Epstein-Barr virus belongs to the family Herpesviridae (herpes type 4) and is the most common and vysokontagioznoy viral infection.
Statistics on the results of up to 60% of children and almost 100% of adults are infected with the virus. Epstein-Barr virus is transmitted by airborne droplets (kissing), contact-household (common household items), less blood through (transmissive) and from mother to fetus (vertical path).
The source of infection is the only person, most often, patients with latent and asymptomatic forms. Epstein-Barr virus enters the body through the upper respiratory tract, where penetrates in the lymphoid tissue, causing the lymph nodes, tonsils, spleen and liver.
What are the causes of disease
Epstein-Barr virus is dangerous not so much acute infection with the human, and propensity to cause cancer. Uniform classification of viral infection with Epstein-Barr virus (VIEB) does not exist, for use in the practice of medicine proposes the following:
- Time of infection - congenital and acquired;
- typical (- diseases in shapeInfectious mononucleosis) And atypical: erased, asimtopmnaya, the defeat of the internal organs;
- by severity - mild, moderate and severe;
- on the flow duration - acute, protracted and chronic;
- phase active - active and inactive;
- complications;
- Mixed (mixed) infection - often seen in conjunction with the cytomegalovirus infection.
Diseases caused by Epstein-Barr virus:
- Filatov (infectious mononucleosis) disease;
- Hodgkin's disease (megakaryoblastoma);
- chronic fatigue syndrome;
- nasopharyngeal malignancy;
- lymphomas, including Burkitt's lymphoma;
- general immune deficiency;
- systematic hepatitis;
- brain and spinal cord injury (multiple sclerosis);
- herpes;
- stomach and intestinal tumors of the salivary glands;
- Hairy leukoplakia of the oral cavity, and others.
Symptoms of Epstein-Barr virus
Acute infection (OVIEB)
OVIEB - is infectious mononucleosis.
The incubation period ranges from 2 days to 2 months, an average of 5-20 days.
The disease begins gradually, with the prodromal period: the patient complains of discomfort, fatigue, sore throat.
The body temperature is slightly increased or normal. After a few days the temperature rises to 39-40 ° C, joins intoxication syndrome.
The main symptom of acute viral infection with Epstein-Barr virus is poliadenopatiya. Basically increased front and rear cervical lymph nodes, as well as the occipital, submandibular, supraclavicular, subclavian, axillary, elbow, hip and inguinal lymph nodes. Their dimensions reach 0,5-2sm in diameter, they testovatoy touch, moderate or slaboboleznennye, not soldered to each other and surrounding tissues. Skin over them is not changed. Maximum severity poliadenopatii diagnosed at 5-7 days of illness, and after 2 weeks of the lymph nodes begin to decrease.
The process involved and the palatine tonsils, which manifests signs sore throatThe process is accompanied by breach of nasal breathing, nasal voice, the presence of purulent material on the back of the throat.
Enlargement of the spleen (splenomegaly) - one of the recent signs of a normal spleen size is returned within 2-3 weeks of the disease, at least 2 months.
Liver enlargement (hepatomegaly) is less common. In some cases, a slight jaundice, darkening of urine.
In acute infection with Epstein-Barr virus rarely suffers from the nervous system. Perhaps the development of serous meningitis, sometimes meningoencephalitis, encephalomyelitis, polyradiculoneuritis, but the process ends complete regression of focal lesions.
There is also a rash, which may be different. It may be spots, papules, roseola, a point or hemorrhage. Rash lasts about 10 days.
Chronic infection with Epstein-Barr virus
HIVEB differ long duration and periodic recurrences of the disease.
Patients complain of general fatigue, weakness, increased sweating. You may experience pain in muscles and joints, exanthema (rash), persistent cough as pokryahtyvaniya, impaired nasal breathing.
Also recorded headaches, discomfort in the right upper quadrant, mental disorders in the form of emotional lability and depression, weakening of memory and attention, reduced mental capacity and sleep disturbance.
There is a generalized lymphadenopathy, and hypertrophy of the pharyngeal tonsils, enlarged liver and spleen. Often chronic infection Epstein-Barr virus join bacteria and fungi (genital herpes and labial herpes, thrush, Inflammation of the digestive tract and respiratory system).
Diagnostics
The diagnosis of acute and chronic infection with Epstein-Barr virus is placed on the basis of complaints, of clinical manifestations and laboratory data:
1. General blood analysis
The increase in white blood cells, ESR, lymphocytes increase and monocytes, The detection of abnormal mononuclear cells. Possible decrease or increase plateletHemoglobin (or autoimmune hemolytic anemia).
2. Blood chemistry
increase AST, ALT, LDH, and other enzymes, detection of acute phase proteins (CRP, fibrinogen) Increase bilirubin and alkaline phosphatase.
3. immunological research
It assesses the state of the interferon system, immunoglobulins, and so on.
4. serological tests
Applicable immunoassay method by which the estimated quantity and class of immunoglobulins (antibodies to Epstein-Barr virus). In the acute stage or exacerbation predominant IgM, and later, after 2-4 months IgG.
Reference values:
IgM antibodies
- <20 U / ml - negative;
- > 40 U / ml - positive;
- 20 - 40 U / ml - * doubtful.
IgG antibodies:
- <20 U / ml - negative;
- > 20 U / ml - positively *.
According to an independent laboratory Invitro
5. DNA diagnostics
Using polymerase chain reaction (PCR) determining the presence of a DNA virus, Epstein-Barr virus in various biological materials (saliva, cerebrospinal fluid, smears from the mucous membrane of the upper respiratory tract, biopsy internal organs).
6. According to the testimony of other studies and consultations
Consultation ENT physician and immunologist, chest X-ray and paranasal sinuses, Abdominal ultrasound, Evaluation of the blood coagulation system, consultation of oncology and hematology.
Treatment of infection Epstein-Barr virus
Specific treatment for the viral infection with Epstein-Barr virus does not exist. Treatment of infectious diseases doctor performs (acute and chronic infections) or a oncologist in the development of tumor growths.
All patients, especially with infectious mononucleosis are hospitalized. Assign appropriate diet for hepatitis development and peace.
Actively used different groups of antiviral drugs: izoprinozin, valtrex acyclovir, Arbidol, viferon, intramuscular interferon (IFN-EU, Roferon).
If appropriate in therapy include antibiotics (tetracycline, sumamed, cefazolin) - for example, in angina with extensive raids rate for 7-10 days.
Also appointed by intravenous immunoglobulins (Intraglobin, pentaglobin), complex vitamins (sanasol, alphabet), antiallergic drugs (tavegil, fenkarol).
Correction performed immunity purpose immunomodulators (likopid, derinat), cytokines (leukinferon), biological stimulants (aktovegin, Solcoseryl).
Relief of symptoms of various diseases is carried antipyretic (paracetamol) as the temperature rises, when coughing - antitussive (libeksin, mukaltin) difficulties with nasal breathing nasal drops (nazivin, adrianol) and other.
The duration of treatment depends on the severity and shape (acute or chronic) illness and may be from 2-3 weeks to several months.
Complications and prognosis
Complications of acute and chronic infections of Epstein-Barr:
- otitis;
- peritonzillit;
- respiratory insufficiency (edema tonsils and soft tissue of the oropharynx);
- hepatitis;
- splenic rupture;
- hemolytic anemia;
- thrombocytopenic purpura;
- liver failure;
- pancreatitis, myocarditis.
The prognosis of acute infection with Epstein-Barr favorable. In other cases, prognosis depends on the severity and duration of the disease, presence of complications, and the development of tumors.
