How the web virus is treated in the hospital. Clinical forms of chronic Epstein-Barr virus infection: issues of diagnosis and treatment

According to research, half of schoolchildren and 90% of forty-year-olds have encountered the Epstein-Barr virus (EBV), are immune to it and do not even know it. This article will focus on those for whom getting to know the virus was not so painless.

Infectious mononucleosis

At the onset of the disease, mononucleosis is practically indistinguishable from ordinary ARVI. Patients are bothered by a runny nose, moderate sore throat, and body temperature rises to subfebrile levels.

The acute form of EBV is called. The virus enters the human body through the nasopharynx. More often through the mouth - no wonder Infectious mononucleosis received beautiful name"kissing disease" The virus multiplies in cells of lymphoid tissue (in particular, in B lymphocytes).

A week after infection, a clinical picture resembling an acute respiratory infection develops:

temperature increase, sometimes up to 40 °C,
hyperemic tonsils, often with plaque,
as well as a chain of lymph nodes in the neck along the sternocleidomastoid muscle, as well as in the back of the head, under the lower jaw, in the armpits and in the groin area,
may be detected during examination of “packets” of lymph nodes in the mediastinum and abdominal cavity, the patient may complain of cough, chest pain or abdominal pain,
the liver and spleen increase in size,
Atypical mononuclear cells appear in a blood test - young blood cells similar to both monocytes and lymphocytes.

The patient spends about a week in bed, during which time he drinks a lot, gargles and takes antipyretics. Specific treatment there is no mononucleosis, the effectiveness of existing antiviral drugs has not been proven, and antibiotics are needed only in the case of a bacterial or fungal infection.

Typically, the fever disappears within a week, the lymph nodes shrink within a month, and blood changes can persist for six months.

After suffering from mononucleosis, specific antibodies remain in the body for life - immunoglobulins of class G (IgG-EBVCA, IgG-EBNA-1), which provide immunity to the virus.

Chronic EBV infection

If the immune response is not effective enough, chronic disease may develop. viral infection Epstein-Barr: erased, active, generalized or atypical.

Erased: the temperature often rises or stays for a long time in the range of 37–38 ° C, may appear increased fatigue, drowsiness, muscle and joint pain, enlarged lymph nodes.
Atypical: infections often recur - intestinal, urinary tract, repeated acute respiratory infections. They are protracted and difficult to treat.
Active: symptoms of mononucleosis (fever, sore throat, lymphadenopathy, hepato- and splenomegaly) recur, often complicated by bacterial and fungal infections. The virus can cause damage to the mucous membrane of the stomach and intestines; patients complain of nausea, diarrhea, and abdominal pain.
Generalized: defeat nervous system(, encephalitis, radiculoneuritis), heart (), lungs (pneumonitis), liver (hepatitis).

In case of chronic infection, both the virus itself can be detected in saliva by PCR, and antibodies to nuclear antigens (IgG-EBNA-1), which are formed only 3-4 months after infection. However, this is not enough to make a diagnosis, because the same picture can be observed in a completely healthy carrier of the virus. Immunologists examine the entire spectrum of antiviral antibodies at least twice.

An increase in the amount of IgG to VCA and EA will suggest relapse of the disease.

How dangerous is Epstein-Barr virus?

Genital ulcers associated with EBV

The disease is quite rare and occurs more often in young women. Quite deep and painful erosions appear on the mucous membrane of the external genitalia. In most cases, in addition to ulcers, general symptoms typical of mononucleosis also develop. Acyclovir, which has proven itself in the treatment of herpes type II, was not very effective for genital ulcers associated with the Epstein-Barr virus. Fortunately, the rash goes away on its own and rarely recurs.

Hemophagocytic syndrome (X-Linked Lymphoproliferative Disease)

Epstein-Barr virus can infect T lymphocytes. As a result, a process is launched that leads to the destruction of blood cells - red blood cells, platelets, and leukocytes. This means that in addition to the symptoms characteristic of mononucleosis (fever, lymphadenopathy, hepatosplenomegaly), the patient develops anemia, hemorrhagic rashes, and blood clotting is impaired. These phenomena may disappear spontaneously, but can also lead to fatal outcome, therefore requiring active treatment.

Cancers associated with EBV

Currently, the role of the virus in the development of such cancers is not disputed:

Burkitt's lymphoma,
nasopharyngeal carcinoma,
lymphogranulomatosis,
lymphoproliferative disease.

Burkitt's lymphoma occurs in children preschool age and only in Africa. The tumor affects the lymph nodes, upper or lower jaw, ovaries, adrenal glands and kidneys. Unfortunately, there are no drugs that guarantee success in its treatment yet.
Nasopharyngeal carcinoma is a tumor located in the upper part of the nasopharynx. It manifests itself as nasal congestion, nosebleeds, hearing loss, sore throat and persistent headache. Most often found in African countries.
Lymphogranulomatosis (otherwise known as Hodgkin's disease), on the contrary, more often affects Europeans of any age. It is manifested by enlarged lymph nodes, usually of several groups, including retrosternal and intra-abdominal, fever, and weight loss. The diagnosis is confirmed by a lymph node biopsy: giant Hodgkin (Reed-Berezovsky-Sternberg) cells are detected. Radiation therapy can achieve stable remission in 70% of patients.
Lymphoproliferative disease (plasma hyperplasia, T-cell lymphoma, B-cell lymphoma, immunoblastic lymphoma) is a group of diseases in which malignant proliferation of lymphoid tissue cells occurs. The disease is manifested by enlarged lymph nodes, and the diagnosis is made after a biopsy. The effectiveness of chemotherapy varies depending on the type of tumor.

Autoimmune diseases

The impact of the virus on the immune system causes failures in the recognition of its own tissues, which leads to the development of autoimmune diseases. EBV infection is among etiological factors development of SLE, chronic glomerulonephritis, autoimmune hepatitis and Sjögren's syndrome.

Chronic fatigue syndrome

Syndrome chronic fatigue may be a manifestation of chronic EBV infection.

Often associated with viruses of the herpes group (which includes the Epstein-Barr virus). Typical symptoms of chronic EBV infection: enlarged lymph nodes, especially cervical and axillary, pharyngitis and low-grade fever, combined with severe asthenic syndrome. The patient complains of fatigue, decreased memory and intelligence, inability to concentrate, headache and muscle pain, and sleep disturbances.

There is no generally accepted treatment regimen for EBV infection. In the arsenal of doctors today there are nucleosides (Acyclovir, Ganciclovir, Famciclovir), immunoglobulins (Alfaglobin, Polygam), recombinant interferons(Reaferon, Cycloferon). However, a competent specialist should decide how to take them and whether it is worth doing at all after a thorough study, including laboratory research.

Which doctor should I contact?

If a patient has symptoms of an Epstein-Barr virus infection, they should be evaluated and treated by an infectious disease specialist. However, often such patients first turn to a general practitioner/pediatrician. If complications or diseases associated with the virus develop, consultations with specialized specialists are prescribed: a hematologist (for bleeding), a neurologist (for the development of encephalitis, meningitis), a cardiologist (for myocarditis), a pulmonologist (for pneumonitis), a rheumatologist (for damage to blood vessels and joints). In some cases, consultation with an ENT doctor is required to rule out bacterial tonsillitis.

Epstein-Barr virus(EBV) belongs to the herpes virus family. It is one of the most common human viruses. For example, in the United States, 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 unconventional methods treatment.

Steps

Part 1

How to reduce the risk of EBV infection

Make sure you have a strong immune system. Home prevention any viral, bacterial or fungal infection - 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.

Get as much vitamin C or ascorbic acid as possible. 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, in Lately In medical circles, concerns began to be expressed that even this amount may not be enough for the normal functioning of the immune system and the body as a whole.

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.

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 body copes with the virus without symptomatic manifestations, some have mild symptoms, while 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 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 a 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 particle size (less than 10 nm in diameter) and purity (no salt or protein impurities) Sub-nanometer silver particles have a strong electric 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, contact your doctor to prescribe effective antiviral or other potent drugs. 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. Please note that if the disease is mild, antiviral therapy 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 may slow the body's immune response to EBV, causing infected with virus the cells will continue to multiply. Therefore, the doctor must decide how much the expected benefit from taking these drugs outweighs the risk of undesirable consequences.
  - The following side effects may occur as a result of taking antiviral drugs: 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.

The Epstein-Barr virus test is performed in two ways: ELISA, which detects antibodies to antigens and establishes the form of infection (chronic, acute, asymptomatic), and PCR (polymer chain reaction). The Epstein-Barr virus PCR method examines the DNA of virus cells and determines its presence or absence in a person. PCR is recommended for examining children, since the child’s body has not yet had time to produce antibodies, and also when the ELISA result is in doubt.

Epstein-Barr virus (EBV) is one of the most common diseases; almost 65% of children under three years, as well as 97% of adults. This is one of the varieties of herpes viruses (type 4), which, after infection, causes diseases:

Lymphoreticular system: changes in the lymph nodes, damage to the liver and spleen.
Immune system: settles inside B-lymphocytes, disrupts their functional properties, which causes immunodeficiency, causes the destruction of the cellular component of immunity.
Epithelial cells of the respiratory and digestive organs: manifested by respiratory syndrome, namely cough, shortness of breath, “ false croup", damage to internal organs is possible.

It is believed that EBV is sometimes a provoking factor in the development of malignant neoplasms: Burkitt's lymphoma, nasopharyngeal cancer, lymphogranulomatosis, although there is no definitive evidence of this. In addition, almost every fourth carrier of chronic EBV infection has an allergy.

The virus remains in the body throughout life, it causes chronic infection, which worsens when conditions favorable to it arise.

What is PCR

There are two types of EBV, but serologically they are no different. Infection is possible from a carrier at the end of the incubation period, throughout the course of the disease, within six months from the date of recovery. Some patients have the ability to secrete the virus from time to time, that is, to become its carriers even many months after infection.

PCR diagnostics involves identifying the DNA of the virus using molecular biology methods. For research, special enzymes are used that repeatedly copy fragments of DNA and RNA of cells. Then the resulting fragments are checked against the database, the presence of EBV and its concentration are detected.

The materials used to determine Epstein-Barr virus DNA are saliva, mucus from the oral or nasal cavity, blood, samples cerebrospinal fluid, scrapings of cells of the urogenital canal, urine.

The appropriateness of choosing a particular material is determined by the doctor. Typically, blood is preferred for PCR, which is collected in a flask with an EDTA solution (6%).

U small child immunity is in the process of being established, so the method for determining antibodies to them is not used; PCR is used for children.

The PCR result is often positive, so it is necessary to differentiate between a sick person and a virus carrier; for this purpose, an analysis with varying sensitivity is used:

up to 10 copies per sample – for carriers;
up to 100 copies – with active Epstein-Barr virus.

PCR gives a very high degree of correctness of the result, but the peculiarity of this analysis is that it is informative only during the replication period, therefore there are 30% of false negative results due to the lack of replication at the time of analysis.

During pregnancy, it is considered mandatory to take a PCR test several times if the virus is first detected after pregnancy, in order to timely detect reactivation of the virus.

Preparing for the test

When taking an Epstein-Barr virus test, it is necessary to exclude all factors that could distort the PCR result:

Biological material must be taken in the morning on an empty stomach.
On the eve of the PCR test, it is recommended to avoid a heavy dinner. It is better to have a small snack 9 hours before the time of taking the biomaterial.
Three days before the test, avoid alcohol, energy drinks, fatty, sweet or starchy foods.
The day before the test, exclude tea and coffee, carbonated drinks.

Before the test, young children are given boiled water (up to 200 ml over half an hour). It is not recommended to take medications starting 10-14 days before PCR, but if they are necessary for health reasons, then their names must be provided to the doctor who will interpret the analysis.

Diagnosis of Epstein-Barr virus (EBV): blood test, DNA, PCR, liver tests

When will the PCR be ready?

Several PCR diagnostic methods are known. But the most reliable and widely used has become real-time analysis, in which there are almost never false negative indicators and quick results are available.

The PCR result can be obtained in a few hours or a few days, it all depends on the laboratory and the emergency of the situation. The average waiting time for results is 1-2 days.

Decoding PCR for Epstein-Barr virus

The very first reasons for prescribing PCR are an excess of leukocytes, platelets and a decrease in the norm of red blood cells and hemoglobin in the blood. If such indicators are detected, the patient is prescribed additional diagnostics- PCR.

The result of the study can be positive or negative. A positive PCR result indicates that the person tested is a carrier of EBV, although its presence does not prove that an infection is present in acute or chronic form.

This proves that EBV once penetrated the body, since herpes is characterized by the fact that after the initial entry into the body, nothing can remove it from it.

Serology, ELISA, PCR for Epstein-Barr virus. Positive and negative result

A negative PCR result is detected if a person has not encountered EBV and does not contain it in his body.

If it is necessary not only to detect the presence of the virus, but also to determine the stage and form of the disease, then an ELISA test is prescribed, during which the following is examined:

IgM VCA antibodies to Epstein-Barr virus capsid antigens;
IgG VCA - to early antigens.

The presence of both shows that the disease is in acute form, because they disappear within 4–6 weeks after the onset of the disease.

PCR diagnostics is considered a young method, but at the same time quite reliable. It is possible to detect the presence of a virus even if only one DNA virus molecule is present. Due to its high accuracy, this type of examination is considered effective way identify herpesvirus and monitor the progress of treatment. At the same time, PCR requires high-tech equipment with a multi-level control system and trained specialists.

The information in this section cannot be used for self-diagnosis and self-treatment. In case of pain or other exacerbation of the disease diagnostic studies should only be prescribed by the attending physician. To make a diagnosis and correct purpose treatment, you should contact your doctor.

Epstein-Barr virus belongs to the herpesvirus family, subfamily g-herpesviruses - human herpes virus type IV. The viral particle consists of a nucleoid, a capsid and an envelope.
The nucleoid contains double-stranded DNA and is surrounded by a capsid consisting of protein subunits. The nucleoid and capsid (nucleocapsid) are surrounded by a lipid-containing outer shell formed from the nuclear or outer membrane of the host cell, into which some viral proteins are integrated even before the assembly of the viral particle begins.
Upon infection, the virus penetrates the epithelium of the human oropharynx and salivary glands and causes an active infection with cell lysis and release of viral particles, resulting in the virus being detected in saliva. In addition, it can penetrate B lymphocytes and nasopharyngeal epithelium and cause latent infection. Epstein-Barr virus can be found in oral secretions healthy but latently infected people. The virus is tropic for B-lymphocytes, but does not affect T-lymphocytes. Having penetrated lymphocytes, the Epstein-Barr virus can cause their transformation, as a result of which clones of atypical lymphocytes capable of unlimited proliferation are formed, containing circular viral DNA in the form of a plasmid. The virus receptor on epithelial cells and B lymphocytes is the CD21 molecule, which also serves as a receptor for the complement fragment C3d. The virus triggers both humoral and cellular responses. Among the antibodies formed, there are those specific to the virus antigens and nonspecific, heterophilic ones. The latter appear as a result of polyclonal activation of B lymphocytes (this may cause interference in some serological studies in people with active Epstein-Barr virus infection). Cellular immunity plays the main role in eliminating this infection. At acute infection primary reproduction of the virus in B lymphocytes is replaced by pronounced proliferation of T lymphocytes with a CD4/CD8 ratio of less than 1.

Acute infection with the Epstein-Barr virus is known as infectious mononucleosis, Filatov's disease, monocytic tonsillitis, idiopathic glandular fever, Afeiffer's disease, acute benign lymphoblastosis.

Epstein-Barr virus - main reason mononucleosis-like syndrome (although acute primary infection caused by this virus and infectious mononucleosis are not synonymous). Acute infection is characterized by fever, sore throat and enlargement of the posterior cervical lymph nodes (less commonly, anterior cervical and ulnar ones; generalized enlargement of the lymph nodes occurs). In 50% of cases, an enlarged spleen is detected, in 10 - 30% of cases - an enlarged liver. Other manifestations of infection may include rash and periorbital swelling. Occasionally complications are observed, including neurological ones, changes in the blood system in the form of hemolytic or aplastic anemia, neutropenia, thrombocytopenia. After an illness, pharyngitis, enlarged lymph nodes, fatigue and inability to concentrate sometimes persist for a long time.
The disease is less contagious. The incubation period (the period of active reproduction and spread of the virus throughout the lymphoid tissue) can last from 30 to 50 days. Infection with this virus at any age, and especially in children, in most cases can be asymptomatic or as a respiratory infection. The proportion of seropositive individuals (having specific antibodies to virus antigens) already among adolescents in different countries ranges from 50 to 90%; among adults, serological signs of infection are detected in almost 100% of cases. The virus is excreted in saliva and transmitted through kissing and other contact of mucous membranes with saliva or objects contaminated with it. Transplacental transmission of the virus is rare. Immunity against infectious mononucleosis is stable.
Although the carcinogenicity of the virus has not been definitively proven, there is reason to believe that it may play a role in the development of a number of malignant neoplasms - Burkitt's lymphoma, nasopharyngeal cancer, lymphogranulomatosis and a number of post-transplant lymphoproliferative syndromes. Against the background of the violation cellular immunity(AIDS, immunosuppression during transplantation, etc.) Epstein-Barr virus can cause infectious mononucleosis with fatal or lymphoproliferative syndromes with the development of B-cell lymphomas.
Laboratory diagnostics infectious mononucleosis
Diagnosis of infectious mononucleosis is based on clinical picture, characteristic changes V clinical analysis blood:

№ 5 Clinical blood test

Blood analysis. Complete blood count (without leukocyte formula and ESR) (Complete Blood Count, CBC)

The study includes determination of hemoglobin concentration, hematocrit value, concentration of erythrocytes, leukocytes, platelets, as well as calculation of erythrocyte indices (MCV, RDW, MCH, MCHC). Blood consists of a liquid part (plasma) and cellular, shaped elements(red blood cells,...

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№ 119 Clinical blood test

Leukocyte formula (differential white blood cell count, leukocytogram, Differential White Blood Cell Count) with blood smear microscopy in the presence of pathological changes

Includes definition total concentration blood leukocytes and percentage main subpopulations of leukocytes. As a result of automated calculation leukocyte formula The hematology analyzer identifies 5 subpopulations of leukocytes: neutrophils, lymphocytes, monocytes, eosinophils and b...

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And the results of serological tests:

№ 186

Antibodies of the IgM class to the capsid antigen of the Epstein-Barr virus (EBV VCA-IgM, Epstein-Barr Virus Capcid Antigen IgM, EBV VCA-IgM)

Markers of primary infection with Epstein-Bar virus. Epstein-Barr virus belongs to the herpesvirus family, the g-herpesvirus subfamily is human herpes virus type IV. The viral particle consists of a nucleoid, a capsid and an envelope. Antibodies of the IgM class to the capsid antigen complex of the Epstein-B virus...

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№ 187 Infectious mononucleosis: Epstein-Barr virus (human herpes virus type 4)

Antibodies of the IgG class to the nuclear antigen of the Epstein-Barr virus (EBV NA IgG, Epstein-Barr Virus Nuclear Antigen IgG, EBNA IgG)

A marker of past Epstein-Barr virus infection. IgG class antibodies to nuclear antigen (IgG-EBNA antibodies) appear 4 to 6 months after the onset of infection, including those occurring in erased forms, and then, in small titers, are detected for life. They can be found in more...

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No. 225 Tumor markers

Beta-2 microglobulin (in urine) (Beta-2 microglobulin, urine)

An early marker of damage to the proximal tubules of the kidneys (see also test No. 208 - beta-2 microglobulin in the blood) and a tumor marker of β-cell tumors, multiple myeloma. Beta-2 Microglobulin is a low molecular weight protein (11,800 Da), present on the surface of nucleated cells as a light...

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By the second week of the disease, relative and absolute lymphocytosis develops with the presence of 10 - 20% of atypical mononuclear cells. Hematological changes resembling the picture of infectious mononucleosis can also be observed with cytomegalovirus infection, toxoplasmosis, acute respiratory viral diseases, chicken pox, measles, infectious hepatitis and other diseases. Therefore, serological tests are advisable to establish a differential diagnosis. Antibodies to virus antigens appear quickly enough, and testing in the acute period of the disease, even a single serum sample different types antibodies can provide a fairly accurate indication of the patient's immunity or susceptibility to Epstein-Barr virus infection, current infection, or reactivation.
Additional confirmation of the course of the acute stages of infection can be the detection of Epstein-Barr virus DNA in the blood and/or saliva using the PCR method

No. 351KR Infectious mononucleosis: Epstein-Barr virus (human herpes virus type 4)

Epstein-Barr virus, determination of DNA (Epstein Barr virus, DNA) in blood

Determination of Epstein-Barr virus DNA in blood using polymerase chain reaction (PCR) with real-time detection. Epstein-Barr virus (EBV) is the cause of infectious mononucleosis. The etiology of some cancers is also associated with the Epstein-Barr virus...

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No. 351VPT Infectious mononucleosis: Epstein-Barr virus (human herpes virus type 4)

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No. 351VPT Infectious mononucleosis: Epstein-Barr virus (human herpes virus type 4)

Epstein Barr virus, DNA determination in effusion

Determination of Epstein-Barr virus DNA in effusion using polymerase chain reaction (PCR) with real-time detection. Epstein-Barr virus (EBV) is the cause of infectious mononucleosis. The etiology of some...

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No. 351MOCH Infectious mononucleosis: Epstein-Barr virus (human herpes virus type 4)

Epstein-Barr virus, DNA determination in urine

Determination of Epstein-Barr virus DNA in urine using polymerase chain reaction (PCR) with real-time detection. Epstein-Barr virus (EBV) is the cause of infectious mononucleosis. The etiology of some cancers is also associated with the Epstein-Barr virus...

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No. 351NOS Infectious mononucleosis: Epstein-Barr virus (human herpes virus type 4)

Epstein-Barr virus, DNA determination (Epstein Barr virus, DNA) in scraping of epithelial cells of the nasal mucosa

Determination of Epstein-Barr virus DNA in scrapings epithelial cells nasopharynx using polymerase chain reaction (PCR) with real-time detection. Epstein-Barr virus (EBV) is the cause of infectious mononucleosis. With the Epstein-Barr virus...

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No. 351ROT Infectious mononucleosis: Epstein-Barr virus (human herpes virus type 4)

Epstein-Barr virus, DNA determination (Epstein Barr virus, DNA) in scraping of epithelial cells of the oropharynx

Determination of Epstein-Barr virus DNA in scrapings of oropharyngeal epithelial cells using polymerase chain reaction (PCR) with real-time detection. Epstein-Barr virus (EBV) is the cause of infectious mononucleosis. With the Epstein-Barr virus...

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No. 351SV Infectious mononucleosis: Epstein-Barr virus (human herpes virus type 4)

Epstein-Barr virus, DNA determination (Epstein Barr virus, DNA) in blood serum

Determination of Epstein-Barr virus DNA in blood serum by polymerase chain reaction (PCR) with real-time detection. Epstein-Barr virus (EBV) is the cause of infectious mononucleosis. The Epstein-Barr virus is also associated with the etiology of...

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No. 351SLN Infectious mononucleosis: Epstein-Barr virus (human herpes virus type 4)

Virus Epstein Barr a (EBV) is one of the representatives of the family of herpetic 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.
Stored not 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.

The source of infection through the air is people in acute stage illnesses(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 acute illness The predominant method of infection is airborne.

After recovery(decrease in temperature and other symptoms of ARVI) the infection is transmitted by contact(with kisses, handshakes, shared dishes, during sex). EBV remains in the lymph for a long time and salivary glands. 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

Epstein-Barr virus enters the body through the mucous membranes of the nasopharynx, mouth or respiratory organs. Through the mucous layer it descends into 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, in acute and chronic stage(carriage) different processes predominate.

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 visible symptoms only in 8-10% of cases. Less often - signs are formed general disease(5-15 days after infection). Availability 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 - general group 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 for misdiagnosis, if instead of a diagnosis of EBV, a person is diagnosed with tonsillitis, 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 - infectious Epstein-Barr mononucleosis or Epstein-Barr syndrome.

Signs of acute mononucleosis:

Symptoms of acute respiratory infections - bad feeling, 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 relapsers 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 manifests other types of herpetic or bacterial infection. 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 significant weakening defensive 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 mucous surfaces hollow organs(nasopharynx, vagina, ureteric canals), from where it gets to other people and causes infection.

Medical fact: viruses herpetic type found in at least 80% of examined people. 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 under 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 ( 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 herpetic 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 because the bara virus is not always present in biological fluids(even if there is infection). Because the PCR method does not provide reliable results of 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 it is related inflammatory process with the presence of a virus.

Epstein Barr virus in children: symptoms, features

Epstein-Barr virus may not manifest itself in a child with normal (average) immunity 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 in children adolescence more likely to cause painful infection- 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 (they say bad habits, sedentary lifestyle life). 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. That's why 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 manifestation 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. With frequent colds measures are needed to strengthen the immune system- hardening procedures, walks on 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, treatment for Epstein-Barr virus uses the following groups 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 wide list side effects (anemia, disorders of the central nervous system, heart, digestion). Therefore, if Epstein-Barr virus is suspected, treatment antiviral drugs 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 - for prevention 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 positive analysis for Epstein-Barr virus. Treatment with vitamins and sorbents is allowed for all categories of sick people.

How to cure Epstein Barr virus

Medical Research Questions: Epstein-Barr Virus - What Is It - dangerous infection or a calm 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. Crash in immune system and infection with the virus occurs when it weakens. This becomes possible when chronic poisoning, long-term therapy medicines, after vaccination.

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