Epstein-barr virus symptoms in adults treatment. Epstein-Barr virus (EBV)

Data 06 Apr ● Comments 0 ● Views

Doctor Dmitry Sedykh

Epstein-Barr virus is the most common virus. According to statistics, 100 percent of adults suffer from it. Epstein-Barr virus symptoms include tumor formation.

Epstein-Barr belongs to the category of viruses. It is dangerous not because it causes disease in a person, but because it gives impetus to the appearance of tumors. Epstein-Barr is divided into the following categories:

by the time when the infection entered the body, it can be acquired and congenital;
it can be typical in shape - it expands the lymph nodes, and causes problems with the circulatory system, spleen and liver, as well as apathetic - no outward signs of the disease are visible, since it affects the internal organs;
by severity - light, medium and heavy;
by activity - active and inactive;
downstream - acute, chronic and protracted;
on a combination of Epstein-Barr and other diseases. Most often, it is combined with a virus that changes the structure of the body.

When ingested, symptoms may not appear until the immune system is reduced. Epstein-Barr does not kill cells. Instead, it enlarges the affected tissues. That is why neoplasms appear.

Symptoms of the disease, which is caused by the Epstein-Barr virus most often - Infectious mononucleosis: incubation period, symptoms (rash, lymph nodes, sore throat).

General symptoms of the presence of Epstein-Barr in the body in an acute form

After Epstein-Barr appears in the body, it will begin to develop. To do this, he needs from several days to two months. Most often, it develops in two to three weeks.

Symptoms of the Epstein-Barr virus appear gradually. First, the patient begins to complain of weakness, malaise, nausea, fatigue and sore throat. The temperature can be normal, or elevated - below 38 degrees. But after a while it rises to 40 degrees, and symptoms of intoxication appear.

The main sign of the presence of this virus in the body is an increase in lymph nodes. The following nodes can be enlarged: on the neck (front and back), occipital, submandibular, above and below the collarbone, elbow, axillary, femoral, inguinal. Their size can be up to two centimeters in diameter. You can feel them, they become a little harder. Mild pain may be present. The lymph nodes become maximally pronounced a week after the first symptoms appear, and after 15 days, they begin to gradually decrease.

In addition to these symptoms, the patient also becomes inflamed tonsils, which leads to tonsillitis, impaired breathing through the nose, and hoarseness. the appearance of abscesses or wounds on the pharynx.

Another symptom is an enlarged spleen. It returns to normal in 20-30 days. The liver is rarely enlarged. With some complications, a mild form of jaundice and darkening of the urine may occur.

The nervous system is rarely affected. But still there is a risk of the following diseases: serous meningitis. Affects the brain and spinal cord, but not purulent. Encephalomyelitis. It affects the brain, causing pathologies in the nervous system. Polyradiculoneuritis. Destroys nerve endings, causes numbness, muscle weakness and temporary paralysis.

A rash on the body may also appear: spots, growths, dots, hemorrhages. It will keep for about two weeks.

Diseases caused by the virus and their symptoms

How to distinguish the Epstein-Barr virus (EBV) from HIV, cytomegalovirus, tonsillitis.

Epstein-Barr virus causes the following diseases and symptoms of these diseases:

Filatov's disease - constant problems with the lymph nodes, circulatory system, liver and throat. In 90 percent of cases, it manifests itself in a chronic form;
Hodgkin's disease - the appearance of a tumor in the lymphatic system;
constant fatigue syndrome;
tumor on the nasopharynx;
Burkitt's lymphoma - she has a very high degree of malignancy;
permanent immune deficiency;
hepatitis - causes inflammation of the liver, most often chronic;
damage to the spinal cord and brain, can lead to sclerosis;
herpes - the appearance of growths on the lips and genitals;
a tumor on one of the organs of the digestive system;
mucosal disease - hairy leukoplakia;
otitis - inflammation of the ear;
rupture of the spleen due to excessive enlargement;
respiratory failure due to swelling of the tonsils;
violation of the functionality of the kidneys;
thrombocytopenic purpura - increased bleeding;
pancreatitis - inflammation of the pancreas;
myocarditis - inflammation of the heart;
cancer of the kidneys, ovaries, one of the organs of the lymphatic system or digestion.

Signs of chronic EBV infection

Chronic, erased and asymptomatic (latent) course of the Epstein-Barr virus (EBV).

The chronic form means that the duration of the course of the disease increases, and there is also a risk of relapse. The symptoms are as follows:

Great weakness, fatigue and increased sweating.
Pain in muscles and joints.
Cough and trouble breathing through the nose.
Headache, pain in the ribs, emotional instability, stress, sclerosis, inattention, poor sleep.
The size of the spleen and liver increases.
Great enlargement of the tonsils, accompanied by pain.

Very often, Epstein-Barr contributes to the appearance of bacteria, fungi and toxins, which leads to disruption of the functionality of the digestive system, herpes on the lips and genitals, thrush, and other problems associated with the reproductive system.

About an increase in the liver and spleen with the Epstein-Barr virus (EBV). Symptoms of a ruptured spleen.

If you experience any of the symptoms listed above, it is recommended that you see a doctor. If Epstein-Barr is confirmed, you'll be hospitalized. Treatment will be prescribed to suppress the development of the virus. You should not self-medicate, as this can lead to negative consequences.

What diseases are caused by the Epstein-Barr virus and their symptoms

Let's look at what diseases are caused by the Epstein-Barr virus and the symptoms of these diseases. The best-known whitening that Epstein virus causes is infectious mononucleosis, but apart from this, Epstein-Barr herpes can lead to Nasopharyngeal carcinoma, Burkitt's lymphoma, CFS (Chronic Fatigue Syndrome), and Lymphogranulomatosis. And now we will analyze these diseases and their symptoms in more detail.

Infectious mononucleosis

Mononucleosis is a disease that often occurs in young children. It is accompanied primarily by elevated body temperature up to 40 degrees, inflammation of the tonsils and an increase in submandibular lymph nodes. Inexperienced doctors often confuse mononucleosis with tonsillitis. But in the later stages, an increase in the spleen is observed, such symptoms usually reveal infectious mononucleosis. Less commonly, the liver may become enlarged, which can lead to hepatitis.

Infectious mononucleosis is also called AVIEB (acute Epstein-Barr virus infection). The incubation period for this disease ranges from one week to three weeks, but can last up to one and a half months.

Lymphogranulomatosis

Lymphogranulomatosis is a malignant tumor. This disease is also called Hodgkin's Lymphoma. This granuloma is theoretically associated with Epstein-Barr for several reasons, and one of them is the association of Hodgkin's Lymphoma with mononucleosis.

Of the symptoms, one can distinguish an increase in lymph nodes not only under the jaw, but also above the collarbones. This occurs at the very beginning of the disease and passes without pain. And then the disease begins to affect the internal organs.

Burkitt's lymphoma

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, such as into the bone marrow, blood, and cerebrospinal fluid. Source - Wikipedia.

If left untreated, lymphoma can lead to death very quickly. Of the symptoms, it is necessary to highlight the increase in internal organs, as a rule, in the abdominal region. Also, Burkitt's lymphoma can lead to constipation and cause bleeding. It happens that with this disease the jaw and neck swell.

Nasopharyngeal carcinoma

Another tumor disease, but with an unusual localization, namely in the nose. The tumor strengthens in the nasopharynx, and then metastasizes to the lymph nodes. Most often, Nasopharyngeal carcinoma is found in Eastern peoples.

The symptoms of this disease are initially associated with difficulty breathing through the nose, then problems with the ears begin, the person seems to gradually lose his hearing and feels discomfort in the area of the auricles.

chronic fatigue syndrome

The so-called chronic fatigue syndrome is a very controversial disease. It is associated with Epstein-Barr and other herpetic manifestations in the body. In the 80s in Nevada there were a large number of people (about two hundred people) with similar depressive symptoms and general weakness of the body. In the study, Epstein-Barr or other herpesviruses were found in all people. But later in Britain, it was nevertheless proved that CFS exists. In addition to the Epstein-Barr virus, chronic fatigue syndrome can also be caused by cytomegalovirus, Coxsackie virus and others.

Of the symptoms, constant fatigue should be distinguished, a person cannot sleep, his head hurts and he feels constant oppression of the body and weakness of the body.

Diagnostics and interpretation of analyzes

Checking the immune response to Epstein-Barr is done using serological blood tests. The analysis does not reveal the DNA of the Epstein-Barr virus, but how the immune system reacts to it.

In order to understand the diagnosis, it is necessary to disassemble some concepts:

IgG antibodies are class G immunoglobulins;
and IgM antibodies are class M immunoglobulins;
EA - early antigen;
EBNA - nuclear antigen;
VCA - capsid antigen.

In the case of the production of certain immunoglobulins to specific antigens, the status of infection with EBV is diagnosed.

To understand the diagnosis of EBV infection in more detail, it is necessary to consider class M immunoglobulins to the capsid antigen, as well as class G immunoglobulins to the capsid, early and nuclear antigens:

IgM to VCA. With the production of class M immunoglobulins to the capsid antigen, the acute stage of infection is diagnosed. That is, either the primary infection was within six months, or there was a relapse of the disease.
IgG to VCA. With the production of class G immunoglobulins to the capsid antigen, an acute form of the disease is diagnosed, which was transferred about a month ago. And also this result can be obtained in the future, since the disease has already been transferred by the body.
IgG to EBNA. The production of class G immunoglobulins to the nuclear antigen indicates that the body has good immunity to Epstein-Barr, which means that the person is completely healthy, which indicates that about six months have passed since infection.
IgG to EA. The production of class G immunoglobulin to an early antigen again tells us about the acute stage of the disease. Which indicates a period of 7 to 180 days of Epstein-Barr's stay in the body from the onset of infection.

Initially, when diagnosing Epstein-Barr, serological tests are done. If the analysis is completely negative, doctors resort to PCR (polymerase chain reaction). This analysis aims to identify the DNA of the virus. If the analysis is negative, this may indicate not only that the person has not encountered Epstein-Barr, but there may be a serious immunodeficiency.

Epstein-Barr Treatment Methods

Treatment for Epstein-Barr virus occurs either on an outpatient basis or during hospitalization. It all depends on how easy it will be to treat the Epstein virus, and this is determined by the severity of the disease. If there has been a reactivation of the Epstein-Barr virus infection, then often Epstein-Barr treatment occurs without hospitalization.

In order to treat the Epstein virus more effectively, a special diet is provided, in which they resort to mechanical or chemical sparing.

If we talk about how Epstein-Barr is treated with medications, it is necessary to distinguish three types of drugs:

Antiviral. Acyclovir is an ineffective Epstein-Barr drug and treatment with this antiviral agent is best started if there are no more effective drugs. Of the better antiviral drugs, Isoprinosine, Valtrex and Famvir can be distinguished.
interferon inductors. Of the interferon inducers, perhaps it is worth stopping at drugs such as Neovir - it is good because it can be taken from infancy. And also from good preparations there are also such as Cycloferon and Anaferon.
Interferon preparations. Of the interferons, Viferon and Kipferon have proven themselves well on the market, they are also convenient in that they can be taken even by newborn children.

Do not self-medicate and prescribe all of the above medications on your own. Do not forget that all antiviral drugs can cause serious side effects and lead to consequences. In addition, any drugs, including interferons, must be selected individually.

What complications can Epstein-Barr give and what is its danger

So, we figured out how the Epstein-Barr virus is treated, and now let's look at what the danger of the Epstein-Barr virus is. Epstein-Barr's main danger is autoimmune inflammation, since when Epstein-Barr enters the bloodstream, immunity begins to produce antibodies, the very immunoglobulins that were written about above. Immunoglobulins, in turn, form the so-called CIC (circulating immune complexes) with Epstein-Barr cells. And these complexes begin to spread throughout the body through the bloodstream and getting into any organ cause autoimmune diseases, of which there are quite a lot.

Epstein-Barr virus is a type 4 herpesvirus. The main disease with which it manifests itself is mononucleosis. It is found in the body of every person, and it manifests itself in lesions of the lymphatic tissue, spleen, liver and tonsils.

Epstein-Barr virus, symptoms in adults are non-specific. In the early stages, there is an increase in temperature, general malaise and intoxication of the body in the patient.

In this article you will learn:

Symptoms of a pathological condition in adults

Symptoms of the disease are characterized by a similar condition as with tonsillitis or flu.

The patient complains of an increase in body temperature up to 39-40 degrees, sharp pain in the throat.

However, there are other signs that indicate the presence of an infection. These include polyadenopathies. This is a process that is accompanied by an increase in lymph nodes in the back and front of the neck. They are joined by others throughout the body.

The size of the lymph nodes when affected by the Epstein-Barr virus increases to two centimeters in diameter.

When touched, slight pain may occur, while the skin above them remains in its previous state.

At the same time, other processes in the body also take place. The defeat of the oropharynx is accompanied by pain in the tonsils, this condition resembles the manifestations of a sore throat.

Sometimes there may be discharge of pus. Enlargement of the liver, spleen, and pain in the muscles, joints are much less common, but still present. The sizes of these organs acquire their former state 2-3 weeks after the onset of the disease.

Pathologies of the lymphoproliferative nature of autoimmune diseases are the main cause of the virus. It spreads rapidly and affects the human lymphatic system.

Therefore, you should take care of your health in order to avoid exacerbation of the Epstein-Barr virus.

Characteristic features

EBV affects many important organs and negatively affects the patient's immune system.

The main characteristic features of the Epstein-Barr virus in adults are:

The entire period of the disease, a person will feel unwell and sleep problems, which can lead to adverse consequences. This can lead to depression.

Another characteristic complication is chronic fatigue syndrome.

It occurs against the background of the Epstein-Barr virus and is accompanied by the following symptoms:

anger without reason for it, later pains are traced that spread in the joints and muscles, depressive and mental disorders, memory problems.

Prognosis and complications of Epstein-Barr virus

The virus infects the human body with various diseases.

However, it also affects him with such complications and consequences:

Inflammation of the heart muscle;
Dysfunction of the glomeruli of the kidneys;
Various hepatitis, especially its severe forms;
Inflammation of the membrane or even the brain.

Manifestations of tonsillitis during infection with the Epstein-Barr virus are possible. It is accompanied by sharp pains in the throat, fever and general malaise.

Complications of infection are different. It depends on how many months from the onset of the disease the Epstein-Barr virus progresses. Therefore, comprehensive and timely treatment will contribute to a quick recovery.

What tissues are affected by the virus

In an adult, after infection, the following types of diseases may appear:

Lymphogranulomatosis;
Burkitt's lymphoma;
Nasopharyngeal carcinoma;
Chronic Fatigue Syndrome.

Each type of disease contributes to the development of complications with different manifestations. However, one of the main organs that are affected in the first place are the lymph nodes. They can increase, while being painful during their examination.

EBV is a virus that has similar symptoms to other viral diseases.

However, it also affects the tissues of the spleen and liver, while they increase in size. After some time, these organs acquire their former shape.

In the patient's body, in addition to internal changes, external signs of the disease appear. This contributes to better detection of the disease and timely treatment.

Prevention

The problem of the spread of the Epstein-Barr virus is very relevant in the modern world, as many people become infected with it and have serious complications after that.

One of the manifestations of the virus is the occurrence of cancer.

Therefore, prevention is very important for many. It is impossible to cure type 4 herpes or find a vaccine for it. However, there are certain preventive methods aimed at improving the condition of a person and completely avoiding the manifestation of symptoms. It is impossible to avoid infection with the virus, but you should increase your immunity and body resistance to various diseases.

This contributes to the manifestation of the disease with minor consequences for the patient:

Timely treatment of other diseases.
Avoidance of stressful situations.
Hardening of the body from an early age.
Compliance with basic rules of personal hygiene.
Regular walks in the fresh air.
Taking vitamins, especially in winter.

By following these simple rules, you can avoid illness or its complications. However, if infection does occur, then the first thing that is needed is proper and timely treatment. So, you can avoid the complications and consequences of the Epstein-Barr virus.

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

According to statistics, up to 60% of children and almost 100% of adults are infected with this virus. The 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 route).

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

What diseases does

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

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

Diseases caused by the Epstein-Barr virus:

Filatov's disease (infectious mononucleosis);
Hodgkin's disease (lymphogranulomatosis);
chronic fatigue syndrome;
malignant formation of the nasopharynx;
lymphomas, including Burkitt's lymphoma;
general immune deficiency;
systemic hepatitis;
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.

Epstein-Barr virus symptoms

Acute infection (AVIEB)

OVIE is infectious mononucleosis.

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

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

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

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

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

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

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

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

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

Chronic Epstein-Barr virus infection

HIVEB is characterized by a long duration and periodic relapses of the disease.

Patients complain of general fatigue, weakness, excessive sweating. There may be pain in the muscles and joints, exanthema (rash), persistent cough in the form of groaning, impaired nasal breathing.

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

There is generalized lymphadenopathy, hypertrophy of the pharyngeal and palatine tonsils, enlargement of the liver and spleen. Often, bacteria and fungi (genital herpes and herpes of the lips, thrush, inflammatory processes of the digestive tract and respiratory system) join a chronic Epstein-Barr virus infection.

Diagnostics

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

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

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

according to independent laboratory Invitro

5. DNA diagnostics

Using the polymerase chain reaction (PCR) method, 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) is determined.

6. Other examinations and consultations as indicated

Consultation of an ENT doctor and an immunologist, X-ray of the chest and paranasal sinuses, ultrasound of the abdominal cavity, assessment of the blood coagulation system, consultation of an oncologist and a hematologist.

Treatment for Epstein-Barr virus infection

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

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

Various groups of antiviral drugs are actively used: isoprinosine, valtrex, acyclovir, arbidol, viferon, intramuscular interferons (reaferon-EC, roferon).

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

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

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

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

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

Complications and prognosis

Complications of acute and chronic Epstein-Barr virus infection:

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

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

Epstein-Barr virus is widespread on all continents, it is registered both in adults and in children. In most cases, the course of the disease is benign and ends in recovery. An asymptomatic course is recorded in 10–25% of cases, in 40% the infection proceeds under the guise of acute respiratory infections, in 18% of cases infectious mononucleosis is recorded in children and adults.

In patients with reduced immunity, the disease proceeds for a long time, with periodic exacerbations, the appearance of complications and the development of adverse outcomes (autoimmune pathology and cancer) and secondary immunodeficiency states. The symptoms of the disease are varied. The leading ones are intoxication, infectious, gastrointestinal, cerebral, arthralgic and cardiac syndromes. Treatment of Epstein-Barr virus infection (EBVI) is complex and includes antiviral drugs, immunomodulators, drugs for pathogenetic and symptomatic therapy. Children and adults after the disease need long-term rehabilitation and clinical and laboratory control.

Rice. 1. The photo shows the Epstein-Barr virus. View in an electron microscope.

Epstein-Barr virus

The Epstein-Barr virus was discovered in 1964 by M. Epstein and Y. Barr. It belongs to the family of herpes viruses (it is a type 4 herpes virus), a subfamily of gamma viruses, a genus of lymphocryptoviruses. The pathogen has 3 antigens: nuclear (EBNA), capsid (VCA) and early (EA). A viral particle consists of a nucleotide (contains 2-stranded DNA), a capsid (consists of protein subunits) and a lipid-containing shell.

Viruses target B-lymphocytes. In these cells, pathogens are able to stay for a long time and, with a decrease in the functioning of the immune system, they cause the development of chronic Epstein-Barr virus infection, a number of severe oncological pathologies of a lymphoproliferative nature, autoimmune diseases, and chronic fatigue syndrome.

Reproducing, viruses activate the division of B-lymphocytes and are transmitted to their daughter cells. Mononuclear cells appear in the patient's blood - atypical lymphocytes.

Pathogens, thanks to a large set of genes, are able to elude the human immune system. And the greater ability to mutate allows viruses to avoid the effects of antibodies (immunoglobulins) developed before the mutation. All this is the reason for the development of secondary immunodeficiency in infected people.

Specific antigens of the Epstein-Barr virus (capsid, nuclear, membrane) are formed sequentially and induce (promote) the synthesis of the corresponding antibodies. Antibodies in the patient's body are produced in the same sequence, which makes it possible not only to diagnose the disease, but also to determine the duration of infection.

Rice. 2. The photo shows two Epstein-Barr viruses under a microscope. The genetic information of virions is enclosed in a capsid - a protein shell. Outside, virions are freely surrounded by a membrane. The capsid core and membrane of viral particles have antigenic properties, which provides pathogens with a high damaging ability.

Epidemiology of Epstein-Barr virus infection

The disease is slightly contagious (slightly contagious). Viruses infect both adults and children. Most often, EBVI is asymptomatic or in the form of acute respiratory infections. Children of the first 2 years of life are infected in 60% of cases. The proportion of people who have antibodies to viruses in their blood among adolescents is 50-90% in different countries, among adults - 95%.

Epidemic rises of the disease are observed 1 time in 5 years. The disease is more often recorded in children aged 1-5 years, staying in organized groups.

Source of infection

The Epstein-Barr virus enters the human body from patients with clinically pronounced and asymptomatic forms of the disease. Patients who have suffered the disease in an acute form remain dangerous to others from 1 to 18 months.

Ways of transmission of the pathogen

The Epstein-Barr virus is spread by airborne droplets (with saliva), contact-household (through household items, toys, oral sex, kissing and shaking hands), parenteral (through blood transfusion), sexual and vertical (from mother to fetus).

entrance gate

The entrance gate for the pathogen is the mucous membrane of the upper respiratory tract. First of all, organs rich in lymphoid tissue are affected - tonsils, spleen and liver.

Rice. 3. Epstein-Barr virus is transmitted through saliva. The disease is often referred to as "kissing disease".

How the disease develops in adults and children

Epstein-Barr virus enters the upper respiratory tract most often by airborne droplets. Under the influence of infectious agents, epithelial cells of the mucous membrane of the nose, mouth and pharynx are destroyed and pathogens penetrate in large numbers into the surrounding lymphoid tissue and salivary glands. Having penetrated B-lymphocytes, pathogens spread throughout the body, affecting primarily the lymphoid organs - tonsils, liver and spleen.

In the acute stage of the disease, viruses infect one of every thousand B-lymphocytes, where they multiply intensively and potentiate their division. When B-lymphocytes divide, viruses are transmitted to their daughter cells. By integrating into the genome of infected cells, viral particles cause chromosomal abnormalities in them.

Part of the infected B-lymphocytes is destroyed as a result of the multiplication of viral particles in the acute phase of the disease. But if there are few viral particles, then B-lymphocytes do not die so quickly, and the pathogens themselves, persisting for a long time in the body, gradually affect other blood cells: T-lymphocytes, macrophages, NK cells, neutrophils and vascular epithelium, which leads to the development secondary immunodeficiency.

Pathogens can be in the epithelial cells of the nasopharyngeal region and salivary glands for a long time. Infected cells stay in the crypts of the tonsils for quite a long time (from 12 to 18 months), and when they are destroyed, viruses with saliva are constantly released into the external environment.

Pathogens in the human body persist (stay) for life and subsequently, with a decrease in the functioning of the immune system and hereditary predisposition, they cause the development of chronic Epstein-Barr virus infection and a number of severe oncological pathologies of a lymphoproliferative nature, autoimmune diseases and chronic fatigue syndrome.

In HIV-infected people, EBVI manifests itself at any age.

In children and adults infected with Epstein-Barr viruses, pathological processes rarely develop, since the normal immune system of the body in most cases is able to control the infection and counteract it. An acute bacterial or viral infection, vaccination, stress - everything that strikes at the immune system leads to the active reproduction of pathogens.

Rice. 4. Epstein-Barr virus under a microscope.

EBVI classification

EBVI can be congenital (in children) or acquired (in children and adults).
The form distinguishes between typical (infectious mononucleosis) and atypical forms (asymptomatic, obliterated, visceral).
The infection can have a mild, protracted and chronic course.
The leading ones are intoxication, infectious (mononuclear-like), gastrointestinal, cerebral, arthralgic and cardiac syndromes.

Acute Epstein-Barr virus infection in adults and children

Acute primary infection caused by Epstein-Barr viruses or mononuclear syndrome (not to be confused with infectious mononucleosis) in adults and children begins with high fever, sore throat and enlarged posterior cervical lymph nodes. The anterior cervical and ulnar lymph nodes are slightly enlarged. There are cases of generalized lymphadenopathy. At a half of patients the spleen increases, at 10 — 30% of patients increase in a liver is noted. Some patients develop periorbital edema.

The incubation period for EBVI lasts 4 to 7 days. Most clearly, all symptoms appear on average by the 10th day of illness.

Symptoms of the acute form of EBVI

Intoxication syndrome

Most cases of the disease begin acutely with a high body temperature. Weakness, lethargy, malaise and loss of appetite are the main symptoms of EBVI during this period. Initially, the body temperature is subfebrile. After 2-4 days it rises to 39-40 0 С.

Generalized lymphadenopathy

Generalized lymphadenopathy is a pathological symptom of EBVI in adults and children. Manifested from the first days of the disease. Increase simultaneously 5 - 6 groups of lymph nodes: more often posterior cervical, somewhat less often - anterior cervical, submandibular and ulnar. In diameter from 1 to 3 cm, they are not soldered to each other, arranged either in chains or in packages. Well visible when turning the head. Sometimes pastosity of tissues is noted above them.

Rice. 5. Most often, with EBVI, the posterior cervical lymph nodes increase. They are clearly visible when turning the head.

Symptoms of tonsillitis in acute form of EBVI

Tonsillitis is the most common and early symptom of the disease in adults and children. Tonsils increase to II - III degree. Their surface becomes smoothed due to infiltration and lymphostasis with islands of dirty gray plaques, sometimes resembling lace, as in diphtheria, they are easily removed with a spatula, they do not sink in water, they are easily rubbed. Sometimes raids become fibrous-necrotic in nature and spread beyond the tonsils. Signs and symptoms of tonsillitis with Epstein-Barr virus infection disappear after 5 to 10 days.

Rice. 6. Angina with EBVI. When plaque spreads beyond the tonsils, differential diagnosis with diphtheria should be carried out (photo on the right).

Symptoms of adenoiditis in acute form of EBVI

Adenoiditis in the disease is often recorded. Nasal congestion, obstructed nasal breathing, and snoring while sleeping with an open mouth are the main symptoms of Epstein-Barr virus infection in adults and children. The patient's face becomes puffy (acquires an "adenoid" appearance), the lips are dry, the eyelids and bridge of the nose are pasty.

Enlargement of the liver and spleen

The liver with a disease in children and adults increases already at the beginning of the disease, but most often - in the 2nd week. Its dimensions return to normal within 6 months. 15-20% of patients develop hepatitis.

Enlargement of the spleen in adults and children is a later symptom of the disease. Its dimensions are normalized in 1-3 weeks.

Rash

Exanthema (rash) appears on 4-14 days of illness. She is varied. It happens spotty, papular, roseolous, punctate or hemorrhagic, without a specific localization. Observed 4 - 10 days. Often leaves behind pigmentation. Especially often the rash appears in children receiving amoxicillin or ampicillin.

Hematological changes

In the acute form of EBVI, leukocytosis, neutropenia, lymphocytosis, and monocytosis are noted. Mononuclear cells appear in the blood in an amount from 10 to 50 - 80%. Mononuclear cells appear on the 7th day of illness and persist for 1-3 weeks. ESR rises to 20 - 30 mm / hour.

Rice. 7. Rash in children with Epstein-Barr virus infection.

Outcomes of acute EBVI in adults and children

There are several options for the outcome of the acute form of the Epstein-Barr virus infection:

Recovery.
Asymptomatic virus carrier.
Chronic recurrent infection.
The development of oncological diseases.
development of autoimmune diseases.
The occurrence of chronic fatigue syndrome.

Disease prognosis

The prognosis of the disease is influenced by a number of factors:

Degree of immune dysfunction.
Genetic predisposition to Epstein-Barr virus-associated diseases.
An acute bacterial or viral infection, vaccination, stress, surgery - everything that strikes at the immune system leads to the active reproduction of pathogens.

Rice. 8. In the photo, infectious mononucleosis in adults. Enlarged lymph nodes are an important sign of the disease.

Infectious mononucleosis is a dangerous disease. At the first signs and symptoms of the disease, you should immediately consult a doctor.

Chronic Epstein-Barr virus infection in adults and children

The chronic form of the disease in adults and children has a variety of manifestations and course options, which makes the diagnosis much more difficult. Chronic Epstein-Barr virus infection is long-term, has a relapsing course. Manifested by chronic mononucleosis-like syndrome, multiple organ failure, hemophagocytic syndrome. There are generalized and erased forms of the disease.

Chronic mononucleosis-like syndrome: signs and symptoms

Chronic mononucleosis-like syndrome in children and adults is characterized by an undulating course, often characterized by patients as chronic influenza. Subfebrile body temperature, weakness and malaise, muscle and joint pain, loss of appetite, discomfort in the throat, difficulty in nasal breathing, heaviness in the right hypochondrium, headaches and dizziness, depression and emotional lability, decreased memory, attention and intelligence are the main symptoms of the disease. Patients have an increase in lymph nodes (generalized lymphadenopathy), an increase in the liver and spleen. The palatine tonsils are enlarged (hypertrophied).

Hemophagocytic syndrome

Hyperproduction of anti-inflammatory cytokines by virus-infected T cells leads to activation of the phagocyte system in the bone marrow, liver, peripheral blood, lymph nodes, and spleen. Activated histiocytes and monocytes engulf blood cells. Anemia, pancytopenia and coagulopathy occur. The patient is concerned about intermittent fever, hepatosplenomegaly, generalized lymphadenopathy, liver failure develops. Lethality reaches 35%.

Consequences of the development of an immunodeficiency state in adults and children

Reduced immunity leads to the development of many diseases of an infectious and non-infectious nature. Conditionally pathogenic flora is activated. Viral, fungal and bacterial infections develop. ARI and other diseases of the ENT organs (rhinopharyngitis, adenoiditis, otitis media, sinusitis, laryngotracheitis, bronchitis and pneumonia) are recorded in patients up to 6-11 times a year.

In patients with a weakened immune system, the number of B-lymphocytes can increase to a huge amount, which negatively affects the work of many internal organs: the respiratory and central nervous systems, the heart, joints, biliary dyskinesia develops, and the gastrointestinal tract is affected.

Rice. 9. Lymphocytic infiltrates in the surface layers of the epithelium of the mucous membrane of the intestinal crypts.

Generalized form of EBVI: signs and symptoms

With severe immune deficiency, patients develop a generalized form of EBVI. Damage to the central and peripheral nervous system is noted. Meningitis, encephalitis, cerebellar ataxia, polyradiculoneuritis develop. Internal organs are affected - kidneys, heart, liver, lungs, joints. The disease often ends in the death of the patient.

Atypical forms of the disease

There are two forms of an erased (latent, sluggish) or atypical form of the disease.

In the first case, patients are concerned about prolonged subfebrile condition of unknown origin, weakness, muscle and joint pain, pain on palpation in the area of peripheral lymph nodes. The disease in adults and children proceeds in waves.
In the second case, all the above complaints are accompanied by symptoms indicating the development of secondary immunodeficiency: diseases of a viral, bacterial or fungal nature develop. There is damage to the respiratory tract, gastrointestinal tract, skin, genital organs. Diseases proceed for a long time, often recur. The duration of their course ranges from 6 months to 10 years or more. Viruses are found in blood lymphocytes and/or saliva.

Rice. 10. Rash in infectious mononucleosis in children.

Asymptomatic carrier

The asymptomatic course is characterized by the absence of clinical and laboratory signs of the disease. DNA of viruses is determined by PCR.

Diagnosis of the chronic form of the Epstein-Barr virus infection

Chronic EBVI is characterized by a symptom complex, including prolonged low-grade fever of unknown origin, decreased performance, unmotivated weakness, sore throat, enlarged peripheral lymph nodes, liver and spleen, liver dysfunction and mental disorders.

A characteristic feature is the absence of a clinical effect from the ongoing conventional therapy.

In the anamnesis of such patients, there are indications of prolonged excessive mental overload and stressful situations, passion for trendy diets and starvation.
Indicates a chronic course:

transferred infectious mononucleosis not more than six months ago or a disease that occurs with high titers of IgM class antibodies (to the capsid antigen);
histological examination (examination of tissues) of organs involved in the pathological process (lymph nodes, liver, spleen, etc.);
an increase in the number of viruses in the affected tissues, proven by the method of anticomplementary immunofluorescence with the nuclear antigen of the virus.

Viral activity is indicated by:

Relative and absolute lymphocytosis. The presence of atypical mononuclear cells in the blood. Somewhat less often lymphopenia and monocytosis. In some cases, thrombocytosis and anemia.
Changes in the immune status (decrease in the content and dysfunction of natural killers of cytotoxic lymphocytes, impaired humoral response).

Differential diagnosis of chronic EBVI

Chronic Epstein-Barr virus infection should be distinguished from viral diseases (viral hepatitis, cytomegalovirus infection, toxoplasmosis, etc.), rheumatic and oncological diseases.

Rice. 11. One of the symptoms of EBVI is a rash on the body of a child and an adult.

virus-associated diseases

Viruses in the human body persist (stay) for life and subsequently, with a decrease in the functioning of the immune system and hereditary predisposition, they cause the development of a number of diseases: severe oncopathology, lymphoproliferative syndrome, autoimmune diseases and chronic fatigue syndrome.

Development of oncopathology

Infection of B-lymphocytes and violation of their differentiation are the main causes of the development of malignant tumors and paraneoplastic processes: polyclonal lymphoma, nasopharyngeal carcinoma, leukoplakia of the tongue and oral mucosa, tumors of the stomach and intestines, uterus, salivary glands, lymphoma of the central nervous system, Burkitt's lymphoma, in AIDS patients.

Development of autoimmune diseases

Epstein-Barr viruses play an important role in the development of autoimmune diseases: rheumatoid arthritis, systemic lupus erythematosus, Sjögren's syndrome, vasculitis, ulcerative colitis.

The development of chronic fatigue syndrome

Epstein-Barr viruses play an important role in the development of chronic fatigue syndrome along with human herpes viruses types 6 and 7.

Some types of oncopathology and paraneoplastic processes

Burkitt's lymphoma

Burkitt's lymphoma is common in Central Africa, where it was first described in 1958 by surgeon Denis Burkitt. It has been proven that the African variant of lymphoma is associated with the effect of viruses on B-lymphocytes. When sporadic("non-African") lymphoma, the association with the virus is less clear.

Most often, single or multiple malignant neoplasms are recorded in the jaw area, growing into neighboring tissues and organs. Young men and children get sick more often. In Russia, there are isolated cases of the disease.

Rice. 12. In the photo, Burkitt's lymphoma is one of the malignant tumors caused by the Epstein-Barr virus. This group includes cancer of the nasopharynx, tonsils, many lymphomas of the central nervous system.

Rice. 13. Burkitt's lymphoma occurs mainly in children of the African continent 4-8 years old. Most often, the upper and lower jaws, lymph nodes, kidneys and adrenal glands are affected.

Rice. 14. T-cell lymphoma of the nasal type. The disease is common in Central and South America, Mexico and Asia. Especially often this type of lymphoma is associated with the Epstein-Barr virus in Asian residents.

Nasopharyngeal carcinoma

Rice. 15. In the photo, an increase in lymph nodes with nasopharyngeal carcinoma in an HIV-infected person.

Kaposi's sarcoma

This is a malignant multifocal tumor of vascular origin that affects the skin, mucous membranes and internal organs. It has several varieties, one of which is the epidemic sarcoma associated with AIDS.

Rice. 16. Kaposi's sarcoma in AIDS patients.

Leukoplakia of the tongue

In some cases, the cause of the disease is the Epstein-Barr virus, which multiplies in the epithelial cells of the mouth and tongue. Plaques of gray or white color appear on the tongue, gums, cheeks and the surface of the sky. They are fully formed within a few weeks and even months. Hardening, plaques take the form of thickened areas that rise above the surface of the mucous membrane. The disease is often recorded in HIV-infected patients.

Rice. 17. In the photo, hairy leukoplakia of the tongue.

Autoimmune diseases

Epstein-Barr virus contributes to the development of autoimmune diseases - systemic lupus erythematosus, rheumatoid arthritis, Sjögren's syndrome, vasculitis, ulcerative colitis.

Rice. 18. Systemic lupus erythematosus.

Rice. 19. Systemic lupus erythematosus and rheumatoid arthritis.

Rice. 20. Sjögren's syndrome is an autoimmune disease. Dry eyes and dry mouth are the main symptoms of the disease. Often the cause of the disease is the Epstein-Barr virus.

Congenital Epstein-Barr virus infection

Congenital Epstein-Barr virus infection is recorded in 67% of cases of the acute form of the disease and in 22% of cases with the activation of the chronic course of infection in women during pregnancy. Newborns are born with pathology of the respiratory, cardiovascular and nervous systems, and their own antibodies and mother's antibodies can be determined in their blood. The gestation period can be interrupted by miscarriages or premature births. Children born with immunodeficiency die from proliferative syndrome as soon as possible after birth.

Diagnosis of the disease

When making a diagnosis of Epstein-Barr virus infection, the following laboratory research methods are used:

General clinical research.
Study of the patient's immune status.
DNA diagnostics.
Serological studies.
Study of various materials in dynamics.

Clinical blood test

In the study, there is an increase in the number of leukocytes, lymphocytes and monocytes with atypical mononuclear cells, hemolytic or autoimmune anemia, a decrease or increase in the number of platelets.

In severe cases, the number of lymphocytes increases significantly. From 20 to 40% of lymphocytes acquire an atypical form. Atypical lymphocytes (mononuclear cells) remain in the patient's body from several months to several years after infectious mononucleosis.

Rice. 21. In the photo, atypical lymphocytes are mononuclear cells. Always found in blood tests for Epstein-Barr virus infections.

Blood chemistry

There is an increase in the level of transaminases, enzymes, C-reactive protein, fibrinogen.

Clinical and biochemical parameters are not strictly specific. Changes are also detected in other viral diseases.

Immunological studies

Immunological studies in the disease are aimed at studying the state of the interferon system, the level of immunoglobulins, the content of cytotoxic lymphocytes (CD8+) and T-helpers (CD4+).

Serological studies

Antigens of Epstein-Barr viruses are formed sequentially (surface → early → nuclear → membrane, etc.) and antibodies to them are also sequentially formed, which makes it possible to diagnose the disease and determine the duration of infection. Antibodies to the virus are determined by ELISA (enzymatic immunoassay).

The production of antigens by Epstein-Barr viruses is carried out in a certain sequence: surface → early → nuclear → membrane, etc.

Specific IgM in the patient's body appear in the acute period of the disease or during exacerbations. Disappear after 4-6 weeks.
Specific IgG to EA ("early") in the patient's body also appear in the acute period, decrease during recovery within 3-6 months.
Specific IgG to VCA ("early") in the patient's body also appear in the acute period. Their maximum is recorded at 2-4 weeks and then there is a decrease, but the threshold level remains for a long time.
IgG to EBNA are detected 2-4 months after the end of the acute phase and are produced in the future throughout life.

Polymerase chain reaction (PCR)

With the help of PCR in case of illness, Epstein-Barr viruses are determined in various biological materials: blood serum, saliva, lymphocytes and leukocytes of peripheral blood. If necessary, biopaths of the liver, intestinal mucosa, lymph nodes, scrapings of the oral mucosa and urogenital tract, prostate secretion, cerebrospinal fluid, etc. are examined. The sensitivity of the method reaches 100%.

Differential Diagnosis

Diseases that have a similar clinical picture include:

HIV infection and AIDS,
anginal (painful) form of listeriosis,
measles,
viral hepatitis,
(CMVI),
localized diphtheria of the pharynx,
angina,
adenovirus infection,
blood diseases, etc.

The fundamental criteria for differential diagnosis are changes in the clinical blood test and serological diagnosis.

Rice. 22. Enlargement of lymph nodes in children with infectious mononucleosis.

Treatment of Epstein-Barr virus infection in adults and children

Before starting treatment for Epstein-Barr virus infection, it is recommended to examine all members of the patient's family in order to identify the release of pathogens with saliva. If necessary, they are given antiviral therapy.

Treatment of EBVI in adults and children during the period of acute manifestation of primary infection

During the period of acute manifestation of primary infection, special treatment for Epstein-Barr virus infection is not required. However, with prolonged fever, a pronounced manifestation of tonsillitis and tonsillitis, an increase in lymph nodes, jaundice, an increasing cough and the appearance of pain in the abdomen, hospitalization of the patient is necessary.

In case of mild and moderate severity of the course of the disease, the patient is recommended a general regimen at an adequate energy level. Prolonged bed rest prolongs the healing process.

Analgesics are used to reduce pain and inflammation. The drugs of the group of non-narcotic analgesics have proven themselves well: Paracetamol and its analogues Ibuprofen and its analogues.

Rice. 23. In the photo on the left is Tylenol (the active ingredient is paracetamol). In the photo on the right is the drug Advil (active ingredient is ibuprofen).

With the threat of developing a secondary infection and with symptoms of discomfort in the throat, drugs are used, which include antiseptics, disinfectants and painkillers.

It is convenient to treat diseases of the oropharynx with combined preparations. They include antiseptics and disinfectants with antibacterial, antifungal, and antiviral effects, painkillers, vegetable oils and vitamins.

Combined preparations for topical use are available in the form of sprays, rinses and lozenges. The use of drugs such as Hexetidine, Stopangin, Geksoral, Tantum Verde, Yoks, Miramistin is shown.

For sore throats, the use of drugs such as TheraFlu LAR, Strepsils Plus, Strepsils Intensive, Flurbiprofen, Tantum Verde, Anti-Angin Formula, Neo-angin, Cameton - aerosol is indicated. Local preparations containing anesthetic components in their composition should not be used in children under 3 years of age due to the risk of developing laryngospasm in them.

Local treatment with antiseptics and disinfectants is indicated in case of secondary infection. In infectious mononucleosis, tonsillitis is aseptic.

Treatment of EBVI in adults and children with a chronic course of the disease

Treatment of Epstein-Barr virus infection is based on an individual approach to each patient, taking into account the course of the disease, its complications and the state of the immune status. Treatment of chronic EBVI should be complex: etiotropic (primarily aimed at the destruction of viruses), continuous and long-term, with continuity of therapeutic measures in a hospital, outpatient setting and rehabilitation. Treatment should be carried out under the control of clinical and laboratory parameters.

Basic therapy

The mainstay of EBVI treatment is antiviral drugs. At the same time, the patient is recommended a protective regimen and dietary nutrition. Treatment of the infection with other drugs is optional.

Of the antiviral drugs used:

Isoprinosine (Inosine pranobex).
Acyclovir and Valtrex (abnormal nucleosides).
Arbidol.
Interferon preparations: Viferon (recombinant IFN α-2β), Reaferon-EC-Lipint, Kipferon, interferons for intramuscular injection (Realdiron, Reaferon-EC, Roferon A, Intron A, etc.).
IFN inductors: Amiksin, Anaferon, Neovir, Cycloferon.

Long-term use of Viferon and Inosine pranobex potentiates immunocorrective and antiviral effects, which significantly increases the effectiveness of treatment.

Immunocorrective therapy

In the treatment of EBVI, the following are used:

Immunomodulators Likopid, Polyoxidonium, IRS-19, Ribomunil, Derinat, Imudon, etc.
Cytokines Leukinferon and Roncoleukin. They contribute to the creation of antiviral readiness in healthy cells, suppress the reproduction of viruses, and stimulate the work of natural killer cells and phagocytes.
Immunoglobulins Gabriglobin, Immunovenin, Pentaglobin, Intraglobin, etc. The drugs of this group are prescribed in case of severe Epstein-Barr infection. They block "free" viruses that are in the blood, lymph and interstitial fluid.
Thymus preparations ( Thymogen, Immunofan, Taktivin etc.) have a T-activating effect and the ability to stimulate phagocytosis.

Treatment of the Epstein-Barr virus infection with drugs, correctors and immune stimulants is carried out only after an immunological examination of the patient and a study of his immune status.

Symptomatic remedies

For fever, antipyretics such as Ibuprofen, Paracetamol, etc. are used.
With difficulty in nasal breathing, nasal preparations of Polydex, Isofra, Vibrocil, Nazivin, Adrianol, etc. are used.
With a dry cough in adults and children, Glauvent, Libexin, etc. are indicated.
With a wet cough, mucolytics and expectorants are prescribed (Bromhexal, Ambro GEKSAL, Acetylcysteine, etc.

Antibacterial and antifungal drugs

In the case of a secondary infection, antibiotics are prescribed. With the Epstein-Barr virus infection, streptococci, staphylococci, fungi of the genus Candida are more often found. The drugs of choice are 2-3 generation cephalosporins, macrolides, carbapenems, and antifungals. With a mixed microflora, the drug metronidazole is indicated. Locally applied antibacterial drugs such as Stopangin, Lizobakt, Bioparox, etc.

Means of pathogenetic therapy

Medications for metabolic rehabilitation: Elkar, Solcoseryl, Actovegin, etc.
To normalize the work of the gastrointestinal tract, hepatoprotectors (Galsten, Hofitol, etc.), enterosorbents (Filtrum, Smecta, Polyphepan, Enterosgel, etc.), probiotics (Acipol, Bifiform, etc.) are used.
Angio- and neuroprotectors (Gliatilin, Instenon, Encephabol, etc.).
Cardiotropic drugs (Cocarboxylase, Cytochrome C, Riboxin, etc.).
Antihistamines I and III generations (Fenistil, Zyrtec, Claritin, etc.).
Protease inhibitors (Gordoks, Kontrykal).
Hormonal preparations prednisolone, hydrocortisone and dexamethasone are prescribed for severe infection - airway obstruction, neurological and hematological complications. The drugs in this group reduce inflammation and protect organs from damage.
Detoxification therapy is carried out when the disease becomes severe and is complicated by rupture of the spleen.
Vitamin-mineral complexes: Vibovit, Multi-tabs, Sanasol, Biovital gel, Kinder, etc.
Antihomotoxic and homeopathic remedies: Aflubin, Oscillococcinum, Tonsilla compositum, Lymphomyosot, etc.
Non-drug methods of treatment (magnetotherapy, laser therapy, magnetotherapy, acupuncture, exercise therapy, massage, etc.)
In the treatment of asthenic syndrome, adaptogens, high doses of B vitamins, nootropics, antidepressants, psychostimulants and correctors of cellular metabolism are used.

Rehabilitation of children and adolescents

Children and adults after EBVI need long-term rehabilitation. The child is removed from the register in half a year - a year after the normalization of clinical and laboratory parameters. Examination by a pediatrician is carried out once a month. If necessary, the child is referred for a consultation with an ENT doctor, hematologist, immunologist, oncologist, etc.

Of the laboratory methods of examination are used:

Once a month for 3 months, a general blood test.
1 time in 3 months ELISA.
PCR according to indications.
Throat swab once every 3 months.
Immunogram 1 time in 3 - 6 months.
According to the indications, biochemical studies are carried out.

Complex therapy and an individual approach in choosing the tactics of managing a patient, both at home and in a hospital, are the key to successful treatment of the Epstein-Barr virus infection.

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