November 11, 2016
Babies are often sick viral diseasesand some of them pose a serious threat to children's health. At the moment, pediatricians around the world pay special attention to the pathology that causes the Epstein-Barr virus.
When a child first gets infected, the symptoms of this infection may go unnoticed. The consequences of the infection after a few months negatively affect all organs and systems of the body. What do parents need to know about the signs of this disease?
Polyclonal activation of B cells promotes the production of antibodies against viral and protein cells. During the acute phase of infectious mononucleosis, about one in 100 B cells in the peripheral blood is infected, while after recovery, 50 out of every million are infected.
The primary infection is usually asymptomatic, especially if acquired during childhood. When this occurs in young people, there is usually an acute picture of fever, odinaphogy and cervical lymphadenopathy, as well as abnormalities in the study of heterophilic antibodies in peripheral blood. This pattern is called infectious mononucleosis or glandular fever.
The Epstein-Barr virus is the causative agent of a number of human diseases, belongs to the group of herpes viruses (another name is the infectious agent of herpes type 4). Discovered in 1964 in Great Britain by scientists Michael Epstein and Yvonne Barr. It multiplies in the cells of the child's immune system (lymphocytes) and causes their uncontrolled growth (cytomegalovirus causes an increase in the size of infected cells).
This is not strange, since the virus is able to interfere with the physiological mechanisms of cell survival and control of proliferation. Infection with this virus is associated with the development of nasopharyngeal carcinoma, Burkitt's lymphoma, Hodgkin's disease, and B-cell lymphoma. In recent years, a relationship has been discovered between several diseases of autoimmune etiology, such as rheumatoid arthritis, systemic lupus erythematosus or multiple sclerosis. This link is not fully established and its pathogenic mechanisms are unknown.
The structure of the virus overlaps with the structure of other viruses in the family. The organization of the chromosome is very similar to that observed in other herpes viruses with terminal replicas at both ends of the molecule. This versatility is one of the reasons why the virus can identify hidden infections.
Associated with the following diseases like:
- Infectious mononucleosis;
- Burkitt's lymphoma;
- Nasopharyngeal carcinoma;
- Other oncological pathologies (chemotherapy and surgery).
The virus contains elements against which B-lymphocytes develop antibodies of the IgM and IgG classes (immunoglobulin M, G) in the bodies of children:
Children become susceptible as soon as the protection of the maternal antibodies disappears. The virus is usually transmitted through saliva and reaches the epithelium of the pharynx, where it can infect the epithelial cells. B cells are infected by contact with these epithelial cells, while lymphocytes from tonsillar crypts are directly infected.
In these cells, the virus multiplies by establishing lytic infections. Some researchers believe that B-lymphocyte infection occurs directly without the involvement of epithelial cells. The introduction of viruses into lymphoid cells is a very complex process involving several viral proteins. The virus is introduced by endocytosis.
- VCA, capsid antigen;
- ENBA - nuclear antigen;
- EA is an early antigen.
When IgM and IgG (immunoglobulin M, G) against the above antigens (VCA, EA, ENBA) are found in the child's blood, if a serological test is performed, then an acute or chronic form of the disease caused by the Epstein-Barr virus can be diagnosed.
How the virus is transmitted
Epstein-Barr virus: prognosis depends on prevention
When the virus spreads through the bloodstream. Most of the antibodies produced by B cells during infection are directed against this protein. At this time, one in 100 B cells in the peripheral blood is infected with the virus, and the convalescent phase is only 1 in a million.
In the fight against infectious mononucleosis, cellular immunity is more important than humoral immunity. If T-cell immunity is compromised, B-cell proliferation can occur and the disease can become lymphoma, although this is just one step many that are required to achieve malignancy. There are rare occasions when viral infection Epstein-Barr reaches the level of Burkitt's lymphoma or nasopharyngeal carcinoma.
The virus has several modes of transmission. It is released into the environment with body fluids. Its greatest concentration accumulates in the saliva of children, therefore, a common pathology caused by it is infectious mononucleosis, otherwise called "kissing disease".
The pathogen spreads when:
Clinical manifestations
Most Epstein-Barr viral infections in children or adolescents are asymptomatic and present as pharyngitis with or without tonsillitis. In contrast, in adults, 75% of infections in adolescents cause infectious mononucleosis. It is a saliva transmission disease. 90% of adults who have some type of antibody. The onset of infectious mononucleosis in the elderly is often nonspecific and includes long-term fever, fatigue, myalgia, and malaise. In contrast, this group of people contains relatively rare manifestations such as pharyngitis, lymphadenopathy, thrombocytopenia, splenomegaly and lymphocytes and atypical monocytes.
- Kisses on the lips;
- Intimate contacts;
- Blood transfusion;
- The use of common objects (dishes, toys) with which a sick baby or a virus carrier came into contact (the pathogen is in his saliva and through it enters the outside world);
- The use of non-sterile medical instruments for injections, surgical interventions, and cosmetic procedures;
- From mother to child through the placenta and breastfeeding.
Cytomegalovirus (CMV) has similar transmission routes, and is especially dangerous for an unborn child if the baby becomes infected from a sick mother. Couples planning to have children need to donate blood for EBV and CMV examinations. If the test is positive, treatment is recommended.
The incubation period for mononucleosis in young adults is 4-6 weeks before symptoms and signs begin to appear. Fatigue, discomfort, and myalgia begin to manifest 1 to 2 weeks before the onset of fever and sore throat. Fever is usually not very intense and is more common in the first two weeks of illness, although it can persist for more than a month. The diagnosis is made using serology to detect antibodies through the Paul-Bunnell test.
Pharyngitis is usually the most conspicuous sign and may be accompanied by swelling of the tonsils, with an exudate resembling a strep throat. In about 5% of cases, a morbo-like or papular exanthema appears, which is usually located on the arms or trunk. Many suffer from these symptoms for 2-4 weeks, but general discomfort and fatigue can last for several months.
Risk group
Epidemiologists identify two risk groups for children:
- One-year-old babies who are actively in contact with others;
- Preschoolers aged 2.5-5 years who regularly attend kindergarten.
Viral infection (EBV, not cytomegalovirus) spreads most rapidly in small closed children's groups, which include groups in kindergartens.
Drowsiness. Swelling of the spleen. Stiffness or muscle pain.
- Pain in the throat.
- Malaise.
- Abdominal pain, nausea, or vomiting.
- Lymphadenopathy.
- Fever.
- Pharyngitis or tonsillitis.
- Splenomegaly.
- Hepatomegaly.
Signs and symptoms
Consider the symptoms of infectious mononucleosis, which is a manifestation of the child's initial contact with the Epstein-Barr virus. Sometimes mononucleosis in children is caused by cytomegalovirus (differential serological analysis is always necessary).
Usually the so-called kissing disease is transmitted mainly by oral secretions or the exchange of saliva, 6% by kissing, drinking the same glass, etc. epidemic episodes have been reported in several parts of the world. The virus is cleared up to 18 months after the initial infection, then it is cleared intermittently throughout life.
The incubation period is 4-7 weeks. Almost all patients have a fever. Odinophagy is also very common in adolescents, with exploratory results from inflammation of the pharynx in 85% of cases. Pulmonary lymphadenopathy is present in 90% of cases.
The disease begins acutely and lasts 3 to 4 weeks.
With mononucleosis (if its cause is EBV, and not cytomegalovirus), the following symptoms appear. It is found upon direct examination of the child:
- Increase in body temperature to 39-40 degrees with severe intoxication syndrome - nausea, vomiting, weakness, headache, tachycardia;
- Swollen lymph nodes throughout the body (especially in the neck - anterior and posterior cervical nodes);
- Nasopharyngitis and tonsillitis with white-gray or yellowish patches (due to the defeat of the palatine mydalins and adenoids);
- Difficulty nasal breathing in the absence of discharge from the nasal passages, puffy face, nasal voice;
- Enlargement of the liver and spleen (hepatosplenomegaly in children), pain in the abdominal cavity, icterus of the sclera and skin;
- Exanthema (rash of viral origin) in the form of spots, papules, vesicles with ubiquitous localization.
Microscopic examination (general) during the period acute infection among ordinary blood cells, large atypical lymphocytes are found that are affected by a virus - mononuclear cells (cytomegalovirus sometimes gives such a blood picture). They persist in the bloodstream for a month after infection.
What is the incubation period for Epstein-Barr disease?
The complete classical triad is present in over 50% of patients. Other common symptoms include prostration, intense fatigue, which is reported in 90% of cases at the onset, mild headache and joint pain. The most common search results, in addition to those already mentioned, are: palatine petechiae, splenomegaly, which in most cases are found only with ultrasound, axillary and inguinal lymphadenopathy, hepatomegaly, erythematous maculosis or maculopapular eruption.
The sick child's immune system is trying to cope with the infected lymphocytes. There is an activation of T-helpers and T-suppressors, NK cells, which destroy mononulears. The surviving B-lymphocytes develop antibodies of the IgG and IgM classes (immunoglobulin M, G) against each of the viral antigens (VCA, EBNA, EA), due to which the work of the cellular link of the immune system becomes possible.
Evolution is generally good and most clinical manifestations have disappeared at the end of the fourth week. After about 6 months, 10% of patients have these symptoms. Death is exceptional, although cases have been reported due to ruptured spleen, myocarditis, secondary bacterial infections, or airway obstruction.
From a clinical point of view, in many cases it is easy to distinguish between them. If this is not possible, special diagnostic tests will be applied. The goal of treatment is to relieve symptoms. Medicines, such as steroids, have little or no benefit. People with the above carcinoma usually show higher titers of antibodies against the virus.
Infectious Mononucleosis (Epstein Barr Virus). Symptoms and Treatment Methods
For the serological diagnosis of mononucleosis, an enzyme immunoassay (ELISA) or polymerase chain reaction (PCR) is used, with which the Epstein-Barr virus is detected.
Diseases caused by a virus
Also called non-Hodgkin's lymphoma, it is cancer that occurs in the lymph tissue. This tissue contains the lymph nodes and associated organs, which are part of the immune system and the blood system that produces blood. The lymph nodes are small, bean-shaped organs found under the skin in the neck, armpits, and groin. They are also found in many other parts of the body, such as the inside chest, abdomen and pelvis.
Principles of Internal Medicine. ... Aplastic anemia occurs when the bone marrow produces very few globules of all types: red, white, and platelets. A decreased red blood cell count leads to a decrease in red blood cell count and hemoglobin. A small number of white blood cells makes the patient susceptible to infections. A small number of platelets can cause the blood to not thicken as it should.
What antibodies (AT) types IgG and IgM (immunoglobulin M, G) are diagnostic when an IF test is performed?
| Antibody type | Characteristic |
| Anti-VCA antibodies of the IgM class (immunoglobulin M to capsid antigen) | Produced in acute EBV infection, circulate in the blood for 2-3 months. Re-synthesized in case of virus reactivation. A high concentration of anti-VCA IgM, which persists for a long time, is evidence of a chronic form of EBV. What Causes Aplastic Anemia?Anaplastic anemia in children has several causes. Some of these causes are idiopathic, i.e. occur sporadically for no known cause. Other causes are secondary, caused by a past illness or disorder. Immune dysfunction or cell malignancy is very common. Many cases of aplastic anemia in childhood occur sporadically with no known cause. However, purchased admissions may include the following. A history of an autoimmune disease such as lupus development of acute lymphocytic leukemia.
|
| Anti-EA antibodies of the IgG class (immunoglobulin G to early antigen) | Appear in the blood 3-4 weeks after the onset of acute EBV infection, persist for 2-6 months. Again anti-EA IgG appears when the pathogen is reactivated. |
| Anti-EBNA IgG antibodies (immunoglobulin G to nuclear antigen) | They begin to circulate in the bloodstream 1-6 months after the primary EBV disease. Their concentration gradually decreases. Anti-EBNA IgG can be detected until the end of a person's life (they are always detected by an IF test). |
If an IF analysis was carried out, a positive result that revealed:
- igG antibodies (immunoglobulin G) against nuclear and early antigens;
- antibodies of the IgM type (immunoglobulin M) to the capsid (VCA) antigen of the virus
Confirms the diagnosis "acute infectious mononucleosis" and indicates EBV infection. Additionally, a blood test is carried out for antibodies against antigens that cytomegalovirus has.
What are the symptoms of aplastic anemia?
Below are the most common symptoms of aplastic anemia. However, each child may experience symptoms differently. Breathing difficulty Irregular energy or fatigue with ease Abnormal pallor or lack of color on the skin Blood in the stool Nasal bleeding Gastric bleeding Sinus tenderness Liver or enlarged spleen Oral pain. Symptoms of aplastic anemia may mimic other blood disorders or medical problems. Always check with your child's doctor for a diagnosis.
What are the complications of infectious mononucleosis (the causative agent of EBV, not cytomegalovirus)?
- Hepatitis;
- Ruptured spleen;
- Development of hematological, oncological pathologies;
- Development of immunodeficiency, anemia, thrombocytopenia;
- Autoimmune pathologies;
- Meningitis and meningoencephalitis;
- Pancreatitis;
- Pneumonia;
- Damage to the myocardium and heart valve apparatus.
In acute EBV infection, complications arise if a secondary bacterial infection joins the virus during the height of the illness or recovery.
How is aplastic anemia diagnosed?
In addition to a complete medical history and physical examination of your child, diagnostic procedures for aplastic anemia may include the following.
Aplastic anemia treatment
In aplastic anemia, the bone marrow is usually replaced with fat. ... The specific treatment for aplastic anemia will be determined by your child's doctor based on.Epstein-Barr virus and infectious mononucleosis
Your child's age, general health, and medical history Degree of anemia Cause of anemia Your child's tolerance for specific drugs, procedures or therapies Expectations about anemia Your opinion or preference. Anaplastic anemia is a serious illness and treatment usually depends on the underlying cause. For some reason, recovery after treatment can be expected; however, relapses may occur. For low blood counts, initial treatment is usually beneficial, meaning that the symptoms need to be treated but the disease cannot be cured.
The most vulnerable to infection are children aged 3-4 to 15-16 years. Babies get sick less often, symptoms of the disease are often not detected in them. A detailed clinical picture and a severe course and negative consequences in a child can occur only if he was infected in utero or suffers from an immunodeficiency of any nature (for example, the immune response does not work due to the lack of antibodies to VCA, EA, ENBA antigen).
The opinion of Dr. Komarovsky
Dr. Komarovsky believes that most children have already met with the Epstein-Barr virus, and the symptoms of the disease were minimal.
Komarovsky warns against the use of amoxicillin and ampicillin for mononucleosis (antibiotics of the penicillin group), which are prescribed to a child in case of misdiagnosis as a treatment for angina. This can provoke the appearance of exanthema.
Pediatrician Komarovsky points out that with mononucleosis, ordinary children without immunodeficiency conditions (when anti-VCA, anti-ENBA antibodies are not produced) are shown exclusively symptomatic treatment. They do not need to be treated with antiviral or immune-boosting drugs.
Infectious Mononucleosis - Doctor Komarovsky School
Prevention
- In order to avoid contracting the Epstein-Barr virus from an early age, teach your child to personal hygiene.
- In autumn and winter, avoid large crowds, as when sneezing and coughing, there is also a possibility of transmission of the pathogen Epstein-Barr.
- Lead a healthy lifestyle, since the Epstein-Barr virus, after entering the body, can remain in it for a long time in a latent form (symptoms appear when immunity is weakened, physical exhaustion, if treatment for another disease is interrupted).
Treatment
Specific treatment for epstein-Barr virus not developed. In the case of a severe course of the disease (bright symptoms) in a hospital setting, drugs are used that are effective against other viruses of the herpes group. The doctor may prescribe immunomodulating drugs for individual indications, taking into account the following indicators:
- the titer of antibodies to VCA, ENBA and EA antigens (capsid, nuclear, early) in the patient (do IF analysis) and
- the presence or absence of antibodies to antigens such as cytomegalovirus.
As a symptomatic treatment of angina caused by the Epstein-Barr pathogen, antiseptic lozenges, gargling with disinfectant solutions or herbal infusions are used.
To reduce the temperature, the child is offered paracetamol.
The rash can be treated with panthenol to speed up healing.
A sick baby needs to drink a lot, all food should be grated or semi-liquid.
Folk recipes
Alternative treatment is powerless over the cause of the disease - the Epstein-Barr virus.
To decrease like effective treatment it is recommended to prepare infusions of chamomile officinalis, mint and sage and rinse the mouth with them.
Give your child plenty of rosehip broth, offer hot tea made from raspberry or currant jam (drinks with vitamin C stimulate the immune system to fight the Epstein-Barr virus).
Epstein-Barr virus is the causative agent of many dangerous infections, but with proper child care, the first meeting with EBV will take place for the baby without complications. Parents need to know the typical signs of an Epstein-Barr infection in order to see a doctor in time, donate blood for a serological test, and maintain children's health.
How can you get mononucleosis? - Doctor Komarovsky
Pathogenic microorganisms have long been distributed throughout all corners of the planet due to the active movement of people. As a result, viruses and bacteria, once inherent in certain regions, gained the ability to function everywhere. One of these is the Epstein-Barr virus (EBV). Recently, it was characteristic of Africa, and today it is capable of overtaking any of us in our native country. Children are no exception. On the contrary, the fragile body of a child is maximally susceptible to a virus belonging to the group
Photo: Epstein-Barr virus
Infection routes
It has been proven that the Epstein-Barr virus is one of the most common on the planet. Infection with them occurs more often in childhood and adolescence. If adults are infected, serious consequences cannot be avoided.
Photo: The spread of the virus
Most often, the virus is transmitted during kissing, which is why most children become infected from their parents. It is no less easy to get infected through household items, toys and during a blood transfusion.
Infection of a child with EBV can occur while still in the womb, which is why it is an obvious danger for pregnant women.
Photo: Infection of the fetus
Definition of infestation
It is not possible to detect infection immediately, which is due to the very long latent period of EBV. It lasts from 1 to 2 months, sometimes longer. During this time, the virus gradually accumulates in the lymph nodes and mucous membranes. And only a few months after infection, the child can first feel the deterioration of health.
Photo: Deterioration of health
Risk group
Among those who are more likely to contract the Epstein-Barr virus are children under one year old... This is due to their constant presence among adults: parents, relatives, doctors. At the same time, the virus often penetrated into the body of infants does not make itself felt even after a couple of months, that is, it does not cause diseases.
In children senior preschool and primary school age, which can become infected with no less probability, everything happens differently: the virus attacking the organism turns into considerable problems. As a rule, the infection results in a disease called. Today, doctors are recording more and more episodes of this disease. Perhaps the most likely reason for the disappointing situation is low immunity in most children.
It is important to understand that the Epstein-Barr virus is not always infectious mononucleosis. There are other diseases it causes: chronic fatigue syndrome, Burkitt's lymphoma, Hodgkin's disease, systemic hepatitis and others. Moreover, infectious mononucleosis is also not always caused by EBV. Sometimes cytomegalovirus is responsible for its development.
Epstein-Barr virus infection is much harder for teens than for children younger age... EBV remains in the body, concentrating in the salivary glands and lymph nodes. Even after recovery, the child poses a danger to others, since he acts as a carrier of such a harmful microorganism.
Photo: Virus in the lymph nodes
After the disappearance of clinical manifestations, the virus is able to circulate in the child's body for a long time, and sometimes for life.
Symptoms
Signs of EBV infection vary, but are often very similar to those of a cold or flu. Once in the body, the virus rapidly spreads through it through the lymph and blood... First, the child's temperature rises. It may be insignificant - slightly above 37 degrees. Cases of severe fever are also frequent (the temperature reaches a critical level). This is followed by intoxication of the body: sweating, chills, headache, lethargy and apathy. A child with inherent discomfort in the throat. Nasal congestion is also present.
Photo: Signs of pharyngitis
One of the obvious signs that a child is infected with the Epstein-Barr virus is snoring during a night's rest. In this case, a runny nose is not observed.
The Epstein-Barr virus affects the condition of the submandibular and posterior cervical lymph nodes. They increase noticeably in size. In some cases, this is determined by the doctor by palpation, in others, everything is noticeable with the naked eye. There is also an increase in the spleen and liver. A rash may appear on the child's body.
When infected with a virus Epstein-Barr baby becomes weak. Rapid fatigability is inherent in him, even for no obvious reason. Such manifestations can persist even after recovery.
Photo: When infected, the child becomes weak
In acute EBV infection, the nervous system is often affected. Development of encephalomyelitis or meningoencephalitis is quite likely.
Diagnostics
To detect the Epstein-Barr virus in a child's body, consultation with a pediatrician and an infectious disease specialist is required. Blood test is required... On the recommendation of a doctor, an immunological examination may be prescribed.
Photo: Immunological studies
Epstein-Barr in children: treatment
At the moment, a definite course of treatment for the Epstein-Barr viral infection has not been developed. Doctors direct their efforts to alleviate the child's condition and prevent possible complications. In other words, symptomatic therapy is important... For this purpose, the following are used:
- Drugs to combat high temperature and minimizing symptoms of infection (body aches, sore throat, headache)
- Corticosteroid medications that help relieve swelling of the tonsils and throat
Photo: Means for relieving nasal breathing
Very often, homeopathic remedies are used to eliminate the inherent EBV symptoms, aimed at normalizing the size of the lymph nodes. One of the most effective is Lymphomyosot.
Antibiotics are not used in EBV treatment due to ineffectiveness... Their reception is justified only in the case of a secondary bacterial infection. It makes no sense to use antiviral drugs ... They, unfortunately, do not have a destructive effect on the Epstein-Barr virus.
Treatment for a child infected with EBV involves drinking enough fluids and good rest... The child must be relieved of excessive mental and physical stress.
Photo: Drinking plenty of fluids
Does traditional medicine make sense?
It is quite clear that if conventional medicine cannot cope with the Epstein-Barr virus, non-traditional medicine will also be powerless. The only way the recipes from the "grandmother's chest" will help is to alleviate the condition of an infected child. For example, eating foods containing echinacea and vitamin C is a way to gain strength, and decoctions of chamomile and immortelle will help minimize the negative effects of the virus on the liver.
You should not warm or massage the lymph nodes without first consulting a doctor!
Photo: Chamomile decoction
Prevention
Unfortunately, a vaccine against the Epstein-Barr virus has not been developed, so parents can protect their child from trouble by explaining the rules of personal hygiene to him and practicing in a timely manner.