Epstein Barra consequences. How dangerous is the Epstein-Barr virus and is it possible to cure the infection?

Many people on the planet have Epstein Barr virus. Symptoms in adults are often confused with other diseases, leading to ineffective treatment.

Symptoms resembling ARVI are caused by the Epstein Barr virus. Symptoms in adults are determined by the strength of the body's immune defense, but treatment is symptomatic. This virus belongs to the herpes family, namely type 4. EBV has the ability to remain in the host’s body for quite a long time, in some cases throughout life.

While in the human body, the causative agent of the disease is capable of causing the development of lymphoproliferative and autoimmune pathologies. The most common manifestation is mononucleosis. In adult patients, transmission of the viral agent occurs during kissing through salivary fluid. A huge number of virions are found in its cells.

Incubation of the Epstein Barr viral agent lasts from 30 to 60 days. At the end of this period, a violent attack begins on the tissue structures of the epidermis and lymph nodes, then the virus migrates into the bloodstream and affects all organs and systems of the body.

Symptoms do not appear immediately; they gradually increase in a certain sequence. In the first phase, symptoms practically do not appear or are very mild, as in an acute respiratory viral infection.

After a chronic viral infection affects the human body, the following symptoms develop:

headache;
sweating increases;
spasmodic pain in the upper quadrant of the abdomen;
complete weakness of the body;
nausea, sometimes turning into vomiting;
problems with fixation of attention and partial memory loss;
increase in body temperature up to 39°C;
a pale papular-spotted rash is observed in 15% of infected people;
sleep problems;
depressive states.

A distinctive feature of the infectious process is enlargement of the lymph nodes and their redness, plaque forms on the tonsils, mild hyperemia of the tonsils develops, a cough is added, a pain in the throat when swallowing and at rest, breathing through the nose becomes difficult.

The infection has phases of increasing and subsiding symptoms. Most victims confuse important signs of pathology with indolent flu.

EBV is often transmitted together with other infectious agents: fungi (thrush) and pathogenic bacteria that cause gastrointestinal diseases.

Potential danger of Epstein-Barr virus

Epstein Barr virus in adults can cause the following complications:

inflammation of the meninges and/or brain;
polyradiculoneuritis;
disturbances in the normal functioning of the glomeruli of the kidneys;
inflammation of the heart muscle;
severe forms of hepatitis.

It is the development of one or several complications at once that can cause death. Epstein Barr virus can lead to various pathologies in the body.

Infectious mononucleosis

This pathology develops in 3 out of 4 patients infected with the Epstein Barr virus. The victim feels weak, the body temperature rises and can last up to 60 days. The process of damage involves the lymph nodes, pharynx, spleen, and liver. Small rashes may appear on the skin. If mononucleosis is not treated, the symptoms will disappear after 1.5 months. This pathology is not characterized by repeated manifestations, but the risk of deterioration cannot be excluded: autoimmune hemolytic anemia, damage to the central nervous system and cranial nerves.

Chronic fatigue and its manifestations

The main symptom of chronic fatigue syndrome is unreasonable anger. Afterwards, depressive disorders, pain in muscles and joints, and problems with fixation of attention are added. This is due to the Epstein Barr virus.

Lymphogranulomatosis

First of all, the lymph nodes in the cervical and subclavian region enlarge; there is no pain on palpation. When tissue becomes malignant, the process may spread to other organs and systems.

African malignant lymphoma

Lymphoid lesion is a malignant neoplasm involving the lymph nodes, ovaries, adrenal glands and kidneys in the pathological process. The disease develops very quickly, and without appropriate treatment leads to an unfavorable outcome.

Cancer of the nasopharynx

Belongs to a class of tumor formations that is localized on the lateral wall of the nose and grows into the back of the nasal cavity with the destruction of lymph nodes by metastases. With further development of the disease, purulent and mucous discharge from the nose occurs, nasal breathing becomes difficult, buzzing in the ears and weakening of hearing acuity.

If the virus affects a person’s immune system, the central nervous system, liver, and spleen begin to suffer. The victim develops jaundice, mental disorders and paroxysmal pain in the stomach.

One of the most dangerous complications is splenic rupture, which is characterized by severe pain in the left abdomen. In such a situation, urgent hospitalization and specialist assistance are necessary, since the resulting bleeding may result in the death of the patient.

If you suspect the presence of the Epstein Barr virus in a person’s body, you should immediately seek specialized help and carry out a set of diagnostic measures. This allows for early stages and reduces the risk of complications.

Diagnosis of Epstein Barr virus

In order to detect the Epstein Barr virus, the doctor must examine the suspected patient and collect an anamnesis. To make an accurate diagnosis, the diagnostic scheme includes the following measures and procedures.

Biochemical diagnostics of blood.
Clinical blood diagnostics, which allows to identify leukocytosis, thrombocytopenia, neutropenia.
Establishing the titer of specific antibodies.
to determine antibodies to Epstein Barr virus antigens.
An immunological test to determine malfunctions of the immune system.
Culture method.

All of the above studies and manipulations will help determine the presence of a pathological process in both men and women as early as possible. This will help start timely therapy and prevent the development of unpleasant complications.

Therapeutic measures

Unfortunately, modern medicine does not offer specific

With strong immune protection, the disease can go away on its own, without the use of medication or procedures. The victim must be surrounded by absolute peace, and he must also maintain a drinking regime. With elevated body temperature and painful sensations, it is possible to use painkillers and antipyretics.

If the pathological process degenerates into a chronic or acute form, the patient is referred to an infectious disease specialist, and if it worsens in the form of tumors, they seek help from an oncologist.

The duration of treatment for the Epstein Barr virus depends on the degree of damage to the body and can range from 3 to 10 weeks.

After conducting immunological studies and identifying abnormalities in the functioning of the immune system, it is necessary to include the following groups of medications in the treatment regimen:

In order to increase the pharmacological activity of the above medications, the following positions can be used:

antiallergic drugs;
bacteria to restore intestinal microflora;
hepatoprotectors;
enterosorbents.

To determine the effectiveness of the prescribed therapy and the patient’s body’s response to the proposed therapy, it is necessary to take a clinical blood test every week and carry out a biochemical study of the blood composition every month.

In case of severe symptoms and complications, the patient should be treated in an inpatient setting at an infectious diseases hospital.

For the entire period of treatment for the Epstein Barr virus, you should strictly adhere to the doctor’s recommendations and the daily regimen he has drawn up, as well as follow a diet. In order to stimulate the body, the doctor recommends an individual set of gymnastic exercises.

If mononucleosis of infectious origin is detected, the patient is additionally prescribed antibacterial therapy (Azithromycin, Tetracycline) for a period of 8-10 days. During this time, the patient should be at constant rest and rest as much as possible to reduce the risk of splenic rupture. Lifting heavy objects is prohibited for 2-3 weeks, in some cases even 2 months.

To avoid re-infection with the Epstein Barr virus, you should go to a sanatorium for a while for wellness treatments.

In people who have encountered and recovered from the Epstein Barr virus, the IgG class is found in the body. They persist throughout life. The Epstein Barr virus is not as scary as it is described, the main thing is to seek treatment in time.

Diet for mononucleosis

Blood analysis

The most common diseases among children are viral. The reason is that the child’s immunity is not yet strong enough, immature, and it is not always easy for him to withstand numerous threats from the outside. But if a lot has been said and written about influenza and chickenpox, and even with measles everything is more or less clear to mothers, then there are viruses in this world, the very names of which fill parents with sacred horror.

One of these little-studied and very common is the Epstein-Barr virus. The famous pediatrician and TV presenter Evgeniy Komarovsky is often asked about him.

What it is

EBV - Epstein Barr virus. One of the most common viruses on the planet. It was first found in tumor samples and described in 1964 by English professor Michael Epstein and his assistant Yvonne Barr. This is the fourth type of herpes virus.

According to medical statistics, traces of past infection are found in the blood tests of half of children aged 5-6 years and in 97% of adults, and they themselves often do not even know about it, because in most people EBV proceeds unnoticed, without symptoms.

A child can become infected in different ways. Most often, EBV is released through biological fluids, usually through saliva. For this reason, infectious mononucleosis, caused by a virus, is called the “kissing disease.”

Infection can occur during transfusion of blood and its components, through things and toys shared with the patient, and the virus is transmitted from an infected mother through the placenta to the fetus during pregnancy. EBV is easily spread through the air and from donor to recipient during bone marrow transplantation.

At risk are children under one year of age who actively explore the world around them through their mouths, trying to taste absolutely every object and thing they can get their hands on. Another “problem” age is children from 3 to 6 years old who regularly attend kindergarten and have numerous contacts.

The incubation period is from 1 to 2 months, after which children develop vivid symptoms characteristic of many viral infections.

However, the virus itself with a complex name is not so scary as the fact that its consequences are completely unpredictable. It may go completely unnoticed in one child, while in another it can cause the development of serious conditions and even cancer.

Komarovsky about VEB

Evgeny Komarovsky urges parents not to create unnecessary hysteria around the Epstein-Barr virus. He believes that most children have already encountered this agent in early childhood, and their immunity has “remembered” it and is able to identify and resist it.

Now let's listen to Dr. Komarovsky about infectious monoculosis.

The symptoms that allow one to suspect EBV in a child are quite vague:

Irritability, tearfulness, increased moodiness and frequent causeless fatigue.
Mild or more noticeable enlargement of lymph nodes. Most often - submandibular and behind-the-ear. If the infection is severe, it spreads throughout the body.
Lack of appetite, digestive problems.
Rash.
High temperature (up to 40.0).
Sore throat (as with sore throat and pharyngitis).
Heavy sweating.
Slight increase in the size of the liver and spleen. In a child, this may manifest itself as aching pain in the abdomen.
Yellowness of the skin. This symptom is extremely rare.

Komarovsky emphasizes that it is impossible to make a diagnosis based on complaints and the presence of certain symptoms alone, since the child’s condition will resemble a sore throat, enterovirus, and lymphogranulomatosis.

To confirm or refute the Epstein-Barr virus, laboratory diagnostics of the patient’s blood samples is required, including biochemical analysis, serological testing, PCR, and it is also advisable to do an immunogram and conduct an ultrasound examination of the abdominal organs - the liver and spleen.

Komarovsky often compares EBV to chickenpox. Both diseases are more easily tolerated at an early age; the younger the person, the simpler the disease and the fewer consequences. The older the primary infection occurs, the greater the chances of severe complications.

Treatment according to Komarovsky

Evgeniy Olegovich warns that treatment with penicillin antibiotics for one of the diseases associated with EBV, infectious mononucleosis, can cause serious complications. Typically, such a prescription is erroneous when the doctor mistakes mononucleosis for an ordinary bacterial sore throat. In this case, exanthema may develop.

Ordinary children who do not suffer from HIV and other severe disorders of the immune system, according to Evgeniy Komarovsky, do not need any antiviral treatment for mononucleosis caused by EBV, and even more so they do not urgently need to be given immunostimulants. The famous pediatrician is confident that the child’s body is able to cope with this threat on its own.

If the course of the disease is severe, which, according to Komarovsky, is very rare, treatment in a hospital may be required. There, most likely, antiherpetic drugs will be used (quite justifiably).

In all other cases, symptomatic treatment is sufficient. This includes antipyretic drugs (if the temperature is above 38.5-39.0), drugs that reduce sore throats (lozenges, antiseptics, gargles), ointments, gels and external sprays with antiseptics for severe skin rashes.

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

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

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

Possible abnormalities in liver function tests in infectious mononucleosis:

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

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

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

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

Treatment of Epstein-Barr virus

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

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

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

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

semi-bed rest, limitation of physical activity,

you need to drink plenty of fluids,

meals should be frequent, balanced, in small portions,

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

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

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

Avoid products containing chemical preservatives, dyes, flavor enhancers,

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

For chronic fatigue syndrome will be useful:

normalization of work, sleep and rest patterns,

positive emotions, doing what you love,

complete nutrition,

multivitamin complex.

Drug treatment for Epstein-Barr virus

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

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

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

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

Principles of drug treatment of chronic fatigue syndrome

Antiviral drugs: Acyclovir, Gerpevir, Interferons,

vascular drugs: Actovegin, Cerebrolysin,

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

sedatives,

multivitamins.

Treatment of Epstein-Barr virus with folk remedies

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

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

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

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

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

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

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

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

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

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

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

FAQ

How does Epstein-Barr virus affect pregnancy?

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

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

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

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

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

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

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

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

premature pregnancy (miscarriages),

stillbirth,

intrauterine growth retardation (IUGR), fetal malnutrition,

prematurity,

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

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

Can Epstein-Barr virus be chronic?

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

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

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

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

What symptoms does the Epstein-Barr igg virus cause?

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

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

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

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

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

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

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

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

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

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

Before use, you should consult a specialist.

Epstein-Barr virus infection (EBVI) is one of the common human diseases. According to WHO, about 55-60% of young children (under 3 years old) are infected with the Epstein-Barr virus; the vast majority of the adult population of the planet (90-98%) have antibodies to EBV. The incidence in different countries of the world ranges from 3-5 to 45 cases per 100 thousand population and is a fairly high indicator. EBVI belongs to the group of uncontrollable infections for which there is no specific prevention (vaccination), which certainly affects the incidence rate.

Epstein-Barr viral infection– an acute or chronic infectious disease of humans caused by the Epstein-Barr virus from the family of herpetic viruses (Herpesviridae), which has a favorite feature of damaging the lymphoreticular and immune systems of the body.

Pathogen EBVI

Epstein-Barr virus (EBV) is a DNA virus from the Family Herpesviridae (gamma herpesviruses), is a type 4 herpesvirus. It was first identified from Burkett's lymphoma cells about 35-40 years ago.
The virus has a spherical shape with a diameter of up to 180 nm. The structure consists of 4 components: core, capsid, inner and outer shell. The core includes DNA, consisting of 2 strands, including up to 80 genes.

The viral particle on the surface also contains dozens of glycoproteins necessary for the formation of virus-neutralizing antibodies. The viral particle contains specific antigens (proteins necessary for diagnosis):

Capsid antigen (VCA);
- early antigen (EA);
- nuclear or nuclear antigen (NA or EBNA);
- membrane antigen (MA).

The significance and timing of their appearance in different forms of EBVI are not the same and have their own specific meaning.

The Epstein-Barr virus is relatively stable in the external environment and dies quickly when dried out, exposed to high temperatures, and exposed to common disinfectants. In biological tissues and fluids, the Epstein-Barr virus can feel beneficial when it enters the blood of a patient with EBVI, brain cells of a completely healthy person, cells during oncological processes (lymphoma, leukemia and others).

The virus has a certain tropism (tendency to infect favorite cells):

1) affinity for cells of the lymphoreticular system(damage to lymph nodes of any group occurs, enlargement of the liver and spleen);
2) affinity for cells of the immune system(the virus multiplies in B-lymphocytes, where it can persist for life, as a result of which their functional state is disrupted and immunodeficiency occurs); in addition to B-lymphocytes, EBVI also disrupts the cellular component of immunity (macrophages, NK - natural killer cells, neutrophils and others), which leads to a decrease in the body’s overall resistance to various viral and bacterial infections;
3) affinity for epithelial cells of the upper respiratory tract and digestive tract, due to which children may experience respiratory syndrome (cough, shortness of breath, “false croup”), diarrhea syndrome (loose stools).

Epstein-Barr virus has allergenic properties, which manifests itself in certain symptoms in patients: 20-25% of patients have an allergic rash, some patients may develop Quincke's edema.

Particular attention is paid to such a property of the Epstein-Barr virus as “ lifelong persistence in the body" Thanks to infection of B-lymphocytes, these cells of the immune system acquire the ability for unlimited life activity (so-called “cellular immortality”), as well as the constant synthesis of heterophilic antibodies (or autoantibodies, for example, antinuclear antibodies, rheumatoid factor, cold agglutinins). EBV lives in these cells permanently.

Currently, strains 1 and 2 of the Epstein-Barr virus are known, which do not differ serologically.

Causes of Epstein-Barr viral infection

Source of infection for EBVI– a patient with a clinically expressed form and a virus carrier. The patient becomes infectious in the last days of the incubation period, the initial period of the illness, the height of the disease, as well as the entire period of convalescence (up to 6 months after recovery), and up to 20% of those who have recovered retain the ability to periodically secrete the virus (that is, they remain carriers).

Mechanisms of EBVI infection:
– this is an aerogenic (airborne transmission route), in which saliva and mucus from the oropharynx, which is released when sneezing, coughing, talking, kissing, is contagious;
- contact mechanism (contact-household transmission route), in which salivation of household items (dishes, toys, towels, etc.) occurs, but due to the instability of the virus in the external environment, it is of unlikely significance;
- a transfusion mechanism of infection is allowed (during transfusion of infected blood and its preparations);
- nutritional mechanism (water-food transmission route);
- the transplacental mechanism of infection of the fetus with the possibility of developing congenital EBVI has now been proven.

Susceptibility to EBVI: Infants (up to 1 year) rarely suffer from Epstein-Barr viral infection due to the presence of passive maternal immunity (maternal antibodies), the most susceptible to infection and the development of a clinically pronounced form of EBVI are children from 2 to 10 years of age.

Despite the variety of routes of infection, there is a good immune layer among the population (up to 50% of children and 85% of adults): many become infected from carriers without developing symptoms of the disease, but with the development of immunity. This is why it is believed that the disease is less contagious to those around an EBVI patient, since many already have antibodies to the Epstein-Barr virus.

Rarely, in closed institutions (military units, dormitories), outbreaks of EBVI can still be observed, which are low-intensity in severity and also extended over time.

EBVI, and in particular its most common manifestation - mononucleosis - is characterized by spring-autumn seasonality.
Immunity after an infection is formed lasting and lifelong. It is impossible to get sick again from the acute form of EBVI. Repeated cases of the disease are associated with the development of a relapse or chronic form of the disease and its exacerbation.

The path of the Epstein-Barr virus in the human body

Entrance gates of infection– mucous membrane of the oropharynx and nasopharynx, where the virus multiplies and nonspecific (primary) defense is organized. The outcomes of primary infection are influenced by: general immunity, concomitant diseases, the state of the entrance gates of infection (the presence or absence of chronic diseases of the oropharynx and nasopharynx), as well as the infectious dose and virulence of the pathogen.

The outcomes of primary infection can be:

1) sanitation (destruction of the virus at the entrance gate);
2) subclinical (asymptomatic form);
3) clinically detectable (manifest) form;
4) primary latent form (in which virus reproduction and isolation are possible, but there are no clinical symptoms).

Next, from the entrance gate of the infection, the virus enters the blood (viremia) - the patient may have a fever and intoxication. At the site of the entrance gate, a “primary focus” is formed - catarrhal tonsillitis, difficulty in nasal breathing. Next, the virus is introduced into various tissues and organs with primary damage to the liver, spleen, lymph nodes and others. It is during this period that “atypical tissue mononuclear cells” appear in the blood against the background of a moderate increase in lymphocytes.

The outcomes of the disease can be: recovery, chronic EBV infection, asymptomatic carriage, autoimmune diseases (systemic lupus erythematosus, rheumatoid arthritis, Sjögren's syndrome and others), cancer; in case of cancer and congenital EBV infection, death is possible.

Symptoms of EBV infection

Depending on the climate, certain clinical forms of EBVI predominate. In countries with a temperate climate, which includes the Russian Federation, infectious mononucleosis is more common, and if there is no deficiency of immunity, a subclinical (asymptomatic) form of the disease may develop. Also, the Epstein-Barr virus can cause “chronic fatigue syndrome” and autoimmune diseases (rheumatic diseases, vasculitis, ulcerative colitis). In countries with tropical and subtropical climates, the development of malignant neoplasms (Burkitt's lymphosarcoma, nasopharyngeal carcinoma and others) is possible, often with metastases to various organs. In HIV-infected patients, EBVI is associated with hairy leukoplakia of the tongue, brain lymphoma, and other manifestations.

Currently, the direct connection of the Epstein-Barr virus with the development of acute mononucleosis, chronic EBV (or EBV infection), congenital EBV infection, “chronic fatigue syndrome”, lymphoid interstitial pneumonia, hepatitis, oncological lymphoproliferative diseases (Burkitt’s lymphoma, T-cell lymphoma, nasopharyngeal carcinoma or NFC, leiomyosarcoma, non-Hodgin lymphomas), HIV-associated diseases (hairy leukoplakia, brain lymphoma, common lymph node neoplasms).

More information about some manifestations of EBV infection:

1. Infectious mononucleosis, which manifests itself in the form of an acute form of the disease with cyclicity and specific symptoms (fever, catarrhal tonsillitis, difficulty in nasal breathing, enlargement of groups of lymph nodes, liver, spleen, allergic rash, specific changes in the blood). For more details, see the article “Infectious mononucleosis”.
Signs unfavorable for the development of chronic EBV infection:

Protracted nature of the infection (long-term low-grade fever - 37-37.5° - up to 3-6 months, persistence of enlarged lymph nodes for more than 1.5-3 months);
- the occurrence of relapses of the disease with the resumption of symptoms of the disease within 1.5-3-4 months after the initial attack of the disease;
- persistence of IgM antibodies (to EA, VCA EBV antigens) for more than 3 months from the onset of the disease; absence of seroconversion (seroconversion is the disappearance of IgM antibodies and the formation of IgG antibodies in different antigens of the Epstein-Barr virus);
- untimely initiation or complete absence of specific treatment.

2. Chronic EBV infection forms no earlier than 6 months after an acute infection, and in the absence of a history of acute mononucleosis - 6 or more months after infection. Often, the latent form of infection with a decrease in immunity turns into a chronic infection. Chronic EBV infection can occur in the form of: chronic active EBV infection, hemophagocytic syndrome associated with EBV, atypical forms of EBV (recurrent bacterial, fungal and other infections of the digestive system, respiratory tract, skin and mucous membranes).

Chronic active EBV infection characterized by a long course and frequent relapses. Patients are concerned about weakness, increased fatigue, excessive sweating, prolonged low temperature up to 37.2-37.5°, skin rashes, sometimes joint syndrome, pain in the muscles of the trunk and limbs, heaviness in the right hypochondrium, discomfort in the throat, slight cough and nasal congestion, some patients have neurological disorders - causeless headaches, memory impairment, sleep disturbances, frequent mood swings, a tendency to depression, patients are inattentive, decreased intelligence. Patients often complain of enlargement of one or a group of lymph nodes, and possibly enlargement of internal organs (spleen and liver).
Along with such complaints, when questioning the patient, it becomes clear that there have been frequent cold infections, fungal diseases, and the addition of other herpetic diseases (for example, herpes simplex on the lips or genital herpes, etc.).
To confirm the clinical data, there will also be laboratory signs (changes in blood, immune status, specific tests for antibodies).
With a pronounced decrease in immunity during chronic active EBV infection, the process generalizes and damage to internal organs is possible with the development of meningitis, encephalitis, polyradiculoneuritis, myocarditis, glomerulonephritis, pneumonia and others.

Hemophagocytic syndrome associated with EBV manifests itself in the form of anemia or pancytopenia (a decrease in the composition of almost all blood elements associated with inhibition of hematopoietic germs). Patients may experience fever (wavy or intermittent, in which both sudden and gradual rises in temperature are possible with restoration to normal values), enlargement of the lymph nodes, liver and spleen, impaired liver function, laboratory changes in the blood in the form of a decrease in both red blood cells and and leukocytes and other blood elements.

Erased (atypical) forms of EBVI: most often this is a fever of unknown origin that lasts for months, years, accompanied by enlarged lymph nodes, sometimes joint manifestations, muscle pain; Another option is secondary immunodeficiency with frequent viral, bacterial, and fungal infections.

3. Congenital EBV infection occurs in the presence of an acute form of EBV or chronic active EBV infection that occurs during the mother’s pregnancy. It is characterized by possible damage to the internal organs of the child in the form of interstitial pneumonia, encephalitis, myocarditis and others. Prematurity and premature birth are possible. Both maternal antibodies to the Epstein-Barr virus (IgG to EBNA, VCA, EA antigens) and clear confirmation of intrauterine infection - the child’s own antibodies (IgM to EA, IgM to VCA antigens of the virus) can circulate in the blood of a born baby.

4. " Chronic fatigue syndrome“characterized by constant fatigue that does not go away after a long and proper rest. Patients with chronic fatigue syndrome are characterized by muscle weakness, periods of apathy, depressive states, mood lability, irritability, and sometimes outbursts of anger and aggression. Patients are lethargic, complain of memory impairment, decreased intelligence. Patients sleep poorly, and both the phase of falling asleep is disrupted and intermittent sleep is observed, insomnia and drowsiness are possible during the day. At the same time, autonomic disorders are characteristic: trembling or tremor of the fingers, sweating, periodically low temperature, poor appetite, joint pain.
At risk are workaholics, people with increased physical and mental work, people in both acute stressful situations and chronic stress.

5. HIV-associated diseases
"Hairy leukoplakia" tongue and oral mucosa appears with severe
immunodeficiency, often associated with HIV infection. On the lateral surfaces of the tongue, as well as on the mucous membrane of the cheeks and gums, whitish folds appear, which gradually merge, forming white plaques with a heterogeneous surface, as if covered with grooves, cracks and erosive surfaces form. As a rule, there is no pain with this disease.

Lymphoid interstitial pneumonia is a polyetiological disease (there is a connection with pneumocystis, as well as with EBV) and is characterized by shortness of breath, unproductive cough
against the background of fever and symptoms of intoxication, as well as progressive weight loss of patients. The patient has an enlarged liver and spleen, lymph nodes, and enlarged salivary glands. X-ray examination showed bilateral lower lobe interstitial foci of inflammation of the lung tissue, the roots were expanded and non-structural.

6. Oncological lymphoproliferative diseases(Burkitt's lymphoma, nasopharyngeal carcinoma - NFC, T-cell lymphoma, non-Hodgin's lymphoma and others)

Diagnosis of Epstein-Barr viral infection

1. Preliminary diagnosis is always set on the basis of clinical and epidemiological data. Suspicion of EBVI is confirmed by clinical laboratory tests, in particular a complete blood count, which can reveal indirect signs of viral activity: lymphomonocytosis (increase in lymphocytes, monocytes), less commonly, monocytosis with lymphopenia (increase in monocytes with a decrease in lymphocytes), thrombocytosis (increase in platelets), anemia (decrease in red blood cells and hemoglobin), the appearance of atypical mononuclear cells in the blood.

Atypical mononuclear cells (or virocytes)- these are modified lymphocytes, which, according to morphological characteristics, have some similarities with monocytes. These are mononuclear cells, are young cells, appear in the blood to fight viruses. It is the latter property that explains their appearance in EBVI (especially in its acute form). The diagnosis of infectious mononucleosis is considered confirmed if the presence of atypical mononuclear cells in the blood is more than 10%, but their number can range from 10 to 50% or more.

For the qualitative and quantitative determination of atypical mononuclear cells, the leukocyte concentration method is used, which is a highly sensitive method.

Dates of appearance: Atypical mononuclear cells appear in the first days of the disease, at the height of the disease their number is maximum (40-50% or more), in some patients their appearance is recorded a week after the onset of the disease.

Duration of their detection: in most patients, atypical mononuclear cells continue to be detected within 2-3 weeks from the onset of the disease, in some patients they disappear by the beginning of the 2nd week of the disease. In 40% of patients, detection of atypical mononuclear cells in the blood continues for up to a month or more (in this case, it makes sense to carry out active prevention of chronicity of the process).

Also, at the preliminary diagnosis stage, a biochemical study of blood serum is carried out, which shows signs of liver damage (slight increase in bilirubin, increased enzyme activity - ALT, AST, GGTP, thymol test).

2. Final diagnosis is determined after specific laboratory tests.

1) Heterophilic test– detection of heterophilic antibodies in blood serum, detected in the vast majority of patients with EBVI. It is an additional diagnostic method. Heterophilic antibodies produced in response to EBV infection are autoantibodies that are synthesized by infected B lymphocytes. These include antinuclear antibodies, rheumatic factor, cold agglutinins. They belong to the IgM class of antibodies. They appear in the first 1-2 weeks from the moment of infection, and they are characterized by a gradual increase during the first 3-4 weeks, then a gradual decrease in the next 2 months and persistence in the blood throughout the entire period of convalescence (3-6 months). If this test is negative in the presence of symptoms of EBVI, it is recommended to repeat it after 2 weeks.
Conditions such as hepatitis, leukemia, lymphoma, and drug use can give a false positive result for heterophilic antibodies. Antibodies of this group can also be positive for: systemic lupus erythematosus, cryoglobulinemia, syphilis.

2) Serological tests for antibodies to the Epstein-Barr virus using ELISA(linked immunosorbent assay).
IgM to VCA(to the capsid antigen) - detected in the blood in the first days and weeks of the disease, maximum by the 3-4th week of the disease, can circulate for up to 3 months, and then their number decreases to an undetectable value and disappears completely. Their persistence for more than 3 months indicates a protracted course of the disease. Found in 90-100% of patients with acute EBVI.
IgG to VCA(to the capsid antigen) - appear in the blood 1-2 months after the onset of the disease, then gradually decrease and remain at a threshold (low level) for life. An increase in their titer is characteristic of exacerbation of chronic EBVI.
IgM to EA(to early antigen) - appears in the blood in the first week of the disease, persists for 2-3 months and disappears. Found in 75-90% of patients. Maintaining high titers for a long time (more than 3-4 months) is alarming in terms of the formation of a chronic form of EBVI. Their appearance during chronic infection serves as an indicator of reactivation. They can often be detected during primary infection in EBV carriers.
IgG to EA(to the early antigen) - appear by the 3-4th week of the disease, become maximum at 4-6 weeks of the disease, disappear after 3-6 months. The appearance of high titers again indicates activation of a chronic infection.
IgG to NA-1 or EBNA(to nuclear or nuclear antigen) - are late, since they appear in the blood 1-3 months after the onset of the disease. For a long time (up to 12 months) the titer is quite high, and then the titer decreases and remains at a threshold (low) level for life. In young children (up to 3-4 years old), these antibodies appear late - 4-6 months after infection. If a person has severe immunodeficiency (stage of AIDS due to HIV infection, oncological processes, etc.), then these antibodies may not be present. Reactivation of a chronic infection or relapse of acute EBVI is observed with high titers of IgG to the NA antigen.

Schemes for decoding results

Rules for qualitative diagnosis of EBV infection:

Dynamic laboratory testing: in most cases, a single antibody test is not enough to make a diagnosis. Repeated studies are required after 2 weeks, 4 weeks, 1.5 months, 3 and 6 months. The dynamic research algorithm and its necessity are determined only by the attending doctor!
- compare results made in one laboratory.
- there are no general standards for antibody titers; The result is assessed by the doctor in comparison with the reference values of a specific laboratory, after which a conclusion is made how many times the required antibody titer is increased compared to the reference value. The threshold level, as a rule, does not exceed a 5-10-fold increase. High titers are diagnosed at 15-30x magnification and higher.

3) PCR diagnostics of EBV infection– qualitative detection of Epstein-Barr virus DNA using PCR.
The material for research is saliva or oral and nasopharyngeal mucus, scrapings of epithelial cells of the urogenital tract, blood, cerebrospinal fluid, prostate secretion, and urine.
Both patients with EBVI and carriers can have a positive PCR. Therefore, to differentiate them, PCR analysis is carried out with a given sensitivity: for carriers up to 10 copies in the sample, and for active infection - 100 copies in the sample. In young children (up to 1-3 years old), due to insufficiently developed immunity, diagnosis by antibodies is difficult, so in this group of patients PCR analysis comes to the rescue.
The specificity of this method is 100%, which virtually eliminates false positive results. However, due to the fact that PCR analysis is informative only when the virus multiplies (replicates), there is a certain percentage of false negative results (up to 30%) associated precisely with the lack of replication at the time of the study.

4) Immunogram or immunological blood test.

With EBVI, there are two types of changes in immune status:

Increasing its activity (increasing the level of serum interferon, IgA, IgM, IgG, increasing CEC, increasing CD16+ - natural killer cells, increasing either T-helper CD4+ or T-suppressor CD8+)
Immune dysfunction or deficiency (decreased IgG, increased IgM, decreased antibody avidity, decreased CD25+ lymphocytes, decreased CD16+, CD4+, CD8, decreased phagocyte activity).

Treatment of EBV infection

1) Organizational and routine measures include hospitalization in an infectious diseases clinic for patients with an acute form of EBVI, depending on the severity. Patients with reactivation of a chronic infection are often treated on an outpatient basis. Diet therapy comes down to a complete diet with mechanical, chemical sparing of the digestive tract.

2) Drug specific therapy for EBVI.
Antiviral drugs (isoprinosine from the first days of life, Arbidol from 2 years, Valtrex from 2 years, Famvir from 12 years, acyclovir from the first days of life in the absence of other drugs, but much less effective).
Interferon preparations (viferon from the first days of life, kipferon from the first days of life, reaferon EC-lipind over 2 years, interferons for parenteral administration over 2 years).
Interferon inducers (cycloferon over 4 years, neovir from the first days of life, amiksin from 7 years, anaferon from 3 years).

Rules for specific therapy for EBVI:
1) All medications, doses, courses are prescribed exclusively by the attending doctor.
2) After the main course of treatment, a long maintenance course is required.
3) Combinations of immunomodulators are prescribed with caution and only by a doctor.
3) Drugs to enhance the intensity of treatment.

Immunocorrection (after immunogram examination) – immunomodulators (thymogen, polyoxidonium, derinat, lycopid, ribomunil, immunorix, roncoleukin and others);
- Hepatoprotectors (karsil, gepabene, hepatofalk, essentiale, heptral, ursosan, ovesol and others);
- Enterosorbents (white coal, filtrum, lactofiltrum, enterosgel, smecta);
- Probiotics (Bifidum-Forte, Probifor, Biovestin, Bifiform and others);
- Antihistamines (Zyrtec, Claritin, Zodak, Erius and others);
- Other drugs according to indications.

Clinical examination of patients with acute and chronic forms of EBVI

All clinical observation is carried out by an infectious disease specialist, or in pediatric practice, in the absence of one, by an immunologist or pediatrician. After infectious mononucleosis, observation is established for 6 months after the illness. Examinations are carried out monthly, if necessary, consultations with narrow specialists: hematologist, immunologist, oncologist, ENT doctor and others
Laboratory tests are carried out quarterly (once every 3 months), and if necessary more often, a general blood test is carried out monthly for the first 3 months. Laboratory tests include: general blood test, antibody tests, PCR study of blood and oropharyngeal mucus, biochemical blood test, immunogram, ultrasound examination and others as indicated.

Prevention of Epstein-Barr viral infection

There is no specific prevention (vaccination). Preventive measures boil down to strengthening the immune system, hardening children, taking precautions when a sick person appears in the environment, and observing the rules of personal hygiene.

Infectious disease doctor N.I. Bykova

Epstein-Barr is very widespread in the human population. According to WHO, up to 90–95% of the population in various countries is infected with it. Once entering the human body, the virus remains in it for life, since it cannot be completely destroyed, like other representatives of the herpes family. Due to the lifelong persistence of the virus in the body, an infected person is a carrier and source of infection until death.

During primary infection, the Epstein-Barr virus penetrates the cells of the mucous membrane of the oropharynx, where it multiplies and enters the blood. After entering the bloodstream, the Epstein-Barr virus begins to attack cells of the immune system - B lymphocytes. It is B lymphocytes that are the main target of the Epstein-Barr virus.

After penetration into B-lymphocytes, the Epstein-Barr virus leads to transformation of the cell, which begins to multiply intensively and produce two types of antibodies. Transformed B lymphocytes produce antibodies to the virus and to themselves. Due to the intensive proliferation of transformed B-lymphocytes, their number increases, and the cells fill the lymph nodes and spleen, causing an increase in their size. These cells then die and the viruses are released into the blood. Antibodies to Epstein-Barr viruses form circulating immune complexes (CICs) with them, which are carried by the blood to all organs and tissues. CECs are very aggressive compounds, because once they enter any tissue or organ, they provoke the development of autoimmune inflammation. The consequence of this type of inflammation may be the development of systemic autoimmune diseases, such as:

Systemic lupus erythematosus;

Rheumatoid arthritis ;

Hashimoto's thyroiditis;

It is the development of autoimmune diseases that represents one of the dangers of the Epstein-Barr virus.

The transformed lymphocytes themselves are destroyed by other types of immunocompetent cells. However, since B lymphocytes themselves are cells of the immune system, their infection leads to immunodeficiency. This state of inadequate immunity can lead to malignant degeneration of lymphocytic tissue, resulting in the formation of lymphomas and other tumors. In general, the danger of the Epstein-Barr virus lies in the fact that it infects cells of the immune system, forming various conditions that can provoke the development of serious diseases. However, such severe diseases develop only if the cells that destroy infected B lymphocytes no longer cope with their task.

So, the Epstein-Barr virus is dangerous because it can provoke the development of the following pathologies:

Proliferative syndrome (Duncan's disease), in which a huge number of B-lymphocytes are formed, which can lead to rupture of the spleen, anemia, and the disappearance of neutrophils, eosinophils and basophils from the blood. Proliferative syndrome due to immunodeficiency usually leads to death. In other cases, it is possible to save people’s lives, but they subsequently develop anemia and lymphoma;