Acquired cytomegalovirus in children. Cytomegalovirus infection: symptoms, diagnosis, treatment. Symptoms of congenital pathology

Infection can occur pre-, peri- or postnatally.

Routes of infection: transplacental, alimentary route of infection after birth (through mother's milk). If infected after birth: pneumonia, hepatosplenomegaly, hepatitis, thrombocytopenia, lymphocytosis (sometimes atypical lymphocytosis). Diagnostics: virus isolation in biological tissue culture. Treatment is supportive (symptomatic).

CMV infection in newborns is often asymptomatic, in some cases children's body copes with the infection on its own without consequences for further life activity, but in some cases life-threatening conditions develop that entail serious consequences.

Epidemiology of cytomegalovirus infection (CMV infection) in children

CMV infection occurs more often in representatives of socially weaker sections of the population than in people with a good standard of living.

0.2-2% of newborns are infected during childbirth.

The presence of antibodies in women aged 20-40 years is present in 40-50%, in women with low social level- in 70-90%.

The reservoir of infection is body fluids: vaginal secretions, semen, urine, saliva, breast milk, tear fluid, as well as blood and its preparations.

Primary infection:

• In 1-4% of pregnant women. Moreover, against the background of viremia, fetal infection occurs in approximately 40% of cases.
• 10-15% of infected newborns exposed to infection during the primary infection of the mother have a clinically manifested picture of the disease with the presence of distant damage.
• The occurrence of fetal damage is possible at any stage of pregnancy, but still, the earlier the infection of the fetus occurs, the more severe the infection will be, and the likelihood of long-term consequences will be higher.

Recurrent maternal infection:

• Approximately 1% of newborns are infected at the time of birth, but in all cases the infection is asymptomatic.
• 5-15% of infected newborns later have moderate symptoms of CMV infection. At the time of birth, infection is possible as a result of exposure to the virus contained in the vaginal secretion.

Extremely premature babies with missing protective antibodies can become infected through breast milk.

Causes of cytomegalovirus infection (CMV infection) in children

Globally, CMV is detected in 0.2-2.2% of live-born infants. Congenital CMV infection is transmitted transplacentally. Severe course of CMV infection with severe clinical picture occurs in those infants whose mothers were primarily infected.

In some higher socioeconomic strata in the United States, 50% of women lack CMV antibodies, increasing their risk of primary infection.

Perinatal CMV infection is transmitted through contact with infected cervical secretions and breast milk. The majority of children to whom protective maternal antibodies were transferred transplacentally, after contact with infection, experience an asymptomatic course of the disease or infection does not occur at all. Premature babies who do not have antibodies to CMV often develop severe course diseases, often fatal, especially after blood transfusions of CMV-positive blood. Transfusion of CMV-positive blood is unacceptable; only CMV-negative blood or blood components should be transfused. Do not allow blood containing leukocytes for transfusion, only leukocyte-free blood.

Symptoms and signs of cytomegalovirus infection (CMV infection) in children

In many women infected with CMV during pregnancy, the disease is asymptomatic, in some it is a type of mononucleosis.

About 10% of children with congenital CMV infection have the following symptoms:

• intrauterine growth and development retardation;
• prematurity;
• microcephaly;
• jaundice;
• petechial rash;
• hepatosplenomegaly;
• pneumonia;
• chorioretinitis.

Neonates infected after birth, especially premature infants, may develop the following conditions: sepsis, pneumonia, hepatosplenomegaly, hepatitis, thrombocytopenia, and sensorineural hearing loss.

The incidence of malformations in congenital cytomegaly is not excessively increased, since CMV is not considered a teratogen. Increased frequency premature birth(up to 30%).

Hepatomegaia: pronounced, goes away after a few months. Transaminase activity and bilirubin (conjugated) levels are increased.

Splenomegaly: Varies from barely palpable spleen to gigantic splenomegaly.

Platelet count: decreases to 20-60/nl → petechiae (persist for several weeks).

Hemolytic anemia: (sometimes occurs late), extramedullary hematopoiesis (blueberry muffins).

Encephalitis → impaired brain development with microcephaly, impaired neuronal migration, delayed myelination, possible foci of intracerebral calcification.

Eyes: chorioretinitis, less often - optic nerve atrophy, microphthalmia, cataracts, calcification of foci of necrosis on the retina. Vision is impaired to one degree or another.

CMV pneumonia occurs rarely with congenital cytomegaly, but is observed very often with postnatally acquired CMV infection.

Teeth: enamel defects often lead to severe caries.

Sensorineural hearing loss: very common (up to 60%), less common (about 8%) with asymptomatic infection. Hearing loss can progress over the years.

Diagnosis of cytomegalovirus infection (CMV infection) in children

Differential diagnosis should be made with other intrauterine infections (toxoplasmosis, rubella, syphilis, etc.):

• isolation of the virus in biological tissue culture;
• PCR from urine, saliva, blood and other tissue samples.

The main diagnostic method for newborns is the isolation of viral cultures from tissue samples (urine, saliva, blood); serological tests can be performed in mothers. Culture samples should be kept refrigerated until inoculation into fibroblasts. After 3 weeks of life, a positive culture result may indicate either congenital or perinatal infection. Over the next few years, CMV may not be detected diagnostically (PCR) in the child, however negative result PCR to detect CMV does not exclude the presence of infection. A positive result of PCR samples (urine, saliva, blood and other tissues) will help in making a diagnosis. PCR diagnostics can determine the presence or absence of infection in the baby's mother.

Additional diagnostics: blood tests, various functional tests (ultrasound or CT (diagnosis of periventricular calcifications, ophthalmological examination, hearing test). Hearing testing should be carried out immediately after birth in all infected newborns, and further follow-up with an audiologist is required, since progression of hearing loss is possible.

Detection of the virus in urine, saliva or in liver or lung tissue post mortem.

• CMV is excreted in urine in high concentration. Urine should be delivered to the laboratory cooled to 4°C. DNA in situ hybridization or CMV-PCR. These methods can detect infection, but not disease!
• The cytopathic effect is visible under a light microscope no earlier than 24 hours later.

It is possible to detect CMV in a drop of dried blood on metabolic disease screening cards.

Important: Cards are generally kept for 3 months only.

Early detection of CMV is possible if a CMV-specific “early antigen” can be detected. The sensitivity of this method is 80-90%, the specificity regarding cell culture is 80-100%.

Antibodies to CMV, determined using an ELISA test, are not differentiated into Child's IgG and IgG obtained from the mother. The level of maternal antibodies after 6-9 months falls below the indication level.

Theoretically, detection of CMV-IgM indicates congenital cytomegaly, but this test is often false negative (sensitivity about 70%). Absence of IgG and IgM to CMV in cord blood V high degree excludes CMV infection.

Treatment of cytomegalovirus infection (CMV infection) in children

There is no specific therapy. Ganciclovir reduces viral shedding in newborns. When ganciclovir therapy is stopped, the virus begins to be released again, so the role of this drug in treatment remains controversial.

Treatment: ganciclovir, foscarnet and (potentially) cidofovir.

Ganciclovir is to a certain extent effective in treating CMV chorioretinitis, pneumonia, and gastroenteritis in patients with immunodeficiency.

Important: Toxicity of the drug with symptoms of leukopenia, thrombocytopenia, dysfunction of the liver, kidneys and gastrointestinal tract. The results of randomized trials assessing its effectiveness in cases of fetal infection are currently lacking, thus, data on the use of ganciclovir are limited to only individual cases of particularly severe cases, such as pneumonia.

Dosage: 10 mg/kg/day IV for 2 administrations over 2 weeks, then maintenance therapy for 4 weeks at a dose of 5 mg/kg/day IV for 1 administration 3 days a week.

Alternatively, ganciclovir maintenance therapy can be administered orally: 90-120 mg/kg/day IV in 3 doses.

• Monitoring the level of the drug in plasma is required. Target concentration 0.5-2.0 mg/l, maximum 9 mg/l.
• Ganciclovir is converted into a suspension in a sweetened solution, for example, in Ora-Sweet solution: 5 x 500 mg of ganciclovir dissolved in 15 ml of water (1 - in 3 ml) + 50 ml of Ora-Sweet + 1 ml of 3% hydrogen peroxide + diluted with Ora water -Sweet up to 100 ml - the suspension contains 25 mg/ml ganciclovir.
• Oral valacyclovir is planned to be available in the future.

Foscarnet and (potentially) IV cidofovir are options for alternative treatment.

The use of CMV hyperimmune sera in the treatment of congenital CMV infection has not been approved.

Prevention of cytomegalovirus infection (CMV infection) in children

Uninfected pregnant women should avoid exposure to the virus. CMV infection is common among children attending kindergartens. Pregnant women should wear protective medical masks and wash their hands.

Transfusions of CMV-positive blood should be avoided; only CMV-negative blood or blood components should be transfused. Do not allow blood containing leukocytes for transfusion, only leukocyte-free blood.

Reliable prevention of congenital CMV infection is unknown. Women planning pregnancy and at risk of CMV infection due to their professional activity(nurses/health attendants, kindergarten teachers) should Special attention take hygienic measures (hand washing, disinfection) when working with biological fluids (urine, feces, saliva) of infants, who are a category of patients potentially releasing CMV.

In full-term and premature newborns, only blood components that do not contain CMV IgG should be used. The use of a leukocyte filter reduces the risk of transfusion transmission of cytomegaly. The use of CMV hyperimmune serum for the prevention of transfusion cytomegaly has not been approved.

Premature< 32 НГ вследствие отсутствия у них протективных антител могут подвергаться заражению ЦМВ через материнское или донорское молоко, содержащее вирусы. Вирусная нагрузка материнского молока может колебаться в значительной степени, поэтому контроль молока на наличие ЦМВ не проводится. Пастеризация молока при t 65°С в течение 30 мин. сокращает опасность заражения.

Prognosis of cytomegalovirus infection (CMV infection) in children

Among newborns with severe CMV infection, a mortality rate of up to 30% has been recorded; 70-90% of survivors develop neurological disorders, including:

• hearing loss,
• mental retardation,
• visual impairment.

90% of newborns who had clinical cytomegaly from the moment of birth later develop erased or pronounced deficits. There is a significant risk of severe mental and psychomotor developmental delays. For many children, the learning process is difficult. Understanding is impaired oral speech, as well as the process of speaking itself.

In pre- and/or perinatally infected newborns with no symptoms of CMV infection after birth, in 10-12% of cases, before the second year of life, late damage develops in the form of hearing loss, less often chorioretinitis.

Treatment with ganciclovir reduces the risk of progressive hearing loss and possibly late neurological damage.

Cytomegalovirus is quite common in newborns. Infection occurs during intrauterine development or after childbirth. Only in 10–15% of cases, signs of the disease appear in babies immediately after birth. Children with asymptomatic cytomegalovirus syndrome are born clinically healthy. An active form of cytomegalovirus infection can be detected in them only after laboratory testing. The sooner treatment measures are taken against the congenital form of the disease, the better the result will be.

What is cytomegalovirus infection

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

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

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

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

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

Congenital cytomegalovirus infection

If a woman is infected with the virus in the first twelve weeks of pregnancy, the pathogens can cause spontaneous abortion or fetal death. The embryo develops serious violations developments incompatible with life. If the fetus manages to survive, the virus causes severe defects. Some of them are considered genetic (Dandy-Walker syndrome).

The most serious malformations occur in children if cytomegaly is detected in a pregnant woman for the first time. As a result of infection, children develop microcephaly (shrinkage of the brain), hepatosplenomegaly (enlargement of the spleen and liver), thrombocytopenia (decreased platelet count, causing decreased blood clotting) and prolonged jaundice (hyperbilirubinemia).

The infection affects the fetal nervous system, causing serious illnesses(debut of episyndrome and treatment-resistant epilepsy, non-occlusive hydrocephalus, childhood cerebral paralysis, autism). In some cases, cytomegalovirus infection in newborns can cause deafness, visual impairment and mental retardation.

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

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

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

Acquired form of cytomegalovirus infection

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

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

Sometimes, after infection with cytomegalovirus, in weak infants the lymph nodes become enlarged and hepatitis develops. Cytomegalic changes in the tubular epithelium may appear in the kidneys. The virus can cause ulcerative lesion in the baby's intestines. Such children have a difficult and long time to heal. They are often developmentally delayed.

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

Acute form of congenital disease

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

The baby's body temperature rises. Bluish-violet spots become noticeable on the face, body and limbs. The baby may develop hemorrhages in the mucous membranes and blood in the stool (hemocolitis). Sometimes from umbilical wound Blood continues to ooze. The development of hepatitis will be indicated by yellowness of the skin.

If newborns have brain damage, they may experience seizures from the first hours of life. It lasts up to 5 days or more. Trembling upper limbs occurs against a background of increased drowsiness.

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

Chronic form of congenital disease

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

baby with chronic form cytomegalovirus infection lags behind in development and does not gain weight well. At older ages, speech defects and mental retardation are detected.

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

The most difficult thing to detect is a latent form of chronic cytomegalovirus infection in a newborn. Such babies do not have visible signs diseases. If after the birth of the child there were no laboratory research, the infection will not be detected for a long time.

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

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

Treatment of a viral disease

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

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

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

But they have no idea what this disease is until they encounter it themselves. What is cytomegalovirus, how does it become infected, how does it manifest itself, how to treat it, and, most importantly, what to do if CMV is detected in a child - the answers to these and many other questions are in our article.

Cytomegalovirus is a type of herpes type 5. Since it was discovered relatively recently, scientists cannot say with certainty that it has been fully studied. At the same time, it is found in more than 40% of adults and 15% of children.

Until recently, it was believed that this disease could only be acquired through unprotected sexual contact with a carrier, but in our time other routes of transmission have been proven.

The insidious feature of this infection is that once it penetrates the body, it remains in it throughout life, but often occurs hidden and does not manifest itself in any way.

In many cases, the manifestations of the disease may be minor, but they pose a danger to children with weakened immune systems, as well as those with chronic diseases.

During pregnancy

Expectant mothers are at particular risk for cytomegalovirus. If a positive test is detected, the likelihood of infection of the fetus is extremely high. But the most dangerous cases are primary infection during pregnancy, because The body lacks the necessary antibodies to fight this disease. Therefore, the infection can manifest itself in an acute form, threatening the health of both the mother and the unborn baby.

You can become infected during pregnancy through sexual contact. Less commonly, infection occurs through contact of a pregnant woman with a carrier of the virus who is in the active stage, as well as through household items, personal hygiene, and kissing.

Therefore, every woman should be tested for antibodies to CMV before pregnancy. In case of their absence, must be observed preventive measures to prevent the virus from entering the body of a pregnant woman. The doctor develops special tactics for managing such a pregnancy.

If detected early in expectant mother and carrying out preventive measures, you can significantly reduce the likelihood of its intrauterine transmission to the fetus.

Causes of cytomegalovirus in children

Infection of babies with cytomegalovirus can occur in utero from an infected mother, or in early childhood. The source of infection is a carrier of a virus with an acute or latent (hidden) form.

CMV infection in children can for a long time be asymptomatic, sometimes signs of a cold or flu appear, but with a longer course. However, cytomegalovirus should not be perceived as harmless disease, since it can cause irreparable damage to the baby’s health, especially against the backdrop of a weakened immune system.

A child can get cytomegalovirus in several ways:

• Transplacental. It is transmitted to the fetus from an infected mother through the placenta.
• During delivery.
• In an infant, the infection enters the body through breast milk.
• By everyday means. An actively sick person can infect a healthy person, especially if the latter has a decrease in immunity due to illness or stress. In this case, infection occurs through airborne droplets, coughing and sneezing. It is also possible to get this virus in children's groups, through shared toys, which children are sure to taste one by one.

Identification of the flow pattern

congenital cytomegalovirus in children

When CMV enters the body, it causes a primary infection. In some cases, it is not expressed by any symptoms, but sometimes it manifests itself acutely, with the occurrence of many complications.

The form of leakage in babies can be of three types:

• Congenital.
• Spicy.
• Generalized.

With congenital liver and spleen are enlarged. Can lead to hemorrhages of internal organs and disruption of the central nervous system.

Acute the form is detected with an acquired virus, its symptoms are similar to colds, but, as a rule, it has a severe course with the addition of secondary infections. The severity of the course directly depends on the child’s immune status.

At generalized observed inflammatory processes in the internal organs, pneumonia often occurs, various lesions of the brain, peripheral nervous system, in many cases aggravated by the addition of a secondary bacterial infection.

Also distinguished recurrent type leakage. He manifests himself in the form frequent colds, complicated by bronchitis and pneumonia, lymph nodes throughout the body enlarge.

Very rarely observed atypical. It can cause damage to the reproductive system, interfere with blood clotting, and lead to hemolytic disease.

If it is congenital

Separately, the congenital form of CMV should be highlighted, since it is this that brings the most severe consequences to the health and development of the baby. From a carrier mother, the virus can enter the fetus at any stage of pregnancy. The nature of the lesions is directly related to the period at which the infection occurred. In the early stages of pregnancy (before 12 weeks), infection often leads to miscarriage.

The newborn is diagnosed with jaundice, convulsions, malformations of internal organs, incompetence respiratory system. In particular severe cases lesions of the central nervous system, hydro- or microcephaly, complete blindness and deafness are observed. As these children grow up, in addition to developmental delays, there are dysfunctions of the musculoskeletal system and mental development.

Symptoms

Manifestations of CMV in children are directly related to the child’s age and state of health.

Often, with the congenital form, there may be no obvious symptoms, but its consequences arise later in the form of visual impairment, neurological abnormalities, delays in growth and development. Less commonly, the disease attacks a newborn immediately after birth. In this case, the salivary glands are affected, jaundice occurs, enlargement and inflammation of the internal organs, skin rash, decreased hearing and vision.

When an infant is infected from mother's milk, as well as in babies under one year of age, symptoms may appear in the form of a rash and pneumonia.

A child 3 years of age or older experiences fever, fatigue, and respiratory symptoms. These conditions usually go away on their own within a few weeks. The older the baby, the easier it will be to cope with an exacerbation.

In general, symptoms after infection do not appear immediately, since the incubation period of the disease can last up to three months. Symptoms of manifestation are often mistaken for a banal ARVI or influenza condition:

• Heat.
• Redness of the throat and pain when swallowing.
• Runny nose.
• General malaise, weakness, drowsiness.
• In some cases, the lymph nodes become enlarged.
• Sometimes a rash appears in the form of red dots all over the body.

In babies with healthy immune systems, these symptoms disappear after a couple of weeks. With a decrease in immunity, weakness and body temperature may remain elevated for a long time, up to several weeks or even months.

Based on severity, the disease is divided into three categories:

• light;
• moderate;
• heavy.

At easy In this form, symptoms may be mild or absent altogether. Recovery occurs on its own, even without special treatment.

At medium-heavy form, damage to internal organs is observed, in many cases reversible.

At severe form, there are pronounced functional disturbances in the functioning of internal organs, as well as severe intoxication of the whole organism.

Diagnosis and treatment of CMV

Cytomegalovirus is diagnosed in the laboratory in several ways:

• Cytological method. Biological fluids are taken for analysis - urine or saliva, and when stained, cytomegalic cells are revealed. One of the disadvantages of this method is its low information content (50%) and the need for multiple repetitions.
• PCR method. More informative compared to cytology. Capable of detecting both active and latent viruses.
• DNA probe method. Detects the presence of a virus from the mucus of the cervical canal.
• Serological method. With this type of study, antibodies to CMV are determined - immunoglobulins M and G (lgM and lgG). This type of diagnosis is highly informative and determines the presence of a primary infection from the beginning of infection until 12 weeks after. The presence of IgG antibodies and high IgG titers indicate activation of the latent virus in the body.
• ELISA diagnostics (enzyme-linked immunosorbent assay). The most accurate diagnostic method, but very expensive. It is able to detect CMV in children's blood even in the presence of other infections in the body.

If the test for antibodies to CMV determines IgG positive in a child, this means that the baby has previously encountered this type and received immunity from it. Antibodies of the IgG type tend to accumulate in the blood and are present in a certain concentration throughout life. The doctor may retest in a few weeks.

An increase in antibody titers several times when compared with the first test result means that the virus is in an active stage of reproduction and treatment is required. If titers do not increase and there are no symptoms, treatment is not prescribed.

Antibodies of the lgM type are actively produced 5-7 weeks after the virus has captured the body, as well as during its next activation. The presence of IgM antibodies means that the infection occurred either recently, or the virus present in the body has entered an active stage. These antibodies may be present in a blood test for 6-12 months and disappear over time.

Treatment

in children it is long-lasting and complex. Unfortunately, it has not yet been developed these days specific remedy to suppress or completely cure this type of virus. Most commonly known antiviral drugs are not effective in treating CMV. Therefore, all measures are aimed at suppressing its activity, increasing protective functions the baby’s body and reducing the frequency of relapses.

In children with a congenital form of CMV, complex antiviral drugs. In addition, measures are being taken to minimize the harm caused by the virus and treat concomitant diseases depending on the severity of the lesions.

Therapy with human immunoglobulin preparations is also used, the administration of which is possible within a few hours after birth, due to their low toxicity.

CMV infection in children under one year of age is dangerous because their immunity is not yet developed enough to resist this disease, and the symptoms can be pronounced. Children with an acquired form of the virus in the latent stage, as a rule, do not require treatment.

The closest attention should be paid to those children whose immunity is weakened by others past diseases. In this case, the disease can strike internal organs, lead to their irreversible changes and incorrect operation in the future.

In other cases, symptomatic treatment is carried out:

• Taking antipyretics when the temperature rises.
• Bed rest.
• Drink plenty of fluids.

A doctor should monitor the condition of a sick child, since he is the one who is able to recognize signs of possible complications of the disease.

Only the attending physician should prescribe medications for treatment and select the dosage of drugs depending on the age of the child and the severity of the disease. Independent uncontrolled reception medications will lead to unpredictable consequences and complications, which, in turn, will complicate further treatment.

Prevention

Use contraceptive methods

A healthy child’s immune system will not allow the virus to activate in the body, or the disease will proceed easily and without complications. Therefore, preventive measures are aimed at strengthening immune defense. Children should eat properly and balanced, harden themselves, and regularly spend time outdoors. fresh air.

Taking multivitamin complexes gives good results, especially in winter. Decoctions of medicinal herbs - rose hips, St. John's wort, chamomile - have a positive effect on the immune system. Regular consumption of them in the form of tea will help to strengthen the children's body.

During epidemics of influenza and ARVI, you should limit the child’s communication with peers for some time, and also pay increased attention to his personal hygiene: regularly wash your hands with soap, when coming from the street, after playing and before eating. Be sure to carry out wet cleaning of the apartment and ventilation.

Sometimes, after an immunological examination of the child, to prevent complications, the doctor may prescribe immunostimulants in the form of medications. This can reduce the symptoms of the virus and transfer the disease to an inactive stage.

It is important for parents to remember that if their baby develops long-term, frequently recurring colds, they should definitely show the baby to a doctor, conduct an examination and never self-medicate. Timely preventive and treatment measures will help transform it into an inactive form and make it non-hazardous to the health and development of your child.

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Basically, cytomegalovirus in children is discovered accidentally when antibodies to CMV are present during a blood test ( Cytomegalovirus infection). Almost 60% of children are infected with CMV, but the virus remains in the latent phase (dormant mode) until a certain time, namely until the immune system declines, without showing itself in any way. Below we will talk about the causes and treatment of this disease, as well as how cytomegalovirus infection manifests itself in children.

Common reasons

Initially, the pathogen penetrates the respiratory system, digestive system or into the genitals through the mucous membranes of the mouth and nose. In the field of implementation of CMV infection in children, modifications (changes) usually do not occur. The virus, once in the body, continues to exist there forever, being in the latent phase until the immunity of the child’s body decreases.

The causes of immune deficiency can be:

• chemotherapy;
• frequent colds– acute respiratory infections, acute respiratory viral infections, sore throat;
• use of cytostatics ( medicinal preparations, suppressing cell division);
• HIV AIDS;
• serious illnesses.

The source of infection with cytomegalovirus in children is only the virus carrier - a person sick with CMV. Let's consider several options for transmission of infection:

• transplacental - the infection is transmitted to the fetus by penetration of the virus through the placenta from an infected mother;
• contact route of infection transmission - when kissing, saliva enters the mucous membranes of the mouth and throat, through the larynx into the upper respiratory system;
• airborne transmission - when a virus carrier sneezes or coughs while communicating with him, as well as through saliva;
• The household route of transmission of infection is through the common use of household items.

Cytomegalovirus infection in a child, as a rule, most often occurs at the age of two years. Children are already going to kindergarten or school, but they are not yet more scrupulous about personal hygiene. In addition, they like to exchange different objects or share food and various goodies.

Ways of infection of a fetus in utero or a newborn child

A newborn baby can be infected by a sick mother during childbirth (intrapartum) or breastfeeding (50% of cases of infection). Cytomegalovirus in a child can occur when the mother has an acute or aggravated infection with cytomegalovirus. In this case, infection of the fetus leads to the development of congenital cytomegaly in children.

Especially serious danger- it is when viral infection Fetal damage occurs early in pregnancy, approximately in the first three months. This can lead to the death of the child, and cytomegalovirus infection in newborns can be reflected in the occurrence of various types of defects - deformity or pathologies of internal organs.

Classification of cytomegalovirus in children

CMVI is characterized by a wide variety of forms:

• latent (sleep mode) or acute;
• localized (place of formation of the pathological process);
• generalized (spread of an abnormal process throughout the body or separate body from the source of infection);
• acquired;
• congenital.

As a rule, CMV infection in newborns occurs in utero. Most often this happens when a woman becomes infected with this disease before conceiving a child or during pregnancy. The fetus becomes infected through the placenta. If infection occurs early in pregnancy, the pregnancy most often ends in miscarriage.

Symptoms

Signs of congenital cytomegalovirus

With neonatal (newborn period) infection, symptoms of cytomegalovirus in children may cause malformations of further development. The virus helps in the formation of heart defects, pathological abnormalities in the formation of the brain and other severe abnormal processes in the child’s body.

The first symptoms of the actual presence of cytomegalovirus infection in children are the following:

• hypotonicity (reduced tone) of muscles;
• general weakness;
• lethargy;
• restless sleep;
• inability to digest food;
• decreased appetite.

In fairly severe cases, death is likely, possibly in the first weeks after birth.

When infected in the third trimester, children usually birth defects formations are completely absent. But there may be complications that are expressed by jaundice (disease of the liver and biliary tract), hemolytic anemia(blood disease), hydrocephalus (dropsy of the brain) and other serious pathologies.

Signs of acquired Cytomegalovirus

Acquired cytomegalovirus can manifest itself in extremely rare cases. Basically, it is in the latent phase, without showing any effect on the baby’s body, which indicates high work immunity in the child. This means that the immune system prevents the reproductive activation of this virus.

If children have low immune defense, then the disease will be expressed by frequent colds. These may be acute respiratory viral infections, acute respiratory infections with high temperature body and inflammation of the lymph nodes.

With chronic immune deficiency, children's bodies are often susceptible to infection. In current situation possible complications are localized (located) in some systems of the child’s body:

• nervous system;
• digestive system;
• the cardiovascular system;
• genitourinary system.

The form of this virus takes quite a long time to be treated, most often without success. But complicated type CMV is very rare. Signs of the disease and methods of treatment are vital information. Parents who care about the physical health of their children will be in mandatory strive to prevent permissible Negative consequences cytomegalovirus.

Diagnostics

Correctly diagnosing cytomegalovirus infection in children is very difficult, because the manifestations are visually similar to some colds. The attending physician carefully examines the children and, if necessary, gives directions for tests for research.

Analyzes

To detect cytomegalovirus in children, it is necessary to undergo tests:

1. blood for the presence of immunoglobulins class M and G to cytomegalovirus. The detection of class M immunoglobulins to CMV in the blood indicates a primary infection, and the detection of immunoglobulins G indicates chronic course diseases;
2. using PCR of urine and saliva, the presence of the pathogen itself can be examined;
3. during a general blood test in children, the number of red blood cells, platelets, and leukocytes is examined;
4. biochemical blood tests to examine liver enzymes.

Instrumental research methods

This examination is appropriately prescribed:

1. Ultrasound abdominal cavity for the study of the liver and spleen;
2. MRI or ultrasound of the brain to examine foci of inflammation.

In case of a generalized infectious disease, children are referred to an ophthalmologist for an examination of the fundus.

Treatment

Treatment of cytomegalovirus infection in children depends significantly on the age of the child, the form of the disease and its severity. Sleep mode form ( latent form) virus does not require special treatment. In this case, children need more special attention in terms of fully ensuring the following aspects:

• balanced diet;
• daily walks in the fresh air;
• easy hardening of the child’s body;
• increased psychological comfort.

Probiotics (apathogenic bacteria for humans, ensure restoration of microflora) and vitamin complexes help prevent dysbiosis and ensure maximum improvement of digestion.

Treatment for cytomegalovirus is required only for children with acute forms of CMV. The mononucleosis-like form of the disease does not require special treatment, but symptomatic treatment is actively used.

For intrauterine cytomegalovirus, as well as for severe overt (manifest) forms, inpatient complex treatment is usually carried out and includes antiviral treatment as:

• antiviral drugs (Ganciclovir, Foscarnet);
• anticytomegalovirus Immunoglobulin (Cytotect);
• interferons (Viferon).

Antiviral medications have pronounced toxicity side effects on circulatory system, as well as the kidneys and liver. In this case, these drugs are prescribed to children if their levels are significantly exceeded. therapeutic effect above high risk formation side effects. Some reduction in toxicity is often observed with the combined use of antiviral drugs with interferon.

Unfortunately, antiviral medicines do not save children from the virus, do not lead to the most complete healing. But their practical use will promptly prevent the formation of complications and literally transfer the virus into a latent mode and a completely inactive form.

In order not to harm the baby’s health, a mandatory consultation with a pediatrician is necessary to find out how to treat cytomegalovirus and with what. If necessary, the attending physician will give referrals for examinations to such specialized specialists as:

• infectious disease physician;
• neurologist;
• nephrologist;
• urologist;
• ophthalmologist (ophthalmologist);
• hepatologist;
• gastroenterologist;
• dentist;
• pulmonologist;
• immunologist

To summarize, it is worth recalling that cytomegalovirus infection, with certain forms of progression, does not always require treatment. It should also be noted that self-medication for CMV infection is not allowed, especially for newborns. Therefore, at the first suspicion of infection, immediately contact the pediatrician.

Cytomegalovirus infection (CMVI) – viral infection. It is caused by a DNA virus - Cytomegalovirus hominis, which belongs to the herpesvirus family, which includes Epstein-Bar, chickenpox and others. The CMV virus can be found in various parts of the human body, but CMV is most likely to settle in the salivary glands.

The causative agent of the disease, after entering the human body, multiplies in the cells of the infected person. HCMV is species-specific for humans, characterized by slow replication, reduced virulence, and low interferon-producing activity. The virus is heat labile, but remains virulent at room temperature.

Why is cytomegalovirus dangerous in children?

When a child is healthy, cytomegalovirus often does not manifest itself. However, the virus is deadly for people with immunodeficiency conditions: HIV patients, people with established transplants, expectant mothers and newborns. After infection, the cytomegalovirus virus can remain hidden in the body for a long time (latent form). It is practically impossible for a person to suspect that he has this infection, but he is a carrier of cytomegalovirus. Cytomegalovirus provokes such life-threatening complications as: inflammation of the brain (encephalitis); diseases of the respiratory system (for example, viral pneumonia); inflammatory and viral diseases in the gastrointestinal tract (enterocolitis, hepatitis) and so on.

The worst outcome of the latent course of CMV infection is malignant neoplasms.

This viral disease affects both children and adults. The child often becomes infected in the womb, through the uterus or placenta. When primary CMV infection occurs in early stages during pregnancy, this can quickly lead to the death of the fetus; in the later stages, the child continues to grow, but CMV infection, in one way or another, affects the quality of its intrauterine development. Congenital cytomegalovirus infection may develop, or infection may occur during childbirth. If the infection recurs, the risk of fetal infection is lower, but treatment is required. In accordance with each specific case, appropriate pregnancy management tactics should be developed.

Cytomegalovirus infection in a child: symptoms and treatment

Cytomegalovirus in children is widespread on the planet, but it is somewhat more common in developing countries with a low standard of living. The virus is detected in a variety of biological fluids human body: in the composition of blood, saliva, urine, breast milk, vaginal discharge and semen. Once in the body, the pathogen remains there for the rest of its life. Usually, CMV infection is not noticeable externally.

The signs of illness in infants are very similar to the symptoms of a common cold: increased fatigue, fever, inflammation in the pharynx, hypertrophy of the tonsils.

Usually, when good condition immunity, cytomegalovirus is in a latent form, without any manifestations clinical signs. Whereas during the period of decreased immunity, generalized forms of the disease develop.

Congenital cytomegalovirus in a child: symptoms

Clear signs of intrauterine infection with cytomegalovirus do not appear immediately after the baby is born, but only at 3-5 years of age. In addition, in children under one year of age, infection with cytomegalovirus occurs through close contact, both from relatives with whom the child lives, and from peers in various preschool institutions.

In both children and adults, the manifestations of CMV often look like an ordinary acute respiratory infection. Symptoms are usually the following: runny nose, fever, swollen lymph nodes, swelling of the pharynx, sometimes pneumonia, severe fatigue, manifestations of disorders in endocrine glands, liver, gastrointestinal tract.

Another consequence of cytomegalovirus is the disease mononucleosis, accompanied by fever, weakness, and fatigue. In the most severe cases, the disease affects all major organs.

Congenital infection with CMV infection in a child leads to impairments in physical and mental development. In addition, cytomegalovirus often leads to death, illness during the perinatal period and delayed disorders in organs and systems. About 40-50% of newborns from mothers who were primarily infected with CMV during pregnancy have intrauterine infection, of which in 5-18% clinical manifestations appear from the first hours of life. In 25-30% of cases of congenital infection with cytomegalovirus, death occurs. 80% of those who survive have significant neurological impairment. However most of infants infected with cytomegalovirus in the womb do not have pronounced clinical symptoms of the disease at birth, but unfortunately, in 10-15% of them the consequences will manifest themselves later in the form of a disorder auditory functions, deterioration of vision to complete blindness, delay in intellectual development, seizures.

Cytomegalovirus in children: causes and routes of infection

The virus can hide for a long time in human body, without showing oneself in any way. But in a situation where there is a failure in the immune system, cytomegalovirus wakes up and causes disease.

In adults, the virus is transmitted sexually, and children become infected with it while still in the womb or during birth canal. But you can become infected later: transmission occurs in domestic conditions with blood or saliva.

According to WHO statistics, about 2.5% of newborns are infected with cytomegalovirus in Europe. In Russia, the figures are higher - about 4% of children born with symptoms of the disease. Children born to mothers suffering from cytomegalovirus infection for the first time and in an acute form are immediately prescribed a test for antibodies to CMV. Intrauterine infection with cytomegalovirus is statistically detected in 0.4-2.3% of children born.

Signs and diagnosis of cytomegalovirus in an infant

In most newborns with congenital cytomegalovirus infection, signs of positive cytomegalovirus are not visible externally. They have temporary signs of the disease, which, after a certain time, will go away without a trace. Only a few people have symptoms of congenital CMV that persist for life.

Diagnosing cytomegalovirus in an infant is difficult, therefore, if infection is suspected, a blood test for antibodies is taken to detect antibodies to CMV.

The diagnosis is made by an infectious disease specialist or therapist, guided by the results special research. For example, polymerase chain reaction. Blood, saliva, vaginal and cervical samples, and amniotic fluid (during pregnancy) can be tested. Another method of testing for the presence of cytomegalovirus is immune, based on the reaction of the child’s immune system. Testing for cytomegalovirus infection is recommended for women planning to become pregnant.

Sometimes a positive cytomegalovirus has signs that are noticeable immediately during the birth process, although more often the consequences are detected months or even years later. Usually this is complete loss of vision and hearing.

Temporary signs of the disease include: damage to the liver, spleen of the lungs, yellowing of the mucous membranes of the eyes and skin, violet-bluish spots on the skin, reduced weight.

Constant signs of CMV infection in newborns are: blindness, deafness, small head, mental retardation, impaired coordination, death.

CMV infection should be distinguished from herpes type 6. Despite the similarity in the clinical manifestations of these two types of herpes viruses, type 6 herpes has serious differences. It is important not to miss the following warning signs:

1. An increase in temperature to 39-40 C, which does not decrease steadily for three to five days.
2. There are no signs of acute respiratory viral infection or intestinal infection.
3. Roseola causes red rashes to appear on the body.
4. Convulsions due to high temperature.
5. ARVI on the tonsils - herpetic sore throat.
6. Inflammation such as stomatitis in the oral cavity.
7. Neurological disorders.

If the manifestations of herpes virus type 6 are not noticed in a timely manner, the child runs the risk of severe damage to the spinal cord or brain. In infants, complications from herpes type 6 lead to death. It is necessary to urgently call a doctor in order to start the necessary medical care for the child in a timely manner.

Diagnosis of cytomegalovirus infection in children

Whether the child has an infection will only be determined by laboratory analysis blood for the presence of antibodies to CMV. If the analysis showed congenital cytomegalovirus, then it is not necessary to expect acute form illness and the child is guaranteed to be in danger. Cytomegalovirus IgG positive, what does it mean? If antibodies to cytomegalovirus in the form of IgG are detected in a child in the first three months of life, most likely they were transferred to the baby from the mother who carried the virus and will soon disappear on their own. In an adult and an older child, this may indicate the development of stable immunity to infection. But if positive antibodies of the IgM class are found in the baby’s blood, giant cells that the body produces in order to respond to the invasion of the virus as quickly as possible, an acute form of cytomegalovirus disease is evident.

How to treat cytomegalovirus infection in children

It is impossible to completely cure cytomegalovirus. However, symptoms can be removed by using antiviral drugs: Panavir, Acyclovir, Cytotect, etc. With these medications the virus will be under control.

For sick expectant and nursing mothers and children, immunity is increased and specialized antiviral drugs are prescribed. In this case, the main emphasis is on increasing immunity. Why are medicinal plants-immunostimulants (such as echinacea, leuzea, ginseng and others) prescribed? active additives(for example, Immunal), medicinal plants-immunostimulants (such as echinacea, leuzea, ginseng and others), balanced diet(minerals and trace elements), which necessarily includes fresh vegetables and fruits (vitamins), frequent walks in the fresh air and regular physical activity. To prevent children from becoming infected with cytomegalovirus, it is necessary to provide them with proper nutrition, do physical exercises with them, avoid contact with sick people and maintain hygiene.

Treatment of cytomegalovirus in children with traditional methods

IN folk recipes No specific treatment, aimed at eliminating cytomegallovirus infection, but there are many means to improve the condition of the immune system. Here are some recommendations:

1. A mixture of licorice root, alder cones, kopeck root, leuzea root, chamomile flowers, string grass - in equal shares. Prepare two tablespoons of a mixture of crushed herbs, pour 0.5 liters of boiled water and leave in a thermos overnight. Reception: a third to a quarter of a glass, 3-4 times a day.
2. Garlic and onions help children cope with the virus, especially during the autumn-winter cold season. At this time, it is recommended to add a clove of garlic or several onion rings to your food every day.
3. Aromatherapy - spraying oil in the apartment tea tree creates a microclimate favorable to health.
4. Take aspen and alder bark, as well as dandelion root, one to one. Pour 0.6 liters of boiling water over a tablespoon of the mixture and simmer over low heat for five minutes. Dosage: 2 tablespoons twice a day before meals.