Epstein-Barr virus belongs to the family of herpes viruses (herpes type 4) and is the most common and highly tangible viral infection.
According to statistics, up to 60% of children and almost 100% of adults are infected with this virus. Epstein-Barr virus is transmitted by airborne droplets (with kisses), contact-household (common household items), less often through the blood (transmissible) and from mother to fetus (vertical path).
The source of infection is only a person, most often it is patients with latent and asymptomatic forms. Epstein-Barr virus enters the body through the upper respiratory tract, where it penetrates into the lymphoid tissue, causing damage to the lymph nodes, tonsils, liver and spleen.
Epstein-Barr virus is dangerous not so much by acute human infection, but by the tendency to cause tumor processes. There is no single classification of Epstein-Barr virus infection (VIEB), the following is proposed for use in practical medicine:
- on the time of infection – congenital and acquired;
- in the form of the disease – typical ( infectious mononucleosis ) and atypical: erased, asymptomatic , damage to internal organs;
- by severity – mild, moderate and severe;
- for the duration of the course – acute, prolonged, chronic;
- in the phase of activity – active and inactive;
- mixed (mixed) infection – most often observed in combination with cytomegalovirus infection.
Diseases caused by Epstein-Barr virus:
- Filatov disease (infectious mononucleosis);
- Hodgkin’s lymphoma (Hodgkin’s disease) illness;
- chronic fatigue syndrome;
- malignant nasopharynx formation;
- lymphomas, including Burkitt’s lymphoma;
- general immune deficiency;
- systemic hepatitis;
- damage to the brain and spinal cord ( multiple sclerosis );
- tumors of the stomach and intestines, salivary glands;
- hairy leukoplakia of the oral cavity and others.
Acute Infection (OVIEB)
OVIEB is an infectious mononucleosis.
The incubation period is from 2 days to 2 months, an average of 5-20 days.
The disease begins gradually, with the prodromal period: the patient complains of indisposition, fatigue, sore throat.
Body temperature slightly elevated or within normal limits. After a few days, the temperature rises to 39-40 ° C, and the intoxication syndrome joins.
The main symptom of acute Epstein-Barr virus infection is polyadenopathy. Mainly enlarged front and rear cervical lymph nodes, as well as occipital, submandibular, supraclavicular, subclavian, axillary, elbow, femoral and inguinal lymph nodes. Their sizes reach 0.5-2 cm in diameter, they are hard- to-touch, moderately or weakly painful , not soldered between themselves and the surrounding tissues. The skin over them does not change. The maximum severity of polyadenopathy is diagnosed at 5-7 days of illness, and after 2 weeks the lymph nodes begin to decrease.
Palatine tonsils are also involved in the process, which is manifested by signs angina, the process is accompanied by a violation of nasal breathing, nasal voices, the presence of purulent discharge on the back of the pharynx.
An enlarged spleen (splenomegaly) is one of the late signs, the spleen returns to normal size after 2-3 weeks of illness, less often after 2 months.
Enlarged liver ( hepatomegaly ) is less common. In some cases, there is mild jaundice, dark urine.
With acute infection of Epstein-Barr virus, the nervous system is rarely affected. Perhaps the development of serous meningitis, sometimes meningoencephalitis, encephalomyelitis, polyradiculoneuritis , but all processes end with a complete regression of focal lesions.
There is also a rash, which may be different. These can be blemishes, papules, roseola, spots or hemorrhages. The exanthema lasts about 10 days.
Chronic Epstein-Barr virus infection
HIWEB has a long duration and periodic relapses of the disease.
Patients complain of general fatigue, weakness, excessive sweating. You may experience pain in the muscles and joints, exanthema (rash), persistent coughing in the form of crying , impaired nasal breathing.
Also noted are headaches, discomfort in the right hypochondrium, mental disorders in the form of emotional lability and depression, impaired memory and attention, mental decline and sleep disturbance.
There is a generalized lymphadenopathy , hypertrophy of the pharyngeal and palatine tonsils, enlarged liver and spleen. Often, bacteria and fungi join the Epstein-Barr chronic infection ( genital herpes and herpes lips, thrush , inflammation of the digestive tract and respiratory system).
The diagnosis of acute and chronic Epstein-Barr infection is made on the basis of complaints, clinical manifestations and laboratory data:
1. Complete blood count
Leukocyte increase, ESR, lymphocyte elevation and monocytes, detection of atypical mononuclears. Possible reduction or increase platelets, hemoglobin (hemolytic or autoimmune anemia).
2. Biochemical blood test
Boost AST, ALT, LDH and other enzymes, detection of acute phase proteins ( CRP, fibrinogen ), increase bilirubin and alkaline phosphatase.
3. Immunological study
The state of the interferon system, immunoglobulins, etc. is assessed.
4. Serological reactions
The method of enzyme immunoassay is used, by means of which the number and class of immunoglobulins (antibodies to Epstein-Barr virus) are evaluated. In the acute stage or during exacerbation, IgM prevail, and later, after 2-4 months, IgG.
IgM class antibodies
- <20 U / ml – negative;
- > 40 U / ml – positive;
- 20 – 40 U / ml – doubtful *.
IgG class antibodies :
- <20 U / ml – negative;
- > 20 U / ml – positive *.
5. DNA diagnostics
Using the method of polymerase chain reaction (PCR) determine the presence of Epstein-Barr virus DNA in various biological materials (saliva, cerebrospinal fluid, smears from the mucous membrane of the upper respiratory tract, biopsies of internal organs).
6. According to the testimony of other studies and consultations
Consultation of an ENT doctor and an immunologist, radiography of the chest and paranasal sinuses, Ultrasound examination of the abdominal cavity , evaluation of the blood coagulation system, consultation with an oncologist and a hematologist.
There is no specific treatment for Epstein-Barr virus infection. The treatment is carried out by an infectious disease physician (for acute and chronic infection) or by an oncologist during the development of tumor-like neoplasms.
All patients, especially those with infectious mononucleosis, are hospitalized. Appropriate diet is prescribed for the development of hepatitis and rest.
Actively apply different groups of antiviral preparations: isoprinosine, Valtrex, acyclovir, arbidol, viferon, intramuscularly interferons (IFN-EU, Roferon).
If necessary, antibiotics (tetracycline, sumamed , cefazolin ) are included in the therapy – for example, with angina with extensive raids with a course of 7-10 days.
Also appointed by intravenous immunoglobulins (Intraglobin, pentaglobin), complex vitamins (sanasol, alphabet), antiallergic drugs (tavegil, fenkarol).
Immunity correction is carried out by the appointment of immunomodulators ( licopid , derinat ), cytokines ( leukinferon ), biological stimulants ( actovegin , solcoseryl ).
Relief of various symptoms of the disease is carried out by antipyretic drugs (paracetamol) with an increase in temperature, with cough – antitussives ( libexin , mukaltin ), with difficulties with nasal breathing nasal drops ( nazivin , adrianol ) and others.
The duration of treatment depends on the severity of the course and the form (acute or chronic) of the disease and can be from 2-3 weeks to several months.
Complications of acute and chronic Epstein-Barr virus infection:
- otitis media;
- respiratory failure (swelling of the tonsils and soft tissues of the oropharynx);
- rupture of the spleen;
- hemolytic anemia;
- thrombocytopenic purpura;
- liver failure;
- pancreatitis,myocarditis .
The prognosis for acute infection with Epstein-Barr virus is favorable. In other cases, the prognosis depends on the severity and duration of the disease, the presence of complications and the development of tumors.