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

According to studies, half of schoolchildren and 90% of forty-year-olds have come across the Epstein-Barr virus (EBV), are immune to it and are not even aware of it. This article will focus on those for whom acquaintance with the virus was not so painless.

Infectious mononucleosis

At the onset of the disease, mononucleosis is practically indistinguishable from ordinary SARS. Patients are worried about a runny nose, moderate sore throat, body temperature rises to subfebrile values.

The acute form of EBV is called. The virus enters the human body through the nasopharynx. More often through the mouth - not without reason Infectious mononucleosis received beautiful name kissing disease. The virus multiplies in the cells of the lymphoid tissue (in particular, in B-lymphocytes).

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

fever, sometimes up to 40 ° C,
hyperemic tonsils, often with plaque,
as well as a chain of lymph nodes on 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 inguinal region,
can be detected during examination of "packages" of lymph nodes in the mediastinum and abdominal cavity, the patient may complain of cough, pain behind the sternum or in the abdomen,
enlargement of the liver and spleen,
atypical mononuclear cells appear in the blood test - young blood cells, similar to both monocytes and lymphocytes.

The patient spends about a week in bed, at which time he drinks a lot, gargles his throat 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 case of a bacterial or fungal infection.

Usually, the fever disappears in a week, the lymph nodes decrease in a month, and blood changes can persist for six months.

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

Chronic EBV infection

If the immune response is not effective enough, chronic 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, it may appear fatigue, drowsiness, muscle and joint pain, increased lymph nodes.
Atypical: often recur infections - intestinal, urinary tract, repeated acute respiratory infections. They are chronic and difficult to treat.
Active: symptoms of mononucleosis (fever, tonsillitis, 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 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 would suggest a relapse of the disease.

Why is the Epstein-Barr virus dangerous?

EBV associated genital ulcers

The disease is quite rare, occurs more often in young women. Quite deep and painful erosions appear on the mucous membrane of the external genital organs. In most cases, in addition to ulcers, general symptoms typical of mononucleosis also develop. Aciclovir, which has proven itself in the treatment of type II herpes, has not been very effective in genital ulcers associated with the Epstein-Barr virus. Fortunately, rashes go away on their own and rarely recur.

Hemophagocytic syndrome (X-Linked Lymphoproliferative Disease)

Epstein-Barr virus can infect T-lymphocytes. As a result, a process is started that leads to the destruction of blood cells - erythrocytes, platelets, 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 disturbed. These phenomena may disappear spontaneously, but may also lead to lethal outcome and therefore require active treatment.

Cancers associated with EBV

Currently, the role of the virus in the development of such oncological diseases 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.
Nasopharyngeal carcinoma is a tumor located in the upper part of the nasopharynx. Manifested by nasal congestion, nosebleeds, hearing loss, sore throat and persistent headache. Most often found in African countries.
Lymphogranulomatosis (otherwise - Hodgkin's disease), on the contrary, more often affects Europeans of any age. Manifested by an increase in lymph nodes, usually several groups, including retrosternal and intra-abdominal, fever, weight loss. The diagnosis is confirmed by lymph node biopsy: giant Hodgkin cells (Reed-Berezovsky-Sternberg) are found. Radiation therapy allows achieving stable remission in 70% of patients.
Lymphoproliferative disease (plasmatic 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 an increase in 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 functioning of 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 SLE development, 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: an increase in lymph nodes, especially cervical and axillary, pharyngitis and subfebrile condition, are combined with severe asthenic syndrome. The patient complains of fatigue, decreased memory and intelligence, inability to concentrate, headache and muscle pain, sleep disturbance.

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

Which doctor to contact

If a patient has symptoms of an Epstein-Barr virus infection, they should be examined and treated by an infectious disease specialist. However, it is not uncommon for such patients to first turn to a general practitioner/pediatrician. With the development of complications or diseases associated with the virus, consultations of specialized specialists are prescribed: a hematologist (with bleeding), a neurologist (with the development of encephalitis, meningitis), a cardiologist (with myocarditis), a pulmonologist (with pneumonitis), a rheumatologist (with damage to blood vessels, joints). In some cases, consultation with an ENT doctor is required to exclude bacterial tonsillitis.

Epstein-Barr virus(EBV) belongs to the herpes virus family. It is one of the most widespread 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 no symptoms of infection. The exception is people with weakened immune systems, who may develop diseases such as mononucleosis and lymphoma against the background of infection with the virus. EBV is transmitted mainly 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 is 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, with the help of 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, it is necessary to do everything possible so that you have a strong immune system that does its job well.

Eat as much vitamin C or ascorbic acid as possible. Until now, the effect of vitamin C on viruses that cause common colds has been mainly studied. However, it has been proven that vitamin C has pronounced antiviral and immunostimulating properties. It helps prevent or reduce the effects of EBV infection by stimulating the production and activity of white blood cells that seek out 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 recent times in medical circles, fears began to be expressed that for the normal functioning of the immune system and the body as a whole, even this amount may not be enough.

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

Take Biologically active additives which help to 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 controlling EBV infection has not been sufficiently studied. This is because high quality Scientific research are costly, and these funds are rarely allocated to natural or "non-traditional" drug research. In addition, a feature of EBV is that it can hide inside B cells - types of white blood cells that the body produces to fight infection. Because of this, EBV is difficult to destroy just by stimulating the immune system, but it is still worth trying.

Be careful while kissing. Most often, adolescents and adults around the world become infected with EBV during a kiss. Someone's body copes with the virus without symptomatic manifestations, someone has mild symptoms, and someone can be sick for several weeks or even months. That's why the best prevention EBV and other viral infections - do not kiss or have sexual contact with anyone who may be sick. Be careful and refrain from romantic kissing 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 without symptoms and still be a carrier.

Part 2
What are the treatment options
1. Only severe symptoms should be treated. Does not exist typical treatment specifically EBV infection, since very often it does not have any symptomatic manifestations at all. As a rule, even mononucleosis resolves on its own in a few months. If you are experiencing 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 very weak.
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 able to destroy even rapidly mutating viral pathogens. True, it has not yet been clarified whether silver particles specifically destroy EBV, so additional research is needed before giving specific recommendations.
  - Silver solution, even in high concentration, is considered non-toxic, but if it is protein-based, then the risk of developing argyria increases. Argyria is a disease that manifests itself as a change in skin color as a result of the accumulation of silver compounds.
  - Dietary supplements with colloidal silver can be bought at pharmacies or specialized stores.
3. Check with your doctor if you have a chronic infection. If EBV infection or mononucleosis does not go away after a few months, see your doctor for an effective antiviral or other medication. 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 may be effective. Keep in mind that if the disease is mild, antiviral therapy ineffective. In the case of chronic EBV infection, immunosuppressants (corticosteroids, cyclosporine) can also be used. They will help temporarily alleviate the symptoms.
  - Immune-suppressing drugs can slow down the body's immune response to EBV, causing virus-infected cells will continue to multiply. Therefore, the doctor must decide how much the expected benefits of taking these drugs outweigh the risk of undesirable consequences.
  - As a result of taking antiviral drugs, there may be such side effects: skin rash, stomach upset, diarrhea, joint pain, headache, dizziness, fatigue.
  - Despite numerous attempts to develop a vaccine against EBV, they have so far been unsuccessful.

Epstein-Barr virus analysis 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 PCR method for the Epstein-Barr virus examines the DNA of the virus cells, determines its presence or absence in humans. PCR is recommended for examining children, since the child's body does not yet have time to develop 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 up to three years as well as 97% of adults. This is one of the varieties of herpesviruses (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, violates their functional properties, which causes immunodeficiency, causes the destruction of the cellular link of immunity.
Epithelial cells of the respiratory and digestive organs: manifested by a 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 for this. In addition, allergies are observed in almost every fourth carrier of chronic EBV infection.

The virus remains in the body for life, it causes chronic infection, which is exacerbated by the occurrence of favorable conditions for it.

What is PCR

Two varieties of EBV are known, but serologically they are no different. Infection is possible from the carrier at the end of the incubation period, the entire duration of the course of the disease, within six months from the date of recovery. Individual patients have the ability from time to time to isolate the virus, that is, to become its carriers even many months after infection.

PCR diagnostics involves the detection of virus DNA by using molecular biology methods. For research, special enzymes are used that repeatedly copy DNA and RNA fragments of cells. Then the obtained fragments are compared with the database, the presence of EBV and its concentration are detected.

The material for determining the DNA of the Epstein-Barr virus is saliva, mucus from the oral or nasal cavity, blood, samples cerebrospinal fluid, scrapings of cells of the urogenital canal, urine.

The expediency of choosing one or another material is determined by the doctor. Usually, blood is preferred for PCR, which is taken into a flask with an EDTA solution (6%).

At small child immunity is in the process of being established, therefore, the method for determining antibodies to them is not applied, PCR is used for children.

The result of PCR is often positive, therefore, it is necessary to differentiate a sick person and a virus carrier, for this an analysis with different 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% 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 virus reactivation.

Preparation for the delivery of the analysis

When testing for the Epstein-Barr virus, it is required to exclude all factors that can distort the PCR result:

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

Before analysis, young children are given boiled water (up to 200 ml for 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 decipher the analysis.

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

When will PCR be ready?

There are several methods of PCR diagnostics. But the real-time analysis has become the most reliable and widely used, in which there are almost never false negatives and a quick result is available.

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

PCR decoding for Epstein-Barr virus

The very first reasons for prescribing PCR are an excess of leukocytes, platelets and a decrease in the rate of erythrocytes and blood hemoglobin. If such indicators are detected, the patient is assigned additional diagnostics— PCR.

The test result is either positive or negative. A positive PCR result indicates that the person who passed the test is a carrier of EBV, although its presence does not prove that 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, it can no longer be removed 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 required not only to identify the presence of the virus, but also to determine the stage and form of the disease, then an ELISA is prescribed, an analysis for, during which the following are examined:

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

The presence of both indicates 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 in the presence of only one DNA virus molecule. Due to the high accuracy, this type of survey is considered effective way identify herpesvirus and follow the course 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 should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease diagnostic studies should be prescribed only by the attending physician. For diagnosis and correct appointment treatment, please contact your doctor.

Epstein-Barr virus belongs to the family of herpesviruses, the subfamily of g-herpesviruses is the human herpesvirus type IV. A virus particle consists of a nucleoid, a capsid, and an envelope.
The nucleoid contains double-stranded DNA, it 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 embedded even before the assembly of the viral particle begins.
When infected, the virus penetrates the epithelium of the oropharynx and salivary glands of a person and causes an active infection with cell lysis and the release of viral particles, as a result of which the virus is found in saliva. In addition, it can penetrate B-lymphocytes and the epithelium of the nasopharynx and cause a latent infection. Epstein-Barr virus can be found in oral secrets healthy but latently infected people. The virus is tropic to B-lymphocytes, it does not affect T-lymphocytes. Having penetrated into 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 C3d complement fragment. The virus triggers both humoral and cellular responses. Among the resulting antibodies are specific to the antigens of the virus and non-specific, heterophilic. The latter appear as a result of polyclonal activation of B-lymphocytes (this may be the cause of interference in some serological studies in people with active Epstein-Barr virus infection). The main role in the elimination of this infection is played by cellular immunity. At acute infection the primary reproduction of the virus in B-lymphocytes is replaced by a pronounced proliferation of T-lymphocytes with a CD4/CD8 ratio of less than 1.

Acute Epstein-Barr virus infection 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 with this virus and infectious mononucleosis are not synonymous). An acute infection is characterized by fever, sore throat and an increase in the posterior cervical lymph nodes (less often - anterior cervical and ulnar, generalized enlargement of the lymph nodes occurs). In 50% of cases, an increase in the spleen is detected, in 10-30% of cases - an increase in the liver. Other manifestations of infection may include rash and periorbital edema. Occasionally, complications are observed, including neurological, changes in the blood system in the form of hemolytic or aplastic anemia, neutropenia, thrombocytopenia. After the disease, pharyngitis, swollen lymph nodes, fatigue and inability to concentrate sometimes persist for a long time.
The disease is not 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 the antigens of the virus) is already among adolescents in different countries ranges from 50 to 90%, among adults, serological signs of infection are found in almost 100% of cases. The virus is excreted with saliva, transmitted through kisses and other contact of the mucosa with saliva or objects contaminated with it. Transplacental transmission of the virus is rare. Immunity in infectious mononucleosis is persistent.
Although the carcinogenicity of the virus has not been conclusively 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 backdrop of violation cellular immunity(AIDS, immunosuppression during transplantation, etc.) Epstein-Barr virus can cause infectious mononucleosis with lethal outcome 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 in clinical analysis blood:

№ 5 Clinical blood test

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

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

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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 a definition total concentration blood leukocytes and percentage major 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-Barr virus. The Epstein-Barr virus belongs to the family of herpesviruses, the subfamily of g-herpesviruses is the human herpesvirus type IV. A virus particle consists of a nucleoid, a capsid, and an envelope. Antibodies of the IgM class to the capsid antigenic 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 (EBNA NA IgG, Epstein-Barr Virus Nuclear Antigen IgG, EBNA IgG)

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

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№ 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 chain...

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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 make a differential diagnosis. Antibodies to the antigens of the virus appear quite quickly, and the study in the acute period of the disease, even a single taking of serum for different types antibodies can give a reasonably accurate indication of whether a patient is immune or susceptible to Epstein-Barr virus infection, ongoing infection, or reactivation.
An 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 by PCR

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

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

Determination of Epstein-Barr virus DNA in blood by 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 detection (Epstein Barr virus, DNA) in effusion

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

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

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

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

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

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

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

Determination of Epstein-Barr virus DNA in oropharyngeal epithelial cell scrapings by 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. 351CB Infectious mononucleosis: Epstein-Barr virus (human herpes virus type 4)

Epstein-Barr virus, determination of DNA (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. 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 no. 6). VEB itself is called herpes under number 4. In the human body, it can be stored dormant for years, but with a decrease in immunity, it is activated, causes acute infectious mononucleosis and later - the formation of carcinomas (tumors). How else does the Epstein bar virus manifest itself, how is it transmitted from a sick person to a healthy one, and how to treat the Epstein Barr virus?

What is Epstein Barr virus?

The virus got its name in honor of researchers - professor and virologist Michael Epstein and his graduate student Yvona 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, tissue growth. This is how tumors (neoplasms) are formed. In medicine, this process is called polyferation - pathological growth.
It is 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 a secondary manifestation of infection, it often does not give in to the action of antibodies developed earlier, at the first meeting.

Manifestations of the virus: inflammation and tumors

Epstein-Barr disease is acute like flu, cold, inflammation. Prolonged low-level inflammation initiates chronic fatigue syndrome and tumor growth. At the same time, for different continents, there are specific features of the course of inflammation and localization of tumor processes.

In the Chinese population, the virus 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 characteristic - high fever (up to 40º for 2-3 or 4 weeks), enlargement of the liver and spleen.

Epstein Barr virus: how is it transmitted

Epstein bar virus is the least studied herpetic infection. However, it is known that the ways of its transmission are diverse and extensive:

airborne;
contact;
sexual;
placental.

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

After recovery(decrease in temperature and other symptoms of SARS) infection is transmitted by contact(with kisses, handshakes, shared utensils, during sex). EBV stays in the lymph for a long time and salivary glands. A person is able to 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, studies confirm 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 blood beta-lymphocytes.

If there is a virus in human blood ( virus carrier) it is able to be transmitted from mother to child through the placenta. In the same way, the virus is spread through blood transfusions.

What happens when you get infected

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

Note: the action of the virus in the body is twofold. Some of the infected cells die. The other part - starts to share. However, in acute and chronic stage(carriage) different processes predominate.

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

The initial penetration of the virus is often asymptomatic. Epstein-Barr virus infection in children appears visible symptoms only in 8-10% of cases. Less often - signs are formed common disease(5-15 days after infection). Availability acute reaction infection indicates low immunity, as well as the presence of various factors that reduce the protective reactions of the body.

Epstein Barr virus: symptoms, treatment

Acute infection with a virus or its activation with a decrease in immunity is difficult to distinguish from a cold, acute respiratory disease or SARS. Epstein Bar's symptoms are called infectious mononucleosis. It - general group symptoms that accompany a variety of infections. By their presence, it is impossible to diagnose the type of disease accurately, one can only suspect the presence of an infection.

In addition to the signs of the usual acute respiratory infections, symptoms of hepatitis, sore throats, and a rash may be observed. 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 virus 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 increase, 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 ARI - bad feeling, fever, runny nose, enlarged lymph nodes.
Hepatitis symptoms: enlarged liver and spleen, pain in the left hypochondrium (due to enlarged spleen), jaundice.
Symptoms of angina: 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 a chronic virus carrier:

chronic fatigue syndrome, anemia.
Frequent relapses 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), Sjögren'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 acquires an extensive character, is characterized by the complexity of diagnosis and treatment. Therefore, the Einstein virus often occurs under the guise of other infectious chronic diseases with undulating manifestations - periodic exacerbations and stages of remission.

Virus carrying: chronic infection

All types of herpesviruses settle in the human body for life. Infection is often asymptomatic. After the initial infection, the virus remains in the body until the end of life.(stored in beta lymphocytes). In this case, a person often does not know about the carriage.

The activity of the virus is controlled by antibodies produced by the immune system. Unable to multiply and express itself actively, the Epstein-Barr infection sleeps as long as the immune system functions normally.

EBV activation occurs with a significant weakening defensive reactions . The reasons for this weakening may be chronic poisoning (alcoholism, industrial emissions, agricultural herbicides), vaccinations, chemotherapy and radiation, tissue or organ transplants, other surgeries, prolonged stress. Once activated, the virus spreads from lymphocytes to mucosal surfaces. hollow organs(nasopharynx, vagina, ureteral canals), from where it gets to other people and causes infection.

Medical Fact: viruses herpetic type 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 under No. 6, which is manifested by prolonged acute respiratory infections). To distinguish the type of herpes, to name the exact virus-causative agent - is possible only after laboratory tests of blood, urine, saliva tests.

The Epstein Barr virus test includes several laboratory tests:

Blood tests 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 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 in chronic carriage. The type and amount of immunoglobulins makes it possible to judge the primacy of infection and its duration (a large titer of G bodies is diagnosed with a recent infection).
Examine saliva or other body fluid (mucus from the nasopharynx, discharge from the genitals). This survey is called PCR, it is aimed at detecting virus DNA in samples of liquid media. The PCR method is used to detect various types herpetic viruses. However, when diagnosing 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 infected). Because the PCR method does not give reliable results of the presence or absence of infection, it is used as a confirmation test. Epstein-Barr in saliva - says there is a virus. But it does not show when the infection occurred, and whether inflammatory process with the presence of a virus.

Epstein-Barr virus in children: symptoms, features

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

Epstein-Barr virus in children adolescence more likely to cause 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 features:

The incubation period of the disease is reduced - from 40-50 days they are reduced to 10-20 days after the virus has penetrated the mucous membranes of the mouth, nasopharynx.
Recovery time is determined by the state of immunity. The defensive reactions of a child often work better than an adult (they say addictions, sedentary image 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 the identification of all side effects. Currently, there are no antiviral drugs for EBV that are recommended for the treatment of children of any age. That's why pediatric treatment begins with general maintenance therapy, and only in cases of urgent need (threat to the life of the child) antiviral drugs are used. How to treat the Epstein bar virus in the stage of acute infection or when chronic carriage is detected?

AT acute manifestation Epstein-Barr virus in a child is treated symptomatically. That is, when symptoms of sore throat appear, they rinse and treat the throat, when symptoms of hepatitis appear, drugs are prescribed to maintain the liver. Mandatory vitamin and mineral support of the body, with a long protracted course - immunostimulating drugs. Vaccination after suffering mononucleosis is postponed for at least 6 months.

Chronic carriage is not subject to treatment if it is not accompanied by frequent manifestations of other infections, inflammations. With frequent colds Immunity boosters needed- tempering procedures, walks on fresh air, physical education, vitamin and mineral complexes.

Epstein-Barr virus: treatment with antiviral drugs

Specific treatment of 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 course of protective reactions. Thus, the Epstein-Barr virus treatment uses following groups drugs:

Immunostimulants and modulators based on interferon (a specific protein that is produced in the human body during the intervention of a virus). Interferon-alpha, IFN-alpha, reaferon.
Drugs with substances that inhibit the reproduction of viruses inside cells. These are valaciclovir (Valtrex drug), famciclovir (Famvir drug), ganciclovir (Cymeven drug), 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 valaciclovir against Epstein-Barr virus is under investigation 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.

When treating in hospitals, hormonal drugs are also prescribed:

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

When 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 supportive therapy. It is prescribed for any infections, diseases, diagnoses, including positive analysis 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 is wondering: Epstein-Barr virus - what is it - dangerous infection Or a quiet neighbor? Is it worth it to fight the virus or take care of maintaining immunity? And how to cure the Epstein-Barr virus? Medical responses are mixed. And until a sufficiently effective cure for the virus is invented, one must rely on the body's immune response.

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

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