(other name - CMV infection ) is an infectious disease that belongs to the family herpesviruses . 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.
According to the existing statistical study, antibodies to cytomegalovirus are found in approximately 10-15% of adolescents. Already at the age of 35, the number of such people increases to 40%.
Cytomegalovirus was discovered by scientists in 1956. A feature of this virus is its affinity for the tissues of the salivary glands. Therefore, if the disease has a localized form, then the virus can be detected exclusively in these glands. This virus is present in the human body for life. However, cytomegalovirus is not highly infectious. As a rule, in order to become infected with the virus, prolonged and repeated contacts, close communication with the carrier are necessary.
Today, there are three groups of people for whom control over the activity of cytomegalovirus is a particularly topical issue. These are pregnant women, people who have recurrent herpes and patients with compromised immune responses.
Causes of cytomegalovirus
A person can become infected with cytomegalovirus in many ways. So, infection can occur by contact, through the use of infected things, in the process of organ transplantation, as well as blood transfusion from a donor previously infected with cytomegalovirus. The disease is transmitted, moreover, through sexual intercourse, by airborne droplets, during pregnancy, in utero and during childbirth. The virus is found in blood, saliva, breast milk, semen, and secretions from the female genital organs. But the virus that enters the human body cannot be recognized immediately, because in this case the duration of the incubation period is about 60 days. These days, the virus may not appear at all, but after the incubation period, the onset of the disease occurs abruptly. Hypothermia and the subsequent decrease in immunity become factors provoking cytomegalovirus. Symptoms of the disease are also manifested due to stress.
Symptoms of cytomegalovirus
If the virus enters the body, then the restructuring of the immune system begins in it. And after the acute phase of the disease is over, the manifestation of vegetative-vascular disorders and asthenia for a long time is possible.
In people with immunodeficiency (people who have undergone chemotherapy, HIV-infected people, and people undergoing immunosuppressive therapy for organ transplants), the presence of cytomegalovirus can provoke the manifestation of very serious diseases. The lesions that occur in such patients can be fatal.
Diagnosis of cytomegalovirus
When diagnosing, one should take into account the fact that the presence of cytomegalovirus can only be detected in the case of special studies of urine, saliva, blood, semen, as well as smears from the genital organs during primary infection with the disease or during an exacerbation of the infection. If the virus is detected at another time, then this is not decisive for diagnosis.
After this infection enters the body, it begins to produce - antibodies to cytomegalovirus. They stop the development of the disease, as a result of which it is asymptomatic. In the course of a laboratory blood test, such antibodies can be detected. However, a single identification of antibody titer does not make it possible to distinguish between a current infection and a past infection. Indeed, in the body of the carrier of the virus, both cytomegalovirus and antibodies are constantly present. In this case, antibodies do not prevent infection, and immunity to cytomegalovirus is not produced. In case of ineffective diagnosis, the patient must be tested again after a few weeks.
Treatment of cytomegalovirus
If a person is diagnosed with cytomegalovirus, the treatment of the disease will be aimed at strangling all forms of manifestation of the disease and eliminating unpleasant symptoms. After all, today doctors do not have a tool that destroys the virus in the human body completely.
If symptoms do not appear in patients who have been diagnosed with cytomegalovirus, treatment of the disease is not required. After all, this indicates the normal immunity of the virus carrier.
If a virus is detected in the blood, in this case, therapy involves supporting and strengthening the immune system. Therefore, it is necessary to carry out immunomodulatory, as well as restorative treatment. Vitamin complexes are also prescribed.
In the treatment of cytomegalovirus in children and adults, it is important to use an integrated approach to prescribing therapy. As a rule, the treatment is prescribed to take drugs with antiviral and immune effects. With the right approach to treatment, the body's defenses are activated, and the activation of the latent form of the disease is further controlled.
It is very important to undergo all the necessary examinations and timely determine the exacerbation of the disease during
. Accordingly, if a cytomegalovirus is detected in a pregnant woman, the treatment is selected taking into account all the individual characteristics of her body. If the case is severe, it is sometimes recommended to resort to termination of pregnancy. Such a conclusion is based on information obtained as a result of virological studies, clinical indications, ultrasound of the placenta and fetus.
Treatment aimed at maintaining immunity includes procedures to strengthen and harden the body. So, bath procedures are often recommended in this case, and those who have some training can periodically bathe in ice water.
There are many medicinal herbs, decoctions of which stimulate the improvement of the general condition of the body. The use of herbs with a choleretic effect is suitable: dog rose, corn stigmas, immortelle, yarrow. You can rinse your mouth with a weak solution .
The doctors
Medications
Prevention of cytomegalovirus
Prevention of cytomegalovirus is mainly in the careful observance of the rules of both personal and sexual hygiene. It is important to exercise due care when coming into contact with infected people. Care should be taken most carefully during pregnancy: in this case, casual sexual intercourse should not be allowed. Another important point in the issue of the prevention of cytomegalovirus is the support of immunity. You should lead a physically active life, eat right, walk in fresh clean air, take vitamins, and avoid stressful situations. Children need to be taught to the right way of life and hygiene from the first years of life.
Cytomegalovirus in children
When children are infected with cytomegalovirus, the incubation period can last from 15 days to 3 months or even more. Allocate congenital and acquired cytomegalovirus infection. Very often, cytomegalovirus in children occurs without severe symptoms. In the congenital form of the disease, the fetus becomes infected during fetal development, becoming infected from the mother. From the mother's blood, the virus enters the placenta, after which it enters the blood of the fetus and then penetrates into the tissue of the salivary glands. If the fetus was infected in the early stages of pregnancy, it may die. Otherwise, the child is born with a number of severe defects. So, cytomegalovirus in children can cause microcephaly
,
, as well as other brain pathologies with subsequent development mental retardation
. Perhaps the birth of children with pathology of the cardiovascular system, gastrointestinal tract, lungs, respiratory tract. Also, cytomegalovirus in children causes convulsions
,
.
If the infection of the child occurred at a later date, then the newborn does not have pronounced defects, however, the disease is expressed by severe jaundice , the child's spleen and liver are enlarged, damage to the lungs and intestines is possible.
If there is an acute course of cytomegalovirus infection, then the newborn has a number of symptoms: poor appetite, fever may rise, the child is not gaining weight well, has an unstable stool. Possible hemorrhagic rashes on the skin. After a certain time, due to poor recruitment, it develops anemia , hypotrophy . In general, a very severe course of cytomegalovirus infection is noted, and as a result, it often ends in the death of a child in the first month of life.
If the disease is chronic or asymptomatic, then the child's condition remains satisfactory.
With the acquired form of the disease, the child becomes infected during childbirth, or gets an infection already in the first days of life during contact with the carrier of the infection.
There are two options for the course of cytomegalovirus in children in this case: either the salivary glands are affected in isolation, or several or one organ is affected. As symptoms, the child manifests a high temperature, an increase in lymph nodes both on the neck and in other places. The mucous membrane of the pharynx swells, the tonsils, spleen, liver increase. The child refuses to eat, the stool is disturbed - either diarrhea appears. Lesions of the lungs, gastrointestinal tract, yellowness of the sclera, trembling of the extremities are manifested. Possible and sepsis , but the effect of therapy with antibacterial drugs is not manifested. The course of the disease is long, the diagnosis, as a rule, is difficult to establish, because cytomegalovirus is sometimes not detected in the blood and saliva.
Also, when a child is infected with cytomegalovirus, cytomegalovirus hepatitis . Such children are born with severe hemorrhagic syndrome and a number of malformations described above. Very often, the course of the disease ends in death.
Cytomegalovirus in pregnant women
However, the most serious complications of this disease occur in women who are expecting a baby. Cytomegalovirus and pregnancy is a rather dangerous combination, because infection with this disease sometimes even leads to premature birth. It is cytomegalovirus that is one of the most frequently manifested causes of abortion.
In addition, a child of a sick mother can be born with low body weight, as well as with serious damage to the lungs, liver and central nervous system. Cytomegalovirus and pregnancy is a risk that the child may not survive at all. So, according to various estimates, 12–30% of such newborns die. In children who survived, in about 90% of cases, a number of late complications are observed: they can lose their hearing, sometimes there are speech disorders, and optic nerves atrophy.
Therefore, a very important step is the screening for the presence of cytomegalovirus infection in the process of planning the birth of a child. If you correctly approach the use of both therapeutic and preventive measures, then the negative impact of cytomegalovirus on the course of pregnancy and the likelihood of manifestation of pathologies in a child can be prevented.
Diet, nutrition with cytomegalovirus
List of sources
- Krasnov V.V., Malysheva E.B. Cytomegalovirus infection. Nizhny Novgorod: Publishing House of NGMA, 2004;
- Isakov, V.A., Arkhipova E.I., Isakov D.V. Human herpesvirus infections: a guide for physicians. - St. Petersburg: Special Lit., 2006;
- Samokhin P.A. Cytomegalovirus infection in children. - M.: Medicine, 1987;
- Borisov L.B. Medical microbiology, virology, immunology: M.: Medical Information Agency LLC, 2002.
Cytomegalovirus - CMV treatment is a rather difficult task. As, in fact, all viral diseases caused by pathogens adapted to modern drugs.
Poses a potential threat to human health. The virus is one of the most common opportunistic pathogens. When exposed to certain factors, it is activated and causes a vivid clinical picture of cytomegaly. In some people, the virus is in an opportunistic state throughout life, not showing up at all, but causing impaired immune defenses.
Of particular danger is the disease for infants and young children, when the virus covers all organs or systems, leading to serious complications, up to the death of the patient. There are still no known effective drugs for the complete expulsion of the virus from the body. If you are infected with cytomegalovirus, drug treatment is carried out to achieve a long-term therapeutic remission in a chronic course and eliminate local manifestations of the infection.
What you need to know about the virus
Cytomegaly appears to be an infectious disease of viral etiology. In some sources, there is a different name - cytomegalovirus infection (in the abbreviation CMV).
Cytomegalovirus is a member of a large group of herpesviruses. The cells affected by the viral agent increase significantly in size, hence the name of the disease - cytomegaly (translated from Latin - "giant cell"). The disease is transmitted through sexual, domestic or blood transfusion routes. The most unfavorable is the transplacental route of transmission.
The symptom complex resembles the development of a persistent cold, which is accompanied by a runny nose, malaise and general weakness, pain in the articular structures, increased salivation due to inflammation of the salivary glands. Pathology rarely has vivid symptoms, mainly proceeding in the latent phase. With generalized forms of damage to the body by viral agents, drug treatment and antiviral drugs are prescribed. There is no alternative effective treatment.
Many people are carriers of cytomegalovirus infection without even knowing it. Only 30% of the viral disease has a chronic course, exacerbated by local symptoms in the form of a herpetic rash, as well as general malaise. Antibodies to cytomegalovirus exist in 13-15% of adolescents, 45-50% in adult patients. The viral agent is often activated after exposure to factors that reduce immunity.
Cytomegalovirus poses a great danger to persons who have undergone organ or bone marrow transplantation, who have congenital forms of the disease or HIV status. The condition is dangerous during pregnancy, leads to serious consequences for the fetus: anomalies in the development of internal organs or systems, deformities and physical disability, miscarriage. For this, a collegial decision of the attending pediatrician and other narrow specialists is necessary.
Cytomegalovirus - treatment
The feasibility of therapy is proportional to the severity of the course and the potential danger to the patient's body. After some diagnostic measures, the risks of a possible threat are determined, an assessment is made of the pathological process. With signs of generalization, drug correction is prescribed. With a short episode of virus activation and while maintaining the patient's normal state of health, no special treatment is carried out. With a burdened clinical history of the patient, the doctor monitors the general condition, controls the level of antigen in the blood as part of laboratory diagnostics.
Often a completely healthy person who has been ill with a virus without any consequences acquires strong immunity. The viral agent itself, at the same time, remains in the body forever, transforms into a conditionally pathogenic form. There is a chronization of the pathology with periods of short-term exacerbations, subject to a pronounced decrease in immune defense. The goals of drug correction of the disease are:
- reducing the negative impact of the virus;
- relief of existing symptoms;
- ensuring stable remission in chronic disease.
Important! In humans, against the background of absolute health, the virus is asymptomatic, and the disease stops on its own. Many patients do not notice when the virus is activated and when its pathogenic activity is reduced.
The main indications for starting treatment
Unfortunately, cytomegalovirus is not treated completely. Medications can only strengthen local immunity and prevent new episodes of exacerbation. Therapy is prescribed in the following cases:
- immunodeficiency diseases of any origin;
- generalized spread of the viral agent;
- preparation of organ transplantation, for chemotherapy in oncological diseases;
- complicated clinical history of the patient (pathology of internal organs or system);
- pregnancy of a woman (often the first trimester);
- preparation for the treatment of encephalitis, meningeal infections.
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Ways of transmission of cytomegalovirus infection (CMV)
Before determining treatment tactics, a differential diagnosis of cytomegalovirus infection with influenza conditions, SARS and other infectious diseases is carried out. It is the similarity of the symptoms of cytomegaly with the classic manifestations of the common cold and untimely or inadequate treatment that provokes the development of severe complications.
What funds can be assigned
So, during the examination, cytomegaloverus was diagnosed - drug treatment will be prescribed in most cases. Conservative and drug therapy are the only ways to correct the condition of patients with CMVI. Pharmaceutical forms are numerous: ointments (liniments) for external use, tablets for oral use, injections for intravenous administration, drops, suppositories.
To eliminate exacerbations of a viral disease, the following groups of drugs are prescribed:
- symptomatic (pain relief, elimination of inflammatory foci, vasoconstriction in the nose, in the sclera);
- antiviral (the main task is to suppress the pathogenic activity of the virus: Panavir, Cidofovir, Ganciclovir, Foscarnet);
- drugs to eliminate complications (multiple groups and pharmacological forms);
- immunomodulators (strengthening and restoration of the immune system, stimulation of the body's natural defenses: Viferon, Leukinferon, Neovir);
- immunoglobulins (binding and removal of viral particles: Cytotect, Neocytotect).
Drugs for the treatment of cytomegalovirus are prescribed in a complex manner. Additionally, vitamin complexes with an enriched mineral composition are prescribed to restore the overall resistance to colds and other chronic pathologies that lead to a decrease in immunity. In systemic autoimmune diseases, as a rule, lifelong drug therapy is prescribed.
Important! With cytomegaly in men, a high therapeutic effect was proved by Ganciclovir, Foscarnet, Viferon, in women - Acyclovir, Cycloferon and Genferon.
Drug treatment has a number of disadvantages due to side effects. The toxicogenic effect is often expressed in dyspeptic disorders, decreased appetite, and the appearance of allergies. Iron deficiency anemia often develops.
Antivirals
To achieve the maximum therapeutic effect, guanosine analogues are prescribed:
- Virolex;
- Acyclovir;
- Zovirax.
The active substance quickly penetrates the cells of the virus, destroys their DNA. These drugs are characterized by high selectivity and low toxicogenic properties. The bioavailability of Acyclovir and its analogues varies from 15 to 30%, and with increasing doses it decreases by almost 2 times. Medicines based on guanosine penetrate into all cellular structures and tissues of the body, in rare cases causing nausea, local allergic manifestations, and headaches.
In addition to Acyclovir, its analogues are prescribed Ganciclovir and Foscarnet. All antiviral agents are often combined with immunomodulators.
Interferon inducers
Interferon inducers stimulate the secretion of interferons within the body. It is important to take them in the first days of an exacerbation of the infection, since on day 4-5 or later their use is practically useless. The disease is running, and the body is already producing its own interferon.
Inductors inhibit the development of CMV, are often well tolerated by the body, promote the synthesis of immunoglobulin G, natural interferons, interleukins. Known drugs containing interferon include Panavir. The drug has a pronounced anti-inflammatory effect, helps with severe pain, reduces the intensity of unpleasant symptoms.
Viferon also helps with viral activity, has a convenient form of suppositories for rectal administration, which is convenient in the treatment of children of any age. Of the interferon inducers, Cycloferon, Inosine-pranobex and its analogues Isoprinosine, Groprinosin are isolated. The latter drugs have a low degree of toxicity, suitable for the treatment of children and pregnant women.
Immunoglobulin preparations
Immunoglobulins are protein compounds in the human body and warm-blooded animals that transport antibodies to pathogenic agents during biochemical interaction. When exposed to CMV, a specific immunoglobulin Cytotect is prescribed, which contains antibodies to cytomegalovirus. Among other things, the composition of the drug includes antibodies to the herpes virus type 1.2, to the Epstein-Barr virus. Therapy with immunoglobulins is necessary to restore the general protective resources of the body to the penetration of viral agents.
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What is the avidity of antibodies to cytomegalovirus (CMV)
Another effective remedy for cytomegalovirus is Intraglobin (III generation), Octagam or Alphaglobin (IV generation). The latter types of drugs meet the most stringent requirements, suitable for patients with severe renal dysfunction (including pre-dialysis and dialysis period).
To achieve maximum therapeutic results, immunoglobulins are prescribed in the form of injections (Pentaglobin). Medicines in the form of injections directly affect the root of the problem, quickly eliminate the symptoms of a generalized manifestation of the disease. In addition, the chemical composition of new generation drugs is not disturbed before interacting with altered cells.
List of the most effective drugs
Despite the wide range of remedies for the relief of CMV symptoms, doctors always build individual therapeutic tactics. Before prescribing a specific medicine, it should be clarified which symptoms of the infection are present in a particular patient. This takes into account: the patient's clinical history, age, weight, general somatic status, complications and other factors that may interfere with proper treatment.
For therapy, the following popular means are used:
- Foscarnet. Refers to antiviral drugs for the treatment of severe forms of pathology complicated by cytomegaly. It is prescribed for reduced immunity. The active substance destroys the pathogenic cell, breaks the biological chain of the virus, stops the reproduction of viral agents.
- Ganciclovir. Antiviral agent for the treatment of cytomegalovirus with a complicated course (diseases of the kidneys, liver, respiratory organs, generalized inflammatory foci). It is widely used to prevent congenital infections, especially if the virus in the mother's body is in the phase of active reproduction. Release form tablets and crystalline powder.
- Cytotec. Being an immunoglobulin, the drug is prescribed for the complex elimination of the infection. The tool compares favorably with low toxicity, the absence of specific and absolute contraindications. The drug is used to prevent large-scale damage by cytomegalovirus in various social groups. Among the side effects are back pain, hypotension, stiffness in the movement of the joints, dyspeptic disorders. If negative conditions appear, the medication is stopped and the doctor is consulted for an alternative prescription.
- Neovir. Belongs to a large group of immunomodulators. Available in solution for injection. It is used for therapeutic correction and prevention of the disease in children or adults with autoimmune diseases, other pathologies, which during the period of exacerbation greatly reduce local immunity. The dosage is determined individually in each case.
- Viferon. Widely used in pediatric practice. Available in the form of suppositories for rectal administration. It is used in the complex therapy of infectious diseases of any origin, complicated or simple in course. Effective for pneumonia, bronchitis, colds as a prevention of possible CMV. Among the side effects are allergic manifestations (itching in the perianal region, urticaria).
- Bischofite. Anti-inflammatory agent for the prevention and treatment of cytomegaly, herpes infection. Available as a gel in a tube or a balm in a glass container. Can be used as a topical remedy for blisters, rashes and inflammation. When applied externally, it resembles the effect of using mineral water, healing mud.
Be sure to use vitamins and other tonics that stimulate the work of many internal structures of the body. The most necessary for viral infections include vitamins C and B9.
Vitamin C is a powerful antioxidant, has regenerative properties, restores cells that are involved in the inhibition of the activity of pathogenic agents. B vitamins are necessary for the normal functioning of the nervous system, support the normal function of the bone marrow, and are responsible for the resistance of the immune system to external or internal negative factors.
Timely diagnosis and detection of severe forms of infection will reduce the level of complications, prevent the generalization of the pathological process. When stopping an exacerbation with a medical method, it is important to take into account a number of important criteria, to conduct a differential diagnosis. Preventive measures during a woman's pregnancy, in young children, as well as the correct treatment tactics will save patients from unpleasant manifestations of cytomegalovirus for a long time.
Higher medical education, venereologist, candidate of medical sciences.
What it is? Cytomegalovirus is a genus of viruses in the herpesvirus family. This virus is quite common, today cytomegalovirus antibodies can be found in about 10-15% of adolescents, and in 40% of adults. Below, we will give a full description of this disease, as well as consider the causes, symptoms and treatments for cytomegalovirus.
Causes and ways of infection with cytomegalovirus
Cytomegalovirus (from lat. Cytomegalovirus) is actually a relative of herpes vulgaris, because it belongs to the group of herpesviruses, which includes, in addition to herpes and cytomegalovirus, also two diseases such as infectious mononucleosis and.
The presence of cytomegalovirus is noted in blood, semen, urine, vaginal mucus, and also in tears, which determines the possibility of infection by it through close contact with these types of biological fluids.
How does infection occur?
Cytomegalovirus infection can occur:- when using contaminated items,
- by blood transfusion and even by airborne droplets,
- as well as during sexual contact,
- during childbirth and pregnancy.
The virus is also found in blood, saliva, cervical secretions, semen, and breast milk.
If a person has already become infected with cytomegalovirus, then he becomes its carrier for life.
Unfortunately, it is not possible to recognize the presence of cytomegalovirus immediately - this disease has an incubation period that can last up to 60 days. During this period, the disease may not manifest itself in any way, but after that, there will definitely be an unexpected and sharp outbreak, which in most cases can be provoked by stress, hypothermia or a general decrease in the immune system.
Once in the blood, cytomegalovirus causes a pronounced immune reaction, manifested in the production of protective protein antibodies - immunoglobulins M and G (IgM and IgG) and an antiviral cellular reaction - the formation of CD 4 and CD 8 lymphocytes.
People who have a normal immune system may be infected with cytomegalovirus and not know about it, as the immune system will keep the virus suppressed, therefore, the disease will be asymptomatic, without causing harm. In rare cases, in people with normal immunity, cytomegalovirus can cause a mononucleosis-like syndrome.
In people with weak or weakened immunity (HIV-infected, cancer patients, etc.), cytomegalovirus causes serious illness, damage occurs:
- eye,
- lungs
- brain and digestive system,
- which eventually leads to death.
Cytomegalovirus is the most dangerous in only two cases. These are people with weakened immune systems and children who were infected while the fetus was in the womb of a mother who contracted the virus during pregnancy.
Symptoms of cytomegalovirus in women
In women, the symptoms of cytomegalovirus will appear depending on the form of the disease. The disease begins with an incubation period of 20-60 days. At this time, the pathogen actively multiplies in the cells, and there are no signs of the disease.
If the woman's immunity is not weakened, then no symptoms of the disease will be observed. In some cases, a woman may be concerned about:
- flu-like symptoms
- a slight increase in temperature up to 37.1 ° C,
- weakness,
- slight discomfort.
Signs in men
Stopping on the symptoms of cytomegalovirus in men, the following manifestations can be distinguished:
- temperature rise;
- chills;
- headache;
- swelling of the mucous membranes and nose;
- enlarged lymph nodes;
- runny nose;
- skin rash;
- inflammatory diseases that occur in the joints.
As you can see, the listed manifestations are similar to the manifestations observed in acute respiratory infections and acute respiratory viral infections. Meanwhile, it is important to take into account that the symptoms of the disease occur only after 1-2 months from the moment of infection, that is, after the end of the incubation period.
Diagnostics
We found out what cytomegalovirus is, and now let's find out how the disease is diagnosed. To diagnose sexually transmitted infections (STIs), methods are used based on the detection of the virus that causes the disease in the body. However, this disease is different. After all, it can be detected with the help of a special study of blood, urine, saliva, smears, semen and scrapings, which are taken from the genital organs during the primary infection or during an exacerbation of the infection.
- For the purpose of diagnosis, a laboratory determination of specific antibodies to cytomegalovirus, immunoglobulins M and G, is carried out in the blood. The presence of immunoglobulins M may indicate a primary infection with cytomegalovirus or a reactivation of a chronic cytomegalovirus infection. Determination of high titers of IgM in pregnant women may threaten infection of the fetus. An increase in IgM is detected in the blood 4-7 weeks after infection with cytomegalovirus and is observed for 16-20 weeks.
- An increase in immunoglobulins G develops during the period of attenuation of the activity of cytomegalovirus infection. Their presence in the blood indicates the presence of cytomegalovirus in the body, but does not reflect the activity of the infectious process.
- To determine the DNA of cytomegalovirus in blood cells and mucous membranes (in the materials of scrapings from the urethra and cervical canal, in sputum, saliva, etc.), the method of PCR diagnostics (polymerase chain reaction) is used. Especially informative is the quantitative PCR, which gives an idea of the activity of cytomegalovirus and the infectious process it causes.
- The diagnosis of cytomegalovirus infection is based on the isolation of cytomegalovirus in clinical material or a fourfold increase in antibody titer.
It is worth noting that it is advisable to take tests for cytomegalovirus for women who are planning a pregnancy. It is also necessary to pass a similar analysis to those people who very often have a cold, since a cold can be a manifestation of this infection.
It is necessary to treat cytomegalovirus infection in a complex way, therapeutic therapy should include drugs that are directly aimed at combating the virus, at the same time, these drugs should increase the protective functions of the body and strengthen the immune system. At present, no such remedy has yet been invented that could completely cure cytomegalovirus, it remains in the body forever.
The main goal of the treatment of cytomegalovirus is the suppression of its activity.
. People who are carriers of this virus need to adhere to a healthy lifestyle, eat well, and consume the amount of vitamins necessary for the body.Due to the fact that in the vast majority of cases the body itself is able to cope with cytomegalovirus, the treatment of the infection associated with it is most often limited to easing the symptoms and reducing the suffering of the patient.
To reduce the temperature characteristic of almost all forms of cytomegalovirus infection, use the usual Paracetamol. Aspirin is not recommended due to possible side effects associated with the viral nature of the disease.
It is also very important for carriers of this disease to lead a normal and proper lifestyle that provides a person with the right amount of fresh air, a balanced diet, movement and all the factors that strengthen the immune system.
In addition, there are a large number of immunomodulatory drugs that are prescribed to strengthen the immune system. In general, treatment with immunomodulators can last several weeks, and only a doctor prescribes such treatment. It should be noted that such treatment is possible if the cytomegalovirus is latent, so these drugs are used for prevention, but not for treatment.
Prevention
It is worth noting that cytomegalovirus is the most dangerous during the initial infection, so it is necessary to take all precautions when contacting already infected people and about preventing this infection. And especially such caution is very important for pregnant women who are not carriers of cytomegalovirus. Therefore, pregnant women, in order to protect their health and the health of the baby, need to give up casual sex.
Prevention of cytomegalovirus for everyone else comes down to observing the basic rules of personal and sexual hygiene.
- You should not enter into new intimate contacts without a condom: this advice from doctors is repeated more and more often and is more relevant than ever.
- When communicating with casual acquaintances, one should not use the same washing utensils and utensils, it is necessary to keep oneself and one's home clean, wash one's hands thoroughly after contact with money and other objects held in the hands of other people.
In addition, it is very important to work on strengthening the immune system, since a healthy immune system, even if cytomegalovirus accidentally enters the body, will not allow the development of an acute cytomegalovirus infection.
The cytomegalovirus affects many organs and systems of the human body, has several transmission mechanisms and entry gates, but the priority remains for the suppression of the immune system. Therefore, the treatment of cytomegalovirus infection (CMV) should primarily be aimed at correcting and restoring the cellular link of immunity. Cytomegalovirus, upon initial entry into the body, persists for a long time in target cells, disrupting the normal immune response.
The mechanism of transmission and pathogenesis of the disease
Getting infected with CMV is not easy. This requires very close contact. Usually infection occurs in groups and crowded places. The source of this infection is only a person - a sick manifest form or a virus carrier (asymptomatic course).
Transfer factors:
- saliva (highest concentrations);
- urine;
- women's milk;
- secretions of the genital tract: mucus of the cervical canal, sperm;
- blood;
- cerebrospinal fluid.
The main routes of entry of the virus into the human body:
The virus has an affinity for the following types of human cells:
- monocytes;
- macrophages;
- epithelium;
- vascular endothelium;
- neurons;
- hepatocytes.
CMV target organs:
- salivary glands;
- kidneys;
- bile ducts;
- pancreas;
- intestines;
- bronchioles and alveoli;
- thyroid;
- brain;
- liver
Upon contact with the mucous membranes or skin, the virus enters the bloodstream. Then settles in "favorite cells", the immune system is activated and tries to destroy the pathogen. Clinically, this period may be accompanied by inflammation of the salivary glands or a mononucleosis-like syndrome. But most often this stage proceeds without any manifestations. Then the cytomegalovirus infection goes into a latent state. The virus persists in the body with its preservation in tissues and organs for life.
Reactivation of the infection occurs when exposed to the following provoking factors:
The greatest danger of cytomegalovirus in women is during pregnancy, since the initial meeting with CMV or its reactivation can lead to congenital cytomegaly.
It is at the stage of reactivation that cytomegalovirus should undergo antiviral and immunomodulatory treatment. Its presence in immunocompetent cells during persistence causes immune suppression. Clinicians classify this infection into congenital and acquired.
Manifestations of acquired CMV
Positive analysis for the presence of antibodies to this infection has 80% of the adult population. CMV is considered a childhood infection, since the majority of people encounter the virus in childhood. The first contact with CMV is often asymptomatic for a person, but the virus remains with him for life. With a decrease in the body's defenses, the reactivation of the infection occurs with the manifestation of clinical symptoms.
The incubation period lasts from 15 days to 3 months. The CMV clinic depends on the state of the immune system.
In people with a normal immune system, the infection manifests as follows:
In persons with a reduced immune response, as well as in infants, this infection occurs with damage to many organs:
The younger the age, the more likely it is to have symptoms of the disease. In adolescents and adults, cytomegaly often occurs latently.
Manifestations of congenital CMV
The manifestations and degree of damage to the fetus are largely determined by the immunity of the mother, as well as the timing of infection. A pregnant woman can pass the infection to her baby in 2 cases:
Congenital CMV can manifest itself in a manifest or latent form. Chronic infection develops when infected in early pregnancy. The child is born underweight with gross malformations: microcephaly, blindness and deafness.
The virus enters the fetus at a time when its immune system is immature and cannot adequately respond to the antigen. Children are often born small. At birth, even with a latent infection, inhibition of the cellular link of immunity, jaundice and a slight increase in the liver and spleen are observed.
Diagnosis and treatment
To detect CMV DNA, PCR is performed. Examine not only blood, but also other biological fluids: urine, saliva, cerebrospinal fluid, smear material from the urethra and cervical canal. Since the treatment of cytomegalovirus should be accompanied by a decrease in the number of virions, the viral load must be determined using PCR. With positive dynamics, the load decreases.
In order to determine the degree of immune response, a blood test for antibodies to the virus is performed:
A cultural method for examining biological fluids for the presence of a virus is also used.
In the general blood test, there is a decrease in leukocytes, platelets, an increase in monocytes, lymphocytes. After 2-3 weeks from the onset of the disease, atypical mononuclear cells appear in an amount of up to 10%.
It is not possible to cure cytomegalovirus forever, but it is possible to suppress an active infection and ensure long-term remission with the help of an arsenal of modern medicines.
Antiviral chemotherapy drugs
The most effective means in the fight against CMV are antiviral drugs. They inhibit viral replication by inhibiting one of the enzymes - DNA polymerase:
Chemotherapy is indicated for the generalized form of CMV with the involvement of the retina and lungs in the process. The drugs are very toxic, so their use is limited. Medicines have a negative effect on the kidneys, dividing cells, have carcinogenic and teratogenic properties.
Therefore, they are not used in children and pregnant women. In exceptional cases, when the child's life is in danger, the attending physician may convene a council to decide how to treat a cytomegalovirus infection in a child with antiviral agents.
Contraindications:
- decrease in hemoglobin below 80 g / l;
- platelet count below 250 thousand * 10¹² g / l;
- the absolute value of neutrophils is below 500 cells per microliter;
- age up to 12 years;
- pregnancy;
- severe renal failure.
Side effects:
There is a method of implanting a Ganciclovir capsule into the vitreous body of the eye to treat retinitis.
Interferons
CMV causes a weak natural production of interferon by leukocytes, so the treatment regimen for cytomegalovirus should be supplemented with interferon preparations to restore the normal level of this substance in the blood. If the cytomegalovirus infection proceeds in a mild form, then isolated treatment with interferon suppositories is carried out.
Immunomodulators should be included in any treatment regimen. The most commonly used interferon preparations are:
- Viferon;
- Genferon;
Hyperimmune human immunoglobulin Cytotect
The tool contains ready-made cytomegalovirus antibodies. This medication is very effective in the treatment of CMV: it creates passive immunity to infection.
The drug is approved for use in pregnant women and children. Indications for treatment with Cytotect are generalized and clinically expressed forms of CMV.
To prevent CMV infection during organ transplantation, 1 injection of Cytotect is performed before surgery at a dosage of 1 ml / 1 kg.
Side effects:
- anaphylactic shock;
- headaches and joint pains;
- nausea and vomiting;
- lowering blood pressure.
A contraindication is the presence of an allergy to human immunoglobulin in history.
Modern additional methods of treatment of CMV. These methods significantly increase the activity of the cellular link of immunity:
- Cryomodification of autoplasma: the method allows to exclude antibodies, inflammatory mediators from the patient's blood.
- Extracorporeal immunopharmacotherapy: leukocytes are isolated from the blood, treated with immunomodulators, and then returned to the bloodstream.
Cytomegalovirus infection- a disease caused by cytomegalovirus - a virus from the subfamily of herpes viruses, which also includes herpes simplex viruses 1 and 2, varicella-zoster virus, zoster virus, Ebstein-Barr virus and human herpesviruses types 6,7 and 8.
Prevalence cytomegalovirus infection extremely high. Once entering the body, cytomegalovirus infection does not leave it - most often it exists in a latent form and manifests itself only with a decrease in immunity.
victims cytomegalovirus infection become HIV-infected, as well as people who have undergone transplantation of internal organs or bone marrow and take drugs that suppress the immune response.
However, an acute infectious disease may occur during the initial infection. Often, infection occurs during the neonatal period and early childhood, especially in developing countries, where the prevalence of cytomegalovirus infection among young people is much higher than in developed countries.
The most dangerous intrauterine form of cytomegalovirus infection, which is typical for children whose mothers suffered a primary cytomegalovirus infection during pregnancy. Congenital cytomegalovirus infection often results in developmental delay as well as numerous adverse outcomes, including mental retardation and hearing loss.
How does cytomegalovirus infection occur?
Cytomegalovirus infection not very contagious. Its transmission requires long-term close communication or repeated contacts.
- Airborne: when talking, coughing, sneezing, kissing, etc.
- Sexual way: during sexual contact, the risk of transmission of the virus is very high, since the virus is shed in semen, vaginal and cervical mucus.
- When transfusing blood and its components containing leukocytes.
- From mother to fetus - most often in primary cytomegalovirus infection or reactivation of a latent infection during pregnancy.
How does the cytomegalovirus infection work?
The virus enters the blood of a healthy person and causes a pronounced immune response, which consists in the formation of antibodies - specific protective proteins - immunoglobulins M (Anti - CMV - IgM), as well as the main protective reaction against viruses - cellular.
CD 4 and CD 8 lymphocytes have potent activity against cytomegaloviruses. Therefore, when the cellular immune response is suppressed, for example, in violation of the formation of CD 4 lymphocytes in AIDS, cytomegalovirus infection actively develops and leads to the reactivation of a previously latent infection.
Immunoglobulins M against cytomegalovirus are formed approximately 4-7 weeks after infection and are in the blood for 16-20 weeks. Their detection in the blood during these periods may be evidence of a primary cytomegalovirus infection. Then immunoglobulins M are replaced by immunoglobulins G (Anti - CMV - IgG), which are present in the blood to varying degrees throughout the rest of life.
In most cases, with normal immunity, cytomegalovirus infection is asymptomatic, although it remains in the body for a long time in the form of a latent infection. Where exactly the virus is stored is unknown, it is assumed that it is present in many organs and tissues.
Cells affected by cytomegalovirus have a characteristic appearance - they increase in size (which determined the name of the virus), and under microscopy they look like an "owl's eye".
Even asymptomatic carriers can transmit the virus to uninfected individuals. An exception is the transmission of the virus from the mother to the fetus, which occurs mainly only with an active infectious process, but only in 5% of cases leads to congenital cytomegaly, in the remaining newborns, cytomegalovirus infection is also asymptomatic.
Mononucleosis-like syndrome
Mononucleosis-like syndrome is the most common form cytomegalovirus infection in persons with normal immunity who have left the neonatal period. Mononucleosis-like syndrome in clinical manifestations cannot be distinguished from infectious mononucleosis, which is caused by another herpes virus, the Ebstein-Barr virus.
The incubation period is 20-60 days. The disease proceeds in the form of a flu-like illness:
- Prolonged high fever, sometimes with chills;
- Severe fatigue, malaise;
- Pain in muscles, joints, headache;
- Sore throat;
- Enlarged lymph nodes;
- Rubella-like skin rash is rare, more common with ampicillin treatment.
Sometimes a primary cytomegalovirus infection is accompanied by signs of hepatitis; jaundice is rare, but an increase in liver enzymes in the blood is often present.
Rarely (in 0-6% of cases) mononucleosis-like syndrome is complicated by pneumonia. However, in immunologically healthy people, it is asymptomatic and is detected only on chest X-ray.
The disease continues for 9-60 days. Most patients recover completely, although residual effects in the form of weakness and malaise, sometimes swollen lymph nodes, persist for several months. Recurrent infections with fever, malaise, hot flashes, and sweating are rare.
Congenital cytomegalovirus infection
Intrauterine infection of the fetus is not always the cause of congenital cytomegaly, in most cases it is asymptomatic, and only in 5% of newborns leads to the development of the disease. Congenital cytomegalovirus occurs in newborns whose mothers have had a primary cytomegalovirus infection.
Manifestations of congenital cytomegaly vary widely:
- Petechiae - skin rashes, which are small hemorrhages, occur in 60-80% of cases;
- Jaundice;
- Intrauterine developmental delay, prematurity occurs in 30-50% of cases;
- Chorioretinitis - inflammation of the retina, which often leads to a decrease and loss of vision;
Mortality in congenital cytomegalovirus infection is 20-30%. Most of the children who survive are mentally retarded or hard of hearing.
Acquired cytomegalovirus infection in newborns
When infected with cytomegalovirus during childbirth (during the passage of the birth canal) or after birth (during breastfeeding or normal contact), in most cases the infection remains asymptomatic.
However, some, especially premature and low birth weight infants cytomegalovirus infection manifested by the development of prolonged pneumonia, which is often accompanied by the addition of a concomitant bacterial infection.
In addition, it is possible to slow down physical development, rash, swollen lymph nodes, hepatitis.
Individuals with weakened immune systems
Immunocompromised individuals include:
- individuals with various types of congenital immunodeficiency.
- persons with acquired immunodeficiency syndrome (AIDS).
- persons who have undergone transplantation of internal organs: kidney, heart, liver, lungs, and bone marrow.
The severity of clinical manifestations depends on the degree of immune suppression, however, chronic use of immunosuppressants leads to more severe manifestations.
Cytomegalovirus infection after transplantation:
- Especially often, cytomegalovirus affects the transplanted organs themselves, causing hepatitis in the transplanted liver, pneumonia in the transplanted lungs, etc.
- After bone marrow transplantation, 15-20% of patients develop cytomegalovirus pneumonia, from which 84-88% of patients die.
- The greatest risk of developing cytomegalovirus infection exists if the donor is infected and the recipient is not.
Cytomegalovirus infection in HIV-infected patients:
Cytomegalovirus infection almost all AIDS patients suffer.
- The onset of infection is usually subacute: fever, malaise, night sweats, muscle and joint pain
- Pneumonia - cough, shortness of breath join the initial signs of the disease
- Ulcers of the esophagus, stomach, intestines, which can lead to bleeding and rupture of the wall
- Hepatitis
- Encephalitis is an inflammation of the substance of the brain. May present with AIDS dementia syndrome or cranial nerve damage, drowsiness, disorientation, nystagmus (rhythmic movements of the eyeballs)
- Retinitis, an inflammation of the retina, is a common cause of vision loss in immunosuppressed patients.
- Multiple organ damage is the defeat of almost all organs by the virus, leading to their dysfunction. Often causes death from cytomegalovirus infection.
Prevention of cytomegalovirus infection
Prevention cytomegalovirus infection it is advisable to carry out in people belonging to the risk group. These include HIV-infected persons, especially those with AIDS; persons who have undergone transplantation of internal organs; persons suffering from immunodeficiency as a result of other causes.
Compliance with the rules of personal hygiene, even the most thorough, does not avoid infection with cytomegaloviruses, since viruses are ubiquitous and are transmitted by airborne droplets. Therefore, prophylaxis in patients at risk is carried out with antiviral drugs: ganciclovir, foscarnet, acyclovir.
In addition, to reduce the likelihood of cytomegalovirus infection among recipients of internal organs and bone marrow, careful selection of donors is recommended, taking into account their infection with cytomegalovirus infection.
Diagnosis of cytomegalovirus infection
Laboratory diagnosis of cytomegalovirus infection is based on serological examinations - the determination of antibodies specific for cytomegalovirus in the blood.
- Immunoglobulins M - Anti - CMV - IgM;
They are markers of acute infection: primary cytomegalovirus infection or reactivation of a chronic infection. If high antibody titers are detected in pregnant women, there is a risk of infection of the fetus. Increase only 4-7 weeks after infection. Remain elevated for 16-20 weeks
- Immunoglobulins G - Anti - CMV - IgG;
The titer of this type of immunoglobulin rises already during the period of decrease in the activity of the infectious process. The presence of Anti - CMV - IgG in the blood indicates only the presence of cytomegalovirus in the body, but does not reflect its activity in any way.
- polymerase chain reaction;
PCR is based on the determination of virus DNA in the blood or in mucosal cells (in scrapings from the urethral, cervical canals, as well as in saliva, sputum, etc.). It is recommended to perform a quantitative PCR reaction, which allows you to judge the degree of reproduction of the virus, and hence the activity of the inflammatory process.
Treatment of cytomegalovirus infection
Mononucleosis-like syndrome with an uncomplicated course does not require special treatment. Traditional treatment is enough, as with a common cold. The main thing is not to forget to drink plenty of fluids.
The drug of choice for the treatment of cytomegalovirus infection in patients at risk is ganciclovir (cymeven). For treatment, intravenous forms of the drug are used. Tablets are effective only in relation to prevention.
Side effects of ganciclovir:
- Inhibition of the formation of blood cells (neutropenia, anemia, thrombocytopenia). Develops in 40% of cases.
- Diarrhea (44%), vomiting, loss of appetite.
- Temperature increase (48% of patients), accompanied by chills, sweating.
- Skin itching.
Warnings:
- Ganciclovir is NOT used in people without immune disorders.
- The use of ganciclovir in pregnant women and children is possible only in life-threatening situations.
- Doses should be adjusted in people with impaired renal function.
For treatment, foscarnet is also used, which is considered more effective in patients with HIV infection.
Side effects:
- Electrolyte disorders: decrease in blood potassium and magnesium.
- Ulcers of the genitals.
- Urinary disorders.
- Nausea.
- Kidney damage: the drug is nephrotoxic, therefore, in case of renal failure, careful use and dose adjustment of the drug is necessary.