Cytomegalovirus infection. Cytomegalovirus. Symptoms, diagnosis, treatment and prevention. Cytomegalovirus infection in the clinic of internal diseases Acute cytomegalovirus infection

Modern statistics show that every fifth child becomes infected with cytomegalovirus infection at the age of 1 year. Among the ways of infection, the most dangerous is intrauterine infection. In this way, 5 to 7 percent of children become infected. About 30 percent of cases of transmission of the virus to the child occur during breastfeeding. The rest of the children become infected with the infection in children's groups. In adolescence, the virus occurs in 15 percent of children. At the age of 35, more than 40 percent of the population is affected by the disease, and by the age of 50, 99 percent of people become infected with the virus.

In the United States of America, a congenital infection is diagnosed in 3 percent of all newborns, of which 80 percent have clinical manifestations in the form of various pathologies. The mortality rate for congenital cytomegalovirus with complications at birth is 20 percent, which is between 8,000 and 10,000 children annually. In the absence of complications at birth, 15 percent of children infected during fetal development subsequently develop diseases of varying severity. Between 3 and 5 percent of children worldwide become infected in the first 7 days of life.

Among pregnant women, about 2 percent of women are exposed to primary infection. The probability of transmission of the virus at the time of bearing a child with primary infection is from 30 to 50 percent. Such children are born with the following deviations - neurosensory disorders - from 5 to 13 percent; mental retardation - up to 13 percent; bilateral hearing loss - up to 8 percent.

Interesting facts about cytomegalovirus infection

The conclusions of the colleges of America and Great Britain boil down to the fact that a systematic examination for the determination of cytomegalovirus in pregnant women is not recommended due to the large number of unexplored factors of this disease. A mandatory recommendation is to provide all pregnant women with information that will allow them to observe precautionary and hygiene measures in the prevention of this disease.

What is cytomegalovirus?

The structure of the cytomegalovirus

The components of the cytomegalovirus virion are:

• virus genome;
• nucleocapsid;
• protein ( protein) matrix;
• supercapsid.

Nucleocapsid
"Nucleocapsid" is translated from ancient Greek as "shell of the nucleus." It is a protein layer that surrounds the virus genome. The nucleocapsid is formed from 162 capsomeres ( shell protein fragments). Capsomeres form a geometric figure with pentagonal and hexagonal faces arranged according to the type of cubic symmetry.

Protein Matrix
The protein matrix occupies the entire space between the nucleocapsid and the outer shell of the virion. Proteins that make up the protein matrix are activated when the virus enters the host cell and participate in the reproduction of new viral units.

Supercapsid
The outer shell of the virion is called the supercapsid. It consists of a large number of glycoproteins ( complex protein structures containing carbohydrate components). Glycoproteins are located differently in the supercapsid. Some of them protrude above the surface of the main layer of glycoproteins, forming small "spikes". With the help of these glycoproteins, the virion "feels" and analyzes the external environment. When the virus comes into contact with any cell of the human body, with the help of "spikes" it attaches itself and penetrates into it.

Properties of cytomegalovirus

The main properties of cytomegalovirus are:

• low virulence ( degree of pathogenicity);
• latency;
• slow reproduction;
• pronounced cytopathic ( cell-destroying) Effect;
• reactivation in host immunosuppression;
• instability in the external environment;
• low contagiousness ( ability to infect).

Latency
Once in the human body, cytomegalovirus remains in it for life. Thanks to the body's immune defense, the virus can exist in a latent, dormant state for a long time without causing any clinical manifestations of the disease.

With the help of glycoprotein "thorns" the virion recognizes and attaches itself to the membrane of the cell it needs. Gradually, the outer membrane of the virus merges with the cell membrane and the nucleocapsid penetrates inside. Inside the host cell, the nucleocapsid inserts its DNA into the nucleus, leaving a protein matrix on the nuclear membrane. Using the enzymes of the cell nucleus, viral DNA multiplies. The protein matrix of the virus, which remained outside the nucleus, synthesizes new capsid proteins. This process is the longest - it takes an average of 15 hours. The synthesized proteins pass into the nucleus and combine with new viral DNA, forming the nucleocapsid. Gradually, proteins of a new matrix are synthesized, which attaches to the nucleocapsid. The nucleocapsid leaves the cell nucleus, attaches to the inner surface of the cell membrane and is enveloped by it, creating a supercapsid for itself. Copies of the virion that have left the cell are ready to penetrate into another healthy cell for further reproduction.

Reactivation in host immunosuppression
For a long time, cytomegalovirus can be in a latent state in the human body. However, under conditions of immunosuppression, when the human immune system is weakened or destroyed, the virus is activated and begins to enter the host cells for reproduction. As soon as the immune system returns to normal, the virus is suppressed and falls into "hibernation".

The main adverse environmental factors for cytomegalovirus are:

• high temperatures ( more than 40 - 50 degrees Celsius);
• freezing;
• fat dissolvers ( alcohol, ether, detergents).

Methods of infection with cytomegalovirus

Favorable factors for infection with cytomegalovirus are:

• constant, long and close contact with the source of infection;
• violation of the biological protective barrier - the presence of tissue damage ( cuts, wounds, microtrauma, erosion) at the site of contact with the infection;
• disturbances in the functioning of the body's immune system during hypothermia, stress, infection, and various internal diseases.

Methods of infection with cytomegalovirus

Contact household way

airborne way

Contact-sexual way

oral route

Transplacental route

iatrogenic pathway

Cytomegalovirus can also enter the body through repeated use of unsterilized medical equipment.

Transplant route

The spread of cytomegalovirus infection in the body proceeds in several stages.

The stages of the spread of cytomegalovirus infection are:

• local cell damage;
• distribution in regional lymph nodes;
• primary immune response;
• circulation in the circulatory and lymphatic system;
• dissemination ( spreading) in organs and tissues;
• secondary immune response.

At this time, the immune system is activated in the human body, which suppresses the spread of foreign particles through the blood and lymph. However, the immune system is not able to completely destroy the infection. Cytomegalovirus can remain latent in the lymph nodes for a long time.

In the case of immunosuppression, the body is not able to stop the reproduction of the virus. Cytomegalovirus penetrates into blood cells and spreads to all organs and tissues, affecting them.
During the secondary immune response, a large number of antibodies to the virus are produced, which suppress its further replication ( reproduction). The patient recovers, but becomes a carrier ( virus persists in lymphoid cells).

Symptoms of cytomegalovirus infection in women

After the penetration of cytomegalovirus into the human body, an incubation period begins. During this period, the virus actively multiplies in the body, but without showing any symptoms. With cytomegalovirus infection, this period lasts from 20 to 60 days. Then comes the acute phase of the disease. Women with strong immune systems may experience this phase with mild flu-like symptoms. A slight temperature may be observed ( 36.9 - 37.1 degrees Celsius), slight malaise, weakness. As a rule, this period passes imperceptibly. However, in favor of the presence of cytomegalovirus in the body of a woman, an increase in the titer of antibodies in her blood testifies. If she makes a serological diagnosis during this period, then acute-phase antibodies to this virus will be detected ( anti-CMV IgM).

The acute phase of cytomegalovirus lasts 4 to 6 weeks. After that, the infection subsides and is activated only with a decrease in immunity. In this form, the infection can persist for life. Only with random or planned diagnostics can it be detected. In this case, in the blood of a woman or in a smear, if a PCR smear is performed, chronic phase antibodies to cytomegalovirus are detected ( anti-CMV IgG).

It is believed that 99 percent of the population is a carrier of latent cytomegalovirus infection, and these people are detected anti-CMV IgG. If the infection does not manifest itself, and the woman's immunity is strong enough for the virus to remain in an inactive form, then she becomes a virus carrier. As a rule, the virus carrier is not dangerous. But, at the same time, in women, a latent cytomegalovirus infection can cause miscarriages, the birth of dead children.

In immunocompromised women, the infection is active. In this case, two forms of the disease are observed - acute mononucleosis-like and generalized form.

Acute cytomegalovirus infection

First, the cervical lymph nodes increase. They can be very large and exceed 5 centimeters. Further, the submandibular, axillary and inguinal nodes increase. The internal lymph nodes are also enlarged. Lymphadenopathy appears first of the symptoms and the last to disappear.

Other symptoms of the acute phase are:

• malaise;
• liver enlargement ( hepatomegaly);
• increase in leukocytes in the blood;
• the appearance in the blood of atypical mononuclear cells.

Differences between cytomegalovirus and infectious mononucleosis
Unlike infectious mononucleosis, angina is not observed with cytomegalovirus. It is also extremely rare to observe an increase in the occipital lymph nodes and spleen ( splenomegaly). In laboratory diagnosis, the Paul-Bunnel reaction, which is inherent in infectious mononucleosis, is negative.

Generalized form of cytomegalovirus infection

The most common manifestations of a generalized infection are:

• liver damage with the development of cytomegalovirus hepatitis;
• lung damage with the development of pneumonia;
• damage to the retina with the development of retinitis;
• damage to the salivary glands with the development of sialadenitis;
• kidney damage with the development of nephritis;
• damage to the organs of the reproductive system.

The course of hepatitis can be acute, subacute and chronic. In the first case, the so-called fulminant hepatitis develops, often with a fatal outcome.

Diagnosis of cytomegalovirus infection is reduced to a puncture biopsy. In this case, with the help of a puncture, a piece of liver tissue is taken for further histological examination. When examining the tissue, huge cytomegalic cells are found.

Cytomegalovirus pneumonia
With cytomegalovirus, as a rule, interstitial pneumonia initially develops. With this type of pneumonia, not the alveoli are affected, but their walls, capillaries and tissue around the lymphatic vessels. This pneumonia is difficult to treat, resulting in a long course.

Very often, such prolonged pneumonia is complicated by the addition of a bacterial infection. As a rule, staphylococcal flora joins with the development of purulent pneumonia. Body temperature rises to 39 degrees Celsius, fever and chills develop. The cough quickly becomes wet with a large amount of purulent sputum. Shortness of breath develops, chest pain appears.

In addition to pneumonia, cytomegalovirus infection can develop bronchitis, bronchiolitis. The lymph nodes of the lungs are also affected.

Cytomegalovirus retinitis
Retinitis affects the retina of the eye. Retinitis is usually bilateral and may be complicated by blindness.

The symptoms of retinitis are:

• photophobia;
• blurred vision;
• "flies" before the eyes;
• the appearance of lightning and flashes before the eyes.

Cytomegalovirus sialadenitis
Sialoadenitis is characterized by damage to the salivary glands. The parotid glands are often affected. In the acute course of sialadenitis, the temperature rises, shooting pains appear in the gland area, salivation decreases and dryness is felt in the mouth ( xerostomia).

Very often, cytomegalovirus sialoadenitis is characterized by a chronic course. In this case, there are periodic pain, slight swelling in the parotid gland. The main symptom continues to be reduced salivation.

Kidney damage
The kidneys are very common in people with an active form of cytomegalovirus infection. In this case, inflammatory infiltration is found in the tubules of the kidney, in its capsule and in the glomeruli. In addition to the kidneys, the ureters and bladder can be affected. The disease proceeds with the rapid development of renal failure. A sediment appears in the urine, which consists of epithelium and cytomegalovirus cells. Sometimes there is hematuria ( blood in urine).

Damage to the organs of the reproductive system
In women, very often the infection occurs in the form of cervicitis, endometritis and salpingitis. As a rule, they proceed chronically with periodic exacerbations. A woman may complain of recurrent, mild pain in the lower abdomen, pain when urinating, or pain during intercourse. Sometimes there may be urination disorders.

Cytomegalovirus infection in women with AIDS

Patients with AIDS develop bilateral pneumonia with diffuse lesions of the lung tissue. Pneumonia is most often prolonged, with a painful cough and shortness of breath. Pneumonia is one of the most common causes of death in HIV infection.

Also, AIDS patients develop cytomegalovirus encephalitis. Encephalitis with encephalopathy rapidly develops dementia ( dementia), which is manifested by a decrease in memory, attention, intelligence. One form of cytomegalovirus encephalitis is ventriculoencephalitis, which affects the ventricles of the brain and cranial nerves. Patients complain of drowsiness, severe weakness, impaired visual acuity.
The defeat of the nervous system in cytomegalovirus infection is sometimes accompanied by polyradiculopathy. In this case, the roots of the nerves are repeatedly affected, which is accompanied by weakness and pain in the legs. Cytomegalovirus retinitis in women with HIV infection often causes complete loss of vision.

Cytomegalovirus infection in AIDS is characterized by multiple lesions of internal organs. In the last stages of the disease, multiple organ failure is detected with damage to the heart, blood vessels, liver, and eyes.

Pathologies that cause cytomegalovirus in women with immunodeficiency are:

• kidney damage- acute and chronic nephritis ( kidney inflammation), foci of necrosis on the adrenal glands;
• liver disease hepatitis, sclerosing cholangitis ( inflammation and narrowing of the intrahepatic and extrahepatic bile ducts), jaundice ( a disease in which the skin and mucous membranes turn yellow), liver failure;
• diseases of the pancreas- pancreatitis ( inflammation of the pancreas);
• diseases of the gastrointestinal tract- gastroenterocolitis ( joint inflammation of the small intestine, large intestine and stomach), esophagitis ( damage to the esophageal mucosa), enterocolitis ( inflammatory processes in the small and large intestine), colitis ( inflammation of the colon);
• lung disease- pneumonia ( pneumonia);
• eye diseases- retinitis ( retinal disease), retinopathy ( non-inflammatory ocular lesion). Eye problems occur in 70 percent of patients with HIV infection. About one fifth of patients lose their sight;
• spinal cord and brain damage- meningoencephalitis ( inflammation of the membranes and substances of the brain), encephalitis ( brain damage), myelitis ( inflammation of the spinal cord), polyradiculopathy ( damage to the nerve roots of the spinal cord), polyneuropathy of the lower extremities ( disorders in the peripheral nervous system), infarction of the cerebral cortex;
• diseases of the genitourinary system- cervical cancer, lesions of the ovaries, fallopian tubes, endometrium.

Symptoms of cytomegalovirus infection in children

Congenital cytomegalovirus infection in children

Cytomegalovirus belongs to the group of TORCH infections that lead to severe malformations. When a virus enters the blood of a child, a congenital infection does not always develop. According to various sources, from 5 to 10 percent of children whose blood has entered the virus develop an active form of the infection. As a rule, these are the children of those mothers who suffered a primary cytomegalovirus infection during pregnancy.
With the reactivation of a chronic infection during pregnancy, the degree of intrauterine infection does not exceed 1-2 percent. In the future, 20 percent of these children have serious pathologies.

Clinical manifestations of congenital cytomegalovirus infection are:

• malformations of the nervous system - microcephaly, hydrocephalus, meningitis; meningoencephalitis;
• Dandy-Walker syndrome;
• heart defects - carditis, myocarditis, cardiomegaly, valve malformations;
• hearing loss - congenital deafness;
• damage to the visual apparatus - cataracts, retinitis, chorioretinitis, keratoconjunctivitis;
• anomalies in the development of teeth.

In the blood of such children, there is an increase in liver enzymes, bilirubin, the number of platelets drops sharply ( thrombocytopenia). Mortality in this period is very high. Surviving children subsequently experience mental retardation, speech disorders. Most children with congenital cytomegalovirus infection suffer from deafness, and blindness is less common.

Due to damage to the nervous system, paralysis, epilepsy, and intracranial hypertension syndrome develop. Subsequently, such children lag behind not only in mental, but also in physical development.

A separate variant of congenital cytomegalovirus infection is Dandy-Walker syndrome. With this syndrome, various anomalies of the cerebellum and expansion of the ventricles are observed. Mortality in this case is from 30 to 50 percent.

The frequency of symptoms in intrauterine CMV infection in children is as follows:

• skin rash - from 60 to 80 percent;
• hemorrhages in the skin and mucous membranes - 76 percent;
• jaundice, 67 percent;
• enlargement of the liver and spleen - 60 percent;
• reduction in the size of the skull and brain - 53 percent;
• disorders of the digestive system - 50 percent;
• prematurity - 34 percent;
• hepatitis, 20 percent;
• inflammation of the brain - 15 percent;
• inflammation of blood vessels and retina - 12 percent.

Acquired cytomegalovirus infection in children

The nature of the consequences of an acquired cytomegalovirus infection depends on the age of the child and the state of his immune system. The most common consequence of the virus is acute respiratory infections ( ORZ), which are accompanied by inflammation of the bronchi, pharynx and larynx. Often there is a lesion of the salivary glands, most often in the parotid zones. A characteristic complication of an acquired infection is inflammatory processes in the connective tissues in the region of the pulmonary alveoli. Another manifestation of cytomegalovirus infection is hepatitis, which occurs in a subacute or chronic form. A rare complication of the virus is such damage to the central nervous system as encephalitis ( inflammation of the brain).

Symptoms of acquired cytomegalovirus infection are:

• children under 1 year old- lag in physical development with impaired motor activity and frequent convulsions. There may be lesions of the gastrointestinal tract, vision problems, hemorrhages;
• children from 1 to 2 years old- most often the disease is manifested by mononucleosis ( viral disease), the consequences of which are an increase in lymph nodes, swelling of the mucous throat, liver damage, changes in blood composition;
• children from 2 to 5 years old- the immune system at this age is not able to adequately respond to the virus. The disease causes complications such as shortness of breath, cyanosis ( bluish discoloration of the skin), pneumonia.

Acquired cytomegalovirus infection in children can also result from blood transfusions or organ transplants. In this case, the penetration of the virus into the body occurs with donated blood or organs. Such an infection usually proceeds according to the type of mononucleosis syndrome. At the same time, the temperature rises, nasal discharge and sore throat appear. At the same time, the lymph nodes are enlarged in children. The main manifestation of post-transfusion cytomegalovirus infection is hepatitis.

In 20 percent of cases after organ transplantation, cytomegalovirus pneumonia develops. After a kidney or heart transplant, the virus causes hepatitis, retinitis, and colitis.

In children with immunodeficiency ( for example, in patients with malignant diseases) cytomegalovirus infection is very difficult. As in adults, it leads to prolonged pneumonia, fulminant hepatitis, and visual impairment. Reactivation of the virus begins with a rise in temperature and chills. Often, children develop a hemorrhagic rash that affects the entire body. Such internal organs as the liver, lungs, central nervous system are involved in the pathological process.

Symptoms of cytomegalovirus infection in women during pregnancy

During the initial infection with the virus or its reactivation, pregnant women may experience a number of symptoms that can manifest themselves or in combination. Some women are diagnosed with increased uterine tone, which does not respond to therapy.

Manifestations of CMV infection in pregnant women are:

• polyhydramnios;
• premature aging or placental abruption;
• improper attachment of the placenta;
• large blood loss during childbirth;
• spontaneous miscarriages.

Inflammatory processes in the genitourinary system in pregnant women with CMV are:

• endometritis (inflammatory processes in the uterus) - pain in the abdomen ( lower part). In some cases, pain may radiate to the lower back or sacrum. Also, patients complain of poor general health, lack of appetite, headaches;
• cervicitis (damage to the cervix) - discomfort during intimacy, itching in the genitals, aching pain in the perineum and lower abdomen;
• vaginitis (inflammation of the vagina) - irritation of the genital organs, an increase in body temperature, discomfort during intercourse, aching pain in the lower abdomen, redness and swelling of the external genital organs, frequent urination;
• oophoritis (inflammation of the ovaries) - a feeling of pain in the pelvis and lower abdomen, spotting that occurs after intercourse, a feeling of discomfort in the lower abdomen, pain when close to a man;
• cervical erosion- the appearance of blood in the discharge after intimacy, abundant vaginal discharge, sometimes there may be pain that is not very pronounced during intercourse.

The effect of CMV on the body of a pregnant woman

The consequences of the virus are:

• inflammation of the salivary glands, tonsils;
• pneumonia, pleurisy;
• myocarditis.

With severely weakened immunity, the virus can take a generalized form, affecting the entire body of the patient.

Complications of a generalized infection in women during pregnancy are:

• inflammatory processes in the kidneys, liver, pancreas, adrenal glands;
• dysfunction of the digestive system;
• vision problems;
• lung dysfunction.

Diagnosis of cytomegalovirus infection

Diagnostic methods for cytomegalovirus infection are:

• isolation of the virus by culturing it in cell culture;
• polymerase chain reaction ( PCR);
• linked immunosorbent assay ( ELISA);
• cytological method.

Virus isolation

Virus isolation occurs in cell culture. Single-layer cultures of human fibroblasts are most commonly used. The studied biological material is initially centrifuged to isolate the virus itself. Next, the virus is applied to cell cultures and placed in a thermostat. There is, as it were, infection of cells with this virus. Cultures are incubated for 12 to 24 hours. As a rule, several cell cultures are infected and simultaneously incubated. Further, the obtained cultures are identified using various methods. Most often, cultures are stained with fluorescent antibodies and examined under a microscope.

The disadvantages of this method is the significant time spent on the cultivation of the virus. The duration of this method is from 2 to 3 weeks. At the same time, fresh material is needed to isolate the virus.

PCR

biological material
For PCR, any biological fluids are taken ( blood, saliva, urine, cerebrospinal fluid), swabs from the urethra and vagina, feces, swabs from mucous membranes.

Conducting PCR
The essence of the analysis is to isolate the DNA of the virus. Initially, a fragment of a DNA strand is found in the test material. Further, this fragment is cloned many times with the help of special enzymes to obtain a large number of DNA copies. The resulting copies are identified, that is, they are determined to which virus they belong. All these reactions take place in a special apparatus called an amplifier. The accuracy of this method is 95 - 99 percent. The method is carried out quickly enough, which allows it to be widely used. Most often, it is used in the diagnosis of latent genitourinary infections, cytomegalovirus encephalitis and for screening TORCH infections.

ELISA

biological material
The patient's blood is used to detect antibodies.

ELISA
The essence of the method is to detect antibodies to cytomegalovirus both in the acute phase and in the chronic. In the first case, anti-CMV IgM are detected, in the second, anti-CMV IgG. The analysis is based on the antigen-antibody reaction. The essence of this reaction is that antibodies ( produced by the body in response to a virus) bind specifically to antigens ( proteins on the surface of the virus).

The analysis is carried out in special tablets with wells. Biological material and antigen are placed in each well. Next, the tablet is placed in a thermostat for a certain time, during which the formation of antigen-antibody complexes occurs. After that, washing is carried out with a special substance, after which the formed complexes remain at the bottom of the wells, and the non-bound antibodies are washed off. After that, more antibodies treated with a fluorescent substance are added to the wells. Thus, a "sandwich" is formed of two antibodies and an antigen in the middle, which are processed with a special mixture. When this mixture is added, the color of the solution in the wells changes. The color intensity is directly proportional to the amount of antibodies in the test material. In turn, the intensity is determined using an apparatus such as a photometer.

Cytological diagnostics

Treatment of cytomegalovirus infection

Mechanism of therapeutic action

Activation of cellular defense genes
Interferons activate a number of genes that are involved in cellular defense against the virus. Cells become less vulnerable to the penetration of viral particles.

p53 protein activation
The p53 protein is a special protein that starts the processes of cell repair when they are damaged. If cell damage is irreversible, then the p53 protein triggers the process of apoptosis ( programmed death) cells. In healthy cells, this protein is in an inactive form. Interferons have the ability to activate the p53 protein in cytomegalovirus-infected cells. It evaluates the state of the infected cell and starts the process of apoptosis. As a result, the cell dies, and the virus does not have time to multiply.

Stimulation of the synthesis of special molecules of the immune system
Interferons stimulate the synthesis of special molecules that help the immune system recognize viral particles more easily and quickly. These molecules bind to receptors on the surface of the cytomegalovirus. Killer cells ( T-lymphocytes and natural killers) of the immune system find these molecules and attack the virions to which they are attached.

Stimulation of cells of the immune system
Interferons have the effect of direct stimulation of certain cells of the immune system. These cells include macrophages and natural killers. Under the influence of interferons, they migrate to the affected cells and attack them, destroying them together with the intracellular virus.

In the treatment of cytomegalovirus infection, various drugs based on natural interferons are used.

Natural interferons used in the treatment of cytomegalovirus infection are:

• human leukocyte interferon;
• leukinferon;
• wellferon;
• feron.

Release form and methods of using some natural interferons in cytomegalovirus infection

The biggest disadvantage of natural drugs is their high cost, so they are used less frequently.

Currently, there are a large number of recombinant drugs of the interferon group, which are used in the complex therapy of cytomegalovirus infection.

The main representatives of recombinant interferons are the following drugs:

• viferon;
• kipferon;
• realdiron;
• reaferon;
• laferon.

Release form and methods of application of some recombinant interferons in cytomegalovirus infection

Evaluation of the treatment method

Is treatment necessary for asymptomatic cytomegalovirus infection?

To do this, it is recommended to lead the prevention of chronic infections ( especially urinary), which are the main cause of reduced immunity. It is also recommended to take immunostimulants, such as Echinacea Hexal, Derinat, Milife. They should only be taken as directed by a doctor.

What are the consequences of cytomegalovirus infection?

The consequences of cytomegalovirus for people with normal immunity

Depending on the moment of infection, the consequences of a cytomegalovirus infection for a developing fetus are:

• blastopathy(malformations that occur when infected during the period from 1 to 15 days of pregnancy) - death of the embryo, non-developing pregnancy, spontaneous abortion, various systemic pathologies in the fetus;
• embryopathies(when infected on the 15th - 75th day of pregnancy) – pathology of the vital systems of the body ( cardiovascular, digestive, respiratory, nervous). Some of these malformations are incompatible with fetal life;
• fetopathy(with late infection) - the infection can provoke the development of jaundice, damage to the liver, spleen, lungs.

The consequences of cytomegalovirus infection for children who have had an acute form of the disease

The consequences of infection with cytomegalovirus in children are:

• jaundice from the first days of life occurs in 50 - 80 percent of sick children;
• hemorrhagic syndrome is registered in 65 - 80 percent of patients and is manifested by hemorrhages in the skin, mucous membranes, adrenal glands. Bleeding from the nose or umbilical wound is also possible;
• hepatosplenomegaly ( enlargement of the liver and spleen) diagnosed in 60-75 percent of children. Together with jaundice and hemorrhagic syndrome, this disease is the most common complication of CMV that develops in infected children from the first days of life;
• interstitial pneumonia manifested by symptoms of respiratory disorders;
• nephritis is a complication that develops in a third of sick children;
• gastroenterocolitis occurs in 30 percent of cases;
• myocarditis ( inflammation of the heart muscle) diagnosed in 10% of patients.

Other complications of cytomegalovirus are:

• lag in psychomotor development;
• lesions of the gastrointestinal tract;
• pathology of the organ of vision ( chorioretinitis, uveitis);
• blood disorders ( anemia, thrombocytopenia).

Cytomegaly

General information

Cytomegaly- an infectious disease of viral origin, transmitted sexually, transplacental, household, blood transfusion. Symptomatically proceeds in the form of persistent cold. There is weakness, malaise, headaches and joint pain, runny nose, enlargement and inflammation of the salivary glands, profuse salivation. Often asymptomatic. The severity of the course of the disease is due to the general state of immunity. In the generalized form, severe foci of inflammation occur throughout the body. Pregnant cytomegaly is dangerous: it can cause spontaneous miscarriage, congenital malformations, intrauterine fetal death, congenital cytomegaly.

Other names for cytomegaly found in medical sources are cytomegalovirus infection (CMV), inclusion cytomegaly, viral disease of the salivary glands, inclusion disease. The causative agent of cytomegalovirus infection, cytomegalovirus, belongs to the human herpesvirus family. Cells affected by cytomegalovirus multiply in size, so the name of the disease "cytomegaly" is translated as "giant cells".

Cytomegaly is a widespread infection, and many people who are carriers of cytomegalovirus are not even aware of it. The presence of antibodies to cytomegalovirus is detected in 10-15% of the population in adolescence and in 50% of adults. According to some sources, the carriage of cytomegalovirus is determined in 80% of women of the childbearing period. First of all, this refers to the asymptomatic and oligosymptomatic course of cytomegalovirus infection.

Not all people who carry cytomegalovirus are sick. Often, cytomegalovirus is in the body for many years and may never manifest itself and not harm a person. The manifestation of a latent infection occurs, as a rule, when the immune system is weakened. Threatening in its consequences, the danger of cytomegalovirus is in people with reduced immunity (HIV-infected, who have undergone bone marrow transplantation or internal organs taking immunosuppressants), with a congenital form of cytomegalovirus, in pregnant women.

Ways of transmission of cytomegalovirus

Cytomegaly is not a highly contagious infection. Usually, infection occurs through close, prolonged contact with carriers of cytomegalovirus. Cytomegalovirus is transmitted in the following ways:

• airborne: when sneezing, coughing, talking, kissing, etc.;
• sexually: during sexual contact through semen, vaginal and cervical mucus;
• blood transfusion: with blood transfusion, leukocyte mass, sometimes - with transplantation of organs and tissues;
• transplacental: during pregnancy from mother to fetus.

The mechanism of development of cytomegaly

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. Inhibition of cellular immunity in HIV infection leads to active development cytomegalovirus and the infection it causes.

The formation of immunoglobulins M, indicating a primary infection, occurs 1-2 months after infection with cytomegalovirus. After 4-5 months, IgM are replaced by IgG, which are found in the blood throughout the rest of life. With strong immunity, cytomegalovirus does not cause clinical manifestations, the course of infection is asymptomatic, hidden, although the presence of the virus is determined in many tissues and organs. By infecting cells, cytomegalovirus causes an increase in their size; under a microscope, the affected cells look like an “owl's eye”. Cytomegalovirus is determined in the body for life.

Even with an asymptomatic course of infection, the carrier of cytomegalovirus is potentially contagious to uninfected individuals. An exception is the intrauterine route of transmission of cytomegalovirus from a pregnant woman to the fetus, which occurs mainly during the active course of the process, and only in 5% of cases causes congenital cytomegaly, while in the rest it is asymptomatic.

Forms of cytomegaly

congenital cytomegaly

In 95% of cases, intrauterine infection of the fetus with cytomegalovirus does not cause the development of the disease, but is asymptomatic. Congenital cytomegalovirus infection develops in newborns whose mothers have had primary cytomegalovirus. Congenital cytomegaly can manifest itself in newborns in various forms:

• petechial rash - small skin hemorrhages - occurs in 60-80% of newborns;
• prematurity and intrauterine growth retardation - occurs in 30% of newborns;
• chorioretinitis is an acute inflammatory process in the retina of the eye, often causing a decrease and complete loss of vision.

Mortality in intrauterine infection with cytomegalovirus reaches 20-30%. Of the surviving children, most have a mental retardation or a hearing and vision disability.

Acquired cytomegaly in newborns

When infected with cytomegalovirus during childbirth (during the passage of the fetus through the birth canal) or in the postpartum period (during household contact with an infected mother or breastfeeding), in most cases an asymptomatic course of cytomegalovirus infection develops. However, in preterm infants, cytomegalovirus can cause prolonged pneumonia, which is often accompanied by a concomitant bacterial infection. Often, when children are affected by cytomegalovirus, there is a slowdown in physical development, an increase in lymph nodes, hepatitis, and a rash.

Mononucleosis-like syndrome

In individuals who have left the neonatal period and have normal immunity, cytomegalovirus can cause the development of a mononucleosis-like syndrome. The clinical course of a mononuclease-like syndrome does not differ from infectious mononucleosiscaused by another type of herpes virus - the Ebstein-Barr virus. The course of a mononucleosis-like syndrome resembles a persistent cold infection. It notes:

• prolonged (up to 1 month or more) fever with high body temperature and chills;
• aching joints and muscles, headache;
• pronounced weakness, malaise, fatigue;
• sore throat;
• enlarged lymph nodes and salivary glands;
• skin rashes resembling rubella rash (usually occurs during treatment with ampicillin).

In some cases, a mononucleosis-like syndrome is accompanied by the development of hepatitis - jaundice and an increase in liver enzymes in the blood. Even less often (up to 6% of cases), pneumonia is a complication of mononucleosis-like syndrome. However, in individuals with normal immune reactivity, it proceeds without clinical manifestations, being detected only when X-rays of the lungs are performed.

The duration of the mononucleosis-like syndrome is from 9 to 60 days. Then, a complete recovery usually occurs, although residual effects in the form of malaise, weakness, and enlarged lymph nodes may persist for several months. Rarely, cytomegalovirus activation causes recurrences of the infection with fever, sweating, hot flashes, and malaise.

Cytomegalovirus infection in immunocompromised individuals

Weakened immunity is observed in persons suffering from congenital and acquired immunodeficiency syndrome (AIDS), as well as in patients who have undergone transplantation of internal organs and tissues: heart, lung, kidney, liver, bone marrow. After organ transplantation, patients are forced to constantly take immunosuppressants, leading to a pronounced suppression of immune responses, which causes the activity of cytomegalovirus in the body.

In patients who have undergone organ transplantation, cytomegalovirus causes damage to donor tissues and organs (hepatitis in liver transplants, pneumonia in lung transplants, etc.). After bone marrow transplantation, in 15-20% of patients, cytomegalovirus can lead to the development of pneumonia with high mortality (84-88%). The greatest danger is the situation when a cytomegalovirus-infected donor material is transplanted to an uninfected recipient.

Cytomegalovirus infects almost all HIV-infected people. At the onset of the disease, malaise, joint and muscle pain, fever, night sweats are noted. In the future, these signs may be accompanied by cytomegalovirus lesions of the lungs (pneumonia), liver (hepatitis), brain (encephalitis), retina (retinitis), ulcerative lesions and gastrointestinal bleeding.

In men, cytomegalovirus can affect the testicles, prostate, in women - the cervix, the inner layer of the uterus, vagina, ovaries. Complications of cytomegalovirus infection in HIV-infected people can be internal bleeding from the affected organs, loss of vision. Multiple damage to organs by cytomegalovirus can lead to their dysfunction and death of the patient.

Diagnosis of cytomegaly

In order to diagnose cytomegalovirus infection, 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 scrapings from the urethra and cervical canal, in sputum, saliva, etc.), the PCR diagnostic method (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 with a fourfold increase in antibody titer. Treatment of cytomegalovirus infection in individuals at risk is carried out with the antiviral drug ganciclovir. In cases of severe cytomegalovirus, ganciclovir is administered intravenously, since the tablet forms of the drug have only a preventive effect against cytomegalovirus. Since ganciclovir has severe side effects (causes hematopoiesis suppression - anemia, neutropenia, thrombocytopenia, skin reactions, gastrointestinal disorders, fever and chills, etc.), its use is limited in pregnant women, children and people suffering from renal insufficiency (only for health reasons), it is not used in patients without impaired immunity.

For the treatment of cytomegalovirus in HIV-infected people, the most effective drug is foscarnet, which also has a number of side effects. Foscarnet can cause electrolyte disturbances (a decrease in magnesium and potassium in the blood plasma), ulceration of the genital organs, impaired urination, nausea, and kidney damage. These adverse reactions require careful use and timely adjustment of the dose of the drug.

Prevention

The issue of prevention of cytomegalovirus infection is especially acute in individuals at risk. The most susceptible to infection with cytomegalovirus and the development of the disease are HIV-infected (especially AIDS patients), patients after organ transplantation and persons with immunodeficiency of a different origin.

Non-specific methods of prevention (for example, personal hygiene) are ineffective against cytomegalovirus, since infection with it is possible even by airborne droplets. Specific prophylaxis of cytomegalovirus infection is carried out with ganciclovir, acyclovir, foscarnet among patients at risk. Also, to exclude the possibility of infection of recipients with cytomegalovirus during organ and tissue transplantation, it is necessary to carefully select donors and control donor material for the presence of cytomegalovirus infection.

Cytomegalovirus is of particular danger during pregnancy, as it can provoke a miscarriage, stillbirth, or cause severe congenital deformities in a child. Therefore, cytomegalovirus, along with herpes, toxoplasmosis and rubella, is one of those infections that women should be examined for prophylactically, even at the stage of pregnancy planning.

Cytomegalovirus infection (CMVI, or cytomegaly) is a chronic anthroponotic disease of viral origin, characterized by a variety of forms of the pathological process from a latent infection to a clinically pronounced generalized disease.

ICD-10 codes
B25. Cytomegalovirus disease.
B27.1. Cytomegalovirus mononucleosis.
P35.1. Congenital cytomegalovirus infection.
B20.2. Illness caused by HIV, with manifestations of cytomegalovirus disease.

Etiology (causes) of cytomegalovirus infection

In the classification of viruses, the CMVI pathogen under the species name Cytomegalovirus hominis is assigned to the Herpesviridae family, Betaherpesviridae subfamily, Cytomegalovirus genus.

CMV features:

Large DNA genome;
- low cytopathogenicity in cell culture;
- slow replication;
- low virulence.

The virus is inactivated at a temperature of 56 °C, stored for a long time at room temperature, and quickly inactivated when frozen to –20 °C. CMV is weakly sensitive to the action of interferon, not susceptible to antibiotics. 3 strains of the virus have been registered: AD 169, Davis and Kerr.

Epidemiology of cytomegalovirus infection

Cytomegaly is a widespread infection. The proportion of seropositive persons among the adult population of the Russian Federation is 73-98%. The incidence rate of CMVI in the country in 2003 was 0.79 per 100,000 population, and in children under the age of 1 year - 11.58; 1–2 years - 1.01; 3–6 years - 0.44 per 100,000. In Moscow in 2006, the incidence rate of CMVI was 0.59 per 100,000 population, in children under the age of 14 3.24; and among the adult population, 0.24 per 100,000 people.

Source of the infectious agent- Human. Cytomegalovirus infection is characterized by a state of long-term latent carriage of the virus with its periodic release into the environment. The virus can be found in any biological fluid, as well as in organs and tissues used for transplantation. In 20-30% of healthy pregnant women, cytomegalovirus is present in saliva, 3-10% in urine, 5-20% in the cervical canal or vaginal secretions. The virus is found in the breast milk of 20–60% of seropositive mothers. About 30% of gay men and 15% of men who marry have the virus in their semen. The blood of about 1% of donors contains CMV.

Ways of infection. Infection is possible by sexual, parenteral, vertical routes, as well as by contact-household, which is provided by the aerosol mechanism of transmission of the pathogen through saliva during close contacts.

Cytomegalovirus infection is a classic congenital infection with an incidence of 0.3–3% of all newborns. The risk of antenatal infection of the fetus in primary CMVI in pregnant women is 30-40%. With reactivation of the virus, which occurs in 2-20% of mothers, the risk of infection of the child is much lower (0.2-2% of cases). Intranatal infection of a child in the presence of CMV in the genital tract in pregnant women occurs in 50–57% of cases. The main route of infection for a child under the age of one year is the transmission of the virus through breast milk.

Children of seropositive mothers, children who are breastfed for more than one month, become infected in 40-76% of cases. Consequently, up to 3% of all newborns become infected with CMV during fetal development, 4-5% - intranatally; by the first year of life, the number of infected children is 10–60%. The contact-household route of transmission of the virus in young children plays a significant role. Infection with cytomegalovirus infection of children attending preschool institutions is significantly higher (80% of cases) than "home" pupils of the same age (20%). The number of seropositive individuals increases with age. About 40–80% of adolescents and 60–100% of the adult population have IgG antibodies to CMV. Infection of an adult with CMV is most likely through sexual contact, also during blood transfusions and parenteral manipulations. Transfusion of whole blood and its components containing leukocytes leads to the transmission of the virus with a frequency of 0.14-10 per 100 doses.

There is a high risk of developing a serious illness with repeated blood transfusions from seropositive donors to newborns, especially premature ones.

Clinically expressed CMVI is one of the most frequent and serious infectious complications in organ transplantation. About 75% of recipients have laboratory signs of active cytomegalovirus infection in the first 3 months after transplantation.

In 5–25% of patients who underwent kidney or liver transplantation, 20–50% of patients after allogeneic bone marrow transplantation, 55–75% of lung and / or heart recipients develop a CMV disease of etiology, cytomegalovirus infection significantly increases the risk of transplant rejection. Manifest infection occupies one of the first places in the structure of opportunistic diseases in HIV-infected patients and is observed in 20-40% of AIDS patients who do not receive HAART, and in 3-7% of HIV-infected patients when it is prescribed. The development of severe cytomegalovirus infection has been described in oncohematological patients, patients suffering from pneumocystis pneumonia, tuberculosis, radiation sickness, burn injury, in persons on long-term corticosteroid therapy who have undergone various stressful situations. Cytomegalovirus can be the cause of post-transfusion and chronic hepatitis, various gynecological pathologies. The role of cytomegalovirus as one of the cofactors in the development of systemic vasculitis, atherosclerosis of chronic disseminated lung diseases, cryoglobulinemia, tumor processes, atherosclerosis, cerebral palsy, epilepsy, Guillain-Barré syndrome, chronic fatigue syndrome is assumed. Seasonality, outbreaks and epidemics are not characteristic of the disease associated with cytomegalovirus infection.

The pathogenesis of cytomegalovirus infection

The decisive condition for the development of antenatal CMVI is maternal viremia. The presence of the virus in the blood leads to infection of the placenta, its damage and infection of the fetus with possible consequences in the form of malformations and intrauterine growth retardation, a pathological process with damage to internal organs, primarily the central nervous system. In the presence of a virus in the cervical canal of a pregnant woman, an ascending (transcervical) route of infection of the fetus is possible without the pathogen entering the bloodstream. Reactivation of cytomegalovirus in the endometrium is one of the factors in early abortions. Intranatal infection with the virus occurs when the fetus passes through an infected birth canal due to aspiration of cytomegalovirus-containing amniotic fluid and / or secretions of the birth canal or through damaged skin and can also lead to the development of clinically significant disease. In postnatal cytomegalovirus infection, the entrance gate for the pathogen is the mucous membranes of the oropharynx, respiratory system, digestive and genital tracts. After the virus has overcome the entrance gate and its local multiplication, a short-term viremia sets in, monocytes and lymphocytes carry the virus to various organs. Despite the cellular and humoral response, cytomegalovirus induces a chronic latent infection.

The reservoir of viral particles are monocytes, lymphocytes, endothelial and epithelial cells. In the future, with a slight immunosuppression, a “local” activation of CMVI is possible with the release of the virus from the nasopharynx or urogenital tract. In the case of deep immunological disorders with a hereditary predisposition to this pathology, the resumption of active virus replication, viremia, dissemination of the pathogen, and the development of a clinically pronounced disease occur. The activity of viral replication, the risk of manifestation of cytomegalovirus infection, the severity of its course are largely determined by the depth of immunosuppression, primarily by the level of reduction in the number of CD4-lymphocytes in the blood.

A wide range of organ lesions are associated with CMVI: lungs, digestive tract, adrenal glands, kidneys, brain and spinal cord, retina. In immunosuppressed patients with CMVI, pulmonary fibroatelectasis is postmortem, sometimes with cysts and encapsulated abscesses; erosive and ulcerative with severe fibrosis of the submucosal layer of the esophagus, colon, less often the stomach and small intestine; massive, often bilateral adrenal necrosis; encephaloventriculitis, necrotic lesion of the spinal cord, retina with the development of necrotic retinitis. The specificity of the morphological picture in CMVI is determined by large cytomegalocells, lymphohistiocytic infiltrates, as well as productive-infiltrative panvasculitis with cytomegalic transformation of cells of all walls of small arteries and veins with an outcome in sclerosis. Such vascular damage serves as the basis for thrombosis, leads to chronic ischemia, against which destructive changes, segmental necrosis and ulcers, and severe fibrosis develop. Widespread fibrosis is a characteristic feature of CMV organ damage. In most patients, the pathological process associated with CMV is generalized.

Clinical picture (symptoms) of cytomegalovirus infection

The incubation period for CMV infection is 2-12 weeks.

Classification

There is no generally accepted classification of CMVI. The following classification of the disease is appropriate.

Congenital CMVI:
- asymptomatic form;
- manifest form (cytomegalovirus disease).
Acquired CMVI.
- Acute CMVI.
- asymptomatic form;
- cytomegalovirus mononucleosis;
- Latent CMVI.
- Active CMVI (reactivation, reinfection):
- asymptomatic form;
– CMV-associated syndrome;
- manifest form (cytomegalovirus disease).

The main symptoms of cytomegalovirus infection

With congenital CMVI, the nature of the fetal lesion depends on the duration of infection. Acute cytomegaly in the mother in the first 20 weeks of pregnancy can lead to severe fetal pathology, resulting in spontaneous miscarriage, intrauterine fetal death, stillbirth, and malformations, in most cases incompatible with life. When infected with cytomegalovirus in late pregnancy, the prognosis for the life and normal development of the child is more favorable.

Clinically pronounced pathology in the first weeks of life occurs in 10–15% of newborns infected with CMV. The manifest form of congenital cytomegalovirus infection is characterized by hepatosplenomegaly, persistent jaundice, hemorrhagic or maculopapular rash, severe thrombocytopenia, increased ALT activity and the level of direct bilirubin in the blood, and increased hemolysis of erythrocytes.

Children are often born prematurely, with a lack of body weight, signs of intrauterine hypoxia. The pathology of the central nervous system in the form of microcephaly is characteristic, less often hydrocephalus, encephaloventriculitis, convulsive syndrome, hearing loss. Cytomegalovirus infection is the main cause of congenital deafness. Possible enterocolitis, pancreatic fibrosis, interstitial nephritis, chronic sialadenitis with fibrosis of the salivary glands, interstitial pneumonia, optic nerve atrophy, congenital cataracts, as well as generalized organ damage with the development of shock, DIC and death of the child. The risk of death in the first 6 weeks of life of newborns with symptomatic CMVI is 12%. About 90% of surviving children suffering from overt CMVI have long-term consequences of the disease in the form of a decrease in mental development, sensorineural deafness or bilateral hearing loss, impaired speech perception while maintaining hearing, convulsive syndrome, paresis, and decreased vision.

With intrauterine infection with cytomegalovirus, an asymptomatic form of infection is possible with a low degree of activity, when the virus is present only in urine or saliva, and a high degree of activity, if the virus is detected in the blood. In 8-15% of cases, antenatal CMVI, without manifesting bright clinical symptoms, leads to the formation of late complications in the form of hearing loss, visual impairment, convulsive disorders, physical and mental retardation. A risk factor for the development of a disease with CNS damage is the persistent presence of CMV DNA in whole blood in the period from birth to 3 months of life. Children with congenital CMVI should be under medical supervision for 3–5 years, since hearing impairment can progress in the first years of life, and clinically significant complications persist even 5 years after birth.

In the absence of aggravating factors, intrapartum or early postnatal CMVI is asymptomatic, clinically manifested only in 2-10% of cases, more often in the form of pneumonia. Premature debilitated babies with low birth weight, infected with cytomegalovirus during childbirth or in the first days of life through blood transfusions, develop a generalized disease by the 3rd–5th week of life, the manifestations of which are pneumonia, prolonged jaundice, hepatosplenomegaly, nephropathy, and intestinal damage. , anemia, thrombocytopenia. The disease has a long relapsing character.

The maximum mortality from CMVI occurs at the age of 2–4 months.

The clinical picture of acquired cytomegalovirus infection in older children and adults depends on the form of infection (primary infection, reinfection, reactivation of the latent virus), routes of infection, the presence and severity of immunosuppression. Primary cytomegalovirus infection of immunocompetent persons usually proceeds asymptomatically and only in 5% of cases in the form of a mononucleosis-like syndrome, the hallmarks of which are high fever, pronounced and prolonged asthenic syndrome, in the blood - relative lymphocytosis, atypical lymphocytes. Angina and swollen lymph nodes are not typical. Infection with the virus by blood transfusion or transplantation of an infected organ leads to the development of an acute form of the disease, including high fever, asthenia, sore throat, lymphadenopathy, myalgia, arthralgia, neutropenia, thrombocytopenia, interstitial pneumonia, hepatitis, nephritis and myocarditis. 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 leads to the resumption of CMV replication, the appearance of the virus in the blood and the possible manifestation of the disease. Re-entry of the virus into the human body against the background of an immunodeficiency state can also be the cause of viremia and the development of clinically pronounced CMVI. During reinfection, the manifestation of CMVI occurs more frequently and is more severe than during reactivation of the virus.

CMVI in immunosuppressed individuals is characterized by a gradual development of the disease over several weeks, the appearance of precursor symptoms in the form of rapid fatigue, weakness, loss of appetite, significant weight loss, prolonged undulating fever of the wrong type with body temperature rises above 38.5 ° C, less often - night sweats, arthralgia and myalgia.

This complex of symptoms is called "CMV-associated syndrome".

In young children, the onset of the disease can occur without a pronounced initial toxicosis at normal or subfebrile temperature.

A wide range of organ damage is associated with CMVI, with the lungs being among the first to suffer. A gradually increasing dry or unproductive cough appears, moderate shortness of breath, symptoms of intoxication increase. X-ray signs of pulmonary pathology may be absent, but during the height of the disease, bilateral small-focal and infiltrative shadows, located mainly in the middle and lower parts of the lungs, are often determined against the background of a deformed enhanced pulmonary pattern. With untimely diagnosis, the development of DN, RDS and death is possible. The degree of lung damage in patients with CMVI varies from minimally severe interstitial pneumonia to widespread fibrosing bronchiolitis and alveolitis with the formation of bilateral polysegmental pulmonary fibrosis.

Often the virus infects the digestive tract. Cytomegalovirus is the main etiological factor in ulcerative defects of the digestive tract in patients with HIV infection. Typical signs of CMV esophagitis are fever, retrosternal pain during the passage of the food bolus, the absence of the effect of antifungal therapy, the presence of shallow round ulcers and/or erosions in the distal esophagus. The defeat of the stomach is characterized by the presence of acute or subacute ulcers. The clinical picture of CMV colitis or enterocolitis includes diarrhea, persistent abdominal pain, colon tenderness on palpation, significant weight loss, severe weakness, and fever. Colonoscopy reveals erosion and ulceration of the intestinal mucosa. Hepatitis is one of the main clinical forms of CMVI in case of transplacental infection of a child, in recipients after liver transplantation, in patients infected with the virus during blood transfusions. A feature of liver damage in CMVI is the frequent involvement of the biliary tract in the pathological process. CMV hepatitis is characterized by a mild clinical course, but with the development of sclerosing cholangitis, pain occurs in the upper abdomen, nausea, diarrhea, liver tenderness, increased activity of alkaline phosphatase and GGTT, and cholestasis is possible.

Liver damage is in the nature of granulomatous hepatitis, in rare cases, pronounced fibrosis and even cirrhosis of the liver are observed. Pathology of the pancreas in patients with CMVI usually proceeds asymptomatically or with an erased clinical picture with an increase in the concentration of amylase in the blood. The cells of the epithelium of the small ducts of the salivary glands, mainly the parotid ones, have a high sensitivity to CMV. Specific changes in the salivary glands in CMVI in children occur in the vast majority of cases. For adult patients with CMVI, sialadenitis is not typical.

Cytomegalovirus is one of the causes of adrenal pathology (often in patients with HIV infection) and the development of secondary adrenal insufficiency, manifested by persistent hypotension, weakness, weight loss, anorexia, intestinal disorders, a number of mental disorders, less often - hyperpigmentation of the skin and mucous membranes. The presence of CMV DNA in the blood of a patient, as well as persistent hypotension, asthenia, anorexia, requires determining the level of potassium, sodium and chlorides in the blood, conducting hormonal studies to analyze the functional activity of the adrenal glands. CMV adrenalitis is characterized by an initial lesion of the medulla with the transition of the process to deep, and later to all layers of the cortex.

Manifest CMVI often occurs with damage to the nervous system in the form of encephaloventriculitis, myelitis, polyradiculopathy, polyneuropathy of the lower extremities. CMV encephalitis in patients with HIV infection is characterized by poor neurological symptoms (intermittent headaches, dizziness, horizontal nystagmus, paresis of the oculomotor nerve, neuropathy of the facial nerve), but pronounced changes in mental status (personality changes, severe memory impairment, decreased ability to intellectual activity, a sharp weakening of mental and motor activity, disorientation in place and time, anosognosia, decreased control over the function of the pelvic organs). Mnestic-intellectual changes often reach the degree of dementia. In children who have had CMV encephalitis, a slowdown in mental and mental development is also detected.

Cerebrospinal fluid (CSF) studies show elevated protein, no inflammatory response or mononuclear pleocytosis, and normal glucose and chloride levels. The clinical picture of polyneuropathy and polyradiculopathy is characterized by pain in the distal lower extremities, less often in the lumbar region, combined with numbness, parasthesia, hyperesthesia, causalgia, hyperpathia. With polyradiculopathy, flaccid paresis of the lower extremities is possible, accompanied by a decrease in pain and tactile sensitivity in the distal legs. In the CSF of patients with polyradiculopathy, an increase in protein content, lymphocytic pleocytosis are detected.

Cytomegalovirus plays a leading role in the development of myelitis in HIV-infected patients. The spinal cord injury is diffuse and is a late manifestation of CMVI. At the onset, the disease has a clinical picture of polyneuropathy or polyradiculopathy, later, in accordance with the predominant level of spinal cord damage, spastic tetraplegia or spastic paresis of the lower extremities develops, pyramidal signs appear, a significant decrease in all types of sensitivity, primarily in the distal legs; trophic disorders. All patients suffer from gross disorders of the function of the pelvic organs, mainly of the central type. In the CSF, a moderate increase in protein content, lymphocytic pleocytosis is determined.

CMV retinitis is the most common cause of vision loss in patients with HIV infection. This pathology has also been described in organ recipients, children with congenital CMVI, and in isolated cases in pregnant women. Patients complain of floating dots, spots, a veil in front of their eyes, a decrease in visual acuity and visual field defects. Ophthalmoscopy on the retina along the periphery of the fundus reveals white foci with hemorrhages along the retinal vessels. The progression of the process leads to the formation of a diffuse extensive infiltrate with zones of retinal atrophy and foci of hemorrhages along the surface of the lesion. The initial pathology of one eye acquires a bilateral character in 2-4 months and, in the absence of etiotropic therapy, leads in most cases to loss of vision. Patients with HIV infection with a history of CMV retinitis may develop uveitis during HAART as a manifestation of the immune system recovery syndrome.

Sensorineural deafness occurs in 60% of children with clinically pronounced congenital CMVI. Hearing loss is also possible in adult HIV-infected individuals with overt CMVI. CMV-associated hearing impairments are based on inflammatory and ischemic damage to the cochlea and the auditory nerve.

A number of works demonstrate the role of CMV as an etiological factor in the pathology of the heart (myocarditis, dilated cardiopathy), spleen, lymph nodes, kidneys, bone marrow with the development of pancytopenia. Interstitial nephritis caused by CMVI, as a rule, proceeds without clinical manifestations. Microproteinuria, microhematuria, leukocyturia, rarely secondary nephrotic syndrome and renal failure are possible. In patients with CMVI, thrombocytopenia is often recorded, less often moderate anemia, leukopenia, lymphopenia and monocytosis.

Diagnosis of cytomegalovirus infection

The clinical diagnosis of CMV disease requires mandatory laboratory confirmation.

Examination of the patient's blood for the presence of specific IgM class antibodies and / or IgG class antibodies is not sufficient either to establish the fact of active CMV replication or to confirm the manifest form of the disease. The presence of anti-CMV IgG in the blood means only the fact of a meeting with the virus.

The newborn receives IgG antibodies from the mother, and they do not serve as evidence of CMV infection. The quantitative content of IgG antibodies in the blood does not correlate with the presence of the disease, or with the active asymptomatic form of the infection, or with the risk of intrauterine infection of the child. Only an increase of 4 or more times in the amount of anti-CMV IgG in “paired sera” during examination with an interval of 14–21 days has a certain diagnostic value.

The absence of anti-CMV IgG in combination with the presence of specific IgM antibodies indicates acute CMVI. Detection of anti-CMV IgM in children during the first weeks of life is an important criterion for intrauterine infection with the virus, however, a serious drawback of determining IgM antibodies is their frequent absence in the presence of an active infectious process and frequent false positive results. The presence of acute CMVI is indicated by neutralizing IgM antibodies present in the blood for no more than 60 days from the moment of infection with the virus. Determination of the anti-CMV IgG avidity index, which characterizes the rate and strength of antigen binding to an antibody, has a certain diagnostic and prognostic value. The detection of a low antibody avidity index (less than 0.2 or less than 30%) confirms a recent (within 3 months) primary infection with the virus. The presence of low-avid antibodies in a pregnant woman is a marker of a high risk of transplantation transmission of the pathogen to the fetus. At the same time, the absence of low-avid antibodies does not completely rule out a recent infection.

The virological method based on the isolation of CMV from biological fluids in cell culture is a specific, but time-consuming, time-consuming, expensive and insensitive method for diagnosing CMV.

In practical healthcare, a rapid cultural method for detecting viral antigen in biological materials is used by analyzing infected culture cells. The detection of early and very early CMV antigens shows the presence of an active virus in a patient.

However, antigen detection methods are inferior in sensitivity to PCR-based molecular methods, which enable direct qualitative and quantitative detection of CMV DNA in biological fluids and tissues in the shortest possible time. The clinical significance of the determination of CMV DNA or antigen in various biological fluids is not the same.

The presence of the pathogen in saliva is only a marker of infection and does not indicate significant viral activity. The presence of CMV DNA or antigen in the urine proves the fact of infection and a certain viral activity, which is important, in particular, when examining a child in the first weeks of his life. The most important diagnostic value is the detection of DNA or antigen of the virus in whole blood, indicating a highly active replication of the virus and its etiological role in the existing organ pathology. Detection of CMV DNA in the blood of a pregnant woman is the main marker of a high risk of fetal infection and the development of congenital CMVI. The fact of infection of the fetus is proved by the presence of CMV DNA in the amniotic fluid or cord blood, and after the birth of the child, it is confirmed by the detection of virus DNA in any biological fluid in the first 2 weeks of life. Manifest CMVI in children of the first months of life is substantiated by the presence of CMV DNA in the blood; in immunosuppressed individuals (recipients of organs with HIV infection), it is necessary to determine the amount of virus DNA in the blood. The content of CMV DNA in whole blood, equal to 3.0 or more log10 in 105 leukocytes, reliably indicates the cytomegalovirus nature of the disease. Quantitative determination of CMV DNA in the blood is also of great prognostic value. The appearance and gradual increase in the content of CMV DNA in whole blood significantly outstrips the development of clinical symptoms. Detection of cytomegalocellular cells in the histological examination of biopsy and autopsy materials confirms the cytomegalovirus nature of organ pathology.

Diagnostic standard

Examination of pregnant women to determine the presence of active CMVI and the degree of risk of vertical transmission of the virus to the fetus.

Determination of the amount of anti-CMV IgG in the blood with an interval of 14–21 days.
Examination of amniotic fluid or umbilical cord blood for the presence of CMV DNA (if indicated).

Blood and urine tests for the presence of DNA or antigen of the virus are carried out routinely at least twice during pregnancy or according to clinical indications.

Examination of newborns to confirm antenatal infection with CMV (congenital CMVI).

Examination of urine or scrapings from the oral mucosa for the presence of CMV DNA or virus antigen in the first 2 weeks of a child's life.
The study of whole blood for the presence of CMV DNA or virus antigen in the first 2 weeks of a child's life, with a positive result, a quantitative determination of CMV DNA in whole blood is indicated.
Blood test for the presence of IgM antibodies to CMV by ELISA.
Determination of the amount of IgG antibodies in the blood with an interval of 14–21 days.

It is possible to conduct a blood test of mother and child for anti-CMV IgG to compare the amount of IgG antibodies in “paired sera”.

Examination of children to confirm intrapartum or early postnatal CMV infection and the presence of active CMVI (in the absence of the virus in the blood, urine or saliva, anti-CMV IgM during the first 2 weeks of life).

Examination of urine or saliva for the presence of CMV DNA or virus antigen in the first 4-6 weeks of a child's life.
The study of whole blood for the presence of CMV DNA or virus antigen in the first 4-6 weeks of a child's life, with a positive result, a quantitative determination of CMV DNA in whole blood is indicated.
Blood test for the presence of IgM antibodies to CMV by ELISA.

Examination of young children, adolescents, adults with suspected acute CMVI.

Whole blood test for CMV DNA or virus antigen.
Urinalysis for the presence of CMV DNA or virus antigen.
Blood test for the presence of IgM antibodies to CMV by ELISA.
Determination of the avidity index of IgG antibodies to CMV by ELISA.
Determination of the amount of IgG antibodies in the blood with an interval of 14–21 days.

Examination of patients with suspected active CMVI and a manifest form of the disease (CMV disease).

The study of whole blood for the presence of CMV DNA or CMV antigen with the mandatory quantitative determination of the content of CMV DNA in the blood.
Determination of CMV DNA in CSF, pleural fluid, bronchoalveolar lavage fluid, bronchial and organ biopsies in the presence of appropriate organ pathology.
Histological examination of biopsy and autopsy materials for the presence of cytomegalo cells (staining with hematoxylin and eosin).

Differential diagnosis of cytomegalovirus infection

Differential diagnosis of congenital CMVI is carried out with rubella, toxoplasmosis, neonatal herpes, syphilis, bacterial infection, hemolytic disease of the newborn, birth trauma and hereditary syndromes. Of decisive importance is the specific laboratory diagnosis of the disease in the first weeks of a child's life, histological examination of the placenta using molecular diagnostic methods. In mononucleosis-like disease, infections caused by EBV, herpesvirus types 6 and 7, acute HIV infection, as well as streptococcal tonsillitis and the onset of acute leukemia are excluded. In the case of the development of CMV respiratory disease in young children, differential diagnosis should be carried out with whooping cough, bacterial tracheitis or tracheobronchitis and herpetic tracheobronchitis. In patients with immunodeficiency, manifest CMVI should be differentiated from pneumocystis pneumonia, tuberculosis, toxoplasmosis, mycoplasmal pneumonia, bacterial sepsis, neurosyphilis, progressive multifocal leukoencephalopathy, lymphoproliferative diseases, fungal and herpes infections, HIV encephalitis. Polyneuropathy and polyradiculopathy of CMV etiology requires differentiation from polyradiculopathy caused by herpes viruses, Guillain-Barré syndrome, toxic polyneuropathy associated with the use of drugs, alcohol and narcotic, psychotropic substances. In order to make an etiological diagnosis in a timely manner, along with an assessment of the immune status, standard laboratory tests, MRI of the brain and spinal cord, a blood test is performed for the presence of CMV DNA, instrumental examinations with the study of CSF, lavage fluid, pleural effusion, biopsy materials for the presence of DNA in them pathogens.

Indications for consulting other specialists

Indications for consultation of specialists in patients with CMVI are severe damage to the lungs (pulmonologist and phthisiatrician), central nervous system (neurologist and psychiatrist), vision (ophthalmologist), hearing organs (otolaryngologist) and bone marrow (oncohematologist).

Diagnosis example

The diagnosis of manifest CMVI is formulated as follows:

Acute cytomegalovirus infection, cytomegalovirus mononucleosis;
- congenital cytomegalovirus infection, manifest form;
- HIV infection, stage of secondary diseases 4 B (AIDS): manifest cytomegalovirus infection (pneumonia, colitis).

Indications for hospitalization

With clinically expressed CMV disease, hospitalization is indicated.

Treatment of cytomegalovirus infection

Mode. Diet

A special regimen and diet for patients with CMVI is not required, restrictions are set based on the patient's condition and the location of the lesion.

Medical treatment

Medicines, the effectiveness of which has been proven by controlled studies in the treatment and prevention of CMV disease, are antiviral drugs ganciclovir, valganciclovir, sodium foscarnet, cidofovir. Interferon preparations and immunocorrectors are not effective in cytomegalovirus infection.

With active CMVI (the presence of CMV DNA in the blood) in pregnant women, the drug of choice is human anticytomegalovirus immunoglobulin (neocytotec). To prevent vertical infection with the virus of the fetus, the drug is prescribed 1 ml / kg per day intravenously, 3 injections with an interval of 1-2 weeks.

In order to prevent the manifestation of the disease in newborns with active CMVI or with a manifest form of the disease with minor clinical manifestations, neocytotec is indicated at 2-4 ml / kg per day for 6 injections (every 1 or 2 days). If children, in addition to CMVI, have other infectious complications, instead of neocytotect, it is possible to use pentaglobin at a dose of 5 ml / kg daily for 3 days, with a repetition, if necessary, of a course or other immunoglobulins for intravenous administration.

The use of neocytotect as monotherapy in patients suffering from overt, life-threatening or severe consequences of CMVI is not indicated.

Ganciclovir and valganciclovir are the drugs of choice for the treatment, secondary prevention and prevention of overt CMVI. Treatment of manifest CMVI with ganciclovir is carried out according to the scheme: 5 mg/kg intravenously 2 times a day with an interval of 12 hours for 14–21 days in patients with retinitis; 3-4 weeks - with damage to the lungs or digestive tract; 6 weeks or more - with pathology of the central nervous system. Valganciclovir is used orally at a therapeutic dose of 900 mg 2 times a day for the treatment of retinitis, pneumonia, esophagitis, enterocolitis of CMV etiology. The duration of administration and efficacy of valganciclovir are identical to parenteral therapy with ganciclovir. The criteria for the effectiveness of treatment are the normalization of the patient's condition, a clear positive trend according to the results of instrumental studies, the disappearance of CMV DNA from the blood. The effectiveness of ganciclovir in patients with CMV lesions of the brain and spinal cord is lower, primarily due to the late etiological diagnosis and untimely initiation of therapy, when irreversible changes in the central nervous system are already present. The effectiveness of ganciclovir, the frequency and severity of side effects in the treatment of children with CMV disease, are comparable to those for adult patients.

With the development of a life-threatening manifest CMVI in a child, the use of ganciclovir is necessary. For the treatment of children with overt neonatal CMVI, ganciclovir is prescribed at a dose of 6 mg/kg intravenously every 12 hours for 2 weeks, then, if there is an initial effect of therapy, the drug is used at a dose of 10 mg/kg every other day for 3 months.

While maintaining the state of immunodeficiency, relapses of CMV disease are inevitable. HIV-infected patients treated with overt CMVI are prescribed maintenance therapy (900 mg/day) or ganciclovir (5 mg/kg/day) to prevent recurrence of the disease. Maintenance treatment in patients with HIV infection who have undergone CMV retinitis is carried out against the background of HAART until the number of CD4 lymphocytes increases by more than 100 cells per 1 μl, which persists for at least 3 months. The duration of the maintenance course in other clinical forms of CMVI should be at least one month. In case of recurrence of the disease, a repeated therapeutic course is prescribed. Treatment of uveitis that has developed during the restoration of the immune system involves systemic or periocular administration of steroids.

Currently, in patients with active cytomegalovirus infection, a strategy of "preemptive" etiotropic therapy is recommended to prevent the manifestation of the disease.

The criteria for prescribing preventive therapy are the presence of profound immunosuppression in patients (in case of HIV infection, the number of CD4-lymphocytes in the blood is less than 50 cells per 1 μl) and the determination of CMV DNA in whole blood at a concentration of more than 2.0 lg10 gene/ml or the detection of DNA CMV in plasma. The drug of choice for the prevention of overt CMVI is valganciclovir, used at a dose of 900 mg/day. The duration of the course is at least a month. The criterion for stopping therapy is the disappearance of CMV DNA from the blood. In organ recipients, preventive therapy is carried out for several months after transplantation. Side effects of ganciclovir or valganciclovir: neutropenia, thrombocytopenia, anemia, increased serum creatinine, skin rash, itching, dyspepsia, reactive pancreatitis.

Standard of care

Treatment course: ganciclovir 5 mg/kg 2 times a day or valganciclovir 900 mg 2 times a day, the duration of therapy is 14–21 days or more until the symptoms of the disease and CMV DNA from the blood disappear. In case of recurrence of the disease, a repeated treatment course is carried out.

Maintenance therapy: valganciclovir 900 mg/day for at least a month.

Preventive therapy for active CMVI in immunosuppressed patients to prevent the development of CMV disease: valganciclovir 900 mg/day for at least a month until there is no CMV DNA in the blood.

Preventive therapy of active CMVI during pregnancy in order to prevent vertical infection of the fetus: neocytotect 1 ml/kg per day intravenously 3 injections with an interval of 2-3 weeks.

Preventive therapy of active CMVI in newborns, young children to prevent the development of a manifest form of the disease: neocytotect 2–4 ml/kg per day intravenously, 6 injections under the control of the presence of CMV DNA in the blood.

Forecast

With an early diagnosis of CMV pneumonia, esophagitis, colitis, retinitis, polyneuropathy and timely initiation of etiotropic therapy, the prognosis for life and ability to work is favorable. Late detection of cytomegalovirus pathology of the retina and the development of its extensive damage leads to a persistent decrease in vision or to its complete loss. CMV damage to the lungs, intestines, adrenal glands, brain and spinal cord can cause disability or death in patients.

Approximate periods of incapacity for work

The working capacity of patients with CMV disease is impaired for at least 30 days.

Clinical examination

Women during pregnancy undergo a laboratory examination to rule out active cytomegalovirus infection. Young children infected with CMVI antenatally are observed by a neuropathologist, otolaryngologist and ophthalmologist.

Children who have undergone clinically pronounced congenital CMVI are under dispensary registration with a neurologist. Patients after transplantation of bone marrow and other organs in the first year after transplantation should be examined for the presence of CMV DNA in whole blood at least once a month. Patients with HIV infection with a CD4-lymphocyte count of less than 100 cells per 1 µl should be examined by an ophthalmologist and tested for the quantitative content of CMV DNA in blood cells at least once every 3 months.

Prevention of cytomegalovirus infection

Preventive measures against CMVI should be differentiated depending on the risk group. It is necessary to counsel pregnant women (especially seronegative ones) on the problem of cytomegalovirus infection and recommendations on the use of barrier contraceptives during sexual intercourse, compliance with personal hygiene rules when caring for young children. It is desirable to temporarily transfer pregnant seronegative women working in orphanages, children's inpatient departments and nursery-type institutions to work that is not associated with the risk of their infection with CMV. An important measure for the prevention of CMVI in transplantology is the selection of a seronegative donor if the recipient is seronegative. There is currently no patented anticytomegalovirus vaccine.

It is hardly possible to meet a person who would never be sick in his life. Sometimes it is difficult to determine the cause of poor health. Under the common cold, pathogens of a wide variety of ailments, including CMV (cytomegaloviruses), are masked.

Cytomegalovirus is a member of the human herpesvirus family. Many are familiar with the disgusting "fever" on the lips. It is caused by the simplexvirus, the cousin of CMV. A distinctive feature of CMV from its brethren is that it affects the internal organs of a person - the kidneys, heart, liver.

A person can be a carrier of the virus for a long time without realizing it. It would seem that if there is no cause for concern, then why is CMV under such scrutiny of scientists? And the thing is that everyone's susceptibility to the virus is different. If for some people the causative agent of cytomegalovirus infection is just an uninvited guest, then for others it can lead to disability and even death.

Who is he?

So, the “culprit” of cytomegalovirus infection is human CMV from the herpesvirus family. It spreads throughout the body, but still the main refuge of the pathogen is the salivary glands.

The geography of the virus is vast: it has been found in absolutely all regions of our planet. Carriers can be people of any socioeconomic group. But the virus is still more common among people of low social status, as well as those living in poor developing countries.

Cytomegalovirus has a complex structure and belongs to human herpesviruses type 5

According to statistics, from 50% to 100% of people (depending on the region) are infected with CMV. This is indicated by antibodies found in the blood of earthly inhabitants. The virus can enter the human body at any time during its life. People with reduced immunity are especially susceptible to infection:

• -infected;
• Taking drugs that weaken the immune response;
• Have undergone a bone marrow or internal organ transplant.

Cytomegalovirus can be both a consequence and a cause of a decrease in immunity.

A more dangerous form of CMV infection is intrauterine.

Possible modes of CMV transmission

CMV infection is not very contagious. To acquire the virus, numerous contacts or long-term close contact with the virus carrier are necessary. Nevertheless, most of the inhabitants of the Earth are infected with it.

The main ways of infection:

1. Sexual. The virus is concentrated in semen, vaginal and cervical mucus.
2. Airborne. Transmitted by coughing, sneezing, talking, kissing.
3. Transfusion of blood or its components that contain leukocytes.
4. Organ transplantation from infected donors.
5. To the fetus from an infected mother.

We are all in a society of our own kind who cough and sneeze, are born to infected women, have multiple sexual partners, receive blood and organs from donors or become one themselves. Therefore, 90 percent can be assumed to have a probability of detecting CMV in a smear, blood, breast milk, saliva, etc.

What is important is not the detection of the virus at all, but the detection of its active form. A sleeping dog, until awakened, is not dangerous. The pathogen “wakes up” only when conditions favorable for it appear in the body.

Options for the development of infection

1) In people with normal immunity

"Uninvited guests" can go unnoticed for a long time. Sometimes there are symptoms resembling SARS. The first signs of the disease appear 20–60 days after the introduction of the virus into the body. But there is a global difference between CMVI and a respiratory disease: if ARVI disappears in the worst case in a week, then a cytomegalovirus infection can remind of itself for a month or more. And the symptoms, at first glance, are very similar:

• Runny nose;
• elevated temperature;
• Weakness;
• Enlarged lymph nodes;
• Headache;
• Chills;
• Inflammation of the joints;
• Enlargement of the liver and spleen;
• The appearance of a rash on the skin.

It should be emphasized that all these manifestations are a normal immune response to CMV activity. After all, elevated temperature is fatal for the virus. And the sites of inflammation are the last refuge of DNA particles. If you completely get rid of the symptoms, the disease becomes protracted. It is necessary to deal with the consequences of infection only in case of their dangerous development.

Good immunity contributes to the formation of antiviral antibodies in the blood, which leads to a quick recovery. However, viruses have been found in human biological fluids for a long time. For many years, pathogenic pathogens are in the body in an inactive form. Their sudden disappearance is also not ruled out.

2) People with weak immune systems

Weak immunity is a paradise for a “sleeping” virus. In such an organism, he does whatever he wants. The disease in patients with reduced immunity can occur with varying degrees of severity. Complications are possible in the form of:

1. Pleurisy;
2. pneumonia;
3. Arthritis;
4. Damage to internal organs;
5. Myocarditis;
6. encephalitis;
7. Vegetative disorders.

Sometimes there may be:

• Eye diseases;
• Inflammatory processes of the brain (up to death);
• Paralysis.

In women, the disease is manifested by erosion of the cervix, inflammation of the genitourinary system. If a woman is pregnant at the same time, then there is a real threat to the fetus. In men, the urethra, testicular tissue may be affected.

But all these complications appear rarely - mainly in people with a reduced immune response.

3) Congenital CMV infection

If during pregnancy (in the first trimester) the fetus becomes infected, a miscarriage may occur. At a later date, cytomegaly develops. It manifests itself in prematurity, pneumonia, enlarged liver, kidney, spleen. Developmental delay, hearing and vision impairment, and dental anomalies may occur.

Diagnostic methods

For the diagnosis of CMVI, the patient's complaints, signs of the disease and the results of laboratory analysis are studied. To make a diagnosis, several laboratory tests are performed at the same time. Researched:

1. Saliva;
2. Liquor;
3. Wash water obtained as a result of lavage of the bronchi and lungs;
4. Biopsies;
5. Urine;
6. Breast milk;
7. Blood;

It is important that no more than four hours elapse from sampling to the start of the study.

Main research methods:

• Detection of antibodies to cytomegalovirus ().

The most accessible laboratory technique is seeding. It does not require sophisticated equipment. With the help of the sowing method, not only the presence of a pathogenic pathogen is determined, but also its type, degree of aggressiveness, form. A very useful addition to the study is the testing of medicinal preparations directly on the colonies of the resulting culture. After all, each case of infection is individual.

The most sensitive method is PCR (polymerase chain reaction). It detects even a small piece of DNA.

The advantage of the PCR technique is to detect infection:

1. Early;
2. Persistent;
3. Latent.

Disadvantages of the technique:

1. Low predictive value;
2. Little specificity.

Last time ELISA method is often used(enzymatic immunoassay). With its help, the CMV antigen is detected, as well. If class M antibodies were detected as a result of a blood test, then a conclusion is made about the primary infection. With intrauterine infection, IgM antibodies are detected in the first 2 weeks of a child's life. A subsequent positive test indicates an acquired infection.

The appearance of IgG antibodies indicates a past illness. What is the standard for this indicator? The presence of an IgG titer in the blood is already the norm, since almost all people sooner or later encounter such a virus. In addition, the presence of antibodies indicates a good immune response - the body reacted to the introduction of the virus and defended itself.

ELISA algorithm for suspected CMV

More accurate is quantitative analysis. Caution should be taken to the growth of IgG titer, which may indicate the progression of pathology. It is important to diagnose the infection as quickly as possible, to identify the stage of the disease, its form and the duration of the infection process.

It should be noted that M and G class antibodies are not always detected. They may not be found in the blood of immunosuppressed patients.

How to treat CMVI?

Unfortunately, it is impossible to completely destroy viruses in the body.. Yes, and it is not necessary. 95% of earthlings have CMVI pathogens, and many people simply do not notice them. They do not notice while the CMV is “sleeping”. And in order to “wake them up”, you have to try very hard - to reach the extreme degree of beriberi, protein starvation or catch HIV.

Treatment of cytomegalovirus infection is required in its active form. But it consists, first of all, in the correction of the immune system. After all, it is in people with a weakened immune response that CMV “wakes up” and begins to destroy the body.

In what cases is treatment prescribed?

• With primary infection with pronounced symptoms of pathology;
• When an immunodeficiency state is detected;
• Pregnant or planning pregnancy in case of primary infection or in case of exacerbation of the disease.

Treat CMV infection strictly according to indications. The detection of a virus in the body cannot be the basis for drug therapy. Self-medication with medicines is unacceptable!

Antiviral drugs may be prescribed, such as ganciclovir, foscarnet, famciclovir. However, they have a hepatotoxic effect and are poorly tolerated by patients. They should not be given to infants and pregnant women. Therefore, funds from the interferon group are more actively used: roferon, intron A, viferon.

To prevent relapses are prescribed panavir And neovir.

In the treatment of CMVI, immunoglobulin enriched with antibodies to this pathogen can be prescribed. Such drugs include cytotect, neo-cytotec.

In case of severe symptoms - pneumonia, encephalitis - a complex of therapeutic measures is carried out aimed at eliminating these symptoms.

Video: cytomegalovirus in the program “Live healthy!”

The specifics of the development of CMVI in children

Most often, the first meeting of a person with CMV occurs in childhood. This does not always happen during fetal development. The child grows up among numerous virus carriers, communicates with children and adults. Avoiding infection in such conditions is almost impossible.

But it's even good. Babies, having met with pathogenic factors in early childhood, acquire immunity to them.

Only 15% of healthy children show symptoms of cytomegalovirus infection. There may be various signs of discomfort.

How to determine the infection in newborns?

Often the baby is born outwardly healthy, without any symptoms of infection. Sometimes there are some temporary signs that pass safely.

Manifestations and complications of CMVI and in general in newborns

Temporary symptoms include:

1. Reduced body weight;
2. Pathological changes in the spleen;
3. Bluish rash on the skin;
4. Liver damage;
5. Jaundice;
6. Lung diseases.

However, a small number of newborns have more persistent disorders that may remain for life.

Common symptoms of CMV include:

• visual impairment;
• Mental retardation;
• Small head;
• Poor coordination of movement;
• Hearing loss.

Sometimes persistent symptoms of CMV show up after several years.

In newborns, the disease is a little different than in older children and adults. Severe symptoms appear in less than 20% of infants. And only a quarter of them require therapeutic treatment.

Any of the manifestations is a reason to visit a pediatrician. Symptoms usually resolve without treatment, but complications do occur, albeit rarely.

Why is CMVI dangerous for children?

The most vulnerable categories for CMVI are newborns with immature immunity, as well as children with immunodeficiency.

The most severe consequences of infection in these children:

1. CNS damage. There are signs of encephalitis: convulsions, increased drowsiness. Hearing damage (up to deafness) is possible.
2. Chorioretinitis is an inflammatory eye disease. The retina is predominantly affected. May lead to blindness.
3. Cytomegalovirus pneumonia. It is considered the main cause of death in immunocompromised patients.
4. Severe encephalitis can lead to the death of a child.

The virus poses a threat to children with leukemia and other cancers, as well as those preparing for organ transplants. Such children must be diagnosed with CMVI. Especially the study is necessary for exacerbation of symptoms of infection.

How to prevent the development of CMV infection in children?

After reading this article, no need to run to the pharmacy for antiviral drugs for parents of healthy children! Only babies with a low immune response should be protected from CMV. If the mother was diagnosed with primary infection, then it is she who should take immunoglobulins. And breast milk transports them to the baby's body.

But still, nothing better has been invented yet than the development and maintenance of children's own immunity through hardening, physical activity, eating vegetables and fruits. For children leading a healthy lifestyle, a pathogenic pathogen that enters the body is not terrible.

Video: pediatrician about cytomegalovirus infection

What is Cytomegalovirus infection

As early as 1882, the German pathologist X. Ribbert discovered peculiar giant cells with inclusions in the nucleus in the renal tubules of a stillborn child. Subsequently, they were called cytomegalic cells (Goodpasture E., Talbot F., 1921). Later, L. Smith and W. Rowe (1956) isolated a virus that causes a disease with the development of characteristic cytomegaly. It was named cytomegalovirus (CMV) and the disease itself was called cytomegalovirus infection.

What Causes Cytomegalovirus Infection?

The causative agent of cytomegalovirus infection- DNA-genomic virus of the genus Cytomegalovirus (Cytomegalovirus hominis) subfamily Betaherpesvirinae of the family Herpesviridae. Three strains of the virus are known: Davis, AD-169 and Kerr. Slow reproduction of the virus in the cell is possible without damaging it. The virus is inactivated by heating and freezing, and is well preserved at room temperature. At - 90 °C, it remains for a long time, is relatively stable at pH 5.0-9.0, and quickly collapses at pH 3.0.

Reservoir and source of infection- a person with an acute or latent form of the disease. The virus can be found in various biological secretions: saliva, nasopharyngeal secretions, tears, urine, feces, seminal fluid, and cervical secretions.

Transmission mechanisms diverse, transmission routes- airborne, contact (direct and indirect - through household items) and transplacental. Infection is possible through sexual contact, during transplantation of internal organs (kidney or heart) and blood transfusion of an infected donor. Intranatal infection of the child is observed much more often than transplacental. The most dangerous for the fetus is infection of the mother in the first trimester of pregnancy. In such situations, the frequency of intrauterine development disorders is highest.

Natural susceptibility of people high, but widespread latent infection. Clinical manifestations of an infection attributed to opportunistic diseases are possible in conditions of primary or secondary immunodeficiency.

The main epidemiological signs of cytomegalovirus infection. The disease is recorded everywhere, its widespread is evidenced by antiviral antibodies detected in 50-80% of adults. The variety of ways of CMV infection and the polymorphism of the clinical picture determine the epidemiological and social significance of CMV infection. This disease plays an important role in transplantation, hemotransfusiology, perinatal pathology, and can be the cause of prematurity, stillbirth, congenital developmental defects. In adults, CMV infection is encountered as a concomitant disease in various immunodeficiency states. Continued environmental pollution, the use of cytostatics and immunosuppressants contribute to an increase in the frequency of CMV infection. In recent years, its exacerbation in HIV-infected people has become especially relevant. In pregnant women with latent CMV infection, fetal damage does not always occur. The probability of intrauterine infection is much higher with the primary infection of a woman during pregnancy. Seasonal or professional features of morbidity have not been identified.

Pathogenesis (what happens?) during Cytomegalovirus infection

With various transmission routes, the infection gates can be the mucous membranes of the upper respiratory tract, gastrointestinal tract or genital organs. The virus enters the blood; short-term viremia quickly ends with the localization of the pathogen when it invades leukocytes and mononuclear phagocytes, where it replicates. Infected cells increase in size (cytomegaly), acquire a typical morphology with nuclear inclusions, which are accumulations of the virus. The formation of cytomegalic cells is accompanied by interstitial lymphohistiocytic infiltration, the development of nodular infiltrates, calcifications and fibrosis in various organs, glandular structures in the brain.

The virus is able to persist for a long time and latently in organs rich in lymphoid tissue, being protected from the effects of antibodies and interferon. At the same time, it can suppress cellular immunity by direct action on T-lymphocytes. In various immunodeficiency states (in early childhood, during pregnancy, the use of cytostatics and immunosuppressants, HIV infection) and, above all, in violations of cellular immunity, further aggravated by direct exposure to the virus, reactivation of the pathogen and its hematogenous generalization are possible with damage to almost all organs and systems . In this case, the epitheliotropy of the virus is of great importance. It is especially pronounced in relation to the epithelium of the salivary glands, which under the influence of the virus turns into cytomegalic cells.

Active CMV infection is considered as an indicator of defects in cellular immunity and is included in the group of AIDS-associated conditions.

Symptoms of Cytomegalovirus Infection

International Classification of Diseases X revision
International Statistical Classification of Diseases and Related Health Problems 10th Revision Version for 2006 does not classify cytomegalovirus infection as a sexually transmitted infection and distinguishes between the following CMV-related diseases.
B25.0 Cytomegalovirus disease
B25.0 Cytomegalovirus pneumonitis
B25.1 Cytomegalovirus hepatitis
B25.2 Cytomegalovirus pancreatitis
B25.8 Other cytomegalovirus diseases
B25.9 Cytomegalovirus disease, nonspecific
B27.1 Cytomegalovirus mononucleosis
P35.1 Congenital cytomegalovirus infection

Among the various variants of the course of CMV infection, subclinical forms and latent virus carriers predominate. Clinically expressed infection becomes in conditions of immunodeficiency. A unified clinical classification of CMV infection has not been developed. In accordance with one of the classifications, congenital CMV infection is distinguished in acute and chronic forms and acquired CMV infection in latent, acute mononucleosis or generalized forms.

Congenital CMV infection. In most cases, it is not clinically manifested in the early stages of a child's life, however, in the later stages of its development, a variety of pathologies are revealed: deafness, chorioretinitis with atrophy of the optic nerves, decreased intelligence, and speech disorders. However, in 10-15% of cases with congenital CMV infection, the so-called overt cytomegalovirus syndrome develops. Its manifestations depend on the timing of infection of the fetus during pregnancy.

.
- In early pregnancy leads to intrauterine death of the fetus or the birth of a child with a variety of malformations: microcephaly, micro- and macrogyria, pulmonary hypoplasia, esophageal atresia, anomalies in the structure of the kidneys, defects in the atrial and interventricular septa, narrowing of the pulmonary trunk and aorta, etc.

When the fetus is infected in late pregnancy malformations are not formed, however, from the first days of life, newborns show signs of various diseases: hemorrhagic syndrome, hemolytic anemia, jaundice of various origins (due to congenital hepatitis, cirrhosis of the liver, atresia of the biliary tract). Various clinical manifestations are possible, indicating the defeat of various organs and systems: interstitial pneumonia, enteritis and colitis, polycystic pancreas, nephritis, meningoencephalitis, hydrocephalus.

- Acute congenital CMV infection with the development of an obvious cytomegalovirus syndrome, it has a tendency to generalization, a severe course with the addition of secondary infections. Death is often inevitable during the first weeks of a child's life.

Chronic congenital CMV infection. Characterized by microgyria, hydrocephalus, microcephaly, clouding of the lens and vitreous body.

Acquired CMV infection.
- In adults and older children in most cases, it proceeds latently in the form of an asymptomatic carriage or a subclinical form with a chronic course.

- Acute form of acquired CMV infection. Often it may not have clear clinical symptoms, sometimes the main clinical manifestations are similar to influenza, infectious mononucleosis or viral hepatitis.

- In immunocompromised adults of varying severity (from physiological immunosuppression during pregnancy to HIV infection), as well as in children under 3 years of age, CMV reactivation manifests itself in the form of a generalized form with various lesions of organs and systems. The process may involve the central nervous system, lungs, liver, kidneys, gastrointestinal tract, genitourinary system, etc. The most commonly diagnosed hepatitis, interstitial pneumonia, enterocolitis, inflammatory processes of various parts of the genital organs (more often in women), encephalitis. With multiple organ lesions, the disease is characterized by a severe course, it can take on the features of sepsis. The outcome is often unfavorable.

Ulcers of the esophagus, stomach, intestines (thick and thin) may develop. Ulcers can lead to bleeding, with perforation, peritonitis develops. Cytomegalovirus hepatitis often develops. In AIDS patients, cytomegalovirus infection often results in chronic encephalitis or subacute encephalopathy. Apathy builds up and after a few weeks or months turns into dementia. Cytomegaly virus can cause the development of retinitis, which leads to blindness in AIDS patients, as well as in people who have undergone organ transplant surgery. Areas of necrosis appear on the retina, which gradually expand.

Eye lesions must be differentiated from similar changes that are observed in toxoplasmosis, candidiasis and herpes infection.

In addition to HIV-infected patients, cytomegalovirus infection is an important pathogenetic factor complicating organ transplantation operations. When transplanting kidneys, heart, liver, cytomegalovirus causes fever, leukopenia, hepatitis, pneumonia, colitis, retinitis. Most often this occurs within 1-4 months after surgery. It should be noted that with primary infection, the complication is more severe than with the activation of a latent cytomegalovirus infection. The severity of the course and clinical manifestations depend both on the degree of immunosuppression and on the immunosuppressant drugs used.

Cytomegalovirus pneumonia develops in about 20% of patients; undergoing bone marrow transplantation. Mortality in this group of patients is 88%. The maximum risk of developing the disease is observed from the 5th to the 13th week after transplantation. More severe cytomegaly occurs in the elderly. In kidney transplant recipients, cytomegalovirus infection can cause graft dysfunction.

- Manifestations of cytomegalovirus infection in pregnant women. In pregnant women, CMVI has various clinical forms. In acute infection, damage to the liver, lungs, and brain can develop. As a rule, patients complain of general malaise, headache, fatigue, mucous discharge from the nose, whitish-blue discharge from the genitals, enlargement and soreness of the submandibular salivary glands. Some characteristic symptoms are manifested in a complex: pronounced hypertonicity of the uterine body, resistant to ongoing therapy, vaginitis, colpitis, hypertrophy, cysts and premature aging of the placenta, polyhydramnios. Against this background, the weight of the fetus often exceeds the gestational age, and there is also an intimate attachment of the chorionic tissue of the placenta, premature detachment of a normally located placenta, blood loss during childbirth, reaching 1% of the woman's body weight, a clinic of latent postpartum endometritis with the development of menstrual disorders in the future.

Most often, cytomegalovirus infection occurs as a latent infection with periodic exacerbations. When making a diagnosis, the results of a laboratory examination are crucial. An auxiliary role is played by the presence of a burdened obstetric history, the threat of termination of a previous pregnancy, premature birth, the birth of sick children with malformations. In women with chronic CMVI, pseudo-erosion of the cervix, endometritis, ovarian dysfunction, extragenital diseases (hepatitis, chronic cholecystitis, pancreatitis, urolithiasis, chronic sinusitis, pneumonia, chronic diseases of the submandibular and parotid salivary glands) are more often noted.

Any manifestations of CMV infection are considered as indicative of HIV infection. In this case, it is necessary to examine the patient for antibodies to HIV.

Complications of cytomegalovirus infection
Complications are varied and depend on the clinical course of the disease: interstitial or segmental pneumonia, pleurisy, myocarditis, arthritis, encephalitis, Guillain-Barré syndrome, but they are relatively rare. After the acute phase, asthenia persists for many weeks, sometimes vegetative-vascular disorders.

Diagnosis of Cytomegalovirus infection

Differential diagnosis of CMV infection rather difficult due to the absence or variety of clinical manifestations.

For diagnosis of CMV infection it is necessary to use 2-3 laboratory tests at the same time. Examine saliva, washings obtained during bronchopulmonary lavage, urine, cerebrospinal fluid, blood, breast milk, sectional material, biopsy specimens. Due to the thermolability of the virus, the material for research must be delivered to the laboratory no later than four hours from the time of sampling.

The examination is carried out by virological, cytological, serological methods. Detection of specifically altered CMB cells is the most accessible method, however, its informative value is 50-70%. The most reliable detection in the material of the virus itself or its DNA. The virological method is still the gold standard. It is the most reliable, but its implementation requires a significant amount of time, so the retrospective nature of the diagnosis does not allow for adequate therapy and prevention.

For diagnosis, it is not necessary to isolate the virus itself, it is enough to isolate its antigen. For this, immunofluorescence reaction (RIF), enzyme immunoassay (ELISA), DNA-CMV hybridization, polymerase chain reaction (PCR) are widely used.

PCR method due to its high sensitivity, it detects even a segment of CMV DNA and is considered very progressive. Its most important advantage is the ability to diagnose early stages of the process, latent and persistent infections, but it has two significant drawbacks. Firstly, low predictive value due to the fact that PCR detects virus DNA even in a latent state. Secondly, this method is not specific enough.

In recent years, the most widespread ELISA method, which allows the detection of CMV antigen and specific antibodies of classes G and M. The detection of IgG is of secondary importance. It should be carried out simultaneously with the detection of IgM, especially for the diagnosis of primary infection. With a single detection of IgG, analysis of their level of avidity (ability to retain antigen) can help in differentiating between active and persistent infection.

It must be borne in mind that specific antibodies may not be detected in persons with reduced immunity, with protein starvation, etc. The determination of IgG must be carried out in paired sera with an interval of at least 10 days.

The recurrent form of CMVI is diagnosed when the virus is re-isolated in seropositive individuals.

The diagnosis of intrauterine CMVI is established during the first three weeks of life. The presence of IgM in a newborn up to two weeks of life indicates an intrauterine infection, after - an acquired one.

Affinity and avidity of antibodies
The importance of diagnosing primary cytomegalovirus infection in pregnant women has led to the study of the properties of antibodies produced by the body in response to infection.

Two main properties of antibodies have been established:
Affinity - the degree of specific affinity of an antibody for the antigen of the pathogen
Avidity - the degree of strength of binding of an antibody molecule to an antigen molecule

A close relationship between them has been established, the higher the affinity, the stronger the antibody binds to the antigen (higher avidity). Degrees of affinity and avidity make it possible to determine the age of class G antibodies and use it to judge the duration of infection and the course of the infectious process (latent course, relapse). The primary phase of infection is judged by the presence of virus-specific IgM antibodies, the period of presence of which in the body in the body is several weeks - months. An increase in IgG levels occurs within a few weeks. Initially, low-affinity antibodies are formed, which are formed during the active reproduction of the virus in the body and persist for up to 1.5 months. from the onset of the disease. Further, the body produces high-affinity IgG antibodies that persist for a long time. High-affinity antibodies remain in the body for a long time, providing immunity from infection.

To distinguish between primary and latent infection, avidity of class G antibodies. If low avid IgG is detected in the blood, this indicates a primary infection. Detection of highly avid G antibodies indicates a latent or past infection. If highly avid G and IgM antibodies are present in the body, then reactivation of a latent infection or re-entry of the virus into the body can be assumed. speaks of a secondary immune response in the event of a pathogen entering the body or exacerbation (reactivation).

In quantitative terms, the so-called avidity index is determined.

Avidity index up to 30% indicates the presence of low-avid antibodies and, accordingly, a primary infection, 30-40% indicates a late stage of a primary infection or a recent infection, an index over 40% indicates a long-standing infection.

Treatment of cytomegalovirus infection

Treatment of cytomegalovirus infection presents certain difficulties, since interferon and many antiviral agents (acyclovir, vidarabine, virazole) were ineffective, and in some cases their use causes paradoxical reactions. Ganciclovir slows down the development of cytomegalovirus retinitis, but has little effect on lesions of the lungs, brain, and gastrointestinal tract. Foscarnet has certain prospects. Perhaps the use of anticytomegalovirus hyperimmune human immunoglobulin. For the treatment of women with a burdened obstetric history, it is proposed to prescribe immunomodulators (levamisole, T-activin).

Mononucleosis-like forms of infection do not require specific treatment.

For the treatment of severe forms of CMVI in immunocompromised individuals and intrauterine CMVI in newborns, ganciclovir is used. It connects to the virus reproduction cycle and interrupts it. After the abolition of ganciclovir, relapses are possible. The drug has a number of side effects in the form of neutropenia, thrombocytopenia, liver and kidney damage, so it is prescribed to children for health reasons. Treatment is carried out under the control of a blood test every two days.

The appointment of interferons is considered effective.

At the present stage, it is important to combine antiviral drugs with interferons, which contributes to the elimination of CMV (combination of acyclovir with a-interferon), and also mutually potentiates the antiviral effect, reduces the toxicity of drugs (ganciclovir with interferon inducers, its most successful combination with amixin). At the same time, drugs are prescribed to correct immune dysfunction.

Specific anticytomegalovirus immunoglobulin is administered intramuscularly in 3 ml daily for 10 days. It contains 60% CMV-specific antibodies.

Nonspecific immunoglobulins for intravenous administration (Sandoglobulin) are prescribed for the prevention of CMVI in immunocompromised individuals. Their effectiveness is lower than specific immunoglobulins.

Effective for the prevention of CMVI in seronegative recipients is the use of immunoglobulins in combination with acyclovir or valaciclovir.

Vaginally use 0.25% bonafton, oxolinic, rhyodoxol, 0.5% tebrofen, florenal, 1% interferon, 3-5% acyclovir ointment 3-5 times a day for 12-15 days (ointments must be changed every 10-14 days).

For the treatment of the oral cavity, the same preparations are used in the form of solutions, as well as 0.5% atonium, 1:5000 furatsilin, 1-5% aminocaproic acid; with fungal complications - 1% iodinol and 0.25% rhyodoxol ointment.

With retinitis, CNS lesions, pneumonia in immunocompromised individuals, ganciclovir or foscarnet are most effective, the course of treatment is 14-21 days.

Prevention of cytomegalovirus infection

Specific prophylaxis not developed. When transfusing blood, you should use the blood of healthy donors that do not contain antibodies to CMV, this also applies to transplantation of internal organs. Prophylactic use of specific hyperimmune immunoglobulin in risk groups (recipients of bone marrow, heart, kidneys and liver; patients receiving cytostatic drugs, pregnant women) is shown. In the prevention of congenital infection, the prevention of contacts between pregnant women and patients, strict adherence to the anti-epidemic regime in obstetric institutions is of great importance. Children born to mothers with CMV infection who do not show signs of infection should not be breastfed. In the case of the birth of a child with CMV infection, a second pregnancy can be recommended no earlier than after 2 years.

Measures to prevent CMV infection in pregnant women
No measures can completely eliminate the risk of infection, but following these rules will reduce the likelihood of CMV infection.

1. Wash your hands thoroughly with soap for 15-20 minutes, especially after changing diapers (pampers) for infants
2. Never kiss children under 5 on the lips.
3. Set aside separate dishes and cutlery for yourself and small children
4. If you work in children's institutions (nurseries, kindergartens), take a vacation during pregnancy or drastically limit contact with children.

Which Doctors Should You See If You Have Cytomegalovirus Infection?

Infectionist

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