What is the avidity of antibodies to the Epstein Barr virus. Epstein-Barr viral infection in children: modern approaches to diagnosis and treatment

According to research, half of schoolchildren and 90% of forty-year-olds have encountered the Epstein-Barr virus (EBV), are immune to it and do not even know it. This article will focus on those for whom getting to know the virus was not so painless.

Infectious mononucleosis

At the onset of the disease, mononucleosis is practically indistinguishable from ordinary ARVI. Patients are worried about a runny nose, moderate sore throat, and body temperature rises to subfebrile levels.

The acute form of EBV is called. The virus enters the human body through the nasopharynx. More often through the mouth - it’s not for nothing that I got infectious mononucleosis beautiful name"kissing disease" The virus multiplies in cells of lymphoid tissue (in particular, in B lymphocytes).

A week after infection, a clinical picture resembling an acute respiratory infection develops:

• temperature increase, sometimes up to 40 °C,
• hyperemic tonsils, often with plaque,
• as well as a chain of lymph nodes in the neck along the sternocleidomastoid muscle, as well as in the back of the head, under the lower jaw, in the armpits and in the groin area,
• may be detected during examination of “packets” of lymph nodes in the mediastinum and abdominal cavity, the patient may complain of cough, chest pain or abdominal pain,
• the liver and spleen increase in size,
• Atypical mononuclear cells appear in a blood test - young blood cells similar to both monocytes and lymphocytes.

The patient spends about a week in bed, during which time he drinks a lot, gargles and takes antipyretics. There is no specific treatment for mononucleosis, the effectiveness of existing antiviral drugs has not been proven, and antibiotics are needed only in the case of a bacterial or fungal infection.

Typically, the fever disappears within a week, the lymph nodes shrink within a month, and blood changes can persist for six months.

After suffering from mononucleosis, specific antibodies remain in the body for life - immunoglobulins of class G (IgG-EBVCA, IgG-EBNA-1), which provide immunity to the virus.

Chronic EBV infection

If the immune response is not effective enough, a chronic Epstein-Barr viral infection may develop: erased, active, generalized or atypical.

1. Severe: the temperature often rises or stays for a long time within 37–38 ° C, increased fatigue, drowsiness, muscle and joint pain, and swollen lymph nodes may appear.
2. Atypical: infections often recur - intestinal, urinary tract, repeated acute respiratory infections. They are protracted and difficult to treat.
3. Active: symptoms of mononucleosis (fever, sore throat, lymphadenopathy, hepato- and splenomegaly) recur, often complicated by bacterial and fungal infections. The virus can cause damage to the mucous membrane of the stomach and intestines; patients complain of nausea, diarrhea, and abdominal pain.
4. Generalized: damage to the nervous system (encephalitis, radiculoneuritis), heart (), lungs (pneumonitis), liver (hepatitis).

In case of chronic infection, both the virus itself can be detected in saliva by PCR, and antibodies to nuclear antigens (IgG-EBNA-1), which are formed only 3-4 months after infection. However, this is not enough to make a diagnosis, because the same picture can be observed in a completely healthy carrier of the virus. Immunologists examine the entire spectrum of antiviral antibodies at least twice.

An increase in the amount of IgG to VCA and EA will suggest relapse of the disease.

How dangerous is Epstein-Barr virus?

Genital ulcers associated with EBV

The disease is quite rare and occurs more often in young women. Quite deep and painful erosions appear on the mucous membrane of the external genitalia. In most cases, in addition to ulcers, general symptoms typical of mononucleosis also develop. Acyclovir, which has proven itself in the treatment of herpes type II, was not very effective for genital ulcers associated with the Epstein-Barr virus. Fortunately, the rash goes away on its own and rarely recurs.

Hemophagocytic syndrome (X-Linked Lymphoproliferative Disease)

Epstein-Barr virus can infect T lymphocytes. As a result, a process is launched that leads to the destruction of blood cells - red blood cells, platelets, and leukocytes. This means that in addition to the symptoms characteristic of mononucleosis (fever, lymphadenopathy, hepatosplenomegaly), the patient develops anemia, hemorrhagic rashes, and blood clotting is impaired. These phenomena may disappear spontaneously, but can also lead to death and therefore require active treatment.

Cancers associated with EBV

Currently, the role of the virus in the development of such cancers is not disputed:

• Burkitt's lymphoma,
• nasopharyngeal carcinoma,
• lymphogranulomatosis,
• lymphoproliferative disease.

1. Burkitt's lymphoma occurs in children preschool age and only in Africa. The tumor affects the lymph nodes, upper or lower jaw, ovaries, adrenal glands and kidneys. Unfortunately, there are no drugs that guarantee success in its treatment yet.
2. Nasopharyngeal carcinoma is a tumor located in the upper part of the nasopharynx. It manifests itself as nasal congestion, nosebleeds, hearing loss, sore throat and persistent headache. Most often found in African countries.
3. Lymphogranulomatosis (otherwise known as Hodgkin's disease), on the contrary, more often affects Europeans of any age. It is manifested by enlarged lymph nodes, usually of several groups, including retrosternal and intra-abdominal, fever, and weight loss. The diagnosis is confirmed by a lymph node biopsy: giant Hodgkin (Reed-Berezovsky-Sternberg) cells are detected. Radiation therapy can achieve stable remission in 70% of patients.
4. Lymphoproliferative disease (plasma hyperplasia, T-cell lymphoma, B-cell lymphoma, immunoblastic lymphoma) is a group of diseases in which malignant proliferation of lymphoid tissue cells occurs. The disease is manifested by enlarged lymph nodes, and the diagnosis is made after a biopsy. The effectiveness of chemotherapy varies depending on the type of tumor.

Autoimmune diseases

The impact of the virus on the immune system causes failures in the recognition of its own tissues, which leads to the development of autoimmune diseases. EBV infection is listed among the etiological factors in the development of SLE, chronic glomerulonephritis, autoimmune hepatitis and Sjogren's syndrome.

Chronic fatigue syndrome

Chronic fatigue syndrome may be a manifestation of chronic EBV infection.

Often associated with viruses of the herpes group (which includes the Epstein-Barr virus). Typical symptoms of chronic EBV infection: enlarged lymph nodes, especially cervical and axillary, pharyngitis and low-grade fever, combined with severe asthenic syndrome. The patient complains of fatigue, decreased memory and intelligence, inability to concentrate, headache and muscle pain, and sleep disturbances.

There is no generally accepted treatment regimen for EBV infection. In the arsenal of doctors today there are nucleosides (Acyclovir, Ganciclovir, Famciclovir), immunoglobulins (Alfaglobin, Polygam), recombinant interferons (Reaferon, Cycloferon). However, a competent specialist should decide how to take them and whether it is worth doing at all after a thorough study, including laboratory research.

Which doctor should I contact?

If a patient has symptoms of an Epstein-Barr virus infection, they should be evaluated and treated by an infectious disease specialist. However, often such patients first turn to a general practitioner/pediatrician. If complications or diseases associated with the virus develop, consultations with specialized specialists are prescribed: a hematologist (for bleeding), a neurologist (for the development of encephalitis, meningitis), a cardiologist (for myocarditis), a pulmonologist (for pneumonitis), a rheumatologist (for damage to blood vessels and joints). In some cases, consultation with an ENT doctor is required to rule out bacterial tonsillitis.

To reliably determine the Epstein Barr virus, it is necessary to detect antibodies to it in the patient’s blood. This way you can safely begin treating the pathology.

Contact of the human body with any infection causes an immune response. Lymphocytes produce specific proteins that attach to a virus or bacteria and present them to cells that destroy foreign organisms. Some proteins remain on the cell membranes of lymphocytes and form a kind of memory for the immune system. After infection with herpes type 4, antibodies to the Epstein-Barr virus are produced.

Infection occurs through household or airborne droplets. It is implemented by the following mechanisms:

Primary infection in most cases is asymptomatic or with mild catarrhal symptoms. Only 20% manifest as primary infectious mononucleosis. Later, in 15% of those infected, the infection proceeds chronically with relapses.

IN different periods diseases, antibodies to the Epstein virus are synthesized - these are proteins of the immunoglobulin class, which, depending on the type and concentration in the blood, indicate an acute or past infection.

EBV leads to the following diseases:

• infectious mononucleosis;
• herpes;
• multiple sclerosis;
• tumors of the salivary glands;
• lymphorganulomatosis;
• lymphoma.

Pathogenesis

The virus enters the mucous membrane of the nasopharynx and respiratory tract, multiplies in the epithelium and infects neighboring cells and lymphocytes. In some of the affected B-lymphocytes, the Epstein virus divides, while in the rest it remains dormant. At the initial stages, T and NK cells are also infected, and a chronic infection occurs with the circulation of the virus in lymphocytes.

This is how the mechanism of evading the immune response is implemented. It produces proteins that are identical in amino acid alternation to interleukin-10, which leads to inhibition of the synthesis of interferon-gamma.

These mechanisms help to evade the reaction of the immune system when infection is activated, cause immunodeficiency and the manifestation of secondary flora.

Diagnostics

The basis of the immune response is made up of three types of antibodies:

• capsid, or VCA;
• nuclear EBNA to viral nuclear antigen;
• early EA.

Antibodies to Epstein-Barr virus belong to the IgM and IgG types. Based on the stage of appearance of AT, the period of infection is determined - primary, transferred or reactivated.

For the study, blood serum (ELISA), biological fluids - saliva, bone marrow, blood (PCR) are used. Antibodies can be detected using enzyme immunoassay, and viral DNA can be detected through PCR.

Early EA belongs to the IgG class, the maximum concentration occurs in the 2nd week of the disease, then over the course of 3-5 months it completely disappears.

After infection, IgM against the virus capsid will be found in 100% of cases. They increase from the first week, reach a maximum at 3, then gradually decrease. Determined in serum up to 6 months after contact with the pathogen. A positive IgM VCA class indicates an exacerbation of the disease.

Antibodies to the Epstein-Barr virus IgG VCA appear early, already at 1-4 weeks, and increase maximally by the 2nd month of the disease. After recovery, their titer gradually decreases, but can be recorded for several years after recovery. VCA IgG speaks about the state after illness and the formation of immunity.

Acute primary infection is reflected by elevated concentrations or a gradual increase in VCA IgG.

Antibodies to nuclear antigen appear at 4 weeks after infection and never in the early phase. Their appearance reflects the stage when the Epstein virus entered the cell nucleus. They increase and gradually stabilize at the 3rd month of infection. They are subsequently determined throughout life.

The combination of antibodies is interpreted as follows.

Virus norm

Deciphering the result is necessary for the doctor to correlate these analyzes with clinical manifestations and make a diagnosis. Immunoglobulin is determined quantitatively. The following indicators are significant:

• negative – less than 20 U/ml;
• doubtful – 20-40 U/ml;
• positive – more than 40 U/ml.

A positive analysis may occur in the following cases:

• acute infection in the last 1-2 months;
• reactivation of the virus;
• chronic infection with constant activity.

A negative study response can be interpreted as follows:

• absence of infection;
• incubation period;
• early or late persistent infection;
• atypical infection or reactivation of the process.

In some cases, difficulties may arise in diagnosis and interpretation of results. Class M antibodies to the viral capsid do not always appear before IgG. This occurs with immunosuppression.

Occasionally, IgM persists in the blood for a long time. As a result, in a patient with a past infection, serological analysis simulates a late primary infection.

During deep immunosuppression, nuclear antigen does not provoke the appearance of IgG.

IgG to EA does not always indicate an early period of primary infection. It can be detected in 70% of patients with acute mononucleosis and can be detected in healthy people, as well as during reactivation of the infection.

Diseases of the immune system can lead to serious distortions in serological analysis. Determination of viral DNA by PCR in biological fluids helps in diagnosis. The most informative method is for analyzing nasopharyngeal swabs obtained during the first 4 weeks of the disease.

High titers of G antibodies to nuclear antigen, capsid and early type are often detected in malignant neoplasms associated with the activity of EBV infection.

This virus has several names and all of them are, to some extent, familiar to the unfortunate victims: infectious mononucleosis, Epstein-Barr virus, EBV infection, “kissing disease”, herpes type 4, VEB, etc.

However, such synonymous abundance, unfortunately, does not eliminate panic among patients, especially among mothers with sick babies. Where did this disease come from? How to treat it? And, most importantly, whether the disease will be confirmed by a general blood test and what changes in it will result.

Doctors, of course, will rush to reassure worried parents, claiming that there was only an activation of the infection inherent in the body’s reserves.

But, since the symptoms in the acute period of the disease are not distinguished by their loyalty to either adults or young patients, it is necessary to act quickly, strictly adhering to the developed treatment algorithm. The mentioned OAC will also help with this, deciphering it will make it clear how correct the chosen path of therapy is and how long it will take the patient to recover.

In order to become more familiar with this disease, it is worth going back a little into history, approximately to the Middle Ages. Yes, back then they didn’t decipher blood tests, looking for EBV infection in them. Why, they didn’t even know about it, since patients of that time were worried "kissing disease", from which most young, loving citizens suffered.

Somewhat later, in 1885, the disease was first publicly described scientist Filatov, thereby giving the infection another name in its honor. In addition, it was he who first drew attention to enlarged lymph nodes in sick patients, as well as pathological changes in the size of the liver and spleen. This was truly a breakthrough in research, which made it possible to rationally approach the treatment of the virus.

However, time passed, and medicine still knew neither the exact ways of spreading/infecting Filatov’s disease, nor the principles of its course. Therefore, in 1964, these aspects were highlighted in their works by researchers who also “gave” the disease a new name in their honor - Epstein-Barr virus.

This time the description of the disease was more comprehensive, having confirmation in the form of tests and laboratory studies. Moreover, thanks to its detailed study, other disease synonyms: infectious mononucleosis, glandular fever, benign lymphoblastosis, herpes group 4 virus, monocytic tonsillitis.

The virus itself is increasingly being called acute infectious disease, relatively harmless, but incredibly contagious. Its “calling card” was enlarged lymph nodes, damage to the mucous membrane of the oropharynx, clinical changes in the composition of the blood (the appearance of certain mononuclear cells in it), skin rashes, as well as other acute symptoms, which are often mistakenly attributed to sore throat.

But, despite such obvious features of the disease, it is almost impossible to diagnose it yourself. Indeed, to complete the picture, you will need a clinical blood test, an ultrasound examination, and a consultation with a specialist to decipher the results obtained.

Interpretation of the analysis for infectious mononucleosis

An undoubted “advantage” when diagnosing EBV infection is the availability of research methods, among which the primacy is occupied by a general blood test.

This is explained, first of all, by the fact that when the virus of the 4th herpes group is activated always changing high-quality composition blood, which is reflected in the UAC:

The most important symptom of infectious mononucleosis is atypical mononuclear cells, which indicate the presence of EBV infection in the body.

Routes of infection with VEB infection

Many representatives modern medicine, while claiming that infectious mononucleosis is incredibly contagious, they forget to mention that 9 out of 10 people have been infected with it since early childhood. This explains its belonging to the herpes group, which can exist in human body and wait for the “opportune moment” to activate.

Moreover, every person who has been ill long time remains contagious to others. This is without mentioning that he will be a passive carrier of the virus until the end of his days.

What can “provoke” Filatov’s disease and what routes of infection Are they considered the most common?

• From mother to baby. During pregnancy, birth and breastfeeding.
• Through the blood. Due to transfusion, organ transplant, bone marrow transplant. The possibility of infection through an unsterile syringe, dropper or other instruments should not be ruled out.
• Through saliva. Infection is possible after simple contact with an infected person, especially if he sneezes and coughs.
• Through kisses. The most common method of infection, which predominates among young people. This also includes failure to comply with basic hygiene rules.

In order to further expand the picture of infection transmission, it is worth mentioning the risk category, which explains the frequency of the disease among certain population groups. This includes young children (up to 12 years of age inclusive), pregnant women, people with weak immune systems, as well as HIV-infected members of society. Often there are also young girls/boys who are in search of their life partner and are not particularly interested in love affairs.

Otherwise, the patient suddenly develops symptoms of an acute viral infection. And if you don’t apply for it in time medical care, you can not only delay treatment, but also contribute to various kinds complications.

Symptoms in adults

In order to adequately behave with infectious mononucleosis, especially if you know for sure that you have recently been in contact with its carrier, you should remember one simple rule: do not relax if symptoms of the disease have not appeared within several days. After all, you have at least 35-45 days to wait for them.

Yes, this is exactly the period of time incubation period Epstein-Barr virus. Therefore, it is better to spend precious time strengthening your own immunity, which will make it possible to completely avoid an acute infection.

The body couldn’t cope and the virus got into the blood? Then be prepared for extensive symptoms:

• A sudden increase in body temperature to 38.5C, chronic fatigue, inflammation of the nasal and oropharyngeal mucosa. In general, the patient simply looks like he has a cold, and without a detailed laboratory examination, his condition does not arouse suspicion even among specialists.
• 6-7 days after the onset of the disease, increased temperature up to 40-41C is observed. Moreover, it can remain this way for several weeks. The accompanying symptoms of fever include headache, joint discomfort, nausea and weakness.
• Along with the elevated temperature, the patient complains of painful sensations in the throat, which visually indicate a sore throat, mucous discharge from the nose, as well as partial manifestation of stomatitis.
• The lymph nodes become significantly enlarged, in several places at once. Often they do not cause pain, but retain a dense consistency for a long time.
• If an ultrasound examination is performed internal organs, then, most likely, the liver will be enlarged by 1-2 cm, and the spleen will reach a very impressive size. Symptomatically, this may be accompanied by pain in the left side/abdomen, dysfunction gastrointestinal tract, lack of appetite, aversion to food, as well as the initial stage of jaundice.

Symptoms in children

Oddly enough, it is for young patients that the Epstein-Barr virus is considered the safest. And it’s not even a matter of the course of the disease, but especially the immune system of the child’s body.

However, as practice suggests, it is children who often experience complications due to false diagnosis and treatment of infectious mononucleosis with antibiotics. The last aspect is the most main mistake, since the general symptoms, although they resemble general outline sore throat, but still has a few differences:

• The child suffers not only from a sore throat, but also from nasal congestion.
• A general blood test will show the presence of atypical mononuclear cells.
• An ultrasound will indicate that the size of the liver and spleen does not correspond to generally accepted standards.
• The lymphoid tissue will be severely inflamed, which can lead to pneumonia, purulent sore throat, otitis media and even cancer.

In turn, in order to eliminate most of the mentioned complications, it is no longer possible to do without antibiotics. And with infectious mononucleosis it’s like a vicious circle.

Despite the constant promotion of safe sex, there are still a lot of dangerous viruses which are sexually transmitted. According to statistics, these diseases are in the forefront of population diseases in the world. One such virus is Epstein Bar disease. What is this disease and what test for the Epstein Bar virus should be taken to identify the disease.

Danger of disease

Epstein Barr virus is a disease that is transmitted through unprotected sex. Over the course of many years of research, it has been proven that the virus can provoke the development of cancerous tumors. Another name for this disease is herpes virus type 4.

Infection occurs from a sick person to a healthy person during sexual contact. Infection can also occur through saliva or airborne droplets. Today, according to experts, about 80% of the adult population of the planet is infected with this virus.

Barr's disease comes in two strains, A and B. The distribution of the strains depends on the geographic area, but they do not differ much from each other. The danger of the disease is that it can often be completely asymptomatic.

If not treated promptly, the virus can cause the following diseases:

• Mononucleosis.
• Splenic rupture.
• Hepatitis.
• Oncological diseases.
• Autoimmune diseases.

However, the virus does not always result in the development of these diseases. A person can recover from the virus, but remain a carrier of the infection forever. Tests for the Epstein bar virus must be taken if infection is suspected and when planning pregnancy.

Diagnosis of the virus

Today in medicine several diagnostic methods are used to determine the virus in the blood. For many years, the simplest and most common diagnostic method has been a general blood test.

However, with this study it is impossible to directly detect the virus; one can only suspect the presence of infection based on some deviations in the indicators.

The main signs of infection in a general blood test can be considered:

• The norm of lymphocytes is increased.
• Increased platelets.
• The rate of red blood cells is reduced.
• Decreased hemoglobin.

If these deviations are detected, the patient is prescribed additional diagnostics. However, these symptoms do not specifically indicate the presence of herpes virus type 4; they are only a reason for a more thorough examination of the patient. Also primary diagnosis blood biochemistry can also be considered. In this study, infection can be suspected by deviations in the levels of transaminases, proteins and enzymes in the direction of increase. However, it is not possible to make an accurate diagnosis based on a biochemical blood test. To confirm the diagnosis, more informative studies need to be carried out.

PCR

Today, the most informative test for the Epstein Barr virus is PCR diagnostics. This method can detect foreign DNA within a few hours after infection. The test is especially informative when diagnosing the virus in children. Unfortunately, other tests for detecting EBV in patients younger age ineffective. Diagnostics using polymerase chain reaction allows you to detect viral DNA at the earliest stages of the disease. For analysis, blood is taken from a patient's vein.

Before donating blood, you must follow the rules for preparing for the test.

PCR analysis is prescribed to confirm the diagnosis of the acute course of the disease. This test is not suitable for determining chronic or past illness. A special advantage of the method is the ability to detect even a single DNA virus. Thus, the test can show the virus already in the first days after infection.

Heterophilic analysis

Another common diagnostic method is heterophilic testing. The accuracy of the analysis is up to 90%. During this study, specialists examine the blood for the presence of heterophilic antibodies, which are produced by the body in the first weeks after infection. Most often, this study is used to confirm the diagnosis of infectious mononucleosis. A positive result confirms the presence of EBV. U healthy person the norm of IgM immunoglobulins does not exceed 1:56. However, in elderly patients these rates may be higher.

The test result may be affected by the presence of the following diseases in the patient:

• Leukemia.
• Hepatitis.
• Lymphoma.

Before taking the test, you must refrain from taking any medications and chemotherapy. If it is impossible to correct the treatment, you should inform your doctor.

ELISA

ELISA analysis is based on the detection of antibodies to infection antigens. ELISA is a type of serological test with which it is possible to determine the content of immunoglobulins to the virus. This study can determine not only the presence of the virus, but also the stage and form of the disease.

In the acute course of the disease, antibodies of the IgM VCA class are detected in the blood. These substances are formed in the first weeks of the primary form of the disease. After 4-6 weeks they disappear and may appear during an exacerbation of the chronic form of the disease.

Antibodies of the IgG VCA class during infection with the Epstein Barr virus are detected during the acute course of the disease. These antibodies are detected in all patients in the acute phase of the disease. They persist in patients throughout their lives. As the disease worsens, their number in the blood increases significantly.

IgG EA antibodies appear early in the disease. The detection of these antibodies indicates acute primary infection or relapse of the disease.

These substances disappear at 4-6 weeks of illness.

IgG EBNA antibodies indicate that the patient had the virus more than 6 months ago. These substances remain in small quantities in the blood of patients throughout their lives. An increase in IgG EBNA antibodies indicates an exacerbation of the chronic course of the disease.

Deciphering the analysis is usually not difficult for specialists. According to the study, it is possible to determine how long the patient has been suffering from the Epstein-Barr virus and whether he has complications in the form of malignant tumors. If complications are detected, additional diagnostics are necessary.

Virus in children

To detect the Epstein Barr virus in newborn infants, only PCR diagnostics are used. This is due to the immaturity of the infant's immune system. The immune system simply cannot yet produce certain antibodies to the virus, on the basis of which other studies are being conducted. Testing for newly born babies is done when the mother is infected. Thus, doctors determine whether intrauterine infection has occurred.

At an older age, when a child begins to attend preschool institutions, infection is possible through household or airborne droplets. Today, experts say that about 50% of children in the world are already infected.

Often this virus in patients childhood confused with sore throat due to the similarity of symptoms.

Today there are no special medications to treat Epstein Barr virus. The main therapy is aimed at strengthening the immune system and symptomatic treatment. The main task Doctors, when a virus is detected, is to transfer the disease from the acute phase to the latent phase. In this case, a person can remain a carrier of infection for the rest of his life.

Virus during pregnancy

Diagnosis of Epstein Barr virus is of particular importance when planning pregnancy. Both partners must be tested. If pregnancy has already occurred and expectant mother The virus has been detected in an acute form, the main thing is to identify it in time and treat it correctly. Unfortunately, a complete cure is still impossible today, but doctors can put the disease into remission so that it does not have any impact. negative influences on fetal development.

Signs of the disease during pregnancy are as follows:

• High body temperature.
• Chills.
• General weakness.
• Severe headaches.
• Increased sweating.
• Sore throat.
• Nasal congestion.
• Enlarged lymph nodes.

All these symptoms are characteristic of many colds; it is for this reason that analysis for Barra virus is carried out extremely rarely for these manifestations. The danger of untimely diagnosis and treatment lies in the possibility of splenic rupture. During pregnancy, a virus can cause premature birth, low birth weight of the newborn, nervous system disorders in infants, visual impairment, breathing problems. Only an experienced doctor should diagnose and prescribe treatment for the virus during pregnancy. Self-medication can provoke the disease to become chronic.

Where can I get tested?

Highly informative analysis, such as polymerase chain reaction, is carried out only in specialized clinics and private diagnostic centers. A referral for this study can be issued by the attending physician if characteristic abnormalities are detected in a general or biochemical blood test.

PCR testing is paid, its price depends on the medical institution and the amount of viruses for which the blood is tested.

Many young couples neglect to take tests at the stage of planning a child, however, as doctors say, the consequences of this irresponsibility in some cases are quite dire. It happens that the fetus becomes infected with a virus in the womb, which can lead to congenital abnormalities and pathologies. If you want to give birth healthy child, you need to undergo all the necessary studies in order to be calm about the outcome of your pregnancy.

Testing both partners for various dangerous diseases before planning a pregnancy is no longer an exception. Today this is the norm, which helps doctors eliminate all possible risks of giving birth to a defective child. If you are already pregnant, tests should be taken before 12 weeks of pregnancy. However, no one can force you to donate blood for research; the health of your unborn baby is solely your responsibility.

Virus prevention

To date, there are no specific methods for preventing the incidence of Epstein Barr virus. As with any viral disease the patient should be isolated from society. To minimize the chances of infection, each person must promptly treat all diseases, strengthen the immune system, and healthy image life and maintain hygiene. Train yourself and your children to use separate towels and their own utensils. After visiting public places, you should wash your hands with soap.

In addition, it is necessary to exclude unprotected sexual contacts with casual partners. We also need to strengthen nervous system. Hardening and playing sports will help you feel less nervous, which means you will strengthen your immune system and help you cope with the disease faster in case of infection.

EBV is a dangerous disease that goes away on its own in most people infected. However, for a certain number of people, especially patients with weak immune systems, this disease can cause a lot of unpleasant complications. Today, scientists are actively developing a vaccine against EBV, which is planned primarily to be used in African countries. It is there that a more severe form of this disease, called Burkitt's Lymphoma, is common.

Etiology. Infectious mononucleosis is caused by the Epstein-Barr virus (EBV) and is characterized by fever, intoxication, generalized lymphadenopathy, and enlarged liver and spleen. Today there is scientific data that allows us to consider this disease as polyetiological, caused by various herpes viruses (cytomegalovirus, human herpes virus type 6). Evidence has been obtained of mixed forms of herpesvirus mononucleosis: Epstein-Barr virus + cytomegalovirus, Epstein-Barr virus + human herpes virus type 6.

EBV affects epithelial cells of the mucous membrane of the respiratory tract, digestive tract, genital organs, as well as cells of the immune system, in particular B lymphocytes. Transmission of viruses occurs through biological fluids and secretions: blood, urine, saliva, tear fluid, breast milk, amniotic fluid, vaginal discharge, sperm. EBV is also characterized by airborne transmission.

Pathogenesis. A distinction is made between primary Epstein-Barr viral infection and reactivation of infection. In most cases, the primary infection is characterized by asymptomatic seroconversion or mild catarrhal symptoms. In 10-20% of cases, the primary infection occurs in the form of manifest infectious mononucleosis; subsequently, in 15-25% of cases, a chronic or recurrent course of infection is noted. Persistence of infection leads to immune deficiency, which is the pathogenetic background that forms the contingent of “frequently ill children.”

After the virus enters the epithelium of the mucous membrane of the oropharynx and upper respiratory tract, lymphocytes become infected. There are certain differences in the infection of epithelial cells and lymphocytes. In epithelial cells, the virus undergoes complete replication with the formation of a large number of virions, lysosomes of epithelial cells, followed by infection of neighboring cells. When B lymphocytes are infected, the virus replicates in only a small percentage of cells, while in the rest it remains in a latent state. The mechanism of interaction between EBV and B lymphocytes is the most studied. The virus supercapsid contains glycoprotein complexes - gp350, 85, 25 and 42. When interacting with B lymphocytes, the leading role is played by the gp350 complex, which is structurally similar to the component of the C3dg complex and interacts with the CD21 molecule on the surface of the B lymphocyte, which is its receptor. Through this interaction, adhesion of the virus to the cell and the beginning of endocytosis are achieved. Penetration of the virus into the cell membrane requires the interaction of the remaining glycoprotein complexes with the β-chain of the HLA class 2 molecule, while interaction of the virus with epithelial cells requires the presence of gp85, 25, for which there is a special receptor on them.

At the early stages of infection, infection of T and NK cells is possible with the development of chronic EBV infection with persistence of the virus in lymphocytes. The ability of EBV to persist, despite its high immunogenicity, indicates that the virus has developed a mechanism for evading the immune response. The protein BCRF-1 expressed by EBV, which coincides in amino acid sequence with the cytokine IL-10 and causes its mimicry, thereby contributes to the suppression of IFN-γ synthesis by peripheral mononuclear cells. Another protein it expresses, BARF-1, functions as a soluble receptor for IL-1 and, by binding it, blocks the activity of IFN-γ. This ensures the virus escapes immune surveillance during acute infection and during its reactivation. Thus, EBV infection is considered a disease of the immune system with impaired interferon formation, and the immunosuppressive effect of the virus leads to the activation of secondary flora, involving various organs in the process.

Autosensitization of lymphocytes to extracts of tissue of the thymus, spleen, and preparations of native and denatured DNA is typical for infectious mononucleosis. The virus persists not only in B-lymphocytes and epithelial cells of the nasopharyngeal region, but is also capable of infecting other cells: T-lymphocytes, macrophages, neutrophils, vascular epithelial cells. By protecting the B-lymphocytes infected by it from apoptosis, the virus enhances the proliferation of these cells; the new generation of B-cells contains genocopies of the Epstein-Barr virus in a latent form, as a result of which the virus can persist in the body for a long time, causing an immunodeficiency state.

EBV-associated infectious mononucleosis can cause complications involving various organs and systems, but mainly this virus affects the epithelium of the gastrointestinal tract with a powerfully developed lymphoid system of the mucous membrane; the pathological role of EBV infection in the pathogenesis of autoimmune chronic gastritis has been proven.

An effective immune response to Epstein-Barr virus infection involves humoral and cellular mechanisms. During primary infection, neutralizing antibodies are formed, IgM and IgG antibodies to the capsid antigen, and later to the early, membrane and nuclear antigens of the virus. Tonsil cells infected with the virus intensively synthesize pro-inflammatory cytokines: tumor necrosis factor-α, interleukins 1, 6, 8. In the acute phase of the disease, the level of interleukin 1, 2, interferon-γ increases in the blood of patients. Long-term persistence of the virus causes an immunodeficiency state of the body.

The condition for the formation of a recurrent course of Epstein-Barr viral infection in children is an inadequate cytokine response in the acute phase of infectious mononucleosis, characterized by insufficient activation of the synthesis of pro-inflammatory cytokines (TNF-α, IL-8, interferon-γ) with increased secretion of an anti-inflammatory cytokine (IL-4) .

Clinic.

When studying placentas that exhibit morphological characteristics infections caused by DNA viruses, Epstein-Barr monoviral infection or Epstein-Barr virus in combination with HSV and CMV are detected. When assessing the somatic status of children with perinatal EBV infection, hypotrophy, low-grade fever, severe catarrhal syndrome, hyperemia and granularity of the pharynx, and lymphoproliferative syndrome were most often observed. Neurological symptoms were manifested by movement disorders syndrome and hydrocephalic syndrome. When studying their immunological status, they revealed suppression of the T-cell component of immunity (decrease in the relative number of CD3+, CD4+, CD8+ cells) and a slight increase in the number of B-cells (CD21+ cells). At the same time, the number of activated cells (CD25+, CD71+, CD95+) remained at the level of the age norm, which indicated the absence of activation of T-cell reactions in response to viral infection.

With postnatal infection, during the incubation period of infectious mononucleosis, which ranges from 4 to 7 weeks, the virus disseminates through the lymphoreticular system, and proliferative changes in the lymphoid tissue occur. The main symptoms of the disease are fever, enlarged lymph nodes, damage to the oropharynx in the form of tonsillitis, adenoiditis, punctate enanthema on the soft palate, difficulty in nasal breathing, an increase in the size of the liver and spleen, and changes in peripheral blood parameters. In addition, the gastrointestinal tract and cardiovascular system are affected.

Tonsillitis can be catarrhal or ulcerative-necrotic; lymph nodes are more than 2 cm, clearly contoured in the form of chains or packets, the skin over them is not changed, and is not painful to the touch. The face is puffy, the eyelids are pasty. Hepatolienal syndrome reaches its maximum by the 3-7th day of illness and lasts for 6 weeks, sometimes the size of the liver remains enlarged for up to 3 months. At the height of the disease, an increase in organ antibody titers is observed. The highest titers were determined for tissues of the intestine, liver, spleen and heart.

Infectious mononucleosis is characterized by changes in the hemogram: moderate leukocytosis (up to 15-30*10 9 /l), an increase in the relative and absolute number of lymphocytes, detection of atypical mononuclear cells, a moderate increase in ESR (up to 20-30 mm/hour). Atypical mononuclear cells appear by the second week of the disease and persist for 1-2 weeks, sometimes up to 4-12 weeks.

According to modern concepts, it is customary to distinguish between chronic and recurrent mononucleosis. Chronic infection is spoken of only when the patient could not identify the onset and previous symptoms of infectious mononucleosis. Prolonged and recurrent forms of the disease can be observed after acute infectious mononucleosis, which is associated with the persistence of the virus in the body with subsequent reactivation. The clinical picture after infectious mononucleosis can manifest itself for six months or more with persistent or recurrent fever, intoxication syndrome (weakness, lethargy, headaches), lymphoproliferative and cardiac syndromes (heart pain, meteosensitivity, arthralgia).

The persistence of the Epstein-Barr virus is found not only in the lymphoid system, but also in the gastric mucosa. According to G.V. Volynets et al. In 76.6% of children with chronic inflammatory diseases of the upper digestive organs, a chronic Epstein-Barr viral infection was detected, while in 30.1% of patients there was replication of the virus in the gastric mucosa.

To verify autoimmune chronic gastritis in children, antibodies to parietal cells were determined by indirect immunofluorescence and serological markers of EBV infection: IgM to the viral capsid antigen, antibodies to the early EBV antigen, and antibodies to the nuclear antigen. In all children, EBV DNA was determined in the blood and in a biopsy of the gastric mucosa using PCR. Markers of active viral infection were the detection of IgM to the viral capsid antigen and IgG to the early EBV antigen, which served as the basis for an adequate choice of antiviral and immune-oriented therapy for patients with chronic autoimmune gastritis.

Diagnostics. The Epstein-Barr virus causes the synthesis of circulating antibodies to both the virus and antigens of sheep, horses, or cow red blood cells. These are heterophilic antibodies, which are detected by agglutination of red cells of a sheep or horse, belong predominantly to the IgM class and are determined in the Paul-Bunnel reaction. An increase in antibody titer occurs at 2-4 weeks of illness.

The greatest significance for the serodiagnosis of Epstein-Barr virus infection is the enzyme-linked immunosorbent assay method with the determination of antibodies to the following viral proteins: early antigen, nuclear antigen and viral capsid antigen of the Epstein-Barr virus. The specificity of antibodies to various viral antigens helps distinguish acute or subclinical infection from anamnestic infection. Thus, IgM to the capsid antigen is produced in the early stages of the disease and disappears later. Antibodies to the nuclear antigen of the virus appear later, in the recovery phase (4 months after infection) and remain for life. Antibodies to early antigen occur during primary infection in 70% of patients and are considered a transient indicator of active infection. Antibodies to the early antigen can be detected in patients within a period of several months to a year. When the infection is reactivated, seroconversion of antibodies (IgG) to the viral capsid and nuclear antigens occurs.

Determination of serum markers of herpesvirus infection cannot serve as a specific test for differentiating primary infection and reactivation. The only way to immediately and reliably diagnose a primary infection is to determine the avidity index (AI) of specific antibodies. To distinguish between primary infection, reinfection and reactivation of the infectious process, a test for determining the avidity of IgG antibodies has been proposed.

Avidity is the strength of the bond between antigen and antibody. The amount of avidity depends on the affinity of specific antibodies and the number of binding sites. Affinity is the degree of specific affinity of the active site to the antigenic determinant.

It is known that the immune response to the first encounter with an antigen begins with the production of class M immunoglobulins. Specific IgG appears later. They replace early IgM antibodies and accumulate in the body in large quantities. Under the influence of the antigen, B cells are stimulated, which leads to an increase in the affinity of IgG antibodies, which is low after the first contact and increases over subsequent weeks or months. One month after infection, the affinity of IgG antibodies increases. This process is called antibody maturation. High doses of antigen contribute to a slower increase in avidity, and low doses of antigen contribute to a more rapid increase in avidity. Consequently, low-avidity antibodies are synthesized during the first week of infection, when antigen content is high. High-affinity antibodies are present in the body for a long time, ensuring the development of a rapid secondary immune response upon repeated contact with the pathogen.

The avidity index (AI) of antibodies is determined using ELISA and calculated using the formula:

IA = -------------- * 100%,

where OP 1 is the optical density in wells with antigens when treated with a denaturing agent;

OD 2 - optical density in wells with the same serum after treatment with a reference solution.

The detection of antibodies with AI below 30-50% in the test serum indicates a fresh primary infection. An AI value above 50% indicates the presence of high-avidity antibodies in the serum - markers of past infection.

Table No. 2

Options for interpreting the results of serological examination of patients with EBV infection

Stage of EBV infection	Low-avidity antibodies				EBNA-IgG
Incubation period or absence of infection
Very early primary infection
Early primary infection
Acute primary infection (inf. mononucleosis)
Late primary infection
Chronic infection
Atypical primary infection
Early past infection
Late past infection
Reactivation

To assess the main indicators of antiviral protection, an immunological examination of the interferon system, the level of immunoglobulins of the main classes of cytotoxic lymphocytes (CD8+), T-helper cells (CD4+) is carried out.

With EBV infection, two types of changes in the immune status are observed: imbalance and insufficiency of individual parts of the immune system and increased activity of others. Immune deficiency in this infection is manifested by a decrease in the ability to stimulate the production of IFN-α or IFN-γ, disimmunoglobulinemia (decreased IgG content, less often IgA, increased IgM content); a decrease in antibody avidity, a decrease in the content of CD25+ lymphocytes, a decrease in the number and functional activity of CD16+, T-helper cells (CD4+), cytotoxic lymphocytes (CD8+), suppression of the functional activity of phagocytes or changes in their response to stimuli, including immunocorrective drugs.

A sign of the intensity of antiviral immunity can be increased levels of IFN-α in the blood serum, IgA, IgM, IgE, CEC, often the appearance of antibodies to DNA, an increase in the content of natural killer cells (CD16+), T-helper cells (CD4+) or cytotoxic lymphocytes (CD8+) . The phagocytosis system can be activated.

Biochemical parameters. In the blood serum of patients, an increase in the level of acute phase proteins, α2-globulins, CRP, fibrinogen, as well as an increase in the level of transaminases, LDH and other enzymes is detected. However, the listed changes are not strictly specific to EBV infection (they can also be found in other viral infections).

To detect the virus antigen (in blood serum, saliva, bone marrow), the polymerase chain reaction is used. The agreement between positive polymerase chain reaction and enzyme immunoassay data is 92.5%. The greatest information content of the PCR method in detecting Epstein-Barr virus DNA in the blood and in nasopharyngeal swabs is achieved within 4 weeks of illness.

Treatment. Neonatal persistent EBV infection in children in the first months of life, the manifestations of which are directly related to the state of the immune system, is supervised using immune-oriented therapy: Likopid and Viferon. The administration of licopid largely contributes to the stabilization of the humoral component of the immune response. Likopid is recommended to be prescribed in an age-specific dose for 10 days with a 10-day break and repeated administration in the next 10 days. Viferon-1 is used 2 times a day in suppositories for 10 days and then 1 suppository at night for the next 10 days. The use of licopid with viferon has a normalizing effect mainly on cell-mediated immunity. Treatment with licopid in combination with viferon reduced the incidence of low-grade fever and lymphoproliferative syndrome. In the future, children who received combined treatment with licopid and viferon, according to our observations, are less likely to suffer from ARVI and obstructive bronchitis.

Sick children with postnatal infectious mononucleosis should be on gentle bed rest, subject to thermal procedures on the area of ​​​​enlarged lymph nodes. Eating warm semi-liquid food; if swallowing is difficult, rinse the throat with decoctions of chamomile and sage.

The specific tropism of the Epstein-Barr virus to immunocompetent cells and the ability of the virus to persist for a long time in the body of children determine the advisability of using immunocorrective agents in the acute period of infectious mononucleosis, in addition to standard antibiotic therapy and symptomatic treatment. Clinical practice shows the effectiveness of the use of interferon-containing drugs and interferon inducers in the treatment of the disease. The choice of drug should be determined depending on the patient’s immune response. When determining the “cellular” version of the immune response in a child, Viferon (in age-appropriate doses) or human leukocyte interferon with leukinferon can be used in therapy. When determining the “humoral” version of the immune response in a child, it is preferable to use a combination of human leukocyte interferon with leukinferon or supplement the 10-day course of Viferon with cycloferon (in age-appropriate doses). After viferon therapy in the period of early convalescence, if there is a tendency to bacterial infections, licopid should be prescribed. To treat children with allergic predisposition, polyoxidonium should be used. For patients prone to protracted infectious mononucleosis, cycloferon is recommended.

Penicillin and cephalosporin antibiotics are prescribed to children early age in severe forms of the disease, with pronounced necrotic changes in the pharynx, a sharp band shift in the blood test and complications (otitis media, pneumonia). Local treatment of the tonsils with a solution of chymotrypsin is prescribed. Symptomatic therapy for infectious mononucleosis includes antipyretics and antihistamines.

In complicated forms of infectious mononucleosis (respiratory obstruction, central nervous system complications, thrombocytopenia), it is recommended to use glucocorticoid hormones.

Due to the fact that infectious mononucleosis is accompanied by the development of immunological deficiency with damage to the gastrointestinal tract, the use of antibiotics in complicated forms of mononucleosis causes changes in the intestinal microbiocenosis, the prescription of probiotic drugs is indicated. It is advisable to use the liquid concentrate of bifidobacteria “Bifidum 791 BAG”. This universal probiotic contains a symbiotic complex of three strains of bifidobacteria. "Bifidum 791 BAG" is prescribed for a course of 10-15 days. From the first days of antibiotic treatment, you can use the Ecoflor probiotic; it ensures the removal of microbial toxins from the body, reduces the toxic load on the liver, and neutralizes the toxic effects of antibiotics. The microbiological basis of "Ecoflora" is a consortium of bifidobacteria and lactobacilli immobilized on the SUMS-1 sorbent, which improves the protection of bifidobacteria and lactobacilli when passing through the stomach. As the sorbent is freed from bacterial colonies, restoration of the intestinal environment and cleansing of the intestines from toxins begins, while endogenous and exogenous intoxication decreases. "Ecoflor" is prescribed to children from 3 years of age, the course is 10 days.

Under the influence of complex therapy with the inclusion of probiotics, there is a significantly faster relief of the main symptoms of the disease, a decrease in temperature, intoxication, and tonsil lesions, the content of atypical mononuclear cells in the blood decreases faster, and altered indicators of the immunological status are more actively restored.

In connection with the elucidation of the pathogenetic links in the development of autoimmune chronic gastritis and the clarification of the role of EBV in the progression of the disease, methods for its treatment have also been developed. In order to suppress the reproduction of the virus, create an antiviral state of uninfected cells, stimulate phagocytes and natural killer cells, the use of interferons is recommended. Interferon-type drugs include viferon, leukinferon, and leukocyte interferon. With the use of interferons, the level of phagocytic activity of monocytes increases, the number of CD3+, CD8+ lymphocytes increases, which contributes to the formation of a full-fledged immune response.

To suppress the replication of the virus in the cell, abnormal nucleotides are used: valacyclovir (Valtrex), ganciclovir (Cymevene), famciclovir (Famvir). One of the most commonly used in the treatment of chronic EBV infection is valacyclovir, a specific inhibitor of DNA polymerase of herpes viruses. It blocks viral DNA synthesis and viral replication. In the human body, valacyclovir is converted to acyclovir and valine. As a result of phosphorylation, active acyclovir triphosphate is formed from acyclovir, which competitively inhibits viral DNA polymerase. The first stage of phosphorylation occurs under the influence of a virus-specific enzyme, which is found only in cells infected with the virus. The need for the presence of a virus-specific enzyme to activate acyclovir largely explains its selectivity. Valacyclovir is active against EBV, CMV and herpes 1, 2 and 6.

The complex of therapy includes Viferon for chronic gastritis with an active phase of EBV infection, and if EBV DNA is detected in a biopsy of the gastric mucosa - Viferon in combination with valacyclovir. The effectiveness of antiviral treatment of chronic gastritis is manifested by an improvement in cellular and humoral immunity, the disappearance of autoantibodies to gastric parietal cells and the formation of long-term clinical and endoscopic remission. More durable treatment results are achieved when using a 3-week course of treatment with valacyclovir in combination with interferon in an intermittent program for 1.5-2 months. Significant effectiveness is detected in children when prescribing Reaferon-EC-Lipint at a dose of 250,000 units. 2 times a day for 7 days, then ½ therapeutic dose is prescribed for 3 weeks.

In case of continuously relapsing course of chronic gastritis, which occurs with impaired cellular and humoral immunity, suppression of the induced synthesis of IFN-α and IFN-γ by blood leukocytes, inclusion in complex treatment children immunocorrector leukinferon in combination with human leukocyte interferon and valacyclovir. Leukinferon is prescribed intramuscularly 3 times a week for the first 2 weeks, then 2 times a week for the next 2 weeks and then in the form of suppositories 2-3 times a week for 2-3 weeks (10 suppositories in total). From the second week, human leukocyte interferon is added intramuscularly 2 times a week (10 injections per course). A comprehensive treatment program helps normalize interferon status, cellular and humoral immunity, and leads to stable clinical and endoscopic remission.

Clinical example. Andrey S., 2 years 5 months, admitted to the hospital on May 5, 2007. with complaints of high temperature 0 - 39 0 C, single vomiting, decreased appetite and loose stools 5 times a day. Ill with ARVI since April 20, 2007, received outpatient symptomatic treatment. By the end of the second week there was an improvement in the condition, but from 05/05/2007 the fever relapsed, t 0 - 38.8-39 0 C. Sent for hospitalization.

Life history: from 1st pregnancy, proceeded with threat of miscarriage, nephropathy, preeclampsia during childbirth. During pregnancy, she suffered from acute respiratory viral infection with lymphadenitis. Examination for prenatal infections, IgG antibodies to CMV and herpes virus were detected. No treatment was given. Delivery at term, birth weight 3500 g, length 51 cm. Attached to the breast immediately, suckled actively, breast-feeding up to one year, complementary foods were introduced at 5 and 6 months. Adaptation to food is normal. I gained enough weight at 2 years and 5 months. - weight 14.810g, height 93 cm.

The state of health during 1 year of life is unfavorable. Jaundice persisted for a long time, at the age of 3 weeks: total bilirubin - 315.1 µmol, indirect - 297.3 µmol, direct - 17.8 µmol. Along with jaundice, there was unstable stool. The coprogram contained neutral fat (++) and mucus (+). Staphylococcus aureus was isolated from stool culture, treatment was carried out with oral ampicillin, then staphylococcal phage, bifidumbacterin. At 1 month of age, a neurologist diagnosed perinatal damage to the central nervous system, hypoxic-ischemic origin, and hypertension syndrome.

At 2 months - re-seeding from feces of Staphylococcus aureus at a titer of 10 5 and fungi of the genus Candida albicans at a titer of 10 4. No examination for IUI was carried out. Treatment with Hilak-Forte was prescribed.

By 6 months age, changes in the blood were noted: hemoglobin - 112 g/l, erythrocytes - 4.2 * 10 12 / l, leukocytes - 7.8 * 10 9 / l, segmented neutrophils - 12%, lymphocytes - 67%, monocytes - 12 %, eosinophils - 8%, basophils - 1%, ESR - 3 mm/hour. Repeated blood tests in the 2nd half of the year continued to reveal neutropenia. He was consulted by a hematologist and diagnosed with benign neutropenia of childhood.

At 10 months a blood test revealed anemia (hemoglobin - 107 g/l, erythrocytes - 3.81*10 12 /l, color index - 0.84, platelets - 280,000, segmented neutrophils - 11%, lymphocytes - 76%, monocytes - 90% , eosinophils - 3%, basophils - 1%). The hematologist prescribed treatment with sorbifer, a course of 1 month.

At 1 year of age, stool analysis for dysbacteriosis revealed a deficiency of bifido- and lactoflora, an increase in Staph. aureus 10 5 and fungi of the genus Candida alb. 10 5.

Examined by an orthopedist: limited hip abduction was noted. At 1 year Ultrasound of the abdominal organs an inflection in the neck of the gallbladder and cholestasis were determined.

He was examined by a geneticist and diagnosed with undifferentiated connective tissue dysplasia affecting the musculoskeletal system.

At 1 year 5 months moved acute enterocolitis of unspecified etiology, was hospitalized in the hospital for 10 days, received treatment with enterol and metronidazole.

For 1.5 years he has suffered from frequent acute respiratory viral infections with an increase in t 0 to 38.8 0 for 3-4 days and catarrhal symptoms.

Objective data during the last hospitalization: symptoms of nasopharyngitis were observed for 5 days, fever up to 39 0 C for 2 days, skin no rash. On examination - hyperemia of the pharynx and enlargement of the submandibular, anterior and posterior cervical lymph nodes, frequent stools up to 3 times a day, from the 5th day of treatment - formed. An ENT doctor diagnosed chronic tonsillitis and adenoiditis, in the acute phase.

Examination: A throat swab contains a culture of hemolytic streptococcus. Cultures for pathogenic intestinal flora are negative. ELISA for rotavirus is negative. RNGA with intestinal diagnostics - negative.

Blood test upon admission from 05/05/07: hemoglobin 104 g/l, erythrocytes - 3.7 * 10 12 / l, color index - 0.85, leukocytes - 6.4 * 10 9 / l, band - 4%, segmented - 72 %, lymphocytes - 18%, monocytes - 4%, eosinophils - 2%, ESR - 4 mm/hour.

Hemograms in dynamics: from 05/09/07 - hemoglobin - 109 g/l, erythrocytes - 3.4 * 10 12 / l, leukocytes - 7.8 * 10 9 / l, band - 19%, segmented - 42%, lymphocytes - 28% (wide-plasma lymphocytes), monocytes - 8%, plasma cells- 1%, eosinophils - 2%, ESR - 13 mm/hour. IN further- red blood remained unchanged, the number of leukocytes did not change, lymphocytosis increased to 43% (wide-plasma forms) and number monocytes up to 12%, ESR increased to 20 mm/hour.

Urinalysis without abnormalities (5 times).

Biochemical blood test shows moderate hypoalbuminemia, liver tests are normal.

Blood test from 05/08/07: ELISA with mycoplasma antigen - IgM and IgG - negative, with herpes viruses IgM and IgG negative, anti-CMV - IgM - negative, anti-CMV IgG - positive, with chlamydial antigen (chlamydia pneumonia) - IgG titer 1:80 (chlamydia trachomatis) - IgG - negative. No CMV DNA markers were found in the urine.

Goff-Bauer's reaction dated 05/07/07 is negative.

Blood test for ELISA for Epstein-Barr virus antigens from 12.05. and 05/14/07: anti-EBV IgM - negative, IgGEA - positive and IgGNA - positive (>0.5 units). The totality of this analysis indicated late primary (mononucleosis) infection.

Thus, based on a retrospective assessment of the child’s medical history, it becomes clear that the patient, infected from birth with the cytomegaly virus and chlamydia, persisted during the first and second year of life and, as a result, had prolonged jaundice, and there was damage to the respiratory organs in the form of “masks” repeated acute respiratory viral infections and intestinal infections with episodes of dysfunction, the formation of dysbacteriosis and an immunodeficiency state. The damage to the central nervous system was registered by a neurologist in the early stages (at the age of 1 month). Viral persistence was supported by constant lymphocytosis and, as a consequence, neutropenia, which is very often underestimated by hematologist consultants and virological testing of patients is not prescribed. After 2 years, against the background of a persistent chlamydial-cytomegalovirus infection, a postnatal EBV infection was layered, which together in a weakened child can subsequently cause a persistent mixed infection (CMV + chlamydia + EBV).

One cannot help but pay attention to the lack of alertness among pediatricians, even with such an unfavorable prenatal history, about the possibility of intrauterine or perinatal infection in a child both in the first weeks and in the subsequent months of his life.

After the examination, the patient was prescribed complex therapy (Licopid + Viferon) in combination with a probiotic (Bifiform).