortness of breath, an unproductive cough against the background of temperature and symptoms of intoxication, as well as progressive weight loss in patients. The patient has enlarged liver and spleen, lymph nodes, enlarged salivary glands. X-ray examination of bilateral lower lobe interstitial foci of inflammation of the lung tissue, the roots are expanded, non-structural.
• 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 lymphoproliferative diseases in transplanted organs after transplantation and subsequent immunotherapy in individuals who have not been exposed to Epstein-Barr virus before transplantation and who do not have immunity to it at the time of intervention (12).

Epstein-Barr virus infection and pregnancy

In recent years, a transplacental mechanism of infection of the fetus has been proven and a congenital Epstein-Barr virus infection has been described that occurs in the fetus during the primary infection of a pregnant woman with the Epstein-Barr virus.

It has been established that the risk of it in 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. Possible prematurity, premature birth.

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

Effect of Epstein-Barr virus on the course of allergic diseases

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

A classic example of the debut of an allergic disease in Epstein-Barr virus infection is the occurrence of a generalized one when taking penicillin antibiotics for the treatment of tonsillitis caused by the Epstein-Barr virus.

The appearance of a rash on aminopenicillins is not an IgE-dependent reaction, so the use has neither a preventive nor a therapeutic effect. After recovery, repeated reactions to penicillin antibiotics may not be observed. Perhaps the development of multiform exudative erythema, 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, self-administration of penicillin antibiotics for angina without a preliminary medical examination and a general blood test is very dangerous.

In recent years, the possible influence of Epstein-Barr virus on the occurrence of chronic relapsing (4) has been studied. The possibility of developing exudative erythema multiforme against the background of Epstein-Barr virus infection has been shown without regard to medication (16).

Infection of children with viral infections is facilitated by the fact that their immune system is weakened, and at the same time they are more likely than adults to come into close contact with virus carriers. It is almost impossible to recognize diseases that arise as a result of the development of viruses of various types without special tests. Even the same virus can manifest itself as symptoms of several diseases that have different consequences and manifestations. For example, the development of the Epstein-Barr virus in a child's body sometimes goes unnoticed. But it can also be a source of very dangerous diseases.

Content:

Characterization of the virus

The discoverers of this infectious agent are the English microbiologist Michael Epstein and his assistant Yvonne Barr. The microorganism of this type is one of the representatives of the herpetic group of viruses. Infection usually occurs in childhood. Most often, children aged 1-6 years are infected as a result of the physiological imperfection of their immunity. A contributing factor is that at this age, most children are still little familiar with the rules of hygiene. Their close contact with each other during the game inevitably leads to the spread of the Epstein-Barr virus (EBV) from one baby to another.

Fortunately, in most cases, infection does not lead to serious consequences, and if the baby is still ill, then he develops strong immunity. In this case, the pathogen remains in the blood for life. Such microorganisms are found in about half of the children who have undergone a virological examination, and in most adults.

EBV infection is extremely rare in breastfed infants, as their body is protected from the effects of viruses by their mother's immunity. At risk are small children born prematurely, with poor development or congenital pathologies, and HIV patients.

At normal temperature and humidity, this type of virus is quite stable, but under dry conditions, under the influence of high temperatures, sunlight, and disinfectants, it quickly dies.

What is the risk of Epstein-Barr infection?

Up to 5-6 years of age, infection most often does not pose a serious threat to health. Symptoms are typical for ARVI, tonsillitis. However, children may become allergic to EBV. In this case, the reaction of the body can be unpredictable, up to Quincke's edema.

The dangerous thing is that, once in the body, the virus remains in it forever. Under certain conditions (decreased immunity, the occurrence of injuries and various stresses), it is activated, which causes the development of serious diseases.

The consequences may appear many years after the infection has occurred. With the development of the Epstein-Barr virus, the occurrence of the following diseases in children is associated:

• mononucleosis - the destruction of lymphocytes by viruses, the consequences of which are meningitis and encephalitis;
• pneumonia, increasing airway obstruction (obstruction);
• immunodeficiency state (IDS);
• multiple sclerosis - a disease caused by the destruction of the nerve fibers of the brain and spinal cord;
• heart failure;
• rupture of the spleen due to its strong increase (with acute pain in the abdomen), which requires immediate hospitalization;
• lymphogranulomatosis - damage to the lymph nodes (cervical, axillary, inguinal and others);
• malignant lesions of the lymph nodes (Burkitt's lymphoma);
• nasopharyngeal cancer.

Most often, an infected baby, after timely treatment, fully recovers, but is a virus carrier. With the transition of the disease into a chronic form, the symptoms periodically worsen.

If you do not conduct a timely examination, then doctors may not recognize the true nature of the symptoms. The patient's condition is deteriorating. A severe option is the development of deadly ailments.

Causes and risk factors

The main cause of infection is the entry of the Epstein-Barr virus directly from a sick person into the body of a small child, which is especially contagious at the end of the incubation period, which lasts up to 1-2 months. During this period, these microorganisms multiply rapidly in the lymph nodes and mucous membranes of the nose and throat, from where they then enter the bloodstream and spread to other organs.

There are the following ways of transmission of infection:

1. Contact. Many viruses are found in saliva. A child can become infected if a sick person kisses him.
2. Airborne. Infection occurs when particles of the patient's sputum are scattered around when coughing and sneezing.
3. Contact household. Infected saliva gets on the child's toys or objects that he touches.
4. Transfusion. Transmission of the virus occurs through the blood during the procedure of its transfusion.
5. Transplant. The virus is introduced into the body during a bone marrow transplant.

The symptoms of the patient may be hidden, so he, as a rule, is unaware of his illness, continuing to contact with a small child.

Video: How EBV infection occurs, what are its manifestations and consequences

Epstein-Barr classification of infections

When prescribing a course of treatment, various factors are taken into account, indicating the degree of activity of the pathogen and the severity of manifestations. There are several forms of Epstein-Barr virus disease.

Congenital and acquired. Congenital infection occurs even during the period of intrauterine development of the fetus when viruses are activated in a pregnant woman. A child can also become infected during passage through the birth canal, since an accumulation of viruses also occurs in the mucous membranes of the genital organs.

Typical and atypical. The typical form usually presents with symptoms of mononucleosis. With an atypical course, the symptoms are smoothed out or similar to manifestations of respiratory diseases.

Light, moderate and severe form. Accordingly, in a mild form, the infection is manifested by a short deterioration in well-being and ends with a complete recovery. A severe form leads to brain damage, goes into meningitis, pneumonia, cancer.

Active and inactive form, that is, the appearance of symptoms of rapid reproduction of viruses or a temporary lull in the development of infection.

Symptoms of EBV infection

At the end of the incubation period, when infected with the EB virus, symptoms appear that are characteristic of the development of other viral diseases. It is especially difficult to understand what a child is sick with, if he is less than 2 years old, he is not able to explain what specifically worries him. The first symptoms, as with SARS, are fever, cough, runny nose, drowsiness, headache.

In primary school children and adolescents, the Epstein-Barr virus is usually the causative agent of mononucleosis (glandular fever). In this case, the virus affects not only the nasopharynx and lymph nodes, but also the liver and spleen. The first sign of such a disease is swelling of the cervical and other lymph nodes, as well as an enlargement of the liver and spleen.

Typical symptoms of such an infection are:

1. Increase in body temperature. By day 2-4, it can rise to 39°-40°. In children, it remains high for up to 7 days, then drops to 37.3°-37.5° and stays at this level for 1 month.
2. Intoxication of the body, the signs of which are nausea, vomiting, dizziness, diarrhea, bloating, aching bones and muscles.
3. Enlargement of lymph nodes (mainly cervical) due to their inflammation. They become painful.
4. Pain in the region of the liver.
5. Inflammation of the adenoids. It is difficult for the patient to breathe through his nose because of his congestion, he is nasal, snoring in his sleep.
6. The appearance of a rash all over the body (such a symptom is a manifestation of an allergy to toxins). This symptom occurs in about 1 in 10 children.

Warning: When visiting a doctor, parents of preschool children should insist on examining the baby for the presence of EBV if he often has colds and sore throats, does not eat well, and often complains of fatigue. You may need treatment with specific antiviral drugs.

With an atypical form of Epstein-Barr virus infection, only a few symptoms appear, and the disease is not as acute as typical. Mild malaise can last much longer than with the usual acute form.

Video: Symptoms of infectious mononucleosis. Can the disease be treated with antibiotics?

Diagnostics

Methods of laboratory blood tests are used, with the help of which viruses are detected, the degree of damage to lymphocytes, and other characteristic changes are determined.

General analysis allows you to set the level of hemoglobin and the presence of an atypical structure of lymphocyte cells. According to these indicators, the activity of the virus is judged.

Biochemical analysis. According to its results, the state of the liver is judged. The content in the blood of enzymes, bilirubin and other substances that are produced in this organ is determined.

ELISA (enzymatic immunoassay). It allows you to detect the presence of specific antibodies in the blood - immune cells that are produced in the body to destroy the EB virus.

Immunogram. The number of cells of various blood elements in a sample taken from a vein (platelets, leukocytes, immunoglobulins) is counted. According to their ratio, the state of immunity is determined.

PCR (polymerase chain reaction). The DNA of microorganisms found in a blood sample is examined. This allows you to confirm the presence of Epstein-Barr viruses, even if they are present in small quantities and are in an inactive form. That is, it is possible to confirm the diagnosis already at the earliest stages of the disease.

Ultrasound of the liver and spleen. The degree of their increase, the presence of changes in the structure of tissues is determined.

Video: How EBV is diagnosed. With what diseases it is differentiated

Epstein-Barr treatment technique

If the disease proceeds in a complicated form, shortness of breath appears or there are signs of heart failure, acute pain in the abdomen, then the child is hospitalized. Conducting an urgent examination. If the presence of a viral infection is confirmed, specific antiviral and ancillary treatment is prescribed.

With a mild form of the disease, treatment is carried out at home. Antibiotics are not prescribed, as they are powerless in the fight against viruses. Moreover, their appointment for mononucleosis can only worsen the patient's condition, since antibiotics have a lot of side effects that are not harmless for babies.

Specific therapy for Epstein-Barr infection

Means to strengthen the immune system and antiviral drugs are prescribed only for severe illness, when there are signs of severe intoxication and immunodeficiency. Children of any age can take Acyclovir, Isoprinosine. From the age of 2, Arbidol, Valtrex are prescribed. After 12 years, you can use Famvir.

Antiviral and immunomodulating agents include interferon derivatives: Viferon, Kipferon (prescribed at any age), Reaferon (from 2 years). Interferon inducers are used (stimulating its own production in the body). Among them are Neovir (appointed from infancy), Anaferon (for children over 1 year old), Kagocel (from the age of 3 years), Cycloferon (after 4 years), Amiksin (after 7 years).

According to the results of the immunogram, the patient can be prescribed immunomodulatory drugs of other groups, such as Polyoxidonium, Derinat, Likopid.

Note: Any medications, and even more specific actions, should be prescribed to children only by a doctor. It is necessary to strictly adhere to the instructions, without violating the dosage and treatment regimen.

Complementary (symptomatic) therapy

It is carried out to alleviate the general condition of sick children.

As antipyretics, paracetamol or ibuprofen is usually given in forms suitable for children: in the form of syrups, capsules, suppositories. To facilitate nasal breathing, vasoconstrictors Sanorin or Nazivin are prescribed (in the form of drops or spray). Gargling with antiseptic solutions of furacilin or soda helps with sore throat. For the same purpose, a decoction of chamomile or sage is used.

Anti-allergic drugs are prescribed (Zirtek, Claritin, Erius), as well as drugs that improve liver function (hepatoprotectors Essentiale, Karsil and others). Vitamins C, group B and others are prescribed as fortifying agents.

Prevention

There is no specific vaccine for the Epstein-Barr virus. You can protect your baby from infection only by instilling hygiene skills in him from birth, as well as strengthening his immunity. The development of the immune system is facilitated by hardening, long walks in the fresh air, good nutrition, and a normal daily routine.

If symptoms of a viral infection occur, you should immediately contact your pediatrician. In the acute form of Epstein-Barr infection, timely treatment leads to a quick recovery. If the symptoms are smoothed out, this does not mean that they should not be paid attention to. The disease can become chronic and give serious complications.

Epstein-Barr virus (EBV). Symptoms, diagnosis, treatment in children and adults

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The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

Possible abnormalities in liver function tests in infectious mononucleosis:

1. 
   Increased transaminase levels several times:
   • ALT norm 10-40 IU/l,
   
   
   • AST norm 20-40 IU / l.
   
   
2. Increase in thymol test - the norm is up to 5 units.


3. Moderate increase in total bilirubin due to unbound or direct: the norm of total bilirubin is up to 20 mmol / l.


4. Increased alkaline phosphatase - the norm is 30-90 IU / l.

A progressive increase in indicators and an increase in jaundice may indicate the development of toxic hepatitis, as a complication of infectious mononucleosis. This condition requires intensive care.

Epstein-Barr virus treatment

There is still no consensus among physicians and scientists regarding the methods of treatment, and a large number of studies are currently being carried out regarding antiviral treatment. At the moment, there are no specific drugs effective against the Epstein-Barr virus.

Infectious mononucleosis is an indication for inpatient treatment, with further recovery at home. Although with a mild course, hospitalization in the hospital can be avoided.

In the acute period of infectious mononucleosis, it is important to observe sparing regimen and diet:

• semi-bed rest, restriction of physical activity,


• need to drink plenty of water


• meals should be frequent, balanced, in small portions,


• exclude fried, spicy, smoked, salty, sweet foods,


• fermented milk products have a good effect on the course of the disease,


• the diet should contain a sufficient amount of proteins and vitamins, especially C, group B,


• refuse products containing chemical preservatives, dyes, flavor enhancers,


• it is important to exclude foods that are allergens: chocolate, citrus fruits, legumes, honey, some berries, out-of-season fresh fruits, and others.

For chronic fatigue syndrome useful will be:

• normalization of the mode of work, sleep and rest,


• positive emotions, doing what you love,


• complete nutrition,


• multivitamin complex.

Epstein-Barr virus drug treatment

The principles of treatment of EBV infection in children and adults are the same, the difference is only in the recommended age dosages.

Treatment of the Epstein-Barr virus is selected individually depending on the severity of the course, the manifestations of the disease, the state of the patient's immunity and the presence of concomitant pathologies.

Principles of drug treatment of chronic fatigue syndrome

• Antivirals: Acyclovir, Gerpevir, Interferons,


• vascular drugs: Actovegin, Cerebrolysin,


• drugs that protect nerve cells from the effects of the virus: Glycine, Encephabol, Instenon,



• sedatives,


• multivitamins.

Epstein-Barr virus treatment with folk remedies

1. Echinacea tincture - 3-5 drops (for children over 12 years old) and 20-30 drops for adults 2-3 times a day before meals.


2. Ginseng tincture - 5-10 drops 2 times a day.


3. herbal collection (not recommended for pregnant women and children under 12):
   
   
   • Chamomile flowers,
   
   
   • Peppermint,
   
   
   • Ginseng,
   
   
   
   • Marigold flowers.
   Take herbs in equal proportions, stir. To brew tea, 1 tablespoon is poured into 200.0 ml of boiling water and brewed for 10-15 minutes. Taken 3 times a day.


4. Green tea with lemon, honey and ginger - increases the body's defenses.


5. fir oil - used externally, lubricate the skin over enlarged lymph nodes.


6. Raw egg yolk: every morning on an empty stomach for 2-3 weeks, improves liver function and contains a large amount of nutrients.


7. Magonia Root or Oregon Grape Berries - add to tea, drink 3 times a day.

Which doctor should I contact with the Epstein-Barr virus?

If infectious mononucleosis becomes a generalized infection, you should immediately call an ambulance and be hospitalized in the intensive care unit (reanimation).

Frequently asked Questions

How does the Epstein-Barr virus affect pregnancy?

• Class immunoglobulins discovered G( VCA and EBNA) - you can easily plan a pregnancy, with good immunity, the reactivation of the virus is not terrible.


• Positive immunoglobulins class M - with the conception of a baby, you will have to wait until complete recovery, confirmed by an analysis for antibodies to EBV.


• There are no antibodies to the Epstein-Barr virus in the blood - it is possible and necessary to become pregnant, but you will have to be observed, periodically taking tests. You also need to protect yourself from possible infection with EBV during the gestation period, strengthen your immunity.

If class M antibodies are detected during pregnancy to the Epstein-Barr virus, then the woman must be hospitalized in a hospital until complete recovery, the necessary symptomatic treatment is carried out, antiviral drugs are prescribed, and immunoglobulins are administered.

How exactly the Epstein-Barr virus affects pregnancy and the fetus is not yet fully understood. But many studies have shown that pregnant women with active EBV infection are much more likely to have pathologies in the child they are carrying. But this does not mean at all that if a woman had an active Epstein-Barr virus during pregnancy, then the child should be born unhealthy.

Possible complications of the Epstein-Barr virus on pregnancy and fetus:

• premature pregnancy (miscarriage),


• stillbirth,


• intrauterine growth retardation (IUGR), fetal hypotrophy,


• prematurity,


• postpartum complications: uterine bleeding, DIC, sepsis,


• possible malformations of the central nervous system of the child (hydrocephalus, underdevelopment of the brain, etc.) associated with the action of the virus on the nerve cells of the fetus.

Can the Epstein-Barr virus be chronic?

1. Infection followed by an active period of the virus (acute viral EBV infection or infectious mononucleosis);


2. Recovery, in which the virus goes into an inactive state , in this form, the infection can exist in the body for life;


3. Chronic viral infection Epstein-Barr - characterized by reactivation of the virus, which occurs during periods of reduced immunity, manifests itself in the form of various diseases (chronic fatigue syndrome, changes in immunity, oncological diseases, and so on).

What are the symptoms of the Epstein-Barr igg virus?

Thus, the entire record "Epstein-Barr virus igg" means that we are talking about the presence in the human body of antibodies of the IgG type to the virus. Currently, the human body can produce several types of IgG antibodies to different parts of the body. Epstein-Barr virus, such as:

• IgG to the capsid antigen (VCA) – anti-IgG-VCA;
• IgG to early antigens (EA) - anti-IgG-EA;
• IgG to nuclear antigens (EBNA) - anti-IgG-NA.

But the detection of antibodies such as anti-IgG-EA may indicate an active course of a chronic infection, which is accompanied by clinical symptoms. Thus, under the entry "Epstein-Barr igg virus" in relation to symptoms, doctors understand precisely the presence in the body of antibodies of the anti-IgG-EA type. That is, we can say that the concept of "Epstein-Barr igg virus" in short form indicates that a person has symptoms of a chronic infection caused by a microorganism.

Symptoms of a chronic Epstein-Barr virus infection (EBSI, or chronic fatigue syndrome) are as follows:

• Prolonged low-grade fever;
• Low performance;
• Causeless and inexplicable weakness;
• Enlarged lymph nodeslocated in various parts of the body;
• sleep disorders;
• Recurrent angina.

In addition, chronic EBV can lead to the formation of some tumors, such as:

• Nasopharyngeal carcinoma;
• Burkitt's lymphoma;
• Neoplasms of the stomach and intestines;
• Hairy leukoplakia of the mouth;
• Thymoma (tumor of the thymus), etc.

The most common diseases among children are viral. The reason is that the child's immunity is still not strong enough, immature, and it is not always easy for him to withstand numerous threats from outside. But if a lot has been said and written about the flu and chickenpox, and with measles, everything is more or less clear to mothers, that is, there are viruses in this world, the names of which alone bring sacred horror to parents.

One of these little-studied and very common is the Epstein-Barr virus. The well-known pediatrician and TV presenter Yevgeny Komarovsky is often asked about him.

What it is

EBV - Epstein Barr virus. One of the most widespread viruses on the planet. It was first found in tumor samples and described in 1964 by English professor Michael Epstein and his assistant Yvonne Barr. This is the herpes virus of the fourth type.

According to medical statistics, traces of the infection are found in the blood tests of half of children aged 5-6 years and in 97% of adults, and they themselves often do not even know about it, because in most people EBV goes unnoticed, without symptoms.

A child can become infected in different ways. Most often, EBV is excreted with body fluids, usually with saliva. For this reason, infectious mononucleosis caused by the virus is called "kissing disease".

Infection can occur during the transfusion of blood and its components, through things and toys shared with the patient, and the virus is also transmitted from an infected mother through the placenta to the fetus during pregnancy. EBV is easily spread by airborne droplets and from donor to recipient during bone marrow transplantation.

At risk are children under one year of age who actively learn the world around them through their mouths, trying to taste absolutely all objects and things that come to their fingertips. Another “problem” age is children from 3 to 6 years old who regularly attend kindergarten and have numerous contacts.

The incubation period is from 1 to 2 months, after which the children develop vivid symptoms that are characteristic of many viral infections.

However, the virus itself with a complex name is not so terrible, but the fact that its consequences are completely unpredictable. It can go completely unnoticed in one child, while in another it will cause the development of serious conditions and even oncological diseases.

Komarovsky on VEB

Evgeny Komarovsky urges parents not to create unnecessary hysteria around the Epstein-Barr virus. He believes that most children have already met with this agent in early childhood, and their immunity "remembered" him and is able to identify and resist.

And now let's listen to Dr. Komarovsky about infectious monoculosis.

The symptoms that make it possible to suspect EBV in a child are rather vague:

• Irritability, tearfulness, increased moodiness and frequent causeless fatigue.
• Slight or more noticeable enlargement of the lymph nodes. Most often - submandibular and behind the ear. If the infection is severe - throughout the body.
• Lack of appetite, digestive problems.
• Rash.
• High temperature (up to 40.0).
• Sore throat (as in sore throat and pharyngitis).
• Strong sweating.
• Slight enlargement of the liver and spleen. In a child, this may be manifested by aching pains in the abdomen.
• Yellowness of the skin. This symptom is extremely rare.

Komarovsky emphasizes that on the basis of complaints alone and the presence of certain symptoms, it is impossible to make a diagnosis, since the child's condition will resemble a sore throat, enterovirus, and lymphogranulomatosis.

To confirm or refute the Epstein-Barr virus, laboratory diagnostics of the patient's blood samples is required, including biochemical analysis, serological testing, PCR, and it is also desirable to make an immunogram and conduct an ultrasound examination of the abdominal organs - the liver and spleen.

Komarovsky often compares VEB with chickenpox. Both diseases are more easily tolerated at an early age, the younger the person, the simpler the disease and the fewer consequences. The older the primary infection occurs, the greater the chances of severe complications.

Treatment according to Komarovsky

Evgeny Olegovich warns that the treatment with antibiotics of the penicillin group of one of the diseases associated with EBV - infectious mononucleosis can cause serious complications. Usually such an appointment is erroneous when the doctor takes mononucleosis for the usual bacterial tonsillitis. In this case, exanthema may develop.

Ordinary children who do not suffer from HIV and other severe disorders of the immune system, according to Yevgeny Komarovsky, do not need any antiviral treatment for mononucleosis caused by EBV, and even more so, they do not need to be urgently given immunostimulants. A well-known pediatrician is sure that the child's body is able to cope with this threat on its own.

If the course of the disease is severe, which, according to Komarovsky, is very rare, treatment in a hospital may be required. There, most likely, antiherpetic drugs will be used (quite justifiably).

In all other cases, symptomatic treatment is sufficient. It includes antipyretics (if the temperature is above 38.5-39.0), remedies that reduce sore throats (lozenges, antiseptics, rinses), ointments, gels and external sprays with antiseptics for severe skin rashes.

Epstein-Barr virus is widespread on all continents, it is registered both in adults and in children. In most cases, the course of the disease is benign and ends in recovery. An asymptomatic course is recorded in 10–25% of cases, in 40% the infection proceeds under the guise of acute respiratory infections, in 18% of cases infectious mononucleosis is recorded in children and adults.

In patients with reduced immunity, the disease proceeds for a long time, with periodic exacerbations, the appearance of complications and the development of adverse outcomes (autoimmune pathology and cancer) and secondary immunodeficiency states. The symptoms of the disease are varied. Leading are intoxication, infectious, gastrointestinal, cerebral, arthralgic and cardiac syndromes. Treatment of Epstein-Barr virus infection (EBVI) is complex and includes antiviral drugs, immunomodulators, drugs for pathogenetic and symptomatic therapy. Children and adults after the disease need long-term rehabilitation and clinical and laboratory control.

Rice. 1. The photo shows the Epstein-Barr virus. View in an electron microscope.

Epstein-Barr virus

The Epstein-Barr virus was discovered in 1964 by M. Epstein and Y. Barr. It belongs to the family of herpes viruses (it is a type 4 herpes virus), a subfamily of gamma viruses, a genus of lymphocryptoviruses. The pathogen has 3 antigens: nuclear (EBNA), capsid (VCA) and early (EA). A viral particle consists of a nucleotide (contains 2-stranded DNA), a capsid (consists of protein subunits) and a lipid-containing shell.

Viruses target B-lymphocytes. In these cells, pathogens are able to stay for a long time and, with a decrease in the work of the immune system, they cause the development of chronic Epstein-Barr virus infection, a number of severe oncological pathologies of a lymphoproliferative nature, autoimmune diseases, and chronic fatigue syndrome.

Reproducing, viruses activate the division of B-lymphocytes and are transmitted to their daughter cells. Mononuclear cells appear in the patient's blood - atypical lymphocytes.

Pathogens, thanks to a large set of genes, are able to elude the human immune system. And the greater ability to mutate allows viruses to avoid the effects of antibodies (immunoglobulins) developed before the mutation. All this is the reason for the development of secondary immunodeficiency in infected people.

Specific antigens of the Epstein-Barr virus (capsid, nuclear, membrane) are formed sequentially and induce (promote) the synthesis of the corresponding antibodies. Antibodies in the patient's body are produced in the same sequence, which makes it possible not only to diagnose the disease, but also to determine the duration of infection.

Rice. 2. The photo shows two Epstein-Barr viruses under a microscope. The genetic information of virions is enclosed in a capsid - a protein shell. Outside, virions are freely surrounded by a membrane. The capsid core and membrane of viral particles have antigenic properties, which provides pathogens with a high damaging ability.

Epidemiology of Epstein-Barr virus infection

The disease is slightly contagious (slightly contagious). Viruses infect both adults and children. Most often, EBVI is asymptomatic or in the form of acute respiratory infections. Children of the first 2 years of life are infected in 60% of cases. The proportion of people who have antibodies to viruses in their blood among adolescents is 50-90% in different countries, among adults - 95%.

Epidemic rises of the disease are observed 1 time in 5 years. The disease is more often recorded in children aged 1-5 years, staying in organized groups.

Source of infection

The Epstein-Barr virus enters the human body from patients with clinically pronounced and asymptomatic forms of the disease. Patients who have suffered the disease in an acute form remain dangerous to others from 1 to 18 months.

Ways of transmission of the pathogen

The Epstein-Barr virus is spread by airborne droplets (with saliva), contact-household (through household items, toys, oral sex, kissing and shaking hands), parenteral (through blood transfusion), sexual and vertical (from mother to fetus).

entrance gate

The entrance gate for the pathogen is the mucous membrane of the upper respiratory tract. First of all, organs rich in lymphoid tissue are affected - tonsils, spleen and liver.

Rice. 3. Epstein-Barr virus is transmitted through saliva. The disease is often referred to as "kissing disease".

How the disease develops in adults and children

Epstein-Barr virus enters the upper respiratory tract most often by airborne droplets. Under the influence of infectious agents, epithelial cells of the mucous membrane of the nose, mouth and pharynx are destroyed and pathogens penetrate in large numbers into the surrounding lymphoid tissue and salivary glands. Having penetrated B-lymphocytes, pathogens spread throughout the body, affecting primarily the lymphoid organs - tonsils, liver and spleen.

In the acute stage of the disease, viruses infect one of every thousand B-lymphocytes, where they multiply intensively and potentiate their division. When B-lymphocytes divide, viruses are transmitted to their daughter cells. By integrating into the genome of infected cells, viral particles cause chromosomal abnormalities in them.

Part of the infected B-lymphocytes is destroyed as a result of the multiplication of viral particles in the acute phase of the disease. But if there are few viral particles, then B-lymphocytes do not die so quickly, and the pathogens themselves, persisting for a long time in the body, gradually affect other blood cells: T-lymphocytes, macrophages, NK cells, neutrophils and vascular epithelium, which leads to the development secondary immunodeficiency.

Pathogens can be in the epithelial cells of the nasopharyngeal region and salivary glands for a long time. Infected cells stay in the crypts of the tonsils for quite a long time (from 12 to 18 months), and when they are destroyed, viruses with saliva are constantly released into the external environment.

Pathogens in the human body persist (stay) for life and subsequently, with a decrease in the functioning of the immune system and hereditary predisposition, they cause the development of chronic Epstein-Barr virus infection and a number of severe oncological pathologies of a lymphoproliferative nature, autoimmune diseases and chronic fatigue syndrome.

In HIV-infected people, EBVI manifests itself at any age.

In children and adults infected with Epstein-Barr viruses, pathological processes rarely develop, since the normal immune system of the body in most cases is able to control the infection and counteract it. An acute bacterial or viral infection, vaccination, stress - everything that strikes at the immune system leads to the active reproduction of pathogens.

Rice. 4. Epstein-Barr virus under a microscope.

EBVI classification

• EBVI can be congenital (in children) or acquired (in children and adults).
• The form distinguishes between typical (infectious mononucleosis) and atypical forms (asymptomatic, obliterated, visceral).
• The infection can have a mild, protracted and chronic course.
• The leading ones are intoxication, infectious (mononuclear-like), gastrointestinal, cerebral, arthralgic and cardiac syndromes.

Acute Epstein-Barr virus infection in adults and children

Acute primary infection caused by Epstein-Barr viruses or mononuclear syndrome (not to be confused with infectious mononucleosis) in adults and children begins with high fever, sore throat and enlarged posterior cervical lymph nodes. The anterior cervical and ulnar lymph nodes are slightly enlarged. There are cases of generalized lymphadenopathy. At a half of patients the spleen increases, at 10 — 30% of patients increase in a liver is noted. Some patients develop periorbital edema.

The incubation period for EBVI lasts 4 to 7 days. Most clearly, all symptoms appear on average by the 10th day of illness.

Symptoms of the acute form of EBVI

Intoxication syndrome

Most cases of the disease begin acutely with a high body temperature. Weakness, lethargy, malaise and loss of appetite are the main symptoms of EBVI during this period. Initially, the body temperature is subfebrile. After 2 - 4 days it rises to 39 - 40 0 ​​С.

Generalized lymphadenopathy

Generalized lymphadenopathy is a pathological symptom of EBVI in adults and children. Manifested from the first days of the disease. Increase simultaneously 5 - 6 groups of lymph nodes: more often posterior cervical, somewhat less often - anterior cervical, submandibular and ulnar. In diameter from 1 to 3 cm, they are not soldered to each other, arranged either in chains or in packages. Well visible when turning the head. Sometimes pastosity of tissues is noted above them.

Rice. 5. Most often, with EBVI, the posterior cervical lymph nodes increase. They are clearly visible when turning the head.

Symptoms of tonsillitis in acute form of EBVI

Tonsillitis is the most common and early symptom of the disease in adults and children. Tonsils increase to II - III degree. Their surface becomes smoothed due to infiltration and lymphostasis with islands of dirty gray plaques, sometimes resembling lace, as in diphtheria, they are easily removed with a spatula, they do not sink in water, they are easily rubbed. Sometimes raids become fibrous-necrotic in nature and spread beyond the tonsils. Signs and symptoms of tonsillitis with Epstein-Barr virus infection disappear after 5 to 10 days.

Rice. 6. Angina with EBVI. When plaque spreads beyond the tonsils, differential diagnosis with diphtheria should be carried out (photo on the right).

Symptoms of adenoiditis in acute form of EBVI

Adenoiditis in the disease is often recorded. Nasal congestion, obstructed nasal breathing, and snoring while sleeping with an open mouth are the main symptoms of Epstein-Barr virus infection in adults and children. The patient's face becomes puffy (acquires an "adenoid" appearance), the lips are dry, the eyelids and bridge of the nose are pasty.

Enlargement of the liver and spleen

The liver with a disease in children and adults increases already at the beginning of the disease, but most often - in the 2nd week. Its dimensions return to normal within 6 months. 15-20% of patients develop hepatitis.

Enlargement of the spleen in adults and children is a later symptom of the disease. Its dimensions are normalized in 1-3 weeks.

Rash

Exanthema (rash) appears on 4-14 days of illness. She is varied. It happens spotty, papular, roseolous, punctate or hemorrhagic, without a specific localization. Observed 4 - 10 days. Often leaves behind pigmentation. Especially often the rash appears in children receiving amoxicillin or ampicillin.

Hematological changes

In the acute form of EBVI, leukocytosis, neutropenia, lymphocytosis, and monocytosis are noted. Mononuclear cells appear in the blood in an amount from 10 to 50 - 80%. Mononuclear cells appear on the 7th day of illness and persist for 1-3 weeks. ESR rises to 20 - 30 mm / h.

Rice. 7. Rash in children with Epstein-Barr virus infection.

Outcomes of acute EBVI in adults and children

There are several options for the outcome of the acute form of the Epstein-Barr virus infection:

• Recovery.
• Asymptomatic virus carrier.
• Chronic recurrent infection.
• The development of oncological diseases.
• development of autoimmune diseases.
• The occurrence of chronic fatigue syndrome.

Disease prognosis

The prognosis of the disease is influenced by a number of factors:

• Degree of immune dysfunction.
• Genetic predisposition to Epstein-Barr virus-associated diseases.
• An acute bacterial or viral infection, vaccination, stress, surgery - everything that strikes at the immune system leads to the active reproduction of pathogens.

Rice. 8. In the photo, infectious mononucleosis in adults. Enlarged lymph nodes are an important sign of the disease.

Infectious mononucleosis is a dangerous disease. At the first signs and symptoms of the disease, you should immediately consult a doctor.

Chronic Epstein-Barr virus infection in adults and children

The chronic form of the disease in adults and children has a variety of manifestations and course options, which makes the diagnosis much more difficult. Chronic Epstein-Barr virus infection is long-term, has a relapsing course. Manifested by chronic mononucleosis-like syndrome, multiple organ failure, hemophagocytic syndrome. There are generalized and erased forms of the disease.

Chronic mononucleosis-like syndrome: signs and symptoms

Chronic mononucleosis-like syndrome in children and adults is characterized by an undulating course, often characterized by patients as chronic influenza. Subfebrile body temperature, weakness and malaise, muscle and joint pain, loss of appetite, discomfort in the throat, difficulty in nasal breathing, heaviness in the right hypochondrium, headaches and dizziness, depression and emotional lability, decreased memory, attention and intelligence are the main symptoms of the disease. Patients have an increase in lymph nodes (generalized lymphadenopathy), an increase in the liver and spleen. The palatine tonsils are enlarged (hypertrophied).

Hemophagocytic syndrome

Overproduction of anti-inflammatory cytokines by virus-infected T cells leads to activation of the phagocyte system in the bone marrow, liver, peripheral blood, lymph nodes, and spleen. Activated histiocytes and monocytes engulf blood cells. Anemia, pancytopenia and coagulopathy occur. The patient is concerned about intermittent fever, hepatosplenomegaly, generalized lymphadenopathy, liver failure develops. Lethality reaches 35%.

Consequences of the development of an immunodeficiency state in adults and children

Reduced immunity leads to the development of many diseases of an infectious and non-infectious nature. Conditionally pathogenic flora is activated. Viral, fungal and bacterial infections develop. ARI and other diseases of the ENT organs (rhinopharyngitis, adenoiditis, otitis media, sinusitis, laryngotracheitis, bronchitis and pneumonia) are recorded in patients up to 6-11 times a year.

In patients with a weakened immune system, the number of B-lymphocytes can increase to a huge amount, which negatively affects the work of many internal organs: the respiratory and central nervous systems, the heart, joints, biliary dyskinesia develops, and the gastrointestinal tract is affected.

Rice. 9. Lymphocytic infiltrates in the surface layers of the epithelium of the mucous membrane of the intestinal crypts.

Generalized form of EBVI: signs and symptoms

With severe immune deficiency, patients develop a generalized form of EBVI. Damage to the central and peripheral nervous system is noted. Meningitis, encephalitis, cerebellar ataxia, polyradiculoneuritis develop. Internal organs are affected - kidneys, heart, liver, lungs, joints. The disease often ends in the death of the patient.

Atypical forms of the disease

There are two forms of an erased (latent, sluggish) or atypical form of the disease.

• In the first case, patients are concerned about prolonged subfebrile condition of unknown origin, weakness, muscle and joint pain, pain on palpation in the region of peripheral lymph nodes. The disease in adults and children proceeds in waves.
• In the second case, all the above complaints are accompanied by symptoms indicating the development of secondary immunodeficiency: diseases of a viral, bacterial or fungal nature develop. There is damage to the respiratory tract, gastrointestinal tract, skin, genital organs. Diseases proceed for a long time, often recur. The duration of their course ranges from 6 months to 10 years or more. Viruses are found in blood lymphocytes and/or saliva.

Rice. 10. Rash in infectious mononucleosis in children.

Asymptomatic carrier

The asymptomatic course is characterized by the absence of clinical and laboratory signs of the disease. DNA of viruses is determined by PCR.

Diagnosis of the chronic form of the Epstein-Barr virus infection

1. Chronic EBVI is characterized by a symptom complex, including prolonged low-grade fever of unknown origin, decreased performance, unmotivated weakness, sore throat, enlarged peripheral lymph nodes, liver and spleen, liver dysfunction and mental disorders.

A characteristic feature is the absence of a clinical effect from the ongoing conventional therapy.

1. In the anamnesis of such patients, there are indications of prolonged excessive mental overload and stressful situations, passion for trendy diets and starvation.
2. Indicates a chronic course:

• transferred infectious mononucleosis not more than six months ago or a disease that occurs with high titers of IgM class antibodies (to the capsid antigen);
• histological examination (examination of tissues) of organs involved in the pathological process (lymph nodes, liver, spleen, etc.);
• an increase in the number of viruses in the affected tissues, proven by the method of anticomplementary immunofluorescence with the nuclear antigen of the virus.

Viral activity is indicated by:

• Relative and absolute lymphocytosis. The presence of atypical mononuclear cells in the blood. Somewhat less often lymphopenia and monocytosis. In some cases, thrombocytosis and anemia.
• Changes in the immune status (decrease in the content and dysfunction of natural killers of cytotoxic lymphocytes, impaired humoral response).

Differential diagnosis of chronic EBVI

Chronic Epstein-Barr virus infection should be distinguished from viral diseases (viral hepatitis, cytomegalovirus infection, toxoplasmosis, etc.), rheumatic and oncological diseases.

Rice. 11. One of the symptoms of EBVI is a rash on the body of a child and an adult.

virus-associated diseases

Viruses in the human body persist (stay) for life and subsequently, with a decrease in the functioning of the immune system and hereditary predisposition, they cause the development of a number of diseases: severe oncopathology, lymphoproliferative syndrome, autoimmune diseases and chronic fatigue syndrome.

Development of oncopathology

Infection of B-lymphocytes and violation of their differentiation are the main causes of the development of malignant tumors and paraneoplastic processes: polyclonal lymphoma, nasopharyngeal carcinoma, leukoplakia of the tongue and oral mucosa, tumors of the stomach and intestines, uterus, salivary glands, lymphoma of the central nervous system, Burkitt's lymphoma, in AIDS patients.

Development of autoimmune diseases

Epstein-Barr viruses play an important role in the development of autoimmune diseases: rheumatoid arthritis, systemic lupus erythematosus, Sjogren's syndrome, vasculitis, ulcerative colitis.

The development of chronic fatigue syndrome

Epstein-Barr viruses play an important role in the development of chronic fatigue syndrome along with human herpes viruses types 6 and 7.

Some types of oncopathology and paraneoplastic processes

Burkitt's lymphoma

Burkitt's lymphoma is common in Central Africa, where it was first described in 1958 by surgeon Denis Burkitt. It has been proven that the African variant of lymphoma is associated with the effect of viruses on B-lymphocytes. When sporadic("non-African") lymphoma, the association with the virus is less clear.

Most often, single or multiple malignant neoplasms are recorded in the jaw area, growing into neighboring tissues and organs. Young men and children get sick more often. In Russia, there are isolated cases of the disease.

Rice. 12. In the photo, Burkitt's lymphoma is one of the malignant tumors caused by the Epstein-Barr virus. This group includes cancer of the nasopharynx, tonsils, many lymphomas of the central nervous system.

Rice. 13. Burkitt's lymphoma occurs mainly in children of the African continent 4-8 years old. Most often, the upper and lower jaws, lymph nodes, kidneys and adrenal glands are affected.

Rice. 14. T-cell lymphoma of the nasal type. The disease is common in Central and South America, Mexico and Asia. Especially often this type of lymphoma is associated with the Epstein-Barr virus in Asian residents.

Nasopharyngeal carcinoma

Rice. 15. In the photo, an increase in lymph nodes with nasopharyngeal carcinoma in an HIV-infected person.

Kaposi's sarcoma

This is a malignant multifocal tumor of vascular origin that affects the skin, mucous membranes and internal organs. It has several varieties, one of which is the epidemic sarcoma associated with AIDS.

Rice. 16. Kaposi's sarcoma in AIDS patients.

Leukoplakia of the tongue

In some cases, the cause of the disease is the Epstein-Barr virus, which multiplies in the epithelial cells of the mouth and tongue. Plaques of gray or white color appear on the tongue, gums, cheeks and the surface of the sky. They are fully formed within a few weeks and even months. Hardening, plaques take the form of thickened areas that rise above the surface of the mucous membrane. The disease is often recorded in HIV-infected patients.

Rice. 17. In the photo, hairy leukoplakia of the tongue.

Autoimmune diseases

Epstein-Barr virus contributes to the development of autoimmune diseases - systemic lupus erythematosus, rheumatoid arthritis, Sjögren's syndrome, vasculitis, ulcerative colitis.

Rice. 18. Systemic lupus erythematosus.

Rice. 19. Systemic lupus erythematosus and rheumatoid arthritis.

Rice. 20. Sjögren's syndrome is an autoimmune disease. Dry eyes and dry mouth are the main symptoms of the disease. Often the cause of the disease is the Epstein-Barr virus.

Congenital Epstein-Barr virus infection

Congenital Epstein-Barr virus infection is recorded in 67% of cases of the acute form of the disease and in 22% of cases with the activation of the chronic course of infection in women during pregnancy. Newborns are born with pathology of the respiratory, cardiovascular and nervous systems, and their own antibodies and mother's antibodies can be determined in their blood. The gestation period can be interrupted by miscarriages or premature births. Children born with immunodeficiency die from proliferative syndrome as soon as possible after birth.

Diagnosis of the disease

When making a diagnosis of Epstein-Barr virus infection, the following laboratory research methods are used:

• General clinical research.
• Study of the patient's immune status.
• DNA diagnostics.
• Serological studies.
• Study of various materials in dynamics.

Clinical blood test

In the study, there is an increase in the number of leukocytes, lymphocytes and monocytes with atypical mononuclear cells, hemolytic or autoimmune anemia, a decrease or increase in the number of platelets.

In severe cases, the number of lymphocytes increases significantly. From 20 to 40% of lymphocytes acquire an atypical form. Atypical lymphocytes (mononuclear cells) remain in the patient's body from several months to several years after infectious mononucleosis.

Rice. 21. In the photo, atypical lymphocytes are mononuclear cells. Always found in blood tests for Epstein-Barr virus infections.

Blood chemistry

There is an increase in the level of transaminases, enzymes, C-reactive protein, fibrinogen.

Clinical and biochemical parameters are not strictly specific. Changes are also detected in other viral diseases.

Immunological studies

Immunological studies in the disease are aimed at studying the state of the interferon system, the level of immunoglobulins, the content of cytotoxic lymphocytes (CD8+) and T-helpers (CD4+).

Serological studies

Antigens of Epstein-Barr viruses are formed sequentially (surface → early → nuclear → membrane, etc.) and antibodies to them are also sequentially formed, which makes it possible to diagnose the disease and determine the duration of infection. Antibodies to the virus are determined by ELISA (enzymatic immunoassay).

The production of antigens by Epstein-Barr viruses is carried out in a certain sequence: surface → early → nuclear → membrane, etc.

• Specific IgM in the patient's body appear in the acute period of the disease or during exacerbations. Disappear after 4-6 weeks.
• Specific IgG to EA ("early") in the patient's body also appear in the acute period, decrease during recovery within 3-6 months.
• Specific IgG to VCA ("early") in the patient's body also appear in the acute period. Their maximum is recorded at 2-4 weeks and then there is a decrease, but the threshold level remains for a long time.
• IgG to EBNA are detected 2-4 months after the end of the acute phase and are produced in the future throughout life.

Polymerase chain reaction (PCR)

With the help of PCR in case of illness, Epstein-Barr viruses are determined in various biological materials: blood serum, saliva, lymphocytes and leukocytes of peripheral blood. If necessary, biopaths of the liver, intestinal mucosa, lymph nodes, scrapings of the oral mucosa and urogenital tract, prostate secretion, cerebrospinal fluid, etc. are examined. The sensitivity of the method reaches 100%.

Differential Diagnosis

Diseases that have a similar clinical picture include:

• HIV infection and AIDS,
• anginal (painful) form of listeriosis,
• measles,
• viral hepatitis,
• (CMVI),
• localized diphtheria of the pharynx,
• angina,
• adenovirus infection,
• blood diseases, etc.

The fundamental criteria for differential diagnosis are changes in the clinical blood test and serological diagnosis.

Rice. 22. Enlargement of lymph nodes in children with infectious mononucleosis.

Treatment of Epstein-Barr virus infection in adults and children

Before starting treatment for Epstein-Barr virus infection, it is recommended to examine all members of the patient's family in order to identify the release of pathogens with saliva. If necessary, they are given antiviral therapy.

Treatment of EBVI in adults and children during the period of acute manifestation of primary infection

During the period of acute manifestation of primary infection, special treatment for Epstein-Barr virus infection is not required. However, with prolonged fever, a pronounced manifestation of tonsillitis and tonsillitis, an increase in lymph nodes, jaundice, an increasing cough and the appearance of pain in the abdomen, hospitalization of the patient is necessary.

In case of mild and moderate severity of the course of the disease, the patient is recommended a general regimen at an adequate energy level. Prolonged bed rest prolongs the healing process.

Analgesics are used to reduce pain and inflammation. The drugs of the group of non-narcotic analgesics have proven themselves well: Paracetamol and its analogues Ibuprofen and its analogues.

Rice. 23. In the photo on the left is Tylenol (the active ingredient is paracetamol). In the photo on the right is the drug Advil (active ingredient is ibuprofen).

With the threat of developing a secondary infection and with symptoms of discomfort in the throat, drugs are used, which include antiseptics, disinfectants and painkillers.

It is convenient to treat diseases of the oropharynx with combined preparations. They include antiseptics and disinfectants with antibacterial, antifungal, and antiviral effects, painkillers, vegetable oils and vitamins.

Combined preparations for topical use are available in the form of sprays, rinses and lozenges. The use of drugs such as Hexetidine, Stopangin, Geksoral, Tantum Verde, Yoks, Miramistin is shown.

For sore throats, the use of drugs such as TheraFlu LAR, Strepsils Plus, Strepsils Intensive, Flurbiprofen, Tantum Verde, Anti-Angin Formula, Neo-angin, Cameton - aerosol is indicated. Local preparations containing anesthetic components in their composition should not be used in children under 3 years of age due to the risk of developing laryngospasm in them.

Local treatment with antiseptics and disinfectants is indicated in case of secondary infection. In infectious mononucleosis, tonsillitis is aseptic.

Treatment of EBVI in adults and children with a chronic course of the disease

Treatment of Epstein-Barr virus infection is based on an individual approach to each patient, taking into account the course of the disease, its complications and the state of the immune status. Treatment of chronic EBVI should be complex: etiotropic (primarily aimed at the destruction of viruses), continuous and long-term, with continuity of therapeutic measures in a hospital, outpatient setting and rehabilitation. Treatment should be carried out under the control of clinical and laboratory parameters.

Basic therapy

The mainstay of EBVI treatment is antiviral drugs. At the same time, the patient is recommended a protective regimen and dietary nutrition. Treatment of the infection with other drugs is optional.

Of the antiviral drugs used:

• Isoprinosine (Inosine pranobex).
• Acyclovir and Valtrex (abnormal nucleosides).
• Arbidol.
• Interferon preparations: Viferon (recombinant IFN α-2β), Reaferon-EC-Lipint, Kipferon, interferons for intramuscular injection (Realdiron, Reaferon-EC, Roferon A, Intron A, etc.).
• IFN inductors: Amiksin, Anaferon, Neovir, Cycloferon.

Long-term use of Viferon and Inosine pranobex potentiates immunocorrective and antiviral effects, which significantly increases the effectiveness of treatment.

Immunocorrective therapy

In the treatment of EBVI, the following are used:

• Immunomodulators Likopid, Polyoxidonium, IRS-19, Ribomunil, Derinat, Imudon, etc.
• Cytokines Leukinferon and Roncoleukin. They contribute to the creation of antiviral readiness in healthy cells, suppress the reproduction of viruses, and stimulate the work of natural killer cells and phagocytes.
• Immunoglobulins Gabriglobin, Immunovenin, Pentaglobin, Intraglobin, etc. The drugs of this group are prescribed in case of severe Epstein-Barr infection. They block "free" viruses that are in the blood, lymph and interstitial fluid.
• Thymus preparations ( Thymogen, Immunofan, Taktivin etc.) have a T-activating effect and the ability to stimulate phagocytosis.

Treatment of the Epstein-Barr virus infection with drugs, correctors and immune stimulants is carried out only after an immunological examination of the patient and a study of his immune status.

Symptomatic remedies

• For fever, antipyretics such as Ibuprofen, Paracetamol, etc. are used.
• With difficulty in nasal breathing, nasal preparations of Polydex, Isofra, Vibrocil, Nazivin, Adrianol, etc. are used.
• With a dry cough in adults and children, Glauvent, Libexin, etc. are indicated.
• With a wet cough, mucolytics and expectorants are prescribed (Bromhexal, Ambro GEKSAL, Acetylcysteine, etc.

Antibacterial and antifungal drugs

In the case of a secondary infection, antibiotics are prescribed. With the Epstein-Barr virus infection, streptococci, staphylococci, fungi of the genus Candida are more often found. The drugs of choice are 2-3 generation cephalosporins, macrolides, carbapenems, and antifungals. With a mixed microflora, the drug metronidazole is indicated. Locally applied antibacterial drugs such as Stopangin, Lizobakt, Bioparox, etc.

Means of pathogenetic therapy

• Medications for metabolic rehabilitation: Elkar, Solcoseryl, Actovegin, etc.
• To normalize the functioning of the gastrointestinal tract, hepatoprotectors (Galsten, Hofitol, etc.), enterosorbents (Filtrum, Smecta, Polyphepan, Enterosgel, etc.), probiotics (Acipol, Bifiform, etc.) are used.
• Angio- and neuroprotectors (Gliatilin, Instenon, Encephabol, etc.).
• Cardiotropic drugs (Cocarboxylase, Cytochrome C, Riboxin, etc.).
• Antihistamines I and III generations (Fenistil, Zyrtec, Claritin, etc.).
• Protease inhibitors (Gordoks, Kontrykal).
• Hormonal preparations prednisolone, hydrocortisone and dexamethasone are prescribed for severe infection - airway obstruction, neurological and hematological complications. The drugs in this group reduce inflammation and protect organs from damage.
• Detoxification therapy is carried out when the disease becomes severe and is complicated by rupture of the spleen.
• Vitamin-mineral complexes: Vibovit, Multi-tabs, Sanasol, Biovital gel, Kinder, etc.
• Antihomotoxic and homeopathic remedies: Aflubin, Oscillococcinum, Tonsilla compositum, Lymphomyosot, etc.
• Non-drug methods of treatment (magnetotherapy, laser therapy, magnetotherapy, acupuncture, exercise therapy, massage, etc.)
• In the treatment of asthenic syndrome, adaptogens, high doses of B vitamins, nootropics, antidepressants, psychostimulants and correctors of cellular metabolism are used.

Rehabilitation of children and adolescents

Children and adults after EBVI need long-term rehabilitation. The child is removed from the register in half a year - a year after the normalization of clinical and laboratory parameters. Examination by a pediatrician is carried out once a month. If necessary, the child is referred for a consultation with an ENT doctor, hematologist, immunologist, oncologist, etc.

Of the laboratory methods of examination are used:

• Once a month for 3 months, a general blood test.
• 1 time in 3 months ELISA.
• PCR according to indications.
• Throat swab once every 3 months.
• Immunogram 1 time in 3 - 6 months.
• According to the indications, biochemical studies are carried out.

Complex therapy and an individual approach in choosing the tactics of managing a patient, both at home and in a hospital, are the key to successful treatment of the Epstein-Barr virus infection.