Pediatrician Mikhail Nikolsky: Herpes - to treat or not to treat

Pediatrician Mikhail Nikolsky: Herpes - to treat or not to treat

Alexandra Petrovskaya: Good afternoon. This is a program for the biggest ones. With us in the studio is pediatrician and candidate of medical sciences Mikhail Nikolsky. Mikhail Andreevich, hello.

Mikhail Nikolsky: Good afternoon.

A.P.: We have gathered here today about your scientific work on herpes types 6 and 7. Let's try to explain to the listeners what it is, and, most importantly, where these types come from, and what other types - the first, second, third and so on - go up to 6 and 7.

M.N.: In total, there are 8 or 9 types of herpes, depending on how you count. The first and second types are common herpes, which causes cold sores on the lips. The third type is the herpes zoster virus, which causes chickenpox or shingles in adults.

A.P.: So what we call chickenpox is, in fact, the same herpes?

M.N.: Not the same, it’s a completely different herpes, but also herpes.

A.P.: By what principle are they all united under this name?

M.N.: It's difficult. When scientists studied the DNA of these viruses, it turned out that they all had similar related features. The fourth type, Epstein-Barr virus, causes infectious mononucleosis. The fifth type is what everyone knows as cytomegalovirus. These are also often infections, mostly for children.

And finally, type 6 and 7 are what I do. Most often they cause roseola in children - a three-day fever or sudden exanthema. Next comes the eighth type of herpes, it occurs in Kaposi's sarcoma. This is a serious disease that predominantly occurs in HIV-infected patients.

A.P.: Besides the common name and some similarities in DNA, what else unites them? Maybe there are common methods of therapy or similar effects of the virus on the body?

M.N.: Firstly, unlike many other viruses, there is a medicine against herpes. This is what makes these viruses different from others in many ways because there are no cures for a huge number of viruses.

A.P.: What about all these fashionable antiviral drugs that are advertised everywhere?

M.N.: Everything that is advertised on TV is, unfortunately, most likely fake.

A.P.: Fakes are prohibited.

M.N.: Fakes are prohibited, but, apparently, advertising of drugs without proven effectiveness is allowed.

A.P.: This is a topic for a separate program.

M.N.: This is a problem for our country, because in our country fakes have even found their way into clinical recommendations. And we treat people with all these “bullshit drugs.” Moreover, we are obliged to treat them, because we have appropriate clinical recommendations.

A.P.: Is someone lobbying for this?

M.N.: Of course, this is lobbied for, it is paid for. And what to take if, excuse me, we have one of the members of the Russian Academy of Sciences - a homeopath.

A.P.: In these words you can feel your contempt for homeopathy.

M.N.: From the point of view of a clinical physician, to some extent, yes, contempt, this is true.

Let's return to herpes. They have a unique feature. After a person becomes ill with a primary herpes infection, these viruses do not leave the human body. All herpes that a person encounters in life remain with him forever.

A.P.: I came across the statement that it is difficult to meet a person on Earth over 10 years old who does not have antibodies to one or another type of herpes.

M.N.: And not only antibodies, but even the herpes themselves. In almost all people after a certain age, one or another herpes can be found in saliva, blood or other tissues. This is the problem with diagnosing them - doctors very often get confused. Colleagues, out of ignorance, but with the best intentions, prescribe, for example, saliva tests for frequently ill patients for the Epstein-Barr virus, cytomegalovirus, herpes type 6, type 7, and find them in the saliva. And this is the norm.

A.P.: Are they starting to treat?

M.N.: Yes, absolutely right. The patient does not know that this is the norm. He sees that he has a “terrible” test, that such and such a number of these herpes have been found, and the doctor, most likely, out of ignorance and lack of understanding of this problem, begins to treat normal carriers of herpes. And what does he treat? He treats with the same fuflomycins. And nothing happens.

A.P.: Bottom line – there is no need to treat herpes?

M.N.: It is necessary if it caused a serious illness - and all herpes in certain cases can cause serious illnesses. For example, herpes type 6 is a common cause of severe conditions in patients after a bone marrow transplant. If herpes after a bone marrow transplant has worsened against the background of a decrease, the actual destruction of one’s own immunity, then therapy necessarily requires powerful antiviral agents.

Well, take chickenpox – it would seem a harmless disease. But after 11 years it is difficult and can have consequences. Therefore, it is believed that if the patient is under 11 years of age, it often goes away on its own. And if you are over 11 years old, then it is better not to risk it, but to prescribe acyclovir.

A.P.: Is this a drug with proven effectiveness?

M.N.: Yes, it acts specifically on the chickenpox virus.

A.P.: It turns out that herpes, which is always in the body, at some point gets worse. For example, I heard about herpes type 6, that this is a typical disease for children under 2-3 years of age. It turns out that no.

M.N.: The fact is that herpes type 6 is the most common infection that always causes sudden exanthema or three-day fever or roseola. In principle, it is a very understandable infection: the child has a high fever for three days, then a typical maculopapular rash appears. Within two days it disappears on its own and the person recovers.

The infection itself can occur even through an ordinary kiss, as happens with many herpes. That is, the virus can enter the child’s body through contact with the saliva of the mother, grandmother, or any adult, who are usually the carrier of all herpes. And so the child suffers this primary infection through the human herpes virus type 6, and after that the human herpes type 6 remains in this child forever. And it won’t go anywhere, and there’s no way to get rid of it.

But it needs to be treated only in one situation - if it has caused some kind of serious illness, which almost never occurs in healthy people. Only for severe immunodeficiencies, which usually occur during organ and tissue transplantation. There are situations when intensive treatment of herpes type 6 is required.

In all other cases, there is no need to shock-treat it. And we must keep in mind that herpes is a very fashionable topic now. Herpes virus type 6 is easy to find, which means it can be presented for almost any disease as a possible diagnosis. And many doctors use this. For example: “I don’t know what’s wrong with you. Let’s look for what you definitely have.” And here is herpes type 6 - it definitely exists, and it is there.

A.P.: Another such moment. What other diseases can be associated with herpes viruses that are present in the body?

M.N.: As I already said, herpes types 6 and 7 “classically” cause roseola in children. Herpes type 6 and sometimes, but rarely, type 7 are also associated with febrile seizures in children. There are studies that show a connection between certain types of epilepsy and human herpes virus type 6. So it turns out that herpes type 6 actually causes a type of epilepsy.

A.P.: This virus is present in almost everyone’s body, but not everyone has epilepsy. That is, this suggests that there is no direct connection; there are other factors influencing the appearance of this disease?

M.N.: Of course, there are many factors here. For example, two people caught the same infection: but one had a runny nose, and the other had meningitis. But the infection is the same. Of course, there are many factors involved.

There was also a study that associated human herpes viruses 6 and 7 with other diseases, suggesting a link with multiple sclerosis. But this has not been proven. This is already a field of science, but we do not have clear indications that herpes is exactly what causes multiple sclerosis.

A.P.: During the program, we talked briefly about all herpes and outlined all the important points. And, concluding the conversation, I want to return to the beginning. What questions does science face today in this area?

M.N.: By the way, I forgot to say that a special form of human herpes type 6 is the chromosomal integrated form of this virus, when herpes type 6 is introduced into the human chromosome and begins to be inherited by all generations.

Now we have received a grant in St. Petersburg. We conduct free examinations of everyone for certain indications for the presence of chromosomally integrated human herpes type 6. It is precisely the presence of chromosomally integrated human herpes type 6 that may provide links with certain diseases. It turns out that almost 1% of the world's population has a chromosomally integrated virus built into its genome.

A.P.: Okay. Remembering my student years, what hypothesis do you have in this scientific research? If something, then what?

M.N.: We are currently recruiting a reference group, we are looking for people, we are examining them. I personally am now most interested in whether there are clinical manifestations of chromosomal integration of human herpes type 6 in newborns. In my opinion, this is the most interesting concept; no one in the world has yet developed this direction. So far there are preliminary results, but I’m not ready to announce them yet.

A.P.: Our guest was Mikhail Nikolsky, a pediatrician and candidate of medical sciences. Thank you and have a nice day everyone!

HERPETIC INFECTION

You chavoy are out of your mind!

There's a pimple on my lip!

L. Filatov

Herpes infection is not a specific disease. This is a term that unites a whole group of diseases and requires some clarification.

Viruses, like all other organisms, are divided by scientists into families, genera, and individual species. Currently, about 80 similar representatives of the herpes virus family have been discovered in nature, 7 of them isolated from humans.

These viruses, although similar to each other, cause diseases that are very different in terms of timing, clinical manifestations, and danger to the human body. By the way, we have already met three diseases - not at all similar, but they are all caused by viruses of the herpes group. These are chicken pox, sudden exanthema and infectious mononucleosis, just discussed.

The time has come to talk about a special virus, perhaps the most widespread, capable of causing a wide variety of diseases, sometimes deadly. It is called “herpes simplex virus”.

According to numerous studies, from 65 to 90% of all inhabitants of planet Earth are infected with the herpes simplex virus! Infection occurs in childhood, by contact or airborne droplets, and by the age of 6, about 80% of children already have the herpes virus in their bodies.

The virus, as it should be, penetrates inside the cells and remains there in an inactive state for life - that is, if infection with the virus has occurred, no medicine can completely get rid of it. But there seems to be nothing wrong with this - an inactive virus does not cause any particular harm. At the same time, if certain accompanying conditions occur, accompanied by a decrease in immunity (cold, other infectious disease, stress, physical fatigue, malnutrition, lack of vitamins, injury, etc.), the virus seems to wake up, begin its dirty work and cause illness .

One of the most typical manifestations of herpes simplex is a rash on the lips, more precisely at the border of the skin and the lip itself. People simply call these itchy blisters “fever.” It is easy to notice that in some people (children) these same fevers occur often, in others - very often, in others - they never occur. It all depends on immunity, on the general level of health of a particular person.

We have already written several times about the main nonspecific antiviral protein - interferon. The fact is that the body reacts differently to each virus, producing a certain amount of interferon. In the language of scientists, each virus has “individual interferonogenic activity,” and readers will forgive me for my very clever words. The particular “harmfulness” of the herpes simplex virus lies precisely in the fact that it hardly stimulates or to a very small extent stimulates the production of natural interferon. Hence the instability and insufficiency of immunity, frequent repetitions (relapses) of the disease.

“Fever” on the lips is still the flowers of the herpes simplex virus. Manifestations of the disease can be much more serious - eye damage, widespread lesions of the skin and oral mucosa (stomatitis), extensive rashes on the genitals (so-called genital herpes), pneumonia and the most terrible manifestation of infection - herpetic encephalitis - severe inflammation of the brain with unpredictable, but, as a rule, very sad consequences.

1. The severity of any manifestations of herpetic infection is determined, first of all, by the state of the immune system! Once again we have to pay attention to the fact that the main method of prevention is a natural lifestyle that ensures the normal functioning of the immune system.
2. Currently, there are drugs that can selectively suppress the reproduction of herpes viruses in the human body. The most famous is acyclovir (synonyms are herpevir, virolex, zovirax), and its appearance is the same revolution in medicine as the discovery of penicillin. Acyclovir is used topically, to treat rashes (ointments, creams, jellies), courses of treatment (sometimes very long) are carried out with tablets, and for herpetic encephalitis and other particularly severe variants of the disease, the drug is administered intravenously.
3. Treatment of herpes infection usually involves the use of interferon. Not those well-known and relatively cheap nasal drops, but expensive and truly effective forms of interferon that are administered by injection. In addition, special medications are used that repeatedly increase the production of interferon in the body (cycloferon, neovir).
4. Herpetic infection, and this is obviously curable. It is impossible, as we already understood, to completely eradicate the virus, but forgetting about its existence is quite possible. The main drawback of all methods of treating herpes infection without exception is the discrepancy between the income of our compatriots and the cost of effective medicines.
5. The difficulty of treating herpes infection is not only the cost of medications. The treatment is long-term, carried out according to certain schemes that take into account the state of immunity, concomitant diseases, and the variant of infection. Parents just need to know the main thing: “herpetic little things” - like blisters on the lips - can sooner or later turn into a more serious problem, and herpes is not a sore when self-medication can lead to success. Hence the urgent need for consultation with a competent specialist and a full examination.

author Komarovsky E.O. book Child's health and the common sense of his relatives published 02/24/2010 18:40

Epstein-Barr virus in children

Epstein-Barr virus in children manifests itself in the form of infectious mononucleosis, ARVI or chronic disease.

For most people, herpes is a “cold on the lips.” However, the Epstein-Barr virus is a type of herpes, but type IV and a “relative” of chickenpox, cytomegalovirus and herpes simplex. The Epstein-Barr virus (like other members of the herpes family) is very widespread, up to 95% of the world's population are its carriers. In 80% of cases, infection occurs in childhood, most often before 3 years. Once an infectious agent enters the body, it remains there for life.

The virus can only reproduce in human cells. Some cells undergo changes under the influence of the disease. The altered cells allow the virus to remain in the human body forever in a “dormant” state. When the host’s immunity decreases, the microorganism is activated, begins to multiply and conquers new cells, which manifests itself as signs of disease

Viruses are transmitted from a sick child to a healthy one; the mode of transmission is airborne droplets from sneezing, coughing and talking; contact when using shared combs, toothbrushes, towels; through kisses. Therefore, the disease caused by the Epstein-Barr virus is called “kissing disease.” Transmission from mother to child during pregnancy is possible. The onset of the disease can be acute or hidden. Often a person does not even suspect that he has become infected.

Infectious mononucleosis in children

Infection caused by the Epstein-Barr virus, otherwise called EBV, in 80% of cases in children occurs as an acute respiratory viral infection, and in 20% infectious mononucleosis develops, a disease associated primarily with the Epstein-Barr virus (but do not forget that the culprits may be cytomegalovirus, herpes virus type 6, etc.). Unlike other pathogens that inhibit the development and reproduction of cells, EBV stimulates changes in cells of the immune system, in particular B-lymphocytes. For this reason, typical clinical signs are observed:

• Enlarged tonsils (tonsillitis)
• Difficulty in nasal breathing
• Enlargement of different groups of lymph nodes: more often cervical, less often axillary, inguinal
• Enlarged liver and spleen
• Increased body temperature

Sometimes chronic EBV infection develops. Parents should be alert to the following signs:

• Low-grade fever (up to 37.9 degrees) for a long time (more than a month)
• Weakness, sweating, sleep disturbances, the child has become capricious
• Previously uncharacteristic headaches, dizziness
• Heaviness in the right hypochondrium, the appearance of yellowness of the sclera and skin

Diagnosis of disease caused by EBV

If you see these symptoms in your child, what should you do next? The best decision is to see a doctor, and he will prescribe the following tests:

• Clinical blood test with leukocyte formula
• PCR research
• Antibodies to Epstein-Barr virus
• If necessary, biochemical tests to assess liver and kidney function

Laboratory tests for mononucleosis

Clinical blood test with leukocyte formula (with mandatory microscopy of a blood smear)

The appearance of reactive lymphocytes in a blood test of more than 10% (usually 60-80%) allows the doctor to suspect mononucleosis and continue to search for its cause.

The targets for the Epstein-Barr virus in the human body are lymphocytes, which change under the influence of the pathogen and become similar in structure to other cells - monocytes. Such cells are called reactive lymphocytes, or atypical mononuclear cells (the name of the disease, mononucleosis, comes from the name of the cells).

PCR research

The PCR method is aimed at identifying the DNA of the Epstein-Barr virus, that is, its genetic material. It is relevant specifically in childhood, during the period of primary infection - with mononucleosis. Blood, urine, saliva, or oropharyngeal swab are examined.

In the chronic course of the disease, PCR will not be so informative, because if the pathogen has entered the body, it remains for life, and detecting it in the blood or tissues will only indicate that the body is infected, but when the infection occurred - a week or 2 years ago - the answer we will not get the answer to the question. To do this, we need to study human immunity by examining antibodies.

Antibodies to Epstein-Barr virus

To understand the essence of the study, let’s figure out what happens in the body in response to an infectious agent?

For each type of pathogen, the immune system produces immunoglobulins (Ig) - specific proteins aimed at recognizing and further protecting against the disease upon encounter.

Immunoglobulins M (IgM) appear first; they are markers of the initial encounter with the pathogen and disappear from the blood after about a month. But during EBV infection, IgM immunoglobulins can persist for a long time, since EBV affects immune cells.

Immunoglobulins G (IgG) are persistent, synthesized later than other antibodies, at 3-4 weeks of the disease and retain information about the disease for life. They clearly indicate that this particular type of herpes has entered the body. Usually, the presence of IgG and the absence of IgM indicates that the encounter with the microorganism occurred a long time ago. This does not apply to herpes viruses. Even with a long-term course of the disease, at what points can IgG and IgM be detected simultaneously.

The structure of the Epstein-Barr virus is complex; it contains many proteins - antigens to which the immune system reacts. The main ones are capsid, early and nuclear antigens, and antibodies of the IgM and IgG classes are produced for each of them. It makes sense to discuss each one in order to be able to understand why the doctor prescribes so many tests and whether it is advisable (spoiler alert - it is advisable!)

So:

• Antibodies to the capsid antigen IgM are produced from the first days of the disease, persist for up to 3 months in the acute form, and can be periodically detected in the blood in the chronic course.
• Antibodies to capsid antigen IgG (IgG to VCA) – are synthesized 1-2 months after the onset of the disease and persist for life
• Antibodies to the early antigen IgM (IgM to EA) - appear in the first week of contact with the pathogen, disappear after 3 months upon recovery. Retention in high titers for a long time (more than 3-4 months) is alarming in terms of the formation of a chronic form of infection. Their appearance in the chronic form serves as an indicator of reactivation. They can often be detected during primary infection in EBV carriers.
• Antibodies to nuclear antigen IgG (IgG to EBNA) - appear later than others, 1-3 months from the onset, remain at high levels for up to 12 months, and remain at low levels for life.

Thus:

• The detection of IgG antibodies to capsid and nuclear antigens indicates a previous disease.
• The detection of IgM antibodies to capsid and early antigens in the absence of IgG to capsid and nuclear antigens is regarded as a period of acute primary infection, which often happens with mononucleosis in children.

And in order for the doctor to understand this, it is necessary to pass all the tests.

• Detection of antibodies to all antigens except nuclear - requires further examination and consultation with a doctor

How to assess the duration of a herpes infection (including EBV)?

For this purpose, the avidity of IgG to the Epstein-Barr virus is determined. Avidity is the degree of strength of binding of antibodies to viral proteins. The longer the virus stays in the body, the stronger and more stable the connection becomes. IgG avidity is expressed as a percentage: high avidity indicates a long-standing disease, even in the presence of IgM; low avidity indicates a recent encounter with the virus.

Treatment of infection caused by the Epstein-Barr virus.

It is known that there is no specific treatment! There are no antiviral drugs that have proven their effectiveness. Therefore, be sure to consult a doctor and do not self-medicate.

Treatment of acute infection is symptomatic and includes the main points:

• Bed rest or rest
• Drinking plenty of fluids is mandatory (to reduce intoxication)
• Taking antipyretic drugs when the temperature rises above 38.5 C
• And most importantly - no antibiotics! Antibiotics do not cure the virus, but they can damage the body and reduce immunity, which will only worsen the course of the disease. Antibiotics are prescribed only by a doctor in case of bacterial complications.

Important: timely diagnosis of mononucleosis and other manifestations of acute primary infection caused by the Epstein-Barr virus facilitates timely treatment and prevents the development of complications.