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

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

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

Possible abnormalities in liver function tests in infectious mononucleosis:

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


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


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

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

Treatment of Epstein-Barr virus

It is impossible to completely overcome herpes viruses; even with the most modern treatment, the Epstein-Barr virus remains in B lymphocytes and other cells for life, although not in an active state. When the immune system weakens, the virus can become active again, and EBV infection worsens.

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

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

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

• semi-bed rest, limitation of physical activity,


• you need to drink plenty of fluids,


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


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


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


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


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


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

For chronic fatigue syndrome will be useful:

• normalization of work, sleep and rest patterns,


• positive emotions, doing what you love,


• complete nutrition,


• multivitamin complex.

Drug treatment for Epstein-Barr virus

Drug treatment should be comprehensive, aimed at immunity, eliminating symptoms, alleviating the course of the disease, preventing the development of possible complications and their treatment.

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

Group of drugs	A drug	When is it appointed?
Antiviral drugs that inhibit the activity of Epstein-Barr virus DNA polymerase	Acyclovir, Gerpevir, Pacyclovir, Cidofovir, Foscavir	In acute infectious mononucleosis, the use of these drugs does not give the expected result, which is due to the structure and activity of the virus. But for generalized EBV infection, cancer associated with the Epstein-Barr virus and other manifestations of the complicated and chronic course of the Epstein-Barr virus infection, the use of these drugs is justified and improves the prognosis of the disease.
Other drugs with nonspecific antiviral and/or immunostimulating effects	Interferon, Viferon, Laferobion, Cycloferon, Isoprinasine (Groprinazine), Arbidol, Uracil, Remantadine, Polyoxidonium, IRS-19 and others.	They are also not effective in the acute period of infectious mononucleosis. They are prescribed only in cases of severe disease. These drugs are recommended during exacerbations of the chronic course of EBV infection, as well as during the recovery period after acute infectious mononucleosis.
Immunoglobulins	Pentaglobin, Polygamy, Sandlglobulin, Bioven and others.	These drugs contain ready-made antibodies against various infectious pathogens, bind to Epstein-Barr virions and remove them from the body. Their high effectiveness in the treatment of acute and exacerbation of chronic Epstein-Barr viral infection has been proven. They are used only in a hospital setting in the form of intravenous drips.
Antibacterial drugs	Azithromycin, Lincomycin, Ceftriaxone, Cefadox and others	Antibiotics are prescribed only in the case of a bacterial infection, for example, purulent sore throat, bacterial pneumonia. Important! For infectious mononucleosis, penicillin antibiotics are not used: Benzylpenicillin,
Vitamins	Vitrum, Pikovit, Neurovitan, Milgama and many others	Vitamins are necessary during the recovery period after infectious mononucleosis, as well as for chronic fatigue syndrome (especially B vitamins), and to prevent exacerbation of EBV infection.
Antiallergic (antihistamine) drugs	Suprastin, Loratadine (Claritin), Tsetrin and many others.	Antihistamines are effective in the acute period of infectious mononucleosis, alleviate the general condition, and reduce the risk of complications.
Nonsteroidal anti-inflammatory drugs	Paracetamol, Ibuprofen, Nimesulide and others	These drugs are used for severe intoxication and fever. Important! Aspirin should not be used.
Glucocorticosteroids	Prednisolone, Dexamethasone	Hormonal drugs are used only in severe and complicated cases of the Epstein-Barr virus.
Preparations for treating the throat and oral cavity	Inhalipt, Lisobakt, Decathylene and many others.	This is necessary for the treatment and prevention of bacterial tonsillitis, which often occurs against the background of infectious mononucleosis.
Drugs to improve liver function	Gepabene, Essentiale, Heptral, Karsil and many others.	Hepatoprotectors are necessary in the presence of toxic hepatitis and jaundice, which develops against the background of infectious mononucleosis.
Sorbents	Enterosgel, Atoxyl, Activated carbon and others.	Intestinal sorbents promote faster removal of toxins from the body and facilitate the acute period of infectious mononucleosis.

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

Principles of drug treatment of chronic fatigue syndrome

• Antiviral drugs: Acyclovir, Gerpevir, Interferons,


• vascular drugs: Actovegin, Cerebrolysin,


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



• sedatives,


• multivitamins.

Treatment of Epstein-Barr virus with folk remedies

Traditional methods of treatment will effectively complement drug therapy. Nature has a large arsenal of drugs to boost immunity, which is so necessary to control the Epstein-Barr virus.

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


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


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


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


5. Fir oil – used externally, lubricate the skin over enlarged lymph nodes.


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


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

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

If infection with a virus leads to the development of infectious mononucleosis (high fever, pain and redness in the throat, signs of sore throat, joint pain, headaches, runny nose, enlarged cervical, submandibular, occipital, supraclavicular and subclavian, axillary lymph nodes, enlarged liver and spleen, abdominal pain
So, with frequent stress, insomnia, unreasonable fear, anxiety, it is best to consult a psychologist. If mental activity deteriorates (forgetfulness, inattention, poor memory and concentration, etc.), it is best to consult a neurologist. For frequent colds, exacerbations of chronic diseases, or relapses of previously cured pathologies, it is best to consult an immunologist. And you can contact a general practitioner if a person is bothered by various symptoms, and among them there are not any of the most severe ones.

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

FAQ

How does Epstein-Barr virus affect pregnancy?

When planning a pregnancy, it is very important to prepare and undergo all the necessary tests, since there are a lot of infectious diseases that affect conception, pregnancy and the health of the baby. Such an infection is the Epstein-Barr virus, which belongs to the so-called TORCH infections. It is suggested that you take the same test at least twice during pregnancy (12th and 30th week).

Planning pregnancy and testing for antibodies to the Epstein-Barr virus:

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


• Positive immunoglobulins class M – conceiving a baby will have to wait until complete recovery, confirmed by an analysis for antibodies to EBV.


• There are no antibodies to the Epstein-Barr virus in the blood - You can and should become pregnant, but you will have to be monitored and undergo periodic tests. You also need to protect yourself from possible EBV infection during pregnancy and strengthen your immunity.

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

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

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

• premature pregnancy (miscarriages),


• stillbirth,


• intrauterine growth retardation (IUGR), fetal malnutrition,


• prematurity,


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


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

Can Epstein-Barr virus be chronic?

Epstein-Barr virus - like all herpes viruses, it is a chronic infection that has its own flow periods:

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


2. Recovery, in which the virus becomes inactive , in this form, the infection can exist in the body for a lifetime;


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

What symptoms does the Epstein-Barr igg virus cause?

To understand what symptoms it causes Epstein-Barr virus igg , it is necessary to understand what is meant by this symbol. Letter combination igg is a misspelling of IgG, used by doctors and laboratory workers for short. IgG is immunoglobulin G, which is a variant of antibodies produced in response to penetration virus into the body for the purpose of its destruction. Immunocompetent cells produce five types of antibodies - IgG, IgM, IgA, IgD, IgE. Therefore, when they write IgG, they mean antibodies of this particular type.

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

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

Each type of antibody is produced at certain intervals and stages of the infection. Thus, anti-IgG-VCA and anti-IgG-NA are produced in response to the initial penetration of the virus into the body, and then remain throughout life, protecting a person from re-infection. If anti-IgG-NA or anti-IgG-VCA are detected in a person's blood, this indicates that he was once infected with the virus. And the Epstein-Barr virus, once it enters the body, remains in it for life. Moreover, in most cases, such virus carriage is asymptomatic and harmless to humans. In more rare cases, the virus can lead to a chronic infection known as chronic fatigue syndrome. Sometimes, during primary infection, a person becomes ill with infectious mononucleosis, which almost always ends in recovery. However, with any variant of the course of infection caused by the Epstein-Barr virus, anti-IgG-NA or anti-IgG-VCA antibodies are detected in a person, which are formed at the moment of the first penetration of the microbe into the body. Therefore, the presence of these antibodies does not allow us to speak accurately about the symptoms caused by the virus at the current time.

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

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

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

Chronic VEBI occurs in waves and over a long period of time, with many patients describing their condition as a “constant flu”. The severity of symptoms of chronic VEBI can alternately vary from strong to weak degrees. Currently, chronic VEBI is called chronic fatigue syndrome.

In addition, chronic VEBI can lead to the formation of certain tumors, such as:

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

Before use, you should consult a specialist.

Epstein Barr virus (EBV) is one of the representatives of the family of herpes infections. Its symptoms, treatment and causes in adults and children are also similar to cytomegalovirus (herpes according to No. 6). EBV itself is called herpes number 4. In the human body, it can be stored for years in a dormant form, but when immunity decreases, it is activated, causes acute infectious mononucleosis and later - the formation of carcinomas (tumors). How else does the Epstein Barr virus manifest itself, how is it transmitted from a sick person to a healthy person, and how to treat the Epstein Barr virus?

What is the Epstein Barr virus?

The virus received its name in honor of the researchers - professor and virologist Michael Epstein and his graduate student Iwona Barr.

Einstein bar virus has two important differences from other herpes infections:

• It does not cause the death of host cells, but on the contrary, it initiates their division and tissue proliferation. This is how tumors (neoplasms) form. In medicine, this process is called proliferation - pathological proliferation.
• It is not stored in the ganglia of the spinal cord, but inside immune cells - in some types of lymphocytes (without their destruction).

The Epstein Barr virus is highly mutagenic. With the secondary manifestation of infection, it often does not respond to the antibodies produced earlier at the first meeting.

Manifestations of the virus: inflammation and tumors

Acute Epstein Barr disease manifests itself like flu, cold, inflammation. Long-term, low-grade inflammation initiates chronic fatigue syndrome and tumor growth. At the same time, different continents have their own characteristics of the course of inflammation and the localization of tumor processes.

In the Chinese population, the virus more often forms nasopharyngeal cancer. For the African continent - cancer of the upper jaw, ovaries and kidneys. For residents of Europe and America, acute manifestations of infection are more typical - high temperature (up to 40º for 2-3 or 4 weeks), enlarged liver and spleen.

Epstein Barr virus: how is it transmitted

Epstein bar virus is the least studied herpes infection. However, it is known that the routes of its transmission are varied and extensive:

• airborne;
• contact;
• sexual;
• placental.

People in the acute stage of the disease become a source of infection through the air(those who cough, sneeze, blow their nose - that is, they deliver the virus into the surrounding space along with saliva and mucus from the nasopharynx). During the period of acute illness, the predominant method of infection is airborne droplets.

After recovery(decrease in temperature and other symptoms of ARVI) the infection is transmitted by contact(with kisses, handshakes, shared dishes, during sex). EBV resides in the lymph and salivary glands for a long time. A person can easily transmit the virus through contact during the first 1.5 years after the disease. Over time, the likelihood of transmitting the virus decreases. However, research confirms that 30% of people have the virus in their salivary glands for the rest of their lives. In the other 70%, the body suppresses a foreign infection, while the virus is not detected in saliva or mucus, but is stored dormant in the beta lymphocytes of the blood.

If there is a virus in a person’s blood ( virus carriers) it can be transmitted from mother to child through the placenta. In the same way, the virus is spread through blood transfusions.

What happens when infected

The Epstein-Barr virus enters the body through the mucous membranes of the nasopharynx, mouth or respiratory organs. Through the mucous layer, it descends into the lymphoid tissue, penetrates beta lymphocytes, and enters the human blood.

Note: the effect of the virus in the body is twofold. Some of the infected cells die. The other part begins to divide. At the same time, different processes predominate in the acute and chronic stages (carriage).

During acute infection, the infected cells die. In case of chronic carriage, the process of cell division with the development of tumors is initiated (however, such a reaction is possible with weakened immunity, but if the protective cells are sufficiently active, tumor growth does not occur).

The initial penetration of the virus often occurs asymptomatically. Epstein Barr virus infection in children manifests itself with visible symptoms only in 8-10% of cases. Less commonly, signs of a general disease develop (5-15 days after infection). The presence of an acute reaction to infection indicates low immunity, as well as the presence of various factors that reduce the body's protective reactions.

Epstein Barr virus: symptoms, treatment

Acute infection by a virus or its activation with decreased immunity is difficult to distinguish from a cold, acute respiratory infection or acute respiratory viral infection. The symptoms of Epstein bar are called infectious mononucleosis. This is a common group of symptoms that accompany a number of infections. Based on their presence, it is impossible to accurately diagnose the type of disease; one can only suspect the presence of an infection.

In addition to the signs of a common acute respiratory infection, Symptoms of hepatitis, sore throat, and rash may occur. The manifestations of the rash increase when the virus is treated with penicillin antibiotics (such erroneous treatment is often prescribed due to incorrect diagnosis, if instead of a diagnosis of EBV, a person is diagnosed with tonsillitis or acute respiratory infections). Epstein-Barr is a viral infection in children and adults, Treatment of viruses with antibiotics is ineffective and fraught with complications.

Epstein Barr infection symptoms

In the 19th century, this disease was called an unusual fever, in which the liver and lymph nodes become enlarged and the throat hurts. At the end of the 21st century, it received its own name - Epstein-Barr infectious mononucleosis or Epstein-Barr syndrome.

Signs of acute mononucleosis:

• Symptoms of acute respiratory infections- feeling unwell, fever, runny nose, enlarged lymph nodes.
• Symptoms of hepatitis: enlarged liver and spleen, pain in the left hypochondrium (due to an enlarged spleen), jaundice.
• Symptoms of a sore throat: soreness and redness of the throat, enlarged cervical lymph nodes.
• Signs of general intoxication: weakness, sweating, soreness in muscles and joints.
• Symptoms of inflammation of the respiratory organs: difficulty breathing, cough.
• Signs of damage to the central nervous system: headache and dizziness, depression, sleep disturbances, attention, memory.

Signs of chronic virus carriage:

• Chronic fatigue syndrome, anemia.
• Frequent recurrences of various infections- bacterial, viral, fungal. Frequent respiratory infections, digestive problems, boils, rashes.
• Autoimmune diseases- rheumatoid arthritis (joint pain), lupus erythematosus (redness and rashes on the skin), Sjogren's syndrome (inflammation of the salivary and lacrimal glands).
• Oncology(tumors).

Against the background of a sluggish infection with the Epstein Barr virus, a person often develops other types of herpes or bacterial infections. The disease becomes widespread and is difficult to diagnose and treat. Therefore, the Einstein virus often occurs under the guise of other infectious chronic diseases with wave-like manifestations - periodic exacerbations and stages of remission.

Virus carriage: chronic infection

All types of herpes viruses reside in the human body for life. Infection often occurs asymptomatically. After the initial infection, the virus remains in the body for the rest of life.(stored in beta lymphocytes). In this case, a person often does not realize that he is a carrier.

The activity of the virus is controlled by antibodies produced by the immune system. Without the opportunity to multiply and manifest itself actively, the Epstein-Barr infection sleeps as long as the immune system functions normally.

EBV activation occurs with a significant weakening of protective reactions. The reasons for this weakening may be chronic poisoning (alcoholism, industrial emissions, agricultural herbicides), vaccination, chemotherapy and radiation, tissue or organ transplantation, other operations, long-term stress. After activation, the virus spreads from lymphocytes to the mucous surfaces of hollow organs (nasopharynx, vagina, ureteral canals), from where it reaches other people and causes infection.

Medical fact: Herpes viruses are found in at least 80% of people examined. Bar infection is present in the body of the majority of the adult population of the planet.

Epstein Barr: diagnosis

Symptoms of Epstein Barr virus are similar to signs of infection cytomegalovirus(also herpetic infection No. 6, which manifests itself as a long-term acute respiratory infection). It is possible to distinguish the type of herpes and name the exact causative virus only after laboratory tests of blood, urine, and saliva.

Testing for Epstein Barr virus includes several laboratory tests:

• Blood is tested for Epstein Barr virus. This method is called ELISA (enzyme-linked immunosorbent assay) determines the presence and amount of antibodies to infection. In this case, primary antibodies of type M and secondary antibodies of type G may be present in the blood. Immunoglobulins M are formed during the first interaction of the body with an infection or when it is activated from a dormant state. Immunoglobulins G are formed to control the virus during chronic carriage. The type and quantity of immunoglobulins allows us to judge the primacy of the infection and its duration (a high titer of G bodies is diagnosed with a recent infection).
• Saliva or other biological fluid of the body (mucus from the nasopharynx, discharge from the genitals) is examined. This examination is called PCR, it is aimed at detecting viral DNA in liquid samples. The PCR method is used to detect various types of herpes viruses. However, when diagnosing the Epstein Barr virus, this method shows low sensitivity - only 70%, in contrast to the sensitivity of detecting herpes types 1, 2 and 3 - 90%. This is explained by the fact that the bara virus is not always present in biological fluids (even when infected). Since the PCR method does not provide reliable results for the presence or absence of infection, it is used as a confirmation test. Epstein-Barr in saliva - says that there is a virus. But it does not show when the infection occurred, and whether the inflammatory process is associated with the presence of the virus.

Epstein Barr virus in children: symptoms, features

Epstein-Barr virus in a child with normal (average) immunity may not cause painful symptoms. Therefore, infection of children of preschool and primary school age with the virus often occurs unnoticed, without inflammation, fever or other signs of illness.

Epstein-Barr virus often causes a painful infection in adolescent children- mononucleosis (fever, enlarged lymph nodes and spleen, sore throat). This is due to a lower protective reaction (the reason for the deterioration of immunity is hormonal changes).

Epstein-Barr disease in children has the following features:

• The incubation period of the disease is reduced - from 40-50 days it is reduced to 10-20 days after the virus penetrates the mucous membranes of the mouth and nasopharynx.
• The recovery time is determined by the state of immunity. A child’s defensive reactions often work better than an adult’s (as evidenced by bad habits and a sedentary lifestyle). Therefore, children recover faster.

How to treat Epstein-Barr in children? Does treatment depend on the person's age?

Epstein Barr virus in children: treatment of acute infection

Since EBV is the least studied virus, its treatment is also under research. For children, only those drugs are prescribed that have passed the stage of long-term testing with identification of all side effects. There are currently no antiviral drugs for EBV that are recommended for the treatment of children of any age. Therefore, pediatric treatment begins with general supportive therapy, and only in cases of urgent need (threat to the child’s life) are antiviral drugs used. How to treat Epstein bar virus in the stage of acute infection or when chronic carriage is detected?

In acute manifestations, the Epstein-Barr virus in a child is treated symptomatically. That is, when symptoms of sore throat appear, they gargle and treat the throat; when symptoms of hepatitis appear, medications are prescribed to support the liver. Vitamin and mineral support of the body is required, in case of long-term protracted course - immunostimulating drugs. Vaccination after suffering from mononucleosis is postponed for at least 6 months.

Chronic carriage cannot be treated unless it is accompanied by frequent manifestations of other infections and inflammations. For frequent colds, measures to strengthen the immune system are necessary.- hardening procedures, walks in the fresh air, physical education, vitamin and mineral complexes.

Epstein Barr virus: treatment with antiviral drugs

Specific treatment for the virus is prescribed when the body cannot cope with the infection on its own. How to treat Epstein bar virus? Several areas of treatment are used: counteracting the virus, supporting one’s own immunity, stimulating it and creating conditions for the full development of protective reactions. Thus, the treatment of Epstein-Barr virus uses the following groups of drugs:

• Immunostimulants and modulators based on interferon (a specific protein that is produced in the human body when a virus intervenes). Interferon-alpha, IFN-alpha, reaferon.
• Drugs containing substances that inhibit the proliferation of viruses inside cells. These are valacyclovir (Valtrex), famciclovir (Famvir), ganciclovir (Cymevene), and foscarnet. The course of treatment is 14 days, with intravenous administration of drugs recommended for the first 7 days.

Important to know: the effectiveness of acyclovir and valacyclovir against the Epstein Barr virus is under research and has not been scientifically proven. Other drugs - ganciclovir, famvir - are also relatively new and insufficiently studied; they have a wide list of side effects (anemia, disorders of the central nervous system, heart, digestion). Therefore, if Epstein-Barr virus is suspected, treatment with antiviral drugs is not always possible due to side effects and contraindications.

During treatment in hospitals, hormonal drugs are also prescribed:

• Corticosteroids are hormones that suppress inflammation (they do not act on the causative agent of infection, they only block the inflammatory process). For example, prednisolone.
• Immunoglobulins - to support immunity (administered intravenously).
• Thymic hormones - to prevent infectious complications (thymalin, thymogen).

If low titers of the Epstein Barr virus are detected, treatment can be restorative - vitamin s (as antioxidants) and drugs to reduce intoxication ( sorbents). This is maintenance therapy. It is prescribed for any infections, diseases, diagnoses, including those with a positive test for the Epstein-Barr virus. Treatment with vitamins and sorbents is allowed for all categories of sick people.

How to cure Epstein Barr virus

Medical research asks: is the Epstein-Barr virus a dangerous infection or a quiet neighbor? Is it worth fighting the virus or focusing on maintaining immunity? And how to cure Epstein Barr virus? The answers from doctors are mixed. And until a sufficiently effective cure for the virus is invented, we must rely on the body's immune response.

A person has all the necessary defense reactions against infections. To protect against foreign microorganisms, it is necessary to have good nutrition, limit toxic substances, as well as positive emotions and the absence of stress. Failure in the immune system and infection with the virus occurs when it is weakened. This becomes possible with chronic poisoning, long-term drug therapy, and after vaccination.

The best treatment for the virus is create healthy conditions for the body, cleanse it of toxins, provide adequate nutrition, provide the opportunity to produce their own interferons against infection.

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

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

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

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

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

There are 2 strains of the Epstein-Barr virus:

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

What tissues are affected by the virus?

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

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

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

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

Methods of infection

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

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

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

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

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

Mechanism of infection

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

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

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

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

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

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

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

Symptoms

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

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

Infectious mononucleosis

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

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

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

• spicy;
• protracted;
• chronic.

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

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

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

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

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

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

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

Characteristic signs

Typical manifestations of infection are:

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

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

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

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

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

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

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

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

Chronic form of infectious mononucleosis

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

The patient constantly experiences:

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

Signs of Burkitt's lymphoma

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

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

• chemotherapy;
• antiviral drugs;
• immunomodulators.

Nasopharyngeal carcinoma

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

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

Treatment

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

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

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

To increase immunity, the following are prescribed:

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

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

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

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

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

Clinical forms of Epstein-Barr virus

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

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

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

Forecast

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

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

The Epstein-Barr virus belongs to the herpeviruses, which, once they enter the human body, persist in it for life, provoking the development of various autoimmune and lymphoproliferative pathologies. People become infected with this virus in childhood - according to statistics, up to 90% of the adult population are its carriers, and 50% of them can be infectious to others.

That is, it turns out that everyone can catch the Epstein-Barr virus, but not everyone gets sick, only people with a weak immune system. Or the carrier of the virus may not get sick for a long time, and in a certain case, when the immune system fails, the disease may manifest itself.

Causes

The Epstein-Barr virus is transmitted in various ways, but the most common is through saliva. In children, infection occurs:

• through toys contaminated with the carrier’s saliva;
• with intravenous injections;
• aerosol route - when the saliva of an infected child comes into contact with a healthy one (for example, when coughing, sneezing, etc.).

Adults most often become infected with this virus through saliva when kissing, which is why the pathology caused by this pathogen, called infectious mononucleosis, is called “kissing disease.” There are other ways of transmitting the virus among children and adults. These are fecal-oral, contact-household and transplantation. In a word, you can catch the Epstein-Barr virus both in kindergarten and school, and on a minibus, on the street, at a party where there is a large crowd of people, etc.

Once on the skin or mucous membranes of children and adults, the virus begins to actively multiply, after which it penetrates the lymph and bloodstream and spreads throughout the body. The main goal of viral variants is to clone immune cells, which leads to their excessive growth and filling of the lymph nodes. That is why, when the Epstein-Barr virus is active in the body, lymph nodes enlarge in children and adults.

As mentioned above, the entry of a pathogen into the body does not guarantee the development of the disease. Therefore, a predisposing factor to the occurrence of pathology is a decrease in immunity, which can occur due to:

• hypothermia of the body;
• frequent use of antibiotics;
• frequent colds;
• regular stress and nervous strain, etc.

Separately, it should be said about the severity of this viral pathology in people with, since they have very low immunity, and the virus in their bodies can cause severe complications and serious pathologies.

Symptoms

Virus carriage itself is asymptomatic, so the time when the Epstein-Barr virus entered the body cannot be determined. However, there is one disease that this virus manifests itself in - this. And it already has certain symptoms that make it possible to diagnose the virus in the human body.

Usually the disease can be found in children, and adults rarely suffer from this disease. The latent period of the disease can be 1.5 months, after which the first symptoms appear:

• hyperemia of the tonsils;
• enlargement of the occipital, parotid and cervical lymph nodes;
• fever;
• chills;
• a sore throat;
• deterioration in general health.

That is, the first symptoms are similar to, and this makes it difficult to make a diagnosis in children. At the same time, testing for the virus makes it possible to make a correct diagnosis, so children with suspected infectious mononucleosis always have blood taken and a throat culture taken for analysis.

If treatment is not started during this period, other symptoms characteristic of infectious mononucleosis appear. These are symptoms such as:

• characteristic rash;
• enlarged spleen;
• liver enlargement;
• periorbital edema;
• indigestion;

In severe cases, the lymph nodes become inflamed throughout the body, and with an atypical course of the disease, the symptoms can either be unexpressed or, conversely, be expressed in a hypertrophied form.

Typically, the symptoms of infectious mononucleosis in children subside 3–4 weeks after the onset of the disease, and people do not get sick with this disease again in childhood and adulthood. Sometimes in children the disease is mild, without severe symptoms, so they are not even tested to confirm mononucleosis and, growing up, they do not know that they are carriers of the virus.

Sometimes children develop severe complications due to infectious mononucleosis. The main complications that occur in children are and. The following may also develop against the background of the disease:

• Bell's syndrome;
• autoimmune;

It should be said that not only infectious mononucleosis is caused by the Epstein-Barr virus, but also some other pathologies, for example:

• proliferative syndrome (especially in patients with immunodeficiency);
• hairy mouth (again in HIV-infected people);
• malignant neoplasms, in particular and others.

There is a theory that this virus is also responsible for the appearance of many malignant tumors in the body, even if it is not diagnosed in them.

Diagnostics

To make a diagnosis, an IgM test is necessary - a positive result indicates the activity of the virus in the body. If the virus in the body of children or adults is in an inactive state, after an illness, an IgG test shows a positive reaction.

Polymerase chain reaction and culture method are also used for diagnosis.

Treatment

Since the virus is transmitted in various ways, it is impossible to protect against infection. It is also impossible to completely cure a person - you can only keep the virus under control, not allowing it to become active. Therefore, treatment consists, first of all, of maintaining the body’s defenses at a high level. Moreover, this is important for both children and adults. Interferon-type drugs are usually prescribed in individual dosages, which are prescribed by the doctor.

If infectious mononucleosis is detected in children, treatment will be specific, and it should consist of taking antiviral drugs such as Zovirax and Acyclovir. The dosage of the drug for children and adults is determined by the doctor, depending on the severity of the pathology. Treatment should be comprehensive and include the latest generation immunomodulators, vitamins C, B, P, and antihistamines. If a bacterial infection occurs, which happens in the event of complications, antibiotics are prescribed.

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

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

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

Epstein-Barr virus

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

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

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

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

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

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

Epidemiology of Epstein-Barr virus infection

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

Epidemic outbreaks of the disease occur once every 5 years. The disease is more often registered in children aged 1 - 5 years living in organized groups.

Source of infection

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

Pathways of pathogen transmission

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

Entrance gate

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

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

How does the disease develop in adults and children?

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

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

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

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

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

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

In children and adults infected with Epstein-Barr viruses, pathological processes rarely develop, since the body's normal immune system is in most cases able to control and counteract the infection. Active reproduction of pathogens is caused by an acute bacterial or viral infection, vaccination, stress - everything that attacks the immune system.

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

EBVI classification

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

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

Acute primary infection caused by Epstein-Barr viruses or mononucleosis-like syndrome (not to be confused with infectious mononucleosis) in adults and children begins with high fever, sore throat and enlarged posterior cervical lymph nodes. The anterior cervical and ulnar lymph nodes are somewhat less likely to enlarge. There are cases of generalized lymphadenopathy. In half of the patients the spleen is enlarged, in 10 - 30% of patients there is an enlargement of the liver. Some patients develop periorbital edema.

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

Symptoms of acute form of EBVI

Intoxication syndrome

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

Generalized lymphadenopathy

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

Rice. 5. Most often, with EBVI, the posterior cervical lymph nodes are enlarged. They are clearly visible when you turn your head.

Symptoms of tonsillitis in acute form of EBVI

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

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

Symptoms of adenoiditis in acute form of EBVI

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

Enlarged liver and spleen

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

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

Rash

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

Hematological changes

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

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

Outcomes of acute form of EBVI in adults and children

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

• Recovery.
• Asymptomatic virus carriers.
• Chronic recurrent infection.
• Development of cancer.
• Development of autoimmune diseases.
• The emergence of chronic fatigue syndrome.

Disease prognosis

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

• Degree of immune dysfunction.
• Genetic predisposition to Epstein-Barr virus-associated diseases.
• Acute bacterial or viral infection, vaccination, stress, surgery—anything that attacks the immune system—causes the active proliferation of pathogens.

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

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

Chronic Epstein-Barr virus infection in adults and children

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

Chronic mononucleosis-like syndrome: signs and symptoms

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

Hemophagocytic syndrome

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

Consequences of the development of immunodeficiency in adults and children

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

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

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

Generalized form of EBVI: signs and symptoms

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

Atypical forms of the disease

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

• In the first case, patients are bothered by prolonged low-grade fever of unknown origin, weakness, muscle-joint pain, and pain on palpation in the area of ​​peripheral lymph nodes. The disease occurs in waves in adults and children.
• In the second case, all the complaints described above are accompanied by symptoms indicating the development of secondary immunodeficiency: diseases of a viral, bacterial or fungal nature develop. There is damage to the respiratory tract, gastrointestinal tract, skin, and genital organs. The diseases last a long time and often recur. Their duration ranges from 6 months to 10 years or more. Viruses are found in blood lymphocytes and/or saliva.

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

Asymptomatic virus carriers

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

Diagnosis of the chronic form of Epstein-Barr virus infection

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

A characteristic feature is the lack of clinical effect from conventional therapy.

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

• infectious mononucleosis no more than six months ago or a disease occurring with high titers of IgM antibodies (to the capsid antigen);
• histological examination (tissue examination) of organs involved in the pathological process (lymph nodes, liver, spleen, etc.);
• an increase in the number of viruses in the affected tissues, proven by anti-complementary immunofluorescence with the nuclear antigen of the virus.

Viral activity is indicated by:

• Relative and absolute lymphocytosis. Presence of atypical mononuclear cells in the blood. Somewhat less common are lymphopenia and monocytosis. In some cases, thrombocytosis and anemia.
• Changes in immune status (decreased content and impaired function of natural killer cytotoxic lymphocytes, impaired humoral response).

Differential diagnosis of chronic EBVI

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

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

Virus-associated diseases

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

Development of oncopathology

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

Development of autoimmune diseases

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

Development of chronic fatigue syndrome

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

Some types of oncopathology and paraneoplastic processes

Burkitt's lymphoma

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

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

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

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

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

Nasopharyngeal carcinoma

Rice. 15. The photo shows enlarged lymph nodes with nasopharyngeal carcinoma in an HIV-infected person.

Kaposi's sarcoma

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

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

Leukoplakia of the tongue

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

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

Autoimmune diseases

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

Rice. 18. Systemic lupus erythematosus.

Rice. 19. Systemic lupus erythematosus and rheumatoid arthritis.

Rice. 20. Sjogren's syndrome is an autoimmune disease. Dry eyes and dry mouth are the main symptoms of the disease. The disease is often caused by the Epstein-Barr virus.

Congenital Epstein-Barr virus infection

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

Diagnosis of the disease

When diagnosing Epstein-Barr virus infection, the following laboratory research methods are used:

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

Clinical blood test

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

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

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

Blood chemistry

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

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

Immunological studies

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

Serological studies

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

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

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

Polymerase chain reaction (PCR)

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

Differential diagnosis

Diseases with a similar clinical picture include:

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

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

Rice. 22. Enlarged lymph nodes in children with infectious mononucleosis.

Treatment of Epstein-Barr virus infection in adults and children

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

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

During the period of acute manifestation of primary infection, special treatment for Epstein-Barr virus infection is not required. However, with prolonged fever, severe manifestations of tonsillitis and tonsillitis, enlarged lymph nodes, jaundice, increasing cough and the appearance of abdominal pain, hospitalization of the patient is necessary.

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

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

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

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

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

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

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

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

Treatment of EBVI in adults and children with chronic disease

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

Basic therapy

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

The following antiviral drugs are used:

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

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

Immunocorrective therapy

When treating EBVI, the following are used:

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

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

Symptomatic remedies

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

Antibacterial and antifungal drugs

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

Means of pathogenetic therapy

• Metabolic rehabilitation drugs: Elkar, Solcoseryl, Actovegin, etc.
• To normalize the functioning of the gastrointestinal tract, hepatoprotectors (Galstena, Hofitol, etc.), enterosorbents (Filtrum, Smecta, Polyphepan, Enterosgel, etc.), probiotics (Acipol, Bifiform, etc.) are used.
• Angio- and neuroprotectors (Gliatilin, Instenon, Encephabol, etc.).
• Cardiotropic drugs (Cocarboxylase, Cytochrome C, Riboxin, etc.).
• Antihistamines of the 1st and 3rd generations (Fenistil, Zyrtec, Claritin, etc.).
• Protease inhibitors (Gordox, Kontrikal).
• Hormonal drugs prednisolone, hydrocortisone and dexamethasone are prescribed for severe infection - airway obstruction, neurological and hematological complications. Drugs in this group reduce inflammation and protect organs from damage.
• Detoxification therapy is carried out when the disease becomes severe and is complicated by a ruptured spleen.
• Vitamin and mineral complexes: Vibovit, Multi-tabs, Sanasol, Biovital gel, Kinder, etc.
• Antihomotoxic and homeopathic remedies: Aflubin, Oscillococcinum, Tonzilla compositum, Lymphomyosot, etc.
• Non-drug treatment methods (magnetic therapy, laser therapy, magnetotherapy, acupuncture, physical therapy, massage, etc.
• When treating asthenic syndrome, adaptogens, high doses of B vitamins, nootropics, antidepressants, psychostimulants and cell metabolism correctors are used.

Rehabilitation of children and adolescents

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