The Epstein Barr Virus
Complication and treatment of Epstein Barr virus
What is the Epstein Barr virus?Mononucleosis is a disease manifested by fever, swollen lymph nodes, sore throat while there is the appearance in the blood atypical mononuclear cells and heterophilic antibodies. The causative agent of infectious mononucleosis is Epstein – Barr. In addition, the Epstein – Barr in humans is associated with some malignant tumors such as nasopharyngeal carcinoma, Burkitt's lymph ( the fact that her cells were first isolated Epstein – Barr), limfogranulematoz, people with weakened immune systems and HIV-infected b - cell lymphoma.
Epstein – Barr belongs to the genus of herpes viruses. Have Epstein – Barr another name – human herpes virus type 4. The genome is a linear double-stranded DNA enclosed in a capsid with icosahedral symmetry with an outer shell composed of glycoproteins. There are two types of Epstein-Barr, but using the standard serological methods, to identify it, is not possible.
Epidemiology of Epstein–Barr
Epstein –Barr is quite common. Often the infection with this virus occurs in early childhood or adolescence, so that more than 90% of adults have already suffered this infection in any form, the body has developed antibodies to the virus. Infectious mononucleosis is considered a disease of the young.
Get infected through saliva by kissing. While adults infect children, and young people from each other. Quite rare to become infected by close contacts. Even this virus can pass through blood transfusion and bone marrow transplantation. Previously, Epstein – Barr detected in saliva in 20% of seropositive healthy individuals.
Modern methods today to identify this virus in more than 90% (quarter check people, this virus stands out with saliva constantly). In the environment the virus of Epstein – Barr mostly patients with infectious mononucleosis and people with weak immune systems.
Infectious mononucleosisIn the case that infection with Epstein – Barr occurred at a young age, 75% of this leads to the development of infectious mononucleosis.
The symptoms of infectious mononucleosis: 4-6 weeks is the incubation period of infectiousmononucleosis in young people. Next, the person feels fatigue, malaise, myalgia – this prodromal period lasts from 1 to 2 weeks. Then fever, sore throat, swollen lymph nodes. Typically, body temperature is subfebrile and this remains during the first two weeks of illness, rarely lasts a month. The disease is especially pronounced in the first two weeks, enlarged lymph nodes and sore throat, splenomegaly - on the second or third week. Swollen lymph nodes occur symmetrically, they are quite painful, but remain movable. As a rule, are particularly affected shinasha and occipital lymph nodes, however, sometimes generalized increase. Clinically this looks like a strep sore throat.
Tonsils swollen with bloom. In 5% of cases develop a rash, maculopapular or papular lesions usually on the torso and arms. Often patients who are treated with ampicillin appears bright red drug rash (but it does not mean that the person will continue to be adverse reactions to penicillin drugs. Possible erythema nodosum and polymorphic exudative erythema. Basically, the disease lasts 2-4 weeks, but malaise and attention disorders are still few months.
Very rarely infectious mononucleosis in infants and young children. The elderly people it occurs without symptoms of angina, increase in lymph nodes and splenomegaly, atypical mononuclear cells in the blood are not observed, people are concerned about fever, fatigue, malaise, and myalgia.
Complications of infectious mononucleosisInfectious mononucleosis usually goes away. Deaths with this disease are extremely rare. Usually they are associated with the CNS, splenic rupture, upper airway obstruction, or bacterial superinfection.
In infectious mononucleosis the CNS develops in the first two weeks of the disease. Sometimes it is the only manifestation of infection, especially in young children. While in the blood can not be observed atypical mononuclear cells and heterophilic antibodies. Quite often manifests itself as meningitis and encephalitis; sometimes headache, meningism, cerebellar ataxia, hemiplegia, psychosis. In the CSF reveals a lymphocytosis, sometimes with atypical mononuclear cells. Quite rare residual neurologicaldefects. In infectious mononucleosis describe the cranial nerves, especially with the bells palsy, Guillain –Barre syndrome, transverse myelitis, neuropathy.
About 2% of cases of infectious mononucleosis in the first two weeks complicated by autoimmune hemolytic anemia with Cold antibodies. Direct Coombs test gives a positive result. Anemia lasts for 1-2 months, usually it easy, there are also severe cases accompanied by jaundice and hemoglobinuria. Identify the following antibodies _ rheumatoid factor, antinuclear antibodies, antibodies to smooth muscle and platelets, as well as cryoglobulin. In some cases, infectious mononucleosis is accompanied by erythroid aplasia, deep neutropenia, pancytopenia, and hemophagocytic syndrome. Less than 0.5 % of cases in men occur a ruptured spleen.
The symptoms in this case are the following: characteristic abdominal pain, radiating to the left shoulder, as well as circulatory disorders.
The possible development of upper airway obstruction due to hyperplasia of the Palatine and pharyngeal tonsils. Found inflammation and edema of the epiglottis and the uvula. Approximately 10% of patients after infectious mononucleosis sick with tonsillitis streptococcal Complications are rare, but if happens, then it could be hepatitis, sometimes with a fulminant course of myocarditis and pericarditis by ECG changes, pneumonia with pleural effusion, interstitial nephritis, vasculitis.
Treatment of infectious mononucleosisTreatment of infectious mononucleosis is carried out taking into account the symptoms, but usually is calm and pain relief. As in the first month is a big risk of a ruptured spleen, must not physically loaded. If, nevertheless, ruptured spleen, it can not be avoided splenectomy. In the absence of complications there is no need to resort to glucocorticoids, as they predispose to bacterial superinfection. In order to prevent airway obstruction when severe hyperplasia of the tonsils, or in autoimmune hemolytic anemia and severe thrombocytopenia prescribed prednisone 40-60 mg/day inside the duration of 2-3 days, after which the dose should be gradually reduced over 1-2 weeks.
Again, the glucocorticoids will be necessary in cases of severe illness and fever, severe CNS or heart. Studies conducted on the drug acyclovir showed that in infectious mononucleosis it in the course of the disease is not affected. However, hairyleukoplakia of the mouth, and sometimes in chronic active infection, which is the causative agent Epstein – Barr, acyclovir (400-800 mg orally 5 times a day) is quite effective, but note that hairy leukoplakia of the mouth often recurs.
Acyclovir is not effective in lymphoproliferative syndrome. Patients with gives relief to reduce the doses of immunosuppressive drugs, and sometimes the destination is less strong drugs, and it is to this we should strive. Now looking for new treatments, tests on the drug interferon, transfusion of donor T-lymphocytes or specific cytotoxic T-lymphocytes, which can recognize virus Epstein –Barr cells.
To isolate people suffering from infectious mononucleosis is not necessary. Today there is a vaccine against Epstein – Barr, which contains the major glycoprotein of the virus. This vaccine has already proven itself positively to animals that currently are in clinical trials.