Features of the course of cytomegalovirus infection in women and methods of its treatment. How does cytomegalovirus infection get infected? What methods of treatment does modern medicine offer?

Cytomegalovirus infection is a viral pathology provoked by an infectious agent from the beta-herpesvirus subfamily. The widespread spread of infection is observed, the process of infection occurs if a healthy person is in close contact with carriers of the infection. If the immune system is functioning properly, cytomegalo treatment viral infection in women it is not required.

What are the signs of cytomegalovirus in women and men? What drugs should be used to treat cytomegalovirus infection? We answer these and other questions in this article.

cytomegalovirus under a microscope

CMV infection in women - what is it?

This is a pathology of viral origin, which is similar to the symptoms of a persistent cold: complaints, weakness, malaise, headache... The salivary glands are inflamed, there is profuse pathological salivation.

CMV analysis in women shows that the cells that are affected by the infection are significantly increased in size, which is why the infection is called "cytomegaly", which means "giant cells".

Antibodies to the virus are detected in 12-16% of adolescents and more than half of the adult population. For a long time, the virus can be dormant and not manifest itself. However, with a weakening of the immune system, its activation is possible.

Ways of infection in adults

photo of cytomegalovirus in women

The main cytomegalovirus in adults is through saliva, as well as with prolonged interaction with an infected person. The disease can be transmitted as follows:

Airborne droplets (during coughing, kissing, etc.).
During sexual intercourse with a carrier.
During blood transfusion.
During the period of bearing a child.

Exists a large number of people who are unaware that they have a positive cytomegalovirus and are carriers of the infection, since the virus is in a latent state.

Features of CMV in men and women

Cytomegalovirus in men and women without impaired functioning of the immune system manifests itself in the form of a mononucleosis-like syndrome:

Prolonged fever (more than 30 days), accompanied by a significant increase in body temperature, chills.
Symptoms of CMV in women and men are associated with complaints of sore throat.
Myalgia, headache.
The first signs in women and men may be associated with an increase lymph nodes.
Skin rashes similar to rubella are formed.
Symptoms of CMV in men and women also manifest themselves in the form of complaints of a significant decrease in working capacity, increased fatigue and weakness.
In isolated cases, the development of jaundice and hepatitis is observed.
Sometimes there are low-symptom manifestations of cytomegalovirus in women of childbearing age.

Symptoms of cytomegalovirus in women and men who have had an infection can go away on their own, but the person continues to be a carrier and excretes the virus along with saliva and other physiological fluids.

After the primary infection has occurred, the virus remains in the human body in a latent form until an endogenous or enzogenic factor affects its activation.

Manifestations of infection in immunocompromised patients

photo cytomegalovirus infection in women and its symptoms

Some categories of patients (for example, people who have undergone a transplant) are shown to take immunosuppressants, which suppress immune reactions and provoke the activation of CMV in the body. Virus infection is observed in almost all patients with HIV infection.

At the initial stage of virus activation, the development of malaise, muscle and joint pain, fever, increased sweating at night is observed.
In the future, there is the development of cytomegalovirus hepatitis, pneumonia, encephalitis, ulcerative lesions stomach and stomach bleeding.
In women, there may be damage to the ovaries, cervix, inner layer of the uterus, vagina.

Patients who are interested in how it affects the conception of cytomegalovirus in men should take into account that the infection can affect the testicular and prostate area. In some cases, this can lead to impaired fertility and requires the appointment of a treatment regimen.

The course of the pathological process

Signs of cyatomegalovirus in women and men will differ, depending on the course of the pathological process.

How does CMV infection progress	Symptoms in women and men	Characteristics
Against the background of normal functioning of the immune system	The incubation period lasts up to 2 months. Cytomegalovirus infection in women and men manifests itself as a mononucleosis-like syndrome. Cytomegalovirus in an adult can last for 14 days to 1.5 months.	In most cases, nonspecific symptoms appear and treatment may not be necessary. This is due to the fact that with the normal functioning of the immune system, the body can independently develop antibodies to a viral infection. In this case, cytomegalovirus in adults can pass on its own, without the use of any drugs.
Cytomegalovirus in men and women with weakened the immune system	Acute and pronounced course of the disease.	Generalized infections develop, the virus infects the kidneys, liver, lungs, organs of vision, pancreas. Patients with a history of organ transplant and HIV infection are susceptible to infection.

After reviewing the information on how cytomegalovirus manifests itself in women, at the first signs of the development of a pathological process, it is recommended to consult a doctor.

Forms of the disease

The classification of cytomegalovirus infections is as follows:

The latent form is characterized by the absence of any manifestations of the disease.
The development of the subclinical form is accompanied by nonspecific symptoms(fever, headache, weakness), which are characteristic of many other diseases.
In congenital form, the infection is transmitted from mother to child during gestation or birth.
In the acquired form, the virus is localized in saliva, in the generalized form, in the area of several organs.
With viral sepsis, there is an increased concentration of the virus in the blood plasma and damage a large number internal organs.

The development of a clinically pronounced form can be acute, subacute and chronic:

In the first case, there is a sudden, pronounced manifestation of symptoms, which quickly disappear.
With a subacute form, there is gradual development pathological process, symptoms are mild.
Chronic cytomegalovirus infection in adults is expressed as a periodic manifestation of symptoms of the disease.

In severe immunodeficiency states, the development of an acute form of the disease can cause death.

Diagnostics

photo of cytomegalovirus in men

Before deciding how to treat cytomegalovirus in men and women, the doctor conducts a full-time examination and prescribes comprehensive examination... An accurate diagnosis depends on the clinical picture of the disease and the results of laboratory tests:

A general blood test, which may indicate an increase in the quantitative content of leukocytes.
Isolation of viruses in cell cultures.
Carrying out cytological studies and light microscopy.
The implementation of the enzyme immunoassay, when it is possible to detect in the blood specific antibodies to certain classes of viral infection. The norm in the blood of an adult is determined individually, depending on the state of the immune system.
Recommended for women gynecological examination for detection of infection in the cervical canal.

Important!

The rate of antibodies to cytomegalovirus igg in women is up to 0.5 IgM. The fact that antibodies are produced in the host's body is good sign indicating the normal functioning of the immune system. However, in the event that anti cmv igg above the norm in women, especially those awaiting the birth of a child, an immediate consultation with an infectious disease doctor is required.

Treatment of cytomegalovirus

To answer the question of whether cytomegalovirus in women can only qualified doctor after the examination, taking into account the accompanying violations.

Patient group	Therapy	Features of therapy
Treatment of cytomegalovirus in men and women with normal immunity, in an uncomplicated form	Does not require specific measures. It is recommended to carry out therapeutic measures by analogy with the therapy of colds.	Antipyretic drugs, pain relievers may be recommended. In order to eliminate intoxication, treatment is supplemented by adherence to the drinking regimen.
Patients at risk: individuals who have undergone organ transplantation, who require hemodialysis, and patients with a history of malignant neoplasms.	Treatment of cytomegalovirus in adults is required if generalized forms of infections are identified. The treatment regimen for cytomegalovirus in women and men is identical: drugs based on ganciclovir are used. Treatment of cytomegalovirus in women and men is recommended to be carried out in stationary conditions.	Reviews indicate that the drug has a number of severe unwanted side effects, including the development of anemia, neutropenia, thrombocytopenia. The drug is not used to treat women who are expecting a baby or patients with a history of kidney failure.
HIV-infected patients	Treatment of CMV in women and men is carried out using the drug Foscarnet. The process should be carried out under the constant supervision of a doctor who will promptly adjust the dosage.	Against the background of the use of the drug, it is possible adverse reactions in the form of electrolyte metabolism disorders, manifestations, urination disorders, nausea, renal dysfunction.

Important!

Medicines based on ganciclovir are not used to treat patients with normal functioning immune system! Having studied the information on how to treat cytomegalovirus in adults, it is strongly recommended to refrain from self-medication.

Complications

It is important not only to have information about how the treatment is going. cytomegalovirus infection in adults. You also need to understand cytomegalovirus for women and men.

Cytomegalovirus in women awaiting the onset is dangerous for miscarriage if the patient becomes infected during the first 12 weeks. Infection after this period is dangerous by the development of complications in the form of congenital cytomegaly.
Infection can be fatal in immunocompromised patients. The listed categories of patients should be subjected to maximum protection against viral infection. In case of infection, it is necessary to start treating cytomegalovirus infection in such people as early as possible due to the risk of hepatitis, retinitis, radicular syndromes, colitis, esophagitis, pneumonitis of cytomegalovirus origin.
A complication in HIV-infected patients can be the development of internal bleeding and a significant decrease in vision, up to its complete loss. With multiple lesions, dysfunction of internal organs develops, which is fatal.

Preventive actions

It is necessary to pay special attention to the prevention of possible infection for those categories of patients who fall into the risk group. Non-specific prophylaxis in the form of personal hygiene is ineffective, therefore it is recommended to pay attention to the use of drugs such as ganciclovir, fornet, acyclovir.

Women planning to conceive a child need to be tested for TORCH infections, including cytomegalovirus, herpes, rubella, toxoplasmosis. This will avoid possible problems when carrying, during and after the birth of a child.

Before starting treatment for cytomegalovirus, it is necessary to accurately diagnose the disease and determine whether treatment of CMVI is necessary at all in your case. Since it is not always required, you need to be aware of this. In addition, it is not easy to diagnose the presence of cytomegalovirus infection and it is easy to confuse CMV with other diseases. Below we will talk about how to cure cytomegalovirus and how it is treated, as well as in what cases it is necessary.

Cytomegalovirus infection should be treated only when the disease is an undeniable danger to human body... Only a specialist, after visiting a sick clinic to diagnose the disease, clearly identifies such cases. If the body has symptoms of a generalized infection of cytomegalovirus, then it is extremely important to go to the clinic. The treatment regimen for cytomegalovirus can be drawn up only after a personal examination of the patient.

A person who has recovered from cytomegalovirus and has suffered an infectious disease without any serious consequences acquires a fairly strong immunity. In the overwhelming majority, cytomegalovirus infection, affecting the human body, does not cause any symptoms. The virus itself in the body takes a dormant mode, remaining in a person forever. And it manifests itself, causing relapses, accompanied by all sorts of complications, only with a strong weakening of the immune system.

In all cases, the treatment of cytomegalovirus infection pursues the stated goal - to significantly mitigate the negative impact of the viral infection on the human body. Most often, after infection, a person with a sufficiently strong immune system easily tolerates an initial outbreak infectious disease, therefore, there is no need for a person with cytomegalovirus to go to the hospital. In such people, after a short-term manifestation, the set of created symptoms ceases without a trace. As a result, the disease goes largely unnoticed.

When is the treatment of cytomegalovirus really necessary?

Specific prevailing circumstances, according to which the attending physician determines the course of treatment for cytomegalovirus infection in adults or in children, are related to such manifestations as:

The presence of acquired or congenital immunodeficiency in a patient of any age.
Generalized stage - the extensive spread of the virus is accompanied by a very painful inflammatory process throughout the body or in a specific organ against the background of the presence of other infections that weaken the basic protective functions of the human body.
Complicated or exacerbated course of cytomegalovirus or preparation for treatment in allogeneic organ transplantation, pneumonia, encephalitis, oncological diseases - when using therapy that severely suppresses the immune system.
During the first trimester of pregnancy, women with weakened immunity may develop primary cytomegalovirus, which can potentially cause extremely severe damage to the fetus, and may also provoke miscarriage.

Generalized stage or symptomatic exacerbation Diseases of cytomegalovirus infection are often characterized by the fact that most patients and even sometimes some doctors confuse this viral disease due to the similarity with the symptoms of influenza or ARVI diseases. And also with other infectious diseases. This often leads to incorrect treatment and a high risk of developing severe complications.

With absolutely accurate differential diagnosis, the patient will be prescribed the most adequate treatment for cytomegalovirus. And the medicines are prescribed for the correct purpose.

Drugs and vitamins for the treatment of cytomegalovirus infection

Let's take a look at how to treat cytomegalovirus with medications. The main medications from cytomegalovirus infection and their treatment, are divided into several small groups:

Symptomatic remedies- provide relief, anesthetize, eliminate inflammation, constrict blood vessels (drops in the nose, eye drops, pain relievers, anti-inflammatory, folk remedies).
Antiviral medications- suppress the activity of infection (Ganciclovir, Panavir, Tsidofovir, Foscarnet).
Syndrome therapy drugs- restore damaged organs and tissues in case of complications (capsules, suppositories, tablets, injections, gels, ointments, drops).
Immunomodulators- strengthen and stimulate the immune system (Leukinferon, Roferon A, Neovir, Genferon, Viferon).
Immunoglobulins- bind and destroy viral particles (Neocytotect, Cytotect, Megalotect).
Vitamin and mineral complex- to support the immune system.

In men, cytomegalovirus is treated antiviral drugs- Foscarnet, Ganciclovir, Viferon. And immunoglobulins - Cytotect, Megalotect.

In women, cytomegalovirus is treated with antiviral drugs - Acyclovir, Viferon, Genferon, Cycloferon.

List of drugs

Foscarnet is an antiviral drug. Infectious cytomegalovirus is treated quite successfully with Foscarnet. It is applied when severe cases diseases and in complex forms of possible exacerbations that can be caused by other diseases. It is advisable to use this drug with a weakened immune system in a patient. When the drug enters the diseased cell, the elongation of the viral chain is disrupted, that is, the drug slows down, and then completely stops the active multiplication of the virus.
Ganciclovir is an antiviral drug. The drug is one of the most effective, rather difficult in practical use. The remedy is prescribed for the course of the disease - cytomegalovirus infection, complicated by especially severe organ pathologies, rather extensive inflammations. It is also used for the prevention of viral infection, congenital CMV infection. Release form - tablets and crystalline powder from the group of polar hydrophilic solvents. For eye gel or injection, the drug is available in the form of a lyophilisate. The use of Ganciclovir is advisable in the treatment of cytomegalovirus, a herpes infection.
Cytotect is an immunoglobulin. For many patients, Cytotect seems to be one of the most optimal agents for the treatment of cytomegalovirus. The drug combines a fairly effective efficacy and an almost complete absence of general toxicity and relative contraindications. It is prescribed for prophylaxis in patients with an immune system suppressed by medications. Prevents massive manifestations of the disease after infection with CMVI. When applied, you can create: headaches; nausea and vomiting; chills and fever; joint aches and mild back pain; sometimes lowering blood pressure.
Neovir is an immunostimulant. Solution for injection, used as an immunostimulating drug for the treatment and prevention of cytomegalovirus infection in people with immunodeficiency.
Viferon is an immunomodulator. Suppositories with antiviral action. It is used for complications infectious diseases, with primary inflammation, as well as recurrence of localized cytomegalovirus infection. The drug is administered rectally. When applied, it may cause an allergy in the form of a skin rash.
Bischofite is an anti-inflammatory drug. It is produced in the form of a balm (gel) in a tube or in a glass container in the form of a brine. It is applied topically as therapeutic mud or mineral water.

List of vitamins

C - Antioxidant with a broad spectrum of action. Stimulates the work of cells that devour bacteria and viruses in the blood. Increases the resistance of the human body various infections with the help of the resistance of cells to the penetration of infectious agents.
B9 - for the powerful maintenance of the manufacturing factory (bone marrow) of the human body's immune system.

TO general rules treatment of cytomegalovirus includes hospitalization of the patient in cases where it is extremely necessary. Since during the period of treatment the patient appears to be a very active source of viral infection for others, the patient must significantly limit any contact with people. Ensure absolute peace as much as possible. Provide the best the necessary conditions microclimate. Observe strict rules of personal hygiene. Use a therapeutic and prophylactic diet.

With strict adherence to these rules and all the recommendations of the attending physician, you can rely on a fairly quick and most effective getting rid of the infection and avoiding complications and relapses.

Treatment with folk remedies

If a person heard that people were being treated for cytomegalovirus with home medicine, then this is a misconception that it is possible, thanks to traditional medicine, to cope with such a difficult task. Treatment of such an infection and all kinds of complications should not proceed by itself without the supervision of a specialist. But support the immune system folk remedies quite appropriate.

Cytomegalovirus is considered a common infection today. Symptoms in women can occur in both mild form, and completely absent, which can be explained by the latent course of the disease. If a person's immune system is strong enough, infectious agents do not pose a threat to the body. Otherwise, especially with an existing immunodeficiency or after a transplant, cytomegalovirus can cause dangerous complications.

Cytomegalovirus in women, when ingested, causes a chronic infectious disease. For the most part, as such, there are no manifestations of infection, but it is not uncommon for pronounced symptoms to occur. The main reason for the entry of foreign agents into a woman's body is a weakened immune system. At the same time, he is no longer able to fight penetrating infections, allowing them to gain a foothold in internal organs and systems. Unfortunately, people of any age are susceptible to the disease.

The primary entry of the virus into a woman's body comes from the direct carrier of this infection. A secondary disease is caused by the influence of a certain external or internal factor that negatively affects protective function immunity. The root causes can be called:

transmission of infection to a child during labor or during the prenatal period;
the entry of the virus into the body when a sick person coughs, sneezes, or when kissing;
infection as a result of transfusion of infected blood to a healthy person;
intercourse with a sick partner is another cause of transmission.

The active course of cytomegalovirus infection can be caused by such provoking factors as the concomitant development of a cancer, HIV infection or AIDS, pathology digestive tract... Anticancer drugs and antidepressants, which a person takes, can also "awaken" the virus.

Symptoms of the acute disease

CMV (cytomegalovirus infection) is accompanied by symptoms that differ from person to person, depending on the form of the disease. In most cases, a latent course is diagnosed, in which pronounced symptoms do not appear until the effect of a provoking factor. In this case, there is an acute form of the disease. In some people, severe damage to internal organs is observed, which characterizes the generalized form of pathology.

The acute form of cytomegalovirus disease bears similarities to infectious mononucleosis. Its beginning is abrupt, with a rise total temperature and febrile syndrome. In addition to this symptomatology, the first signs of pathology are also in the defeat of the lymph nodes, during which they increase in size. Their soreness, increased softness and elasticity are also noted.

At stage 1 of the development of acute cytomegalovirus infection, the cervical lymph nodes are involved in the lesion. Following them, the submandibular, axillary, and inguinal increases. It is lymphadenopathy that is the first sign of the disease and the last in its disappearance. Other symptoms of this condition include headache, general malaise, hepatomegaly (an increase in the size of an organ such as the liver), atypical mononuclear cells in the blood.

The main difference between cytomegalovirus infection and mononucleosis is the absence of tonsillitis in the first case. Also, the occipital lymph nodes and spleen are rarely enlarged.

Symptoms of the disease of the generalized form

This form of the disease manifests itself quite rarely, but with the development of severe symptoms. Basically, generalized cytomegalovirus infection in women occurs against the background of immunodeficiency or other infection. In the first case, the preceding factor may be chemotherapy or radiotherapy, and in the second, HIV infection. The generalized form of the disease can occur together with damage to internal organs, blood vessels, nerves, salivary glands.

Development of cytomegalovirus hepatitis and pneumonia

Hepatitis with cytomegalovirus is accompanied by the involvement of organ cells and blood vessels in the pathological process. In this case, the development of inflammatory infiltration and necrosis occurs. Dead cells are exfoliated and infiltrated bile duct, clogging it up and causing stagnation. As a result, jaundice, the main symptom of which is yellowness. skin... There is also general malaise, nausea and vomiting.

At the beginning of the development of generalized cytomegalovirus infection, interstitial pneumonia occurs, which is accompanied by damage not to the alveoli, but to their walls, capillaries and tissue around the vessels. Treatment of this type of pneumonia is difficult, which explains its long course. In some cases, there is a connection bacterial infections with the appearance of the following symptoms: a significant increase in the general temperature, febrile syndrome, cough with sputum, feeling of lack of air.

Development of cytomegalovirus retinitis and sialoadenitis

A disease such as retinitis is accompanied by damage to the optic retina. Both eyes are involved in the pathological process. Retinitis proceeds with the following symptoms: photophobia, clouding and goosebumps.

With sialoadenitis, the salivary glands, especially the parotid glands, are affected. In this case, an increase in the general temperature occurs, the occurrence of a shooting pain syndrome in the affected area, a decrease in salivation and dryness in oral cavity.

Development of cytomegalovirus nephritis and diseases of the reproductive system

The inflammatory process in the kidneys develops in areas of the organ such as tubules, capsules, glomeruli. In addition to the kidneys, the ureters and bladder may be involved. Renal failure develops rather quickly, which is accompanied by the appearance of a sediment in the urine, including epithelium and cytomegalovirus cells.

Perhaps the development of cervicitis, endometritis, salpingitis - those pathologies that are chronic. In this case, such a symptom arises as periodic, unexpressed pain in the lower abdomen, which manifests itself during urination and during intercourse.

Features of the course of cytomegalovirus infection in women with AIDS

According to numerous studies, 9 out of 10 women suffering from acquired immunodeficiency syndrome are also infected with cytomegalovirus. Such patients often suffer bilateral pneumonia, which proceeds together with damage to the lung tissue. Such a concomitant disease is characterized by a protracted course with the occurrence of a painful cough and shortness of breath. Another symptom of cytomegalovirus in women with AIDS is encephalitis, the complications of which are dementia, decreased memory and attention.

Involved in defeat and nervous system... Polyradiculopathy often develops - a disease characterized by damage to the nerve roots, general malaise and pain in the lower extremities. Cytomegalovirus infection in women with AIDS also occurs with the involvement of such organs in the pathological process as:

kidneys, followed by the development of acute nephritis, etc.;
liver, with the onset of hepatitis, jaundice, liver failure, etc.;
pancreas, with the development of pancreatitis, etc.;
eyes, with the onset of retinitis, retinopathy, etc.;
organs of the genitourinary system, with further development cancer of the cervix, endometrium, etc.

The treatment regimen for cytomegalovirus in such cases is determined by the attending physician. Often it is the cytomegalovirus infection that occurs in women with AIDS that is the cause of death.

Treatment

Treatment of cytomegalovirus in women, first of all, consists in taking antiviral chemotherapy drugs, active ingredients which contribute to the inhibition of the DNA polymerase of the virus.

Chemotherapy is prescribed, as a rule, if the disease proceeds in a generalized form, when the retina or lungs are involved in the pathological process. Such drugs are highly toxic, which does not allow their use during pregnancy. The impact of chemotherapy drugs on the human body becomes the cause of a negative effect on an organ such as the kidneys.

Contraindications to the use of chemotherapeutic agents are: decreased hemoglobin (less than 80 g / l) and platelet count (less than 250 thousand * 10¹² g / l), the development of severe renal failure. Side effects may also occur, for example, such as impaired functioning of the liver, kidneys, seizures, candidiasis, ataxia.

Other drugs used in the treatment of cytomegalovirus infection are interferons. During the vital activity of such a virus, leukocytes in the blood weakly produce natural interferon, which is the reason for replenishing it with the help of drugs. The most common of these are: Viferon, Cycloferon, Genferon. The advantage of such drugs is the limited number of side effects.

Another drug for the elimination of cytomegalovirus infection is the hyperimmune human immunoglobulin Cytotect, which contains antibodies to the virus. The drug can be used even during pregnancy. Despite such a great effectiveness of the drug, it can cause side symptoms: headache and joint pain, nausea, vomiting, anaphylactic shock, hypotension. The main contraindication to taking the drug is individual intolerance to its components.

How to prevent infection of the body with cytomegalovirus

How to treat cytomegalovirus has been elucidated. It is worth mentioning the methods of prevention, because if you take all preventive measures, you can significantly reduce the risk of pathology. For this reason, it is recommended to observe the following recommendations:

Limiting contact with people suffering from cytomegalovirus infection.
Systematic ventilation of premises, including industrial and public ones, where there is a mass gathering of people.
Preventive examinations of women both during pregnancy and in the planning stage, even if there are no pronounced symptoms.
Blood test of donors for the presence of cytomegalovirus infection.

And, of course, the most important rule of disease prevention is a timely visit to the doctor, at the first alarming symptoms.

Cytomegalovirus infection Is a viral disease in which giant cells and lymphohistiocytic infiltrates are formed in the affected organs, a latent course in people with a normal immune system, mainly in children early age.

Etiology. CMV belongs to p-herpes viruses (herpesvirus type 5). The DNA-containing virion has a spherical shape, its diameter is 150-300 nm. Three CMV strains are known: AD 169, Davies and Kerr.

CMV is tropathic to epithelial cells (especially to the epithelium of the salivary glands and renal tubules), vascular endothelium, leukocytes (lymphocytes, macrophages and neutrophils), megakaryocytes, fibroblasts, neuroglia, neurons, etc. CMV replication disrupts synthetic processes and energy metabolism in infected cells, as a result of which they turn into cytomegalic cells (CMB). These are giant cells (25-40 microns) with an enlarged nucleus shifted to the basal surface ("owl's eye"),

In the process of viral replication, pre-early antigens (IEA) are first expressed, then late antigens, which is used for serological diagnosis of the stages of the disease. CMV can persist for a long time in cells with subsequent reactivation under IDS conditions. CMV ranks second after HIV in terms of immunosuppressive activity. With CMVI, deep T-cell immunodeficiency develops, polyclonal activation of B-cells, functional activity of macrophages, natural killer cells, interferon production, and cytokine status are impaired.

The virus is unstable in the external environment, sensitive to high temperature (at 56 ° C dies within 10-20 minutes), freezing, drying, the action of standard disinfectants and organic solvents.

Causes

CMVI is characterized by widespread distribution, lack of seasonality and epidemic outbreaks. In economically developed countries, 0.5-2% of newborns are infected with CMV, 10-30% of children aged one year, 40% of persons aged 35 and almost the entire population over the age of 50 (95%). In countries with low level socio-economic development and sanitary and hygienic culture of the population, CMV infection occurs mainly in early childhood. The large number of people who release the virus into the environment, the many routes of transmission, the lack of vaccine prophylaxis, adverse consequences served as the basis for the inclusion of CMVI by the WHO European Office in the group of diseases that determine the future of infectious pathology in the 21st century.

The sources are the patient and the virus carrier. Approximately 10% of people, mainly young children, shed CMV into the environment. The virus is found in blood, urine, saliva, lacrimal fluid, nasopharyngeal mucus, cerebrospinal fluid, semen, cervical and vaginal secretions, breast milk, feces. Ways of CMV transmission - airborne, fecal-oral, contact, parenteral, sexual, vertical. Infection can occur only through close contact with the source of infection, which for the child is most often the mother.

The first epidemic rise of CMVI occurs in the early childhood... Vertical transmission is more often realized in the antenatal period (95%), less often - intrapartum (5%). CMVI is the most common antenatal infection and is diagnosed in 0.5-2% of newborns. With primary CMVI, which 2% of women undergo during pregnancy, the risk of vertical transmission is 30-50%, 10% of children have symptoms of congenital CMVI, and another 10-15% have long-term consequences of antenatal infection. When CMVI is reactivated during pregnancy (20% of women), the frequency of vertical transmission of the virus is much lower (0.2-2%), the disease in children occurs mainly in a latent form, and long-term consequences are practically not recorded. During the first months of life, 5-30% of children become infected with CMV. Approximately 20% of seropositive nursing mothers excrete CMV in breast milk, saliva, urine, feces and are a source of infection for children. After starting a visit to the nursery preschool the source of infection of the child are virus-shedding children.

The second epidemic rise occurs in adolescence, which is associated with the transmission of the virus by contact ("kissing disease") and sexual routes.

Pathogenesis. The entrance gates for CMV are mucous membranes. respiratory tract, digestive tract, genitals, conjunctiva of the eyes, damaged skin.

The pathogenesis of CMVI includes several stages.

1. Introduction of the pathogen. At the entrance gate of the virus pathological changes absent.

2. Viremia. Once in the bloodstream, the virus infects leukocytes (lymphocytes, macrophages, neutrophils) and multiplies in them. Depending on the state of the immune system, hematogenous dissemination of the virus or its long-term persistence is possible.

3. Development of serous inflammation. In the affected organs and tissues, CMBs are formed, in which the virus multiplies. In these cells, the mechanisms of CMV inactivation are activated due to lysosomal catalase and the secretion of a mucous-protein secretion that envelops the virus. However, the latter defense mechanism, on the contrary, contributes to the "masking" of CMV antigens from recognition by cells of the immune system. Ultimately, as a result of the multiplication of the virus and the release of virions, the CMB dies. In individuals with a normal immune system, CMV can persist for a long time in target cells without their death.

4. Development of complications. The immunosuppressive properties of CMV and the ability to activate the replication of other viruses lead to the development of a mixed infection, the etiological agents of which are bacteria, intracellular pathogens (chlamydia, mycoplasma), viruses (including other herpes viruses), protozoa and fungi. The development of mixed infection occurs with active replication of CMV in conditions of IDS.

5. Formation specific immunity... At the initial stages, the leading role in anti-infectious protection is played by innate resistance factors - macrophages, NK cells and the interferon system. A specific immune response develops quite late, 14-28 days after the introduction of the pathogen. This is due to the weak immunogenicity and slow replication of CMV, its immunosuppressive activity, the ability to multiply in the cells of the immune system, "masking" of viral antigens with mucous-protein secretions, etc. macrophages into the focus of inflammation, which leads to the formation of lymphohistiocytic infiltrates. Subsequently, as a result of the activation of fibroblasts, fibrosis and cysts are formed at the site of lymphohistiocytic infiltrates. Thus, the characteristic pathomorphological triad of CMVI includes the sequential appearance of CMB, lymphohistiocytic infiltrates, and cystofibrosis. The humoral immune response in CMVI is of lesser importance. Anti-CMV antibodies bind the extracellular virus. Complexes "antigen-antibody" circulate in the blood for a long time, are deposited in the tissues and cause their damage. In addition, CMV induces the production of autoantibodies to different cells organism. Immunity in CMVI is non-sterile, does not lead to the elimination of the virus, which remains in the body for life.

6. Reactivation under IDS conditions. CMVI refers to opportunistic infections, the manifestation of which occurs only in conditions of IDS. In addition, the dose and route of transmission of the pathogen are of great importance. In persons with severe IDS or when infected with a large dose of the virus by the parenteral route, an acute form of the disease develops, which goes through all the indicated stages of pathogenesis. In people with a normal immune system, with a small infectious dose, latent CMVI is formed, and with moderate IDS, a chronic form of the disease. Under the influence of factors leading to the development of IDS, CMV reactivation occurs with the subsequent development of viremia and damage to new target cells.

The pathogenesis of congenital CMVI has a number of features. The virus causes impaired growth and reproduction of cells of the embryo and fetus, has mutagenic activity. In addition to the direct action of CMV, indirect factors have an adverse effect - metabolic disorders in the mother's CMVI patient, hyperthermia, hypoxia, the development of placentitis, etc. last years it was found that antenatal CMV infection leads to the development of immunological tolerance - the elimination of CMV-specific clones of lymphocytes and the inability to form a specific immune response. An important role in the pathogenesis of congenital CMVI is played by the features of the inflammatory response of the embryo and fetus. When infected in the first two weeks of pregnancy, the death of the embryo occurs or a systemic pathology similar to a genetic disease (blastopathy) is formed. With a gestation period of 3 to 10 weeks, the embryo has only an alterative component of inflammation, which leads to embryopathy - true malformations at the organ and cellular levels. With a gestational age of 11 to 28 weeks, the alterative and proliferative components of inflammation predominate, resulting in false defects associated with cystic-sclerotic deformity of organs (early fetopathy). At a gestational age of more than 28 weeks, the inflammatory reaction is characterized not only by alterative-proliferative, but also by exudative components, which is the reason for the generalization of the infectious process.

Classification

The generally accepted classification of CMVI has not been developed. V practical work you can use a working version of the CMVI classification proposed by A.M. Ozhegov et al.

1. The period of occurrence. Intrauterine (congenital). Postnatal (acquired). 2. Form. Localized (sialoadenitis). Generalized (meningitis, encephalitis, pneumonia, carditis, hepatitis, nephritis, enterocolitis, chorioretinitis, etc.). 3. Phase. Active. Inactive. Residual (no relapse, with relapse, with superinfection). 4. Current. Sharp. Chronic. Latent. 5. Complications. Associated with damage to organ systems. DIC syndrome. Secondary immune deficiency. Secondary bacterial, viral, fungal infection... 6. Outcomes. Recovery. Damage to the central nervous system. Deafness, visual defects. Lagging in physical and mental development. Chronic pathology of internal organs. Anemia, thrombocytopenic purpura, thrombocytopathy. Death.

Symptoms

Congenital CMVI. In the world, 1.2 million children are born annually with congenital CMVI, in the Russian Federation - 75 thousand. In 90–95% of patients, the disease is latent, and in 5–10% at birth, symptoms of residual, acute or chronic forms of congenital CMVI occur.

When infected in the first 28 weeks of pregnancy, the child is born with a residual clinic. There are multiple malformations of the heart, central nervous system, kidneys, gastrointestinal tract, organs of vision and hearing, musculoskeletal system. Babies are born prematurely, with signs of delay intrauterine development... Their condition progressively worsens due to the deepening of neurological disorders, malnutrition, the addition of a mixed infection, which acquires a generalized course and often leads to death.

The acute form develops when infection occurs at a gestational age of more than 28 weeks. It is characterized by a severe course and generalized damage to various organ systems, however, isolated pathology may prevail. Symptoms occur from the moment of birth, but in some patients they appear by the end of the first - the beginning of the second day of life. Symptoms of intoxication are expressed (fever, lethargy, decreased appetite, etc.), they can persist for 2-6 weeks.

CMV causes a catabolic orientation of metabolic processes, therefore, metabolic syndrome is often recorded. One third of children are born with signs of intrauterine growth retardation, later in 50-70% of patients there is a poor increase in body weight and growth retardation.

A third of children develop encephalitis and meningoencephalitis. The virus infects the ependyma of the ventricles, the periventricular region of the brain substance, the choroidal plexus and blood vessels. Changes in the substance of the brain are in the nature of productive-necrotic leuko-encephalitis with the formation of cysts and calcifications. Symptoms of CMV encephalitis and meningoencephalitis are quite polymorphic and not always clearly expressed. In the neonatal period, there is anxiety, lethargy, impaired consciousness up to coma, suppression or absence of reflexes of newborns, muscle hypo- and hypertension, paresis, paralysis, hyperkinesis, violation of sucking, swallowing, breathing, strabismus, facial asymmetry, nystagmus, convulsions, meningeal signs ... These patients are often mistakenly diagnosed with hypoxic-traumatic lesions of the central nervous system. In the future, CMV encephalitis is characterized by a long undulating course. In the neonatal period, the leading role is played by the syndrome of oppression, at the age of 1-2 months - movement disorders, at 2-6 months - hypertensive syndrome, at 6-12 months - delayed psychomotor development. In the cerebrospinal fluid, lymphocytic or mixed pleocytosis and an increase in protein content are detected, however, there are no changes in some patients. When examining the methods of neurosonography, computed tomography and nuclear magnetic resonance in newborns in the periventricular areas, swelling of the brain tissue and areas of increased density are visualized. At the age of 1-3 months, cysts are found in the periventricular region, and calcifications are found in the region of the vessels and ventricles. By 4-12 months, atrophy of the brain substance, a violation of its architectonics and signs of hydrocephalus join. In 15% of patients, as a result of the development of proliferative-exudative vasculitis, hemorrhages in the brain and subarachnoid space occur.

From the first days of life, 50-80% of patients develop jaundice, which is characterized by an increase within two weeks, followed by a slow and wave-like decrease over one to six months. Jaundice is associated with the development of CMV hepatitis and with increased hemolysis of erythrocytes. CMV hepatitis is characterized by the rapid addition of the cholestatic syndrome. Hepatosplenomegaly, a change in the color of urine and feces, hyperbilirubinemia due to the direct fraction, an increase in the activity of transaminases (up to 2-5 norms), alkaline phosphatase, cholesterol are recorded. Damage to bone marrow cells leads to increased hemolysis of erythrocytes. In this case, CMVI proceeds under the "mask" of hemolytic disease of newborns, conjugational jaundice or prolonged physiological jaundice. Urine and feces retain their usual color, hyperbilirubinemia is observed due to the indirect fraction with normal transaminase activity. With the development of cholestatic syndrome, there is a moderate increase in the activity of transaminases (up to 1.5-2 norms) and alkaline phosphatase (up to 2-3 norms).

Hemorrhagic syndrome is recorded in 65-80% of patients, caused by damage to the capillary endothelium, the development of disseminated intravascular coagulation syndrome and thrombocytopenia due to damage to megakaryocytes. It manifests itself as hemorrhages in the skin, mucous membranes, brain and adrenal glands, bleeding from the nose and umbilical wound, vomiting of "coffee grounds", melena and hematuria.

The majority of patients (60-75%) have hepatosplenomegaly, which, along with jaundice and hemorrhagic rash, is included in the triad of symptoms that make it possible to suspect CMVI in children during the first days of life. In some patients, interstitial pneumonia develops, which proceeds under the "mask" of a syndrome of respiratory disorders (shortness of breath, dyspnea, tachypnea, apnea). X-ray examination reveals bilateral interstitial infiltrates and emphysema.

A third of patients develop interstitial nephritis and glomerulopathy, which are characterized by the appearance of CMB in the urine, proteinuria, cylindruria, erythrocyturia and leukocyturia, an increase in the content of urea and residual nitrogen in the blood.

In 30% of children, CMV gastroenterocolitis occurs, the symptoms of which are vomiting, loose stools and bloating. In the large intestine, some patients develop ulcers, which leads to the appearance of pathological impurities in the stool (mucus, blood), perforation and peritonitis. Perhaps the development of CMV pancreatitis, which proceeds under the "mask" of cystic fibrosis.

10% of patients are diagnosed with myocarditis, chorioretinitis and uveitis. All patients have CMV-sialoadenitis, but most often it remains clinically unrecognized. In some children, a polymorphic macular, papular and maculopapular rash without typical localization appears on the skin.

A general blood test reveals hypochromic anemia, leukocytosis up to leukemoid reaction or leukopenia, thrombocytopenia.

Mortality in acute congenital CMVI ranges from 5 to 30%. In 70-90% of surviving children, there are residual effects in the form of neurosensory deafness, blindness, severe mental retardation, childhood cerebral palsy, liver cirrhosis, chronic pancreatitis, polycystic kidney disease, ureteral stenosis, hydronephrosis, etc.

The chronic form develops as an outcome of acute congenital CMVI or as a primary chronic process. It is characterized by a long course with periodic exacerbations, which are associated with the deepening of IDS and the addition of a mixed infection. As in the acute form, multiple organ lesions are characteristic, however, the pathology of any one organ may dominate. In addition, during the first 3-6 months of life, the presence of maternal antibodies inhibits the dissemination of the pathogen, therefore, clinical symptoms may be mild ("light interval", "latent CMV syndrome"). These circumstances lead to a late diagnosis of the disease.

The symptoms of chronic congenital CMVI include prolonged subfebrile condition and poor weight gain. The clinic of chronic CMV encephalitis includes psychomotor retardation, hypertension-hydrocephalic syndrome, episyndrome, vegetovisceral disorders syndrome, pyramidal disorders, focal symptoms, optic atrophy, sensorineural hearing loss, etc.

Generalized lymphadenopathy and hepatosplenomegaly are quite common. Half of the patients develop chronic CMV-hepatitis, which is characterized by an increase and hardening of the liver, splenomegaly, an increase in transaminase activity, and the development of hypo- and dysproteinemia. Formation of liver cirrhosis is possible.

Patients with chronic congenital CMVI belong to the group of frequently ill children. They have repeated rhinopharyngitis, laryngotracheitis, obstructive bronchitis, bronchiolitis, pneumonia. In 25% of patients, pyelonephritis and cystofibrotic changes in the kidneys occur. Most children have changes from the outside.

Gastrointestinal tract - decreased appetite, regurgitation, vomiting, unstable stools, flatulence, signs of intestinal dysbiosis and dyspan-creatism are found. 10-15% of patients develop chronic chorioretinitis and uveitis, which often result in loss of vision. Sialoadenitis occurs in all patients, but clinically, as a rule, is not recognized. A general blood test reveals anemia and thrombocytopenia.

Reactivation of chronic congenital CMVI occurs, as a rule, at the age of 3-6 months, which is associated with catabolism of maternal antibodies and the addition of a mixed infection caused by viruses (including herpes viruses), intracellular pathogens (chlamydia, mycoplasma), bacteria, fungi and protozoa ... The formation of a mixed infection against the background of deepening IDS is often fatal.

The latent form is the most common (90-95% of patients) and is characterized by the absence of clinical symptoms at birth. At the same time, these children represent a risk group for the unfavorable course of intercurrent infectious diseases. CMV reactivation can proceed under the "masks" of prolonged subfebrile condition, lymphadenopathy, acute respiratory infection and others. In 5-17% of children in preschool and primary school age, there are long-term consequences of antenatal infection - chorioretinitis, deafness, delayed mental and speech development, behavioral disorders, learning difficulties, chronic pathology liver, etc.

Acquired CMVI. The clinic of acquired CMVI depends on the child's age, condition immune status, ways of infection and the dose of the virus.

Acquired CMVI in infants often occurs in a latent form. Clinical manifestation occurs in 20% of patients. Body temperature rises, lethargy, drowsiness, weakness, anxiety, vomiting, regurgitation, decreased appetite and weight gain, unstable stool, enlarged lymph nodes, liver, spleen, sialoadenitis, hemorrhagic syndrome, pulmonary pathology (pneumonia, bronchitis, bronchiolitis ), kidney (nephritis, pyelonephritis), liver (hepatitis), central nervous system (encephalitis, meningoencephalitis), gastrointestinal tract (enterocolitis) and anemia. The disease is characterized by a protracted undulating course. If a mixed infection develops, a lethal outcome is possible. Subsequently, micro- and hydrocephalus, spastic paralysis, psychomotor retardation, chorioretinitis, cataracts, and atrophy of the optic nerve join.

Acquired CMVI in older children also occurs mainly in a latent form. Reactivation occurs asymptomatically or is accompanied by a subfebrile condition, lymphadenopathy, catarrh of the upper respiratory tract, etc. These patients have a more severe course of intercurrent infectious diseases.

The acute form develops, as a rule, in conditions of IDS or during transfusion infected blood. Incubation period ranges from 15 days to 3 months. Localized forms include sialoadenitis, flu-like syndrome, and hepatitis. It should be noted that from the point of view of pathogenesis, their isolation is rather arbitrary. Generalized forms are characterized by an acute onset, severe symptoms of intoxication and multiple organ lesions. They include mononucleosis-like syndrome, damage to the lungs, central nervous system, kidneys, liver, gastrointestinal tract, etc.

With CMV sialoadenitis, the body temperature rises, moderately pronounced symptoms of intoxication appear, an increase and soreness of the salivary glands (more often the parotid, less often the submandibular and sublingual). In the future, sialoadenitis acquires a chronic course and is accompanied by fibrosis salivary gland.

Mononucleosis-like syndrome develops mainly in children under three years of age. The disease begins with an increase in body temperature to subfebrile numbers and the appearance of symptoms of intoxication, which can persist for two or more weeks. A third of patients have a febrile body temperature. There is a systemic increase in lymph nodes, mainly in the anterior cervical. Lymph nodes in most children (70%) do not reach large sizes (micro-polyadia). Hepatosplenomegaly is recorded in 40% of patients. Tonsillitis often has a catarrhal character, there are signs of adenoiditis. Polymorphic exanthema of a spotty, papular and maculopapular character is quite rare. An increase in the salivary glands is possible. In a blood test, lymphocytosis and atypical mononuclear cells are detected.

Interstitial CMV pneumonia is accompanied by an increase in body temperature, the appearance of an unproductive whooping cough, shortness of breath and cyanosis. Physical data are rather scarce. Some patients develop obstructive bronchitis.

The defeat of the central nervous system occurs in the form of meningoencephalitis, the clinical symptoms of which are impaired consciousness, mental disorders, convulsions, spastic hemi- and paraparesis, meningeal signs. Patients with IDS may develop encephalomyelopathy, myelopathy, and polyradiculoneuropathy.

Clinical symptoms of CMV nephritis are usually absent. In the analysis of urine, CMB, proteinuria, cylindruria, a large amount of epithelium are detected.

Liver damage occurs in the form of subacute hepatitis with cholestatic syndrome. Against the background of symptoms of intoxication, moderate jaundice and hepatosplenomegaly appear. Hyperbilirubinemia due to the direct fraction, an increase in the activity of transaminases, alkaline phosphatase, and an increase in cholesterol are noted.

With the defeat of the gastrointestinal tract, bloating, persistent vomiting, loose stools without pathological impurities, and a decrease in body weight occur. Ulcers may form in the stomach and intestines, leading to perforation and the development of peritonitis. Due to cystic degeneration and dysfunction of the pancreas, a large amount of neutral fat appears in the coprogram.

The chronic form often occurs under the "masks" of recurrent obstructive bronchitis, chronic pneumonia, chronic sialo-adenitis, hepatitis, pancreatitis, nephritis, gastritis, enterocolitis, vegetative-vascular dystonia, diencephalic syndrome, etc.

Diagnostics

Diagnosis of CMVI is based on taking into account the data of the epidemic history (risk group), clinical symptoms and additional examination. Laboratory diagnostics includes three groups of methods.

1. Detection of CMV and its DNA.

The virological method is the "gold standard" in laboratory tests. Materials are blood, urine, saliva, cerebrospinal fluid, cervical mucus, amniotic fluid, semen, and tissue samples. The disadvantages include the complexity and duration of the conduct (2–3 weeks). ... The rapid culture method (shell vial assay) is a variant of the virological method, in which early CMV antigens are detected 6 hours after infection of a cell culture using monoclonal antibodies. ... Polymerase chain reaction (PCR) allows the detection of viral DNA in various biological materials. Mbtode real-time PCR (real-time PCR) allows you to determine the titer of the virus in biological fluids, cells, biopsies. In patients with HIV infection, the indicators of CMV activity are the viral load of the blood of more than 10 4 copies of DNA in 1 ml of plasma and more than 10 3 copies of DNA in 100 thousand leukocytes.

2. Determination of markers of a specific humoral immune response. The enzyme-linked immunosorbent assay (ELISA) allows for the separate determination of antibodies of the IgM and IgG classes, including those to the immediate early (IEA) and late CMV antigens, as well as the avidity of IgG antibodies. IgM antibodies appear 7 days after primary infection or reactivation of CMV. With a primary infection, their titer increases within 2 months, and by the 10th month, IgM antibodies disappear. When reactivated, IgM antibodies disappear for more short time... The production of antibodies of the IgG class begins from 3-4 weeks with primary CMVI and 2 weeks after its reactivation. Currently, test systems have been developed to characterize the avidity of IgG antibodies (the strength of antigen and antibody binding). Low avidity antibodies (avidity index less than 30%) are indicative of early primary infection. A high titer of moderate IgG (avidity index 31-49%) indicates late primary infection. High avidity IgG (avidity index more than 50%), taking into account the titer, indicates a latent or chronic infection. Test systems are also produced that allow the detection of IgM and IgG antibodies to early (1EA) and late CMV antigens. The presence of IgM and IgG antibodies to early CMV proteins indicates active viral replication. For the diagnosis of cytomegalovirus encephalitis, test systems have been developed to determine the intrathecal synthesis of IgG antibodies.

3. Identification of markers of the cytopathogenic action of the virus. The cytological method is more often used to detect CMB in urine and saliva, less often in cerebrospinal fluid, breast milk, gastric juice, semen, and cervical mucus. The sensitivity of the method is rather low (50%), therefore the study is recommended to be repeated within 3-4 days. It is currently used as an auxiliary diagnostic method. Detection of CMB in biological materials indicates active viral replication.

Taking into account the weak immune response in CMVI, laboratory diagnostics should be carried out using at least two groups of laboratory tests - detection of CMV, its DNA and the detection of specific antibodies. The first group of methods has a higher diagnostic value because the virus itself and its DNA can be detected before the onset of clinical symptoms or simultaneously with it. A specific immune response develops at a later date and is not always adequate. In addition to the actual diagnosis of CMVI, laboratory examination aims to determine the activity of the infectious process.

Laboratory diagnostics of congenital CMVI should be carried out in the first two weeks of life, since intra- and postnatal infection cannot be ruled out at a later date.

When interpreting the results of the detection of the virus and its DNA, it should be remembered that CMV quickly disappears from the blood, but can be isolated from other biological media for a long time.

Serological diagnostics congenital CMVI is significantly complicated. This is due to the fact that during the first 3-6 months of life, maternal IgG antibodies circulate in the child. The half-life of IgG is 21 days, therefore, during the first three to four weeks of life, the titer of these antibodies decreases by one and a half to two times. Due to the phenomenon of immunological tolerance, the production of their own antibodies in children may be reduced. In 35% of children with congenital CMVI, IgM antibodies are absent at birth and appear only at the age of over one month of life.

The following rules of serological examination should be adhered to:

If congenital CMVI is suspected, the child should be examined in the first two weeks of life. ... Until the age of six months, the mother is examined at the same time as the child. ... The examination should be carried out before the administration of blood products. ... It is necessary to re-determine the titers of antibodies with an interval of two to three weeks in the same laboratory using the same methods and reagents. ... It is obligatory to carry out clinical and laboratory comparisons.

Criteria laboratory diagnostics congenital CMVI:

Detection of CMV and its DNA in blood or other biological fluids. ... Detection of antibodies of the IgM class (including to the immediate early antigen), the titer of IgG antibodies in the child is four times higher than that of the mother, an increase in the titer of total IgG, low avid IgG and IgG to the immediate early antigen in dynamics by four or more times. Laboratory criteria for the activity of congenital CMVI. ... Detection of CMV and its DNA in blood and cerebrospinal fluid. ... Detection of antibodies of the IgM class (including to the immediate early antigen), the titer of IgG antibodies in the child is four times higher than that of the mother, an increase in the titer of total IgG, low avid IgG and IgG to the immediate early antigen in dynamics by four or more times.

The criteria for laboratory diagnosis of acquired CMVI, for determining the stage of the disease and the activity of the infectious process are presented in table.

Infectious diseases	Non-communicable diseases
TORCH syndrome
... Congenital toxoplasmosis Congenital rubella Congenital IPG Congenital chicken pox Congenital chlamydia Congenital mycoplasmosis Congenital enterovirus infection Congenital listeriosis Congenital syphilis, etc.	... Genetic pathology Congenital malformations on action ionizing radiation, medicines, toxic agents, etc.
Sialoadenitis syndrome
... Parotitis Purulent (secondary) sialoadenitis Mumps in HIV infection Tuberculosis of the salivary glands Actinomycosis of the salivary glands	... Mikulich's syndrome in acute leukemia Recurrent allergic mumps Swelling of the salivary gland Salivary stone disease
Mononucleosis-like syndrome
... Epstein-Barr viral infection Herpes simplex infection Human herpesvirus type 6 infection Human herpesvirus type 7 infection Adenovirus infection HIV infection Toxoplasmosis Chlamydia Yersiniosis Listeriosis Tularemia Brucellosis	... Tuberculosis Oncological diseases(leukemia, lymphogranulomatosis, lymphoma, histiocytosis)

Taking into account the immunosuppressive activity of CMV, it is imperative to include a study of the immune status in the examination complex. The immunogram reveals a decrease in the number of T-lymphocytes (CD3) and their proliferation in response to mitogens, an inversion of the CD4 / CD8 immunoregulatory index due to a decrease in T-helpers (CD4) and an increase in cytotoxic T-lymphocytes (CD8), polyclonal activation of B-lymphocytes ( CD20), which is accompanied by hyper- or hypoimmunoglobulinemia, a decrease in the functional activity of macrophages, neutrophils, a decrease in the number of natural killer cells (CD16), the production of interleukins (IL-1, IL-2) and interferon.

Differential diagnostics. The variety of clinical symptoms of CMVI dictates the need differential diagnosis with a wide range of infectious and non-infectious diseases, taking into account the leading clinical syndrome... In congenital CMVI, the leading one is TORCH syndrome, in acquired CMVI - "Syndrome of sy-aloadenitis" and "Acute mononucleosis-like syndrome".

Treatment

Treatment of CMVI is staged, complex, includes a regimen, diet, etiotropic, pathogenetic and symptomatic therapy. Hospitalization is carried out taking into account the form of the severity of the disease. For the period of severity of the condition, bed rest is prescribed. Medical nutrition should be balanced in the main ingredients, include vitamins and microelements.

The indications for the appointment of etiotropic therapy are clinical and laboratory indicators of CMVI activity. For the treatment of CMVI, several groups of etiotropic drugs are used, the choice of which depends on the form of the disease.

1. Virucidal drugs - abnormal nucleosides (ganciclovir, acyclovir, valacyclovir, famciclovir), foscarnet, inosine pranobex, arbidol. Ganciclovir (Cymevene) has the highest activity against CMV. Indications for its appointment are generalized forms of CMVI, as well as localized forms with a severe and complicated course. The drug is administered by intravenous drip for 2-3 weeks, then they switch to supportive therapy. Side effects often occur - anemia, neutropenia, thrombocytopenia, increased serum creatinine, reactive pancreatitis, etc. Foscarnet is an inhibitor of viral DNA polymerase. Indications for administration are similar to those for ganciclovir. Introduced intravenously drip for 10-14 days. Often causes the development of side effects (anemia, neutropenia, thrombocytopenia, etc.), does not penetrate the blood-brain barrier. In severe pathology (CMV pneumonia in persons with IDS), foscarnet is recommended to be combined with ganciclovir. Inosine pranobex inhibits CMV replication by binding to the ribosome of cells and changing its stereochemical structure. The drug is effective against other DNA and RNA-containing viruses, has immunomodulatory activity - it enhances the proliferation of T-lymphocytes, T-helpers, natural killer cells, stimulates the functional activity of T-lymphocytes, the production of interleukins, antibodies, increases the chemotactic and phagocytic activity of macrophages and neutrophils. With light and medium severe forms isoprinosine (inosine pranobex) is prescribed at a dose of 50-100 mg / kg / day in 3-4 doses for a course of 7-10 days, in severe forms - 10-15 days. If necessary, 2 more courses are carried out with an interval of 7-10 days. Valacyclovir (Val-Trex) is used in children over 12 years of age to prevent CMVI reactivation after transplantation. The drug is administered orally for three months. The sensitivity of CMV to other abnormal nucleosides (acyclovir, famciclovir) is low. The effectiveness of arbidol in the treatment of CMV mononucleosis in children has been proven. The drug is prescribed in an age dose for 7 days, then 2 times a week for 4 weeks.

2. Immunoglobulins. Neocytect is a human immunoglobulin with an increased content of antibodies against CMV. The drug is used for generalized forms of CMVI, as well as for localized forms with severe and complicated course. The neocytotect is injected intravenously once every two days until the symptoms of the disease disappear. The drug is free of the side effects typical for ganciclovir and foscarnet. Use other immunoglobulins to intravenous administration(sandoglobulin, pentaglobin, immunovenin, intraglobin, intratect, etc.). In milder forms, a complex immunoglobulin drug (CIP) is prescribed internally.

3. Interferons. Interferons are used in combination with virucidal drugs and immunoglobulins. Interferons for intramuscular administration (Reaferon, Realdiron, Roferon A, Intron A, etc.) are prescribed for children over 2 years of age with generalized forms of CMVI, as well as with severe and complicated course of localized forms. The drugs are administered intramuscularly at a dose of 500 thousand - 2 million IU once a day for 10-14 days, then 3 times a week for 3-6 months, or the patient is transferred to maintenance therapy with Viferon Reaferon-EC-Lipint or Genferon-Light under the control of clinical and laboratory parameters. Viferon for the treatment of congenital CMVI is administered rectally 2 times a day every day for 10 days, then they switch to maintenance therapy 2 times a day every other day for 3-6 months. Children under the age of 2 months are prescribed Viferon-1 1 candle 2 times a day, from 2 to 4 months - Viferon-1 2 candles in the morning and 1 candle in the evening, from 4 to 6 months - Viferon-1 2 candles 2 times per day, over 6 months - Viferon-2, 1 suppository 2 times a day. For the treatment of acquired CMVI in children under 7 years of age, Viferon-1 is used, over 7 years old - Viferon-2. The drug is prescribed 1 suppository 2 times a day for 10 days, then 1 suppository 2 times a day 3 times a week for 1-6 months under the control of clinical and laboratory parameters. Single dose of genferon light in the form rectal suppositories for children under 7 years old it is 125 thousand ME, over 7 years old - 250 thousand ME. Initial therapy - 1 suppository 2 times a day for 10 days, supportive treatment - 1 suppository at night every other day for 1-3 months. Reaferon-EC-lipint for generalized congenital CMVI and CMV-hepatitis is prescribed to children over 5 years of age at a dose of 3 million U / m 2 orally 2 times a day for 10 days, then 1 time a day for 3 months.

4. Interferon inducers (neovir, cycloferon, anaferon, kagocel, amiksin) are shown as starting therapy in combination with virucidal drugs for mild and moderate forms, as maintenance therapy after a course of virocidal drugs and interferons. The drugs are prescribed according to prolonged regimens.

5. Antibiotics are used for the development of bacterial infections. Protected aminopenicillins, 3-4th generation cephalosporins, macrolides, carbapenems are used.

Pathogenetic therapy includes the appointment of immunomodulators (thymalin, taktivin, thymogen, imunofan, polyoxidonium, lycopid, immunorix, derinat, sodium nucleinate, neupogen, IRS-19, ribomunil, bronchomunal, immunomax, etc.) and cytokine drugs under the control of leukinferon (leukinferon) immunograms. Conduct detoxification therapy. For mild and moderate forms, it is recommended plentiful drink, and for generalized, severe and complicated - intravenous drip infusion of glucose-saline solutions. For the purpose of detoxification in mild and moderate forms, enterosorbents are used (smecta, filtraum, enterosgel, etc.), in severe and complicated forms, methods of extrarenal detoxification (hemosorption, plasmapheresis) are used. Patients are prescribed multivitamins and vitamin-mineral complexes, metabolic therapy drugs (riboxin, cocarboxylase, cytochrome C, elkar, etc.), probiotics (bifiform, linex, bifidum-bacterin-forte), plant adaptogens. According to indications, antihistamines, protease inhibitors, cerebro-and angioprotectors, oxygen therapy are used. Pathogenetic therapy of specific nosological forms (encephalitis, pneumonia, hepatitis, pancreatitis, carditis) is carried out according to general rules.

Symptomatic therapy includes the appointment of antipyretic drugs, cardiac glycosides, etc.

Rehabilitation

Dispensary supervision is carried out by a local pediatrician and an infectious disease specialist. Patients with congenital CMVI and children of the risk group born to women with CMVI and mothers with a burdened obstetric history need dispensary observation. Patients with acute congenital CMVI and children at risk are observed for one year, patients with chronic CMVI - within three years after stable remission, children with residual form - until adolescence. Examinations are carried out at the age of 1, 3, 6 and 12 months of life, then once every six months. The examination includes a clinical examination, according to indications - consultations of specialists (neurologist, JlOP-doctor, gastroenterologist, hematologist, nephrologist, pulmonologist, ophthalmologist, dentist, cardiologist, immunologist, etc.). Laboratory examination is carried out - general analysis blood, urine, CMVI markers by ELISA and PCR, urine and saliva on CMB, immunogram; according to indications - biochemical blood test, markers of HSV, EBV, VVZ, HHV-6, HHV-7, toxoplasma, chlamydia, mycoplasma by ELISA and PCR, bacteriological examination. If necessary, an instrumental examination is prescribed - an examination of the fundus, ultrasound of the abdominal organs, neurosonography, Doppler ultrasonography, CT and MRI of the brain, EEG, REG, audiogram, etc.

Rehabilitation therapy includes a protective regimen, a balanced diet, enriched with vitamins and microelements. Interferons (viferon, reaferon-EC-lipint) are prescribed according to the maintenance therapy scheme, interferon inducers (cycloferon, neovir, amiksin, anaferon) according to prolonged regimens under the control of clinical and laboratory parameters. They recommend taking multivitamins, vitamin and mineral complexes, metabolic therapy drugs, probiotics. Under the control of an immunogram, immunomodulators are used.

Prophylaxis

CMV vaccines have not been licensed for safety, so non-specific prophylaxis is of prime importance. Prevention of congenital CMVI is carried out at the pregravid, gravidar and postnatal stages. Breastfeeding female virus-shedders are advised to strictly observe the rules of personal hygiene when caring for children, refuse to breastfeed or feed the baby with breast milk pasteurized at 72 ° C for 30 seconds. Non-specific prevention of acquired CMVI consists in observing the rules of personal hygiene and sanitary and anti-epidemic regime in contact with a patient with a manifest form of CMVI or a virus releasing agent. It is necessary to examine blood donors and organs, reduce indications for blood transfusions, and transfuse washed erythrocytes. Cytotect, ganciclovir, foscarnet and valacyclovir are used to prevent CMVI reactivation in transplant recipients. Prevention of sexual and parenteral transmission of CMV is promoted by moral education of adolescents, propaganda healthy way life, drug refusal.

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

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

Causes of the disease

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

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

Once infected with cytomegalovirus, a person, as a rule, remains the carrier of this infection for life.

Symptoms of CMV Infection

Distinguish how many variants of the course of CMV infection.

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

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

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

3) Congenital cytomegalovirus infection.

Intrauterine infection of the fetus for up to 12 weeks, as a rule, ends; if infected after 12 weeks, the child may develop a serious disease - congenital cytomegaly. According to statistics, congenital cytomegaly affects about 5% of infected intrauterine newborns. Its symptoms include prematurity, enlargement of the liver, kidneys, spleen, pneumonia. Children who have had CMV infection in utero and who have avoided generalization of the process may have psychomotor retardation, hearing loss, visual impairment, and dental anomalies.

Diagnostics

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

Laboratory methods for identifying cytomegalovirus include:

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

Treatment of cytomegalovirus

Carriage of viruses and mononucleosis-like syndrome in persons with normal immunity does not require treatment.

People with weakened immunity are trying to transfuse blood products and transplant organs from CMV-negative donors.

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