Although modern medicine can save a person from many diseases and their terrible consequences, there are still problems that it cannot completely solve. The Epstein-Barr herpes virus in children, which does not manifest itself for a long time, is just one of these. For a child whose immunity is not yet very strong, the risk of infection is higher than for an adult. How to protect it?

Reasons for the appearance of the virus in the body

The pathogen enters the body in several ways:

• airborne (if the patient coughs and sputum penetrates the skin/eyes);
• contact-household (when using the same things with the patient);
• sexual (a child can become infected while in the mother’s womb or during conception);
• after a transfusion of contaminated blood.

Most often, it is transmitted to a child from a pregnant mother, for example, through a kiss (which is why mononucleosis is called the “kissing disease”). Scientists say that about 90% of the world's population are carriers of the virus, and everyone is capable of infecting a child with it. The main risk group is children under 1 year of age.

The disease takes from 4 weeks to several months to incubate. For a long time, it simply “nests” in blood cells, which are not destroyed, and even multiplies inside them. The body develops immunity to the pathogen, but this does not mean that mononucleosis, as one of the consequences, will not develop.

Epstein-Barr virus in children can occur in a latent form for 3 years after infection. To start the inflammatory process, you don’t need a large number of bacteria, and the trigger can be anything, from frostbite to another vaccination. If, at the time of intoxication or a sharp decrease in immunity, there are enough viruses in the body, this can provoke a disease.

Consequences of pathogen infection

Despite the fact that modern medicine knows how to treat the Epstein-Barr virus in children, it is almost impossible to completely get rid of the consequences of infection. A disease provoked by a pathogen - infectious mononucleosis - for a long time was generally considered exclusively for children.

And, alas, it has certain, not the most pleasant consequences. For example, even after recovery from infectious mononucleosis, the lymph nodes will enlarge (albeit slightly), and for about a year and a half the patient can accidentally transmit the pathogen by airborne droplets. This is especially true in cases where the virus triggers pathological processes in the body, but does not manifest itself externally. This can affect, for example, the kidneys and liver. There are frequent cases in which mononucleosis causes cancer.

If treatment is not started on time or treated incorrectly, the following complications may develop:

• anemia (anemia) associated with a change in the number of blood cells in the vessels;
• proliferative syndrome (can develop if the immune system is already impaired, and lead to numerous disorders in the internal functioning of the body);
• breathing problems (lymph nodes grow in size and simply block the airways);
• damage to the central nervous system (encephalitis, meningitis);
• rupture of the spleen (in case of excessive physical exertion during illness);
• disease of the cranial nerves (Martin-Bell syndrome, neuropathy, myelitis);
• hairy leukoplakia of the mouth (expressed in the appearance of specific tubercles inside the cheeks and on the tongue and may indicate third-party infection with HIV infection);
• complete blockage of the nasal sinuses and ear canals – otitis media, sinusitis;
• rapid hepatitis.

It is much more difficult to cure secondary diseases. Therefore, at the slightest suspicion of mononucleosis, it is necessary to show the child to a doctor to rule out the Epstein-Barr virus.

Symptoms in children. How to recognize that a child is sick?

The degree of manifestation of infectious mononucleosis directly depends on the form of the pathology. So, if there is a virus in the body, but without a pronounced disease, its presence can be detected through diagnostics. Another form, chronic, appears periodically, progresses imperceptibly, and sometimes even expands the lesion. According to statistics, chronic mononucleosis occurs most often.

The first symptoms of the pathogen, unfortunately, appear weakly or are perceived as a common cold. Later, when the disease is at an advanced stage, parents note a variety of manifestations: from the usual enlargement of lymph nodes to mental disorders. Other common symptoms:

• high temperature (above 37.5°);
• mild migraine;
• frequent fungal infections;
• disturbances in the functioning of the central nervous system, irritability, due to which the child begins to cry;
• slight hyperplasia of the lymph nodes in the neck and ears, occasionally throughout the body;
• skin rashes;
• muscle pain;
• weakened digestion, rare stools, weakened appetite;
• chronic fatigue;
• pneumonia.

The acute form of the disease is characterized by the following symptoms:

• high fever;
• hyperplasia of lymph nodes;
• enlarged liver/spleen;
• tonsillitis, breathing problems;
• third-party hepatitis.

The older the child, the more pronounced the symptoms appear, and the easier it is to identify the disease. The more accurately the parent describes the clinical picture, the faster the doctor will tell you how to treat the child - and, therefore, the lower the risk of complications.

Pathogen diagnosis

Most often, according to statistics, the presence of a pathogen in the body is diagnosed between the ages of 4 and 15 years. Before this, the Epstein-Barr virus manifests itself slightly.

Symptoms and treatment of children must be carried out under the supervision of a doctor!

The following methods are used in diagnosis:

1. An immunogram indicates the number of immune cells that are responsible for fighting infection - if there are any deviations from the norm, the disease is diagnosed. Different pathologies cause different abnormalities, so in some cases an immunogram is used as an additional study;
2. PCR (polysized chain reaction) studies DNA and gives a 100% error-free result. The technique allows you to determine whether the child has antibodies, what stage the disease is at, how enlarged the internal organs are (and whether they are enlarged at all). It is mandatory after blood transfusion and organ transplantation.

If Epstein-Barr virus is detected in a child, there is no need to panic. With timely suppression of signs of the disease, timely prevention, hardening and a healthy lifestyle, it is quite possible to get rid of problems.

What tests will be needed?

A patient with suspected mononucleosis will have to undergo the following tests:

• general blood test. Detects the number of blood cells (lymphocytes and platelets), as well as their condition, and is used to determine the stage and form of the disease;
• donate blood - biochemical analysis. Examines the level of certain chemical elements in the blood and identifies the possible development of hepatitis;
• serological test for Epstein-Barr virus in children. It allows you to detect the presence of a virus in the body, although even if it is “positive”, this does not mean that it is active. Prescribed after actual contact with the carrier, pregnant women and if an acute form is suspected.

The problem with some diagnostic methods (in particular, blood tests and immunograms) only detect the presence of certain disorders in the body, but not a specific disease. Other diagnostic methods are suitable for secondary testing, and often targeted treatment for mononucleosis begins only when the results of these tests are available.

What does the doctor usually prescribe?

To begin treatment for Epstein-Barr virus in children (even if it is carried out at home), you must first consult a doctor to clarify exactly how the pathogen interacts with his body. If it does not manifest itself in any way, and the classic symptoms of mononucleosis do not appear, treatment will not be prescribed. If the disease has already begun to develop, the child may be admitted to an infectious diseases hospital. In the case of sick leave at home, the attending physician issues a certificate for 12 days. If a child goes to school or kindergarten, quarantine is not declared.

There are no drugs that specifically “exterminate” mononucleosis. The fight against infection is carried out by the immune system, and the task of treatment is only to stimulate it. However, if complications are observed, the attending physician may prescribe antiviral drugs:

• for children - “Cycloferon” in the form of injections;
• up to 2 years - “Acyclovir”, “Zovirax”, taken for 7-10 days;
• up to 7 years - “Viferon 1” rectally.

For chronic mononucleosis the following is prescribed:

• "Reaferon-ES";
• "Intron A";
• "Roferon-A".

To relieve painful symptoms:

• antipyretics - Panadol, Paracetamol;
• antihistamines – “Tavegil”, “Fenistil”;
• ascorbic acid and other vitamins;
• herbal decoctions (chamomile, sage) or furatsilin for gargling;
• nasal drops to constrict blood vessels - but not longer than 3 days, as they can be addictive.

In combination with clinical recommendations (including individual ones prescribed by the attending physician), complex therapy quickly suppresses the Epstein-Barr virus in the body. Treatment in children should be carried out only after a medical examination: even the most harmless remedy can greatly affect the baby’s health.

What to do to speed up recovery?

• bed rest;
• reducing physical activity during treatment and a month after recovery;
• The child should drink a lot, as liquid helps avoid intoxication.

Infectious mononucleosis entails metabolic disorders and weakens the immune system, and therefore the attending physician prescribes a special diet. It should contain in abundance:

• fresh vegetables;
• porridge and cereals (buckwheat, oatmeal);
• lean fish (cod, pollock) – boiled or steamed;
• white lean meat (rabbit, beef);
• milk (cheese, cottage cheese);
• non-acidic berries;
• bakery products (dried).

If necessary, you can add one egg to your daily diet, but no more. Fatty foods should be avoided and sweets should be limited. After the disease has been cured, the child should be observed by a specialist for several years in case of relapse. When visiting other doctors, you must always remind that the child has suffered mononucleosis.

Here is what Komarovsky says about the Epstein-Barr virus in children:

How dangerous is Epstein-Barr virus?

Symptoms in children are not clearly expressed at its initial stage, so it is necessary to monitor any condition of the child. However, even following all the rules does not guarantee that the treatment will end successfully and without further complications. There are several conditions under which a doctor can make a favorable prognosis for recovery:

• the child is not infected with immune diseases;
• mononucleosis is not advanced and is in the primary stage;
• treatment is targeted, all rules are followed;
• the necessary prevention was carried out from the first days of life;
• complications do not develop, such as sinusitis, sinusitis, pneumonia, etc.

Unfortunately, it is impossible to “rid the body” of a pathogen completely, but you can make it inactive. That’s why doctors suggest carrying out routine vaccinations to maintain immunity, and avoiding them is not always the best solution because the consequences of the pathogen are very serious.

Prevention. What to do to avoid getting sick?

The pathogen is quite common in everyday life, and therefore quite difficult to avoid. However, this is not a reason to panic: with the proper lifestyle, the body is able to develop immunity, so that the carrier of the virus does not encounter pronounced forms of the disease. You can strengthen your immune system in the following ways:

1. regularly walk with your baby in the fresh air;
2. move more, stimulating the child to play sports from the very first years;
3. take vitamins recommended by your pediatrician;
4. eat healthy, regularly eating vegetables and fruits;
5. in the presence of somatic diseases, do not rely on your own knowledge, but go to the doctor to avoid accidental mistakes;
6. beware of stressful situations;
7. visit public places less often where there is a risk of contracting mononucleosis.

Useful video

Doctors are of the opinion that it is not necessary to be zealous with prevention. The sooner a child gets sick, the easier he will cope with this disease. However, this does not mean that you need to leave the baby’s health to chance, and therefore following preventive requirements is extremely important.

Epstein-Barr virus is one of the most common viral pathologies affecting children. Despite the fact that this herpes virus was discovered relatively recently, scientists have already established its characteristic symptoms and developed effective treatment methods. If the symptoms of this disease are not detected and eliminated in a timely manner, this type of virus can lead to serious consequences. To avoid complications, parents should know how this pathology manifests itself and how it can be cured.

Epstein-Barr virus: what is it?

The Epstein-Barr virus (hereinafter referred to as EBV), often erroneously called the Einstein-Barr virus, was first described in 1964 by the English scientist Michael Anthony Epstein and his assistant Yvonne Barr. This human herpes virus type 4 is nothing more than the causative agent of mononucleosis, one of the most common infections among people. According to statistics, 9 out of 10 patients are carriers of a latent or active form of this disease, becoming a potential source of infection.

In most cases, infection occurs in early childhood, and infants under 1 year of age are at increased risk of the disease. Most often, EBV is detected in children aged 4-15 years. Signs of the disease manifest themselves in the same way in boys and girls, but this pathology is most common in dysfunctional families with low social status.

Once in the human body, the herpes virus will live there until the end of life, since in modern medicine there are no ways to completely get rid of it. Often, with the help of drug therapy, the virus is transferred to a latent state, which is not as dangerous to children’s health as its active stage.

Depending on the region of distribution, this disease manifests itself differently. For example, among European residents, the main symptoms of pathology include hyperthermic syndrome and enlarged lymph nodes. In the Chinese, EBV often leads to malignant tumors of the nasopharynx, and in Africans, the herpes virus can provoke the development of Burkitt's lymphoma.

Methods of infection

The following routes of infection with this type of virus are distinguished:

Infection with human herpes virus type 4 has a number of features:

• in most cases occurs in early childhood, for example, when kissing the mother;
• transmission of the pathogen is possible only through close contact of a healthy child with an infected person;
• The symptoms of the disease in children and adult patients are somewhat different.

Symptoms in children

Symptoms of the disease usually appear 30-45 days after the virus enters the child’s body. However, in children under 3 years of age the disease may be asymptomatic. Common signs of pathology include:

Many manifestations of the disease resemble the development of tonsillitis. In this case, self-medication is extremely dangerous, since antibacterial drugs of the penicillin group, often used to eliminate signs of sore throat, can only aggravate the problem.

With timely treatment, complete recovery occurs no earlier than after 14-21 days. An improvement in the child’s condition may be followed by periods of exacerbation of the disease - this indicates a weakened child’s body. In some cases, recovery is delayed for several years.

Diagnosis of EBV

Treatment of the disease is prescribed only after an accurate diagnosis has been made. If a child develops symptoms of EBV, laboratory tests are immediately prescribed. Only timely diagnosis of pathology allows one to avoid serious consequences and contribute to the rapid elimination of symptoms of the disease. The main diagnostic methods used to determine human herpes virus type 4 are presented in the table.

When deciphering the serological analysis for EBV, it should be taken into account that each laboratory conducting the study has its own normal values. They must be indicated on the form with the analysis results.

Treatment of a child

Modern medicine does not have the ability to completely eliminate the causative agent of mononucleosis. Standard treatment of the disease is aimed at:

• reducing the activity of human herpes virus type 4 to transfer it to a latent state;
• normalization of the immune system of children;
• application of measures to prevent possible complications.

Along with taking medications, it is necessary to follow certain nutritional rules, avoid emotional stress, and correct the daily routine. The effectiveness of treatment is confirmed by the normalization of the results of a serological blood test.

Drug therapy

Drug therapy depends on the reaction of the child’s body to the penetration of the herpes virus into it. In most cases, babies are treated with the following medications:

Symptomatic therapy is carried out together with the use of the listed drugs:

• Sprays with antiviral properties (Panavir, Inlight) and lozenges (Strepsils, Faringosept) help to cope with sore throats;
• for a runny nose, rinsing the nasal passages with solutions of Aqualor and Aqua Maris, as well as the use of vasoconstrictor drugs, for example, Nazivin;
• To reduce fever in children, you can use medications such as Nurofen and Panadol;
• wet cough is effectively eliminated by Bromhexine and ACC, dry cough by Libexin and Glauvent.

At the same time, it is strictly forbidden to use antibacterial drugs of the penicillin group (Ampicillin, Amoxicillin) - this can aggravate the course of the disease and provoke the appearance of rashes on the baby’s skin.

The use of antibiotic therapy is justified only in cases where the disease is complicated by sinusitis, otitis media or pneumonia. In this situation, antibacterial drugs of the macrolide and carbapenem group are used.

Children diagnosed with EBV are required to take a course of vitamin complexes and medications to restore liver cells. During treatment, the small patient must remain at home. If circumstances do not allow the child to stay at home during therapy, the doctor prescribes a sick leave for at least 12 days until the acute stage of the disease passes. After an illness, the baby must be registered at the dispensary for a year.

Infection leads to disruption of the metabolism of proteins, fats and carbohydrates, as a result of which the child’s body’s defenses are noticeably weakened. During treatment, the baby is prescribed a special dietary diet, which involves including the following products in the daily diet:

Along with this, fatty foods should be excluded from the diet. The consumption of sweets and confectionery products should be kept to a minimum. The daily menu should contain no more than 1 egg.

Preventive measures

As noted earlier, due to insufficient knowledge of the human herpes virus type 4, there are currently no drugs that completely destroy the herpes virus. However, if reasonable safety measures are taken, the baby can be protected from developing this disease. At the same time, experts note that the sooner a small patient recovers from this infection, the milder the form it will manifest itself.

Prevention of EBV is aimed at systematically and comprehensively strengthening the child’s body’s defenses, which implies compliance with the following measures:

1. Hardening children from an early age.
2. Daily long stay in the fresh air.
3. Regular intake of a complex of vitamins. Vitamin preparations should be prescribed by a pediatrician. Incorrectly selected products can only undermine children's health.
4. Balanced diet. The daily menu should consist of a sufficient amount of fruits and vegetables, cereals and protein foods. You should avoid consuming products containing artificial colors and chemical additives.
5. High physical activity. From an early age, a child should be taught to do daily morning exercises. In addition, parents are recommended to enroll their child in a sports section. At the same time, physical activity should be reasonable; regular excessive overexertion will not benefit a growing body.
6. Protecting the baby from frequent stays in crowded places.
7. Avoiding stressful situations and emotional stress.
8. Timely and high-quality elimination of diseases. It is not recommended to self-medicate.

Like many other pathologies, EBV is dangerous due to its likely consequences. To avoid complications of the disease, parents should be attentive to the health of their child and, when identifying the first signs of the disease, immediately take measures to eliminate them. In this case, it is better to avoid infection than to have to deal with its symptoms for a long time and painfully.

Prognosis for recovery

With timely treatment of EBV, the prognosis for recovery is favorable. The outcome of the disease depends on the following conditions:

• absence of immune pathologies in the little patient;
• carrying out regular prevention from an early age;
• quality treatment;
• seeking medical help in the early stages of the disease;
• no complications.

The causative agent of mononucleosis is activated when the child’s body’s defenses are weakened. Routine vaccination can remove the herpes virus from a latent state. For this reason, on the eve of the test, parents must inform the doctor about the fact that the child has a history of mononucleosis.

Possible complications

The likelihood of complications occurring in the early stages of EBV infection is virtually eliminated. However, in advanced cases, the disease can cause the following negative consequences:

Children at risk for complications caused by EBV include:

1. With primary and secondary immunodeficiency. In children with a congenital disorder of immunological reactivity, the herpes virus can provoke the development of proliferative syndrome, which can lead to malfunction of internal organs. This complication can lead to the death of the baby.
2. Suffering from genetic disorders.
3. Living in regions with maximum survival rate of the disease pathogen.

Children often suffer from viral diseases, and some of them pose a serious threat to children's health. Currently, pediatricians around the world are paying special attention to pathologies caused by the Epstein-Barr virus.

When a child is initially infected, the symptoms of this infection may go unnoticed. The consequences of infection after a few months negatively affect all organs and systems of the body. What do parents need to know about the signs of this disease?

The Epstein-Barr virus is the causative agent of a number of human diseases and belongs to the group of herpes viruses (another name is the infectious agent of herpes type 4). Discovered in 1964 in Great Britain by scientists Michael Epstein and Yvonne Barr. It multiplies in the cells of the child’s immune system (lymphocytes) and causes their uncontrolled growth (cytomegalovirus causes an increase in the size of infected cells).

Associated with the following diseases::

1. Infectious mononullosis;
2. Burkitt's lymphoma;
3. Nasopharyngeal carcinoma;
4. Other oncological pathologies (chemotherapeutic and surgical treatment).

The virus contains the following elements against which B-lymphocytes produce antibodies of the IgM and IgG classes (immunoglobulin M, G) in the bodies of children:

• VCA – capsid antigen;
• ENBA – nuclear antigen;
• EA – early antigen.

When IgM and IgG (immunoglobulin M, G) against the above antigens (VCA, EA, ENBA) are detected in the child’s blood, if a serological analysis is performed, then an acute or chronic form of the disease caused by the Epstein-Barr virus can be diagnosed.

How the virus is transmitted

The virus has several modes of transmission. Released into the environment with biological fluids of the body. Its highest concentration accumulates in the saliva of children, so a common pathology caused by it is infectious mononucleosis, otherwise called the “kissing disease.”

The pathogen spreads when:

• Kisses on the lips;
• Intimate contacts;
• Blood transfusion;
• Using common objects (dishes, toys) with which a sick baby or a virus carrier has come into contact (the pathogen is in his saliva and through it enters the outside world);
• Use of non-sterile medical instruments for injections, surgical interventions, cosmetic procedures;
• From mother to child through the placenta and during breastfeeding.

Cytomegalovirus (CMV) has similar transmission routes, and is especially dangerous for the unborn child if the baby becomes infected from a sick mother. Couples planning children must donate blood for EBV and CMV testing. If the test result is positive, treatment is recommended.

Risk group

Epidemiologists identify two risk groups among children:

• One-year-old babies who actively contact others;
• Preschoolers aged 2.5-5 years who regularly attend kindergarten.

A viral infection (EBV, not cytomegalovirus) spreads most quickly in small closed children's groups, which include groups in kindergartens.

Signs and symptoms

Let's look at the symptoms of infectious mononucleosis, which is a manifestation of a child's primary contact with the Epstein-Barr virus. Sometimes mononucleosis in children is caused by cytomegalovirus (differential serological analysis is always necessary).

The disease begins acutely and lasts from 3 to 4 weeks.

With mononucleosis (if it is caused by EBV and not cytomegalovirus), the following symptoms appear. It is discovered during direct examination of the child:

1. Increase in body temperature to 39-40 degrees with severe intoxication syndrome - nausea, vomiting, weakness, headache, tachycardia;
2. Enlarged lymph nodes throughout the body (especially in the neck - anterior and posterior cervical nodes);
3. Nasopharyngitis and tonsillitis with white-gray or yellowish plaques (due to damage to the tonsils and adenoids);
4. Difficulty nasal breathing in the absence of discharge from the nasal passages, puffiness of the face, nasal voice;
5. Enlarged liver and spleen (hepatosplenomegaly in children), abdominal pain, icterus of the sclera and skin;
6. Exanthema (rash of viral origin) in the form of spots, papules, vesicles with widespread localization.

During a microscopic examination (complete blood count), during an acute infection, large atypical lymphocytes are found among ordinary blood cells that are affected by the virus - mononuclear cells (cytomegalovirus sometimes gives this picture of the blood). They remain in the bloodstream for a month from the moment of infection.

The immune system of a sick child tries to cope with infected lymphocytes. There is an activation of T-helpers and T-suppressors, NK cells, which destroy mononuclear cells. Surviving B-lymphocytes produce antibodies of the IgG and IgM classes (immunoglobulin M, G) against each of the viral antigens (VCA, EBNA, EA), making the work of the cellular part of the immune system possible.

Infectious Mononucleosis (Epstein Barr Virus). Symptoms and Treatment Methods

For serological diagnosis of mononucleosis, an enzyme-linked immunosorbent assay (ELISA) or polymerase chain reaction (PCR) is used, which detects the Epstein-Barr virus.

What antibodies (AT) of the IgG and IgM types (immunoglobulin M, G) are diagnostic when performing an IF analysis?

If an IF analysis was performed, a positive result revealed:

• IgG antibodies (immunoglobulin G) against nuclear and early antigens;
• antibodies of the IgM type (immunoglobulin M) to the capsid (VCA) antigen of the virus

Confirms the diagnosis of “acute infectious mononucleosis” and indicates EBV infection. Additionally, a blood test is performed for antibodies against antigens that cytomegalovirus has.

What are the complications of infectious mononucleosis (caused by EBV, not cytomegalovirus)?

1. Hepatitis;
2. Splenic rupture;
3. Development of hematological and oncological pathologies;
4. Development of immunodeficiency, anemia, thrombocytopenia;
5. Autoimmune pathologies;
6. Meningitis and meningoencephalitis;
7. Pancreatitis;
8. Pneumonia;
9. Lesions of the myocardium and valvular apparatus of the heart.

In acute EBV infection, complications arise if the virus is accompanied by a secondary bacterial infection during the height of the disease or recovery.

Children aged 3-4 to 15-16 years are most vulnerable to infection. Infants get sick less often, and symptoms of the disease often go undetected. A detailed clinical picture and a severe course and negative consequences in a child can only occur if he was infected in utero or suffers from an immunodeficiency of any nature (for example, the immune response does not work due to the lack of antibodies to VCA, EA, ENBA antigen).

Doctor Komarovsky's opinion

Dr. Komarovsky believes that most children have already encountered the Epstein-Barr virus, and the symptoms of the disease were minimal.

Komarovsky warns against the use of amoxicillin and ampicillin for mononucleosis (antibiotics of the penicillin group), which are prescribed to a child in case of incorrect diagnosis as a treatment for sore throat. This can provoke the appearance of exanthema.

Pediatrician Komarovsky points out that for mononucleosis, only symptomatic treatment is indicated for ordinary children without immunodeficiency conditions (when anti-VCA, anti-ENBA antibodies are not produced). They do not need to be treated with antiviral or immunostimulating drugs.

Infectious mononucleosis – School of Dr. Komarovsky

Prevention

1. In order to avoid infection with the Epstein-Barr virus, teach your child personal hygiene from an early age.
2. In autumn and winter, avoid large crowds of people, as sneezing and coughing also have a chance of transmitting the Epstein-Barr pathogen.
3. Lead a healthy lifestyle, since the Epstein-Barr virus, after entering the body, can remain in the body for a long time in a latent form (symptoms appear when the immune system is weakened, physical exhaustion, if treatment for another disease is interrupted).

Treatment

Specific treatment for Epstein-Barr virus has not been developed. In the case of a severe course of the disease (severe symptoms), drugs that are effective against other viruses of the herpes group are used in a hospital setting. The doctor may prescribe immunomodulatory drugs according to individual indications, taking into account the following indicators:

• titer of antibodies to VCA, ENBA and EA antigens (capsid, nuclear, early) in the patient (IF analysis is done) and
• the presence or absence of antibodies to antigens such as cytomegalovirus.

As a symptomatic treatment of sore throat caused by the Epstein-Barr pathogen, antiseptic lozenges, gargles with disinfectant solutions or herbal infusions are used.

To reduce the child's temperature, paracetamol is offered.

The rash can be treated with panthenol to speed up healing.

A sick baby needs to drink a lot, all food should be ground or semi-liquid.

Folk recipes

Traditional treatment is powerless against the cause of the disease – the Epstein-Barr virus.

To reduce a sore throat, as an effective treatment, it is recommended to prepare infusions of chamomile, mint and sage and rinse the mouth with them.

Give your child plenty of rosehip infusion and offer your baby hot tea made from raspberry or currant jam (drinks with vitamin C stimulate the immune system to fight the Epstein-Barr virus).

The Epstein-Barr virus is the causative agent of many dangerous infections, but with proper care for the child, the first encounter with EBV will be without complications for the baby. Parents should know the typical signs of Epstein-Barr infection in order to see a doctor on time, donate blood for a serological test and maintain their child’s health.

How can you become infected with mononucleosis? – Doctor Komarovsky

When coming into contact with the outside world, the likelihood of picking up some kind of bacteria is very high, but this will not necessarily immediately cause the development of the disease. Some microorganisms are very rare, others enter the body of almost every person.

The virus is easy to catch in normal situations

The latter includes the Epstein-Barr virus; it is considered one of the most widespread on the planet. This virus belongs to the herpetic group, so it is often called herpes type four. This microorganism was discovered in 1964 by scientists from Great Britain, after whom it was named. Why is it necessary to know about this virus? The thing is that infection often occurs before the age of 15 and can cause the development of infectious mononucleosis, but if the virus is activated in adulthood, this leads to serious disruptions in the functioning of the body. It is important to recognize and deal with the problem in time - after suffering from the disease, the child develops immunity and is no longer afraid of the virus.

Symptoms and routes of entry of the virus

Another name for the disease is “kissing disease”, since the pathogen can be transmitted by parents to children through kisses

The Epstein-Barr virus is very specific: once it enters the body, it can remain there for many years without showing the slightest sign of its presence - it is contained thanks to the body’s immune defense. As soon as the immune system weakens for one reason or another, the child becomes ill.

Typically, the infection spreads through carriers, or more precisely, through their saliva. That is why the disease is often called the “kissing disease” - the pathogen is transmitted to the child through frequent parental kisses.

The most common methods of penetration of a microorganism (besides kissing) are the use of common hygiene products, the same dishes or toys (especially those that have been in the mouths of other children). There are known cases when infection occurred at the stage of intrauterine development.

High fever is a symptom of the virus

The incubation period can last from one to two months, and the first manifestations are of a general nature, characteristic of all viral infections:

• initially there appears weakness in the body, aches, appetite significantly worsens;
• after a few days there is a strong increase in temperature (up to 40 degrees), which is accompanied by an increase in the size of the cervical lymph nodes;
• pain often occurs in the liver area;
• in some situations, a rash appears all over the body (1 case out of 10).

Gradually, the presence of the virus in the body leads to the occurrence of other diseases. The most common manifestation of the Epstein-Barr virus in children is infectious mononucleosis, but other ailments may also appear (herpes sore throat, tonsillitis).

Provoked infectious mononucleosis has specific symptomatic manifestations. Thus, the temperature remains at a fairly high level for a long period of time (from 2 weeks to a month).

Symptoms of mononucleosis also include: general weakness, headache, disruption of the gastrointestinal tract, pain in the joints. Without proper treatment, the risk of lung complications increases.

It is important to know that this disease develops extremely rarely in infants, since the baby is protected by the mother’s immunity, transmitted through milk. If symptoms of the disease are detected, you must immediately go to the hospital - timely treatment will not only improve the general condition, but will also significantly reduce the risk of dangerous complications. In some situations, outpatient treatment is required.

Dangerous consequences of virus activity

The type of complications is related to what kind of disease was provoked by the activity of the virus, while the incidence of complications is low, but the probability still exists. For example, the possible consequences of advanced infectious mononucleosis include:

• damage to the central nervous system (meningitis, encephalitis). Symptoms of this condition usually appear after the first two weeks of illness (headache, psychosis, even paralysis of the facial nerves is possible);
• splenic rupture (the probability of such a complication is 0.5%, with a higher risk in males). Characteristic manifestations: acute abdominal pain, disturbances in hemodynamic processes;
• due to excessive tissue growth in the tonsils, the disease may be complicated by airway obstruction;
• there is a low likelihood of developing myocarditis, vasculitis, hepatitis and pericarditis.

How to treat Epstein-Barr virus in a child?

First of all, it is necessary to carry out a diagnosis

When visiting a hospital, diagnostic procedures are initially carried out to identify the causative agent of the disease - a blood test is sufficient for this. As soon as the exact diagnosis is clarified, active treatment begins depending on the stage of advanced disease. So, if the disease occurs in an acute form, then the first steps will be aimed at reducing the intensity of symptoms and transferring it to a milder form. Standard complex of drugs: antiviral agents and agents to strengthen the immune system. Additionally, symptomatic treatment is prescribed, namely drugs to lower the temperature, gargling to reduce pain when swallowing, etc.

When the disease has already become chronic, treatment becomes much more complicated - in addition to medications, it is no longer possible to do without a set of physical exercises and a special diet. Nutritional correction in such a situation is aimed at reducing the load on the liver and increasing the level of immune protection through the consumption of healthy foods.

If the activity of the virus in the child’s body was mild or asymptomatic, then the reason for contacting doctors will be the disease that developed against this background. So, if a microorganism provokes infectious mononucleosis, then the main efforts will be aimed at eliminating this disease.

The prognosis for treating children is positive; symptoms usually subside completely within three weeks. Despite the treatment procedures, general weakness and poor health remain for some time (this period can last for several months).

Traditional methods of treatment

Since the opinions of specialists regarding the correct approach to treating the disease do not coincide, parents often have doubts about traditional treatment - this becomes the impetus for the use of traditional medicine. No matter what, before using any remedy, it is better to consult with your doctor and make sure that independent actions will not harm the child.

So, herbal medicine is widely used to treat Epstein-Barr virus. It is believed that the following recipes will help cope with the problem:

• chamomile, calendula flowers, coltsfoot, mint and dum root can be brewed and given to the child instead of tea no more than three times a day. These herbs contain a huge amount of useful substances that improve the functioning of the immune system, and also have a calming effect necessary during illness;
• Regular consumption of green tea with additives (honey and lemon) will be beneficial. When using such a product, you need to remember the likelihood of an allergic reaction;
• a decoction of chamomile, immortelle, yarrow and centaury;
• tincture of ginseng (for a child, the recommended dose is up to 10 drops);
• inhalations with eucalyptus or sage;
• a sore throat can be gently lubricated with essential oils (fir, juniper or sage).

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

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. 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, pathogenetic and symptomatic therapy. Children and adults after illness require long-term rehabilitation and clinical and laboratory monitoring.

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

Epstein-Barr virus

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

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

As viruses multiply, they activate the division of B lymphocytes and are transmitted to their daughter cells. Mononuclear cells—atypical lymphocytes—appear in the patient’s blood.

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

Specific antigens of the Epstein-Barr virus (capsid, nuclear, membrane) are formed sequentially and induce (promote) the synthesis of 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. The outside of the virions is loosely surrounded by a membrane. The capsid core and membrane of viral particles have antigenic properties, which provides pathogens with high damaging ability.

Epidemiology of Epstein-Barr virus infection

The disease is low contagious (lowly contagious). Viruses infect both adults and children. Most often, EBVI occurs asymptomatically or in the form of acute respiratory infections. Children in 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 outbreaks of the disease occur once every 5 years. The disease is more often registered in children aged 1 - 5 years living 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 an acute form of the disease remain dangerous to others for 1 to 18 months.

Pathways of pathogen transmission

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

Entrance gate

The entry gate for the pathogen is the mucous membrane of the upper respiratory tract. Organs rich in lymphoid tissue - tonsils, spleen and liver - are primarily affected.

Rice. 3. Epstein-Barr virus is transmitted through saliva. The disease is often called the “kissing disease.”

How does the disease develop in adults and children?

Epstein-Barr virus most often enters the upper respiratory tract through 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 quantities into the surrounding lymphoid tissue and salivary glands. Having penetrated B-lymphocytes, the pathogens spread throughout the body, primarily affecting the lymphoid organs - tonsils, liver and spleen.

In the acute stage of the disease, viruses infect one out 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.

Some of the infected B-lymphocytes are 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 infect other blood cells: T-lymphocytes, macrophages, NK cells, neutrophils and vascular epithelium, which leads to the development secondary immunodeficiency.

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

The pathogens persist (stay) in the human body for life and subsequently, with a decrease in the functioning of the immune system and hereditary predisposition, become the cause of 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 body's normal immune system is in most cases able to control and counteract the infection. Active reproduction of pathogens is caused by an acute bacterial or viral infection, vaccination, stress - everything that attacks the immune system.

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

EBVI classification

• EBVI can be congenital (in children) and acquired (in children and adults).
• Based on the form, they distinguish between typical (infectious mononucleosis) and atypical forms (asymptomatic, erased, visceral).
• The infection can be mild, protracted or chronic.
• The leading ones are intoxication, infectious (mononucleotide-like), gastrointestinal, cerebral, arthralgic and cardiac syndromes.

Acute form of Epstein-Barr virus infection in adults and children

Acute primary infection caused by Epstein-Barr viruses or mononucleosis-like 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 somewhat less likely to enlarge. There are cases of generalized lymphadenopathy. In half of the patients the spleen is enlarged, in 10 - 30% of patients there is an enlargement of the liver. Some patients develop periorbital edema.

The incubation period for EBVI lasts 4 - 7 days. All symptoms are most pronounced on average by the 10th day of illness.

Symptoms of acute form of EBVI

Intoxication syndrome

Most cases of the disease begin acutely with 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 ​​C.

Generalized lymphadenopathy

Generalized lymphadenopathy is a pathogonic symptom of EBVI in adults and children. It appears from the first days of the disease. 5-6 groups of lymph nodes enlarge simultaneously: more often the posterior cervical ones, somewhat less frequently - the anterior cervical, submandibular and ulnar ones. In diameter from 1 to 3 cm, not soldered together, arranged either in chains or in packages. They are clearly visible when you turn your head. Sometimes pasty tissue is observed above them.

Rice. 5. Most often, with EBVI, the posterior cervical lymph nodes are enlarged. They are clearly visible when you turn your 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 enlarge to II - III degree. Their surface becomes smoothed due to infiltration and lymphostasis with islands of dirty gray deposits, sometimes resembling lace, as in diphtheria, they are easily removed with a spatula, do not sink in water, and are easily rubbed. Sometimes plaques become fibrous-necrotic in nature and spread beyond the tonsils. Signs and symptoms of tonsillitis due to Epstein-Barr virus infection disappear after 5 to 10 days.

Rice. 6. Sore throat with EBVI. When plaque spreads beyond the tonsils, differential diagnosis should be made with diphtheria (photo on the right).

Symptoms of adenoiditis in acute form of EBVI

Adenoiditis in the disease is often recorded. Nasal congestion, difficulty breathing through the nose, snoring while sleeping with your mouth open are the main symptoms of Epstein-Barr virus infection in adults and children. The patient’s face becomes puffy (takes on an “adenoid” appearance), the lips are dry, the eyelids and bridge of the nose are pasty.

Enlarged liver and spleen

When the disease occurs in children and adults, the liver enlarges already at the beginning of the disease, but most often in the 2nd week. Its size returns to normal within 6 months. Hepatitis develops in 15–20% of patients.

An enlarged spleen in adults and children is a later symptom of the disease. Its size returns to normal in 1 to 3 weeks.

Rash

Exanthema (rash) appears on days 4–14 of the disease. It's varied. It can be spotted, papular, roseolous, pinpoint or hemorrhagic, without a specific localization. Observed for 4 - 10 days. Often leaves behind pigmentation. The rash appears especially often in children receiving amoxicillin or ampicillin.

Hematological changes

In the acute form of EBVI, leukocytosis, neutropenia, lymphocytosis, and monocytosis are observed. Mononuclear cells appear in the blood in quantities 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 form of EBVI in adults and children

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

• Recovery.
• Asymptomatic virus carriers.
• Chronic recurrent infection.
• Development of cancer.
• Development of autoimmune diseases.
• The emergence 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.
• Acute bacterial or viral infection, vaccination, stress, surgery—anything that attacks the immune system—causes the active proliferation of pathogens.

Rice. 8. The photo shows 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 diagnosis much more difficult. Chronic Epstein-Barr virus infection lasts a long time and has a relapsing course. Manifests itself as 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 a wave-like course, often described by patients as chronic flu. Low-grade 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 - the main symptoms of the disease. Patients experience enlarged lymph nodes (generalized lymphadenopathy), enlarged liver and spleen. The palatine tonsils are enlarged (hypertrophied).

Hemophagocytic syndrome

Overproduction of anti-inflammatory cytokines by T cells infected with viruses 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 worried about intermittent fever, hepatosplenomegaly, generalized lymphadenopathy is noted, and liver failure develops. Mortality reaches 35%.

Consequences of the development of immunodeficiency in adults and children

Decreased immunity leads to the development of many diseases of infectious and non-infectious nature. Conditionally pathogenic flora is activated. Viral, fungal and bacterial infections develop. Acute respiratory infections and other diseases of the ENT organs (rhinopharyngitis, adenoiditis, otitis, sinusitis, laryngotracheitis, bronchitis and pneumonia) are registered 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 number, which negatively affects the functioning of many internal organs: the respiratory and central nervous system, heart, joints, biliary dyskinesia develops, and the gastrointestinal tract is affected.

Rice. 9. Lymphocytic infiltrates in the superficial 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, and 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 erased (latent, sluggish) or atypical forms of the disease.

• In the first case, patients are bothered by prolonged low-grade fever of unknown origin, weakness, muscle-joint pain, and pain on palpation in the area of ​​peripheral lymph nodes. The disease occurs in waves in adults and children.
• In the second case, all the complaints described above 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, and genital organs. The diseases last a long time and often recur. Their duration ranges from 6 months to 10 years or more. Viruses are found in blood lymphocytes and/or saliva.

Rice. 10. Rash due to infectious mononucleosis in children.

Asymptomatic virus carriers

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

Diagnosis of the chronic form of Epstein-Barr virus infection

1. Chronic EBVI is characterized by a symptom complex that includes 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 lack of clinical effect from conventional therapy.

1. The anamnesis of such patients indicates prolonged excessive mental overload and stressful situations, a passion for fashionable diets and fasting.
2. A chronic course is indicated by:

• infectious mononucleosis no more than six months ago or a disease occurring with high titers of IgM antibodies (to the capsid antigen);
• histological examination (tissue examination) 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 anti-complementary immunofluorescence with the nuclear antigen of the virus.

Viral activity is indicated by:

• Relative and absolute lymphocytosis. Presence of atypical mononuclear cells in the blood. Somewhat less common are lymphopenia and monocytosis. In some cases, thrombocytosis and anemia.
• Changes in immune status (decreased content and impaired function of natural killer 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 persist (stay) in the human body for life and subsequently, with a decrease in the functioning of the immune system and hereditary predisposition, become the cause of 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 disruption 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, AIDS patients.

Development of autoimmune diseases

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

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. In case sporadic(“non-African”) lymphoma, the connection with the virus is less clear.

Most often, single or multiple malignant neoplasms are recorded in the jaw area, growing into adjacent 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, and many lymphomas of the central nervous system.

Rice. 13. Burkitt's lymphoma occurs mainly in children of the African continent aged 4 - 8 years. 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. This type of lymphoma is especially often associated with the Epstein-Barr virus in Asian populations.

Nasopharyngeal carcinoma

Rice. 15. The photo shows enlarged 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 epidemic sarcoma associated with AIDS.

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

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 oral cavity and tongue. Gray or white plaques appear on the tongue, gums, cheeks and palate. They are fully formed within a few weeks or even months. As the plaques harden, they take the form of thickened areas that rise above the surface of the mucous membrane. The disease is often reported in HIV-infected patients.

Rice. 17. The photo shows hairy leukoplakia of the tongue.

Autoimmune diseases

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

Rice. 18. Systemic lupus erythematosus.

Rice. 19. Systemic lupus erythematosus and rheumatoid arthritis.

Rice. 20. Sjogren's syndrome is an autoimmune disease. Dry eyes and dry mouth are the main symptoms of the disease. The disease is often caused by 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 when the chronic course of the infection is activated in women during pregnancy. Newborns are born with pathologies of the respiratory, cardiovascular and nervous systems, and their own antibodies and the mother’s antibodies can be detected in their blood. The pregnancy 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 diagnosing Epstein-Barr virus infection, the following laboratory research methods are used:

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

Clinical blood test

During the study, 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 is observed.

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

Rice. 21. In the photo there are atypical lymphocytes - mononuclear cells. They are always detected in blood tests for Epstein-Barr virus infections.

Biochemical blood test

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

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

Immunological studies

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

Serological studies

Epstein-Barr virus antigens 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 (enzyme-linked immunosorbent assay).

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

• Specific IgM in the patient’s body appears during the acute period of the disease or during exacerbations. Disappears after 4 - 6 weeks.
• Specific IgG to EA (“early”) also appears in the patient’s body during the acute period and decreases during recovery within 3–6 months.
• Specific IgG to VCA (“early”) also appears in the patient’s body during the acute period. Their maximum is recorded at 2–4 weeks and then decreases, but the threshold level remains for a long time.
• IgG to EBNA is detected 2-4 months after the end of the acute phase and is subsequently produced throughout life.

Polymerase chain reaction (PCR)

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

Differential diagnosis

Diseases with a similar clinical picture include:

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

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

Rice. 22. Enlarged 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 detect the release of pathogens in saliva. If necessary, they receive 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 the primary infection, special treatment for Epstein-Barr virus infection is not required. However, with prolonged fever, severe manifestations of tonsillitis and tonsillitis, enlarged lymph nodes, jaundice, increasing cough and the appearance of abdominal pain, hospitalization of the patient is necessary.

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

Analgesics are used to reduce pain and inflammation. Drugs from 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 the drug for pain relief Tylenol (the active ingredient is paracetamol. In the photo on the right is the drug Advil (the active ingredient is ibuprofen).

If there is a threat of developing a secondary infection or if there is discomfort in the throat, medications are used that include antiseptics, disinfectants and analgesics.

It is convenient to treat diseases of the oropharynx with combination drugs. They contain 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, Hexoral, Tantum Verde, Yox, Miramistin is indicated.

For sore throat, the use of drugs such as TeraFlu LAR, Strepsils Plus, Strepsils Intensive, Flurbiprofen, Tantum Verde, Anti-Angin Formula, Neo-angin, Kameton - aerosol is indicated. Local preparations containing analgesic components cannot be used in children under 3 years of age due to the risk of developing laryngospasm.

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 chronic 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 comprehensive: etiotropic (aimed primarily at the destruction of viruses), continuous and long-term, maintaining continuity of treatment measures in inpatient, outpatient and rehabilitation settings. Treatment should be carried out under the control of clinical and laboratory parameters.

Basic therapy

The basis of treatment for EBVI is antiviral drugs. At the same time, the patient is recommended a protective regime and dietary nutrition. Treatment of infection with other drugs is additional.

The following antiviral drugs are used:

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

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

Immunocorrective therapy

When treating EBVI, the following are used:

• Immunomodulators Lykopid, 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. Drugs in this group are prescribed in cases of severe Epstein-Barr virus infection. They block “free” viruses that are found in the blood, lymph and intercellular fluid.
• Thymus preparations ( Timogen, Immunofan, Taktivin etc.) have a T-activating effect and the ability to stimulate phagocytosis.

Treatment of Epstein-Barr virus infection with corrector drugs 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, antipyretic drugs Ibuprofen, Paracetamol, etc. are used.
• If nasal breathing is difficult, nasal medications Polydexa, Isofra, Vibrocil, Nazivin, Adrianol, etc. are used.
• For dry cough in adults and children, Glauvent, Libexin, etc. are recommended.
• For wet cough, mucolytics and expectorants are prescribed (Bromhexal, Ambro HEXAL, Acetylcysteine, etc.

Antibacterial and antifungal drugs

In case of secondary infection, antibacterial drugs are prescribed. With Epstein-Barr virus infections, streptococci, staphylococci, and fungi of the genus Candida are more often found. The drugs of choice are 2nd - 3rd generation cephalosporins, macrolides, carbapenems and antifungal drugs. For mixed microflora, the drug metronidazole is indicated. Antibacterial drugs such as Stopangin, Lizobakt, Bioparox, etc. are used locally.

Means of pathogenetic therapy

• Metabolic rehabilitation drugs: Elkar, Solcoseryl, Actovegin, etc.
• To normalize the functioning of the gastrointestinal tract, hepatoprotectors (Galstena, 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 of the 1st and 3rd generations (Fenistil, Zyrtec, Claritin, etc.).
• Protease inhibitors (Gordox, Kontrikal).
• Hormonal drugs prednisolone, hydrocortisone and dexamethasone are prescribed for severe infection - airway obstruction, neurological and hematological complications. 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 a ruptured spleen.
• Vitamin and mineral complexes: Vibovit, Multi-tabs, Sanasol, Biovital gel, Kinder, etc.
• Antihomotoxic and homeopathic remedies: Aflubin, Oscillococcinum, Tonzilla compositum, Lymphomyosot, etc.
• Non-drug treatment methods (magnetic therapy, laser therapy, magnetotherapy, acupuncture, physical therapy, massage, etc.
• When treating asthenic syndrome, adaptogens, high doses of B vitamins, nootropics, antidepressants, psychostimulants and cell metabolism correctors are used.

Rehabilitation of children and adolescents

Children and adults who have suffered EBVI need long-term rehabilitation. The child is removed from the register six months to a year after clinical and laboratory parameters are normalized. Examination by a pediatrician is carried out once a month. If necessary, the child is referred to a consultation with an ENT doctor, hematologist, immunologist, oncologist, etc.

Laboratory examination methods used:

• General blood test once a month for 3 months.
• ELISA once every 3 months.
• PCR according to indications.
• Throat swab once every 3 months.
• Immunogram once every 3-6 months.
• Biochemical studies are carried out according to indications.

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