Epstein barr virus infection in children. Analysis for the Epstein-Barr virus in children - diagnosis and treatment of the disease

Described by Michael Epstein and Yvonne Barr in 1964. Often the disease is latent. Characteristic symptoms viruses are very similar to the common flu, so the disease is quite difficult to diagnose.

EBV affects leukocytes, but does not kill them, it changes the structure. Penetrates into all organs. Can disrupt the activity of the central nervous system.

General information

The virus has just been discovered. A complete description does not exist. Physicians consider possible its presence in the body of 90% of the population. Children become infected between the ages of 2 and 5 years. The source of infection is a sick or cured person.

The effect of the virus on the child's body and classification

After the Epstein-Barr virus enters the body of a child, it takes root in B-lymphocytes. Its DNA is integrated into the DNA of cells. The death of the latter does not occur. Infected B-lymphocytes, when dividing, produce their own kind.

Conventionally, VEB can be classified:

• by type of infection: acquired (infection from outside) or congenital (infection of the fetus during pregnancy);
• asymptomatic or typical (, SARS, rhinitis, sinusitis) form;
• mild, moderate, severe degree of the disease;
• inactive or active form the course of the disease.

The virus remains in the body for life after recovery. When the immune system is weakened, it can provoke serious diseases.

What is dangerous for children

Primary infection proceeds imperceptibly. It is not always possible to make a diagnosis right away. In infectious mononucleosis caused by EBV, there are 2 ways:

• cure with lifelong presence of the virus in the body;
• the transition of the disease to a chronic form.

If a child has an immunodeficiency, EBV provokes the development of:

• nasopharyngeal cancer;
• hepatitis A;
• Hodgkin's disease;
• Alice in Wonderland syndrome;
• infectious mononucleosis;
• Burkitt's lymphoma.

Diseases caused by the virus are complicated by otitis media, liver failure, and rupture of the spleen.

Little has been written about this virus, and the unknown scares parents. For a child, it is not the presence of EBV in the body that is dangerous, but the consequences.

More than half of 5-year-olds show signs of the disease. Mothers are often unaware of the disease, it is asymptomatic.

Children's immunity is young. It is not always possible to quickly cope with the infection. The consequences cannot be foreseen. In some children, infection causes complications, in other cases it proceeds without consequences.

“Most adults have been infected with EBV during childhood. They are unaware of it and feel great. The panic around the bizarrely named virus is unfounded.”

Risk group and transmission routes

People are the first to be infected:

• with reduced immunity;
• children aged 0 to 1 year;
• kids from 3 to 6 years old attending Kindergarten;
• not observing the hygiene of communication.

The disease happens with pronounced symptoms or without them. But a person is at risk of infection in any case.

1. When kissing through saliva. The second name is kissing disease.
2. Through common toys, dishes (with saliva on objects).
3. Airborne (when coughing, sneezing).
4. During blood transfusion. Rare route of infection.
5. Organ transplantation (bone marrow).
6. Vertical. During pregnancy from mother to fetus. Dangerous early complications.

You can only become infected through close contact! The virus does not live outside the body.

Characteristic symptoms

The presence of a virus can be indicated by frequent:

• ARVI, acute respiratory infections;
• colds;
• sore throats;
• inflammation respiratory tract(rhinitis, sinusitis, tonsillitis).

Epstein-Barr virus symptoms in children:

• the child complains of fatigue after kindergarten or school;
• hard to wake up in the morning;
• malnourished and eats little.

With a combination of complaints, you should consult a doctor. The examination will confirm or refute the diagnosis.

The first time the virus does not appear. During the latent period (1-2 months), an infected person is dangerous to others.

In 25% of cases, the primary infection is asymptomatic. In the rest, it has the following features:

• ARVI disease (40% of cases);
• infectious mononucleosis (18% of cases).

Diseases are treated by traditional methods. Subsequently, the virus does not manifest itself.

Recovered children remain a source of infection up to 18 months!

Diagnostic methods

If you suspect EBV infection, you should visit your local pediatrician. The doctor will prescribe laboratory tests. Treatment based on results.

Rules for preparing and donating blood:

• the material is taken on an empty stomach;
• 72 hours to exclude fatty, sweet, alcohol;
• stop drinking tea, coffee, carbonated drinks within 24 hours;
• On the eve of dinner, replace it with a light meal.

Parents should teach their children simple preventive techniques:

• compliance with the daily routine;
• conducting healthy lifestyle life;
• alternation of mental and physical stress;
• ability to overcome stress;
• strengthening immunity (walking, physical education, diet);
• observance of personal hygiene and hygiene of communication;
• intimate life hygiene (for teenagers).

Compliance with such simple preventive measures will strengthen the child's immunity. After all, only strong immunity will not allow the virus to go into an acute form and keep it in a depressed state.

Epstein-Barr viral infection(EBVI) is one of the most common human diseases. According to WHO, about 55-60% of young children (up to 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. Incidence in different countries world ranges from 3-5 to 45 cases per 100 thousand population and is a fairly high rate. EBVI belongs to the group of uncontrolled infections, in which there is no specific prevention (vaccination), which certainly affects the incidence rate.

Epstein-Barr virus infection- acute or chronic infection human, caused by the Epstein-Barr virus from the family of herpetic viruses (Herpesviridae), which has a favorite feature of the defeat of the lymphoreticular and immune systems of the body.

The causative agent of EBVI

Epstein-Barr virus (EBV) is a DNA-containing virus from the Herpesviridae Family (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.

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

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

Significance, timing of their appearance at various forms EBVI is not the same and has its own specific meaning.

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

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

1) tropism for cells of the lymphoreticular system(defeat occurs lymph nodes any groups, enlargement of the liver and spleen);
2) affinity for cells immune system (the virus multiplies in B-lymphocytes, where it can persist for life, due to which their functional state is disturbed and immunodeficiency occurs); in addition to B-lymphocytes, EBVI also disrupts the cellular link of immunity (macrophages, NK - natural killers, neutrophils, and others), which leads to a decrease in the overall resistance of the body 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 a respiratory syndrome (cough, shortness of breath, "false croup"), diarrheal syndrome (loose stools).

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

Particular attention is drawn to such a property of the Epstein-Barr virus as " lifelong persistence in the body". Due to the infection of B-lymphocytes, these cells of the immune system acquire the ability for unlimited life activity (the 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 permanently in these cells.

Epstein-Barr virus strains 1 and 2 are currently known and do not differ serologically.

Causes of Epstein-Barr virus infection

Source of infection in EBVI- a patient with a clinically pronounced form and a virus carrier. The patient becomes infectious last days the incubation period, the initial period of the disease, 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 been ill retain the ability to periodically isolate the virus (that is, they remain carriers).

Mechanisms of EBVI infection:
- it is aerogenic (airborne transmission), in which saliva and mucus from the oropharynx are contagious, which is released when sneezing, coughing, talking, kissing;
- a contact mechanism (contact-household transmission), in which salivation of household items (dishes, toys, towels, etc.) takes place, however, due to the instability of the virus in the external environment, it is of unlikely importance;
- the transfusion mechanism of infection is allowed (during the transfusion of infected blood and its preparations);
- alimentary mechanism (water-food transmission route);
- currently proven transplacental mechanism of infection of the fetus with the possibility of developing congenital EBVI.

Susceptibility to EBVI: children infancy(up to 1 year old) rarely get Epstein-Barr virus 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 old.

Despite the variety of ways of infection, there is a good immune layer among the population (up to 50% of children and 85% of adults): many are infected from carriers without developing symptoms of the disease, but with the development of immunity. That is why it is believed that the disease is not contagious for the environment of a patient with EBVI, since many already have antibodies to the Epstein-Barr virus.

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

EBVI, and in particular its most frequent manifestation, mononucleosis, is characterized by spring-autumn seasonality.
Immunity after an infection is formed strong, lifelong. Get sick again acute form EBVI is not possible. Repeated cases of the disease are associated with the development of a relapse or chronic form of the disease and its exacerbation.

Epstein-Barr virus pathway in humans

Entry gate of infection- the mucous membrane of the oropharynx and nasopharynx, where the virus multiplies and the organization of nonspecific (primary) protection occurs. The outcomes of primary infection are influenced by: general immunity, concomitant diseases, the state of the entrance gate of infection (there are or are no chronic diseases oropharynx and nasopharynx), as well as the infectious dose and virulence of the pathogen.

Outcomes of primary infection can be:

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

Further, from the entrance gate of infection, the virus enters the bloodstream (viremia) - the patient may have a temperature and intoxication. At the site of the entrance gate, a “primary focus” is formed - catarrhal tonsillitis, difficulty in nasal breathing. Next, the virus enters various tissues and organs with a primary lesion of the liver, spleen, lymph nodes and others. It was during this period that “atypical tissue mononuclear cells” appeared 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), oncological diseases, with oncological diseases and congenital EBV infection - a fatal outcome is possible.

Symptoms of EBV infection

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

At present, the fact of a direct connection of the Epstein-Barr virus with the development of acute mononucleosis, chronic EBVI (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-Hodgkin's lymphomas), HIV-associated diseases ("hairy leukoplakia", brain lymphoma, common lymph node neoplasms).

More 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, an increase in groups of lymph nodes, liver, spleen, allergic rash, specific changes in the blood). For more details, see the article " Infectious mononucleosis".
Signs unfavorable in terms of the development of chronic EBV infection:

The protracted nature of the course of infection (prolonged subfebrile condition - 37-37.5 ° - up to 3-6 months, the preservation 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 onset of the primary attack of the disease;
- preservation of IgM antibodies (to EA, VCA antigens of EBV) for more than 3 months from the onset of the disease; lack of seroconversion (seroconversion is the disappearance of IgM antibodies and the formation IgG antibodies in different antigens of the Epstein-Barr virus);
- untimely started or completely absent specific treatment.

2. Chronic EBV infection formed not earlier than 6 months after the transferred acute infection, and in the absence of acute mononucleosis in history - 6 or more months after infection. Often, a 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 digestive system, respiratory tract, skin and mucous membranes).

Chronic active EBV infection characterized by long duration and frequent relapses. Patients are concerned about weakness, fatigue, excessive sweating, prolonged slight temperature up to 37.2-37.5°, skin rashes, sometimes articular 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 changes, tendency to depression, patients are inattentive, decreased intelligence. Often, patients complain of an increase in one or a group of lymph nodes, an increase in internal organs(spleen and liver).
Along with such complaints, when questioning the patient, the recent presence of frequent colds, fungal diseases, the addition of other herpetic diseases (for example, herpes simplex on the lips or genital herpes, etc.)
In confirmation of clinical data, there will also be laboratory signs (changes in blood, immune status, specific tests for antibodies).
With a pronounced decrease in immunity in 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 sprouts). Patients may experience fever (wave-like or intermittent, in which both sharp and gradual rises in temperature are possible with recovery to normal values), swollen lymph nodes, liver and spleen, abnormal 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 it is a fever of unknown origin lasting for months, years, accompanied by an increase in lymph nodes, sometimes joint manifestations, muscle pain; another option is secondary immunodeficiency with frequent viral, bacterial, fungal infections.

3. Congenital EBV infection occurs in the presence of an acute form of EBVI or chronic active EBV infection that occurred 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. Possible prematurity, premature birth. In the blood of a born baby, both maternal antibodies to the Epstein-Barr virus (IgG to EBNA, VCA, EA antigens) and a clear confirmation of intrauterine infection - the child's own antibodies (IgM to EA, IgM to VCA antigens of the virus) can circulate.

four. " chronic fatigue syndrome» characterized constant fatigue, which does not pass after a long and proper rest. Patients with chronic fatigue syndrome are characterized by muscle weakness, periods of apathy, depressive states, mood lability, irritability, sometimes outbursts of anger, aggression. Patients are lethargic, complain of memory impairment, decreased intelligence. Patients do not sleep well, and both the falling asleep phase is disturbed, and intermittent sleep is observed, insomnia and drowsiness during the day are possible. At the same time, vegetative 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 who are both in acute stressful situations and in chronic stress.

5. HIV-associated diseases
"Hairy leukoplakia" tongue and oral mucosa appears with severe
immunodeficiency associated more often with HIV infection. On the lateral surfaces of the tongue, as well as on the mucous membrane of the cheeks, gums, whitish folds appear, which gradually merge, forming white plaques with an inhomogeneous surface, as if covered with furrows, cracks and erosive surfaces form. Usually, pain not 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 temperature and symptoms of intoxication, as well as progressive weight loss in patients. The patient has an enlarged liver and spleen, lymph nodes, enlarged salivary glands. X-ray examination of bilateral lower lobe interstitial foci of inflammation of the lung tissue, the roots are expanded, non-structural.

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

Diagnosis of Epstein-Barr virus infection

1. Preliminary diagnosis always exhibited on the basis of clinical and epidemiological data. Suspicion of EBVI is confirmed by clinical laboratory tests, in particular general analysis blood, which can reveal indirect signs of viral activity: lymphomonocytosis (increase in lymphocytes, monocytes), less often 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 features, have some similarity with monocytes. These are single-nuclear cells, they are young cells that appear in the blood in order 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 there are more than 10% of atypical mononuclear cells in the blood, but their number can vary 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.

Appearance dates: 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.

The duration of their discovery: 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, atypical mononuclear cells continue to be detected in the blood for up to a month or more (in this case, it makes sense to actively prevent the process from becoming chronic).

Also, at the stage of preliminary diagnosis, biochemical research blood serum, in which there are signs of liver damage (a slight increase in bilirubin, an increase in the activity of enzymes - ALT, AST, GGTP, thymol test).

2. Final Diagnosis exhibited after specific laboratory tests.

1) Heterophilic test- detection of heterophile antibodies in the blood serum, are detected in the vast majority of patients with EBVI. Is additional method diagnostics. Heterophilic antibodies are produced in response to infection with EBV - these are autoantibodies that are synthesized by infected B-lymphocytes. These include antinuclear antibodies, rheumatic factors, cold agglutinins. They are antibodies. class IgM. They appear in the first 1-2 weeks from the moment of infection, and their gradual increase is characteristic during the first 3-4 weeks, then gradually decrease in the next 2 months and remain in the blood for the entire period of convalescence (3-6 months). If this test is negative in the presence of EBVI symptoms, it is recommended to repeat it after 2 weeks.
False-positive results for heterophile antibodies can give conditions such as hepatitis, leukemia, lymphoma, drug use. Also positive antibodies of this group can be with: systemic lupus erythematosus, cryoglobulinemia, syphilis.

2) Serological tests for antibodies to the Epstein-Barr virus by ELISA(linked immunosorbent assay).
IgM to VCA(to the capsid antigen) - are detected in the blood in the first days and weeks of the disease, are maximum by the 3rd-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 lingering course illness. They are found in 90-100% of patients with acute EBVI.
IgG to VCA(to the capsid antigen) - appear in the blood after 1-2 months from the onset of the disease, then gradually decreases and remains at the threshold (low level) for life. An increase in their titer is characteristic of an exacerbation of chronic EBVI.
IgM to EA(to an early antigen) - appears in the blood in the first week of the disease, persists for 2-3 months and disappears. It is found in 75-90% of patients. Preservation in 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 at chronic infection serves as an indicator of reactivation. Often they can be detected during primary infection in carriers of EBV.
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 repeatedly indicates the activation of a chronic infection.
IgG to NA-1 or EBNA(to nuclear or nuclear antigen) - are late, because 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 the 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 a pronounced immunodeficiency (AIDS stage with HIV infection, oncological processes, etc.), then these antibodies may not be present. Reactivation of chronic infection or relapse of acute EBVI is observed at high titers of IgG to the NA antigen.

Results interpretation schemes

Rules for the 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!
- to compare the results made in one laboratory.
- No general norms for antibody titers; the result is evaluated by the doctor in comparison with the reference values ​​​​of a particular laboratory, after which it is concluded how many times the desired antibody titer is increased compared to the reference value. The threshold level, as a rule, does not exceed 5-10 times increase. High titers are diagnosed at 15-30x magnification and above.

3) PCR diagnostics of EBV infection– qualitative detection of Epstein-Barr virus DNA PCR method.
The material for the study is saliva or oropharyngeal and nasopharyngeal mucus, scraping epithelial cells urogenital tract, blood, cerebrospinal fluid, prostate secretion, urine.
Both EBVI patients and carriers may have a positive PCR. Therefore, for their differentiation, PCR analysis is performed with a given sensitivity: up to 10 copies per sample for carriers, and 100 copies per sample for active infection. In young children (up to 1-3 years old), due to insufficiently formed immunity, diagnosis by antibodies is difficult, therefore, in this group of patients, it is PCR analysis that comes to the rescue.
Specificity this method 100%, which virtually eliminates false positive results. However, due to the fact that PCR analysis is informative only during the reproduction (replication) of the virus, 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 examination of blood.

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

An increase in its activity (an increase in the level of serum interferon, IgA, IgM, IgG, an increase in the CEC, an increase in CD16 + - natural killers, an increase in either CD4 + T-helpers, or CD8 + T-suppressors)
Immune dysfunction or insufficiency (decrease in IgG, increase in IgM, decrease in antibody avidity, decrease in CD25+ lymphocytes, decrease in CD16+, CD4+, CD8, decrease in phagocyte activity).

Treatment for EBV infection

1) Organizational and regime measures include hospitalization in the infectious diseases clinic of patients with acute EBVI, depending on the severity. Patients with reactivation of a chronic infection are more often treated on an outpatient basis. Diet therapy is reduced 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 old, valtrex from 2 years old, famvir from 12 years old, acyclovir from the first days of life in the absence of other means, but much less effective).
Interferon preparations (viferon from the first days of life, kipferon from the first days of life, reaferon EC-lipind older than 2 years, interferons for parenteral administration older than 2 years).
Interferon inductors (cycloferon over 4 years old, neovir from the first days of life, amixin from 7 years old, anaferon from 3 years old).

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

Immunocorrection (after an immunogram study) - immunomodulators (thymogen, polyoxidonium, derinat, licopid, ribomunil, immunorix, roncoleukin and others);
- Hepatoprotectors (karsil, hepabene, 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 EBVI

All dispensary observation carried out by an infectious disease specialist, in pediatric practice, in the absence of such, by an immunologist or pediatrician. After suffering infectious mononucleosis, observation is established for 6 months after the illness. Examinations are carried out monthly, if necessary, consultations of narrow specialists: hematologist, immunologist, oncologist, ENT doctor and others
Laboratory tests are carried out quarterly (1 time in 3 months), and if necessary more often, a general blood test is carried out monthly for the first 3 months. Laboratory tests include: complete blood count, antibody tests, PCR analysis of blood and oropharyngeal mucus, biochemical analysis blood, immunogram, ultrasound examination and others according to indications.

Prevention of Epstein-Barr virus infection

There is no specific prophylaxis (vaccination). Preventive measures are reduced to strengthening the immune system, hardening children, precautions when a patient appears in the environment, and observing the rules of personal hygiene.

Infectious disease specialist Bykova N.I.

The disease, commonly called "kissing", has nothing to do with sexually transmitted infections. The virus, which is carried by 90% of the inhabitants of the planet, is considered little studied. It is only now that the Epstein-Barr virus (EBV) has gained some "fame". Most adults are immune to EBV because they had the disease in childhood or adolescence. 9 out of 10 adults who have contact with a child are potentially able to infect him.

What is Epstein-Barr virus

EBV or EBV infection is type 4 herpes, belongs to the herpesvirus family, and causes infectious mononucleosis. The name was given in honor of the virologists who discovered it in 1964. It is important to know how the pathogen is transmitted in order to comply with safety measures. The route of infection is airborne, the source of infection is a person, the virus is transmitted through very close contact, more often with kisses. Epstein-Barr virus DNA laboratory research found in saliva.

Why is this pathogen dangerous? Penetrating into the lymphoid tissue, it affects the lymph nodes, tonsils, spleen and liver. The risk group for infection is children from one year old. In children under three years of age, the disease is often asymptomatic, and the diseases that the virus causes are activated at school and adolescence. There are very few cases of infection in people over 35 years of age. In 25% of carriers of the pathogen, infection particles are found in saliva all the time, all their lives.

EBV causes the following diseases:

• Infectious mononucleosis;
• lymphogranulomatosis;
• herpes;
• multiple sclerosis;
• tumors of the salivary glands and gastrointestinal tract;
• lymphomas;
• systemic hepatitis.

In rare cases, chronic mononucleosis is observed, a dangerous pathology with serious complications. Epstein-Barr virus and pregnancy is a separate issue. Viral infection in pregnant women is sometimes asymptomatic or may be mild, it is mistaken for the flu. If the woman's immunity is weakened, the whole picture of infectious mononucleosis is observed. EBV is transmitted to the fetus and affects the course of pregnancy. The child born may suffer from lesions nervous system, visual organs, have other deviations from the norm.

Symptoms

The main symptoms in EBV are associated with infectious mononucleosis, referred to as OVIE. Incubation period illness from 2 days to 2 months. At the onset of the disease, the patient complains of fatigue, malaise, sore throat. At this time, the temperature is normal, after a few days it rises sharply to 40 ° C. Symptoms appear:

• an increase in lymph nodes in the neck up to 0.5-2 cm in diameter;
• tonsils swell, purulent plaque forms on them;
• breathing through the nose is disturbed;
• the spleen (sometimes the liver) is enlarged.

In children

Epstein-Barr virus in a child is often accompanied by a rash that lasts up to 10 days and is aggravated by antibiotics. Rashes in infectious mononucleosis have a different appearance:

• spots;
• points;
• papules;
• roseola.

In adults

Recognizing the virus in an adult is not easy, the disease is atypical for adulthood, and such patients are rarely sent for analysis. Often in adults, the disease is latent, while the temperature is kept at 37.5 ° C, there is a general malaise, long-term exhaustion. EBV is closely associated with chronic fatigue syndrome and is one of the hallmarks of infection.

What does a blood test for a virus say?

EBV is detected in the body in several ways, doctors prescribe:

• a complete blood count that detects atypical mononuclear cells;
• biochemical analysis;
• serological studies.

Specific diagnostic methods are PCR and ELISA tests. PCR detects virus DNA in body fluids, ELISA detects antibodies to its antigens. An antigen is a substance that is foreign to the body, these include viruses. For each of these hostile molecules, our immune system produces an antibody that recognizes a specific antigen and destroys it.

Antibody detection

A positive test for antibodies to infectious mononucleosis antigens means that the body is fighting the infection. To EBV, antibodies of the IgG and IgM classes, immunoglobulin proteins are produced. The virus has 3 main types of antigens that are recognized by our immune system:

• VCA - capsid;
• EBNA - nuclear or nuclear;
• EA, early antigen.

to the capsid antigen

IgM antibodies to the viral capsid protein, VCA, appear first. Finding them speaks of early stage disease, these immunoglobulins are characteristic of an acute infection. IgM disappear within 4-6 weeks from the onset of the primary infection. If the disease is reactivated, the antibodies reappear. IgM are replaced by other antibodies to VCA, IgG, they persist for life.

to nuclear antigen

Antibodies to the nuclear antigen are not detected at the acute stage. If the analysis determined them, then the disease lasts at least 6-8 weeks. The EBNA antigen is produced when the genome of the virus is introduced into the nucleus of an organism's cell, hence its name. An antibody test allows not only to confirm the infection caused by the virus, but also to determine its stage.

How to Treat the Epstein-Barr Virus

specific medicines no treatment for this infection. In the presence of strong immunity, the disease passes naturally. Often, EBV is treated like the flu, symptomatically: antipyretic, antiviral. If the disease is acute, corticosteroids are prescribed to cure the patient. Children with VEB are prescribed:

• "Acyclovir";

• Candles "Viferon";

• "Arbidol", "Cycloferon" (adult patients also take them).

In the complex of therapeutic agents used human immunoglobulin. If the illness is mild form, you don't need to go to the hospital. During the period of temperature rise it is recommended:

• compliance with bed rest;
• warm drink rich in vitamins;
• gargling with antiseptics, instillation of the nose vasoconstrictor drugs;
• lowering the temperature with medicines;
• taking vitamins and antihistamines;
• a diet that excludes junk food.

Treatment of the Epstein-Barr virus in adults is the same as in children, the differences are only in the dosage of the drugs. Antibiotics are used if a secondary bacterial infection occurs or complications develop. Folk remedies against infections caused by EBV also have a positive effect. To get rid of the symptoms of the disease and weaken the virus help:

• decoctions medicinal herbs and roots: chamomile, coltsfoot, ginseng, mint;
• echinacea: 30 drops 3 times a day orally or apply compresses to abscesses;
• linseed oil(taken orally);
• inhalations with sage, eucalyptus.

The one who cures the virus folk remedies, must take into account that the body needs additional strengthening. If pharmacy vitamin complexes do not suit you, include freshly squeezed juices in your diet: vegetable, fruit. Enrich nutrition fatty acids, salmon and trout contain a lot of them. After an illness, it is important to eat a balanced diet, avoid mental stress and stress.

Video: Komarovsky on the symptoms and treatment of the Epstein-Barr virus

It is almost impossible to avoid contact with EBV carriers, and the prevention of the disease consists in strengthening the immune system. An adult has a 95% chance that he has already had infectious mononucleosis. Is it possible to get sick again, and how to protect the child from this infection to the maximum? The well-known pediatrician Yevgeny Komarovsky tells in detail about the infection, symptoms and treatment of the virus.

Attention! The information provided in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and make recommendations for treatment, based on individual features specific patient.

Given the high infection of the adult population with the Epstein-Barr virus (up to 90% of people), there is an unfairly frivolous attitude towards this pathogen. Recently, a number of studies have been carried out, as a result of which it was revealed that this virus is involved in the occurrence of not only infectious mononucleosis, but also belongs to the group of oncogenic viruses. It can cause some tumors of the nasopharynx, as well as high-grade lymphoma.

Epstein-Barr virus (EBV) refers to representatives of herpes viruses. In 1964, this pathogen was discovered by Canadian scientists, after whom it was named. In its structure, this virus contains a DNA molecule that has a spherical shape. Initially, this virus was found in lymphoma cells. Upon further study of this microorganism, it turned out that it can cause many diseases, the clinical picture of which has different “masks”.

Diseases that the Epstein-Barr virus can cause:

• The defeat of the respiratory tract ().
• Nasopharyngeal carcinoma (malignant disease of the nasopharynx).
• Burkitt's lymphoma.
• Chronic Fatigue Syndrome.

How does a viral infection spread?

EBV is transmitted in the following ways:

1. Airborne (is the most common).
2. Contact (the virus is transmitted with saliva, infection is possible when kissing, when transferring toys from children, using the same dishes, towels).
3. Sexual way (the pathogen is found on the mucous membrane of the genital organs).
4. Infection of the child during childbirth when passing through the birth canal.
5. Transmission of the virus with blood (during the transfusion of blood components).
6. The penetration of the virus through the placenta in utero.

EBV or human herpesvirus type 4

Important! Human susceptibility to EBV is extremely high. By the age of 40, almost all people become infected with this pathogen. But this does not mean that a person will develop a certain disease. The likelihood of a particular pathology caused by this virus largely depends on our immune system. But the degree of viral load during the spread of infection is also very important. This means that the transmission of viral particles from a person suffering from the disease in the acute stage is hundreds of times greater than from a virus carrier who does not have any symptoms.

It is also interesting that a person who has had an acute EBV infection continues to excrete the pathogen for 2-18 months even after complete clinical recovery and the absence of any symptoms of the disease.

Infectious mononucleosis

Infectious mononucleosis is an infectious disease characterized by the spread and multiplication of a virus in human lymphoid tissue.

This disease most often affects children in adolescence, but can also occur in adults. For this pathology, seasonality is very characteristic with a pronounced autumn and spring peak.

Symptoms of the disease:

Very rarely (in 0.1% of cases) patients have a rupture of the spleen as a result of a significant increase in this body. The spleen capsule cannot withstand the tension and ruptures. The clinical picture of intra-abdominal bleeding develops (a sharp drop in pressure, tachycardia, fainting, sharp pain in the abdomen, positive peritoneal phenomena, muscle tension abdominal wall on the left side in the hypochondrium). In such a situation, an emergency operation is needed to stop the bleeding.

In addition to the typical form of the disease with bright clinical picture infectious mononucleosis can occur atypically:

1. Erased form. It is characterized by the presence of symptoms, but mild. The patient practically does not complain. Also, the erased form can manifest itself as an acute respiratory disease.
2. Asymptomatic form proceeds without any signs of disease. The person in this case is only a carrier of the virus.
3. Visceral shape characterized by severe damage to internal organs (kidneys, adrenal glands, liver, heart, etc.)

Diagnosis of mononucleosis

For this disease characteristic:

With what diseases it is necessary to carry out differential diagnostics?

The clinical symptoms of some diseases (especially and) are very similar to infectious mononucleosis. In order to distinguish them and make the correct diagnosis, you need to know some of the features of these diseases.

Treatment of infectious mononucleosis

With a mild form of the disease, treatment is exclusively symptomatic, that is, it is aimed only at eliminating and alleviating the main symptoms of the disease. However, in severe form, the treatment regimen is different. Given the viral nature of the infection, the main treatment is aimed at reducing the activity of the virus.

Important! The introduction of the penicillin group of antibiotics in infectious mononucleosis is contraindicated due to the risk of developing an allergic reaction.

The key to success in the treatment of infections caused by the Epstein-Barr virus is the complex prescription of drugs that enhance the effect of each other.

Disease outcome and prognosis

In most cases, infectious mononucleosis proceeds without complications. After 4 weeks, as a rule, the symptoms of the disease disappear. But it is impossible to talk about a complete recovery, since the Epstein-Barr virus continues to be in the body in the lymphoid tissue. However, its reproduction (replication of the virus) stops. It is for this reason that antibodies remain in the body of those who have recovered from mononucleosis for life.

Rehabilitation after infectious mononucleosis

1 month after the disappearance of the symptoms of the disease, it is necessary to take a general blood test. After 6 months, you need to check the viral load in the body. For this, an ELISA is taken with the determination of antibody titers. While maintaining the activity of the virus in the body, it is necessary to take maintenance antiviral therapy in small doses. Patients with chronic EBV infection in remission need to take vitamin-mineral complexes to maintain immunity.

Video: Epstein-Barr virus in children, mononucleosis - Dr. Komarovsky

chronic fatigue syndrome

This disease began to be talked about more than 30 years ago, when the Epstein-Barr virus was found in most people suffering from similar symptoms.

Symptoms of the disease

Features of treatment

In addition to the appointment of antiviral therapy, in the treatment of chronic fatigue syndrome, it is important to use individual approach. Unfortunately, there is no strictly developed treatment regimen for this condition.

However, the following methods are effective:

• General strengthening therapy (immunomodulatory drugs, physiotherapeutic methods of treatment, vitamin therapy).
• In cases of depression on the background of this disease, it is necessary to consult a psychiatrist.

Disease prognosis

In most cases, patients report an improvement in their condition after 1-2 years of treatment. But, unfortunately, the full restoration of working capacity practically does not occur.

Cancers caused by EBV infection

Nasopharyngeal carcinoma

Nasopharyngeal carcinoma is a malignant disease of the nasopharynx.

It has been proven that the main trigger for the development of nasopharyngeal carcinoma is the long-term presence of EBV infection in the body.

Nasopharyngeal carcinoma

Symptoms of the disease:

1. Difficulty in nasal breathing.
2. One-sided hearing loss is possible (during the transition of a malignant oncological process to the Eustachian tube).
3. Patients often experience nosebleeds.
4. Bad breath and breath.
5. Pain in the nasopharynx.
6. Unhealed sores in the throat.
7. Pain when swallowing.

Treatment Methods

Nasopharyngeal carcinoma is an example of a long-term neglected chronic viral infection that caused an oncological process.

Among the methods of treatment, the fight against malignant formation comes to the fore:

1. Surgery. Quite good results were shown by the use of "Cyber-Knife" in the early stages of the disease.
2. Radiation and chemotherapy are complementary to the surgical method. The use of this type of treatment before and after surgery improves the prognosis for the patient.
3. Antiviral treatment is prescribed after surgery for a long time in order to minimize the activity of oncogenic viruses.

Burkitt's lymphoma

Burkitt's lymphoma is a malignant disease that affects the lymphoid tissue. In advanced stages, the oncological process can spread to other organs and tissues.

In 95% of cases, the Epstein-Barr virus is involved in the occurrence of this disease.

Symptoms of the disease:

1. Most often, the disease begins with the defeat of the lymph nodes of the nasopharynx and oropharynx, mandibular, behind the ear, supraclavicular lymph nodes. It is for this reason that the first symptoms are a violation of nasal breathing, pain when swallowing.
2. The disease progresses quite quickly, involving new groups of lymph nodes in the pathological process.
3. At advanced stages of the oncological process, the organs of the thoracic and abdominal cavity.

Treatment

Given the high malignancy of the disease, they are used simultaneously surgical method as well as radiation and chemotherapy. This disease has a high risk of recurrence. With the reappearance of symptoms of the disease in the patient's blood, a high titer of antibodies to the Epstein-Barr virus can be detected. It is for this reason that antiviral therapy is necessary.

The prognosis for the patient is unfavorable, given the high malignancy of Burkitt's lymphoma. In the early stage of the disease, with timely complex treatment, the prognosis improves.

Diagnosis of diseases, antibodies to the Epstein-Barr virus

Given the variety of diseases caused by this virus, diagnosis is often difficult.

If symptoms suspected of EBV infection appear, additional laboratory methods should be used to detect this pathogen.

The Epstein-Barr virus is recognized by our body due to the presence of the following foreign components (antigens) in its structure:

1. capsid.
2. Nuclear.
3. Early.
4. Membrane.

The immune system of the body responds to the presence of a virus in the body by producing specific proteins against this microorganism. These proteins are called antibodies, or immunoglobulins (Ig). When the virus first enters the body, class M immunoglobulins are formed within 3 months, and when the infection becomes chronic and the pathogen remains in the body tissues for a long time, class G immunoglobulins are synthesized.

In order to confirm the involvement of this virus in the disease, it is necessary to detect specific antibodies (immunoglobulins) in the blood using the ELISA method (enzymatic immunoassay):

• Antibodies to an early antigen indicate an early stage of the disease and a primary lesion (class M immunoglobulins - IgM)
• Antibodies to the capsid and nuclear antigen are an indicator of a long-standing infection and the chronic nature of the disease (class G immunoglobulins - IgG).

What to do if antibodies to EBV are detected during pregnancy?

Despite the fact that EBV is able to cross the placenta to the baby, the presence of positive antibodies is not always dangerous.

When should you not be concerned?

When is antiviral therapy needed during pregnancy?

• When a high titer of class G immunoglobulins is detected, even in the absence of symptoms of the disease, it indicates the presence of a chronically occurring EBV infection, which can be dangerous for the development of the child.
• Detection of class M antibodies (IgM) means an exacerbation of EBV infection.

The presence of IgM antibodies is dangerous for the baby, and also creates a risk for the course of this pregnancy. It has been proven that the presence of EBV infection in the body of a pregnant woman leads to gestosis, the threat of interruption, placental pathology, premature birth, impaired blood flow, and fetal hypoxia.

It is necessary to approach the appointment of antiviral treatment during pregnancy individually. It is also obligatory to consult an infectious disease specialist and an immunologist. The appointment of any drug must be justified and have an evidence base.

Such a wide distribution of the Epstein-Barr virus, as well as a significant variety of “masks” that this infection takes, contribute to increased attention to this microorganism. Unfortunately, at the moment, there is no single and clear treatment regimen for this infection. Moreover, the complete disposal of this virus is impossible, since it continues to be in the body in an inactive stage. However, despite all these difficulties, today there are drugs that successfully help fight the symptoms of this disease.

It is important to remember that antiviral treatment should not be neglected, since a neglected EBV infection can cause malignant oncological processes that are very difficult to treat.

Video: Epstein-Barr virus, what is dangerous, the program “Live great!”

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

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

What it is

EBV - Epstein Barr virus. One of the most widespread 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 herpes virus of the fourth type.

By medical statistics, traces of the 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 goes unnoticed, without symptoms.

A child can become infected in different ways. Most often, EBV is excreted with body fluids, usually with saliva. For this reason, infectious mononucleosis caused by the virus is called "kissing disease".

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

At risk are children under one year of age who actively learn the world around them through their mouths, trying to taste absolutely all the objects and things that come to their fingertips. 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 the children develop vivid symptoms that are characteristic of many viral infections.

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

Komarovsky on VEB

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

And now let's listen to Dr. Komarovsky about infectious monoculosis.

The symptoms that make it possible to suspect EBV in a child are rather vague:

• Irritability, tearfulness, increased moodiness and frequent causeless fatigue.
• Slight or more noticeable enlargement of the lymph nodes. Most often - submandibular and behind the ear. If the infection is severe - throughout the body.
• Lack of appetite, digestive problems.
• Rash.
• High temperature (up to 40.0).
• Sore throat (as in sore throat and pharyngitis).
• Strong sweating.
• Slight enlargement of the liver and spleen. In a child, this may be manifested by aching pains in the abdomen.
• jaundice skin. This symptom is extremely rare.

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

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

Komarovsky often compares VEB with chickenpox. Both diseases are more easily tolerated in early age The younger the person, the easier the disease and the fewer consequences. The older the primary infection occurs, the greater the chances of severe complications.

Treatment according to Komarovsky

Evgeny Olegovich warns that the treatment with antibiotics of the penicillin group of one of the diseases associated with EBV - infectious mononucleosis can cause serious complications. Usually such an appointment is erroneous when the doctor takes mononucleosis for the usual bacterial tonsillitis. In this case, exanthema may develop.

Ordinary children who do not suffer from HIV and other severe disorders of the immune system, according to Yevgeny Komarovsky, do not need any antiviral treatment for mononucleosis caused by EBV, and even more so, they do not need to be urgently given immunostimulants. A well-known pediatrician is sure 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. It includes antipyretics (if the temperature is above 38.5-39.0), remedies that reduce sore throats (lozenges, antiseptics, rinses), ointments, gels and external sprays with antiseptics for severe skin rashes.