Epstein-Barr virus (Epstein Barr virus) is a very common disease, similar in origin to the well-known herpes virus. In the literature, this virus can be found under the abbreviated form - EBV or VEBI.

It is dangerous because it provokes many diseases of the human body, in particular, the digestive tract, central nervous system, as well as bacterial and fungal diseases, etc. Infection is fraught with serious complications for the whole organism.

Infection occurs through everyday contact, through saliva during kissing, and also through sexual contact.

Once in the body of a healthy person, the Epstein-Barr virus does not manifest itself immediately, but only after a month or two. During this time, it actively multiplies, and then "carries" the circulatory system throughout the body.

The highest concentration is in saliva: it is for this reason that there is a danger of becoming infected through a kiss, common dishes and through the use of other household items.

Symptoms

The external manifestation of infection is expressed:

• rise in temperature;
• the appearance of chills;
• general weakness;
• enlarged lymph nodes;
• headaches;
• fast fatigue;
• disruption of the gastrointestinal tract.

Sometimes the presence in the body is asymptomatic.

With a weakened immune system, EBV can go into one of the chronic forms:

• Erased form. Signs: increase and prolonged retention of body temperature in the range of 37-38 degrees, increased fatigue, muscle and joint pain, drowsiness, enlarged lymph nodes.
• active form. Signs: recurrence of symptoms of mononucleosis (tonsillitis, fever, inflammation of the lymph, etc.) with complications on the background of fungal and bacterial infections. Possible herpetic formations on the skin, damage to the gastrointestinal tract (diarrhea, nausea, abdominal pain).
• generalized form. Signs: damage to the central nervous system, heart, lungs, liver.
• atypical form. Signs: recurrence of intestinal infections, diseases of the genitourinary system, repeated infections with acute respiratory infections. Diseases, as a rule, are of a protracted nature and are difficult to treat.

Infectious mononucleosis, known as Filatov's disease, is the most common manifestation of Epstein-Barr. This is a condition of the body similar to the common cold, when the patient has complaints of sore throat and fever. A severe form of leakage seriously affects the respiratory tract (up to pneumonia) and other internal organs, in particular the liver and spleen. If you do not seek medical help in time, the infection can be fatal. Children and adolescents are most often affected.

Diagnostics

Differentiate mononucleosis from similar diseases and detect the presence of EBV in the body using one of the following methods:

• Serological diagnosis. Allows you to set the titer of IgM antibodies, for example, a titer of 1:40 is typical for the symptoms of mononucleosis.
• Determination of the titer of specific antibodies. It is most often used in the study of children in whose bodies there are no heterophile antibodies.
• Enzyme immunoassay (ELISA). Allows you to identify various compounds based on the antigen-antibody reaction.
• Polymerase chain reaction (PCR).
• cultural method. It is carried out by sowing virions on a nutrient surface for the purpose of subsequent analysis of drug resistance.

The last three techniques make it possible to detect DNA and even virus particles in blood or separately collected material.

It is important to know that when chronic form the PCR method can show the presence of antibodies to nuclear antigens (IgG-EBNA-1) in saliva. However, such a study is not enough to confirm the diagnosis, so immunologists conduct at least double testing of the entire spectrum of antibodies.

Treatment

To date, there are no treatment regimens for chronic Epstein-Barr virus. Severe forms are treated on an outpatient basis to protect a sick person from healthy people.

The first step is to take a course of antioxidants and detoxify the body. Then antiviral drugs and drugs to increase immunity are used. It is important to observe the rest mode, proper nutrition, refusal to use alcoholic beverages and smoking, etc.

It is recommended to undergo treatment in a hospital with regular clinical checks of blood counts (once a week or two). Biochemistry is carried out monthly (for certain indications - more often), and immunological examination - once every 30-60 days.

The generalized form is treated strictly in stationary conditions under the supervision of a neurologist.

Latent (erased) - can be treated on an outpatient basis.

Usually, home treatment is based on taking interferon-alpha, to which, if necessary, antiviral drugs, immunoglobulins and immunocorrectors are connected.

It is important to know that carriers or so-called owners of "asymptomatic latent infection" should undergo laboratory control once a quarter, in particular, take a clinical blood test, biochemistry, as well as undergo PCR and immunological examination.

It has been established that with a moderate form and in cases of latent infection, the effectiveness of therapy increases to 70-80%: it is possible not only to achieve a clinical effect, but also to suppress virus replication. In this case, the patient is recommended to conduct additional spa treatment.

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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, a malignant tumor caused by impaired 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. Another recognized international name for Epstein-Barr infection is 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 of the 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. The second peak of Epstein-Barr infection occurs at the age of 20-30 years.

There are especially many infected in developing countries, where by the age of 3 all children are infected. The disease lasts 2-4 weeks. Acute symptoms of Epstein-Barr virus infection 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 of varying severity may develop.

Infectious mononucleosis

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

In young children, 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 of the tonsils.

Purulent follicular tonsillitis with a dense coating on the tonsils may develop. 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, subfebrile temperature may persist for a long time (up to six months).

Characteristic features

Typical manifestations of infection are:

• enlarged lymph nodes - first, the tonsils of the pharyngeal ring, cervical lymph nodes increase, 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 is a 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 enlarges, and even in more 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 a fungal or bacterial infection joins the viral infection.

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

A malignant disease, Burkitt's lymphoma often develops in children from 3 to 7 years old, young men, is a tumor of the lymph nodes of the upper jaw, small intestine, and 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 of Epstein-Barr virus infection, treatment is prescribed, 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 in severe forms of EBV, the infection passes 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. Under unfavorable 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 of Epstein-Barr infection.

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Epstein-Barr virus treatment

Causes of the Epstein-Barr virus

Infection caused by (EBV infection) - a common herpesvirus disease, most often occurring in the form of infectious mononucleosis, but may be accompanied by other manifestations due to suppression of the immune system, is associated with a number of oncological (nasopharyngeal carcinoma), predominantly lymphoproliferative diseases (Burkitt's lymphoma), as well as with autoimmune disease.

Over the past 10 years, the infection of the population with EBV in the world has increased several times and ranges from 90 to 100%. EBV infection is the most common herpesvirus infection in Ukraine. Epidemiological studies have shown that before reaching adulthood, about 90% of people become infected with EBV.

EBV is a human B-lymphotropic virus with pronounced oncogenic properties and exhibits tropism for B- and T-lymphocytes. The virus contains specific antigens: capsid, nuclear, early, membrane. The time of appearance and the biological significance of these antigens are not the same. Knowledge of the timing of the appearance of various antigens and the detection of antibodies to them make it possible to diagnose one or another clinical variant of the course of EBV infection. The virus also shares antigens with other herpesviruses. It is sensitive to the action of diethyl ether.

The source of infection are patients, including those with an erased course. The virus is excreted with nasopharyngeal mucus, saliva. Isolation of EBV sometimes lasts 18 months from the onset of the disease. The mechanism of transmission of infection is airborne. Due to the absence of cough and runny nose, EBV is not released intensively, at a short distance from the patient, and therefore cause of EBV lies in long-term contact. Children often become infected with EBV through toys contaminated with the saliva of a sick child or virus carrier. In the spread of infection, the sharing of dishes and linen by sick and healthy people is important. Blood contact and sexual transmission of the infection are also possible. Cases of vertical transmission of EBV from mother to fetus have been described, suggesting that this virus may be the cause of intrauterine anomalies.

The first infection with the virus depends on social conditions. In developing countries or in socially unfavorable families, infection of children occurs mainly before 3 years of age. In developed countries, the maximum infection occurs at the age of 15-18 years. Most of the manifesting lesions in EBV infection are recorded in males. But the reactivation of the infection can occur at any age; it is promoted by factors of decrease in the general and local immunity.

Immunity in infectious mononucleosis is persistent, reinfection only leads to an increase in antibody titer. There are certain features of the answer human body for EBV infection. So, in East and Central Africa, the development of Burkitt's lymphoma predominates, in some regions of East Asia - nasopharyngeal carcinoma. While this is an inexplicable fact. Morphologically, in the acute period of the disease, a biopsy of the lymph nodes determines the proliferation of reticular and lymphoid tissue with the formation of large mononuclear cells, circulatory disorders. At the same time, Kupffer cell hyperplasia is detected, and in some cases, focal and widespread necrosis. The same histological changes are noted in the tonsils and paratonsillar tissue. In the spleen, follicular hyperplasia, edema and infiltration of its capsule by mononuclear cells are found. In severe forms of the disease, bile pigment is deposited in the hepatocytes of the central zones of the lobules.

In the International Classification of Diseases, in various sections, the following nosological forms that EBV infection entails are distinguished:

• gammaherpesvirus infectious mononucleosis,
• immunodeficiency due to a hereditary defective response to EBV,
• Burkitt's lymphoma
• malignant nasopharyngeal tumor.

In general, many syndromes and diseases are now associated with EBV. In particular, there is reason to believe that VEEB is associated with the development of Hodgkin's disease and some non-Hodgkin's lymphomas, chronic fatigue syndrome, Stevens-Johnson syndrome, multiple sclerosis, hairy leukoplakia of the tongue, and the like. To date, there is no generally accepted clinical classification of EBV infection.

There are primary (acute infectious process - infectious mononucleosis) and chronic EBV infection. The incubation period for infectious mononucleosis varies from 6 to 40 days. Sometimes the disease begins with a prodromal period lasting 2-3 days, during which moderate fatigue, insensible lethargy, and a slight decrease in appetite appear. In typical cases, the onset of the disease is acute, the body temperature rises to 38-39 ° C. Patients complain of moderate headache, nasal congestion, discomfort in the throat when swallowing, sweating.

With infectious mononucleosis, the level of intoxication is much less than does not happen with fever of another etiology. Already in the first 3-5 days, acute tonsillitis, enlarged lymph nodes, liver and spleen appear. Fever in infectious mononucleosis can be constant, remitting or irregular, sometimes undulating. The duration of the febrile period ranges from 4-5 days to 2-4 weeks or more.

Lymphadenopathy is the most stable manifestation of the disease. First of all, the cervical lymph nodes increase, especially those located along the posterior edge of the sternocleidomastoid muscle, at the angle of the lower jaw. The increase in these nodes is noticeable at a distance when turning the head to the side. Sometimes the lymph nodes look like a chain or a package and are often symmetrically located, their diameter can reach 1-3 cm. They are elastic, moderately sensitive to the touch, not soldered together, mobile, the skin above them is not changed. At the same time, axillary and inguinal lymph nodes can (not always) increase, less often - bronchopulmonary, mediastinal and mesenteric.

There is a certain difficulty in nasal breathing, the voice may change somewhat. Discharge from the nose in the acute period of the disease is almost absent, since infectious mononucleosis develops posterior rhinitis - the mucous membrane of the lower nasal concha, the entrance to the nasal part of the throat, is affected. Simultaneously with lymphadenopathy, symptoms of acute tonsillitis and pharyngitis appear. Changes on the tonsils can be catarrhal, follicular, lacunar, ulcerative-necrotic, sometimes with the formation of a pearly white or cream-colored plaque, and in some cases - soft fibrin films, which to a certain extent resemble diphtheria. Such raids can occasionally even spread beyond the tonsils, accompanied by an increase in fever or its increase after a previous decrease in body temperature. There are cases of infectious mononucleosis without signs of severe tonsillitis.

Enlargement of the liver and spleen is one of the constant symptoms of infectious mononucleosis. In most patients, an enlarged spleen is detected already from the first days of the disease, it is of a relatively soft consistency, reaches its maximum size on the 4-10th day of the disease. Normalization of its size occurs no earlier than the 2-3rd week of the disease, after normalization of the size of the liver. The liver also increases as much as possible on the 4-10th day of illness. In some cases, an increase in the liver may be accompanied by a slight violation of its function, moderate jaundice.

In 5-25% of patients with infectious mononucleosis, a rash develops, which can be spotted, maculopapular, urticaria (urticaria), hemorrhagic. The timing of the appearance of the rash is different, it lasts for 1-3 days and disappears without a trace. Often occurs in the case of the appointment of aminopenicillins (ampicillin, amoxicillin) and is an immunoallergic reaction.

The atypical course of infectious mononucleosis includes cases of the disease when only some typical symptoms appear (for example, polyadenitis) or the most pronounced signs that are not typical are exanthema, jaundice, symptoms of damage to the nervous system.

After primary EBV infection, persistence of the virus in the body is often detected. It may not be clinically manifested (asymptomatic carrier or latent EBV infection). However, reactivation of EBV infection is possible, which leads to the development of a chronically relapsing variant of the course with damage to the central nervous system, myocardium, kidneys, and various lymphoproliferative disorders.

Individuals with severe immune deficiency may develop a generalized course of EBV infection with damage to the central and peripheral nervous system in the form of meningitis, encephalitis, polyradiculoneuritis. Immunodeficiency due to a defective hereditary response (lymphoproliferative disease associated with the X chromosome, Duncan's disease, Partilo's syndrome) in boys is characterized by an inadequate response to EBV for certain mutations in the X chromosome.

The prognosis is poor due to the occurrence of severe hepatitis, acute bone marrow failure, fleeting non-Hodgkin's lymphomas. Burkitt's lymphoma is a very high-grade non-Hodgkin's lymphoma that develops from B-lymphocytes and tends to spread outside the lymphatic system (to the bone marrow, blood, spinal column). Burkitt's lymphoma can develop at any age, but it is most common in children and young adults, especially men. Often the tumor develops in patients with HIV infection. Lymphoma cells can accumulate in in large numbers in the lymph nodes and abdominal organs, which leads to their increase. They can pass into the small intestine, causing intestinal obstruction or bleeding. Sometimes there is swelling of the neck and jaw, which can be very painful. Without treatment, Burkitt's lymphoma progresses rapidly and leads to death.

Nasopharyngeal carcinoma is a tumor that develops in the upper part of the throat and differs significantly from other types of head and neck tumors in its development, causes, clinical course, and treatment tactics.

How to treat the Epstein-Barr virus?

Infectious mononucleosis usually does not require antiviral treatment. Acyclovir preparations in this case do not give an effect.

In severe cases, a short course of glucocorticosteroids is indicated, for example, prednisolone at a dose of 0.001 g / kg per day for 5-7 days. Hyposensitizing and symptomatic agents are recommended.

In the case of a secondary bacterial infection, antibacterial drugs are prescribed in age-appropriate doses, with the exception of aminopenicillins. Among the etiotropic agents for the treatment of chronic active EBV infection in the reactivation stage, acyclovir and ganciclovir are used. However, these drugs do not give an effect in the latent course of the disease.

Acyclovir is prescribed in the same way as for herpes zoster. Ganciclovir is administered intravenously at a dose of 0.005-0.015 g/kg 3 times a day for 10-15 days. The course can be extended up to 21 days. The maintenance dose is 0.005 g/kg per day. The drug in this dose is administered for a long time to prevent recurrence of the disease. For maintenance therapy, ganciclovir tablets 1 g 3 times a day can be used.

Alfa interferon preparations are used in the treatment of chronic active EBV infection. Recombinant interferon is prescribed in doses of 1 million IU per 1 m 2 of body area. The frequency of administration of the drug is 2 times a day with an interval of 12 hours. Duration of treatment at a dose of 1-3 million IU 2 times a day for the first week, then 3 times a week for 3-6 months.

In the case of severe forms of EBV infection, immunoglobulin is used for intravenous administration in a single dose of 3-4 ml/kg of body weight per day (0.15-0.2 g/kg of body weight per day) from 1 to 5 injections per course of treatment. The course dose should not exceed 2 g per 1 kg of body weight.

Burkitt's lymphoma is highly sensitive to various types of cytosatics; they are administered intravenously at a dose of 0.03-0.04 g/kg once if the disease is diagnosed at an early stage. Effective is the treatment with cyclophosphamide, which is twice with an interval of 10-14 days. If the process spreads to the membranes and substance of the spinal cord and brain, methotrexate is administered intralumbally at a dose of 0.005 g, followed by its increase.

What diseases can be associated

Complications of infectious mononucleosis are varied and include:

• ruptured spleen,
• hypoplatelet bleeding,
• pharyngotracheal obstruction,

Chronic EBV infection is more often complicated in immunocompromised individuals by diseases such as:

• acute respiratory failure,
• bleeding,

In general, in infectious mononucleosis, the prognosis is more favorable than in other forms of EBV infection, and only in a chronic course is it unfavorable.

Epstein-Barr virus treatment at home

Therapeutic measures for diseases provoked by EBV infection are carried out in a medical hospital, but the therapy does not differ in short-term therapy, and therefore some medications are also allowed at home.

Self-treatment of the disease is unacceptable, the maximum effect is achieved only in cooperation with competent specialists.

What drugs to treat the Epstein-Barr virus?

• - at the rate of 1,000,000 IU per 1 m 2 of body area, the frequency of administration twice a day with an interval of 12 hours; duration of treatment at a dose of 1-3 million IU twice a day for the first week, then 3 times a week for 3-6 months;
• - 0.005-0.015 g / kg 3 times a day for 10-15 days, and sometimes for 21 days; the maintenance dose is 0.005 g / kg per day for a long period;
• - in a single dose of 3-4 ml / kg of body weight per day, from 1 to 5 injections per course of treatment;
• - 0.001 g/kg per day for 5-7 days.

Treatment of the Epstein-Barr virus with folk methods

Infectious mononucleosis is a complex disease, the full treatment of which is possible only through the use of pharmaceuticals and traditional medicine methods. Folk remedies do not have sufficient potential to destroy the virus that has entered the body.

Epstein-Barr virus treatment during pregnancy

At the stage of pregnancy planning, expectant parents are advised to be screened for the presence of antibodies to the Epstein-Barr virus in their blood. The presence of antibodies is assessed positively, and the presence of the infection itself requires further clarification of its state - passive or active.

The active course of the disease at the stage of pregnancy affects the process very negatively. In most cases, expectant mothers with such an ailment are placed in a hospital until complete recovery. The optimal and safest treatment for the fetus for the mother is carried out after consulting the attending physician and passing specialized tests. Treatment of the Epstein-Barr virus is carried out only with the use of special modern preparations that contain interferon-alpha substances, abnormal nucleotides and various cytostatics. Immunoglobulins are also administered intravenously and corticosteroid hormones are used.

In the general analysis of the blood of patients with infectious mononucleosis, the changes are quite characteristic. Leukopenia, which may appear in the first 2 days of illness, is replaced by leukocytosis with a significant increase in the number of mononuclear cells - lymphocytes, monocytes. The level of segmented neutrophils decreases, while the number of stab neutrophils even slightly increases. ESR increases slightly. A characteristic feature is the presence of atypical mononuclear cells - mature mononuclear cells that have a large spongy nucleus, asymmetrically located in the cell. The cell protoplasm is wide and contains delicate azurophilic granularity. A belt of enlightenment often appears between the nucleus and the cytoplasm. The number of atypical mononuclear cells can reach 20% of all leukocytes or more. They appear on the 2-3rd day of illness and are observed in the blood for 3-4 weeks, sometimes up to 2 months or more.

With liver damage, the activity of ALT and AST, the level of bilirubin moderately increase.

The polymorphism of clinical manifestations, as well as the involvement of the immune system in the pathological process, necessitate specific confirmation of the diagnosis. Detection in blood serum of heterophilic antibodies to erythrocytes of various animals (sheep, bull, horse, etc.) in infectious mononucleosis is now practically not used due to certain technical problems and relative non-specificity. The method of choice is ELISA, which allows to detect antibodies of different classes. PCR is also actively used.

Treatment of other diseases with the letter - in

The information is for educational purposes only. Do not self-medicate; For all questions regarding the definition of the disease and how to treat it, contact your doctor. EUROLAB is not responsible for the consequences caused by the use of the information posted on the portal.

One of the urgent problems of modern medicine is the high infection of the population with one of the representatives of opportunistic pathogens - the Epstein-Barr virus (EBV). Practitioners in their daily practice are more likely to encounter clinically manifest forms of primary Epstein-Barr virus infection (EBVI) in the form of an acute, usually unverified respiratory infection (more than 40% of cases) or infectious mononucleosis (about 18% of all diseases). In most cases, these diseases are benign and end in recovery, but with lifelong persistence of EBV in the body of the ill person.

However, in 10-25% of cases, primary infection with EBV, which is asymptomatic, and acute EBVI can have adverse consequences with the formation of lymphoproliferative and oncological diseases, chronic fatigue syndrome, EBV-associated hemophagocytic syndrome, etc.

To date, there are no clear criteria to predict the outcome of primary EBV infection. The doctor who consults a patient with acute EBVI always faces the question: what to do in each specific case in order to minimize the risk of developing chronic EBVI and EBV-associated pathological conditions. This question is not idle, and it is really very difficult to answer it, because to. there is still no clear pathogenetically substantiated treatment regimen for patients, and the available recommendations often contradict each other.

According to many researchers, the treatment of EBVI-mononucleosis (EBVIM) does not require the appointment of specific therapy. Treatment of patients, as a rule, is carried out on an outpatient basis, isolation of the patient is not required. Indications for hospitalization should be considered prolonged fever, severe tonsillitis syndrome and / or tonsillitis syndrome, polylymphadenopathy, jaundice, anemia, airway obstruction, abdominal pain and the development of complications (surgical, neurological, hematological, from the cardiovascular and respiratory system, syndrome Reye).

In mild and moderate EBV MI, it is advisable for patients to recommend a ward or general regimen with a return to normal activities at an adequate physical and energy level for each individual patient. A multicenter study has shown that unreasonably recommended strict bed rest prolongs the recovery period and is accompanied by a prolonged asthenic syndrome, often requiring medical treatment.

In mild EBV MI, treatment of patients is limited to maintenance therapy, including adequate hydration, rinsing the oropharynx with an antiseptic solution (with the addition of 2% lidocaine (xylocaine) solution with severe discomfort in the throat), non-steroidal anti-inflammatory drugs such as paracetamol (Acetaminophen, Tylenol). According to a number of authors, the appointment of H2 receptor blockers, vitamins, hepatoprotectors and local treatment of the tonsils with various antiseptics are ineffective and unreasonable methods of treatment. Of the exotic methods of treatment, we should mention the recommended by F. G. Bokov et al. (2006) the use of megadoses of bifidobacteria in the treatment of patients with acute mononucleosis.

Opinions on the advisability of prescribing antibacterial drugs in the treatment of EBVIM are very controversial. According to Gershburg E. (2005), tonsillitis in MI is often aseptic and antibiotic therapy is not justified. There is also no point in using antibacterial agents for catarrhal angina. An indication for prescribing antibacterial drugs is the addition of a secondary bacterial infection (development of lacunar or necrotic tonsillitis in a patient, complications such as pneumonia, pleurisy, etc.), as evidenced by pronounced inflammatory changes in blood parameters that persist for more than three days and febrile fever. The choice of drug depends on the sensitivity of the microflora on the patient's tonsils to antibiotics and possible adverse reactions from organs and systems.

According to H. Fota-Markowcka et al. (2002) in patients, Haemophilus influenzae, Staphylococcus aureus, and Pyogenic Streptococcus are more often isolated, less often, fungi of the genus Candida, therefore, it should be recognized as reasonable to prescribe these patients drugs from the group of 2-3 generation cephalosporins, lincosamides, macrolides, and antifungal agents (fluconazole) in therapeutic doses for 5-7 days (less often - 10 days). Some authors recommend using metronidazole at 0.75 g/day, divided into 3 doses, for 7-10 days in the presence of necrotic angina and putrid breath, probably caused by the associated anaerobic flora.

Drugs from the aminopenicillin group (ampicillin, amoxicillin (Flemoxin Solutab, Hikoncil), amoxicillin with clavulanate (Amoxiclav, Moxiclav, Augmentin)) are contraindicated due to the possibility of developing an allergic reaction in the form of exanthema. The appearance of a rash on aminopenicillins is not an IgE-dependent reaction, therefore, the use of histamine H1 receptor blockers has neither a preventive nor a therapeutic effect.

According to a number of authors, the empirical approach to the appointment of glucocorticosteroids in patients with EBVI is still preserved. Glucocorticosteroids (prednisolone, prednisone (Deltazone, Meticorten, Orazon, Liquid Pred), Solu Cortef (hydrocortisone), dexamethasone) are recommended for patients with severe EBVIM, with airway obstruction, neurological and hematological complications (severe thrombocytopenia, hemolytic anemia). The daily dose of prednisolone is 60-80 mg for 3-5 days (rarely 7 days) followed by rapid withdrawal of the drug. There is no single point of view on the appointment of glucocorticosteroids in these patients with the development of myocarditis, pericarditis and CNS lesions.

In severe EBVIM, intravenous detoxification therapy is indicated; in case of rupture of the spleen, surgical treatment is indicated.

The question of prescribing antiviral therapy for patients with EBVI remains the most controversial. Currently, a large list of drugs that are inhibitors of EBV replication in cell culture is known.

According to E. Gershburg, J. S. Pagano (2005), all modern "candidates" for the treatment of EBVI can be divided into two groups:

I. Inhibiting activity of EBV DNA polymerase:

1. acyclic nucleoside analogs (acyclovir, ganciclovir, penciclovir, valaciclovir, valganciclovir, famciclovir);
2. acyclic nucleotide analogs (cidofovir, adefovir);
3. pyrophosphate analogues (Foscarnet (foscavir), phosphonoacetic acid);
4. 4 oxo-dihydroquinolines (possibly).

II. Various compounds that do not inhibit viral DNA polymerase (the mechanism is being studied): maribavir, beta-L-5 uracil iododioxolane, indolocarbazole.

However, a meta-analysis of five randomized controlled trials involving 339 EBVIM patients taking acyclovir (Zovirax) showed the drug to be ineffective.

One of possible causes lies in the development cycle of EBV, in which the DNA of the virus has a linear or circular (episomal) structure and multiplies in the nucleus of the host cell. Active replication of the virus occurs during the productive (lytic) stage of the infectious process (linear EBV DNA). In acute EBVI and activation of chronic EBVI, a cytolytic cycle of virus development occurs, in which it triggers the expression of its own early antigens and activates some genes of macroorganism cells, the products of which are involved in EBV replication. With latent EBVI, the DNA of the virus has the form of an episome (circular supercoiled genome) located in the nucleus. The circular EBV DNA genome is characteristic of CD21+ lymphocytes, in which, even during primary infection with the virus, the lytic stage of the infectious process is practically not observed, and DNA is reproduced in the form of an episome synchronously with the cell division of infected cells. The death of EBV-affected lymphocytes is not associated with virus-mediated cytolysis, but with the action of cytotoxic lymphocytes.

When prescribing antiviral drugs for EBVI, the doctor must remember that their clinical effectiveness depends on the correct interpretation of the clinical manifestations of the disease, the stage of the infectious process and the cycle of development of the virus at this stage. However, no less important is the fact that most of the symptoms of EBVI are not associated with the direct cytopathic effect of the virus in infected tissues, but with the mediated immunopathological response of EBV-infected B lymphocytes circulating in the blood and located in the cells of the affected organs. That is why nucleoside analogues (acyclovir, ganciclovir, etc.) and polymerase inhibitors (Foscarnet), which suppress EBV replication and reduce the virus content in saliva (but do not completely sanitize it), do not have a clinical effect on the severity and duration of EBVIM symptoms.

Indications for the treatment of EBVIM with antiviral drugs are: severe, complicated course of the disease, the need to prevent EBV-associated B-cell lymphoproliferation in immunocompromised patients, EBV-associated leukoplakia. Bannett N. J., Domachowske J. (2010) recommend oral acyclovir (Zovirax) 800 mg orally 5 times a day for 10 days (or 10 mg/kg every 8 hours for 7-10 days). In case of lesions of the nervous system, the intravenous method of administering the drug at a dose of 30 mg / kg / day 3 times a day for 7-10 days is preferable.

According to E. Gershburg, J. S. Pagano (2005), if under the influence of any factors (for example, immunomodulators, in case of EBV-associated malignant tumors - the use of radiation therapy, gemcitabine, doxorubicin, arginine butyrate, etc.), it is possible to translate EBV DNA from the episome to an active replicative form, i.e. to activate the lytic cycle of the virus, then in this case a clinical effect of antiviral therapy can be expected.

IN last years Increasingly, for the treatment of EBVI, recombinant alpha-interferons (Intron A, Roferon-A, Reaferon-EC) at 1 million IU IM for 5-7 days or every other day have been used; with chronic active EBVI - 3 million IU intramuscularly 3 times a week, course 12-36 weeks.

As an interferon inducer in severe EBVI, it is recommended to use Cycloferon 250 mg (12.5% ​​2.0 ml) intramuscularly, 1 time per day, No. 10 (the first two days daily, then every other day) or according to the scheme: 250 mg/day, IM on the 1st, 2nd, 4th, 6th, 8th, 11th, 14th, 17th, 20th, 23rd, 26th th and 29th day in combination with etiotropic therapy. Orally, Cycloferon is prescribed at 0.6 g / day, a course dose (6-12 g, i.e. 20-40 tablets).

Drug correction of asthenic syndrome in chronic EBVI includes the appointment of adaptogens, high doses of B vitamins, nootropic drugs, antidepressants, psychostimulants, drugs with a procholinergic mechanism of action and cellular metabolism correctors.

The key to successful treatment of a patient with EBVI is complex therapy and strictly individual management tactics both in the hospital and during dispensary observation.

Literature

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Data 06 Apr ● Comments 0 ● Views

Doctor Maria Nikolaeva

In 40% of cases, adults and children develop a herpes infection. However, this family of pathogens has many variations. This infection is referred to as the Epstein-Barr virus. Pathogens are dormant in the body long time, and as soon as immunity decreases, their activity begins. In this case, the patient needs to know which doctor to contact and how the Epstein-Barr treatment is carried out. Timely therapy will prevent the development of the disease and will not lead to complications.

If symptoms of EBV (Epstein-Barr virus) appear, you need to contact an infectious disease specialist or an immunologist. When tumor-like formations began to appear, an oncologist is engaged in the treatment of the Epstein-Barr virus. The patient is diagnosed by an appropriate specialist. To determine which complex of treatment is required to prescribe, the doctor should familiarize himself with the results of the anamnesis, laboratory tests and examination of the patient.

To determine the Epstein-Barr infection, a general condition is distinguished:

• intoxication of the body;
• temperature rise;
• fever;
• lymph nodes are enlarged;
• difficulty breathing.

At laboratory research in the presence of the virus, an increase in the liver and spleen is observed. In the results general analysis blood, changes in the increase in the level of lymphocytes and monocytes are noted. During the course of infection, the number of segmented neutrophils decreases. The ESR indicator is able to remain at the same level. If the result changes, then this slightly affects the general condition. When the infection affects the liver, an increase in bilirubin is noted.

How is Epstein-Barr virus treated?

Treatment of Epstein-Barr virus (EBV) in children and adults.

Certain complex measures for the treatment of Epstein-Barr virus do not exist. If the immune system is not weakened, then the recovery of the body occurs without the use of therapy. To do this, it is necessary to provide the patient with a constant replenishment of the water balance. To eliminate the clinical manifestations of Epstein-Barr disease in an adult, antipyretics are prescribed. Otherwise, painkillers help. This is included in the general restoration measures.

General treatment regimen

If EBV manifests itself in the form of infectious mononucleosis, then special therapy is not carried out. In this case medications with the content of acyclovir do not bring benefits. With a severe manifestation of the activity of pathogens, the general treatment regimen for the Epstein-Barr virus in adults is to take medications, vitamin complexes and maintain immunity.

In chronic or acute course of the disease, the use of glucocorticosteroids is prescribed. Prednisolone is prescribed for the treatment of Epstein-Barr infection. The dosage in severe infections is 0.001 g/kg per day. The recovery course lasts 1 week. In addition, the drug is recommended to use drugs to eliminate other symptoms of the disease.

If a secondary infection joins the disease, then treating the Epstein-Barr virus in adults is required with the use of antibiotics. At the same time, the dosage of medicines is observed. The exception includes drugs containing aminopenicillin. As etiotropic agents use "Acyclovir" or "Ganciclovir". It is noted that these funds do not provide a positive result during the latent course of infection.

When the chronic form of the Epstein-Barr virus disease occurs in adults, the treatment is with the use of Alpha Interferon. At the same time, the dosage of the drug is 1 million IU per 1 m2 of the patient's body area. The agent is administered 2 times a day every 12 hours. The course of treatment is 7 days. Then every day the medicine is administered 3 times a week. The duration of the course of treatment is 180 days.

With Epstein-Barr infection in adults, Acyclovir is prescribed, in addition, the drug is indicated for use in herpes zoster. To eliminate some symptoms, the ointment is applied to the inflamed areas. Doctors recommend rubbing the medicine up to 5 times a day.

In addition to medicines, general therapy includes vitamin and mineral complexes to maintain the state of the immune system. Doctors recommend that the patient review his diet and add more vegetables and fruits to his diet.

What drugs to treat the Epstein-Barr virus?

The disease has unpleasant clinical manifestations. Therefore, the use of drugs in the treatment of Epstein-Barr virus in adults is symptomatic. In addition to general medicines, therapeutic measures are prescribed:

1. "Ganciclovir";
2. "Alpha Interferon";
3. "Prednisolone".

In the treatment of EBV, the drug "Ganciclovir" is used, which is administered intravenously. The dosage is up to 0.015 g / kg 3 times every day. The course of treatment is 2 weeks. In individual cases, the drug is used up to 20 days. If the infection proceeds in a chronic form, then the dosage is 0.005 g / kg. This is done during a prophylactic course to avoid recurrence of the infection. In this case, the injection continues for a long time. In addition, Ganciclovir tablets are actively used.

In a severe form of Epstein-Barr infection in adults, potent medications are used, which include immunoglobulin. The drug is used for internal administration. The dosage is 4 ml / kg during the day. During the course of treatment, do not exceed 2 g / kg of the amount of medication per day.

Is the virus treated at home or traditional medicine?

Therapeutic therapy at home for Epstein-Barr virus in adults does not differ from stationary conditions. At the same time, doctors allow you to take some medicines at home. However, self-medication is not allowed. To get a positive result, you need to interact with qualified specialists.

It will take much longer to cure the Epstein-Barr virus using traditional medicine than in a hospital. In addition, to use herbal remedies, you will need to consult with your doctor. traditional medicine used as an additional therapy to consolidate the positive results of treatment.

Some symptoms of the disease begin to appear after infection with the Epstein-Barr virus. Therefore, it is necessary to pay attention to the state of health than to wait for serious signs of infection. Therapeutic measures for Epstein-Barr disease are more effective if the patient recovers in a hospital setting. In this case, the general treatment regimen is to take medicines and vitamin complexes. Some drugs are given by injection. Self-treatment and the introduction of drugs in the wrong dosage will lead to unpleasant consequences.

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