What is Epstein Barr Virus? Epstein-Barr viral infection and its effect on allergic diseases. Complications and severe forms of diseases caused by the Epstein-Barr virus

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 infection) is one of the newest terms in medicine. And although 90% of the population or more are infected with EBV infection, there is still no complete information about the effect of the virus on the body.

You can live your whole life without even knowing about its presence, or you can find out about infection when a serious illness is detected.

So, the Epstein-Barr virus: a fashionable diagnosis that sucks in money for expensive drugs, or a really serious problem that requires increased attention?

Epstein-Barr virus - what is it?

Epstein-Barr virus is a microorganism from the family of herpes viruses, called herpes type 4. The virus invades B-lymphocytes, but does not destroy them, but transforms them.

Herpes virus type 4 spreads exclusively among people (including patients with asymptomatic forms of infection) in the following ways:

1. Airborne - when saliva or mucus enters the patient’s nasopharynx;
2. Sexual and blood transfusion - through sexual contact or blood transfusion/bone marrow transplant from an infected person;
3. Intrauterine - EBV disease in a woman during pregnancy leads to the formation of malformations in the fetus (earlier contact with the infection does not pose such a serious threat to the fetus).

Features of EBV infection:

• Infection usually occurs in infancy (from the mother's kiss).
• Although EBV is contagious, infection occurs only through close contact between an infected person and a healthy person. That is why the disease is called the kissing disease.
• Typical symptoms of the Epstein-Barr virus in children are frequent colds and inflammation of the upper respiratory tract (sinusitis, tonsillitis, rhinitis), which are difficult to treat with traditional treatment.
• In adults, the presence of EBV infection can be suspected if there is constant fatigue and weakness in the morning. It is herpes infection that most often provokes chronic fatigue syndrome.

Recent medical studies have shown that the Epstein-Barr virus can trigger processes in the body that lead to severe and sometimes incurable diseases:,.

The virus, initially affecting lymphoid tissue (B-lymphocytes) and epithelial cells of the salivary glands and nasopharyngeal region, can multiply minimally and not show external symptoms for a long time (hidden course).

The impetus for active reproduction is any condition that causes immune weakness and an inadequate immune response (autoimmune reaction). An imbalance in the immune system - a decrease in the level of T-lymphocytes and an increase in B-lymphocytes - subsequently provokes serious disturbances in the division and maturation of cells of various organs and often leads to cancer.

EBV infection can occur:

• Acute and chronic;
• With typical and hidden (asymptomatic form) manifestations, damage to various internal organs;
• According to the mixed type - most often in combination with cytomegalovirus.

Diseases caused by the Epstein-Barr virus

EBV infection manifests itself in three scenarios: primary infection against the background of immunodeficiency, a sluggish ongoing infection, or activation of a latent EBV infection with a sharp decrease in immune defense (surgery, colds, stress, etc.). As a result, the virus can provoke:

• Hodgkin's lymphoma () and its non-Hodgkin's forms;
• nasopharyngeal carcinoma;
• herpes of the skin and mucous membranes - herpetic rashes on the lips, herpes zoster;
• chronic fatigue syndrome;
• Burkitt's lymphoma - a cancerous tumor that affects the jaw, kidneys, retroperitoneal lymph nodes and ovaries;
• oncology of the digestive tract;
• leukoplakia - the appearance of white spots on the skin and mucous membranes, and their high bleeding is noted;
• severe damage to the liver, heart and spleen;
• autoimmune diseases - lupus erythematosus, rheumatoid arthritis,;
• blood diseases - pernicious anemia, leukemia,.

Types of EBV infection

The Epstein-Barr virus produces several specific proteins (antigens):

1. Capsid (VCA) - antigen to the internal protein content of the herpes virus;
2. Membrane (MA) - protein agents aimed at the envelope of the viral substance;
3. Nuclear (EBNA) is an antigen that controls the reproduction of the virus and prevents its death.

In response to antigen synthesis, the immune system produces antibodies to the Epstein-Barr virus, which serve as an indicator of the stage of the disease. Their presence in the blood and quantity varies depending on the stage of the disease:

In the absence of infection- antibodies to herpes type 4 IgM - less than 20 U/ml, IgG - less than 20 U/ml.

At an early stage of the disease- only antibodies to the capsid antigen of the Epstein-Barr virus are detected (anti-VCA IgM more than 40 U/ml). Maximum performance is achieved at 1-6 weeks. from the onset of the disease, and their normalization takes 1-6 months. The presence of IgM in the blood indicates an active infection.

In acute cases- antiproteins to VCA IgM and VCA IgG appear. Caspid antibodies of the IgG class for Epstein-Barr virus in the acute phase are positive and show more than 20 U/ml and reach a maximum value by 2 months from the onset of the disease, decreasing during the recovery process (can be detected for several more years).

The more acute the infection during the initial infection, the higher the titer of anti-VCA IgG.

In the persistent stage- all types of antibodies are synthesized (VCA IgM, VCA IgG and EBNA IgG). The appearance of IgG-class antibodies to the nuclear protein antigen EBNA indicates the onset of regression of the disease and rapid recovery. Their titer increases by 3-12 months. disease and continues to remain at high levels for several years.

In the absence of painful symptoms of anti-EBNA IgG in the blood, the fact of a previous illness is stated, possibly in an asymptomatic form.

Symptoms of Epstein-Barr virus

The symptoms of infection with the Epstein-Barr virus and the duration of the disease depend on both the form of the disease and the direction of the viral “hit”.

Primary infection can pass into the carrier phase asymptomatically; signs of the viral presence are detected only by serological blood testing.

With an erased course, traditional treatment of ARVI in children with Epstein-Barr virus does not bring a quick recovery.

In other cases, an acute disease occurs with pronounced symptoms or a sluggish current infection with chronic pathological abnormalities. Sometimes a generalized form develops with severe damage to organs and systems.

Infectious mononucleosis

From infection to the appearance of the first signs of the disease, 5 to 45 days pass. The main symptoms of mononucleosis:

• Catarrhal phenomena - loose tonsils and hyperemia of the palatine arches (symptoms of tonsillitis), clear or purulent nasal discharge, ulcerative stomatitis.
• Intoxication - from the first days of the disease, significant hyperthermia (above 38C), chills, joint pain, weakness. This picture lasts for 1-4 weeks.
• Enlarged lymph nodes - detected 7 days after the onset of the disease, painless and dense. Palpated in the neck area: occipital, submandibular, axillary, sub- and supraclavicular.
• Enlargement of the liver - by 2 fingers (detected by tapping) a week after the appearance of the first signs of the disease. Accompanied by abdominal pain, lack of appetite, nausea, jaundice (yellowish skin and sclera, discolored stool, dark urine).
• Enlarged spleen - significant splenomegaly is accompanied by pain in the left side.

Recovery occurs no earlier than 2-3 weeks. With gradual improvement in well-being, periods of exacerbation of the disease may occur. Periodic recurrence of symptoms indicates a weak immune system. Recovery may take 1.5 years.

Chronic fatigue syndrome

A striking example of the symptoms of a sluggish EBV infection. Patients constantly complain of weakness, even after a full night's sleep. Temperature up to 37.5ºC for no apparent reason, headache, muscle and joint pain are often perceived as a cold.

Moreover, this condition continues for a long time, and against the background of poor sleep and mood swings, the exhausted body reacts with depression or psychosis.

The performance of adults also suffers noticeably. Children experience severe memory loss, absent-mindedness and inability to concentrate.

Generalized EBV infection

Generalized infection by the virus occurs against the background of significant immune failure. After an acute course of infectious mononucleosis, the following may develop:

• severe pneumonia accompanied by respiratory failure;
• inflammation of the membranes of the heart (fraught with cardiac arrest);
• , encephalitis (threat of cerebral edema);
• toxic hepatitis and liver failure;
• splenic rupture;
• DIC syndrome (intravascular blood coagulation);
• damage to lymph nodes throughout the body.

Often the generalization of EBV infection is accompanied by a bacterial attack, which can lead to death.

No specific drugs have been created to completely eliminate EBV. Treatment of Epstein-Barr virus involves reducing the infection, balancing the immune system, and preventing complications. Drug therapy depends on the type of immune response to the viral attack and includes:

1. Antiviral drugs - Granciclovir, Valaciclovir, Famciclovir, Acyclovir (least effective), course for at least 2 weeks;
2. Interferons and immunoglobulins - Reaferon is the most effective;
3. Thymus hormones (Timalin, Thymogen) and immunomodulators (Dekaris, Lykopid) - increasing the level of T-lymphocytes and decreasing B-cells);
4. Corticosteroids (Prednisolone, Dexamethasone) and cytostatics - for an autoimmune reaction.

At the same time, symptomatic treatment and antibiotic therapy or Cefazolin (as indicated) are carried out. Be sure to maintain a healthy sleep schedule, eat well, avoid alcohol and avoid stressful situations.

The effectiveness of treatment is confirmed by normalization of blood serology.

Forecast

For most patients diagnosed with Epstein-Barr virus, the prognosis is good. You just need to be attentive to your health and do not delay consulting a doctor if signs of illness appear.

• The main criterion for success and prevention of severe consequences is maintaining immunity at a sufficient level.

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.

Epstein-Barr herpes virus is a common infection and does not have a specific method of prevention. EBV affects B-lymphocytes, which causes their uncontrolled reproduction, promotes the formation of autoimmune diseases, and tumor growth of lymphoid tissue.

The Epstein–Barr virus was isolated in 1964 from Burkitt's lymphoma, a malignant tumor caused by a disorder of cell division and maturation of B lymphocytes. Epstein-Barr virus (EBV or EBV infection) is a low-contagious disease; this disease does not cause epidemics, due to the fact that 55 - 60% of children and 90% of adults have antibodies to it.

The disease is named after the scientists who isolated the virus. Another recognized international name for Epstein-Barr infection is infectious mononucleosis.

EBV belongs to the DNA-containing herpesviruses Herpesviridae, carries 4 types of antigens (protein receptors), due to which it exhibits pathogenic activity. In terms of antigens (AGs), the Epstein-Barr virus does not differ from herpes simplex.

Specific antigens are used to diagnose Epstein–Barr virus using blood and saliva tests. You can read about ways to recognize the Epstein-Barr virus, tests for EBV infection, symptoms and treatment in children and adults on the website.

There are 2 strains of the Epstein-Barr virus:

• strain A is found everywhere in the world, but in Europe and the USA it more often manifests itself in the form of infectious mononucleosis;
• strain B - in Africa it manifests itself as Burkitt's lymphoma, in Asia - as nasopharyngeal carcinoma.

What tissues are affected by the virus?

Epstein-Barr virus has tropism (ability to interact) with:

• lymphoid tissues - causes enlargement of lymph nodes, liver, spleen;
• B-lymphocytes - multiplies in B-lymphocytes, without destroying them, but accumulating inside the cells;
• respiratory tract epithelium;
• epithelium of the digestive tract.

The uniqueness of the Epstein-Barr virus is that it does not destroy infected cells (B-lymphocytes), but provokes their reproduction and growth (proliferation) in the body.

Another feature of EBV is its ability to exist for life in infected cells. This process is called persistence.

Methods of infection

Epstein-Barr virus is an anthroponotic infection transmitted through humans. EBV is often found in the saliva of people with immunodeficiencies, such as HIV.

The Epstein-Barr virus survives in a humid environment, which makes it easier to penetrate the body, and is transmitted, like herpes:

• airborne method;
• tactile through hands, saliva during a kiss;
• during blood transfusion;
• transplacental method - infection in the fetus from a woman occurs in utero, and the child is already born with symptoms of the Epstein-Barr virus.

EBV dies when heated, dried, or treated with antiseptics. Infection occurs in childhood in children from 2 to 10 years old. The second peak of Epstein-Barr infection occurs at the age of 20-30 years.

There are especially many infections in developing countries, where by the age of 3 all children are infected. The disease lasts 2-4 weeks. Acute symptoms of Epstein-Barr virus infection appear in the first 2 weeks.

Mechanism of infection

Epstein-Barr viral infection enters the body through the mucous membrane of the nasopharynx, affects B-lymphocytes in the lymph nodes, causing the first clinical symptoms to appear in adults and children.

After an incubation period of 5–43 days, infected B lymphocytes are released into the blood, from where they are distributed throughout the body. The incubation period of the Epstein-Barr virus averages 7 days.

In in vitro (test tube) experiments, B lymphocytes infected with EBV infection are characterized by “immortality.” They acquire the ability to reproduce by division indefinitely.

It is assumed that this property underlies malignant changes in the body during EBV infection.

The immune system counters the spread of infected B-lymphocytes with the help of another group of lymphocytes - killer T-lymphocytes. These cells respond to viral Ag, which appears on the surface of the infected B lymphocyte.

Natural killer NK cells are also activated. These cells destroy infected B lymphocytes, after which EBV becomes available for inactivation by antibodies.

After recovery, immunity to infection is created. Antibodies in EBV are detectable throughout life.

Symptoms

The outcome of EBV infection depends on the state of the person’s immune system. Symptoms of Epstein-Barr virus infection in adults may involve only moderate liver enzyme activity and may not require treatment.

Epstein-Barr viral infection can occur with mild symptoms, manifested by enlarged cervical lymph nodes, as in the photo. But with a decrease in the body’s immune reactivity, especially with insufficient activity of T-lymphocytes, infectious mononucleosis of varying severity can develop.

Infectious mononucleosis

Infection with the Epstein-Barr virus occurs in mild, moderate, and severe forms. In the atypical form, the disease can be asymptomatic in a hidden (latent) form, relapsing with a decrease in immune reactivity.

In young children, the disease progresses as it begins acutely. Adults are characterized by a less acute onset of infection with the Epstein-Barr virus and a gradual development of symptoms.

The following forms of the virus are distinguished according to the nature of their course:

• spicy;
• protracted;
• chronic.

Epstein-Barr infection is detected at a young age. In its manifestations it resembles, accompanied by severe swelling of the tonsils.

A purulent follicular sore throat with a dense coating on the tonsils may develop. What a sore throat looks like in the photo, see the article What does a sore throat look like in adults and children.

Characteristic symptoms of EBV include nasal congestion and swelling of the eyelids.

The first symptoms of Epstein-Barr virus infection are signs of intoxication:

• headache, muscle pain;
• lack of appetite;
• sometimes nausea;
• weakness.

Symptoms of infection develop within a week. A sore throat appears and intensifies, and the temperature rises to 39 degrees. An increase in temperature is observed in 90% of patients, but, unlike acute respiratory viral infections, a rise in temperature is not accompanied by chills or increased sweating.

High fever can last for more than a month, but more often it lasts from 2 days to 3 weeks. After recovery, a low-grade fever may persist for a long time (up to six months).

Characteristic signs

Typical manifestations of infection are:

• enlargement of lymph nodes - first the tonsils of the pharyngeal ring, cervical lymph nodes enlarge, then axillary, inguinal, mesenteric ones;
• sore throat - the virus affects the respiratory tract in this area;
• skin rash caused by allergic reactions;
• joint pain due to the action of immune complexes that arise in response to the introduction of viruses;
• abdominal pain caused by enlarged mesenteric lymph nodes.

One of the most typical symptoms is symmetrical enlargement of the lymph nodes, which:

• reach the size of a pea or walnut;
• move freely under the skin, are not fused to it;
• dense to the touch;
• do not fester;
• do not solder to each other;
• slightly painful, surrounding tissue may be swollen.

The size of the lymph nodes decreases after 3 weeks, but sometimes they remain enlarged for a long time.

The appearance of pain is typical for infection. Pain occurs due to enlarged tonsils, which are hyperemic and covered with a white coating.

Not only the tonsils become inflamed, but also other tonsils of the pharyngeal ring, including, which is why the voice becomes nasal.

• Epstein-Barr infection is characterized by an increase in liver size by 2 weeks and the appearance of a jaundiced coloration of the skin. The size of the liver returns to normal after 3-5 weeks.
• The spleen also enlarges, and even to a greater extent than the liver, but after 3 weeks of illness its size returns to normal.

Infection with Epstein-Barr viruses is often accompanied by signs of allergies. In a quarter of patients, infection is manifested by the appearance of a rash and Quincke's edema.

Chronic form of infectious mononucleosis

Chronic infection with EBV leads to immunodeficiency, due to which a fungal or bacterial infection is added to the viral infection.

The patient constantly experiences:

• headache;
• discomfort in muscles and joints;
• seizures;
• weakness;
• mental disorders, memory impairment;
• depression;
• constant feeling of fatigue.

Signs of Burkitt's lymphoma

The malignant disease Burkitt's lymphoma often develops in children from 3 to 7 years of age and young men; it is a tumor of the lymph nodes of the upper jaw, small intestine, and abdominal cavity. The disease often occurs in people who have had mononucleosis.

To establish a diagnosis, a biopsy of the affected tissue is performed. When treating Burkitt's lymphoma the following is used:

• chemotherapy;
• antiviral drugs;
• immunomodulators.

Nasopharyngeal carcinoma

Nasopharyngeal carcinoma occurs more often in men aged 30–50 years; the disease is common in China. The disease manifests itself as a sore throat and a change in the timbre of the voice.

Carcinoma is treated with surgery, during which enlarged lymph nodes are removed. The operation is combined with chemotherapy.

Treatment

Treatment is aimed at increasing immune reactivity, for which Isoprinosine, Viferon, and alpha-interferon are used. Anti-virus agents are used to stimulate the production of interferon in the body:

• Neovir – from birth;
• Anaferon – from 3 years;
• Cycloferon – from 4 years;
• Amiksin - after 7 years.

The activity of the virus inside cells is suppressed by drugs from the group of abnormal nucleotides, such as Valtrex, Famvir, Cymevene.

To increase immunity, the following are prescribed:

• immunoglobulins, interferons – Intraglobin, Reaferon;
• immunomodulators – Thymogen, Likopid, ;
• cytokines - Leukinferon.

In addition to specific antiviral and immunomodulatory treatment, for Epstein-Barr virus the following are used:

• antihistamines - Fenkarol, Tavegil, Zirtek;
• glucocorticosteroids for severe disease;
• antibiotics for angina of the macrolide group, such as Sumamed, Erythromycin, the tetracycline group, Cefazolin;
• probiotics – Bifiform, Probiform;
• hepatoprotectors to support the liver - Essentiale, Gepabene, Karsil, Ursosan.

For fever, cough, nasal congestion and other symptoms of Epstein-Barr viral infection, treatment is prescribed, including antipyretics.

Despite the variety of medications, a unified scheme for how and how to treat infectious mononucleosis in adults and children with infection with the Epstein-Barr virus has not been developed.

Clinical forms of Epstein-Barr virus

After recovery, patients are monitored at the dispensary for six months. Once every 3 months, blood and oropharyngeal mucus are donated for EBV.

The disease rarely causes complications. But in severe forms of EBV, the infection becomes persistent and can manifest itself:

• Hodgkin's lymphoma - cancer of the lymph nodes;
• systemic hepatitis;
• autoimmune diseases - multiple sclerosis, systemic lupus erythematosus;
• tumors of the salivary glands, intestines, leukoplakia of the tongue;
• lymphocytic pneumonia;
• chronic fatigue syndrome.

Forecast

The prognosis for infection with Epstein-Barr viruses is favorable. Complications leading to death are extremely rare.

Virus carriage poses a danger. Under unfavorable conditions, which may also be associated with decreased immunity, they can cause relapses of chronic infectious mononucleosis and manifest themselves in various malignant forms of Epstein-Barr infection.

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Treatment of Epstein-Barr virus

Causes of Epstein-Barr virus

Infection caused by (EBV infection) is a common herpesvirus disease, most often occurring in the form of infectious mononucleosis, but may be accompanied by other manifestations due to suppression of the immune system, is associated with a number of cancers (nasopharyngeal carcinoma), predominantly lymphoproliferative diseases (Burkitt's lymphoma), as well as with autoimmune pathology.

Over the past 10 years, EBV infection in the world population has increased several times and ranges from 90 to 100%. EBV infection is the most common herpes virus infection in Ukraine. Epidemiological studies have proven that before reaching adulthood, about 90% of people are infected with EBV.

EBV is a human B-lymphotropic virus that has pronounced oncogenic properties and exhibits tropism for B- and T-lymphocytes. The virus contains specific antigens: capsid, nuclear, early, membrane. The time of appearance and biological significance of these antigens are not the same. Knowing the timing of the appearance of various antigens and identifying antibodies to them makes it possible to diagnose one or another clinical variant of the course of EBV infection. The virus also shares antigens with other herpesviruses. It is sensitive to the action of diethyl ether.

The source of infection is patients, including those with an erased course. The virus is released in nasopharyngeal mucus and saliva. Isolation of EBV sometimes lasts 18 months from the onset of the disease. The mechanism of transmission of infection is airborne. Due to the absence of a cough and runny nose, EBV is not released intensively, at a short distance from the patient, and therefore cause of EBV lies in prolonged contact. Children often become infected with EBV through toys contaminated with the saliva of a sick child or a virus carrier. The sharing of dishes and linen between sick and healthy people plays a role in the spread of infection. Blood-contact and sexual transmission of infection are also possible. Cases of vertical transmission of EBV from mother to fetus have been described, suggesting that this virus may be the cause of intrauterine anomalies.

The first infection with the virus depends on social conditions. In developing countries or in socially disadvantaged families, infection of children occurs mainly before 3 years of age. In developed countries, maximum infection occurs between the ages of 15 and 18 years. Most of the manifesting lesions during EBV infection are recorded in males. But reactivation of the infection can occur at any age; it is facilitated by factors that reduce general and local immunity.

Immunity in infectious mononucleosis is stable, reinfection only leads to an increase in antibody titer. There are certain features of the human body's response to EBV infection. Thus, in East and Central Africa the development of Burkitt's lymphoma predominates, in certain regions of East Asia - nasopharyngeal carcinoma. So far this is an inexplicable fact. Morphologically, in the acute period of the disease, a biopsy of the lymph nodes determines the proliferation of reticular and lymphoid tissue with the formation of large mononuclear cells and circulatory disorders. At the same time, Kupffer cell hyperplasia is detected, and in some cases, focal and widespread necrosis. The same histological changes are noted in the tonsils and paratonsillar tissue. In the spleen, follicular hyperplasia, edema and infiltration of its capsule by mononuclear cells are detected. In severe forms of the disease, bile pigment is deposited in the hepatocytes of the central zones of the lobules.

In the International Classification of Diseases, the following nosological forms are distinguished in various sections, which entail EBV infection:

• gammaherpesvirus infectious mononucleosis,
• immunodeficiency due to an inherited defective response to EBV,
• Burkitt's lymphoma,
• malignant nasopharyngeal tumor.

In general, many syndromes and diseases are now associated with EBV. In particular, there is reason to believe that the connection between EEEB and the development of Hodgkin's disease and some non-Hodgkin's lymphomas, chronic fatigue syndrome, Stevens-Johnson syndrome, multiple sclerosis, hairy leukoplakia of the tongue, and the like has been proven. Today there is no generally accepted clinical classification of EBV infection.

There are primary (acute infectious process - infectious mononucleosis) and chronic EBV infection. The incubation period for infectious mononucleosis varies between 6-40 days. Sometimes the disease begins with a prodromal period lasting 2-3 days, during which moderate fatigue, subtle lethargy, and a slight decrease in appetite appear. In typical cases, the onset of the disease is acute, body temperature rises to 38-39 °C. Patients complain of moderate headache, nasal congestion, discomfort in the throat when swallowing, and sweating.

With infectious mononucleosis, the level of intoxication is significantly less than does not occur with fever of other etiologies. Already in the first 3-5 days, acute tonsillitis, enlarged lymph nodes, liver and spleen appear. Fever in infectious mononucleosis can be constant, remitting or irregular, and sometimes wave-like. The duration of the febrile period ranges from 4-5 days to 2-4 weeks or more.

Lymphadenopathy is the most persistent manifestation of the disease. First of all, the cervical lymph nodes enlarge, especially those located along the posterior edge of the sternocleidomastoid muscle, at the angle of the lower jaw. The increase in these nodes is noticeable at a distance when turning the head to the side. Sometimes the lymph nodes look like a chain or a package and are often symmetrically located, their diameter can reach 1-3 cm. They are elastic, moderately sensitive to the touch, not welded together, mobile, the skin over them is not changed. At the same time, the axillary and inguinal lymph nodes may (not always) enlarge, and less commonly, bronchopulmonary, mediastinal and mesenteric lymph nodes.

There is a certain difficulty in nasal breathing, and the voice may change somewhat. There is almost no discharge from the nose during the acute period of the disease, since with infectious mononucleosis posterior rhinitis develops - the mucous membrane of the inferior turbinate, the entrance to the nasal part of the throat, is affected. Simultaneously with lymphadenopathy, symptoms of acute tonsillitis and pharyngitis appear. Changes in the tonsils can be catarrhal, follicular, lacunar, ulcerative-necrotic, sometimes with the formation of pearly-white or cream-colored plaque, and in some cases - soft fibrin films, which to a certain extent resemble diphtheria. Such plaques can occasionally even spread beyond the tonsils and be accompanied by an increase in fever or its increase after a previous decrease in body temperature. There are cases of infectious mononucleosis without signs of severe tonsillitis.

An enlarged liver and spleen is one of the constant symptoms of infectious mononucleosis. In most patients, an enlarged spleen is detected already from the first days of the disease; it has a relatively soft consistency and reaches its maximum size on the 4-10th days of the disease. Normalization of its size occurs no earlier than the 2-3rd week of illness, after normalization of the size of the liver. The liver also enlarges to its maximum on days 4-10 of illness. In some cases, liver enlargement may be accompanied by a slight impairment of its function, moderate jaundice.

In 5-25% of patients with infectious mononucleosis, a rash appears, which can be macular, maculopapular, urticarial (urticaria), hemorrhagic. The timing of the appearance of the rash varies, it lasts for 1-3 days and disappears without a trace. Often occurs when aminopenicillins (ampicillin, amoxicillin) are prescribed and is an immunoallergic reaction.

The atypical course of infectious mononucleosis includes cases of the disease when only some typical symptoms appear (for example, polyadenitis) or the most pronounced signs that are not typical are exanthema, jaundice, symptoms of damage to the nervous system.

After primary EBV infection, persistence of the virus in the body is often detected. It may not be clinically manifest (asymptomatic virus carriage or latent EBV infection). However, reactivation of EBV infection is possible, which leads to the development of a chronically relapsing course with damage to the central nervous system, myocardium, kidneys and various lymphoproliferative disorders.

In persons with severe immune deficiency, a generalized course of EBV infection may develop with damage to the central and peripheral nervous system in the form of meningitis, encephalitis, and polyradiculoneuritis. Immunodeficiency due to a defective hereditary response (X-linked lymphoproliferative disease, Duncan's disease, Partillo syndrome) in boys is characterized by an inadequate response to EBV due to certain mutations in the X chromosome.

The prognosis is unfavorable due to the occurrence of severe hepatitis, acute bone marrow failure, and fleeting non-Hodgkin's lymphomas. Burkitt's lymphoma is a very high-grade non-Hodgkin's lymphoma that develops from B lymphocytes and tends to spread beyond the lymphatic system (to the bone marrow, blood, spinal column). Burkitt's lymphoma can develop at any age, but it is most common in children and young adults, especially men. Often a tumor develops in patients with HIV infection. Lymphoma cells can accumulate in large numbers in the lymph nodes and abdominal organs, which leads to their enlargement. They can penetrate the small intestine, causing intestinal obstruction or bleeding. Sometimes there is swelling of the neck and jaw, which can be very painful. Without treatment, Burkitt's lymphoma progresses rapidly and leads to death.

Nasopharyngeal carcinoma is a tumor that develops in the upper part of the throat and differs significantly from other types of head and neck tumors in its development, causes, clinical course and treatment tactics.

How to treat Epstein-Barr virus?

Antiviral treatment is usually not required for infectious mononucleosis. Acyclovir drugs have no effect in this case.

In severe cases, the use of a short course of glucocorticosteroids, for example, prednisolone at a dose of 0.001 g/kg per day for 5-7 days, is indicated. Hyposensitizing and symptomatic agents are recommended.

In case of secondary bacterial infection, antibacterial drugs are prescribed in age-specific doses, with the exception of aminopenicillins. Among the etiotropic drugs for the treatment of chronic active EBV infection in the reactivation stage, acyclovir and ganciclovir are used. However, these drugs do not have an effect in latent disease.

Acyclovir is prescribed in the same way as for herpes zoster. Ganciclovir is administered intravenously at a dose of 0.005-0.015 g/kg 3 times a day for 10-15 days. The course can be extended up to 21 days. The maintenance dose is 0.005 g/kg per day. The drug at this dose is administered for a long time to prevent relapse of the disease. For maintenance therapy, you can use ganciclovir tablets 1 g 3 times a day.

In the treatment of chronic active EBV infection, alpha-interferon drugs are used. Recombinant interferon is prescribed in doses of 1 million IU per 1 m 2 of body area. The frequency of administration of the drug is 2 times a day with an interval of 12 hours. Duration of treatment at a dose of 1-3 million IU 2 times a day during the first week, then 3 times a week for 3-6 months.

In case of severe forms of EBV infection, immunoglobulin is used for intravenous administration in a single dose of 3-4 ml/kg body weight per day (0.15-0.2 g/kg body weight per day) from 1 to 5 injections per course of treatment. The course dose should not exceed 2 g per 1 kg of body weight.

Burkitt's lymphoma is highly sensitive to various types of cytotoxic drugs; they are administered intravenously at a dose of 0.03-0.04 g/kg once if the disease is diagnosed at an early stage. Treatment with cyclophosphamide twice with an interval of 10-14 days is effective. If the process spreads to the membranes and substance of the spinal cord and brain, methotrexate is administered intralumbarally at a dose of 0.005 g with its subsequent increase.

What diseases can it be associated with?

Complications of infectious mononucleosis are varied and include:

• splenic rupture,
• hypothrombotic bleeding,
• pharyngotracheal obstruction,

Chronic EBV infection is more often complicated in immunocompromised individuals by diseases such as:

• acute respiratory failure,
• bleeding,

In general, with infectious mononucleosis the prognosis is more favorable than with other forms of EBV infection, and only with a chronic course is it unfavorable.

Treatment of Epstein-Barr virus at home

Treatment for diseases caused by EBV infection is carried out in a medical hospital, but therapy is not short-term, and therefore some medications can also be taken at home.

Self-medication of the disease is unacceptable; the maximum effect is achieved only in cooperation with competent specialists.

What medications are used to treat Epstein-Barr virus?

• - at the rate of 1,000,000 IU per 1 m2 of body area, with a frequency of administration twice a day with an interval of 12 hours; duration of treatment at a dose of 1-3 million IU twice a day during the first week, then 3 times a week for 3-6 months;
• - 0.005-0.015 g/kg 3 times a day for 10-15 days, and sometimes for 21 days; the maintenance dose is 0.005 g/kg per day for a long period;
• - in a single dose of 3-4 ml/kg body weight per day, from 1 to 5 injections per course of treatment;
• - 0.001 g/kg per day for 5-7 days.

Treatment of Epstein-Barr virus with traditional methods

Infectious mononucleosis is a complex disease, the full treatment of which is possible only through the use of pharmaceuticals and traditional medicine. Folk remedies do not have sufficient potential to destroy the virus that has entered the body.

Treatment of Epstein-Barr virus during pregnancy

At the stage of pregnancy planning, future parents are recommended to undergo testing to determine the presence of antibodies to the Epstein-Barr virus in their blood. The presence of antibodies is assessed positively, and the presence of the infection itself requires further clarification of its status - passive or active.

The active course of the disease during pregnancy affects the process very negatively. In most cases, expectant mothers with this disease are placed in a hospital until complete recovery. The optimal and safest treatment for the fetus for the mother is carried out after consultation with the attending physician and specialized tests. Treatment of Epstein Barr virus is carried out only with the use of special modern drugs that contain interferon-alpha substances, abnormal nucleotides and various cytostatics. Immunoglobulins are also administered intravenously and corticosteroid hormones are used.

In a general blood test of patients with infectious mononucleosis, the changes are quite characteristic. Leukopenia, which can appear in the first 2 days of the disease, is replaced by leukocytosis with a significant increase in the number of mononuclear cells - lymphocytes, monocytes. The level of segmented neutrophils decreases, while the number of band neutrophils even increases slightly. ESR increases slightly. A characteristic feature is the presence of atypical mononuclear cells - mature mononuclear cells that have a large spongy nucleus, asymmetrically located in the cell. The protoplasm of the cells is wide and contains delicate azurophilic granules. A band of clearing often appears between the nucleus and the cytoplasm. The number of atypical mononuclear cells can reach 20% of all leukocytes or more. They appear on the 2-3rd day of illness and are observed in the blood for 3-4 weeks, sometimes up to 2 months or more.

With liver damage, the activity of ALT and AST and bilirubin levels moderately increase.

The polymorphism of clinical manifestations, as well as the involvement of the immune system in the pathological process, necessitate specific confirmation of the diagnosis. Detection in the blood serum of heterophilic antibodies to the erythrocytes of various animals (sheep, bull, horse, etc.) for infectious mononucleosis is now practically not used due to certain technical problems and relative nonspecificity. The method of choice is ELISA, which allows the detection of antibodies of different classes. PCR is also actively used.

Treatment of other diseases starting with the letter - B

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