Epstein Barr treatment in a sanatorium. Epstein-Barr virus infection

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

Steps

Part 1

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

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

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

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

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

   Part 2

   What treatment options are there?

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

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

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

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

      • Immune suppressant drugs can slow the body's immune response to EBV, causing cells infected with the virus to continue to multiply. Therefore, the doctor must decide how much the expected benefit from taking these drugs outweighs the risk of undesirable consequences.
      • As a result of taking antiviral drugs, there may be such side effects: skin rash, stomach upset, diarrhea, joint pain, headache, dizziness, fatigue.
      • Despite numerous attempts to develop a vaccine against EBV, they have so far been unsuccessful.
      Warning
      • A doctor may mistake mononucleosis for a sore throat and prescribe an antibiotic (such as amoxicillin). In this case, a common reaction to the antibiotic is a skin rash.

Epstein-Barr virus (EBV 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 discovered.

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 - during sexual contact or blood transfusion/transplant bone marrow 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(when kissing mother).
• 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), difficult to respond to traditional treatment.
• In adults, the presence of EBV infection can be suspected if there is constant fatigue and weakness in the morning. Exactly herpetic infection most often provokes the syndrome chronic fatigue.

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 get well soon. 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 viral presence are detected only when serological study blood.

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

In other cases it occurs acute illness With severe symptoms or sluggish current infection with chronicity pathological deviation. 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 37.5ºС without 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 virus 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. Compliance is mandatory healthy regime sleep, good nutrition, avoiding alcohol and avoiding 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.

One of current problems modern medicine is the high infection rate of the population with one of the representatives of opportunistic pathogens - the Epstein-Barr virus (EBV). Practicing doctors in their daily practice more often encounter clinically manifest forms of primary Epstein-Barr virus infection (EBVI) in the form of acute, usually unverified respiratory infection(more than 40% of cases) or infectious mononucleosis(about 18% of all diseases). In most cases, these diseases are benign and end in recovery, but with lifelong persistence of EBV in the body of the person who has recovered from the disease.

However, in 10-25% of cases, primary EBV infection, which is asymptomatic, and acute EBV infection can have adverse consequences with the formation of lymphoproliferative and oncological diseases, chronic fatigue syndrome, EBV-associated hemophagocytic syndrome, etc.

To date, there are no clear criteria to predict the outcome of primary EBV infection. A doctor who is approached by a patient with acute EBVI always faces the question: what to do in each specific case in order to minimize the risk of developing chronic EBVI and EBV-associated pathological conditions. This question is not idle, and it is really very difficult to answer, because Because there is still no clear pathogenetically substantiated treatment regimen for patients, and existing recommendations often contradict each other.

According to many researchers, treatment of EBVI mononucleosis (EBVIM) does not require specific therapy. Treatment of patients is usually carried out on an outpatient basis; patient isolation is not required. Indications for hospitalization include prolonged fever, pronounced syndrome tonsillitis and/or tonsillitis syndrome, polylymphadenopathy, jaundice, anemia, airway obstruction, abdominal pain and the development of complications (surgical, neurological, hematological, cardiovascular and respiratory system, Reye's syndrome).

In mild to moderate cases of EBV MI, it is advisable for patients to be recommended a ward or general regimen with a return to normal activities at a physical and energetic level that is adequate for each individual patient. A multicenter study showed that unreasonably recommended strict bed rest prolongs the recovery period and is accompanied by prolonged asthenic syndrome, which often requires drug treatment.

In mild cases of EBV MI, treatment of patients is limited to supportive therapy, including adequate hydration, rinsing the oropharynx with an antiseptic solution (with the addition of a 2% solution of lidocaine (xylocaine) for severe discomfort in the throat), non-steroidal anti-inflammatory drugs such as paracetamol (Acetaminophen, Tylenol). According to a number of authors, the prescription of H2 receptor blockers, vitamins, hepatoprotectors and local treatment of the tonsils with various antiseptics are ineffective and unfounded methods of treatment. Of the exotic treatment methods, mention should be made of those recommended by F. G. Bokov et al. (2006) the use of megadoses of bifidobacteria in the treatment of patients with acute mononucleosis.

Opinions on the appropriateness of the appointment antibacterial drugs in the treatment of EBVIM are very controversial. According to Gershburg E. (2005), tonsillitis in MI is often aseptic and the prescription of antibacterial therapy is not justified. There is also no point in using antibacterial agents with catarrhal sore throat. The indication for prescribing antibacterial drugs is the addition of a secondary bacterial infection (the development of lacunar or necrotizing tonsillitis in a patient, complications such as pneumonia, pleurisy, etc.), as evidenced by pronounced inflammatory changes in blood counts and febrile fever that persist for more than three days. The choice of drug depends on the sensitivity of the microflora on the patient’s tonsils to antibiotics and possible adverse reactions from organs and systems.

According to H. Fota-Markowcka et al. (2002) in patients, hemophilus influenzae, staphylococcus and streptococcus pyogenes are more often isolated, and fungi of the genus Candida are less often isolated, so it should be considered justified to prescribe to these patients drugs from the group of 2-3 generation cephalosporins, lincosamides, macrolides and antifungal agents(fluconazole) in therapeutic doses for 5-7 days (less often - 10 days). Some authors, in the presence of necrotizing sore throat and putrefactive breath, probably caused by associated anaerobic flora, recommend the use of metronidazole 0.75 g / day, divided into 3 doses, for 7-10 days.

Drugs from the group of aminopenicillins (ampicillin, amoxicillin (Flemoxin Solutab, Hiconcil), amoxicillin with clavulanate (Amoxiclav, Moxiclav, Augmentin)) are contraindicated due to the possibility of developing allergic reaction in the form of exanthema. The appearance of a rash to aminopenicillins is not an IgE-dependent reaction, therefore the use of H1 blockers histamine receptors has neither prophylactic nor therapeutic effect.

According to a number of authors, the empirical approach to prescribing glucocorticosteroids to patients with EBVI is still maintained. Glucocorticosteroids (prednisolone, prednisone (Deltazone, Meticorten, Orazon, Liquid Pred), Solu Cortef (hydrocortisone), dexamethasone) are recommended for patients with severe EBVIM, airway obstruction, neurological and hematological complications (severe thrombocytopenia, hemolytic anemia) . The daily dose of prednisolone is 60-80 mg for 3-5 days (less often 7 days), followed by rapid discontinuation of the drug. There is no identical point of view on prescribing glucocorticosteroids to these patients with the development of myocarditis, pericarditis and central nervous system lesions.

In severe cases of EBVIM, intravenous detoxification therapy is indicated; in case of splenic rupture, surgical treatment is indicated.

The most controversial question remains about the purpose antiviral therapy patients with EBVI. Currently, a large list of drugs is known that are inhibitors of EBV replication in cell culture.

According to E. Gershburg, J. S. Pagano (2005), all modern “candidates” for the treatment of EBVI can be divided into two groups:

I. Suppressing the activity of EBV DNA polymerase:

1. acyclic nucleoside analogs (acyclovir, ganciclovir, penciclovir, valacyclovir, valganciclovir, famciclovir);
2. acyclic nucleotide analogues (cidofovir, adefovir);
3. pyrophosphate analogues (Foscarnet (foscavir), phosphonoacetylic acid);
4. 4 oxo-dihydroquinolines (possibly).

II. Various compounds that do not inhibit viral DNA polymerase (the mechanism is being studied): maribavir, beta-L-5 uracil iododioxolane, indolocarbazole.

However, a meta-analysis of five randomized controlled trials involving 339 EBVIM patients taking acyclovir (Zovirax) showed the drug to be ineffective.

One of the possible reasons lies in the development cycle of EBV, in which the viral DNA has a linear or circular (episome) structure and multiplies in the nucleus of the host cell. Active replication of the virus occurs during the productive (lytic) stage infectious process(EBV DNA linear form). With acute EBVI and activation of chronic EBVI, a cytolytic cycle of virus development occurs, during which it triggers the expression of its own early antigens and activates some genes of the host cells, the products of which are involved in the replication of EBV. In latent EBVI, the DNA of the virus has the form of an episome (circular supercoiled genome) located in the nucleus. The circular genome of EBV DNA is characteristic of CD21+ lymphocytes, in which, even during primary infection with the virus, the lytic stage of the infectious process is practically not observed, and the DNA is reproduced in the form of an episome synchronously with cell division infected cells. The death of EBV-affected B lymphocytes is not associated with virus-mediated cytolysis, but with the action of cytotoxic lymphocytes.

When prescribing antiviral drugs for EBVI, the doctor must remember that their clinical effectiveness depends on the correct interpretation of the clinical manifestations of the disease, the stage of the infectious process and the development cycle of the virus at this stage. However, no less important is the fact that most of the symptoms of EBV are associated not with the direct cytopathic effect of the virus in infected tissues, but with the indirect immunopathological response of EBV-infected B lymphocytes circulating in the blood and located in the cells of the affected organs. That is why nucleoside analogues (acyclovir, ganciclovir, etc.) and polymerase inhibitors (Foscarnet), which suppress EBV replication and reduce the virus content in saliva (but do not completely sanitize it), do not have a clinical effect on the severity and duration of EBVIM symptoms.

Indications for the treatment of EBVIM with antiviral drugs are: severe, complicated course of the disease, the need to prevent EBV-associated B-cell lymphoproliferation in immunocompromised patients, EBV-associated leukoplakia. Bannett N.J., Domachowske J. (2010) recommend the use of acyclovir (Zovirax) orally at a dose of 800 mg orally 5 times a day for 10 days (or 10 mg/kg every 8 hours for 7-10 days). For lesions of the nervous system, the preferred route of administration is intravenous at a dose of 30 mg/kg/day 3 times a day for 7-10 days.

According to E. Gershburg, J. S. Pagano (2005), if under the influence of any factors (for example, immunomodulators, in EBV-associated malignant tumors - the use of radiation therapy, gemcitabine, doxorubicin, arginine butyrate, etc.) it is possible to transfer EBV DNA from the episome into an active replicative form, i.e., activate the lytic cycle of the virus, then in this case a clinical effect from antiviral therapy can be expected.

In recent years, EBVI has been increasingly used for the treatment of recombinant alpha interferons(Intron A, Roferon-A, Reaferon-EC) 1 million IU intramuscularly for 5-7 days or every other day; for chronic active EBVI - 3 million IU intramuscularly 3 times a week, course 12-36 weeks.

As an interferon inducer in severe cases of EBVI, it is recommended to use Cycloferon 250 mg (12.5% ​​2.0 ml) IM, 1 time per day, No. 10 (the first two days daily, then every other day) or according to the scheme: 250 mg/day, IM on the 1st, 2nd, 4th, 6th, 8th, 11th, 14th, 17th, 20th, 23rd, 26th 1st and 29th day in combination with etiotropic therapy. Orally, Cycloferon is prescribed at 0.6 g/day, course dose (6-12 g, i.e. 20-40 tablets).

Medication correction asthenic syndrome for chronic EBVI includes the administration of adaptogens, high doses of B vitamins, nootropic drugs, antidepressants, psychostimulants, drugs with a procholinergic mechanism of action and correctors of cellular metabolism.

Collateral successful treatment patient with EBVI are complex therapy and strictly individual management tactics both in the hospital and during dispensary observation.

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Epstein-Barr virus often disguises itself as other diseases, and doctors waste valuable time trying to make a correct diagnosis. Anna Levadnaya (@doctor_annamama) - new generation doctor, pediatrician, candidate 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 their children for Epstein-Barr Virus (hereinafter referred to as EBV) 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 during childhood (in most cases from 2 to 6 years) through saliva, blood or by contact(with kisses, through dishes, toys, underwear), penetrating 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.

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The reason is an increase in adenoid tissue, therefore vasoconstrictor drops the nose won't 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: increase in monocytes (more than 10%) with the appearance of atypical mononuclear cells, as well as leukocytes, lymphocytes, in biochemical analysis- increased 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 won't be talked about 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 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. Epstein-Barr virus is transmitted by airborne droplets(when kissing), contact-household ( general subjects everyday life), less often through the blood (transmissible) and from mother to fetus (vertical route).

The source of infection is only humans, 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 the lymphoid tissue, causing damage to the lymph nodes, tonsils, liver and spleen.

What diseases does it cause?

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

• by 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;
• by activity phase – 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;
• brain damage and spinal cord(multiple sclerosis);
• tumors of the stomach and intestines, salivary glands;
• hairy leukoplakia of the oral cavity and others.

Symptoms of Epstein-Barr virus

Acute infection (AVIEB)

CVIEB 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, increased fatigue, sore throat.

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

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, ulnar, femoral and inguinal lymph nodes. Their sizes reach 0.5-2 cm in diameter, they are doughy to the touch, moderately or slightly painful, and are not fused to each other and the surrounding tissues. The skin over them does not change. The maximum severity of polyadenopathy is diagnosed on days 5-7 of illness, and after 2 weeks the lymph nodes begin to shrink.

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

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

Enlarged liver (hepatomegaly) is less common. In some cases, mild jaundice and darkening of the urine are observed.

Acute Epstein-Barr virus infection rarely affects the nervous system. Possible development 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. Exanthema lasts about 10 days.

Chronic Epstein-Barr virus infection

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

Patients complain of general fatigue, weakness, increased sweating. Pain in the muscles and joints, exanthema, persistent cough in the form of grunting, and impaired nasal breathing may occur.

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.

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

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 chain reaction (PCR) method, the presence of Epstein-Barr virus DNA is determined in various biological materials (saliva, cerebrospinal fluid, smears from the mucous membrane of the upper respiratory tract, biopsy samples of internal organs).

6. If indicated, other studies and consultations

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

Treatment of 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 for the development of tumor-like neoplasms.

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

Actively used various groups antiviral drugs: isoprinosine, Valtrex, acyclovir, arbidol, viferon, intramuscular interferons (reaferon-EC, roferon).

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

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

Correction of immunity is carried out by prescribing immunomodulators (lykopid, derinat), cytokines (leukinferon), biological stimulants (actovegin, solcoseryl).

Relief of various symptoms of the disease is carried out with antipyretics (paracetamol) when the temperature rises, for coughs - antitussives (libexin, mucaltin), for difficulties with nasal breathing, nasal drops (nazivin, adrianol), etc.

The duration of treatment depends on the severity and 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;
• splenic rupture;
• thrombocytopenic purpura;
• liver failure;

The prognosis for acute infection with the Epstein-Barr virus 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.