Barr infection in children symptoms manifestations treatment. Epstein-Barr virus (EBV): characteristics, what diseases it causes, symptoms, treatment

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

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

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

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

Diseases caused by the virus

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

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

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

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

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

Varieties of the Epstein-Barr virus

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

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

Epstein-Barr virus symptoms

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

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

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

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

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

Treatment of Epstein-Barr virus infection

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

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

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

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

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

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

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

Disease prevalence

90% of the population at the age of 25 are already carriers of the virus.

Both sexes suffer from Epstein-Barr with equal frequency. Does not affect the prevalence of infection and a certain race.

Ways of infection

Scientists have been studying the virus for over 40 years, but all Epstein-Barr distribution routes have not been fully identified to date.

In rare cases, infection occurs through breast milk.

There are known cases of infection through personal hygiene products, touching and common utensils, sexually and through transfusion of infected blood or bone marrow transplantation.

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

Epstein-Barr virus symptoms

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

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

After the defeat of a chronic infection of viral origin of 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 - a pale maculopapular rash;
• decreased memory and attention;
• depression.

The infection is characterized by enlargement and redness of the lymph nodes, hyperemic tonsils with plaque, cough, sore throat at rest and when swallowing, and difficulty in nasal breathing.

The course of infection is characterized by the presence of periods of remission and increase in symptoms. Many patients mistake occasional warning signs for chronic influenza.

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

With significantly weakened immunity in a patient, it is possible to affect the cranial and spinal nerves and the central nervous systems s.

Possible Complications

The 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 the operation, how to remove the hump on the nose.

Diseases provoked 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, 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 unreasonable anger, depression, joint and muscle pain and deterioration in concentration.
• Lymphogranulomatosis, characterized by an increase in lymph nodes above the collarbone and on the neck without pain. With the progression of a malignant disease of the lymphoid tissue, the spread of pathological processes to the 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. 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, frequent tinnitus.

With a weakened immune system, the nervous system, spleen and liver can suffer, which manifests itself in the form of jaundice, sharp pains in the abdomen, mild mental abnormalities.

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

If symptoms of the Epstein-Barr virus appear, you should immediately seek help from a doctor for diagnosis, selection effective treatment and reducing the risk of deterioration and the development of complications and pathologies.

Infection Diagnosis

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.
• Set the titer of specific bodies.
• The method of molecular diagnostics with the identification of pathogen DNA.
• Serological studies to find antibodies to Epstein-Barr virus antigens.
• Immunological examination, in which disturbances in the functioning of the immune system are visible.
• cultural 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 pain medications are used to relieve symptoms.

The treatment is carried out in acute and chronic form by an infectious disease specialist, in 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.

With a decrease in immunity and in order to reduce the risk of complications, 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 once a month.

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

When attached to the infectious mononucleosis virus, the doctor prescribes antibiotics to the patient (Sumamed, Tetracycline) for 8-10 days, provides rest and rest, mainly to reduce the risk of rupture of the spleen. 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 resort treatment is recommended.

People who have had the Epstein-Barr virus retain antibodies of the IgG class 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 concerned about chronic fatigue syndrome, which persists for up to 2 years.

Sometimes otitis 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 leads to complications in the oncological diseases.

There is no way to exclude the possibility of infection with 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 of the body;
• Exclusion of stressful situations;
• Frequent exposure to fresh air;
• Compliance with the rules of personal hygiene;
• Taking vitamins;
• Getting rid of bad habits.

Epstein-Barr virus is a serious disease that can provoke the development of serious diseases. It is important to consult a doctor in time when the first alarming symptoms are detected. After the 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 plot of the Living Healthy program.

Epstein-Barr virus belongs to the herpesvirus family (herpes type 4) and is the most common and highly contagious viral infection.

According to statistics, up to 60% of children and almost 100% of adults are infected with this virus. The Epstein-Barr virus is transmitted by airborne droplets (with kisses), contact-household (common household items), less often through the blood (transmissible) and from mother to fetus (vertical route).

The source of infection is only a person, most often these are patients with latent and asymptomatic forms. The Epstein-Barr virus enters the body through the upper respiratory tract, from where it penetrates into the lymphoid tissue, causing damage to the lymph nodes, tonsils, liver and spleen.

What diseases does

The Epstein-Barr virus is dangerous not so much because of acute infection of a person, but as a tendency to cause tumor processes. There is no single classification of Epstein-Barr virus infection (EBV), the following is proposed for use in practical medicine:

• by the time of infection - congenital and acquired;
• according to the form of the disease - typical (infectious mononucleosis) and atypical: erased, asymptomatic, damage to internal organs;
• according to the severity of the course - mild, moderate and severe;
• according to the duration of the course - acute, protracted, chronic;
• according to the phase of activity - active and inactive;
• complications;
• mixed (mixed) infection - most often observed in combination with cytomegalovirus infection.

Diseases caused by the Epstein-Barr virus:

• Filatov's disease (infectious mononucleosis);
• Hodgkin's disease (lymphogranulomatosis);
• chronic fatigue syndrome;
• malignant formation of the nasopharynx;
• lymphomas, including Burkitt's lymphoma;
• general immune deficiency;
• systemic hepatitis;
• damage to the brain and spinal cord (multiple sclerosis);
• tumors of the stomach and intestines, salivary glands;
• hairy leukoplakia oral cavity and others.

Epstein-Barr virus symptoms

Acute infection (AVIEB)

OVIE is infectious mononucleosis.

The incubation period ranges from 2 days to 2 months, with an average of 5-20 days.

The disease begins gradually, with a prodromal period: the patient complains of malaise, fatigue, sore throat.

Body temperature is slightly elevated or within normal limits. After a few days, the temperature rises to 39-40°C, intoxication syndrome joins.

The main symptom of acute Epstein-Barr virus infection is polyadenopathy. The anterior and posterior cervical lymph nodes are mainly enlarged, as well as the occipital, submandibular, supraclavicular, subclavian, axillary, elbow, femoral and inguinal lymph nodes. Their sizes reach 0.5-2 cm in diameter, they are test-like to the touch, moderately or slightly painful, not soldered to each other and the surrounding tissues. The skin over them does not change. The maximum severity of polyadenopathy is diagnosed on the 5-7th day of illness, and after 2 weeks the lymph nodes begin to decrease.

The palatine tonsils are also involved in the process, which is manifested by signs of sore throat, the process is accompanied by a violation of nasal breathing, nasal voice, the presence of purulent discharge on the back of the pharynx.

Enlargement of the spleen (splenomegaly) is one of the late signs, the spleen returns to normal size after 2-3 weeks of the disease, less often after 2 months.

Liver enlargement (hepatomegaly) is less common. In some cases, there is mild jaundice, darkening of the urine.

The nervous system is rarely affected in acute Epstein-Barr virus infection. Perhaps the development of serous meningitis, sometimes meningoencephalitis, encephalomyelitis, polyradiculoneuritis, but all processes end in complete regression of focal lesions.

There is also a rash, which can be different. These may be spots, papules, roseola, dots or hemorrhages. The exanthema lasts about 10 days.

Chronic Epstein-Barr virus infection

HIVEB is characterized by a long duration and periodic relapses of the disease.

Patients complain of general fatigue, weakness, excessive sweating. There may be pain in the muscles and joints, exanthema (rash), persistent cough in the form of groaning, impaired nasal breathing.

Headaches, discomfort in the right hypochondrium, mental disorders in the form of emotional lability and depression, weakening of memory and attention, decreased mental abilities and sleep disturbance are also noted.

There is generalized lymphadenopathy, hypertrophy of the pharyngeal and palatine tonsils, enlargement of the liver and spleen. Often, bacteria and fungi (genital herpes and herpes of the lips, thrush, inflammatory processes of the digestive tract and respiratory system) join a chronic Epstein-Barr virus infection.

Diagnostics

The diagnosis of acute and chronic Epstein-Barr infection is made on the basis of complaints, clinical manifestations and laboratory data:

• < 20 Ед/мл - отрицательно;
• > 40 U / ml - positive;
• 20 - 40 U / ml - doubtful *.

• < 20 Ед/мл - отрицательно;
• > 20 U / ml - positive *.

according to independent laboratory Invitro

5. DNA diagnostics

Using the polymerase method chain reaction(PCR) determine the presence of Epstein-Barr virus DNA in various biological materials (saliva, cerebrospinal fluid, swabs from the upper mucosa respiratory tract, biopsy specimens of internal organs).

6. Other examinations and consultations as indicated

Consultation of an ENT doctor and an immunologist, X-ray of the chest and paranasal sinuses, ultrasound of the abdominal cavity, assessment of the blood coagulation system, consultation of an oncologist and a hematologist.

Treatment for Epstein-Barr virus infection

There is no specific treatment for Epstein-Barr virus infection. Treatment is carried out by an infectious disease specialist (for acute and chronic infections) or an oncologist with the development of tumor-like neoplasms.

All patients, especially those with infectious mononucleosis, are hospitalized. An appropriate diet is prescribed for the development of hepatitis and rest.

Various groups of antiviral drugs are actively used: isoprinosine, valtrex, acyclovir, arbidol, viferon, intramuscular interferons (reaferon-EC, roferon).

If necessary, antibiotics (tetracycline, sumamed, cefazolin) are included in the therapy - for example, with tonsillitis with extensive raids, a course of 7-10 days.

Intravenous immunoglobulins (intraglobin, pentaglobin), complex vitamins (sanasol, alphabet), antiallergic drugs (tavegil, fenkarol) are also prescribed.

Correction of immunity is carried out by the appointment of immunomodulators (likopid, derinat), cytokines (leukinferon), biological stimulants (actovegin, solcoseryl).

Relief of various symptoms of the disease is carried out with antipyretics (paracetamol) with an increase in temperature, with coughing - antitussives (libexin, mukaltin), with difficulties with nasal breathing, nasal drops (nazivin, adrianol) and so on.

The duration of treatment depends on the severity of the course and the form (acute or chronic) of the disease and can range from 2-3 weeks to several months.

Complications and prognosis

Complications of acute and chronic Epstein-Barr virus infection:

• peritonsillitis;
• respiratory failure (swelling of the tonsils and soft tissues of the oropharynx);
• hepatitis;
• rupture of the spleen;
• thrombocytopenic purpura;
• liver failure;

The prognosis for acute Epstein-Barr virus infection is favorable. In other cases, the prognosis depends on the severity and duration of the disease, the presence of complications and the development of tumors.

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

Are there strictly specific for EBV changes in laboratory parameters?

What does complex therapy for EBV infection include?

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

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

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

In acute or active infection, lytic viral replication predominates.

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

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

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

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

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

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

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

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

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

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

Erased variants of chronic EBV infection

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

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

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

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

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

Laboratory studies in the diagnosis of EBV infection

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

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

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

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

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

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

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

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

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

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

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

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

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

Treatment of chronic Epstein-Barr virus infection

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Literature

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

I. K. Malashenkova, Candidate of Medical Sciences

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

J. Sh. Sarsania, Candidate of Medical Sciences

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

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

T. S. Guseva, O. V. Parshina

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

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

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

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

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

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

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

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

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

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

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

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

Note!

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

The study of the Epstein-Barr virus in recent years has radically changed the idea of ​​​​everything related to health. It exhausts the human body in full, causing a variety of and sometimes unrelated pathologies.

It turned out that the Epstein-Barr virus, from the category of those diseases that no one had previously considered diseases, causes significant harm to humans, and is also the root cause and trigger of many unpleasant and even dangerous health problems.

This infection is not amenable to complete extermination and continues to spoil a person's life from the moment it enters the body, causing the most unpredictable consequences. According to statistics, the Epstein-Barr virus lives in the body of 60% of children under the age of 5 years and in almost 100% of the adult population of the planet Earth.

What is this disease?

This virus is from the herpetic family, namely herpes type 4. The Epstein-Barr virus strikes at the immune system, the central nervous system, as well as all human systems and organs.

Penetrating through the mucous membranes of the mouth and nose, it enters the bloodstream and spreads throughout the body. That is why EBV is very diverse and can have various manifestations, ranging from mild discomfort to extremely serious health problems.

There are cases when the carrier of the Epstein-Barr virus never suffers from its manifestations. Many famous doctors consider him the culprit of all existing diseases among mankind.

In medical literature, for better visual perception, the Epstein-Barr virus is abbreviated VEB or WEB.

Disease prevalence

WEB is one of the most common viruses in the world among the population. According to WHO (World Health Organization) statistics, 9 out of 10 people are carriers of this herpes infection.

Despite this, his research began quite recently, so it cannot be said that he is well studied. Babies often become infected with EBV in utero or in the first few months after birth.

Recent studies show that it is the Epstein-Barr virus that is the provoking factor in other pathologies that cannot be completely cured.

Namely:

• Rheumatoid polyarthritis;
• Autoimmune thyroidin;
• Diabetes.

However, the infection does not lead to diseases on its own, but interacting with other viral lesions.

If a person is prone to chronic fatigue syndrome and it seems to him that he does not get enough sleep, there is a lack of vitamins in the body, or a reaction to weather conditions, then it is possible that it is the Epstein-Barr virus that provokes all of the above symptoms.

Often it is the cause of the decline in vitality.

Ways of infection

Sources of EBV infection are:

• Those who have it in active form with last days incubation period;
• People who contracted the virus more than six months ago;
• Any carrier of the virus is a potential source of infection for everyone with whom it comes into contact.

The most vulnerable categories for potential infection:

• Women during pregnancy;
• HIV positive;
• Children under the age of 10 years.

WEB transmission paths:

How does infection occur in adults?

Stages of infection:

Symptoms of the disease

Most often, people become infected with EBV during early childhood (childhood or adolescence), because it has many routes of transmission through contact with an infected person.

In adults, the Epstein-Barr virus is reactivated and does not have acute symptoms.

Symptoms of primary infection:

The chronic course of the Epstein-Barr virus is characterized by a long-term manifestation of symptoms. different kind and intensity level.

Namely:

• Rapid fatigue and general weakness;
• Strong sweating;
• Difficulty in nasal breathing;
• Pain in the joints and muscles;
• Periodic mild cough;
• Persistent headaches;
• Aching pain in the right hypochondrium;
• Mental disorders, emotional instability, depressive states, deterioration in concentration and memory lapses;
• sleep disorders;
• Inflammatory diseases of the respiratory tract and gastrointestinal disorders.

Photos of the manifestations of the virus:

Why is the Epstein-Barr virus dangerous in adults?

With a single infection, Epstein-Barr remains forever in the human body. In good health, the course of the infection has no pronounced symptoms or with minimal manifestations.

When the immune system of an infected person is weakened by other factors, then, as a rule, the Epstein-Barr virus affects the following organs and systems:

• Mucous membranes of the upper respiratory tract and ENT organs;
• epithelial cells;
• Nerve fibers;
• macrophages;
• NK cells;
• T-lymphocytes.

The Epstein-Barr virus is extremely dangerous for HIV-positive people. Infection with them can lead to death for them.

What diseases can provoke the Epstein-Barr virus in adults?

Complicated consequences:

Development of oncopathologies:

• Lymphoma;
• Lymphogranuloma;
• Gland cancer, neoplasms of ENT organs;
• Cancer of the gastrointestinal tract.

Epstein-Barr cells are found in most biopsy samples along with malignant cells. It is not the main cause of cancerous tumors, but acts as a provoking factor along with other pathologies.

Diseases of the autoimmune system:

• Diabetes;
• Multiple sclerosis;
• Arthritis.

The Epstein-Barr virus, along with other cell-damaging viruses, leads to impaired immune responses. Immunity perceives its own cells as enemy cells and begins to attack them, thus damaging them.

Immunity disorders:

Diseases of the circulatory system:

Among other things, the presence of EBV can provoke the development of bacterial and fungal diseases. As well as damage to the central nervous system and a decrease in the general tone of the body, as a result of which chronic fatigue syndrome develops.

Diagnostic Measures

If EBV infection is suspected, the patient turns to a general practitioner who conducts an on-site examination and analysis of the patient's complaints.

Research methods to detect the Epstein-Barr virus:

• ELISA- allows you to determine the presence of antibodies to various Epstein-Barr antigens, this helps to identify the form of infection: chronic, acute, asymptomatic;
• PCR- By this method it is possible to find out whether a person has a virus. It is used for children whose immature immune system does not produce antibodies to EBV. Also, this method is used for clarifying purposes in case of doubtful ELISA results.

Decryption of PCR analyzes:

• The main criterion makes it possible to find out about the presence of a virus in the body;
• The result can be positive or negative;
• At the same time, a positive result does not in any way indicate the presence of an acute or chronic process, despite the presence of EBV in humans;
• A positive test result means that the patient has already contracted EBV;
• With a negative analysis, it can be said with confidence that EBV has never penetrated into the human body.

Explanation of ELISA analyzes:

• For all antigens, ELISA, in addition to a positive or negative result, is still doubtful;
• In case of a doubtful result, the analysis must be retaken after 7-10 days;
• In the case of a positive result, the Epstein-Barr virus is present in the body;
• According to the results, which antigens were detected, one can judge the stage of infection (asymptomatic, chronic, acute).

This analysis allows you to determine the presence of an antigen in the human body:

• lgG to VCA capsid antigen- in case of a negative result, the human body has never encountered EBV. But at the same time, there may be the presence of EBV cells in the body if the infection occurred 10 to 15 days ago. A positive result indicates the presence of the virus in humans. But he cannot say what stage the infection is in and when exactly the infection occurred. Results:
  • from 0.9 to 1 - the analysis is required to be retaken;
• gG to EBNA nuclear antigen- with a positive result, a person is immune to EBV, but this does not indicate a chronic course of the infection, with a negative analysis, a virus of this type has never entered the patient's body. Results:
  • up to 0.8 - the result is negative;
  • from 1.1 - the result is positive;
  • from 0.9 to 1 - the analysis requires a retake;
• lgG to EA early antigen- in the case when lgG to the anti-lgG-NA nuclear antigen is negative, then the infection has occurred recently, is the primary infection. Results:
  • up to 0.8 - the result is negative;
  • from 1.1 - the result is positive;
  • 0.9 -1 - the analysis requires a retake;
• lgM to VCA capsid antigen- with a positive result, we are talking about a recent infection (up to three months), as well as reactivation of the infection in the body. A positive indicator of this antigen can be present from 3 months to a year. Close-to-positive anti-lgM-VCA may also indicate a chronic infection. In the acute course of Epstein-Barr, this analysis is looked at in dynamics so that one can judge the adequacy of treatment. Results:
  • up to 0.8 - the result is negative;
  • from 1.1 and above - the result is positive;
  • from 0.9 to 1 - the analysis requires a retake.

Deciphering the analysis on VEB

To accurately decipher the result of a laboratory test for EBV, it is advisable to use the table:

Treatment Methods

VEB, like the rest, cannot be completely cured. EBV cells remain in the body for life, and their influence is controlled by the immune system. When immunity decreases, the virus becomes active.

General principles of treatment

These include the following basic principles:

• Infection activity is blocked by antiviral drugs and stimulation of the general resistance of the body. With all its possibilities, even modern medicine cannot help kill all Epstein-Barr virus cells, or eliminate them completely from the body;
• Infectious mononucleosis being treated in a hospital or at home under the supervision of a specialist;
• Additionally, the patient is assigned to comply with bed rest and balanced diet with limited physical activity. The patient is recommended to drink plenty of water, including in the diet fermented milk products, food with sufficient protein content. Exclusion of products that can cause allergic reactions;
• Chronic fatigue syndrome will help neutralize:
  • Compliance with sleep and rest;
  • Balanced diet;
  • Vitamin complexes;
  • Moderate physical activity;
• Drug treatment of EBV is complex and aimed at strengthening immunity, removal of symptomatic manifestations, reduction of their aggressiveness. It also includes preventive measures to prevent complications.

Medical treatment

For drug therapy, the following drugs can be prescribed.

Immunostimulating drugs - funds are used during periods of exacerbation of EBV and for recovery from infectious mononucleosis:

• Arbidol;
• Viferon;
• Interferon;
• Groprinasin;
• Laferobion.

Antiviral drugs - used in the treatment of complications caused by EBV:

• Gerpevir;
• Valvir;
• Valtrex.

Antibacterial drugs- are prescribed in cases of complications with bacterial infections, such as pneumonia, etc. Any antibacterial drugs can be used, except for penicillins.

For example:

• Cefodox;
• Lincomycin;
• Azithromycin;
• Ceftriaxone.

Vitamin complexes are used for recovery after the acute stage of EBV, as well as for the prevention of complications:

• Duovit;
• Complivit;
• Vitrum.

Sorbents - needed to alleviate the manifestations of infectious mononucleosis. Contribute to the removal of toxic substances:

• White coal;
• Atoxil;
• Polysorb;
• Enterosgel.

Supportive drugs for the liver (hepatoprotectors) - help support the liver after an acute period of EBV:

• Karsil;
• Essentiale;
• Gepabene;
• Darsil.

- are used to prevent complications that EBV can cause:

• Ketotifen;
• Cetrin;
• Eden;
• Suprastin;
• Diazolin.

Means for the treatment of the oral cavity - are used in preventive measures for the sanitation of the oral cavity:

• Decatylene;
• Inglalipt;
• Chlorophyllipt.

Anti-inflammatory - relieve symptoms of fever and general symptoms of malaise:

• Paracetamol;
• Nurofen;
• ibuprofen;
• Nimesulide.

The exception is Aspirin.

Glucocorticosteroids - help to deal with severe complications:

• Dexamethosone;
• Prednisolone.

Drug treatment is prescribed by the attending physician on a strictly individual basis in each case. Uncontrolled intake of medications can be not only useless, but also dangerous.

To combat chronic fatigue, which is caused by the presence of the Epstein-Barr virus in the body, the patient is prescribed a treatment consisting of taking:

• multivitamins;
• antidepressants;
• Antiherpetic drugs;
• Cardiovascular;
• Preparations supporting the nervous system:
  • Instenon;
  • Enciphabol;
  • Glycine.

Folk methods of treatment

Folk remedies have a good effect in the fight against many diseases, the Epstein-Barr virus is no exception. Folk methods perfectly complement traditional methods of treatment for the acute course of the virus and for infectious mononucleosis.

They are aimed at strengthening the overall immune qualities, relieving inflammation and avoiding exacerbation of the disease.

Echinacea:

• Echinacea infusion perfectly strengthens the immune system and helps to avoid exacerbations;
• It should be consumed daily, 20 drops per glass of water.

Green tea:

Ginseng tincture:

• Ginseng tincture is just a storehouse for the defenses of the human body;
• It should be added to tea, about 15 drops per glass of drink.

The consequences of the Epstein-Barr virus during pregnancy

In the case of pregnancy planning, a number of tests are prescribed for future parents in preparation.

Wherein Special attention given to infections.

They can influence conception, the course of pregnancy and its favorable completion by birth. healthy child.

Among these infections, EBV is quite significant.

It belongs to the "TORCH" series:

• T - toxoplasmosis (toxoplasmosis);
• O - others (others): listeriosis, chlamydia, measles, syphilis, hepatitis B and C, HIV;
• R - (rubella);
• C - cytomegalovirus (cytomegalovirus);
• H - herpes (herpes simplex virus).

Infection of any of the TORCH infections during pregnancy can be detrimental to the child, cause serious health problems, deformities and pathologies incompatible with life.

That is why the passage of this analysis, through an unpleasant procedure - taking blood from a vein is mandatory. Timely therapy and constant monitoring of specialists can minimize the risks to the health of the fetus.

Such an analysis is future mother is carried out not only during planning, but also twice during the gestation period, namely at 12 and 30 weeks.

According to the results of the analyzes, it is customary to draw conclusions regarding the following points:

• In the absence of antibodies to EBV in the blood it is required to actively observe and protect yourself from possible infection as much as possible;
• In the presence of positive immunoglobulin class M with the birth of a child, it is necessary to wait until the development of antibodies to this species virus;
• Blood contains class G immunoglobulins- this means the presence of antibodies in the body of the expectant mother, which means that her immunity will protect the baby as much as possible.

When the Epstein-Barr virus is detected in an active acute form in a pregnant woman, this requires urgent hospitalization and therapy in a hospital under the supervision of specialists.

The measures are aimed at neutralizing the symptoms and supporting the immune system of the expectant mother by introducing antiviral drugs and immunoglobulins.

It is impossible to say for sure exactly how EBV will affect the course of pregnancy and the health of the fetus. However, it is reliably known that babies whose mothers carry the active form of the Epstein-Barr virus during pregnancy often have malformations.

At the same time, its presence in a woman's body in a primary or acute form does not exclude the birth of a healthy child, and its absence does not guarantee.

Possible consequences of EBV infection during pregnancy:

• miscarriages and stillbirths;
• premature birth;
• Developmental delay (IUGR);
• Complications in childbirth: sepsis, uterine bleeding, DIC;
• Violations in the development of the central nervous system of the baby. It is due to the fact that EBV affects nerve cells.

The prognosis is sick

As a rule, the entry of the Epstein-Barr virus into the body system is accompanied by various symptoms ranging from mild discomfort to more severe manifestations.

With proper and adequate treatment and the normal state of the immune system, this virus does not cause significant damage to the body and does not interfere with the normal life of a person.

Prevention measures

Given the prevalence of EBV, and the ease of transmission, it is extremely difficult to protect yourself from infection.

Physicians around the world are faced with the task of inventing prophylactic agents to combat this virus, since it is a provoking factor in the development of oncological processes and other dangerous diseases.

Many scientific research centers currently conducting clinical trials on this issue. It is impossible to protect yourself from infection, but you can get by with minimal consequences, having a strong body.

Therefore, EBV prevention measures are aimed at overall strengthening protective functions human body:

home » hip » Barr infection in children symptoms manifestations treatment. Epstein-Barr virus (EBV): characteristics, what diseases it causes, symptoms, treatment