Epstein Barr Virus

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Das Epstein Barr Virus zählt zu den verbreitetsten Viren überhaupt. Fast jeder erwachsene Mensch ist Träger dieses Virus. Rund 90 Prozent der mitteleuropäischen Bevölkerung sollen Schätzungen zu Folge mit ihm infiziert sein, doch nur die wenigsten bemerken ernsthafte Symptome.

Obwohl das Virus neben dem Ausbruch des Pfeifferschen Drüsenfiebers noch andere schwerwiegende Erkrankungen begünstigen kann, wurde es über viele Jahre von der Allgemeinheit unterschätzt.

Was genau ist das Epstein Barr Virus?

Bei dem Epstein Barr Virus handelt es sich um einen doppelsträngigen DNA – Virus, der zur Gruppe der Gamma – Herpesviren gehört und auch als Humanes-Herpes-Virus 4 bezeichnet wird. Die Gamma – Herpesviren infizieren häufig die Abwehrzellen des Körpers, die T- oder B-Lymphozyten.

Das Virus verbleibt lebenslang in den lymphoiden Zellen des Körpers und kann reaktiviert werden, unabhängig davon ob es zuvor symptomatisch oder asymptomatisch verlaufen ist. Auch die Reaktivierung des Virus kann mit oder ohne Symptome erfolgen und wird durch Stress oder ein geschwächtes Immunsystem ausgelöst.

Zumeist wird das Virus durch die natürliche Abwehr des Körpers unbemerkt eingedämmt. Das macht es für die Betroffenen so schwer, die Infektion mit dem Epstein Barr Virus überhaupt zu bemerken. Während dieser Infektionsphase sind im Speichel des Betroffenen Viren nachweisbar, die wiederum andere Menschen unbemerkt anstecken können.

Das Virus ist so aufgebaut, dass es die menschlichen Zellen zwar infiziert, aber nicht abtötet. Der Viruskern mit den DNA Informationen ist von einer Eiweißummantelung geschützt, der das Erbmaterial vor Schädigungen von außen bewahrt. Das Ganze ist noch ein mal von einer Hülle viruseigener Zuckereiweiße umgeben, die das Andocken an die Wirtszellen ermöglichen.

Seinen Namen verdankt das Virus Sir Michael Anthony Epstein und Yvonne M. Barr, die das Virus erstmals 1965 in den B-Lymphozyten eines afrikanischen Patienten mit Burkitt-Lymphom, einer aggressiven Krebsform, entdeckten.

Wie wird das Epstein Barr Virus übertragen?

Die Durchseuchung mit dem Epstein Barr Virus beginnt meist schon im Kindesalter. Die Ansteckung erfolgt durch eine Tröpfcheninfektion, Kontaktinfektion oder eine Schmierinfektion. Vor allen Dingen über Speichel kommen die meisten Ansteckungen zustande. Daher wird eine Folgeerkrankung des Virus, das Pfeiffersche Drüsenfieber, auch Kusskrankheit genannt.

Weniger häufig, aber auch möglich ist die Übertragung durch Bluttransfusionen oder Transplantationen. Auch über einen sexuellen Kontakt kann eine Ansteckung erfolgen, da die Epstein Barr Viren auch in Genitalsekreten vorkommen.

Wie verläuft eine Infektion mit dem Epstein Barr Virus?

Die Erstinfektion mit dem Virus findet zumeist im Kindesalter statt und verläuft zu diesem Zeitpunkt asymptomatisch. Zuerst werden die Epithelzellen von Mund, Nase und Rachen, sowie die B-Lymphozyten befallen. Dort vermehrt sich das Virus und infiziert weitere Zellen. Nach Ende der Inkubationszeit gelangt das Epstein Barr Virus dann in lymphatisches Gewebe und andere Organe und verbleibt im Körper. Es ruht, bildet ein Reservoir und kann bei einer einer erneuten Aktivierung aufbrechen und Viren freisetzen.

Ersterkrankte Jugendliche und Erwachsene, die sich mit dem Virus infiziert haben, erkranken häufig am Pfeifferschen Drüsenfieber. Ob die Krankheit ausbricht und welchen Verlauf sie nimmt, hängt von verschiedenen Faktoren ab, deren Funktionsweise noch nicht vollständig entschlüsselt ist. Eine wichtige Rolle spielt vor allem die Stärke des Immunsystems. So besteht bei immungeschwächten Personen die Gefahr eines gefährlicheren Krankheitsverlaufs.

Bei stark geschwächten Personen wie HIV Infizierten oder Personen denen Organe transplantiert wurden, können sich die Viren ungehindert vermehren, was zu lebensgefährlichen Komplikationen führen kann. Ab dem 40. Lebensjahr sollen Untersuchungen zu Folge 98 Prozent der Bevölkerung mit dem Epstein Barr Virus infiziert sein. Während der Infektion bildet der Organismus Antikörper gegen das Virus, die im Blut nachgewiesen werden können.

Man vermutet einen engen Ursachenzusammenhang zwischen dem Epstein Barr Virus und verschiedenen Krebserkrankungen. Zu nennen wären das Burkitt-Lymphom, Lymphdrüsenkrebs oder des Nasopharynxkarzinoms, einem bösartigen Tumor, der Nase, Rachen und Kehlkopf angreift.

Untersuchungen legen nahe, dass das Virus auch in Verbindung mit einigen Autoimmunerkrankungen oder dem chronischen Erschöpfungssyndrom stehen könnte. In Teilen Afrikas brechen immer wieder Epidemien aus, die auf eine endemische Variante des Epstein Barr Virus bedingten Burkitt-Lymphoms zurück zu führen sind. Der Virus könnte zudem ein Kofaktor für die Malaria Erkrankung sein.

Symptome des Epstein Barr Virus

Ein akuter Ausbruch des Virus bzw. eine Erstinfektion im Jugend- oder Erwachsenenalter manifestiert sich durch grippeähnlichen Symptome. Bei 30 bis 60 Prozent der Erkrankten führt es zur Erkrankung am Pfeifferschen Drüsenfieber. Leichtes bis mittleres Fieber, Kopf – und Gliederschmerzen, Halsschmerzen und eine verstärkte Abgeschlagenheit können auf eine Infektion hindeuten.

Zudem finden sich bei einigen Patienten angeschwollene Lymphknoten im Hals und Nacken Bereich, sowie unter den Achseln oder in der Leistengegend. Rund die Hälfte der Patienten bekommt zusätzlich eine Mandelentzündung, die mit einem starken Mundgeruch einhergeht. Auch Schwellungen von Milz und Leber oder ein juckender Hautausschlag sind keine Seltenheit. In der Regel verlaufen die Infektionen nicht lebensbedrohlich.

Bei schwereren Krankheitsverläufen können jedoch Komplikationen auftreten. Eine Herzmuskelentzündung, Blutarmut oder eine Entzündung des Gehirns gehören zu den seltenen Folgeerkrankungen.

Bei Kindern ist eine Infektion mit dem Epstein Barr Virus schwer zu erkennen. Ein verminderter Antrieb und wochenlange Müdigkeit lassen sich nur schwer als Symptome für das Virus einordnen. Meist erinnert die Infektion in der Kindheit nur an eine leichte Erkältung.

Diagnose des Epstein Barr Virus

Ein Blutbild kann den Nachweis über eine mögliche Infektion mit dem Virus liefern, denn die Anzahl der Lymphozyten erhöht sich bei einer Erkrankung meist. Zudem stehen den Medizinern verschiedene Testverfahren zur Verfügung, mit denen gegen das Virus gebildete Antikörper im Organismus nachgewiesen werden können.

Dadurch können sogar Neuinfektionen von vergangenen unterschieden werden. Eine massive Erhöhung der antinukleären Antikörper deutet auf eine chronische Immunbelastung durch das Virus hin. Bei einem deutlichen Anstieg der Early Antikörper kann man von einer chronisch – reaktivierten, also einer früheren Erkrankung ausgehen.

Auch erhöhte Leberwerte können einen Hinweis auf das Epstein Barr Virus darstellen. Wenn man unter dem Mikroskop T-Lymphozyten betrachtet und an diesen charakteristische Veränderungen feststellt, kann das die Diagnose des Pfeifferschen Drüsenfiebers untermauern.

Therapie des Epstein Barr Virus

Bis heute gibt es kein Medikament, das den Virus wirksam bekämpfen kann. Auch ein Impfstoff gegen das Epstein Barr Virus wurde noch nicht entwickelt. Behandelt werden können daher nur die Symptome der Erkrankung. Bettruhe und körperliche Schonung gehören zu den wichtigsten zu ergreifenden Maßnahmen.

Bei auftretendem Fieber muss zusätzlich auf eine ausreichende Flüssigkeitszufuhr geachtet werden. Auch fiebersenkende, verschreibungspflichtige Mittel können helfen. Folgeerkrankungen wie Mandelentzündungen sollten mit Antibiotika behandelt werden. Doch einige Breitbandantibiotika, wie Ampicillin und Amoxicillin, können bei einer akuten Infektion mit dem Epstein-Barr Virus eine allergische Reaktion auslösen.

Erkrankt der Patient am Pfeifferschen Drüsenfieber kann zusätzlich noch die Einnahme von Schmerzmitteln gut sein. Bei sehr schweren Verlaufsformen des Pfeifferschen Drüsenfiebers können Ärzte die Wirkstoffe Ganciclovir oder Aciclovirverschreiben, welche die Virusvermehrung hemmen. Die Krankheit dauert in der Regel mehrere Wochen, in schweren Fällen einige Monate.

Bei einer chronischen Erkrankung durch das Epstein Barr Virus oder einer schwereren Verlaufsform sollte unbedingt ein Arzt konsultiert werden. Immuntherapien werden von vielen Ärzten oder Heilpraktikern als wirksame Waffe gegen chronische Verlaufsformen des Virus angepriesen.

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