Razvoj produženog KOVID-a kao posledice kompleksnog odnosa između Epštajn-Bar virusa i našeg imunskog sistema
Sažetak
Uvod: Patofiziološki osnov razvoja produženog COVID-a (engl. Long COVID, LC) još uvek je nedovoljno poznat. Međutim, sindrom zamora nakon infekcije viđen je i ranije, kod drugih patogenima uključujući Epstein-Barr virus (EBV). Uzimajući u obzir rezervoare EBV kod pacijenata sa COVID-19, ovaj pregledni rad ima za cilj opis aktuelnih saznanja u vezi sa ulogom EBV u razvoju LC i sa potencijalnom dijagnostičkom implementacijom parametara EBV infekcije.
EBV infekcija: Nakon primarne litičke infekcije epitelnih orofaringealnih i nazofaringealnih ćelija, EBV uspostavlja veoma složen mehanizam doživotnog preživljavanja u B limfocitima. Latentna infekcija sa povremenim reaktivacijama stalno stimuliše imuni odgovor domaćina. Kod osoba sa imunološkim disbalansom, uključujući COVID-19, to može izazvati dugoročne posledice.
EBV i COVID-19: Aktivna EBV infekcija najrasprostranjenija je infekcija među ostalim humanim herpesvirusima kod COVID-19 pacijenata (41%). Takođe je prijavljena korelacija između nedostatka sposobnosti za regulaciju EBV izazvane limfocitopenije, povećanja EBV viremije i komplikacija COVID-19.
EBV i Long COVID: Prisustvo EBV DNK tokom akutne infekcije SARS-CoV-2 pokazalo se kao prediktor simptoma do 60 dana nakon COVID-19. Povezanost između EBV infekcije i simptoma kao što su “moždana magla”, umor, artralgija i osip na koži prethodno je opisana u postinfekcijskim posledicama ME/CFS. Anti-EBV EA-D IgG antitela pokazana su kod dve trećine LC ispitanika. Povećanje nivoa anti-EBNA1 IgG mesecima nakon početka COVID-19 u rekonvalescentnoj LC populaciji mogu poslužiti kao potencijalni marker reaktivacije EBV-a u vreme akutne infekcije SARS-CoV-2. Neki autori su takođe uspeli da pokažu seropozitivnost anti-EBV VCA IgM kod polovine pacijenata sa COVID-19 što ukazuje na koinfekciju ili reaktivaciju EBV.
Zaključak: LC je multisistemska bolest bez definisanog spektra dijagnostičkih i terapijskih mogućnosti. Dok reaktivacija EBV sama ili zajedno sa drugim faktorima rizika pokreće simptome LC, neophodne su dalje prospektivne studije koje uključuju različite kohorte i rezervoare tkiva u cilju razumevanja osnovnih bioloških procesa.
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