Epstein Barr virus blood test for viral infection. Epstein Barr virus test

Epstein-Barr virus (EBV) is one of the pathogens of the herpesvirus family. It is transmitted in several ways:

• airborne;
• contact-household, through kisses and common dishes;
• blood transfusion or organ transplant;
• during pregnancy and childbirth from a sick mother to a child.

After entering the body, the virus primarily affects the mucous membranes of the mouth and nose. It then enters the bloodstream and spreads throughout the body. Its main difference from other types of herpes is the preservation of the cell and the stimulation of the growth of similar cells.

In response, the immune system destroys infected cells with the help of T-lymphocytes. Due to this process, the lymph nodes increase in size.

If a person's immunity is weak, then EBV becomes chronic or latent, affecting the salivary glands, liver and spleen. If a person has previously had chickenpox, then in his body there are antibodies that react to the presence of the virus and partially suppress it. But such cases rarely occur. Therefore, infection leads to infectious mononucleosis, which is successfully treated.

Developed antigens to EBV keep it inside the infected B-lymphocytes. And for most of its stay in the body, it is in a latent state. Weakened immunity leads to a relapse of the disease and turns a person from a passive carrier of the virus into an active source of infection.

Diseases and their symptoms

The main cause of EBV is infectious mononucleosis. In terms of symptoms, it is very similar to a cold or sore throat. It is characterized by a gradual increase in temperature, muscle pain, sore throat, general malaise, lack of appetite.

As a result of virus activation, severe diseases of the nervous system occur: meningitis, encephalitis, meningoencephalitis. They may be accompanied by a rash in the form of papules, redness, small subcutaneous hemorrhages. If the therapy is chosen correctly and at the right time, then these complications disappear without a trace.

EBV infects lymphatic tissue. This process is called polyadenopathy. The main symptom of this disease is a significant increase in the lymph nodes located on the neck, in the collarbone, in the groin. The inflammation is accompanied by pain.

The virus can also infect the tonsils and cause tonsillitis, which manifests itself with characteristic symptoms:

• heat;
• pus on the tonsils;
• general intoxication of the body;

Hodgkin's disease may also appear, as a result of which malignant formations (tumors) occur in the lymph nodes, accompanied by severe poisoning by the decay products of inflamed body tissues, severe headaches, weakness and fatigue. Close nodes can unite with each other into larger neoplasms.

Hairy leukoplakia can also be a confirmation of the lack of immunity. It is accompanied by the formation of white growths in the oral cavity, which eventually transform into plaques.

In addition to these diseases, EBV causes many others:

• generalized infection on the background of HIV/AIDS;
• systemic hepatitis;
• blood infection or cancer;
• chronic fatigue syndrome;
• cancerous tumors of the digestive organs of the upper circle and the oral cavity;
• arthritis;
• diabetes;
• multiple sclerosis;
• allergy.

Diagnostic methods and interpretation of results

Several types of blood tests are used to determine EBV in the body:

• general;
• biochemical;
• enzyme immunoassay (ELISA);
• polymerase chain reaction (PCR).

The first method is considered the basic analysis in the diagnosis of any disease. If the results confirm an increase in the number of platelets and lymphocytes and a simultaneous decrease in the number of red blood cells and hemoglobin levels, then they are an indirect symptom of the activity of the virus in the body.

The second method allows you to monitor the current state of internal organs. Since EBV affects the liver, special attention is paid to changing the amount of enzymes and proteins secreted by it. These include transaminases, bilirubin, alkaline phosphatase. Their control helps prevent the development of jaundice as a consequence of toxic hepatitis.

The third method examines the presence in the blood of antibodies to virus molecules, called antigens. There are 3 types in total:

• EA, early antigen;
• VCA, capsid antigen;
• EBVA is a nuclear antigen.

For each antigen in the body, immunoglobulins of 2 classes are formed - IgG and IgM.

Detection of IgG to EA indicates primary infection and acute course of the disease. It is present in the blood until the symptoms disappear completely. Its reappearance indicates a relapse or chronic form of the disease.

IgM antibodies to EA appear in the first week and disappear at 8-12 weeks after the onset of the first symptoms. If the period of their presence in the blood exceeds this value, then this indicates the transition of the disease to a chronic form. Re-detection signals a secondary development of infection.

The presence of IgM antibodies to VCA (capsid protein antigen) signals the onset of the acute phase of the disease. They also appear in case of relapse. Their prolonged presence in the blood is a symptom of a chronic form of the disease.

The detection of antibodies of the IgG class to the capsid protein indicates that EBV is active for 8 weeks after the initial infection. Also, this indicates that a person has immunity to this strain.

Antibodies of the IgG type to the nuclear or nuclear antigen (EBNA) appear closer to the stage of the patient's recovery. They remain in the blood for a long time.

If there are no antibodies to the nuclear antigen of the IgG class in the blood, but there is IgM against the capsin protein, then this signals an acute development of the infection.

In addition to IgG and IgM, the designation IgA is sometimes present in the form with the results. It indicates a latent or chronic form of the disease in the absence of IgM class antibodies.

Depending on the method used by the laboratory, a quantitative value called the antigen avidity index may be present in the table with the results of the study. It is measured as a percentage and allows you to determine the time elapsed since the onset of infection.

The use of enzyme immunoassay for diagnosis in children is ineffective. This is due to the fact that their immune system reacts to the pathogen very slowly.

Polymerase chain reaction is a procedure in which virus DNA is isolated from any biological fluid of a patient and compared with an extensive virus base. This method is accurate, but ineffective at the initial stage of the disease. If you take the material for analysis during this period of time, the result will be false negative.

A positive result of such an examination is a strong argument for making a final diagnosis. Also, this method allows you to detect EBV in the body of a child.

Preparation for the procedure

To improve the accuracy of blood tests, you need to fulfill a few simple requirements:

• hand over the sampling of materials on an empty stomach;
• fatty foods, alcohol and smoking should be avoided 12 hours before the procedure;
• stop taking antiviral drugs and antibiotics;
• children under 5 years of age drink warm boiled water 30 minutes before donating blood.

False results

All research methods are not 100% accurate. Therefore, when detecting EBV, errors can occur. The main reason may be an early examination, when the infection is in a state of development. In this case, a second examination after 14 days is usually prescribed.

Another obstacle to an accurate result is the presence of a related strain - cytomegalovirus or herpesvirus type 6.

The impact of the disease on the body of a pregnant woman and fetus

Before a planned pregnancy, a woman should undergo an examination that finds out the current state of immunity. If antibodies of the IgG class were detected, this means that EBV reactivation is unlikely during pregnancy. And it is advisable not to ignore tests confirming the presence of IgM class antibodies, and it is better to wait for a complete recovery before conception.

The presence of an active form of EBV in the body of a future mother can cause the following fetal pathologies:

• stillbirth;
• miscarriage or premature birth;
• pathology of the development of the nervous system;
• uterine bleeding, sepsis.

The Epstein-Barr virus is the cause of many diseases affecting the work of all systems and organs. For its detection, enzyme immunoassay and polymerase chain reaction are used. If antibodies to the Epstein-Barr IgG class are found in the blood during the first, then this positive result means that the person has an acute disease, but he has immunity to this strain. The interpretation depends on which antigen antibodies have arisen against.

Epstein-Barr virus is an infectious disease of herpetic origin, named after two scientists - researchers who discovered it in 1964, namely, Canadian professor and virologist Michael Epstein and Yvona Barr, who was his graduate student. Due to its nature, EBV is also called type 4 herpes. Recently, its prevalence (especially in children) has increased significantly and is up to 90% of the total population of the planet.

Epstein-Barr virus in children - what is it and why is it dangerous?

The Epstein-Barr virus is able to be present in the body for several years and not manifest itself in any way. In 25% of people who are its carriers, it can be throughout life. A weakened immune system can provoke its activation. After infection, a person develops permanent immunity to the disease in the future. At the same time, the virus continues to exist in the body, like its herpes counterparts.

According to statistics, children from a year and older are most susceptible to it, since it is during this period that babies begin to actively interact with other children. Until the age of three, the course of the disease often goes without severe symptoms and has much in common with a mild cold. The characteristic signs of the disease begin to appear in schoolchildren and adolescents.

The number of infected people after 35 years is minimal, and in cases where infection occurs, the pathology is not accompanied by its characteristic symptoms. This is due to the fact that adults already have immunity to the herpes group viruses.

The virus includes a spherical-shaped DNA molecule found in human saliva. When it enters the lymphoid tissue, it infects the lymph nodes, tonsils, spleen and liver.

As a result of the penetration of the virus into the body, acute infectious mononucleosis usually develops. However, this is not the only pathology that this type of pathogen can provoke. The Epstein-Barr virus is dangerous for the development of:

• respiratory infectious diseases of the respiratory tract;
• nasopharyngeal carcinoma, which is a malignant disease of the nasopharynx;
• Burkitt's lymphoma;
• multiple sclerosis;
• herpes;
• systemic hepatitis;
• lymphomas;
• tumors of the salivary glands and gastrointestinal tract;
• immune deficiency;
• Hodgkin's disease or lymphogranulomatosis;
• polyadenopathies;
• hairy leukoplakia of the oral cavity;
• chronic fatigue syndrome.

The table below shows the conditional classification of VEB according to certain criteria:

Ways of transmission of the virus and sources of infection

The main route by which viral pathogens are transmitted is contact with an infected person or someone who is healthy but is a carrier of the virus. A person who has been ill with EBV, but is already absolutely healthy from a clinical point of view, in the period from 2 months to a year and a half after complete recovery and the disappearance of symptoms, is still isolating the infectious agent.

The largest accumulation of particles is in human saliva, which is exchanged by people kissing each other. It is for this reason that the Epstein-Barr virus is called the "kissing disease." In addition to close contact with a sick or carrier, there are other ways to become infected:

• in the process of blood transfusion - parenteral method;
• during transplantation;
• contact-household way, when people use the same utensils or household items and personal hygiene - this option is unlikely, because this type of herpes virus is unstable and does not live in the environment for a long time;
• airborne route, which is the most common;
• during sexual intercourse, if the causative agent of the disease is present on the mucous membrane of the genital organs.

As for children, they can be infected not only when communicating with a child infected with the virus, playing with his toys, but also in utero through the placenta. The virus can be transmitted to the baby during childbirth, when it passes through the birth canal.

Thus, the main source of the spread of the Epstein-Barr virus is an infected person. Of particular danger are those people in whom the disease is asymptomatic or in a latent form. The threat of infection from a patient with EBV becomes real a couple of days before the end of the incubation period.

Symptoms of the disease in a child

Due to the fact that most often the Epstein-Barr virus provokes the development of acute infectious mononucleosis, it is also characterized by the corresponding manifestations, which include four main signs of this disease:
(we recommend reading:)

• fatigue;
• increase in body temperature;
• the appearance of a sore throat;
• swollen lymph nodes (we recommend reading:).

The incubation period of EBV can last from 2 days to 2 months. The active period of the disease is 1-2 weeks, after which a gradual recovery begins. The course of the pathological process occurs in stages. At the initial stage, an infected person develops a feeling of malaise, which can last for about a week, and a sore throat. At this stage, the temperature indicators remain normal.

At the next stage, there is a sharp increase in body temperature to 38-40 degrees. This symptom is accompanied by intoxication of the body and polyadenopathy - a change in the size of the lymph nodes, which reach 0.5 - 2 cm. The anterior and posterior cervical lymph nodes usually increase, but it is also possible to increase the lymph nodes located on the back of the head, under the jaw, above and below the collarbones, armpits, elbows, groin and thighs. On palpation, they become like dough, there are minor painful sensations.

In addition, the pathological process extends to the tonsils, which resembles the symptoms of angina. The tonsils swell, the back wall of the pharynx is covered with a purulent coating, nasal breathing is disturbed and a nasal voice appears.

In the later stages of development, the Epstein-Barr virus affects internal organs such as the liver and spleen. Liver damage is accompanied by hepatomegaly, its increase and heaviness in the right hypochondrium. Sometimes the urine becomes dark in color and mild jaundice occurs. The spleen also increases in size with EBV.

Another symptom of the Epstein-Barr virus, which is often observed in children, is a rash. The rash usually lasts up to 10 days. The degree of their severity is due to the use of antibiotics. They may look like:

• spots;
• points;
• papules;
• hemorrhages;
• roseol.

Diagnostic methods

Symptoms of the Epstein-Barr virus have much in common with various diseases, including:

• cytomegalovirus (we recommend reading:);
• herpes no. 6;
• HIV infection and AIDS;
• anginal form of listeriosis;
• measles;
• viral hepatitis;
• localized diphtheria of the pharynx;
• angina;
• adenovirus infection;
• blood diseases.

For this reason, it is important to conduct a differential diagnosis in order to distinguish pathological processes from each other and prescribe the correct treatment. In order to accurately determine the causative agent of the virus, it is necessary to take blood, urine and saliva tests and conduct their laboratory tests.

Blood tests

An examination of blood for the presence of EBV in it is called an enzyme-linked immunosorbent assay (ELISA), during which the qualitative and quantitative indicators of antibodies to the infection are deciphered, which makes it possible to find out whether the infection is primary and how long ago it occurred.

Two types of antibodies can be detected in the blood:

1. Immunoglobulins or primary type M antibodies. Their formation occurs when the virus first enters the body or as a result of the activation of an infection that is in a "sleeping" state.
2. Immunoglobulins or secondary type G antibodies. They are characteristic of the chronic form of pathology.

According to the general blood test, the presence of mononuclear cells in the blood is also judged. This is an atypical form, which is acquired by 20-40% of lymphocytes. Their presence indicates infectious mononucleosis. Mononuclear cells can continue to be in the blood for several years after recovery.

PCR method

Epstein-Barr virus DNA is detected by examining the biological fluid of the body: saliva, mucus from the nasopharynx and oral cavity, cerebrospinal fluid, prostate secretion or secretions from the genital organs by PCR (polymerase chain reaction).

PCR is characterized by high sensitivity only during the period of reproduction of the pathogen of the virus. However, the method is effective in detecting herpes infections of types 1, 2 and 3. Sensitivity for herpes #4 is lower at only 70%. As a result, the PCR method of studying salivary secretions is used as a test that will confirm the presence of the virus in the body.

Another option for diagnosing EBV is to determine the amount of liver enzymes. In almost 80% of those infected with this type of virus, their level rises. Their number returns to normal after 3 months from the moment of infection. Occasionally, liver function tests may remain elevated for up to 1 year.

Features of the treatment of the disease in children

Epstein-Barr virus is a young and not yet fully understood disease, and treatments continue to improve. In the case of children, any medications are prescribed only after they have been carefully studied and all side effects have been identified.

Currently, antiviral drugs that would effectively fight this type of pathology and suit any age category of people remain at the development stage. Children can be prescribed a course of such funds in exceptional situations when the life of the baby is at risk.

The first thing that the parents of a child infected with EBV need to do is to provide healthy conditions for his body so that the baby can cope with the infection on his own, because he has the resources and defense mechanisms for this. Should:

• to cleanse the body of toxins with the help of sorbents;
• diversify the diet so that the baby receives good nutrition;
• provide additional support to the immune system by drinking vitamins that act as antioxidants, immunomodulators, cytokines and biostimulants;
• eliminate stress and increase the amount of positive emotions.

The second thing therapy comes down to is symptomatic treatment. In the acute form of the disease, it is necessary to alleviate the condition of the crumbs, reducing the severity of the symptoms present in him - give antipyretic drugs when raising a high body temperature or instill drops in the nose if there are breathing problems. With signs of a sore throat, it is required to gargle and treat the throat, and for hepatitis, drink drugs that support the liver.

Forecast of recovery and possible complications

In general, with proper and timely care, the acute form of the Epstein-Barr virus has a favorable prognosis. The person recovers and develops lifelong immunity to this type of herpes (or becomes an asymptomatic carrier). Otherwise, everything is determined by the severity of the course of the disease, its duration, the presence of complications and the development of tumor formations.

The main danger of this virus is that it spreads through the circulatory system of the human body, as a result of which, after a certain period of time, it is able to affect the bone marrow and any other internal organ.

The Epstein-Barr virus can cause the development of such serious and dangerous pathologies as:

• oncological diseases of various organs;
• pneumonia;
• immunodeficiency;
• damage to the nervous system that cannot be cured;
• heart failure;
• otitis;
• paratonsillitis;
• respiratory failure, which leads to the appearance of swelling of the tonsils and soft tissues of the oropharynx;
• hepatitis;
• rupture of the spleen;
• hemolytic anemia;
• thrombocytopenic purpura;
• liver failure;
• pancreatitis;
• myocarditis.

Another rare complication after EBV is genital ulcers. The female representatives are more susceptible to it. The disease is a deep and painful erosion that appears on the mucous membrane of the external genitalia. Usually ulcers of this kind go away on their own.

Another possible consequence of type 4 herpes infection is hemophagocytic syndrome. It is caused by an infection of T-lymphocytes, which destroys blood cells, namely red blood cells, platelets and white blood cells. Anemia, hemorrhagic rash and problems with blood clotting are added to the known symptoms, which, in turn, is fraught with a fatal outcome.

The Epstein-Barr virus also negatively affects the functioning of the entire immune system. As a result of the body's inability to recognize its own tissues, various autoimmune pathologies begin to develop, including:

• chronic glomerulonephritis;
• rheumatoid arthritis;
• autoimmune hepatitis;
• systemic lupus erythematosus;
• Sjögren's syndrome.

Among the oncological diseases, the impetus for the development of which EBV can become, there are:

1. Burkitt's lymphoma. Tumor formations affect the lymph nodes, the upper or lower jaw, ovaries, adrenal glands and kidneys.
2. Nasopharyngeal carcinoma. The localization of the tumor is the upper part of the nasopharynx.
3. Lymphogranulomatosis. The main signs are an increase in lymph nodes of different groups, including retrosternal and intra-abdominal, fever and weight loss.
4. Lymphoproliferative disease. This is a malignant proliferation of cells of the lymphoid tissue.

Prevention of EBV in a child

To date, there are no specific preventive measures aimed at preventing Epstein-Barr virus pathogens from entering the body and their reproduction. First of all, it concerns vaccination. It is not carried out, since the vaccine has not yet been developed. Its absence is due to the fact that the proteins of the virus vary greatly in their composition - this is affected by the stage of development of the pathology, as well as the type of cells where pathogenic bacteria multiply.

Despite the fact that in the vast majority of cases of infection with this type of virus, the result of proper treatment is recovery, pathology is dangerous for its complications. In view of this, it is still necessary to think about any possible preventive measures. The main method of prevention is reduced to a general strengthening of immunity, because it is as a result of its decrease that activation of the disease can occur.

The normal functioning of the immune system in an adult or a child can be maintained in the simplest and most reliable way by following a healthy lifestyle, which includes:

1. Complete nutrition. The diet should be varied, providing a person with vitamins and useful minerals.
2. hardening. Reasonable tempering procedures are an effective way to improve health and immunity.
3. Physical activity. Movement is life, and in order for the body to fully function, it must be regularly maintained in good shape, play sports or take regular walks in the fresh air. It is important not to sit at home at the computer or in front of the TV all the time.
4. Reception of immunomodulators of plant origin. Examples of such drugs are Immunal and Immunorm. According to the instructions, they are taken 20 drops three times a day. They stimulate immune reactions and activate the regeneration of the mucous membranes of various organs and cavities in the human body. You can turn to folk remedies, namely, to herbal preparations.

Prevention of the Epstein-Barr virus in childhood consists not only in strengthening immunity, but also in minimizing the possibility of becoming infected by contact and household contact when communicating with other children. To do this, it is necessary from an early age to teach the child to follow the basic rules of personal hygiene, including washing hands after walking and before eating, and other sanitary procedures.

Epstein-Barr virus from the family of herpes viruses (herpes of the fourth type) is called the most highly contagious and common viral infection. According to World Health Organization statistics, up to 60% of all children and almost 100% of adults are infected with this virus. At the same time, research on this virus began relatively recently, and therefore it is impossible to say about the complete study of the virus.

What is EBV infection

Epstein-Barr virus is transmitted in the following ways:

The source of EBV infection is only people who are most often ill with an asymptomatic and latent form. Moreover, a person who has recovered from this virus remains contagious to others for many more years. The virus enters the body through the respiratory tract.

The following categories of people are most susceptible to infection with the Epstein-Barr virus:

• children under 10 years old;
• people with immunodeficiency;
• HIV patients, especially AIDS category;
• pregnant women.

Classification of EBV infection

Acute infection with the virus is not very dangerous for humans. A great danger is the tendency to form tumor processes. A unified classification of viral infection (VIEB) has not yet been invented, and therefore practical medicine offers the following:

Diseases caused by EBV:

• chronic fatigue syndrome;
• lymphogranulomatosis;
• immune deficiency;
• Infectious mononucleosis;
• tumors of the intestines and stomach, salivary glands;
• malignant formations in the nasopharynx;
• systemic hepatitis;
• lymphomas;
• lesions of the spinal cord and brain (or otherwise multiple sclerosis);
• herpes.

Epstein-Barr virus: symptoms of the disease

Polyadenopathy is the main symptom in the course of EBV in an acute form. The symptom characterizes an increase in the anterior and posterior cervical lymph nodes, as well as occipital, submandibular, supraclavicular, subclavian, axillary, ulnar, femoral and inguinal lymph nodes.

Their dimensions are about 0.5–2 cm in diameter, they are testy to the touch, slightly painful or moderately painful. The maximum stage of severity of polyadenopathy is observed on the 5-7th day of the course of the disease, and after two weeks, the lymph nodes gradually decrease.

• Infectious mononucleosis is an acute infection or abbreviated OVIEB, the incubation period of which is estimated from two days to 2 months. The disease begins gradually: the patient experiences increased fatigue, malaise, sore throat. The temperature rises slightly or remains normal. After a few days, the temperature reaches 39–40 ° C, intoxication syndrome begins.
• The symptom of polyadenopathy also affects the palatine tonsils, as a result of which signs of a sore throat appear, nasal breathing is disturbed, the voice becomes nasal, and pus forms in the back of the throat.
• Splenomegaly, or enlargement of the spleen, is one of the late symptoms. After 2-3 weeks, sometimes after 2 months, the size of the spleen returns to its original state.
• The symptom of hepatomegaly (or liver enlargement) is less common. This symptom is characterized by dark urine, mild jaundice.
• The nervous system also suffers from acute Epstein-Barr virus. Serous meningitis may develop, sometimes meningoencephalitis, encephalomyelitis, polyradiculoneuritis, but, as a rule, focal lesions regress.
• Other symptoms are possible in the form of the appearance of various rashes, spots, papules, roseola, dots or hemorrhages. The exanthema lasts about 10 days.

Diagnosis of the Epstein-Barr virus

The diagnosis of chronic or acute EBV is made on the basis of clinical manifestations, complaints and laboratory data.

General blood analysis. An increase in leukocytes, ESR, an increase in monocytes and lymphocytes, the occurrence of atypical mononuclear cells are diagnosed. An increase or decrease in the level of platelets, hemoglobin is likely (autoimmune or hemolytic anemia).

Based on a biochemical blood test, an increase in ALT, AST, LDH and other enzymes is detected, acute phase proteins (fibrinogen, CRP), an increase in bilirubin, alkaline phosphatase are detected.

Immunological study- evaluate the level of interferon, immunoglobulins, etc.

Serological reactions. Serological tests help determine the immune response to EBV, while the content of the virus in the blood is not determined. Serological tests allow to detect antibodies to EBV infection:

1. Antibodies of the M-class (IgM) to the capsid antigen (VCA) - are formed during the acute phase from the very beginning of infection to six months from the onset of the disease or during exacerbation of chronic EBV infection.
2. Antibodies of the G-class (IgG) to the antigen (VCA) - these immunoglobulins are formed after the acute stage of the disease (three weeks after infection), during convalescence their number increases, in addition, they are detected after the disease throughout life.
3. Antibodies G (IgG) to the early antigen (EA) - similar to the M-class, these antibodies are produced during the acute phase of EBV infection (between one week and six months from the moment of infection).
4. Late G-class antibodies (IgG) to nuclear antigen (EBNA) - occur with complete recovery, usually after six months, and characterize persistent immunity to EBV infection. Let's explain what a positive result for EBV antibodies means.
5. A positive result determines the level of immunoglobulins above the established norm. Each laboratory has its own norm indicators, which depend on the methods of determination, types of equipment and units of measurement. For convenience, the norm indicators are indicated in the columns of the results obtained.

PCR diagnostics of the Epstein-Barr virus

Diagnosis by polymerase chain reaction is a laboratory research method aimed not at detecting an immune response, but at determining the presence of the virus itself, its DNA, in the body. This diagnostic method is modern and has an accuracy of 99.9%.

The PCR method allows examine blood, sputum, swabs from the nasopharynx, biopsy formations of various tumors. Epstein-Barr virus PCR is prescribed if generalized EBV infection is suspected, in immunodeficiencies such as HIV, in difficult or doubtful clinical cases.

The method is also widely used to detect various oncological diseases. PCR is not used for the study of the Epstein-Barr virus as the first analysis, since such analyzes are very complex and very expensive.

Only 2 PCR results for EBV differ: positive and negative results. The first indicates the presence of EBV DNA in the body and the active process of the Epstein-Barr virus. A negative result, on the contrary, indicates the absence of the virus in the body.

According to the indications, it is possible to conduct other studies and consultations. Consultations of an immunologist and an ENT doctor, radiography of the paranasal sinuses and chest, ultrasound of the abdominal cavity, blood clotting tests, consultations of a hematologist and an oncologist.

Epstein-Barr virus: treatment methods

It is impossible to completely recover from herpetic viruses, even using the most modern methods of treatment, since EBV, although not in an active state, still remains in B-lymphocytes and other cells for life.

If the immune system weakens, the virus can reactivate again, exacerbating EBV infection. There is still no consensus on how to treat EBV, neither scientists nor doctors, and therefore, in our time, a lot of research is being done in the field of antiviral treatment. There are still no effective specific drugs in the fight against EBV infection.

In the acute course of infectious mononucleosis, it is necessary keep a sparing diet and regimen: limit physical activity, lead half-bed rest, drink plenty of fluids, you need to eat often, balanced and in small portions, while excluding spicy, fried, salty, sweet, smoked foods from the diet.

Fermented milk products have a beneficial effect on the course of the disease. It is important that the diet contains many vitamins and proteins. It is better to refuse those products that contain chemical preservatives, flavor enhancers, dyes. It is necessary to remove allergen products from the diet: citrus fruits, chocolate, honey, legumes, some fruits and berries.

In the treatment of chronic fatigue syndrome, it will be useful to adhere to a normal mode of work, rest and sleep, active physical activity, positive emotions, doing what you love, good nutrition and a multivitamin complex.

Medical treatment for EBV infection

The principles of EBV treatment in adults and children are the same, the difference is only in dosages. Antiviral drugs inhibit the activity of EBV DNA polymerase. This group includes: Paciclovir, Aciclovir, Cidofovir, Gerpevir, Foskavir.

These drugs are effective only for oncological diseases, generalized EBV infection, chronic course of the disease and the appearance of complications.

Other drugs have non-specific immunostimulating and antiviral action, among which are: Viferon, Interferon, Cycloferon, Laferobion, Arbidol, Isoprinosine (Isoprinosine), Remantadine, Uracil, IRS-19, Polyoxidonium and others. These drugs are prescribed only for severe cases of the disease.

Immunoglobulins such as Polygam, Pentaglobin, Bioven recommended for exacerbations of chronic EBV, as well as for recovery after an acute period of infectious mononucleosis.

These immunoglobulins contain ready-made antibodies that bind to Epstein-Barr virus virions and remove them from the body. Highly effective in the treatment of chronic and acute CVEB. They are used only in stationary clinics in the form of intravenous droppers.

Antibacterial drugs include: Lincomycin, Azithromycin, Cefadox, Ceftriaxone and others. But antibiotics are prescribed exclusively when a bacterial infection is attached, for example, with bacterial pneumonia, purulent tonsillitis.

Treatment of the disease select individually based on the severity of the course of the disease, the presence of relevant pathologies and the state of the patient's immunity.

Chronic fatigue syndrome can treat with antiviral drugs: Gerpevir, Acyclovir, Interferons; vascular drugs: Cerebrolysin, Actovegin; drugs that protect nerve cells from the virus: Encephabol, Glycine, Instenon, as well as antidepressants, sedatives and multivitamins.

The use of folk remedies in the treatment of Epstein-Barr virus

Drug therapy is effectively complemented by traditional methods of treatment. Nature has a great arsenal for strengthening immunity.

herbal collection cannot be applied children under 12 and pregnant women. The composition of the collection includes: peppermint, chamomile flowers, coltsfoot, calendula flowers, ginseng.

Herbs are taken in equal proportions, stir and brew tea: for 1 tablespoon of herbal collection 200.0 ml of boiling water. Wait for brewing 10-15 minutes. Take this infusion three times a day.

Green tea with honey, lemon and ginger increases the body's defenses. Fir oil is used externally. And also use raw egg yolks: on an empty stomach every morning for 2-3 weeks. They contribute to the good functioning of the liver, contain many useful substances.

Epstein-Barr virus infection (EBVI) is one of the most common human diseases. According to WHO, about 55-60% of young children (up to 3 years old) are infected with the Epstein-Barr virus, the vast majority of the adult population of the planet (90-98%) have antibodies to EBV. The incidence in different countries of the world ranges from 3-5 to 45 cases per 100 thousand population and is a fairly high rate. EBVI belongs to the group of uncontrolled infections, in which there is no specific prevention (vaccination), which, of course, affects the incidence rate.

Epstein-Barr virus infection- an acute or chronic human infectious disease caused by the Epstein-Barr virus from the family of herpes viruses (Herpesviridae), which has a favorite feature of damaging the lymphoreticular and immune systems of the body.

The causative agent of EBVI

Epstein-Barr virus (EBV) is a DNA-containing virus from the Herpesviridae Family (gamma-herpesviruses), is a type 4 herpesvirus. It was first identified from Burkett's lymphoma cells about 35-40 years ago.
The virus has a spherical shape with a diameter of up to 180 nm. The structure consists of 4 components: core, capsid, inner and outer shell. The core includes DNA, consisting of 2 strands, including up to 80 genes. A virus particle on the surface also contains dozens of glycoproteins necessary for the formation of virus-neutralizing antibodies. The virus particle contains specific antigens (proteins necessary for diagnosis):
- capsid antigen (VCA);
- early antigen (EA);
- nuclear or nuclear antigen (NA or EBNA);
- membrane antigen (MA).
The significance, timing of their appearance in various forms of EBVI is not the same and has its own specific meaning.

The Epstein-Barr virus is relatively stable in the external environment, it quickly dies when dried, exposed to high temperatures, as well as the action of common disinfectants. In biological tissues and fluids, the Epstein-Barr virus is able to feel favorably when it enters the bloodstream of a patient with EBVI, brain cells of a completely healthy person, cells during oncological processes (lymphoma, leukemia, and others).

The virus has a certain tropism (the tendency to infect favorite cells):
1) tropism for cells of the lymphoreticular system(there is damage to the lymph nodes of any groups, enlargement of the liver and spleen);
2) affinity for cells of the immune system(the virus multiplies in B-lymphocytes, where it can persist for life, due to which their functional state is disturbed and immunodeficiency occurs); in addition to B-lymphocytes, EBVI also disrupts the cellular link of immunity (macrophages, NK - natural killers, neutrophils, and others), which leads to a decrease in the overall resistance of the body to various viral and bacterial infections;
3) affinity for epithelial cells of the upper respiratory tract and digestive tract, due to which children may experience a respiratory syndrome (cough, shortness of breath, "false croup"), diarrheal syndrome (loose stools).

The Epstein-Barr virus has allergenic properties, which is manifested by certain symptoms in patients: 20-25% of patients have an allergic rash, some patients may develop Quincke's edema.

Particular attention is drawn to such a property of the Epstein-Barr virus as " lifelong persistence in the body". Due to the infection of B-lymphocytes, these cells of the immune system acquire the ability for unlimited life activity (the so-called "cellular immortality"), as well as the constant synthesis of heterophilic antibodies (or autoantibodies, for example, antinuclear antibodies, rheumatoid factor, cold agglutinins). EBV lives permanently in these cells.

Epstein-Barr virus strains 1 and 2 are currently known and do not differ serologically.

Causes of Epstein-Barr virus infection

Source of infection in EBVI- a patient with a clinically pronounced form and a virus carrier. The patient becomes contagious in the last days of the incubation period, the initial period of the disease, the height of the disease, as well as the entire period of convalescence (up to 6 months after recovery), and up to 20% of those who have been ill retain the ability to periodically secrete the virus (that is, remain carriers).

Mechanisms of EBVI infection:
- it is aerogenic (airborne transmission), in which saliva and mucus from the oropharynx are contagious, which is released when sneezing, coughing, talking, kissing;
- a contact mechanism (contact-household transmission), in which salivation of household items (dishes, toys, towels, etc.) takes place, however, due to the instability of the virus in the external environment, it is of unlikely importance;
- the transfusion mechanism of infection is allowed (during the transfusion of infected blood and its preparations);
- alimentary mechanism (water-food transmission route);
- currently proven transplacental mechanism of infection of the fetus with the possibility of developing congenital EBVI.

Susceptibility to EBVI: Infants (up to 1 year old) rarely get Epstein-Barr virus infection due to the presence of passive maternal immunity (maternal antibodies), the most susceptible to infection and the development of a clinically pronounced form of EBVI are children from 2 to 10 years old.

Despite the variety of ways of infection, there is a good immune layer among the population (up to 50% of children and 85% of adults): many are infected from carriers without developing symptoms of the disease, but with the development of immunity. That is why it is believed that the disease is not contagious for the environment of a patient with EBVI, since many already have antibodies to the Epstein-Barr virus.

Rarely, in institutions of a closed type (military units, dormitories), outbreaks of EBVI can still be observed, which are of low intensity in severity, and are also extended in time.

EBVI, and in particular its most frequent manifestation, mononucleosis, is characterized by spring-autumn seasonality.
Immunity after an infection is formed strong, lifelong. It is impossible to get sick again with an acute form of EBVI. Repeated cases of the disease are associated with the development of a relapse or chronic form of the disease and its exacerbation.

Epstein-Barr virus pathway in humans

Entry gate of infection- the mucous membrane of the oropharynx and nasopharynx, where the virus multiplies and the organization of nonspecific (primary) protection occurs. The outcomes of primary infection are influenced by: general immunity, concomitant diseases, the state of the entrance gate of infection (there are or are no chronic diseases of the oropharynx and nasopharynx), as well as the infectious dose and virulence of the pathogen.

Outcomes of primary infection can be: 1) sanitation (destruction of the virus at the entrance gate); 2) subclinical (asymptomatic form); 3) clinically determined (manifest) form; 4) primary latent form (in which the reproduction of the virus and its isolation are possible, but there are no clinical symptoms).

Further, from the entrance gate of infection, the virus enters the bloodstream (viremia) - the patient may have a temperature and intoxication. At the site of the entrance gate, a “primary focus” is formed - catarrhal tonsillitis, difficulty in nasal breathing. Next, the virus enters various tissues and organs with a primary lesion of the liver, spleen, lymph nodes and others. It was during this period that “atypical tissue mononuclear cells” appeared in the blood against the background of a moderate increase in lymphocytes.

The outcomes of the disease can be: recovery, chronic EBV infection, asymptomatic carriage, autoimmune diseases (systemic lupus erythematosus, rheumatoid arthritis, Sjögren's syndrome and others), oncological diseases, with oncological diseases and congenital EBV infection - death is possible.

Symptoms of EBV infection

Depending on the climate, certain clinical forms of EBVI predominate. In countries with a temperate climate, which include the Russian Federation, infectious mononucleosis is more common, and if there is no immunity deficiency, then a subclinical (asymptomatic) form of the disease may develop. Also, the Epstein-Barr virus can cause "chronic fatigue syndrome", autoimmune diseases (rheumatic diseases, vasculitis, ulcerative colitis). In countries with a tropical and subtropical climate, the development of malignant neoplasms (Burkitt's lymphosarcoma, nasopharyngeal carcinoma, and others) is possible, often with metastases to various organs. In HIV-infected patients, EBVI is associated with hairy leukoplakia of the tongue, brain lymphoma, and other manifestations.

At present, the fact of a direct connection of the Epstein-Barr virus with the development of acute mononucleosis, chronic EBVI (or EBV infection), congenital EBV infection, "chronic fatigue syndrome", lymphoid interstitial pneumonia, hepatitis, oncological lymphoproliferative diseases (Burkitt's lymphoma, T-cell lymphoma, nasopharyngeal carcinoma or NFC, leiomyosarcoma, non-Hodgkin's lymphomas), HIV-associated diseases ("hairy leukoplakia", brain lymphoma, common lymph node neoplasms).

More about some manifestations of EBV infection:

1. Infectious mononucleosis, which manifests itself in the form of an acute form of the disease with cyclicity and specific symptoms (fever, catarrhal angina, difficulty in nasal breathing, enlarged groups of lymph nodes, liver, spleen, allergic rash, specific changes in the blood). For more details, see the article " Infectious mononucleosis".
Signs unfavorable in terms of the development of chronic EBV infection:
- protracted nature of the course of infection (prolonged subfebrile condition - 37-37.5 ° - up to 3-6 months, preservation of enlarged lymph nodes for more than 1.5-3 months);
- the occurrence of relapses of the disease with the resumption of symptoms of the disease within 1.5-3-4 months after the onset of the primary attack of the disease;
- preservation of IgM antibodies (to EA, VCA antigens of EBV) for more than 3 months from the onset of the disease; lack of seroconversion (seroconversion - the disappearance of IgM antibodies and the formation of IgG antibodies in different antigens of the Epstein-Barr virus);
- untimely started or completely absent specific treatment.

2. Chronic EBV infection formed no earlier than 6 months after an acute infection, and in the absence of acute mononucleosis in history - 6 or more months after infection. Often, a latent form of infection with a decrease in immunity turns into a chronic infection. Chronic EBV infection can occur in the form of: chronic active EBV infection, hemophagocytic syndrome associated with EBV, atypical forms of EBV (recurrent bacterial, fungal and other infections of the digestive system, respiratory tract, skin and mucous membranes).

Chronic active EBV infection characterized by a long course and frequent relapses. Patients are concerned about weakness, fatigue, excessive sweating, prolonged low temperature up to 37.2-37.5 °, skin rashes, sometimes articular syndrome, pain in the muscles of the trunk and limbs, heaviness in the right hypochondrium, discomfort in the throat, slight cough and nasal congestion, some patients have neurological disorders - causeless headaches, memory impairment, sleep disturbances, frequent mood swings, a tendency to depression, patients are inattentive, decreased intelligence. Often, patients complain of an increase in one or a group of lymph nodes, an increase in internal organs (spleen and liver) is possible.
Along with such complaints, when questioning the patient, the recent presence of frequent colds, fungal diseases, the addition of other herpetic diseases (for example, herpes simplex on the lips or genital herpes, etc.)
In confirmation of clinical data, there will also be laboratory signs (changes in blood, immune status, specific tests for antibodies).
With a pronounced decrease in immunity during chronic active EBV infection, the process generalizes and damage to internal organs is possible with the development of meningitis, encephalitis, polyradiculoneuritis, myocarditis, glomerulonephritis, pneumonia, and others.

Hemophagocytic syndrome associated with EBV manifests itself in the form of anemia or pancytopenia (a decrease in the composition of almost all blood elements associated with inhibition of hematopoietic sprouts). Patients may experience fever (wave-like or intermittent, in which both sharp and gradual rises in temperature are possible with recovery to normal values), swollen lymph nodes, liver and spleen, abnormal liver function, laboratory changes in the blood in the form of a decrease in both red blood cells and and leukocytes and other blood elements.

Erased (atypical) forms of EBVI: most often it is a fever of unknown origin lasting for months, years, accompanied by an increase in lymph nodes, sometimes joint manifestations, muscle pain; another option is secondary immunodeficiency with frequent viral, bacterial, fungal infections.

3. Congenital EBV infection occurs in the presence of an acute form of EBVI or chronic active EBV infection that occurred during the mother's pregnancy. It is characterized by possible damage to the internal organs of the child in the form of interstitial pneumonia, encephalitis, myocarditis and others. Possible prematurity, premature birth. In the blood of a born baby, both maternal antibodies to the Epstein-Barr virus (IgG to EBNA, VCA, EA antigens) and a clear confirmation of intrauterine infection - the child's own antibodies (IgM to EA, IgM to VCA antigens of the virus) can circulate.

4. " chronic fatigue syndrome»characterized by constant fatigue, which does not go away after a long and proper rest. Patients with chronic fatigue syndrome are characterized by muscle weakness, periods of apathy, depressive states, mood lability, irritability, and sometimes outbursts of anger and aggression. Patients are lethargic, complain of memory impairment, decreased intelligence. Patients do not sleep well, and both the falling asleep phase is disturbed, and intermittent sleep is observed, insomnia and drowsiness during the day are possible. At the same time, vegetative disorders are characteristic: trembling or tremor of the fingers, sweating, periodically low temperature, poor appetite, joint pain.
At risk are workaholics, people with increased physical and mental work, people who are both in acute stressful situations and in chronic stress.

5. HIV-associated diseases
"Hairy leukoplakia" tongue and oral mucosa appears with severe
immunodeficiency associated more often with HIV infection. On the lateral surfaces of the tongue, as well as on the mucous membrane of the cheeks, gums, whitish folds appear, which gradually merge, forming white plaques with an inhomogeneous surface, as if covered with furrows, cracks and erosive surfaces form. As a rule, there is no pain in this disease.

Lymphoid interstitial pneumonia is a polyetiological disease (there is a connection with pneumocystis, as well as with EBV) and is characterized by shortness of breath, unproductive cough
against the background of temperature and symptoms of intoxication, as well as progressive weight loss in patients. The patient has enlarged liver and spleen, lymph nodes, enlarged salivary glands. X-ray examination of bilateral lower lobe interstitial foci of inflammation of the lung tissue, the roots are expanded, non-structural.

6. Oncological lymphoproliferative diseases(Burkitt's lymphoma, nasopharyngeal carcinoma - NFC, T-cell lymphoma, non-Hodgkin's lymphoma and others)

Diagnosis of Epstein-Barr virus infection

1. Preliminary diagnosis always exhibited on the basis of clinical and epidemiological data. Suspicion of EBVI is confirmed by clinical laboratory tests, in particular a complete blood count, which can reveal indirect signs of viral activity: lymphomonocytosis (increase in lymphocytes, monocytes), less often monocytosis in lymphopenia (increase in monocytes with a decrease in lymphocytes), thrombocytosis (increase in platelets), anemia (decrease in red blood cells and hemoglobin), the appearance of atypical mononuclear cells in the blood.

Atypical mononuclear cells (or virocytes)- These are modified lymphocytes, which, according to morphological features, have some similarity with monocytes. These are single-nuclear cells, they are young cells that appear in the blood in order to fight viruses. It is the latter property that explains their appearance in EBVI (especially in its acute form). The diagnosis of infectious mononucleosis is considered confirmed if there are more than 10% of atypical mononuclear cells in the blood, but their number can vary from 10 to 50% or more.

For the qualitative and quantitative determination of atypical mononuclear cells, the leukocyte concentration method is used, which is a highly sensitive method.

Appearance dates: Atypical mononuclear cells appear in the first days of the disease, at the height of the disease their number is maximum (40-50% or more), in some patients their appearance is recorded a week after the onset of the disease.

The duration of their discovery: in most patients, atypical mononuclear cells continue to be detected within 2-3 weeks from the onset of the disease, in some patients they disappear by the beginning of the 2nd week of the disease. In 40% of patients, atypical mononuclear cells continue to be detected in the blood for up to a month or more (in this case, it makes sense to actively prevent the process from becoming chronic).

Also, at the stage of preliminary diagnosis, a biochemical study of blood serum is carried out, in which there are signs of liver damage (a slight increase in bilirubin, an increase in the activity of enzymes - ALT, AST, GGTP, thymol test).

2. Final Diagnosis exhibited after specific laboratory tests.

1) Heterophilic test- detection of heterophile antibodies in the blood serum, are detected in the vast majority of patients with EBVI. It is an additional diagnostic method. Heterophilic antibodies are produced in response to infection with EBV - these are autoantibodies that are synthesized by infected B-lymphocytes. These include antinuclear antibodies, rheumatic factors, cold agglutinins. They belong to the IgM class of antibodies. They appear in the first 1-2 weeks from the moment of infection, and their gradual increase is characteristic during the first 3-4 weeks, then gradually decrease in the next 2 months and remain in the blood for the entire period of convalescence (3-6 months). If this test is negative in the presence of EBVI symptoms, it is recommended to repeat it after 2 weeks.
False-positive results for heterophile antibodies can give conditions such as hepatitis, leukemia, lymphoma, drug use. Also positive antibodies of this group can be with: systemic lupus erythematosus, cryoglobulinemia, syphilis.

2) Serological tests for antibodies to the Epstein-Barr virus by ELISA(linked immunosorbent assay).
IgM to VCA(to the capsid antigen) - are detected in the blood in the first days and weeks of the disease, are maximum by the 3rd-4th week of the disease, can circulate for up to 3 months, and then their number decreases to an undetectable value and disappears completely. Their persistence for more than 3 months indicates a protracted course of the disease. They are found in 90-100% of patients with acute EBVI.
IgG to VCA(to the capsid antigen) - appear in the blood after 1-2 months from the onset of the disease, then gradually decreases and remains at the threshold (low level) for life. An increase in their titer is characteristic of an exacerbation of chronic EBVI.
IgM to EA(to an early antigen) - appears in the blood in the first week of the disease, persists for 2-3 months and disappears. It is found in 75-90% of patients. Preservation in high titers for a long time (more than 3-4 months) is alarming in terms of the formation of a chronic form of EBVI. Their appearance in chronic infection serves as an indicator of reactivation. Often they can be detected during primary infection in carriers of EBV.
IgG to EA(to the early antigen) - appear by the 3-4th week of the disease, become maximum at 4-6 weeks of the disease, disappear after 3-6 months. The appearance of high titers repeatedly indicates the activation of a chronic infection.
IgG to NA-1 or EBNA(to nuclear or nuclear antigen) - are late, because they appear in the blood 1-3 months after the onset of the disease. For a long time (up to 12 months), the titer is quite high, and then the titer decreases and remains at the threshold (low) level for life. In young children (up to 3-4 years old), these antibodies appear late - 4-6 months after infection. If a person has a pronounced immunodeficiency (AIDS stage with HIV infection, oncological processes, etc.), then these antibodies may not be present. Reactivation of chronic infection or relapse of acute EBVI is observed at high titers of IgG to the NA antigen.

Results interpretation schemes

Rules for the qualitative diagnosis of EBV infection:
- dynamic laboratory examination: in most cases, a single antibody test is not enough to make a diagnosis. Repeated studies are required after 2 weeks, 4 weeks, 1.5 months, 3 and 6 months. The dynamic research algorithm and its necessity are determined only by the attending doctor!
- to compare the results made in one laboratory.
- there are no general norms for antibody titers; the result is evaluated by the doctor in comparison with the reference values ​​​​of a particular laboratory, after which it is concluded how many times the desired antibody titer is increased compared to the reference value. The threshold level, as a rule, does not exceed 5-10 times increase. High titers are diagnosed at 15-30x magnification and above.

3) PCR diagnostics of EBV infection– qualitative detection of Epstein-Barr virus DNA by PCR.
The material for the study is saliva or oropharyngeal and nasopharyngeal mucus, scraping of epithelial cells of the urogenital tract, blood, cerebrospinal fluid, prostate secretion, urine.
Both EBVI patients and carriers may have a positive PCR. Therefore, for their differentiation, PCR analysis is performed with a given sensitivity: up to 10 copies per sample for carriers, and 100 copies per sample for active infection. In young children (up to 1-3 years old), due to insufficiently formed immunity, the diagnosis of antibodies is difficult, therefore, in this group of patients, it is the PCR analyth that comes to the rescue.
The specificity of this method is 100%, which virtually eliminates false positive results. However, due to the fact that PCR analysis is informative only during the reproduction (replication) of the virus, there is a certain percentage of false negative results (up to 30%), associated precisely with the lack of replication at the time of the study.

4) Immunogram or immunological examination of blood.
With EBVI, there are two types of changes in the immune status:
An increase in its activity (an increase in the level of serum interferon, IgA, IgM, IgG, an increase in the CEC, an increase in CD16 + - natural killers, an increase in either CD4 + T-helpers, or CD8 + T-suppressors)
Immune dysfunction or insufficiency (decrease in IgG, increase in IgM, decrease in antibody avidity, decrease in CD25+ lymphocytes, decrease in CD16+, CD4+, CD8, decrease in phagocyte activity).

Treatment for EBV infection

1) Organizational and regime measures include hospitalization in the infectious diseases clinic of patients with acute EBVI, depending on the severity. Patients with reactivation of a chronic infection are more often treated on an outpatient basis. Diet therapy is reduced to a complete diet with mechanical, chemical sparing of the digestive tract.

2) Drug specific therapy for EBVI.
Antiviral drugs (isoprinosine from the first days of life, arbidol from 2 years old, valtrex from 2 years old, famvir from 12 years old, acyclovir from the first days of life in the absence of other means, but much less effective).
Interferon preparations (viferon from the first days of life, kipferon from the first days of life, reaferon EC-lipind older than 2 years, interferons for parenteral administration older than 2 years).
Interferon inductors (cycloferon over 4 years old, neovir from the first days of life, amixin from 7 years old, anaferon from 3 years old).

Rules for specific EBVI therapy:
1) All drugs, dose, courses are prescribed exclusively by the attending doctor.
2) After the main course of treatment, a long maintenance course is necessary.
3) Combinations of immunomodulators are prescribed with caution and only by a doctor.
3) Drugs to enhance the intensity of treatment.
- Immunocorrection (after an immunogram study) - immunomodulators (thymogen, polyoxidonium, derinat, likopid, ribomunil, immunorix, roncoleukin and others);
- Hepatoprotectors (karsil, hepabene, hepatofalk, Essentiale, heptral, ursosan, ovesol and others);
- Enterosorbents (white coal, filtrum, lactofiltrum, enterosgel, smecta);
- Probiotics (bifidum-forte, probifor, biovestin, bifiform and others);
- Antihistamines (Zyrtec, Claritin, Zodak, Erius and others);
- Other drugs according to indications.

Clinical examination of patients with acute and chronic EBVI

All dispensary observation is carried out by an infectious disease specialist, in pediatric practice, in the absence of one, by an immunologist or pediatrician. After suffering infectious mononucleosis, observation is established for 6 months after the illness. Examinations are carried out monthly, if necessary, consultations of narrow specialists: hematologist, immunologist, oncologist, ENT doctor and others
Laboratory tests are carried out quarterly (1 time in 3 months), and if necessary more often, a general blood test is carried out monthly for the first 3 months. Laboratory tests include: complete blood count, antibody tests, PCR analysis of blood and oropharyngeal mucus, biochemical blood test, immunogram, ultrasound examination and others as indicated.

Prevention of Epstein-Barr virus infection

There is no specific prophylaxis (vaccination). Preventive measures are reduced to strengthening the immune system, hardening children, precautions when a patient appears in the environment, and observing the rules of personal hygiene.

Infectious disease specialist Bykova N.I.

(EBVI) is one of the most common human infectious diseases. Antibodies (Abs) to the Epstein-Barr virus (EBV) are found in 60% of children in the first two years of life and in 80-100% of adults. The incidence of acute EBVI (AEBVI) in different regions of the world ranges from 40 to 80 cases per 100,000 population. The chronic form of EBVI (CHEBVI) develops in 15-25% of individuals after AEBVI. The role of EBV in the development of malignant neoplasms, autoimmune diseases and chronic fatigue syndrome has been established. All this testifies to the relevance of the EBVI problem.

VEB, discovered in 1964 by M. Epstein and Y. Barr, refers to γ-herpes viruses. EBV contains 3 antigens: capsid (VCA), early (EA) and nuclear (EBNA). The peculiarity of the pathological process in EBVI is determined by the ability of EBV to transform B-lymphocytes, lifelong persistence in the human body, induction of a secondary immunodeficiency state (IDS), autoimmune reactions, and malignant tumors.

The source of EBV infection is patients with manifest and asymptomatic forms. 70-90% of people who have undergone AEBVI shed the virus in the next 1-18 months. Ways of transmission of EBV: airborne, contact-household, parenteral, sexual, vertical. AEBVI is characterized by epidemic rises 1 time in 6-7 years, more often recorded at the age of 1 to 5 years, in organized groups.

The entrance gate for EBV is the mucous membrane of the upper respiratory tract: the virus penetrates into the lymphoid tissue, infects B-lymphocytes, polyclonal activation of B-lymphocytes develops, dissemination of the pathogen in B-lymphocytes, the synthesis of antibodies (Ab) in response to antigenic stimulation is reduced. First of all, EBV affects the lymphoid organs (tonsils, liver, spleen).

The next stage is the formation of a clone of sensitized cytotoxic CD8 cells, the sequential synthesis of Abs to the VCA, EA, and EBNA antigens of the virus. Due to impaired immune response, functional activity of innate resistance factors (neutrophils, macrophages, NK cells, interferon system), secondary IDS is formed.

The immune status of 109 patients with AEBVI aged 5 to 14 years in our work revealed signs of activation of the T-cell link of the immune system - an increase in the number of T-lymphocytes (CD3), cytotoxic T-lymphocytes (CD8), cells with markers of late activation (HLA- DR); polyclonal activation of B-lymphocytes - an increase in the number of CD20 cells, immunoglobulins (Ig) IgA, IgM, IgG, circulating immune complexes (CIC). Signs of suppression of the immune system were found: the normal content of T-helpers (CD4), a decrease in the immunoregulatory index CD4 / CD8, the number of natural killer cells NK (CD16), an increase in the readiness of immunocompetent cells for apoptosis (CD95). There was an activation of oxygen-dependent metabolism of neutrophils and a reduction in its adaptive capacity.

In a third of the examined children (33.9%), AEBVI proceeded in the form of a mixed infection with cytomegaloviruses (CMV), herpes simplex viruses types 1 and 2 (HSV-1, HSV-2). Bacteriological examination of smears from the oropharynx in 41.3% of patients revealed Streptococcus (S.) viridans, 11.9% have candida albicans, 8.2% - Staphylococcus (Staph.) epidermidis, 6.4% have S. pyogenes, 2.7% have Klebsiella (Kl.) pneumoniae, 41.3% have an association of bacteria. In 43.1% of patients - serological markers of the active form, in 30.3% - mycoplasmosis.

The following outcomes of AEBVI are possible: latent infection, CHEBVI, IDS, oncological, autoimmune diseases,. The transition to CHEBVI is associated with a complex of unfavorable factors in the ante-, intra- and postnatal periods, impaired neuroimmunoendocrine regulation, and genetic predisposition.

Our survey of 60 children aged 5 to 14 years with CHEBVI showed that in this group, 86.7% of mothers had a burdened obstetric anamnesis; 83.3% of children were found to have perinatal and postnatal pathology of the central nervous system, ENT organs, etc.

In the immune status of patients with CHEBVI, an increase in the content of the interleukin-1 antagonist (IL-1RA), insufficient activation of immunocompetent cells (decrease in HLA-DR) and an increase in their readiness for apoptosis (increase in CD95) were revealed. There was a violation of the functional activity of T-helper type 1 (Th1) (decrease in the content of interferon γ (IFN γ)); a decrease in the total pool of T cells (CD3), the number of lymphocytes with receptors for IL-2 (CD25) and NK cells (CD16); the content of cytotoxic CD8-lymphocytes was increased. Preservation of EBV replication markers for a long time in this group indicated a violation of virus elimination; at the same time, there was an increase in the functional activity of Th2, polyclonal activation of B-lymphocytes (CD20), an increase in the content of IgA, IgM, IgG, CEC, a decrease in the level of neutrophil chemotactic factor (IL-8), and a change in their metabolism.

Violations of the immune status led to the activation of opportunistic microflora, viral and fungal infections. In the microbial spectrum of the oropharyngeal mucosa of patients with CHEBVI, S. viridans (30%), candida albicans (28,3%), Staph. Epidermidis (25%), S. pyogenes (20%), Kl. Pneumoniae(8.4%), association of bacteria (41.7%); in 28.3% - serological markers of the active form of chlamydia, in 26.7% - mycoplasmosis. In 90% of patients, the disease proceeded in the form of a mixed infection with the participation of: EBV + CMV, EBV + HSV-1, HSV-2.

Classification. There is no generally accepted classification of the disease; we recommend using the EBVI working classification developed by us.

• According to the period of occurrence: congenital, acquired.
• In form: typical (infectious mononucleosis), atypical: erased, asymptomatic, visceral.
• Severity: light, medium, heavy.
• Downstream: acute, protracted, chronic.
• By phase: active, inactive.
• Complications: hepatitis, rupture of the spleen, meningoencephalitis, polyradiculoneuropathy, myocarditis, sinusitis, otitis media, hemolytic anemia, thrombocytopenia, neutropenia, pancreatitis, etc.
• Mixed infection.

Diagnosis examples:

1. Main: Acquired EBVI, typical severe form (), acute course, active phase. Donkey:
2. Main: Acquired EBVI, visceral form (meningoencephalitis, hepatitis, nephritis), severe chronic course, active phase. Donkey: acute hepatic-renal insufficiency. Resist.: Respiratory chlamydia ( , ).

Clinical picture of acute EBVI was first described by N. F. Filatov (1885) and E. Pfeifer (1889). The incubation period lasts from 4 days to 7 weeks. A complete symptom complex is formed by the 4-10th day of illness.

We examined 109 children with AEBVI. In most patients, the disease begins acutely, with an increase in body temperature and the appearance of symptoms of intoxication; less often there is a gradual onset: a few days there is malaise, weakness, lethargy, loss of appetite. Body temperature is subfebrile or normal. By the 2-4th day of illness, the temperature reaches 39-40 ° C; fever and symptoms of intoxication may persist for 2-3 weeks or more.

Generalized lymphadenopathy refers to the pathognomonic symptoms of EBVI and from the first days of the disease manifests itself as a systemic lesion of 5-6 groups of lymph nodes (LN), with a predominant increase of up to 1-3 cm in diameter of the anterior and posterior cervical, submandibular LNs. LNs are slightly painful on palpation, are not soldered to each other and surrounding tissues, are arranged in the form of a "chain", "package"; visible when turning the head, give the neck a "scalloped" shape. Sometimes soft tissue pastosity is noted over enlarged lymph nodes.

- the most frequent and early symptom of AEBVI, accompanied by an increase in the tonsils to II-III degree. The lacunar pattern is emphasized due to infiltration of the tonsil tissue or smoothed out due to lymphostasis. On the tonsils - raids of yellowish-white or dirty gray in the form of islands, stripes. They come from gaps, have a rough surface (reminiscent of lace), are easily removed without bleeding, rubbed, do not sink in water. A discrepancy between the size of plaque and the degree of increase in regional LNs is characteristic. With the fibrinous-necrotic nature of the raids, if they spread beyond the tonsils, a differential diagnosis with diphtheria is necessary. Raids on the tonsils disappear, as a rule, after 5-10 days.

Signs of adenoiditis are found in the vast majority of patients. Nasal congestion, difficulty in nasal breathing, snoring breathing with an open mouth, especially during sleep, are noted. The patient's face acquires an "adenoid" appearance: puffiness, pasty eyelids, nose bridges, breathing through an open mouth, dry lips.

Hepatomegaly can be detected from the first days of the disease, but is more often detected in the second week. Normalization of liver size occurs within six months. In 15-20% of patients, hepatitis develops as a complication.

Splenomegaly refers to late symptoms, occurs in most patients. Normalization of the size of the spleen occurs within 1-3 weeks.

Exanthema in AEBVI appears on the 3-14th day of illness, has a polymorphic character - spotty, papular, maculopapular, roseolous, punctate, hemorrhagic. There is no specific localization. The rash is observed within 4-10 days, sometimes leaves pigmentation. In children treated with ampicillin or amoxicillin, rash appears more often (90-100%).

Hematological changes include leukocytosis (10-30 x 10 9 /l), neutropenia with a stab shift to the left, an increase in the number of lymphocytes, monocytes, atypical mononuclear cells up to 50-80%, an increase in ESR up to 20-30 mm/hour. A characteristic hematological sign is atypical mononuclear cells in the amount of 10-50%: they appear by the end of the first week of the disease and persist for 1-3 weeks.

Chronic EBVI is the outcome of AEBVI or develops as a primary chronic form. We examined 60 children with CHEBVI, the clinic of which included chronic mononucleosis-like syndrome and multiple organ pathology. All patients had lymphoproliferative syndrome (generalized lymphadenopathy, hypertrophy of the palatine and pharyngeal tonsils, enlargement of the liver and spleen) and signs of chronic intoxication (prolonged subfebrile condition, weakness, loss of appetite, etc.). Due to the development of IDS, acute and ENT organs were observed with exacerbations up to 6-11 times a year: rhinopharyngitis (28.3%), pharyngotonsillitis (91.7%), adenoiditis (56.7%), otitis media (11.7%) , sinusitis (20%), laryngotracheitis (18.3%), bronchitis (38.3%), pneumonia (25%). Attention was drawn to the high frequency of multiple organ pathology due to prolonged replication of EBV, secondary IDS, autoimmune reactions (pathology of the central nervous system;,,; cardiac syndrome, arthralgia).

In recent years, congenital EBVI has been described. It has been established that the risk of it in primary EBVI during pregnancy is 67%, with reactivation - 22%. The clinic of congenital EBVI is similar to CMVI.

The role of EBV in the development of oncological diseases and paraneoplastic processes has been established - Burkett's lymphoma, nasopharyngeal carcinoma, lymphogranulomatosis, tumors of the stomach, intestines, salivary glands, uterus, leukoplakia of the tongue and oral mucosa, as well as a number of autoimmune diseases - lymphoid interstitial pneumonitis, uveitis, etc. . . EBV, along with human herpesvirus types 6 and 7, is the etiological factor and the most common cause (15%) of the development of prolonged fever of unknown origin.

EBVI diagnostics is based on taking into account risk groups, leading clinical syndromes and laboratory data. Risk groups in the mother include a burdened history, markers of herpes virus infections, etc., in a child - perinatal CNS damage, an allergic phenotype, IDS, markers of herpes virus infections, etc. The leading clinical syndromes of EBVI are mononucleosis-like, general infectious syndromes, exanthema, syndrome of multiple organ pathology.

The mandatory standard for diagnosing EBVI includes a clinical blood test, a general urinalysis, a biochemical blood test, a bacteriological examination of the mucus of the oropharynx and nose, serological markers of EBV, other herpes viruses, chlamydia, mycoplasmas, ultrasound of the abdominal organs, consultation of an ENT doctor, according to indications - radiography of the paranasal sinuses, chest organs, ECG. Additional diagnostic standard (in a specialized medical institution): markers of EBV, other herpes viruses, chlamydia, mycoplasmas by polymerase chain reaction (PCR), immunogram of the second level, consultation of an immunologist, according to indications - coagulogram, morphological picture of sternal puncture, consultation of a hematologist , oncologist.

Abs against EBV antigens are determined by enzyme-linked immunosorbent assay (ELISA), which makes it possible to carry out laboratory diagnosis of EBVI and determine the period of the infectious process.

Abs of the IgM class to VCA appear simultaneously with the AEBVI clinic, persist for 2-3 months, and are re-synthesized during EBV reactivation. Long-term persistence of high titers of these Abs is characteristic of CHEBVI, EBV-induced tumors, autoimmune diseases, and IDS.

Abs of the IgG class to EA reach a high titer on the 3-4th week of AEBVI, disappear after 2-6 months. They appear during reactivation, absent in atypical form of EBVI. High titers of Abs of this class are detected in CHEBVI, EBV-induced oncological and autoimmune diseases, and IDS.

Abs of the IgG class to EBNA appear 1-6 months after the primary infection. Then their titer decreases and persists throughout life. When EBVI is reactivated, their titer increases again.

Of great importance is the study of the avidity of Ab class IgG (strength of antigen binding to Ab). In primary infection, Abs with low avidity are synthesized first (avidity index (AI) less than 30%). The late stage of primary infection is characterized by Abs with moderate avidity (IA - 30-49%). Highly avid antibodies (AI - more than 50%) are formed 1-7 months after infection with EBV.

Serological markers of the active phase of EBVI are Ab IgM to VCA and Ab IgG to EA, low and moderate avidity of Ab IgG to markers of the inactive phase, Ab IgG to EBNA.

The material for PCR is blood, cerebrospinal fluid, saliva, smears from the oropharyngeal mucosa, biopsy specimens of organs, etc. The sensitivity of PCR in EBVI (70-75%) is lower than in other herpesvirus infections (95-100%). This is due to the appearance of EBV in biological fluids only during immune-mediated lysis of infected B-lymphocytes.

Treatment. The principles of EBVI therapy are the complex nature, the use of etiotropic drugs, the continuity, duration and succession of therapeutic measures at the stages of "hospital → clinic → rehabilitation center", control of clinical and laboratory parameters.

Based on the experience of treating 169 children with EBVI, we have developed a standard for the treatment of this disease.

Basic therapy: protective mode; medical nutrition; antiviral drugs: virucidal drugs - inosine pranobex (Isoprinosine), abnormal nucleosides (Valtrex, Acyclovir), Arbidol; IFN preparations - recombinant IFN α-2β (Viferon), Kipferon, Reaferon-EC-Lipint, interferons for intramuscular injection (Reaferon-EC, Realdiron, Intron A, Roferon A, etc.); IFN inductors - Amiksin, ultra-low doses of antibodies to γ-IFN (Anaferon), Cycloferon, Neovir. According to indications: local antibacterial drugs (Bioparox, Lizobakt, Stopangin, etc.); systemic antibacterial drugs (cephalosporins, macrolides, carbapenems); immunoglobulins for intravenous administration (Immunovenin, Gabriglobin, Intraglobin, Pentaglobin, etc.); vitamin and mineral complexes - Multi-tabs, Vibovit, Sanasol, Kinder Biovital gel, etc.

Intensification of basic therapy according to indications:

Immunocorrective therapy under the control of immunograms - immunomodulators (Polyoxidonium, Likopid, Ribomunil, IRS-19, Imudon, Derinat, etc.), cytokines (Roncoleukin, Leukinferon); probiotics (Bifiform, Acipol, etc.); drugs for metabolic rehabilitation (Actovegin, Solcoseryl, Elkar, etc.); enterosorbents (Smecta, Filtrum, Enterosgel, Polyphepan, etc.); second-generation antihistamines (Claritin, Zyrtec, Fenistil, etc.); hepatoprotectors (Hofitol, Galstena, etc.); glucocorticosteroids (prednisolone, dexamethasone); protease inhibitors (Kontrykal, Gordox); neuro- and angioprotectors (Encephabol, Gliatilin, Instenon, etc.); "cardiotropic" drugs (Riboxin, Cocarboxylase, Cytochrome C, etc.); homeopathic and antihomotoxic remedies (Oscillococcinum, Aflubin, Lymphomyosot, Tonsilla compositum, etc.); non-drug methods (laser therapy, magnetotherapy, acupuncture, massage, physiotherapy, etc.)

Symptomatic therapy.

With fever - antipyretic drugs (paracetamol, ibuprofen, etc.); with difficulty in nasal breathing - nasal preparations (Isofra, Polydex, Nazivin, Vibrocil, Adrianol, etc.); with a dry cough - antitussive drugs (Glauvent, Libeksin), with a wet cough - expectorant and mucolytic drugs (AmbroGEKSAL, bromhexine, acetylcysteine, etc.).

For several years, we have been successfully using a combined staged etiotropic therapy for the treatment of EBVI, which includes inosine pranobex (Isoprinosine) and recombinant interferon α-2β (Viferon) (Fig. 1, 2). Inosine pranobex (Isoprinosine) inhibits the synthesis of viral proteins and inhibits the replication of a wide range of DNA and RNA viruses, including EBV. The drug has immunocorrective activity - modulates the immune response by cell type, stimulates the production of antibodies, cytokines, IFN, increases the functional activity of macrophages, neutrophils and NK cells; protects affected cells from post-viral decrease in protein synthesis. Inosine pranobex (Isoprinosine) was administered at 50-100 mg/kg/day orally in 3-4 doses. Conducted three courses of treatment for 10 days with an interval of 10 days. Recombinant IFN α-2β (Viferon) inhibits viral replication due to endonuclease activation, destruction of viral messenger RNA. The drug modulates the immune response, promotes the differentiation of B-lymphocytes, stimulates the production of cytokines, increases the functional activity of macrophages, neutrophils and NK cells. Its natural antioxidants (vitamins E and C) stabilize cell membranes. The drug was prescribed according to a prolonged regimen (V. V. Malinovskaya et al., 2006).

The effectiveness of etiotropic therapy for AEBVI was evaluated in two groups of patients. Patients of the 1st group (52 children) received inosine pranobex (Isoprinosine) in combination with recombinant IFN α-2β (Viferon), patients of the 2nd group (57 children) received monotherapy with recombinant IFN α-2β (Viferon). Clinical and serological parameters before treatment and after 3 months of therapy are presented in . In patients of both groups, there was a significant decrease in such symptoms as generalized lymphadenopathy, tonsillitis, adenoiditis, hepatomegaly and splenomegaly over time. However, against the background of combination therapy, the positive dynamics of clinical indicators was more significant; acute respiratory infections (ARI) only in 19.2% of patients of the 1st group and in 40.3% of patients of the 2nd group (p< 0,05). На фоне комбинированной терапии наблюдалось более быстрое исчезновение серологических маркеров репликации.

Combination therapy for AEBVI contributed to the modulation of the immune response by cell type (an increase in CD3-, CD4-, CD8-, CD16- and HLA-DRT-lymphocytes). The readiness of immunocompetent cells for apoptosis (CD95) decreased. Stimulation of IgA production, switching of Ab synthesis from IgM to IgG, a decrease in the content of the CEC, and improved parameters of neutrophil metabolism were noted.

The effectiveness of etiotropic therapy was studied in 60 patients with CHEBVI. Patients of group 1 (30 children) received inosine pranobex (Isoprinosine) and recombinant IFN α-2β (Viferon), group 2 (30 children) received monotherapy with recombinant IFN α-2β (Viferon). Regardless of the treatment regimen, 3 months after the start of therapy, there was a significant decrease in the incidence of generalized lymphadenopathy, hypertrophy of the palatine and pharyngeal tonsils, splenomegaly, intoxication, infectious and vegetative-visceral syndromes ( ). The combination of inosine pranobex (Isoprinosine) with recombinant IFN α-2β (Viferon) contributed to a more significant dynamics of clinical parameters. The number of ARI episodes decreased from 6-11 (7.9 ± 1.1) to 4-6 (5.2 ± 1.2) per year during monotherapy with recombinant IFN α-2β (Viferon), and to 2-4 ( 2.5 ± 1.4) per year against the background of combination therapy (p< 0,05). В обеих группах уменьшалась частота репликации ВЭБ, однако при сочетанном применении противовирусных препаратов этот эффект был более выраженным.

The use of a combination of inosine pranobex (Isoprinosine) and recombinant IFN α-2β (Viferon) in patients with CHEBVI led to more pronounced positive dynamics of the immune status indicators (decrease in the content of IL-1RA, normalization of the expression of activation markers of immunocompetent cells (HLA-DR) and apoptosis receptors ( CD95); increase in the functional activity of Th1 (increase in IFN γ), restoration of the number of T-lymphocytes and NK cells, a higher content of CD8-lymphocytes than with monotherapy. There was no complete normalization of the expression of the receptor for IL-2 (CD25). against the background of combined antiviral therapy, the functional activity of Th2 decreased (normalization of the level of IL-4. The number of B cells at the end of treatment was normal. An increase in the level of IgA and a switch in Ab synthesis from the IgM class to IgG were recorded; the content of the CIC decreased. The indicators of neutrophil metabolism improved The content of the chemotactic factor of neutrophils (IL-8) did not reach the norm, however, it was higher than with Viferon monotherapy.

There were no side effects when using inosine pranobex (Isoprinosine) and recombinant IFN α-2β (Viferon).

The results of the study indicate the potentiation of effects when inosine pranobex (Isoprinosine) is combined with recombinant IFN a-2b (Viferon) in patients with EBVI.

Potentiation of antiviral, immunomodulatory and cytoprotective effects of these drugs leads to a more significant positive dynamics of manifestations of EBVI clinical symptoms than in monotherapy, to the disappearance of serological markers of the activity of the infectious process. It should be noted the high efficiency and safety of combination therapy using inosine pranobex (Isoprinosine) and recombinant IFN α-2β (Viferon).

Rehabilitation. The child is observed by the local doctor and infectious disease specialist, deregistered 6-12 months after the disappearance of clinical and laboratory indicators of the activity of the infectious process. The frequency of inspections is once a month. According to the indications, it is recommended to consult an ENT doctor, an immunologist, a hematologist, an oncologist, etc. Laboratory and instrumental studies of patients include: a clinical blood test once a month for 3 months, then once every 3 months, more often according to indications; serological markers of EBV by ELISA once every three months, according to indications - more often; PCR of blood, swabs from the oropharynx 1 time in 3 months, according to indications - more often; immunogram - 1 time in 3-6 months; biochemical and instrumental studies - according to indications.

Rehabilitation therapy includes: protective regimen, therapeutic nutrition, antiviral drugs according to prolonged schemes. Under the control of the immunogram, immunocorrection is carried out. According to the indications, local antibacterial drugs, courses of vitamin-mineral complexes, pro- and prebiotics, metabolic rehabilitation drugs, enterosorbents, antihistamines, hepato-, neuro- and angioprotectors, cardiotropic drugs, enzymes, homeopathic remedies, non-drug methods of treatment are prescribed.

Thus, EBVI is characterized by a wide distribution, a long course with periodic reactivation of the infectious process in some patients, the possibility of developing complications and adverse outcomes (oncological diseases, autoimmune pathology). An important role in EBVI is played by the formation of secondary IDS. The leading clinical syndromes of EBVI are acute and chronic mononucleosis-like syndromes, intoxication, infectious, cerebral, gastrointestinal, cardiac and arthralgic syndromes. Diagnosis of EBVI is based on the analysis of risk groups, identification of leading clinical syndromes and laboratory testing. Treatment of EBVI is complex and includes etiotropic drugs (virostatic drugs, interferon and its inducers), drugs of pathogenetic, immunomodulatory, symptomatic therapy. The combined prolonged use of inosine pranobex (Isoprinosine) and recombinant IFN α-2β (Viferon), which potentiate their immunocorrective and cytoprotective effects, significantly increases the effectiveness of treatment. Patients with EBVI need long-term rehabilitation with mandatory monitoring of clinical and laboratory indicators of the activity of the infectious process.

For literature inquiries, please contact the editor.

E. N. Simovanyan, doctor of medical sciences, professor
V. B. Denisenko, Candidate of Medical Sciences
L. F. Bovtalo, Candidate of Medical Sciences
A. V. Grigoryan
Rostov State Medical University, Rostov-on-Don