Chronic herpetic infection web. Epstein-Barr virus: symptoms and treatment, manifestations in children. The use of folk remedies in the treatment of Epstein-Barr virus

Epstein-Barr virus (EBV), or herpes virus type 4, is a DNA-containing lymphoproliferative virus of the Herpesviridae subfamily. Gammaherpesvirinae sort of Lymphocriptoviruses. Infection caused by EBV is an anthroponotic infectious disease. EBV is tropic for B-lymphocytes, and in some cases, B-lymphocytes after infection are transformed into blasts and continue to proliferate for up to 22 days; in other cases, EBV infects B-lymphocytes without disrupting proliferation with the inclusion of DNA in the form of a plasmid transmitted through a series of generations of these cells. The virus is capable of infecting epithelial cells of the oropharynx and nasopharynx, poorly differentiated epithelial cells of the salivary glands and thymus, and infecting peripheral blood monocytes. Its genome is also found in T lymphocytes with the ability of cells to express early and membrane antigens. The difference between EBV and other herpes viruses is its ability to cause not cytolysis, but the proliferation of affected B-lymphocyte cells. In this case, a latent infection is formed and the EBV genome persists for life in some cells of the macroorganism; the virus acquires an infectious nature during periods of reactivation.

The source of infection is a sick person or carrier. Routes of transmission: airborne, sexual, parenteral, transplacental. Factors of transmission of the virus are saliva, blood, sperm, vaginal secretions, donor organs and tissues, household items, toys contaminated with infected saliva. Within 2 hours after a person is infected with this virus, the synthesis of viral proteins begins, after 8 hours its maximum amount accumulates, and after 10 hours the first virions with infectious properties appear. The virus is detected in saliva and oropharyngeal washings of healthy individuals in 15–25% of cases. The frequency of virus isolation increases sharply with disorders in the immune system.

The population's susceptibility to EBV is high. Along with the known role of EBV as a causative agent of infectious mononucleosis, Burkitt's lymphoma and nasopharyngeal carcinoma, its contribution to the development of chronic fatigue syndrome is noted. According to a number of authors, EBV can lead to intrauterine infection of the fetus with adverse pregnancy outcomes and affect the health of newborns and young children.

In most cases, acute EBV infection in childhood is asymptomatic, while in adolescents and young adults (usually up to 20-25 years of age), EBV infection in 25–70% of cases leads to the development of infectious mononucleosis. The peak incidence of infectious mononucleosis occurs between 14 and 18 years of age, and antibodies to EBV are detected in most adults. Complications of mononucleosis are rare, but the development of autoimmune hemolytic anemia, thrombocytopenia, agranulocytosis, splenic rupture, hepatitis, pericarditis, myocarditis, damage to the nervous system (meningitis, encephalitis, damage to cranial nerves, myelitis, polyradiculitis, polyneuropathy, Guillain-Barre syndrome) is possible. Clinical manifestations of damage to the nervous system occur in 0.5–7.5% of cases; In 25% of patients with infectious mononucleosis, pathological deviations in the composition of the cerebrospinal fluid are detected.

The origin of hairy leukoplakia is closely related to the high level of replication of the EBV virus in the epithelial cells of the tongue. The presence of hairy leukoplakia directly indicates HIV infection (in 98% of people with this lesion, antibodies to HIV are detected), as well as its progression.

Half of all HIV-related non-Hodgkin's lymphomas are associated with EBV. The incidence of primary brain lymphoma has increased significantly over the past 10 years; This pathology affects up to 10% of patients with HIV infection with severe immunosuppression (the number of CD4+ T-lymphocytes is less than 100 cells/μl). CNS lymphoma is the second most common cause of focal brain lesions after toxoplasmosis in adult patients in the late stages of HIV infection.

• Confirmation of the diagnosis of infectious mononucleosis;
• mononucleosis-like syndrome in persons with weakened immunity (HIV, chemotherapy for malignant neoplasms, immunosuppressive therapy for internal organ transplantation, etc.);
• lymphadenopathy (with a predominant increase in the occipital, posterior cervical and submandibular lymph nodes);
• recurrent inflammatory diseases of the oropharynx;
• preventive screening studies;
• skin rash (mononucleosis-like rash);
• hepatitis of unknown etiology;
• hepatosplenomegaly;
• gastrointestinal pathology that is difficult to respond to standard therapy;
• presence of a burdened obstetric history (perinatal losses, birth of a child with congenital malformations);
• Pregnant women or women planning pregnancy have a history of infectious mononucleosis;
• children with symptoms of congenital infection, developmental defects, or born to women at risk for intrauterine transmission of EBV;
• patients (primarily newborns) with sepsis, hepatitis, meningoencephalitis, pneumonia, and gastrointestinal lesions.

Differential diagnosis. Adenoviral infection, rubella, measles, CMV (mononucleosis-like form), acute HIV infection (mononucleosis-like syndrome), pseudotuberculosis (mononucleosis-like syndrome); tonsillitis, oropharyngeal diphtheria, lymphogranulomatosis.

Material for research

• Blood, blood plasma, lymphocytes or leukocytes, sputum, urine, saliva, CSF, throat scrapings, nasopharyngeal washings - DNA detection, determination of hypertension;
• blood serum - determination of AT.

Etiological laboratory diagnosis includes detection of DNA and antigens of the pathogen, determination of antibodies to Epstein-Barr virus antigens in the blood.

Comparative characteristics of laboratory diagnostic methods. Determination of virus-specific antibodies is a common method for diagnosing EBV. Several groups of EBV antigens have been identified, the identification of antibodies to which allows not only to determine the presence of infection, but also to differentiate the stages of the disease, predict its development and monitor the effectiveness of treatment measures. In the early phase of the lytic cycle, the virus produces an early antigen (EBV-EA), then a capsid antigen (EBV-VCA) appears simultaneously with the viral genome. During the latent cycle, nuclear Ag (EBV-NA), latent membrane proteins, and small RNA molecules are synthesized. Determination of IgM and IgG antibodies to individual proteins makes it possible to more accurately determine the phase of the infection, taking into account the high frequency of virus persistence.

The use of the immunoblot method to determine IgM and IgG class antibodies to individual proteins provides additional information about the phase of the infection. Detection of the VCA 125 protein indicates the early phase of the infection. During the height of the infection and at the stage of completion of the acute process, VCA 19 appears. The late phase of the infection is indicated by the detection of a highly specific marker VCA 22, which is detected alone or together with EBNA-1 (p79). The latter protein is present for a long time in people who have had an infection and convincingly indicates a previous infection. There is a frequent presence of IgM-p45 and IgM-p79 during an active process, IgM-p43 and IgG-p27 correlate with the severity of the infection, and the detection of IgM-p65, IgM-p33 correlates with the presence of hepato- and splenomegaly. To detect EBV antigens in various biomaterial samples, the RIF and RNIF methods can be used. The use of this diagnostic ensures 100% detection of a specific EBV marker in lymphocytes, however, in the chronic course of the disease, negative results are possible. The use of immunocytochemistry or immunohistochemistry to detect EBV antigens has found application in the diagnosis of EBV-associated tumors.

DNA detection when diagnosing EBV can be carried out in a qualitative or quantitative format. Determination of EBV DNA is carried out in various biological materials: scrapings from the mucous membranes, plasma, CSF, etc. The detection of DNA (especially determination of the viral load) in blood plasma or in tissue scrapings taken from the nasopharyngeal ring in the early period of the disease is of greatest importance. Quantitative determination of Epstein-Barr virus DNA in the blood makes it possible to distinguish carriage (low concentration of the virus) from manifestations of an infectious process with active reproduction of EBV.

Indications for the use of various laboratory tests. For congenital infection and reactivation of persistent infection, the method of choice is the detection of EBV DNA in blood plasma and CSF. AT IgM is rarely detected. It is recommended to determine IgA antibodies to certain “early” Ags: EA-Rp93, EA-Dp45, EA-Dp43; capsid AG (CA): p125 (early phase marker), p65, p42, p41, p40, p33; p22 is a late phase marker.

AT-EBV NA IgG appears 3–6 weeks after the onset of the disease and persists throughout a person’s life. The determination of these antibodies has retrospective significance; its use for examining pregnant women and newborns is not justified.

Interpretation of results. The presence of EBV DNA in blood plasma and CSF confirms the active course of the infection. If IgM antibodies to the Epstein-Barr virus are detected in the blood, a conclusion can be made about the acute nature of the infection; if low-avidity, “early” IgG antibodies are detected, a conclusion can be made about the reactivation of the virus.

A single negative result of detecting EBV DNA in saliva and blood cells does not exclude the replication of the virus in the gastrointestinal tract, bone marrow, skin, lymph nodes, etc., which justifies the determination of IgM and IgA antibodies, the presence of which indicates an active infection.

Epstein-Barr virus is a type 4 herpes virus.
It can remain in the human body throughout life, causing autoimmune and lymphoproliferative diseases.
The most common manifestation of infection is mononucleosis.
In adults, the infection is most often transmitted by kissing through saliva, the epithelial cells of which contain a significant amount of virions.

Prevalence of the disease

90% of the population, upon reaching the age of 25, are already carriers of the virus.

Both sexes suffer from Epstein-Barr at equal rates. A specific race does not affect the prevalence of infection.

Routes of infection

Scientists have been studying the virus for more than 40 years, but all the ways Epstein-Barr spreads have not been fully identified to date.

In rare cases, infection through breast milk occurs.

There are known cases of infection through personal hygiene products, touch and shared utensils, sexual contact and through contaminated blood transfusions or bone marrow transplants.

In people who become ill for the first time, the virus is contained in the saliva and oropharyngeal mucus for about 1 – 1.5 years. In 30% of them, the virus content in saliva is detected throughout their life.

Symptoms of Epstein-Barr virus

The incubation period of the disease is about 1-2 months. After this period, the virus begins an active attack on skin tissue and lymph nodes, penetrates the blood and spreads throughout the human body.

The development of symptoms of the virus is long and occurs in several phases. At the initial stage, signs may be absent or appear to a slight extent, like ARVI.

After a chronic infection of viral origin affects the immune system, the following symptoms are observed:

• pain in the abdomen in the upper quadrant;
• general malaise;
• headache;
• sweating;
• nausea;
• sleep disorders;
• increase in body temperature to 38-39 degrees Celsius;
• skin rashes occur in 15% of cases - pale maculopapular rash;
• decreased memory and attention;
• depression.

The infection is characterized by enlarged and reddened lymph nodes, swollen tonsils with plaque, cough, sore throat at rest and when swallowing, and difficulty breathing through the nose.

The course of the infection is characterized by periods of subsidence and increasing symptoms. Many patients mistake the occasional warning signs for chronic flu.

Companions of the Epstein Barr virus are fungal and bacterial infections, for example, thrush, diseases of the gastrointestinal tract, and oncological processes in the body.

If the patient’s immunity is significantly weakened, the cranial and spinal nerves and the central nervous system may be affected.

Possible complications

Complications of the virus include:

• polyradiculoneuritis;
• meningitis;
• encephalitis;
• myocarditis;
• glomeruritis;
• complex forms of hepatitis.

The occurrence of severe complications can lead to death.

On the page: it is written about an operation on how to remove a hump on the nose.

Diseases caused by the presence of the Epstein Barr virus in the body:

• Infectious mononucleosis, observed in 3 out of 4 cases. The patient feels a general malaise, fever appears and lasts up to 2 weeks - a month, the lymph nodes and pharynx, liver and spleen are affected, and rashes are noted on the skin.

  Signs of mononucleosis disappear after a month and a half without treatment. The disease is not characterized by relapses, but there is a risk of complications - autoimmune hemolytic anemia, damage to the cranial nerves and nervous system.

• Chronic fatigue syndrome with the manifestation of causeless anger, depression, joint and muscle pain and deterioration in concentration.
• Lymphogranulomatosis, characterized by enlarged lymph nodes above the collarbone and on the neck without pain. With the progression of a malignant disease of lymphoid tissue, the spread of pathological processes to internal organs and their diffuse damage is observed.
• Burkitt's lymphoma is a malignant tumor that affects the ovaries, lymph nodes, kidneys and adrenal glands. The pathology is characterized by rapid development and leads to death in the absence of therapy.
• Nasopharyngeal carcinoma is a tumor that arises on the lateral wall of the nose and grows into the nasopharynx with metastasis to the lymph nodes. As the disease progresses, the following symptoms are observed: nasal congestion, discharge of mucus and pus from the nose, hearing loss, and frequent tinnitus.

With a weakened immune system, the nervous system, spleen and liver may suffer, which manifests itself in the form of jaundice, severe abdominal pain, and mild mental disorders.

The danger is the risk of splenic rupture, accompanied by severe pain on the left side of the abdomen. In this case, emergency medical attention is required, since internal bleeding that occurs can lead to the death of the patient.

If symptoms of the Epstein-Barr virus appear, you should immediately seek help from a doctor to diagnose, select effective treatment and reduce the risk of deterioration of the condition and the development of complications and pathologies.

Diagnosis of infection

To detect the Epstein Barr virus in the body, specialists conduct an initial examination and identify complaints, then use the following diagnostic methods to confirm the diagnosis:

• Blood chemistry.
• Complete blood count, which reveals neutropenia, leukocytosis or thrombocytopenia.
• The titer of specific bodies is established.
• Molecular diagnostic method with detection of pathogen DNA.
• Serological tests to detect antibodies to Epstein Barr virus antigens.
• Immunological examination, which shows disturbances in the functioning of the immune system.
• Culture method.

Treatment methods

There are currently no specific treatment regimens for Epstein Barr virus.

With strong immunity, the disease can pass without the use of therapy. It is enough to provide the patient with plenty of fluids and rest. Antipyretics and painkillers are used to relieve symptoms.

Treatment is carried out for acute and chronic forms by an infectious disease specialist, and for tumor-like neoplasms - by an oncologist.

The duration of therapy depends on the stage of the disease and can range from 3 weeks to several months.

When immunity is weakened and in order to reduce the risk of complications, the following drugs are used:

To enhance the effect of drugs, medications are prescribed:

• enterosorbents;
• antihistamines;
• hepatoprotectors;
• probiotics.

To analyze the effectiveness of treatment and the patient’s condition, a general blood test is performed once a week and a biochemical blood test is performed once a month.

Depending on the manifestations of the disease, it is possible to hospitalize the patient in the infectious diseases department.

When infectious mononucleosis is associated with the virus, the doctor prescribes antibiotics to the patient (Sumamed, Tetracycline) for 8-10 days, provides rest and rest, mainly to reduce the risk of splenic rupture. Lifting weights is prohibited for 2-3 weeks, sometimes up to 2 months.

To prolong the stage of remission of the Epstein-Barr virus, health spa treatment is recommended.

People who have had the Epstein-Barr virus retain IgG antibodies throughout their lives.

Disease prognosis

In the absence of immunodeficiency in the human body, the prognosis is quite favorable.

In rare cases, patients, mostly women, are bothered by chronic fatigue syndrome that lasts up to 2 years.

Sometimes otitis media or sinusitis appears as complications.

Prevention measures

To date, no vaccine has been developed against herpes type 4, which provokes the development of Epstein-Barr virus infection.

Scientists around the world are working to identify ways to create a vaccine against a common virus that, when complicated, leads to cancer.

There is no way to eliminate the possibility of contracting a virus.

The only way is to take measures to increase the body’s defenses to reduce the risk of getting sick or suffering from diseases without complications:

• Timely treatment of skin pathologies and infectious diseases;
• Hardening the body;
• Elimination of stressful situations;
• Frequent exposure to fresh air;
• Compliance with personal hygiene rules;
• Taking vitamins;
• Getting rid of bad habits.

Epstein-Barr virus is a serious disease that can provoke the development of serious illnesses. It is important to consult a doctor in time when you identify the first alarming symptoms. After diagnosis, the specialist will prescribe competent treatment, which will help eliminate the risk of complications and pathologies and lead to a speedy recovery.

How dangerous the Epstein-Barr virus is for human health is described in the story of the “Live Healthy” program.

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

The number of patients who want to treat Epstein-Barr Virus (hereinafter referred to as EBV) in their children or try to link all their problems with EBV carriage is off the charts. Therefore, a post about him!

Epstein-Barr virus: what is this virus?

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

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

Epstein-Barr virus: symptoms

• Increased temperature (more than 38.5⁰C, sometimes difficult to control, sometimes prolonged, up to several weeks), sometimes severe intoxication (malaise, chills, nausea, vomiting, headache).
• Snoring and difficulty breathing through the nose.

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

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

Epstein-Barr virus: additional diagnostics

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

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

IgM to capsid a/g EBV they speak of an acute infection (the child has encountered the virus for the first time) and persists for 1-3 months.

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

Heterophilic antibody test- positive from the end of the second week of illness.

Methods that will not indicate an acute illness(can be determined after illness throughout life):

• PCR of the virus in saliva and blood
• IgG to EBV

How to treat mononucleosis

In most cases, the prognosis for infectious mononucleosis is favorable, goes away on its own, and complications are rare. Treatment for infectious mononucleosis comes down to alleviating the symptoms of the disease: rinse the nose, ventilate the room, give plenty of fluids, ensure rest, select antipyretics, etc.

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

Thank you

The Epstein-Barr virus is a virus that belongs to the herpes virus family, the 4th type of herpes infection, capable of infecting lymphocytes and other immune cells, the mucous membrane of the upper respiratory tract, neurons of the central nervous system and almost all internal organs. In the literature you can find the abbreviation EBV or VEB - infection.

Possible abnormalities in liver function tests in infectious mononucleosis:

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


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


4. Increased alkaline phosphatase levels – norm 30-90 U/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.

Treatment of Epstein-Barr virus

There is still no consensus among doctors and scientists about treatment methods, and a large number of studies are currently being conducted 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 in mild cases, hospitalization can be avoided.

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

• semi-bed rest, limitation of physical activity,


• you need to drink plenty of fluids,


• 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,


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


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

For chronic fatigue syndrome will be useful:

• normalization of work, sleep and rest patterns,


• positive emotions, doing what you love,


• complete nutrition,


• multivitamin complex.

Drug treatment for Epstein-Barr virus

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

Treatment for Epstein-Barr virus is selected individually depending on the severity of the disease, manifestations of the disease, the patient’s immune system and the presence of concomitant pathologies.

Principles of drug treatment of chronic fatigue syndrome

• Antiviral drugs: Acyclovir, Gerpevir, Interferons,


• vascular drugs: Actovegin, Cerebrolysin,


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



• sedatives,


• multivitamins.

Treatment of Epstein-Barr virus 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 years of age):
   
   
   • Chamomile flowers,
   
   
   • Peppermint,
   
   
   • Ginseng,
   
   
   
   • Calendula flowers.
   Take herbs in equal proportions and stir. To brew tea, pour 200.0 ml of boiling water into 1 tablespoon and brew for 10-15 minutes. Take 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 useful substances.


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

Which doctor should I contact if I have Epstein-Barr virus?

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

FAQ

How does Epstein-Barr virus affect pregnancy?

• Class immunoglobulins detected G( VCA And EBNA) – you can safely plan a pregnancy; with good immunity, reactivation of the virus is not scary.


• Positive immunoglobulins class M – conceiving a baby 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 - You can and should become pregnant, but you will have to be monitored and undergo periodic tests. You also need to protect yourself from possible EBV infection during pregnancy and strengthen your immunity.

If class M antibodies were detected during pregnancy to the Epstein-Barr virus, then the woman must be hospitalized in a hospital until complete recovery, undergo the necessary symptomatic treatment, prescribe antiviral drugs, and administer immunoglobulins.

How exactly the Epstein-Barr virus affects pregnancy and the fetus has not yet been fully studied. But many studies have proven that pregnant women with active EBV infection are much more likely to experience pathologies in their pregnant baby. 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 the fetus:

• premature pregnancy (miscarriages),


• stillbirth,


• intrauterine growth retardation (IUGR), fetal malnutrition,


• prematurity,


• postpartum complications: uterine bleeding, disseminated intravascular coagulation, sepsis,


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

Can 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 becomes inactive , in this form, the infection can exist in the body for a lifetime;


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

What symptoms does the Epstein-Barr igg virus cause?

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

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

Symptoms of chronic Epstein-Barr virus infection (EBSV, or chronic fatigue syndrome) are:

• Prolonged low-grade fever;
• Low performance;
• Causeless and inexplicable weakness;
• Enlarged lymph nodes located in various parts of the body;
• Sleep disorders;
• Recurrent sore throats.

In addition, chronic VEBI can lead to the formation of certain 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 Epstein-Barr virus is widespread on all continents and is recorded in both adults and children. In most cases, the course of the disease is benign and ends with recovery. An asymptomatic course is registered in 10 - 25% of cases, in 40% the infection occurs under the guise of an acute respiratory infection, in 18% of cases in children and adults infectious mononucleosis is registered.

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. Symptoms of the disease are varied. The leading ones are intoxication, infectious, gastrointestinal, cerebral, arthralgic and cardiac syndromes. Treatment of Epstein-Barr virus infection (EBVI) is complex and includes antiviral drugs, immunomodulators, pathogenetic and symptomatic therapy. Children and adults after illness require long-term rehabilitation and clinical and laboratory monitoring.

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

Epstein-Barr virus

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

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

As viruses multiply, they activate the division of B lymphocytes and are transmitted to their daughter cells. Mononuclear cells—atypical lymphocytes—appear in the patient’s blood.

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

Specific antigens of the Epstein-Barr virus (capsid, nuclear, membrane) are formed sequentially and induce (promote) the synthesis of 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. The outside of the virions is loosely surrounded by a membrane. The capsid core and membrane of viral particles have antigenic properties, which provides pathogens with high damaging ability.

Epidemiology of Epstein-Barr virus infection

The disease is slightly contagious (lowly contagious). Viruses infect both adults and children. Most often, EBVI occurs asymptomatically or in the form of acute respiratory infections. Children in 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 outbreaks of the disease occur once every 5 years. The disease is more often registered in children aged 1 - 5 years living 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 an acute form of the disease remain dangerous to others for 1 to 18 months.

Pathways of pathogen transmission

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

Entrance gate

The entry gate for the pathogen is the mucous membrane of the upper respiratory tract. Organs rich in lymphoid tissue - tonsils, spleen and liver - are primarily affected.

Rice. 3. Epstein-Barr virus is transmitted through saliva. The disease is often called the “kissing disease.”

How does the disease develop in adults and children?

Epstein-Barr virus most often enters the upper respiratory tract through 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 quantities into the surrounding lymphoid tissue and salivary glands. Having penetrated B-lymphocytes, the pathogens spread throughout the body, primarily affecting the lymphoid organs - tonsils, liver and spleen.

In the acute stage of the disease, viruses infect one out 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.

Some of the infected B-lymphocytes are 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 infect other blood cells: T-lymphocytes, macrophages, NK cells, neutrophils and vascular epithelium, which leads to the development secondary immunodeficiency.

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

The pathogens persist (stay) in the human body for life and subsequently, with a decrease in the functioning of the immune system and hereditary predisposition, become the cause of 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 body's normal immune system is in most cases able to control and counteract the infection. Active reproduction of pathogens is caused by an acute bacterial or viral infection, vaccination, stress - everything that attacks the immune system.

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

EBVI classification

• EBVI can be congenital (in children) and acquired (in children and adults).
• Based on the form, they distinguish between typical (infectious mononucleosis) and atypical forms (asymptomatic, erased, visceral).
• The infection can be mild, protracted or chronic.
• The leading ones are intoxication, infectious (mononucleotide-like), gastrointestinal, cerebral, arthralgic and cardiac syndromes.

Acute form of Epstein-Barr virus infection in adults and children

Acute primary infection caused by Epstein-Barr viruses or mononucleosis-like 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 somewhat less likely to enlarge. There are cases of generalized lymphadenopathy. In half of the patients the spleen is enlarged, in 10 - 30% of patients there is an enlargement of the liver. Some patients develop periorbital edema.

The incubation period for EBVI lasts 4 - 7 days. All symptoms are most pronounced on average by the 10th day of illness.

Symptoms of acute form of EBVI

Intoxication syndrome

Most cases of the disease begin acutely with 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 ​​C.

Generalized lymphadenopathy

Generalized lymphadenopathy is a pathogonic symptom of EBVI in adults and children. It appears from the first days of the disease. 5-6 groups of lymph nodes enlarge simultaneously: more often the posterior cervical ones, somewhat less frequently - the anterior cervical, submandibular and ulnar ones. In diameter from 1 to 3 cm, not soldered together, arranged either in chains or in packages. They are clearly visible when you turn your head. Sometimes pasty tissue is observed above them.

Rice. 5. Most often, with EBVI, the posterior cervical lymph nodes are enlarged. They are clearly visible when you turn your 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 enlarge to II - III degree. Their surface becomes smoothed due to infiltration and lymphostasis with islands of dirty gray deposits, sometimes resembling lace, as in diphtheria, they are easily removed with a spatula, do not sink in water, and are easily rubbed. Sometimes plaques become fibrous-necrotic in nature and spread beyond the tonsils. Signs and symptoms of tonsillitis due to Epstein-Barr virus infection disappear after 5 to 10 days.

Rice. 6. Sore throat with EBVI. When plaque spreads beyond the tonsils, differential diagnosis should be made with diphtheria (photo on the right).

Symptoms of adenoiditis in acute form of EBVI

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

Enlarged liver and spleen

When the disease occurs in children and adults, the liver enlarges already at the beginning of the disease, but most often in the 2nd week. Its size returns to normal within 6 months. Hepatitis develops in 15–20% of patients.

An enlarged spleen in adults and children is a later symptom of the disease. Its size returns to normal in 1 to 3 weeks.

Rash

Exanthema (rash) appears on days 4–14 of the disease. It's varied. It can be spotted, papular, roseolous, pinpoint or hemorrhagic, without a specific localization. Observed for 4 - 10 days. Often leaves behind pigmentation. The rash appears especially often in children receiving amoxicillin or ampicillin.

Hematological changes

In the acute form of EBVI, leukocytosis, neutropenia, lymphocytosis, and monocytosis are observed. Mononuclear cells appear in the blood in quantities 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/hour.

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

Outcomes of acute form of EBVI in adults and children

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

• Recovery.
• Asymptomatic virus carriers.
• Chronic recurrent infection.
• Development of cancer.
• Development of autoimmune diseases.
• The emergence 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.
• Acute bacterial or viral infection, vaccination, stress, surgery—anything that attacks the immune system—causes the active proliferation of pathogens.

Rice. 8. The photo shows 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 diagnosis much more difficult. Chronic Epstein-Barr virus infection lasts a long time and has a relapsing course. Manifests itself as 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 a wave-like course, often described by patients as chronic influenza. Low-grade 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 - the main symptoms of the disease. Patients experience enlarged lymph nodes (generalized lymphadenopathy), enlarged liver and spleen. The palatine tonsils are enlarged (hypertrophied).

Hemophagocytic syndrome

Overproduction of anti-inflammatory cytokines by T cells infected with viruses 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 worried about intermittent fever, hepatosplenomegaly, generalized lymphadenopathy is noted, and liver failure develops. Mortality reaches 35%.

Consequences of the development of immunodeficiency in adults and children

Decreased immunity leads to the development of many diseases of infectious and non-infectious nature. Conditionally pathogenic flora is activated. Viral, fungal and bacterial infections develop. Acute respiratory infections and other diseases of the ENT organs (rhinopharyngitis, adenoiditis, otitis, sinusitis, laryngotracheitis, bronchitis and pneumonia) are registered 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 number, which negatively affects the functioning of many internal organs: the respiratory and central nervous systems, heart, joints, biliary dyskinesia develops, and the gastrointestinal tract is affected.

Rice. 9. Lymphocytic infiltrates in the superficial 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, and 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 erased (latent, sluggish) or atypical forms of the disease.

• In the first case, patients are bothered by prolonged low-grade fever of unknown origin, weakness, muscle-joint pain, and pain on palpation in the area of ​​peripheral lymph nodes. The disease occurs in waves in adults and children.
• In the second case, all the complaints described above 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, and genital organs. The diseases last a long time and often recur. Their duration ranges from 6 months to 10 years or more. Viruses are found in blood lymphocytes and/or saliva.

Rice. 10. Rash due to infectious mononucleosis in children.

Asymptomatic virus carriers

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

Diagnosis of the chronic form of Epstein-Barr virus infection

1. Chronic EBVI is characterized by a symptom complex that includes 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 lack of clinical effect from conventional therapy.

1. The anamnesis of such patients indicates prolonged excessive mental overload and stressful situations, a passion for fashionable diets and fasting.
2. A chronic course is indicated by:

• infectious mononucleosis no more than six months ago or a disease occurring with high titers of IgM antibodies (to the capsid antigen);
• histological examination (tissue examination) 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 anti-complementary immunofluorescence with the nuclear antigen of the virus.

Viral activity is indicated by:

• Relative and absolute lymphocytosis. Presence of atypical mononuclear cells in the blood. Somewhat less common are lymphopenia and monocytosis. In some cases, thrombocytosis and anemia.
• Changes in immune status (decreased content and impaired function of natural killer 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 persist (stay) in the human body for life and subsequently, with a decrease in the functioning of the immune system and hereditary predisposition, become the cause of 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 disruption 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, 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.

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 connection with the virus is less clear.

Most often, single or multiple malignant neoplasms are recorded in the jaw area, growing into adjacent 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, and many lymphomas of the central nervous system.

Rice. 13. Burkitt's lymphoma occurs mainly in children of the African continent aged 4 - 8 years. 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. This type of lymphoma is especially often associated with the Epstein-Barr virus in Asian populations.

Nasopharyngeal carcinoma

Rice. 15. The photo shows enlarged 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 epidemic sarcoma associated with AIDS.

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

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 oral cavity and tongue. Gray or white plaques appear on the tongue, gums, cheeks and palate. They are fully formed within a few weeks or even months. As the plaques harden, they take the form of thickened areas that rise above the surface of the mucous membrane. The disease is often reported in HIV-infected patients.

Rice. 17. The photo shows hairy leukoplakia of the tongue.

Autoimmune diseases

The 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. Sjogren's syndrome is an autoimmune disease. Dry eyes and dry mouth are the main symptoms of the disease. The disease is often caused by the Epstein-Barr virus.

Congenital Epstein-Barr virus infection

Congenital Epstein-Barr virus infection is recorded in 67% of cases of acute form of the disease and in 22% of cases when the chronic course of the infection is activated in women during pregnancy. Newborns are born with pathologies of the respiratory, cardiovascular and nervous systems, and their own antibodies and the mother’s antibodies can be detected in their blood. The pregnancy 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 diagnosing Epstein-Barr virus infection, the following laboratory research methods are used:

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

Clinical blood test

During the study, 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 is observed.

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

Rice. 21. In the photo there are atypical lymphocytes - mononuclear cells. They are always detected in blood tests for Epstein-Barr virus infections.

Blood chemistry

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

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

Immunological studies

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

Serological studies

Epstein-Barr virus antigens 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 (enzyme-linked immunosorbent assay).

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

• Specific IgM in the patient’s body appears during the acute period of the disease or during exacerbations. Disappears after 4 - 6 weeks.
• Specific IgG to EA (“early”) also appears in the patient’s body during the acute period and decreases during recovery within 3–6 months.
• Specific IgG to VCA (“early”) also appears in the patient’s body during the acute period. Their maximum is recorded at 2–4 weeks and then decreases, but the threshold level remains for a long time.
• IgG to EBNA is detected 2-4 months after the end of the acute phase and is subsequently produced throughout life.

Polymerase chain reaction (PCR)

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

Differential diagnosis

Diseases with a similar clinical picture include:

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

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

Rice. 22. Enlarged 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 detect the release of pathogens in saliva. If necessary, they receive 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, severe manifestations of tonsillitis and tonsillitis, enlarged lymph nodes, jaundice, increasing cough and the appearance of abdominal pain, hospitalization of the patient is necessary.

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

Analgesics are used to reduce pain and inflammation. Drugs from 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 the drug for pain relief Tylenol (the active ingredient is paracetamol. In the photo on the right is the drug Advil (the active ingredient is ibuprofen).

If there is a threat of developing a secondary infection or if there is discomfort in the throat, medications are used that include antiseptics, disinfectants and analgesics.

It is convenient to treat diseases of the oropharynx with combination drugs. They contain 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, Hexoral, Tantum Verde, Yox, Miramistin is indicated.

For sore throat, the use of drugs such as TeraFlu LAR, Strepsils Plus, Strepsils Intensive, Flurbiprofen, Tantum Verde, Anti-Angin Formula, Neo-angin, Kameton - aerosol is indicated. Local preparations containing analgesic components cannot be used in children under 3 years of age due to the risk of developing laryngospasm.

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 chronic 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 immune status. Treatment of chronic EBVI should be comprehensive: etiotropic (aimed primarily at the destruction of viruses), continuous and long-term, observing the continuity of treatment measures in inpatient, outpatient and rehabilitation settings. Treatment should be carried out under the control of clinical and laboratory parameters.

Basic therapy

The basis of treatment for EBVI is antiviral drugs. At the same time, the patient is recommended a protective regime and dietary nutrition. Treatment of infection with other drugs is additional.

The following antiviral drugs are used:

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

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

Immunocorrective therapy

When treating EBVI, the following are used:

• Immunomodulators Lykopid, 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. Drugs in this group are prescribed in cases of severe Epstein-Barr virus infection. They block “free” viruses that are found in the blood, lymph and intercellular fluid.
• Thymus preparations ( Timogen, Immunofan, Taktivin etc.) have a T-activating effect and the ability to stimulate phagocytosis.

Treatment of Epstein-Barr virus infection with corrector drugs 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, antipyretic drugs Ibuprofen, Paracetamol, etc. are used.
• If nasal breathing is difficult, nasal medications Polydexa, Isofra, Vibrocil, Nazivin, Adrianol, etc. are used.
• For dry cough in adults and children, Glauvent, Libexin, etc. are recommended.
• For wet cough, mucolytics and expectorants are prescribed (Bromhexal, Ambro HEXAL, Acetylcysteine, etc.

Antibacterial and antifungal drugs

In case of secondary infection, antibacterial drugs are prescribed. With Epstein-Barr virus infections, streptococci, staphylococci, and Candida fungi are more often found. The drugs of choice are 2nd - 3rd generation cephalosporins, macrolides, carbapenems and antifungal drugs. For mixed microflora, the drug metronidazole is indicated. Antibacterial drugs such as Stopangin, Lizobakt, Bioparox, etc. are used locally.

Means of pathogenetic therapy

• Metabolic rehabilitation drugs: Elkar, Solcoseryl, Actovegin, etc.
• To normalize the functioning of the gastrointestinal tract, hepatoprotectors (Galstena, 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 of the 1st and 3rd generations (Fenistil, Zyrtec, Claritin, etc.).
• Protease inhibitors (Gordox, Kontrikal).
• Hormonal drugs prednisolone, hydrocortisone and dexamethasone are prescribed for severe infection - airway obstruction, neurological and hematological complications. 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 a ruptured spleen.
• Vitamin and mineral complexes: Vibovit, Multi-tabs, Sanasol, Biovital gel, Kinder, etc.
• Antihomotoxic and homeopathic remedies: Aflubin, Oscillococcinum, Tonzilla compositum, Lymphomyosot, etc.
• Non-drug treatment methods (magnetic therapy, laser therapy, magnetotherapy, acupuncture, physical therapy, massage, etc.
• When treating asthenic syndrome, adaptogens, high doses of B vitamins, nootropics, antidepressants, psychostimulants and cell metabolism correctors are used.

Rehabilitation of children and adolescents

Children and adults who have suffered EBVI need long-term rehabilitation. The child is removed from the register six months to a year after clinical and laboratory parameters are normalized. Examination by a pediatrician is carried out once a month. If necessary, the child is referred to a consultation with an ENT doctor, hematologist, immunologist, oncologist, etc.

Laboratory examination methods used:

• General blood test once a month for 3 months.
• ELISA once every 3 months.
• PCR according to indications.
• Throat swab once every 3 months.
• Immunogram once every 3-6 months.
• Biochemical studies are carried out according to indications.

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