Epstein-barr virus diagnosis and treatment. Latent infection. Epstein-Barr virus. What to do if antibodies to EBV are detected during pregnancy

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

The acute form of EBV is called. The virus enters the human body through the nasopharynx. More often through the mouth - it is not for nothing that infectious mononucleosis has received the beautiful name "kissing disease". The virus multiplies in the cells of the lymphoid tissue (in particular, in B-lymphocytes).

A week after infection develops clinical picture resembling 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,
• appear in the blood test atypical mononuclear cells- 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 no mononucleosis, the effectiveness of existing antiviral drugs has not been proven, and antibiotics are needed only if a bacterial or fungal infection is attached.

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, a chronic Epstein-Barr virus infection may develop: erased, active, generalized or atypical.

1. Erased: the temperature often rises or stays for a long time within the range of 37-38 ° C, increased fatigue, drowsiness, muscle and joint pain, an increase in lymph nodes.
2. Atypical: often recur infections - intestinal, urinary tract, repeated acute respiratory infections. They are chronic and difficult to treat.
3. 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.
4. Generalized: damage to the nervous system (, encephalitis, radiculoneuritis), heart (), lungs (pneumonitis), liver (hepatitis).

At chronic infection can be detected as the virus itself in saliva PCR method, 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. On the mucosa of the external genitalia appear quite deep and painful erosions. In most cases, in addition to ulcers, there are also general symptoms typical of mononucleosis. 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 can spontaneously disappear, but can also lead to death, 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.

1. 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.
2. 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.
3. 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 to achieve stable remission in 70% of patients.
4. 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 immune system causes failures in the recognition of its own tissues, which leads to the development autoimmune diseases. EBV infection is among etiological factors SLE development, chronic glomerulonephritis, autoimmune hepatitis and Sjögren's syndrome.

chronic fatigue syndrome

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

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

The disease is named after the scientists who isolated the virus. Other recognized international name Epstein-Barr infections- Infectious mononucleosis.

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

Specific antigens are used to diagnose the Epstein-Barr virus by analyzing blood and saliva. You can read about the methods for recognizing the Epstein-Barr virus, tests for EBV infection, symptoms and its treatment in children and adults on the website.

There are 2 strains of the Epstein-Barr virus:

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

What tissues are affected by the virus

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

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

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

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

Methods of infection

Epstein-Barr virus refers to anthroponotic infections, transmitted through people. EBV is often found in the saliva of people with immunodeficiencies, such as those with HIV.

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

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

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

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

Mechanism of infection

Epstein-Barr virus infection enters the body through the nasopharyngeal mucosa, affects B-lymphocytes in the lymph nodes, causing the first clinical symptoms in adults and children.

After 5 - 43 days of the incubation period, infected B-lymphocytes enter the bloodstream, from where they spread throughout the body. The duration of the incubation period of the Epstein-Barr virus is on average 7 days.

In in vitro (in vitro) experiments, B-lymphocytes infected with EBV infection are characterized by "immortality". They acquire the ability to multiply by division indefinitely.

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

The immune system counteracts the spread of infected B-lymphocytes with the help of another group of lymphocytes - T-killers. These cells respond to the viral antigen that appears on the surface of the infected B-lymphocyte.

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

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

Symptoms

The outcome of EBV infection depends on the state of the human immune system. Symptoms of infection with the Epstein-Barr virus in adults may be manifested only by moderate activity of liver enzymes and do not require treatment.

Epstein-Barr virus infection can occur with erased symptoms, manifested by an increase in the cervical lymph nodes, as in the photo. But with a decrease in the immune reactivity of the body, especially with insufficient activity of T-lymphocytes, infectious mononucleosis may develop. varying degrees gravity.

Infectious mononucleosis

Infection with the Epstein-Barr virus occurs in a mild, moderate, severe form. At atypical form the disease can be asymptomatic in a latent (latent) form, recurring with a decrease in immune reactivity.

In children younger age the disease proceeds, as it begins acutely. Adults are characterized by a less acute onset when infected with the Epstein-Barr virus, the gradual development of symptoms.

The following forms of the virus are distinguished by the nature of the course:

• sharp;
• protracted;
• chronic.

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

Purulent may develop follicular tonsillitis with a dense coating on the tonsils. See what a sore throat looks like in the photo in the article What does a sore throat look like in adults and children.

Nasal congestion and eyelid edema are characteristic of EBV.

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

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

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

A high temperature can last for more than a month, but more often lasts from 2 days to 3 weeks. After recovery may long time(up to six months) subfebrile temperature persists.

Characteristic features

Typical manifestations of infection are:

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

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

• reach the size of a pea or walnut;
• freely displaced under the skin, not soldered to it;
• dense to the touch;
• do not suppurate;
• do not get drunk among themselves;
• slightly painful, surrounding tissues may be edematous.

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

Typically for infection, the appearance of pain occurs due to enlarged tonsils, which are hyperemic, covered with a white coating.

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

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

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

Chronic form of infectious mononucleosis

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

The patient constantly experiences:

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

Signs of Burkitt's lymphoma

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

To establish the diagnosis, a biopsy of the affected tissues is performed. In the treatment of Burkitt's lymphoma use:

• chemotherapy;
• antiviral drugs;
• immunomodulators.

Nasopharyngeal carcinoma

Nasopharyngeal carcinoma is more common in men aged 30-50 years, the disease is common in China. The disease is manifested by a sore throat, a change in the timbre of the voice.

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

Treatment

Treatment is aimed at increasing immune reactivity, for which Isoprinosine, Viferon, alpha-interferon are used. Against the virus, drugs are used that stimulate the production of interferon in the body:

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

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

To increase immunity appoint:

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

In addition to specific antiviral and immunomodulatory treatment, Epstein-Barr virus uses:

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

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

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

Clinical forms of the Epstein-Barr virus

After recovery, patients are on dispensary records for six months. Once every 3 months, donate blood and oropharyngeal mucus to the EBV.

The disease rarely causes complications. But at severe forms EBV infection goes into a persistent state, and can manifest itself:

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

Forecast

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

The danger is virus. At adverse conditions, which, among other things, may be associated with a decrease in immunity, they can cause relapses of chronic infectious mononucleosis, manifest themselves in various malignant forms Epstein-Barr infections.

Epstein-Barr virus belongs to the herpesvirus family (herpes type 4) and is the most common and highly contagious viral infection.

According to statistics, up to 60% of children and almost 100% of adults are infected with this virus. Epstein-Barr virus is transmitted by airborne droplets(with kisses), contact-household (common household items), less often through the blood (transmissible) and from mother to fetus (vertical path).

The source of infection is only a person, most often these are patients with latent and asymptomatic forms. Epstein-Barr virus enters the body through the upper Airways, from where it penetrates into the lymphoid tissue, causing lesions lymph nodes, tonsils, liver and spleen.

What diseases does

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

• by the time of infection - congenital and acquired;
• according to the form of the disease - typical (infectious mononucleosis) and atypical: erased, asymptomatic, lesion internal organs;
• according to the severity of the flow - light, medium degree and heavy;
• according to the duration of the course - acute, protracted, chronic;
• according to the phase of activity - active and inactive;
• complications;
• mixed (mixed) infection - most often observed in combination with cytomegalovirus infection.

Diseases caused by the Epstein-Barr virus:

• Filatov's disease (infectious mononucleosis);
• Hodgkin's disease (lymphogranulomatosis);
• chronic fatigue syndrome;
• malignant formation of the nasopharynx;
• lymphomas, including Burkitt's lymphoma;
• general immune deficiency;
• systemic hepatitis;
• head injury and spinal cord(multiple sclerosis);
• tumors of the stomach and intestines, salivary glands;
• hairy leukoplakia oral cavity and others.

Epstein-Barr virus symptoms

Acute infection (AVIEB)

OVIE is infectious mononucleosis.

The incubation period ranges from 2 days to 2 months, with an average of 5-20 days.

The disease begins gradually prodromal period: the patient complains of malaise, fatigue, sore throat.

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

The main symptom of acute Epstein-Barr virus infection is polyadenopathy. The anterior and posterior cervical lymph nodes are mainly enlarged, as well as the occipital, submandibular, supraclavicular, subclavian, axillary, ulnar, femoral and inguinal lymph nodes. Their sizes reach 0.5-2 cm in diameter, they are test-like to the touch, moderately or slightly painful, not soldered to each other and the surrounding tissues. Skin over them do not change. The maximum severity of polyadenopathy is diagnosed on the 5-7th day of illness, and after 2 weeks the lymph nodes begin to decrease.

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

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

Liver enlargement (hepatomegaly) is less common. In some cases, there is mild jaundice, darkening of the urine.

At acute infection Epstein-Barr virus rarely affects the nervous system. Perhaps the development of serous meningitis, sometimes meningoencephalitis, encephalomyelitis, polyradiculoneuritis, but all processes end in complete regression of focal lesions.

There is also a rash, which can be different. These may be spots, papules, roseola, dots or hemorrhages. The exanthema lasts about 10 days.

Chronic Epstein-Barr virus infection

HIVEB is different long duration and periodic relapses of the disease.

Patients complain about general fatigue, weakness, excessive sweating. Pain in muscles and joints, exanthema, persistent cough in the form of groaning, impaired nasal breathing.

Headaches, discomfort in the right hypochondrium, mental disorders in the form of emotional lability and depression, weakening of memory and attention, decreased mental capacity and sleep disturbance.

There is a generalized lymphadenopathy, hypertrophy of the pharyngeal and palatine tonsils, enlarged liver and spleen. Often, bacteria and fungi (genital herpes and herpes of the lips, thrush, inflammatory processes digestive tract and respiratory system).

Diagnostics

The diagnosis of acute and chronic Epstein-Barr infection is made on the basis of complaints, clinical manifestations and laboratory data:

• < 20 Ед/мл - отрицательно;
• > 40 U / ml - positive;
• 20 - 40 U / ml - doubtful *.

• < 20 Ед/мл - отрицательно;
• > 20 U / ml - positive *.

according to independent laboratory Invitro

5. DNA diagnostics

Using the polymerase method chain reaction(PCR) determine the presence of Epstein-Barr virus DNA in various biological materials(saliva, cerebrospinal fluid, smears from the mucosa of the upper respiratory tract, biopsy specimens of internal organs).

6. Other examinations and consultations as indicated

ENT and immunologist consultation, radiography chest and paranasal sinuses nose, ultrasound of the abdominal cavity, assessment of the blood coagulation system, consultation of an oncologist and a hematologist.

Treatment for Epstein-Barr virus infection

There is no specific treatment for Epstein-Barr virus infection. Treatment is carried out by an infectious disease specialist (for acute and chronic infections) or an oncologist with the development of tumor-like neoplasms.

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

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

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

Immunoglobulins are also prescribed intravenously (intraglobin, pentaglobin), complex vitamins(sanasol, alphabet), antiallergic drugs (tavegil, fenkarol).

Correction of immunity is carried out by the appointment of immunomodulators (likopid, derinat), cytokines (leukinferon), biological stimulants (actovegin, solcoseryl).

Relief various symptoms diseases are carried out with antipyretics (paracetamol) with an increase in temperature, with coughing - antitussives (libexin, mukaltin), with difficulties with nasal breathing, nasal drops (nazivin, adrianol) and so on.

The duration of treatment depends on the severity of the course and the form (acute or chronic) of the disease and can range from 2-3 weeks to several months.

Complications and prognosis

Complications of acute and chronic Epstein-Barr virus infection:

• peritonsillitis;
• respiratory failure (swelling of the tonsils and soft tissues of the oropharynx);
• hepatitis;
• rupture of the spleen;
• thrombocytopenic purpura;
• liver failure;

The prognosis for acute Epstein-Barr virus infection is favorable. In other cases, the prognosis depends on the severity and duration of the disease, the presence of complications and the development of tumors.

It was discovered in the sixties of the last century by the scientist M.E. Epstein and his assistant I. Barr during microscopic studies malignant tumor cells, which later became known as Burkitt's lymphoma.

transmission path

Infected in childhood and adolescence. Although the features and its distribution have been studied for 40 years, they remain not fully elucidated. They are infected by an aerosol, transmissible way, and it can also be transmitted through contact with an infected person, through mother's milk and sexually (during oral sex).

Infection in childhood occurs through toys on which saliva remains in the carrier in a latent form. Among adults, the distribution is characteristic dangerous virus when kissing with saliva. This method considered to be very common and common.

Invading the salivary glands, thymus, cells of the mouth and nasopharynx, the Epstein-Barr virus begins to infect the human body. With a decrease in immunity, the latent can go into open form causing a number of dangerous diseases.

Pathogenesis

There are 4 stages in the pathogenesis:

At the first stage there is an introduction into the oral cavity and nasopharynx, it enters salivary ducts, into the nasopharynx, where it multiplies, infecting healthy cells.

At the second stage enters the lymph nodes through the lymphatic pathways, B-lymphocytes and dendritic cells are affected, causing their avalanche-like reproduction, which leads to swelling and enlargement of the lymph nodes.

Third stage- the central nervous system and lymphoid tissues are affected, along with them, and others important organs: heart, lungs, etc.

Fourth stage characterized by the development specific immunity against a virus that produces the following result:

• complete recovery;
• or the infection becomes chronic.

Two forms are known - typical and atypical. The typical has all the symptoms characteristic diseases, in atypical - only 2-3 symptoms (maybe even one). Atypical are identified on the basis of laboratory data.

According to the degree of severity, it occurs in mild, moderately severe and severe forms. In severe cases, the body temperature reaches its maximum, the febrile state lasts for a long time, the lymph nodes become greatly enlarged, as well as the spleen, and sometimes the liver.

Adenoiditis persists for a long time, the tonsils are very hyperemic, the tongue is lined, the level of leukocytes in the general blood test is higher than normal.

Diagnostics

Diagnosis is carried out on the basis of patient complaints, according to manifestations primary symptoms and laboratory blood test data.

Important in the diagnosis are:

1. Indicators of the general blood test. After the introduction of the virus B - lymphocytes become infected, and their active reproduction begins. The process leads to an increase in their concentration in the blood. Such cells have received the scientific name "atypical mononuclear cells".

In infected ESR indicators, the number of leukocytes and lymphocytes are higher than normal. Platelets also increase or vice versa can be reduced, the same with hemoglobin indicators (anemia of a hemolytic or autoimmune nature is observed). When viewed under a microscope, doctors identify them.

2. For exact definition virus infection, blood is taken for analysis to detect antibodies against antigens. When antigens enter the blood, they are recognized by the cells of the immune system.

3. In a biochemical analysis of blood taken from a vein on an empty stomach, a protein is detected in the acute phase, elevated rates bilirubin indicate liver disease.

ALT, AST, LDH are special proteins found in the cells of the body. When an organ is damaged, they enter the bloodstream, and their increase indicates a disease of the liver, pancreas, or heart.

4. A consultation of narrow specialists is held with the involvement of an immunologist and an ENT specialist, an oncologist and a hematologist. The final conclusions are made on the basis of clinical studies with a blood test for clotting, according to x-rays nasopharynx and chest, ultrasound of the abdominal cavity.

Initial virus symptoms Epstein Barr, indicating that the patient is infected

The incubation period of the acute form lasts about a week after the introduction. The patient begins to develop a picture similar to an acute respiratory illness.

These are the initial symptoms:

• temperature rises to critical indicators, the patient is shivering;
• sore throat, swollen tonsils can be seen plaque;
• on palpation, there is an increase in the lymph nodes under the jaw, on the neck, in the groin and armpits.

When analyzing blood, the appearance of atypical mononuclear cells is observed - young cells that are similar to lymphocytes and monocytes.

A person quickly gets tired, appetite and performance decrease. A papular rash can be seen on the body and hands. Activity is disrupted gastrointestinal tract. Patients can often find soreness in the muscles and joints. They often suffer from insomnia and chronic fatigue syndrome.

Related diseases

most dangerous disease, which can cause, is considered Filatov's disease, or it is also called infectious mononucleosis. The duration of the incubation period of this disease is usually about a week, but can last up to 2 months.

At the beginning, the patient begins to feel chills and malaise, articular and muscle pain, the throat swells up, the patient quickly gets tired, sleeps badly.

The body temperature gradually rises and reaches critical - up to 40 degrees, the patient has a fever. The main defining symptom of a viral infection is polyadenopathy, which appears 5-6 days after the onset and is characterized by an increase in all lymph nodes. They become slightly painful during palpation.

Nausea and pain in the abdomen leads to vomiting. The skin remains unchanged, but sometimes there are herpetic eruptions. The palatine tonsils become inflamed, with rear wall pharynx separates pus. nasal breathing becomes difficult, accompanied by a nasal voice.

Later, the spleen enlarges (the phenomenon of splenomegaly), which returns to normal after 2-3 weeks. Accompanied by the appearance of a rash on the body, papules and spots, roseola points, as well as hemorrhages.

Sometimes there is jaundice mild degree with dark urine.

A person who has had infectious mononucleosis will no longer get sick, but will remain a carrier for life. Epstein-barr virus is dangerous for its complications: meningoencephalitis, serous meningitis, and there may also be a threat of encephalomyelitis.

Those infected with the Epstein-Barr virus can get sick with other diseases:

• lymphogranulomatosis;
• systemic hepatitis;
• lymphoma, including Burkitt's lymphoma;
• malignant tumors of the nasopharynx;
• neoplasms in salivary glands, gastrointestinal system;
• herpetic lesions of the genitals and skin;
• hairy leukopenia; chronic fatigue syndrome;
• multiple sclerosis;
• proliferative syndrome, which develops in those who have acquired immunodeficiency or from birth.

With the development of infection, B-lymphocytes increase so much that the functioning of important internal organs is disrupted. Many children who have a congenital form of immunodeficiency die from this disease. Those that survive suffer from lymphoma, anemia, agranulocytosis, or hypergammaglobulinemia.

Treatment

Infection should be treated by a doctor who specializes in infectious diseases, and if a tumor is detected in the form of neoplasms, an oncologist. Patients with severe infectious mononucleosis are subject to immediate hospitalization with the appointment of an appropriate diet and bed rest.

Active treatment begins with the use of drugs to stimulate phagocytes and natural killers, creating an antiviral state of healthy cells.

The effectiveness of such appointments has been proven:

• interferon preparations - alpha: acyclovir and arbidol, viveron, valtrex and isoprinosine;
• intramuscular injection of roferon and reaferon-EC;
• intravenous administration of immunoglobulins, such as pentaglobin and intraglobin, which also give a good result;
• immunomodulatory drugs: Derinat, Likopid and Leukinferon;
• biological stimulants (solcoseryl and actovegin).

An auxiliary role in the treatment is played by the complex intake of vitamins and antiallergic drugs, such as tavegil and suprastin.

When identifying purulent tonsillitis prescribe a course of antibiotics for a week or 10 days (cefazolin or tetracycline).

With an increase in body temperature, antipyretic tablets of paracetamol are prescribed, and for coughing - tablets of mukaltin or libexin. With difficulty breathing through the nose, drops of naphthyzinum help.

Patients can be treated on an outpatient basis, prescribing interferon-alpha under systematic laboratory control. After three to four months, you need to donate blood for biochemical analysis for immunological examination and PCR - diagnostics.

The treatment may take two to three weeks or several months, depending on the severity and complications, as well as its types (acute or chronic).

If a disease is detected, a saliva examination of other family members should be carried out in order to avoid reinfection infection.

Why is Epstein Barr dangerous?

Represents serious danger with its complications. At the very beginning of the disease, in the very first weeks, it can lead to damage to the central nervous system. Often there are meningitis, psychosis and hemiplegia.

Sometimes the Epstein-Barr virus provokes an autoimmune hemolytic anemia. Appearing pain in the abdomen, radiating to left shoulder may indicate a ruptured spleen. With severe swelling of the palatine tonsils, obstruction of the upper respiratory tract is sometimes observed.

Epstein Barr virus during pregnancy can cause intrauterine infection of the fetus and lead to the pathology of its important organs and lymph nodes.

Preventive measures against Epstein-Barr virus

You should not be afraid of the virus, because it is impossible to avoid infection. Adults are already immune because they develop antibodies to the Epstein-Barr virus after past illness in childhood.

If the child has a good the immune system, it should not be too protected from infection. It has been noticed: the earlier children get sick with the Epstein-Barr virus, the more weak form there will be a course of the disease. Maybe they won't even feel it. And immunity will be developed for life in children who have been ill.

For those who have weak immunity are currently developing a special vaccine to protect the body from infection with this virus.

The most effective prevention is considered to be an increase in resistance caused by the Epstein Barr virus, strengthening the immune system.

Here are the mandatory preventive measures:

• Hardening from birth is recommended. Toddlers should be gradually accustomed to bathing in warm water with body temperature and walking on fresh air and also help in hardening application cold water for douches throughout life.
• Doing healthy lifestyle life, competently, scientifically you need to make the right diet balanced nutrition with the introduction fresh vegetables and fruits. Vitamins and trace elements contained in them, special multivitamins should support the body at a high level.
• Do not allow any somatic diseases causing weakening of the immune system.
• Psychological and physical stress also negatively affect the state of the body and reduce immunity.
• We must live with the motto “movement is life”, spend a lot of time outdoors in any weather, engage in feasible sports: skiing in winter and swimming in summer.

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Latent infections are one of the categories of diseases that are dangerous due to their unpredictability. From the moment of infection to the day when the pathogen manifests itself, it may take not even a few weeks, but several years. And what will be the course of the disease, it is difficult to guess. AT rare cases latent infection throughout life does not make itself felt at all, but it will be transmitted genetically to children. One of the causative agents of this group of diseases is the Epstein-Barr virus. What it is?

Epstein-Barr virus: general characteristics

In general medical classification this microorganism is listed as human herpesvirus type 4 - it belongs to the subfamily of gammaherpesviruses, which are specific for T- and B-lymphocytes. At rest, they reside in the lymphoid tissue and are dangerous because they can provoke the appearance of malignant cells, which then develops into a full-fledged tumor. According to medical statistics, the Epstein-Barr virus (classical abbreviation - EBV) is one of the main factors provoking cancer.

The best environment for the activity and reproduction of this microorganism are:

• Burkitt's lymphoma;
• leukemic cells;
• blood infected with mononucleosis (infectious etiology);
• brain cells.

This virus was discovered a little more than half a century ago by an English scientist named Epstein, after whom he was named. The second part of the name came from graduate student Yvonne Barr, so she doesn't lean. EBV is considered the most common of all human viruses, according to official figures, especially in the United States, where nearly 95% of adults have been infected at one time or another. Moreover, it is possible that in childhood.

How does infection occur?

The source of infection is a person who may not even know about the existence of such a disease: the absence of symptoms does not affect the activity and transmission of the pathogen. Predominantly, penetration occurs through the respiratory tract, often through kissing, since saliva is the main transmission medium. Infection during blood transfusion cannot be ruled out.

After a person is infected, he becomes dangerous to others only after 18 months. If there were no clinical manifestations of the disease, the release of the virus "into the air" will occur in periods.

Epstein-Barr virus symptoms in adults and children

This microorganism may not show its activity for a very long time. The impetus for his "awakening" and the appearance of symptoms of an acute form will be strong decline immunity, which can occur for any reason: from a cold that developed into SARS to pregnancy, chronic stress or long-term use antibiotics. Vivid symptoms Epstein-Barr virus appear only in the case of an acute form of the disease. Here stand out:

• An increase in the tonsils, as a result of which a person may initially think about a sore throat. The appearance of a white coating on their surface.
• Enlargement of lymph nodes, mainly in the neck, but a similar picture can also appear in inguinal zone and in the armpits.
• Rise in temperature to 38-39 degrees, febrile state. In rare cases, the thermometer can show 40 degrees.
• Pain in the abdomen, if the spleen is enlarged, or there is swelling of the lymph nodes in the abdominal cavity. Also possible pain in the chest.

If you observe all the symptoms at once, this is an occasion for an immediate visit to the doctor in order to diagnose with laboratory research blood, as well as examination of the spleen and liver: the organs most acutely responsive to the activity of this virus.

However, medical statistics make it clear that acute form occurs rarely, mostly in adults. Symptoms of the Epstein-Barr virus in children, even with the development of the disease, are often almost absent, and they tolerate the disease more easily. The chronic condition can be detected mainly by tests, and it is divided into 4 categories:

• Atypical form - characterized by frequent relapses various diseases caused by infection. Mostly suffering genitourinary system as well as the intestines. Flu and colds are not ruled out, which always end in complications.
• Generalized form - affects nervous system against which a person can be diagnosed with encephalitis, meningitis. In addition, it is possible to shift the emphasis to the lungs, heart, liver, i.e. the result of the activity of the virus is hepatitis, pneumonia, myocarditis.
• Erased form - is considered the most common, characterized by a breakdown, rare temperature jumps to subfebrile values ​​​​and without obvious prerequisites. May experience drowsiness, myalgia, swollen lymph nodes.
• The active form is similar to the atypical one due to frequent relapses infectious diseases, but it is almost always accompanied by bacterial or fungal disease. In addition, standard signs of herpes may appear (the so-called "cold" on the lips, in the nose, on the vaginal mucosa).

To a greater extent, physicians focus not on individual signs Epstein-Barr virus, but on the general symptoms of latent infections: weakness and drowsiness, changes in the size of the spleen, lymph nodes, and fever. If we talk about a blood test, then atypical mononuclear cells and an increase in the level of lymphocytes will be observed in it, and in a person who has already been ill once, immunoglobulins-G will remain.

Autoimmune diseases, ulcers in the genital area, oncology are not the only consequences that an active Epstein-Barr virus can give, so treatment should be taken care of as soon as possible. Paint therapeutic regimen should the doctor, focusing on the form of the disease, the affected organs, as well as general state health.

• If the disease is in mild form, can only be done symptomatic therapy, and also it will be necessary to take care of strengthening the immune system.
• The severe form may require the use of corticosteroid hormones, but only under medical supervision.
• Among antiviral drugs, valacyclovir and ganciclovir are especially effective, but even they are prescribed as part of complex therapy.