The diagnosis is cytomegalovirus infection. Symptoms of exacerbation of chronic CMV infection. In people with weak immune systems

The name of the virus is due to the fact that when cells are infected with a virus, they increase in size (translated as giant cells).

Depending on the state of the immune system, infection with cytomegalovirus can cause various changes: from an asymptomatic course and a mild mononucleosis-like syndrome to severe systemic infections affecting the lungs, liver, kidneys and other organs.

Causes of the disease

Cytomegalovirus is ubiquitous. Infection can occur through close contact with a carrier of infection or a sick person. The virus is released into the environment with various human biological fluids: saliva, urine, feces, breast milk, semen, vaginal discharge. The routes of transmission include airborne, food, sexual. A newborn baby can become infected from the mother through breast milk. It should be noted the vertical route of transmission of infection from mother to fetus during. When the fetus is infected, a very serious disease, congenital cytomegaly, can develop.

Infection can also occur during blood transfusion (in Russia, donor blood is not tested for the presence of cytomegalovirus) and during organ transplantation from a donor with CMV infection.

Once infected with cytomegalovirus, a person usually remains a carrier of this infection for life.

Symptoms of CMV infection

Distinguish how many variants of the course of CMV infection.

1) CMV infection in individuals with normal immunity.
Most often, primary infection is manifested by a mononucleosis-like syndrome. The incubation period is 20-60 days, the duration of the disease is 2-6 weeks. As a rule, there is fever, weakness, swollen lymph nodes,. With a sufficient immune response, the body produces antibodies against the virus and the disease ends in self-healing. Isolation of viruses in body fluids continues for months and years after recovery. After primary infection, cytomegalovirus can be in the body for decades in an inactive form or spontaneously disappear from the body. On average, 90-95% of the adult population has class G antibodies to CMV.

2) CMV infection in immunocompromised individuals (patients with lymphoproliferative diseases, hemoblastoses, HIV-infected patients, patients after transplantation of internal organs or bone marrow).

In such patients, generalization of the infection may occur, the liver, kidneys, lungs, retina, pancreas and other organs are affected.

3) Congenital cytomegalovirus infection.

Intrauterine infection of the fetus for up to 12 weeks, as a rule, ends; if infected after 12 weeks, the child may develop a serious illness - congenital cytomegaly. According to statistics, about 5% of newborns infected in utero suffer from congenital cytomegaly. Its symptoms include prematurity, enlargement of the liver, kidneys, spleen, pneumonia. In children who have had intrauterine CMV infection and avoided the generalization of the process, psychomotor developmental delay, hearing loss, visual impairment, and anomalies in the development of teeth may be detected.

Diagnostics

The diagnosis of CMV infection is based on the clinical picture and laboratory research methods.

Laboratory methods for the identification of cytomegalovirus include:

• virus isolation in cell culture;
• cytological examination (light microscopy) - detection of specific giant cells with intranuclear inclusion;
• enzyme immunoassay (ELISA) - detection in the blood of specific antibodies to cytomegalovirus classes M and G;
• polymerase chain reaction - allows you to determine the DNA of cytomegalovirus in any biological tissues.

Treatment of cytomegalovirus

Virus carrying and mononucleosis-like syndrome in persons with normal immunity does not require treatment.

Immunocompromised individuals are tried to transfuse blood products and transplant organs from CMV-negative donors.

The main prevention of fetal infection is a test for the presence of cytomegalovirus infection before pregnancy. Antiviral therapy during pregnancy is not used, as it is toxic and has a potential risk to the fetus. If a woman has a cytomegalovirus infection confirmed by laboratory methods, pregnancy is permissible only against the background of achieving a stable remission.

Character, the causative agent of which belongs to the herpes family. Pathology can proceed both asymptomatically and significantly worsen the well-being and quality of life of a person, affecting the internal organs and the central nervous system. According to statistics, almost half of the world's population are carriers of the virus. However, most people are not even aware of its presence.

What it is?

CMV infection is a disease, the development mechanism of which is as follows: a virus containing DNA molecules enters the human body and inserts its genome into the host cells. As a result of this process, the process of their pathological change is launched. The affected cells increase in size, that is, they become cytomegalic, and they themselves begin to produce the virus. Due to this, there is a violation of energy and synthetic processes. Unlike other viruses belonging to the herpes family, this pathogen has a rather long replication (reproduction) process, which prevents the formation of stable immunity.

You can only get infected from a sick person. It is important to know that in the body of both women and men, CMV infection remains forever. In the dormant form, it does not manifest itself in any way and does not have a negative impact. The transition to the acute phase occurs when the body's defenses are weakened.

In the International Classification of Diseases (ICD-10), CMV infections are assigned the code B25.

Ways of infection

The degree of contagiousness of cytomegaly is not high. In order for the virus to be transmitted from a sick person to a healthy one, it is necessary to have long and close contact with the carrier of the infection.

You can become infected in the following ways:

• Airborne (during a conversation, when sneezing, coughing or kissing).
• Sexual (during sexual contact, the virus is contained in the female secret and in the semen of men).
• Hemotransfusion (during the transfusion of blood or its components, as well as during tissue and organ transplantation).
• Transplacental (during pregnancy from mother to child).

When CMV enters the body, the infection does not cause any symptoms only if the person has high immunity. In this case, the pathogen is found in the biomaterial of an infected person. As soon as the body's defenses are weakened, the disease can go into an active form. Most often in a person in the process of diagnosis (along with CMV infection) EBV - Epstein-Barr virus is detected. It also belongs to the herpes family and does not have a negative effect on high immunity.

Symptoms

CMV infection is persistent, that is, having a chronic character. It is characterized by a variety of clinical manifestations, the severity of which depends on the form of pathology.

Specialists subdivide CMV infection into the following types:

1. Congenital. The main symptom of the disease is an increase in the size of the spleen and liver. Against the background of the development of the disease, jaundice and internal bleeding may occur. In addition, there are signs of disorders of the central nervous system.
2. Sharp. It is characterized by the presence of symptoms similar to those of a common cold. Also on the tongue and gums of the patient, you can notice a white coating.
3. Generalized. It is characterized by the development of inflammatory processes in the pancreas, kidneys and adrenal glands, spleen. As a rule, a bacterial infection is also detected during the diagnostic process.

Currently, it is extremely difficult to determine the duration of the course of CMV infection. The latent form is conditionally designated as an interval of 1-2 months, since it is impossible to determine the initial moment of the development of the disease.

Doctors identify several possible options for the development of pathology, each of which is characterized by a certain set of signs:

• The transition to the active phase occurs during the normal functioning of the body's defense system. It should be noted that such cases are extremely rare. The development of the disease is accompanied by fever, muscle weakness, deterioration in general well-being. In addition, a person's lymph nodes are enlarged. In most cases, the disease goes away on its own, which is a consequence of the powerful work of the body's defenses. As a rule, people do not even realize that they have suffered an acute phase of CMV infection, attributing everything to a cold.
• The active form of the disease passes when the immune system is weakened. In such cases, they speak of an illness. Pathology manifests itself in the defeat of the pancreas, liver, kidneys, lungs and retina. Most often it occurs in people with severe immunodeficiency, leukemia, hemoblastosis, as well as in those who have recently undergone transplantation of any internal organ.
• Symptoms appear shortly after the birth of a child who has been infected in utero. Signs of CMV infection in this case are: a delay in physical development, a violation of the formation of the jaws, poor hearing and vision. In addition, there is an increase in internal organs (usually the spleen, liver or kidneys).

In males, the infection in most cases is dormant. The transition to the active phase is carried out with a significant weakening of the body's defenses, which is the result of a cold or prolonged exposure to stress.

The symptoms are:

• increased body temperature;
• chills;
• nasal congestion;
• headache;
• rash;
• inflammatory processes in the joints.

Thus, the manifestations of infection are similar to those of acute respiratory infections and acute respiratory viral infections. The fundamental difference from colds is the duration of the preservation of the clinical picture. With cytomegaly, symptoms bother a person for about 1 month.

Diagnostics

If you experience anxiety symptoms, you should consult a therapist. If a specialist suspects the presence of cytomegalovirus, he will refer you to a venereologist or dermatovenereologist for a consultation.

During the reception, the doctor conducts a primary diagnosis of CMV infection, including a survey and examination. The specialist needs to provide information regarding the symptoms present and how long ago they occurred. After that, the doctor assesses the condition of the skin and palpates the internal organs to detect their increase in size.

If a cytomegalovirus infection is suspected, the specialist issues a referral for the following laboratory tests:

1. cultural sowing. Biomaterial can be blood, urine, saliva or semen. During the study, it is possible not only to identify CMV infection in adults and children, but also to understand what degree of activity the disease has. In addition, this analysis is also prescribed after the course of treatment. With its help, it is possible to evaluate the effectiveness of the prescribed therapeutic regimen. The study is also informative for individuals with both CMV and HSV infection (herpes simplex virus).
2. Light microscopy. The essence of the method lies in a thorough study of the biomaterial, during which pathologically altered cells of huge sizes with specific intranuclear inclusions are detected.
3. enzyme immunoassay. This is a blood test that detects antibodies to CMV infection. The method is not informative for immunodeficiency. This is due to the fact that in this state, the process of producing antibodies does not occur.
4. DNA diagnostics. The study of the biomaterial is carried out in order to detect these molecules. The disadvantage of the method is that it detects only the presence of an infection, and it is impossible to obtain information regarding the degree of activity with its help.

As a rule, doctors prescribe several types of studies at once. This is because the disease can have various forms, and one method is not enough to make an accurate diagnosis.

Conservative therapy

Information on how to treat CMV infection should only be provided by a physician based on diagnostic results.

Currently, there are no drugs whose action can completely rid the body of the pathogen. According to the guidelines, uncomplicated CMV infection does not require treatment. In other cases, it is aimed at getting rid of unpleasant symptoms. To eliminate intoxication, it is necessary to consume at least 2.5 liters of pure non-carbonated water per day.

In most cases, the treatment of CMV infection in adults is carried out with the drug "Ganciclovir". This is an antiviral agent that is prescribed only when the immune system is weakened. It is available in the form of tablets and solution. Injections are indicated for patients with severe forms of the disease.

In the treatment of pathology in people with immunodeficiency, the drug "Foscarnet" showed the greatest effectiveness. But it can also cause serious complications, and therefore it must be taken with caution and according to a strict regimen drawn up by a doctor.

During treatment, it is not required to adhere to any diet or a specific daily routine.

Cytomegalovirus infection during pregnancy

During the period of bearing a child, the disease poses a danger to the fetus. In some cases, it serves as an indication for artificial termination of pregnancy. The most serious consequences are observed during primary infection. This is due to the fact that in the mother's body there are no antibodies to the pathogen. It is necessary to know that CMV infection in women is an ailment that is transmitted at the time of conception, through the placenta and during delivery. In addition, the pathogen enters the body of the child along with breast milk.

CMV infection during pregnancy can provoke intrauterine death of the child, especially in the first trimester. If the gestational period is completed successfully, they speak of a congenital form of the disease. In this case, the symptoms in the infant appear immediately or after 2-5 years.

However, one should not think that CMV infection in women is such a pathology that is a sentence. Currently, pregnant women at risk are given special attention. With the timely provision of medical care, the likelihood that the child will be born healthy is significantly increased.

In order to prevent infection, a pregnant woman is advised to avoid mass gatherings of people. If it does, the following symptoms occur:

• general weakness;
• slight increase in body temperature;
• aching sensation in muscles and joints.

In many cases, the course of the disease is not accompanied by the appearance of any alarming signs. As a rule, pathology is detected in the process of standard diagnostics.

Treatment of CMV infection in pregnant women involves taking antiviral and immunomodulating agents. If a woman is a carrier of a pathogen that is in an inactive phase, therapy is not required. But in this case, she needs to monitor her health and avoid situations that weaken the body's defenses.

Cytomegalovirus infection in children

In most cases, infection occurs in utero. In this case, only about 17% of the pathogen manifests itself with various signs.

Symptoms of CMV infection in children are:

• jaundice;
• enlargement of the liver and spleen in size;
• low hemoglobin level;
• changes in the composition of the blood;
• disturbances in the work of the central nervous system;
• damage to the visual system and hearing aid;
• rashes on the skin;
• the presence in the stool of an admixture of liquid connective tissue.

In severe cases, the vital activity of pathogenic microorganisms negatively affects the brain. At the same time, the child has convulsions, and hands often tremble.

Shortly after birth, the baby's blood is taken for analysis. The presence of antibodies in it does not mean that the child may develop an acute form of the disease. Children with an identified infection should be regularly examined by a doctor to prevent the occurrence of various complications.

In the acquired form of the disease (for example, if the infection occurred in a kindergarten through saliva on toys), the following symptoms appear:

• increased body temperature;
• enlarged lymph nodes;
• chills;
• runny nose;
• drowsiness.

In addition, the endocrine and respiratory systems are often affected.

Treatment of CMV infection in children involves taking antiviral and immunomodulating agents.

Possible Complications

The negative consequences of the disease are very diverse. The following disorders are most often diagnosed in patients:

• hepatitis;
• stomach and duodenal ulcer;
• esophagitis;
• pancreatitis;
• diabetes;
• significant deterioration of vision up to its complete loss;
• low blood pressure;
• anorexia;
• hyperpigmentation of the skin;
• mental and neurological disorders;
• deafness;
• pathology of the cardiovascular system.

The above disorders are only a part of the possible complications. It is impossible to predict which organ will be affected. In this regard, if CMV infection is detected, the recommendations of the attending physician should be followed regularly. In addition, it is necessary to periodically donate blood to timely detect the transition of the pathogen into the active phase.

Prevention

Currently, there is no vaccine that would reliably protect a person from infection. In addition, standard measures (for example, good personal hygiene) also do not reduce the likelihood of infection.

The issue of prevention in relation to persons at risk is extremely acute. To reduce the likelihood of infection, they are prescribed immunomodulators and antiviral drugs. In addition, women planning a pregnancy need to undergo a thorough examination.

Finally

Cytomegalovirus infection is a chronic disease. Its causative agent belongs to the herpes family and, when it enters the human body, remains in it forever. With strong immunity, the pathogen does not affect the functioning of internal organs and systems. Activation of the infection occurs with a significant weakening of the body's defenses.

Currently, there is no treatment that can completely get rid of CMV infection. The aim of therapy is to eliminate symptoms and prevent the development of complications. Treatment is with antiviral and immunomodulatory drugs. Compliance with standard preventive measures also does not reduce the risk of infection.

Cytomegalovirus is a virus that is widespread throughout the world among adults and children, belonging to the group of herpes viruses. Since this virus was discovered relatively recently, in 1956, it is considered not yet sufficiently studied, and is still the subject of active discussion in the scientific world.

Cytomegalovirus is quite widespread, antibodies of this virus are found in 10-15% of adolescents and young people. In people aged 35 years and over, it is found in 50% of cases. Cytomegalovirus is found in biological tissues - semen, saliva, urine, tears. When it enters the body, the virus does not disappear, but continues to live with its host.

What it is?

Cytomegalovirus (another name is CMV infection) is an infectious disease that belongs to the herpesvirus family. This virus infects a person both in utero and in other ways. So, cytomegalovirus can be transmitted sexually, by airborne droplets through the alimentary route.

How is the virus transmitted?

The routes of transmission of cytomegalovirus are diverse, since the virus can be found in blood, saliva, milk, urine, feces, seminal fluid, and cervical secretions. Possible airborne transmission, transmission by blood transfusion, sexual contact, possibly transplacental intrauterine infection. An important place is occupied by infection during childbirth and when breastfeeding with the milk of a sick mother.

There are frequent cases when the carrier of the virus does not even suspect about it, especially in situations where the symptoms are almost not manifested. Therefore, you should not consider every carrier of cytomegalovirus as sick, since existing in the body, it may never manifest itself in a lifetime.

However, hypothermia and the subsequent decrease in immunity become factors provoking cytomegalovirus. Symptoms of the disease are also manifested due to stress.

Cytomegalovirus igg antibodies detected - what does this mean?

IgM are antibodies that the immune system begins to produce 4-7 weeks after a person is first infected with cytomegalovirus. Antibodies of this type are also produced every time when the cytomegalovirus, which has remained in the human body after a previous infection, begins to multiply actively again.

Accordingly, if a positive (increased) titer of IgM antibodies against cytomegalovirus was detected in you, then this means:

• that you have recently been infected with cytomegalovirus (not earlier than within the last year);
• That you were infected with cytomegalovirus for a long time, but recently this infection began to multiply again in your body.

A positive titer of IgM antibodies can persist in human blood for at least 4-12 months after infection. Over time, IgM antibodies disappear from the blood of a person infected with cytomegalovirus.

Development of the disease

The incubation period is 20-60 days, the acute course is 2-6 weeks after the incubation period. Being in the body in a latent state both after infection and during periods of attenuation is an unlimited time.

Even after the course of treatment, the virus lives in the body for life, maintaining the risk of relapse, so doctors cannot guarantee the safety of pregnancy and full bearing even if a stable and prolonged remission occurs.

Symptoms of cytomegalovirus

Many people who are carriers of cytomegalovirus do not show any symptoms. Signs of cytomegalovirus may appear as a result of disorders in the immune system.

Sometimes in persons with normal immunity, this virus causes the so-called mononucleosis-like syndrome. It occurs 20-60 days after infection and lasts 2-6 weeks. It manifests itself as high, chills, fatigue, malaise and headache. Subsequently, under the influence of the virus, the body's immune system is restructured, preparing to repel the attack. However, in case of lack of strength, the acute phase passes into a calmer form, when vascular-vegetative disorders often appear, and internal organs are also damaged.

In this case, three manifestations of the disease are possible:

1. Generalized form- CMV damage to internal organs (inflammation of the liver tissue, adrenal glands, kidneys, spleen, pancreas). These organ damage can cause, which further worsens the condition and puts increased pressure on the immune system. In this case, antibiotic treatment is less effective than with the usual course of bronchitis and / or pneumonia. However, it can be observed in the peripheral blood, damage to the walls of the intestine, blood vessels of the eyeball, brain and nervous system. Outwardly manifested, in addition to enlarged salivary glands, skin rash.
2. - in this case, it is weakness, general malaise, headaches, runny nose, enlargement and inflammation of the salivary glands, fatigue, slightly elevated body temperature, whitish deposits on the tongue and gums; sometimes it is possible to have inflamed tonsils.
3. Damage to the organs of the genitourinary system- manifests itself in the form of periodic and non-specific inflammation. At the same time, as in the case of bronchitis and pneumonia, inflammation is difficult to treat with traditional antibiotics for this local disease.

Particular attention should be paid to CMVI in the fetus (intrauterine cytomegalovirus infection), in the newborn and young children. An important factor is the gestational period of infection, as well as the fact whether the infection of the pregnant woman occurred for the first time or the infection was reactivated - in the second case, the probability of infection of the fetus and the development of severe complications is much lower.

Also, in the case of infection of a pregnant woman, fetal pathology is possible, when the fetus becomes infected with CMV that enters the blood from outside, which leads to miscarriage (one of the most common causes). It is also possible to activate a latent form of the virus that infects the fetus through the mother's blood. Infection leads either to the death of the child in the womb / after childbirth, or to damage to the nervous system and brain, which manifests itself in various psychological and physical diseases.

Cytomegalovirus infection during pregnancy

When a woman is infected during pregnancy, in most cases she develops an acute form of the disease. Possible damage to the lungs, liver, brain.

The patient complains about:

• fatigue, headache, general weakness;
• increase and soreness when touching the salivary glands;
• discharge from the nose of a mucous nature;
• whitish discharge from the genital tract;
• abdominal pain (due to increased uterine tone).

If the fetus is infected during pregnancy (but not during childbirth), the development of congenital cytomegalovirus infection in a child is possible. The latter leads to severe diseases and lesions of the central nervous system (mental retardation, hearing loss). In 20-30% of cases, the child dies. Congenital cytomegalovirus infection occurs almost exclusively in children whose mothers first become infected with cytomegalovirus during pregnancy.

Treatment of cytomegalovirus during pregnancy includes antiviral therapy based on intravenous injection of acyclovir; the use of drugs for the correction of immunity (cytotect, intravenous immunoglobulin), as well as conducting control tests after the course of therapy.

Cytomegalovirus in children

Congenital cytomegalovirus infection is usually diagnosed in a child in the first month and has the following possible manifestations:

• cramp, trembling of the limbs;
• drowsiness;
• visual impairment;
• problems with mental development.

The manifestation is also possible at an older age, when the child is 3-5 years old, and usually looks like an acute respiratory disease (fever, sore throat, runny nose).

Diagnostics

Cytomegalovirus is diagnosed using the following methods:

• detection of the presence of the virus in body fluids;
• PCR (polymerase chain reaction);
• sowing on cell culture;
• detection of specific antibodies in blood serum.

Cytomegalovirus in newborns is quite common. Infection occurs during fetal development or after childbirth. Only in 10-15% of cases, signs of the disease appear in babies immediately after birth. Children with asymptomatic cytomegalovirus syndrome are born clinically healthy. It is possible to detect an active form of cytomegalovirus infection in them only after a laboratory test. The sooner you take therapeutic measures against the congenital form of the disease, the better the result will be.

What is cytomegalovirus infection

(cytomegaly) is a viral disease caused by human cytomegalovirus (CMV) from the herpesvirus family. It mainly affects the salivary glands (especially the parotid). In the most severe form, the pathological process spreads to other organs - the lungs, liver, kidneys, adrenal glands, intestines, esophagus, pancreas, retina, and even the brain. Weak and premature babies have internal bleeding and cell death in the body.

Under the action of the virus, cells grow, which increase to gigantic sizes (30–40 times). A dense large intranuclear inclusion appears inside them. It makes the cell look like an owl's eye.

The virus is most dangerous for the fetus at the stage of embryonic development, if the pregnant woman was first infected with cytomegalovirus. Due to the absence of antibodies to the causative agent of the disease in the expectant mother, an unattenuated virus infects the embryo and disrupts its formation. The virus is also serious for the fetus at a later stage of development. Cytomegalovirus is able to overcome the placental barrier and affect the health of the child. During the primary infection of a pregnant woman, infection of the fetus occurs in 40–50% of cases.

1. If a woman is not infected with the virus for the first time, her antibodies weaken the pathogens and reduce their aggressive effect on the fetus. In such cases, the risk of infection of the child is no more than 1-2%.
2. The likelihood of infection is increased by constant stress, malnutrition, a sedentary lifestyle and chronic diseases.
3. The insidiousness of cytomegalovirus infection lies in its ability to proceed hidden or disguise itself as an acute respiratory viral infection. For this reason, the disease in pregnant women is often not diagnosed.

The detection of antibodies to CMV in newborns does not indicate their infection. Transfer of antibodies can be carried out through the placenta from mother to fetus during pregnancy. The diagnosis of cytomegalovirus infection is made by identifying pathogens in urine, blood and saliva.

Congenital cytomegalovirus infection

If a woman was infected with the virus in the first twelve weeks of pregnancy, pathogens can cause spontaneous abortion or fetal death. The embryo has serious developmental disorders that are incompatible with life. If the fetus manages to survive, the virus causes severe defects in it. Some of them are classified as genetic (Dandy-Walker syndrome).

The most serious malformations occur in children if a pregnant woman is diagnosed with cytomegaly for the first time. As a result of the infection, children develop microcephaly (a decrease in the brain), hepatosplenomegaly (an enlargement of the spleen and liver), thrombocytopenia (a decrease in the number of platelets, causing a decrease in blood clotting), and prolonged jaundice (hyperbilirubinemia).

The infection affects the nervous system of the fetus, provoking severe diseases (the debut of the episyndrome and treatment-resistant epilepsy, non-occlusive hydrocephalus, cerebral palsy, autism). In some cases, cytomegalovirus infection in newborns can cause deafness, visual impairment and mental retardation.

But most often the infection causes damage to the brain. With a congenital form of cytomegalovirus infection, meningoencephalitis (inflammation of the membranes and substances of the brain), pathology of the brain ventricles, calcifications (salt deposits in soft tissues) and "calcification" of the cerebral vessels (mineralization vasculopathy) are diagnosed. All these pathologies are accompanied by neurological disorders (cerebral changes, hypertensive-hydrocephalic syndrome). Mineralization vasculopathy often causes convulsive syndrome in the newborn.

1. A common manifestation of cytomegalovirus infection is the blockade of the CSF pathways.
2. It is diagnosed in 7% of cases when the brain is damaged by a viral infection.
3. The virus infects the choroid plexus of the ventricles of the brain and causes the appearance of cysts in it.

If infection occurred in the second and third trimester of pregnancy, the virus can provoke hemorrhagic syndrome, hemolytic anemia, cirrhosis of the liver, interstitial pneumonia, enteritis, colitis, polycystic pancreas and nephritis.

Acquired form of cytomegalovirus infection

Immediately after birth, a newborn in 30% of cases is infected with cytomegalovirus from its mother through biological fluids containing the virus (saliva, breast milk, urine, genital discharge, blood). The baby can also get infected from other people.

According to pediatrician Yevgeny Komarovsky, if a child has a well-developed immune system, pathogens are unable to cause serious illness in him. Premature babies, as well as babies with immunodeficiency, are vulnerable to the virus. They may develop productive peribronchitis or lingering pneumonia.

Sometimes, after infection with cytomegalovirus, weak infants have enlarged lymph nodes, hepatitis develops. In the kidneys, cytomegalic changes in the tubular epithelium may appear. The virus can cause ulcers in the intestines of a child. Such children are difficult and take a long time to recover. They often lag behind in development.

Babies with an acquired form of cytomegalovirus infection do not develop brain damage.

Acute congenital disease

Congenital cytomegalovirus infection can occur in acute and chronic forms. In the acute course of the disease, the first signs of the disease appear immediately after the birth of the child or during the first 24 hours.

The baby's body temperature rises. Bluish-violet spots become noticeable on the face, body and limbs. The infant may develop bleeding into the mucous membranes and blood in the stool (hemocolitis). Sometimes blood continues to ooze from the umbilical wound. The yellowness of the skin will indicate developing hepatitis.

If the brain is affected in newborns, they may experience convulsive syndrome from the first hours of life. It lasts up to 5 days or more. Trembling of the upper extremities occurs against the background of increased drowsiness.

Acute congenital cytomegalovirus infection can manifest as impaired coordination, hearing, and vision. Sometimes it causes blindness. The baby often develops pneumonia. Weak immunity and the addition of another acute infection can lead to the death of a newborn.

Chronic congenital disease

The chronic form of cytomegalovirus infection can be manifest and asymptomatic. Symptoms of the manifest course of the disease are manifested in the form of visual impairment. Clouding of the lens and vitreous body cause deterioration or complete loss of visual perception. An infant has hydrocephalus, epilepsy, microgyria (structural abnormalities in the cerebral cortex), microcephaly, or signs of cerebral palsy.

A baby with a chronic form of cytomegalovirus infection lags behind in development and gains weight poorly. At an older age, speech defects and mental retardation are found.

It is not always diagnosed in the first weeks after the birth of the baby. Therefore, the treatment of the disease is sometimes started too late. Early diagnosis and timely therapy can prevent visual impairment, stop the progression of epilepsy, hydrocephalic syndrome and other pathologies. In most cases, developmental delays can be avoided. Children with autism who have received adequate treatment are able to study in ordinary comprehensive schools.

The most difficult thing is to detect a latent form of chronic cytomegalovirus infection in a newborn. These babies do not show any visible signs of the disease. If laboratory tests were not carried out after the birth of the child, infection will not be detected for a long time.

A characteristic sign of defeat by cytomegalovirus is a tendency to bacterial infections. Often in the first year of a child's life, diseases of bacterial origin overcome. He is diagnosed with pyoderma (purulent skin lesions), recurrent stomatitis, otitis, sinusitis, bronchitis, pneumonia, cystitis, pyelonephritis. In some cases, symptoms of cytomegalovirus infection are detected only at school age.

Vaccinations are contraindicated for such children. Vaccination can give them autism, epilepsy, cerebral palsy, or mental retardation.

Treatment of a viral disease

Currently, with cytomegalovirus infection in newborns, injections of immunoglobulin into a vein are prescribed. Immediately after birth, the infant is injected with Cytotect hyperimmune immunoglobulin. The drug contains 10 times more than other immunoglobulins. It is made from the blood of donors who have a large number of antibodies produced by the body. "Cytotect" also contains antibodies to microbial pathogens that most often affect newborns in the postpartum period.

A significant improvement in the infant's condition is observed 7-8 days after the administration of Cytotect. The blood actively produces its own anti-cytomegalovirus and anti-herpetic antibodies.

Antibiotics are used to treat diseases caused by bacteria. Most often, a combined preparation with a wide spectrum of bactericidal action "Sulperazon" is prescribed to newborns. It contains 3rd generation cephalosporins (cefoperazone and sulbactam). "Sulperazon" is administered first intravenously, and then intramuscularly. The course of treatment is 8-14 days. In order for the baby to recover faster, he is also protected from other infections.

Cytomegalovirus (CMV) or herpes virus type 5, is a DNA-containing Cytomegalovirus hominis virus of the Herpesviridae family of the Betaherpesvirinae subfamily. Human cytomegalovirus infection (CMVI) is a chronic anthroponotic disease of viral etiology, characterized by a variety of forms of the pathological process and clinical manifestations - from a latent infection to a clinically pronounced generalized disease. CMVI disease is classified depending on the timing and mechanisms of infection (congenital and acquired infection, prenatal, intranatal and postnatal), the degree of virus activity (latent, persistent and reactivated infection), primary or re-infection (acute infection, virus reactivation and reinfection).

Distinctive features of the infection are the ability of CMV to persist in many organs and its ability to infect almost all cells of the human body, which predetermines the variety of clinical manifestations, both in congenital and acquired forms of infection. CMV is considered as the main causative agent of intrauterine infection, which has a variety of outcomes: from infection without the implementation of infection, the formation of malformations and diseases of newborns to fetal death and stillbirth.

CMVI is a typical anthroponosis. The source of infection is a sick person or a virus carrier. Ways of transmission: vertical, sexual, airborne, fecal-oral, artificial (parenteral). Transmission factors are blood, cervical and vaginal secretions, semen, and human milk. The virus is excreted in urine, faeces, saliva, sputum, and to a lesser extent in lacrimal fluid. Infection can also occur during blood transfusion, organ and tissue transplantation. Cytomegaly is a widespread infection; among the adult population of the Russian Federation, AT-CMV is found in 73–98% of cases.

CMVI refers to opportunistic infections, it is of particular danger to patients with immunodeficiencies of various nature. Immunosuppression leads to the reactivation of a latent infection and the development of manifest variants of the disease with damage to various organs and systems that can lead to death. Manifest CMVI occupies one of the first places in the structure of opportunistic diseases in HIV-infected patients. This pathology occurs in 20-40% of AIDS patients not receiving antiretroviral therapy. Clinically expressed CMVI is one of the serious infectious complications in organ transplantation, the infection exacerbates the processes leading to transplant rejection.

With the persistence of CMV in the human body, two stages are distinguished, which replace each other - productive (with virus replication) and latent. The release of the virus from the latent stage means reactivation, which may be predetermined by a decrease in immunoresistance or the appearance of other factors that contribute to its reproduction. (viremia, DNA or AG) indicates the presence of infection.

During primary infection, IgM antibodies are produced on days 5–7, after 10–14 days, low-avidity IgG antibodies are produced, then gradually the avidity of these antibodies increases, they become highly avid. IgM Abs disappear after one month, low-avid IgG Abs disappear after 1–3 months, and high-avid IgG Abs circulate in the carrier's blood for life. During primary infection in the “serological window” stage, before the start of AT synthesis, active replication of the virus occurs, during this period the only marker of infection is the virus DNA in the blood. During reactivation, IgM and/or IgA antibodies may appear, as well as low-avid IgG antibodies; at the peak of reactivation, CMV DNA or AG is detected in the blood plasma.

The decisive condition for antenatal CMVI is viremia in the mother due to primary or re-infection with the virus or its reactivation. CMV is able to cross the placental barrier and infect the fetus at various stages of pregnancy, causing congenital infection. According to various authors, the active form of CMVI is detected in women with a burdened obstetric history in 35-60% of cases. The entrance gate for the virus in the antenatal and intranatal periods of pregnancy can be the placenta and fetal membranes, in the neonatal period and later - the respiratory tract and digestive tract, infection through the blood is also possible.

CMV has a predominantly neurotropic, epitheliotropic, hepatotropic and cardiotropic effect on the fetus. Its impact can also be indirect, leading to various disorders in the placenta: a disorder of the uteroplacental circulation, a deviation in the evolutionary formation of the placenta. The clinical equivalent of these disorders can be a reduction in the duration of pregnancy and premature delivery, the birth of children with symptoms of hypoxia or signs of intrauterine malnutrition, general intrauterine growth retardation.

The hematogenous route of infection is of the greatest importance for the development of early perinatal lesions of the fetus. In addition, for intranatal and later lesions, vertical and contact routes of CMV transmission are characteristic, and cases of mixed infection are also not uncommon. Acute CMVI can occur in the form of a generalized form with the addition of secondary infections and be fatal in the first weeks of a child's life. When a fetus is infected during reactivation of latent CMVI, late manifestations of infection in the form of visual impairment, hearing impairment, mental retardation, and motor disorders are more common. In the absence of pronounced immunological disorders, acute CMVI becomes latent with a lifelong presence of the virus in the human body. The development of immunosuppression, in particular associated with HIV infection, leads to the resumption of CMV replication, the appearance of the virus in the blood and the manifestation of the disease. The lethality of patients with HIV infection suffering from CMVI is 25-27%.

The clinical diagnosis of CMV infection requires mandatory laboratory confirmation. Detection of AT-CMV IgM and/or IgG in the patient's blood is not sufficient either to establish the fact of active CMV replication or to confirm the manifest form of the disease.

Indications for examination

• Women planning a pregnancy;
• women with a burdened obstetric history (perinatal losses, the birth of a child with congenital malformations);
• pregnant women (primarily those with ultrasound signs of intrauterine infection, lymphadenopathy, fever, hepatitis and hepatosplenomegaly of unknown origin);
• pregnant women with immunodeficiency, including those with HIV infection;
• mothers who gave birth to a child with signs of intrauterine infection or congenital malformations;
• children with symptoms of congenital infection, malformations or born to women at risk for intrauterine transmission of CMV;
• patients (primarily newborns) with sepsis, hepatitis, meningoencephalitis, pneumonia, gastrointestinal lesions;
• patients with the presence of immunodeficiency with a clinical picture of organ or generalized lesions.

Differential Diagnosis

• Congenital CMVI - rubella, toxoplasmosis, neonatal herpes, syphilis, bacterial infection, hemolytic disease of the newborn, birth trauma, hereditary syndromes;
• mononucleosis-like disease - infections caused by the Epstein-Barr virus, herpes viruses types 6 and 7, acute HIV infection, streptococcal tonsillitis, the onset of acute leukemia;
• respiratory disease in young children - whooping cough, bacterial tracheitis or tracheobronchitis, RS-viral infection, herpetic tracheobronchitis;
• in patients with immunodeficiency - pneumocystis pneumonia, tuberculosis, toxoplasmosis, mycoplasmal pneumonia, fungal and herpes infections, bacterial sepsis, lymphoproliferative diseases, HIV encephalitis, neurosyphilis, progressive multifocal leukoencephalopathy;
• polyneuropathy and polyradiculopathy - polyradiculopathy caused by herpesvirus types 2 and 6, Guillain-Barré syndrome, toxic polyneuropathy associated with taking drugs, alcohol, narcotic psychotropic substances.

Etiological laboratory diagnostics includes microscopic studies, detection of a pathogen in cell culture, detection of AG or DNA, determination of AT IgM, IgA, IgG, avidity of AT IgG.

Research material

• Blood (serum, plasma), blood leukocytes, urine, saliva, CSF - culture studies, DNA detection;
• cord blood, amniotic fluid - DNA detection;
• saliva, urine - detection of hypertension;
• serum / blood plasma - determination of AT.

Comparative characteristics of methods of laboratory diagnostics. Using the PCR method allows you to determine the presence of virus DNA in tissues and biological fluids. The study has high specificity (100%) and sensitivity (85–100%). CMV DNA can also be detected in latent CMVI, indicating continued replication of the virus even in the complete absence of clinical symptoms of the disease. The use of real-time PCR makes it possible to determine the level of viremia (“viral load”) in the blood and CSF.

Isolation of the virus from blood leukocytes, urine, saliva, cerebrospinal fluid, semen, etc. in cell culture has long been called the "gold standard" in the diagnosis of CMVI. At present, with the advent of highly sensitive and specific molecular biological methods, virological studies no longer occupy the main place in the laboratory diagnosis of CMVI. This is due both to the characteristics of the virus - the result of cultivation is affected by the instability of CMV to temperature changes and freezing, and the need to perform research in a specially equipped virological laboratory, which is usually not available in medical institutions. In addition, virological examination does not distinguish between primary infection and recurrent CMVI infection, especially in asymptomatic cases. Some laboratories use a “rapid culture method” with the preliminary introduction of the biomaterial into the fibroblast culture and the detection of the cytopathic effect of CMV when RIF is used.

To detect the AG virus in saliva and urine, the RIF method is used; by the number of luminous cells, one can approximately estimate the intensity of virus isolation. In connection with the persistence of CMV, the detection of AH does not indicate the activity of the infectious process; additional studies are required to evaluate it - the identification of individual antigens of the virus (p55, pp65, etc.).

When conducting a microscopic examination (light microscopy), the main morphological features of CMVI are giant cells with intranuclear inclusions (cytomegals). They can be found in the epithelium of the renal tubules, bile ducts, excretory ducts of the salivary glands, pancreas, lung tissue, glia cells, neurons, endotheliocytes. The presence of such cells indicates the reproduction of the virus, but they are not found in all cases of active infection. The diagnostic sensitivity of the method does not exceed 50%.

To determine AT-CMV, the ELISA method is usually used. The presence of IgM antibodies is indicative of acute infection or reactivation. Reactivation is much more often accompanied by overproduction of IgA antibodies than IgM. The detection of IgG antibodies has a low diagnostic value. The diagnostic value of the test is increased by the determination of the avidity of IgG antibodies: the detection of low-avid IgG antibodies indicates current or recently transferred CMVI, a decrease in the avidity index is also possible with reactivation. Detection of highly avid antibodies excludes primary infection, but reactivation can occur in the presence of highly avid antibodies, as evidenced by the detection of CMV, its antigens (“early proteins”) or DNA, as well as by the detection of IgA antibodies.

The determination of specific antibodies to the virus helps in recognizing human infection with CMV, but due to the long period of increase in the titer of antibodies from the moment of infection, their subsequent long-term retention in the blood, the transplacental transfer of IgG antibodies from mother to fetus (detected in a child up to 1.5 years old) diagnostic value research is limited. When observed in dynamics (2–4 weeks), a 4-fold increase in the IgG AT titer indicates active CMVI. However, the need for a long observation period (up to 4 weeks) and the possibility of maintaining an elevated titer of antibodies for a number of years limits the use of this approach to diagnosis.

An additional study in brain damage caused by CMV may be the parallel detection of IgG antibodies in peripheral blood and CSF by ELISA with subsequent calculation of their ratio. The value of the ratio makes it possible to identify intrathecal AT production and, accordingly, the involvement of the CNS in the infectious process.

Immunoblot makes it possible to detect IgM and IgG antibodies to individual CMV proteins, confirm the specificity of the study, monitor the appearance and disappearance of individual proteins in dynamics, which has a high diagnostic and prognostic value. The presence of antibodies to individual antigens of the virus confirms the formation of an immune response to CMV.

Indications for the use of various laboratory tests and interpretation of their results in different categories of subjects

Diagnosis of primary infection, including during pregnancy, is possible only in patients whose blood does not contain AT-CMV. Regardless of the clinical variants of the disease, primary CMVI reveals direct (presence of the virus, its DNA or AG) and indirect (CMV-AT) laboratory markers of active CMV replication. When examining patients with suspected active CMVI and a manifest form of the disease (CMV disease), it is necessary to quantify the content of CMV DNA in the blood. Determination of CMV DNA in cerebrospinal fluid, pleural fluid, BALF, bronchial biopsy specimens, organ biopsy specimens is performed in the presence of the corresponding organ pathology.

Identification of direct markers of viral replication(viremia, DNA or AG) indicates the presence of infection. Detection of CMV DNA or AH virus in the blood of a pregnant woman is the main marker of a high risk of fetal infection and the development of congenital CMVI.

Absence of AT-CMV IgM, IgA and IgG means the absence of CMV in the body. However, in persons with severe immunodeficiency with active CMV replication, the production of specific antibodies can be reduced to an undetectable level.

Detection of AT-CMV of different classes allows you to determine the phase of the infectious process (replicative or latent). AT IgM is more often evaluated as a marker of primary herpes virus infection. If IgM antibodies are detected to confirm CMV infection, additional studies are recommended: determination of IgA antibodies or IgG antibodies avidity, detection of antibodies to individual proteins using immunoblot; re-examination of a woman or child after 2 weeks. Detection of IgA Abs and/or low-avid IgG Abs confirms the presence of infection. In case of repeated detection of IgM antibodies and the absence of IgA and (or) low-avid IgG, the result of detection of IgM antibodies is considered false positive.

Detection of IgM and IgG antibodies to immediate early antigen proteins and low-avid IgG antibodies indicates a primary infectious process.

Detection of IgG antibodies only does not allow to characterize the period of the disease. In the presence of immunosuppression, the classical (4-fold) increase in IgG antibodies during relapse is not observed.

Establishing the fact of infection of the fetus based on the detection of CMV DNA. The choice of biological material is determined taking into account the gestational age, which determines the possibility of conducting one or another method of invasive prenatal diagnosis: amniotic fluid - 16-23 weeks, cord blood - 20-24 weeks. An indirect confirmation of the fact of infection of the fetus is the detection of IgM antibodies and / or IgA antibodies in umbilical cord blood (a study is possible from the 22nd week of pregnancy).

Laboratory diagnosis of congenital CMVI is based on the detection of CMV, its DNA or AG in various biological material (peripheral blood, urine, saliva, swabs and swabs from the oropharynx, CSF) and the detection of IgM and IgA antibodies in serum or blood plasma during the first 7 days after birth. Conducting a study at a later date does not allow differentiating between congenital and acquired infection. Detection of CMV DNA or AG virus in blood, urine, scrapings from the oral mucosa after 4-6 weeks of a child's life in the absence of the virus in the first 2 weeks indicates intranatal or early post-natal infection. Confirmation of manifest CMVI in children during the first months of life is the presence of CMV DNA in the blood.

With questionable results, additional diagnostic information can be provided by the detection of IgM antibodies to individual virus antigen proteins by immunoblot. The absence of AT-CMV in children with congenital CMVI may be associated with the development of immunological tolerance to cytomegalovirus AG (CMV infection is not accompanied by effective synthesis of AT-CMV).

When examining children in post-neonatal age detection of the pathogen (classical or modified virological method), its DNA or AG (“early proteins”) and AT IgM and IgA is shown. The detection of anti-CMV IgM in children during the first weeks of life is considered a criterion for intrauterine infection with the virus. The disadvantage of determining AT IgM is their frequent absence in the blood in the presence of an active infectious process and no less frequent false positive results. When examining children under the age of 4–6 months of life, it is advisable to simultaneously determine AT in the child and mother, followed by a comparison of their level (titer) and the nature of avidity. When examining a child over the age of 6 months, only the child's blood can be examined. To exclude CMVI in children of the first year of life, it is recommended to determine DNA or AG in the urine.

The detection of IgG antibodies in the blood serum of a newborn without comparison with the level of antibodies in the mother's blood is not diagnostically significant due to the possibility of their transplacental transfer from the mother's body. Only with a dynamic (with an interval of 14–21 days) comparison of the level of IgG antibodies of a newborn child with the level of IgG antibodies in the mother's blood, one can judge their nature. If the titers of IgG Abs in a child at birth are equal to maternal ones, and upon re-examination after 3–4 weeks, they decrease by approximately 1.5–2 times, then the Abs detected in the child are maternal.

Screening of pregnant women– detection of IgM antibodies and low-avid IgG antibodies. To exclude reactivation, it is advisable to determine IgA antibodies and low-avid IgG antibodies.

Examination of patients with immunodeficiency if active CMVI and a manifest form of the disease (CMV disease) are suspected, it includes a histological examination of biopsy materials to detect cytomegals (hematoxylin and eosin staining), detection of CMV DNA in the cerebrospinal fluid, pleural fluid, BAL, bronchial biopsy specimens, biopsy specimens of internal organs in the presence of an appropriate organ pathology; detection of CMV AG in the blood, determination of the concentration of CMV DNA in the blood by PCR. In the diagnosis of CMVI in HIV-infected people, the most informative is the presence of high concentrations of CMV DNA in the blood (in blood plasma > 10,000 copies / ml, in leukocytes > 1,000 copies / 105 leukocytes).