Epstein-Barr Virus
synonym
- Kissing Disease Virus
- EBV
- Pfeiffer's disease
- infectious mononucleosis
- Infectious mononucleosis
and - Monocyte angina
Symptoms
If you are infected with the Epstein Barr Virus In adolescence or adulthood, unspecific flu-like symptoms appear. Patients show an increased temperature between 38.5 ° and 39 ° Celcius, limb and abdominal pain, as well Fatigue and exhaustion. Furthermore, the Lymph nodes on the neck and neck swollen. It can also become a Swelling of the lymph nodes in the armpits or come at the bar (Lymphadenopathy). Sufferers can also have a throat or Tonsillitis (Tonsillar angina) and sometimes show a rather dirty gray instead of white coating on the tonsils, which with a bad smelling halitosis (=Foetor ex ore) goes hand in hand.
In addition, various other symptoms and changes in the host organism, such as an enlarged spleen or sometimes liver (see also: swollen liver), Abdominal, muscle or headpain, Loss of appetite, depression, Mood swingsgeneral weakness, rash, dizziness or disorientation chills, dry cough and nausea occur.
The disease can last from several days to a few weeks, during which the patients are weakened.
Signs of Epstein Barr Virus infection
Typical signs of Epstein-Barr virus infection include flu-like symptomswith which Pfeiffer's glandular fever usually starts after an incubation period of 4-6 weeks:
These include, on the one hand, the occurrence of high fever, accompanying a headache and Body aches as well as tiredness and feelings of exhaustion.
On the other hand, severely swollen, tenderness, movable lymph nodes can be noticed, which are primarily located in the neck and neck area and less often in the armpit or groin region (Lymphadenopathy).
In addition, most patients have a characteristic, very painful throat or neck pain. Tonsillitis (Tonsillar angina). This is characterized by a typical, dirty gray, flat coating on the swollen and reddened tonsils, which is usually strictly limited to these and does not encroach on the surrounding pharynx.
You can find out more about the topic here: Swollen tonsils
A putrid halitosis (Foetor ex ore), Difficulty swallowing or even breathing (due to the swelling of the pharynx with greatly enlarged tonsils), Hoarseness, or clumsy language.
In some cases it may be beyond the above Cardinal symptoms there are also other signs that speak for an Epstein-Barr virus infection:
The virus can occasionally have a Liver enlargement (Hepatomegaly) and / or inflammation of the liver (hepatitis) trigger, which is characteristic of the rise Liver values can be detected in the blood as part of a blood test and an ultrasound scan.
The spleen, as the host organ of many defense cells of the immune system, can also react during an EBV infection with:
the infection leads to an increased production and filtering of defense cells, which can lead to swelling of the spleen (splenomegaly).
In rare cases (with 5-10% the patient) can also be raised, blotchy skin rash occur which can lead to severe itching.
The very rare symptoms, which usually only occur in older patients with an existing immune deficit, also include meningitis or symptoms of paralysis, both manifestations being associated with a significantly poorer prognosis.
Structure of the virus
The genetic information of the Epstein-Barr Virus (EBV), the DNA, winds around a protein molecule, which is called the core or nucleoid, and is surrounded by a protein coat, the capsid.
This virus-own protein coating protects the genetic material of the virus from harmful external influences and fulfills important tasks in the infection of the host cell by the virus.
The capsid is in turn surrounded by a virus envelope. This consists of a portion of the host cell's plasma membrane or membranes that surround structures within the host cell.
In addition, the envelope carries the virus 'own sugar proteins, which are necessary for the virus to dock on to its host cell, and allow the membranes to fuse together so that the virus' genetic material can be introduced into the cell. Antibodies that are formed by the host organism against the virus are directed against sugar proteins in the virus envelope. In contrast to naked viruses, enveloped viruses are very susceptible to external influences such as heat or dehydration.
infection
The Epstein Barr Virus attacks the epithelial cells in the mouth, nose and throat, as well as the B-lymphocytes, which belong to the white blood cells and perform important tasks in the defense against pathogens that have penetrated the body. The first infection usually occurs in childhood and is usually asymptomatic.
Adolescents and adults who become infected for the first time show flu-like symptoms, mostly without complications. The through the Epstein-Barr Virus Caused disease is called Student’s Kissing Disease or Kiss sickness because the virus is transmitted mouth-to-mouth, especially in young adults.
The actual name Pfeiffer's disease goes back to the name of Emil Pfeiffer, who practiced as a pediatrician around 1900. Further names for the disease caused by the Epstein-Barr virus are infectious mononucleosis, mononucleosis infectiosa and monocyte angina.
The onset of the disease, the associated complications and the course depend on many factors, some of which are not understood. Among other things, the strength of the immune system plays an important role. According to this, it is mainly the immunocompromised who get sick. An estimated 95% of the population is infected by the age of 30. After the age of 40, an infection of almost 100% (approx. 98%) is suspected.
The virus goes through two phases of development. In the lytic first phase it multiplies in the infected host cells, is then released in innumerable copies of these and can infect other cells, while in the second phase, which is also known as the latency phase, it rests in the host cell and follows the immune system withdraws from the host organism, so that it forms a reservoir which, when activated again, can break open and release viruses.
During one Infection with the Epstein Barr Virus antibodies against the virus are formed, which can be detected in the blood of 95% of the population. The virus remains in the body for life and dwells in so-called memory cells of the white blood cells (B memory cells). Reactivations occur when the immune system is weakened, but are usually successfully contained without being noticed by the body's natural defenses. In this phase, viruses can be detected in the saliva, for example, through which other people can also become infected without being noticed. In patients whose immune system is suppressed, for example at HIV patients or organ transplant patients, the virus can spread unhindered in the body, multiply and lead to complications.
It is responsible for the development of various rare cancers like that Burkitt lymphoma responsible. This occurs in Africa, caused by a special EBV species, locally limited to one area (endemic). Burkitt's lymphoma is a malignant, rapidly growing tumor that occurs mainly in children in Africa. In Asia, the virus is considered a risk factor for the development of nasopharyngeal cancer, a malignant tumor that infiltrates the nose, throat and larynx.
Furthermore, the Epstein Barr Virus as a cofactor in the development of Breast cancer and malaria discussed.
CA-IgG-Ab
The body's own immune system reacts in its first defense measure with the formation of antibodies against certain building blocks that have penetrated the body Epstein-Barr Virusto keep this in check at the beginning and then destroy it in the course.
These antibodies are certain proteins that are produced by specific immune cells in the blood (B lymphocytes) and are directed against certain components of viruses (antigens).
First of all, they are antibodies of the class IgM, however, a little later, mainly antibodies of the class IgG which, in the case of the Epstein-Bar virus, are directed against certain protein components of the virus envelope or the virus coat (so-called Epstein Capsid Antigens; EBV-CA).
These EBV-CA-IgG antibodies are considered to be specific early markers in the course of an Epstein-Barr virus infection and can be detected in the blood as part of a confirmatory test.
Transmission of the virus
The transfer of the Epstein Barr Virus occurs mainly through a droplet infection or contact infection, in particular with saliva or through a Smear infection. Less common transmission options for the Epstein Barr Virus offer transplants or Blood transfusions, possibly also sexual contact with an infected person.
Since the virus depends on its reservoir host, humans, in order to survive, it has tried in the course of evolution to adapt to its life in order to infect human cells but not to kill them. The illness Glandular Pfeiffer feverthat through the Epstein Barr Virus (EBV) caused is therefore only very rarely fatal.
diagnosis
In most cases, an infection goes unnoticed, especially with initial infections in childhood, due to the lack of symptoms and is therefore not diagnosed.
The detection of Epstein-Barr virus antibodies in a patient's blood can confirm a suspected diagnosis if the patient presents to the doctor with unspecific symptoms such as tiredness and fatigue. Various tests are available for this, with which different types of antibodies formed by the host organism against the virus can be detected. With the help of these examinations, recent infections can also be distinguished from past infections.
Read more on this topic under. Epstein-Barr Virus Disease Blood Counts - These parameters are important
Usually, but not necessarily, the concentration of white blood cells (Leukocytes) increased in blood (Leukocytosis) and above all the B-lymphocytes show an increase compared to the remaining leukocytes (relative lymphocytosis).
In the blood smear, under the microscope, characteristic changes in the T lymphocytes can be seen, called Pfeiffer cells and confirming the diagnosis. Since the viruses can inhabit liver cells in addition to the epithelial cells of the nasopharynx, the liver values of infected people are usually elevated.
Complications
Asymptomatic courses of the Epstein Barr Virus predominantly join Toddlers on. Patients with chronic disease suffer from for months persistent fatigue and fatigue, as well fever and decreased drive. They often show chronic, painful swelling of the lymph nodes.
Reactivations of the virus are at Herpes virus infections not infrequently and usually show a weaker course. Bacterial co-infection of the tonsils occurs in about every tenth infected person Streptococcus bacteria on.
Various, rarer complications include inflammation of the brain (Encephalitis), Changes in blood cells or anemia, swelling of the liver and spleen (Hepato and splenomegaly), such as Myocarditis (Myocarditis) and kidney inflammation (nephritis). Due to the swelling of the spleen and the associated risk of rupture of the spleen (Ruptured spleen) Sufferers should make efforts like sports and lifting heavy objects as the disease progresses and for a few weeks thereafter until the swelling subsides spleen avoid.
Does the Epstein Barr Virus cause cancer?
It is assumed that about 90% of the total world population is infected with the Epstein-Barr virus.
It is only noticeable that only some of them actually get sick with the virus. In most cases, the virus invades the body unnoticed and stays there for life without anything happening. At least as long as the immune system is intact and the virus can keep in check.
In the other cases, however, the virus causes different diseases, so that especially in Europe and North America Pfeiffer's glandular fever, in Africa that Burkitt lymphoma (more vicious Lymph gland cancer) and in Southeast Asia that Nasopharyngeal carcinoma (malignant cancer of the nasopharynx) can be observed in connection with an EBV infection.
If a disease does actually develop, however, in most cases it is the one that usually heals without consequences Mononucleosis (= Pfeiffer's glandular fever), only very rarely do those affected ultimately develop a malignant tumor.
According to scientists, the reason for this is the presence of differently aggressive Epstein-Barr virus strains with different genetic material, which occur in different latitudes and which can therefore also cause different diseases.
Epstein-Barr viruses of the one strain, which are predominantly found in Southeast Asia, preferentially infect the epithelia of the mucous membranes in the nasopharynx, where they can then induce the development of a malignant tumor.
In contrast, the viruses of the other strains can only attack the B cells of the immune system and thus either Pfeiffer's glandular fever cause or lead to an uncontrolled increase in genetically modified B cells in the blood, causing Burkitt's lymphoma to develop.
Overall, it was found that around 20% of all Burkitt lymphoma patients also carry the Epstein-Barr virus in their bodies, compared with 80-90% in patients with a malignant nasopharynx tumor.
Therapy for an Epstein-Barr virus
Against that Pfeiffer's glandular fever there is no special therapy.
fever requires adequate fluid intake, possibly antipyretic medication and, above all, plenty of rest. Furthermore, the disease can also be symptomatic with pain relievers and if an additional bacterial infection occurs Antibiotics be treated.
Read more information on the topic Therapy Epstein Barr Virus
Since Pfeiffer's glandular fever is a viral infection, there is no causal therapy for treating the disease.
The administration of antibiotics would be ineffective in this case, as these are not bacteria that are to be fought. It is only indicated if an additional bacterial infection (Superinfection) to the existing one Pfeiffer's glandular fever is present or suspected to avoid a complicated course. Here, however, should strictly antibiotics from the group of Aminopenicillins (Ampicillin, amoxicillin) as these lead to an itchy rash in the case of an EBV infection (Ampicillin rash) being able to lead.
Thus, only a treatment and alleviation of the symptoms occurring during the infection is possible: besides Quiet and the physical protection is sufficient Fluid intake important, especially if the infection is accompanied by a fever and this leads to fluid loss.
Antipyretic, anti-inflammatory and analgesic medication can be taken against the fever if necessary - after consulting the attending physician (e.g. Ibuprofen, Paracetamol). These can also relieve sore throats and swallowing difficulties.
The pain reliever acetylsalicylic acid (ASS; aspirin), as this increases the risk of bleeding if necessary Almond removal (Tonsillectomy) is enlarged in the severe course. Cold neck compresses and mouthwashes with pain relieving, disinfected solutions or chamomile tea can also help against the sore throat and the swollen, painful cervical lymph nodes.
If the Epstein-Barr virus infection is severe, drugs prescribed by the doctor to prevent the virus from multiplying (Antivirals) be indicated so that the intake of z. B. Acyclovir or Ganciclovir represents a meaningful therapeutic measure.
If threatening complications arise, such as a Meningitis, anemia caused by the infection or an airway obstructed by severe swelling, cortisone should be given as quickly as possible in order to contain the excessive or spreading inflammatory reactions.
If the complication of spleen swelling occurs and this possibly also tears (Rupture of the spleen), immediate emergency surgery must be initiated. The spleen, as an organ with a very high blood supply, can lead to rapid, large blood loss if it ruptures, so that the therapy of choice is the fastest possible surgical removal of the spleen.
In order to avoid a rupture of the spleen from the outset, it is essential to take physical rest as long as there is detectable spleen swelling.
Homeopathy for an Epstein Barr virus
Since that Pfeiffer's glandular fever as a viral infection cannot be treated causally (The administration of antibiotics has no effect as it is not a bacterial infection), only therapeutic measures to alleviate symptoms can be initiated.
This can also include the use of homeopathic remedies: for example, it is possible to take Belladonna, Aconite or Gelsemium to lower the fever, the gift of Phosphorus C7 to prevent inflammation of the liver (hepatitis) and taking Phytolacca decandra C5 against sore throats and headaches.
The intake of Schüssler salts No. 3 (Ferrum Phosphoricum), No. 4 (Kalium Chloratum), No. 5 (Kalium Phosphoricum), No. 10 (Sodium Sulfuricum) and No. 11 (Silicea) can be used for the homeopathic treatment of EBV infection.
prophylaxis
There is against that by that Epstein-Barr Virus Pfeiffer’s glandular fever has so far not caused any vaccines, so that the only preventive measure is avoiding infected people. However, this is impossible due to the high infection rate of the population with the virus and the unspecific course of an infection.
Post-Infectious Immunity
As already mentioned, antibodies are formed in the course of an initial infection, which usually enable the infected person to have lifelong immunity. Reactivations can occur in immunosuppressed individuals. However, the reasons for this are not yet sufficiently understood.
Summary
The human pathogenic Epstein-Barr Virus is a double-stranded one DNA Virus. It belongs to the gamma herpes viruses, a subfamily that is characterized by a narrow range of hosts.
Gamma herpes viruses typically infect T or B lymphocytes, i.e. special defense cells (White blood cells) of the immune system.
The duration of the virus multiplication varies. In addition, this group leads to cell proliferation, can in lymphoid cells (white blood cells) to survive (med. to persist) what is called Latency stage denotes and reactivates what, depending on the course of the resurgence of the virus, with or without symptoms, Recurrence or Relapse is called.
The E.pstein-B.arr-Virus (EBV) is the cause of the infectious mononucleosis, which are also called Kiss sickness is referred to as the Epstein-Barr Virus often transmitted through kissing among young adults.
Furthermore, the Epstein-Barr virus (EBV) for benign enlargements and swelling of Lymph nodes (Lymphoma) and for immunocompromised for special Tumors be causative.
Like all Herpes viruses After the first infection of the host, the Epstein-Barr virus can also survive for life in infected host cells and be reactivated
