Cytomegalovirus infection. Cytomegalovirus infection: symptoms, diagnosis, treatment

Before starting treatment for cytomegalovirus, it is necessary to accurately diagnose the disease and determine whether treatment for CMVI is necessary in your case. Since it is not always required, you need to be aware of it. In addition, it is not easy to diagnose the presence of cytomegalovirus infection and CMV is easily confused 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 the human body. Such cases are clearly identified only by a specialist, after visiting a sick clinic to diagnose the disease. If the body has symptoms of a generalized cytomegalovirus infection, then it is extremely important to contact the clinic. The treatment regimen for cytomegalovirus can only be drawn up after a personal examination of the patient.

A person who has been ill with cytomegalovirus and has had an infectious disease without any serious consequences acquires a fairly strong immunity. In the vast majority of cases, cytomegalovirus infection, having struck the human body, does not cause any symptoms. The virus itself in the body takes a sleep 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 goal - to significantly mitigate the negative impact of a viral infection on the human body. Most often, after infection, a person with a sufficiently strong immune system easily endures the primary outbreak of an infectious disease, so there is no need for a person with cytomegalovirus to go to the hospital. In such people, after a short manifestation, the set of symptoms that have been created ceases without a trace. As a result, the disease mostly goes unnoticed.

When is cytomegalovirus treatment really necessary?

The specific circumstances under which the attending physician determines the course of treatment for cytomegalovirus infection in adults or in children include such manifestations as:

• The presence of acquired or congenital immunodeficiency in a patient of any age.
• Generalized stage - the widespread spread of the virus is accompanied by a very painful inflammatory process throughout the body or in a certain 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 with allogeneic organ transplantation, pneumonia, encephalitis, oncological diseases - when using therapy that severely suppresses the immune system.
• During the first trimester of pregnancy, immunocompromised women may develop primary cytomegalovirus, which can potentially cause extremely severe damage to the fetus, and may also cause miscarriage.

The generalized stage or symptomatic exacerbation of a cytomegalovirus infection is often characterized by the fact that most patients, and even sometimes some doctors, confuse this viral disease due to its similarity with the symptoms of influenza-like diseases or SARS. As well as other infectious diseases. Often this leads to erroneous treatment and a high risk of developing severe complications.

With absolutely accurate differential diagnosis, the treatment for cytomegalovirus will be prescribed to the patient as adequate as possible. And the medicines are prescribed for the right purpose.

Drugs and vitamins for the treatment of cytomegalovirus infection

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

• Symptomatic remedies- provide relief, anesthetize, eliminate inflammation, constrict blood vessels (nasal drops, eye drops, painkillers, anti-inflammatory, folk remedies).
• Antiviral drugs- inhibit the activity of the infection (Ganciclovir, Panavir, Cidofovir, Foscarnet).
• Posyndromic 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 with antiviral drugs - Foscarnet, Ganciclovir, Viferon. And immunoglobulins - Cytotect, Megalotect.

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

List of drugs

1. Foscarnet is an antiviral drug. Infectious cytomegalovirus is treated quite successfully with Foscarnet. It is used in severe cases of the disease 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 reproduction of the virus.
2. Ganciclovir is an antiviral drug. The drug is one of the most effective, rather difficult in practical use. The remedy is prescribed during the course of the disease - a cytomegalovirus infection, complicated by especially severe organ pathologies, rather extensive inflammations. It is also used to prevent viral infection, congenital CMV infection. Release form - tablets and crystalline powder from the group of polar hydrophilic solvents. For ophthalmic gel or injection, the drug is available as a lyophilisate. The use of Ganciclovir is advisable in the treatment of cytomegalovirus - a herpes infection.
3. Cytotect - immunoglobulin. For many patients, Cytotect seems to be one of the most optimal means for the treatment of cytomegaluvirus. The drug combines a fairly effective efficiency and an almost complete absence of general toxicity and relative contraindications. Prescribed for prophylaxis in patients with suppressed immune system drugs. Prevents mass manifestations of the disease after infection with CMVI. When applied, it can create: headaches; nausea and vomiting; chills and fever; joint pain and mild back pain; sometimes a decrease in blood pressure.
4. Neovir is an immunostimulant. Solution for injection, used as an immunostimulating drug for the treatment and prevention of cytomegalovirus infection in people with immunodeficiency.
5. Viferon is an immunomodulator. Candles with antiviral action. It is used for complications of infectious diseases, for primary inflammation, as well as for recurrence of cytomegalovirus infection of a localized form. The drug is applied rectally. When applied, it can cause an allergic reaction in the form of a skin rash.
6. Bischofite is an anti-inflammatory drug. 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

1. C - Broad spectrum antioxidant. Stimulates the work of cells that eat bacteria and viruses in the blood. Increases the resistance of the human body to various infections through the resistance of cells to the penetration of infectious agents.
2. B9 - for the powerful maintenance of the production factory (bone marrow) of the human body's immune system.

The general rules for the treatment of cytomegalovirus include hospitalization of the patient in cases where it is absolutely necessary. Since during the treatment period the patient appears to be a very active source of viral infection for others, the patient must significantly limit any contact with people. Ensure maximum peace of mind. Provide the best necessary microclimate conditions. Observe strict rules of personal hygiene. Use a therapeutic and preventive 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 way to get rid of the infection and prevent complications and relapses.

Treatment with folk remedies

If a person heard that people were treated for cytomegalovirus by home medicine, then this is an erroneous idea that, thanks to traditional medicine, it is possible to cope with such a difficult task. Treatment of such an infection and all sorts of complications should not occur on its own without the supervision of a specialist. But it is quite advisable to support the immune system with folk remedies.

Cytomegalovirus - CMV treatment is a rather difficult task. As, in fact, all viral diseases caused by pathogens adapted to modern drugs.

Poses a potential threat to human health. The virus is one of the most common opportunistic pathogens. When exposed to certain factors, it is activated and causes a vivid clinical picture of cytomegaly. In some people, the virus is in an opportunistic state throughout life, not showing up at all, but causing impaired immune defenses.

Of particular danger is the disease for infants and young children, when the virus covers all organs or systems, leading to serious complications, up to the death of the patient. There are still no known effective drugs for the complete expulsion of the virus from the body. If you become infected with cytomegalovirus, drug treatment is carried out to achieve a long-term therapeutic remission in a chronic course and eliminate local manifestations of the infection.

What you need to know about the virus

Cytomegaly appears to be an infectious disease of viral etiology. In some sources, there is a different name - cytomegalovirus infection (in the abbreviation CMV).

Cytomegalovirus is a member of a large group of herpesviruses. The cells affected by the viral agent increase significantly in size, hence the name of the disease - cytomegaly (translated from Latin - "giant cell"). The disease is transmitted through sexual, domestic or blood transfusion routes. The most unfavorable is the transplacental route of transmission.

The symptom complex resembles the development of a persistent cold, which is accompanied by a runny nose, malaise and general weakness, pain in the articular structures, increased salivation due to inflammation of the salivary glands. Pathology rarely has vivid symptoms, mainly proceeding in the latent phase. With generalized forms of damage to the body by viral agents, drug treatment and antiviral drugs are prescribed. There is no alternative effective treatment.

Many people are carriers of cytomegalovirus infection without even knowing it. Only 30% of the viral disease has a chronic course, exacerbated by local symptoms in the form of a herpetic rash, as well as general malaise. Antibodies to cytomegalovirus exist in 13-15% of adolescents, 45-50% in adult patients. The viral agent is often activated after exposure to factors that reduce immunity.

Cytomegalovirus poses a great danger to persons who have undergone organ or bone marrow transplantation, who have congenital forms of the disease or HIV status. The condition is dangerous during pregnancy, leads to serious consequences for the fetus: anomalies in the development of internal organs or systems, deformities and physical disability, miscarriage. For this, a collegial decision of the attending pediatrician and other narrow specialists is necessary.

Cytomegalovirus - treatment

The feasibility of therapy is proportional to the severity of the course and the potential danger to the patient's body. After some diagnostic measures, the risks of a possible threat are determined, an assessment is made of the pathological process. With signs of generalization, drug correction is prescribed. With a short episode of virus activation and while maintaining the patient's normal state of health, no special treatment is carried out. With a burdened clinical history of the patient, the doctor monitors the general condition, controls the level of antigen in the blood as part of laboratory diagnostics.

Often a completely healthy person who has been ill with a virus without any consequences acquires strong immunity. The viral agent itself, at the same time, remains in the body forever, transforms into a conditionally pathogenic form. There is a chronization of the pathology with periods of short-term exacerbations, subject to a pronounced decrease in immune defense. The goals of drug correction of the disease are:

• reducing the negative impact of the virus;
• relief of existing symptoms;
• ensuring stable remission in chronic disease.

Important! In humans, against the background of absolute health, the virus is asymptomatic, and the disease stops on its own. Many patients do not notice when the virus is activated and when its pathogenic activity is reduced.

The main indications for starting treatment

Unfortunately, cytomegalovirus is not treated completely. Medications can only strengthen local immunity and prevent new episodes of exacerbation. Therapy is prescribed in the following cases:

• immunodeficiency diseases of any origin;
• generalized spread of the viral agent;
• preparation of organ transplantation, for chemotherapy in oncological diseases;
• complicated clinical history of the patient (pathology of internal organs or system);
• pregnancy of a woman (often the first trimester);
• preparation for the treatment of encephalitis, meningeal infections.

Read also related

What is a positive IGG to cytomegalovirus, what to do

Before determining the treatment tactics, a differential diagnosis of cytomegalovirus infection with influenza conditions, SARS and other infectious diseases is carried out. It is the similarity of the symptoms of cytomegaly with the classic manifestations of the common cold and untimely or inadequate treatment that provokes the development of severe complications.

What funds can be assigned

So, during the examination, cytomegaloverus was diagnosed - drug treatment will be prescribed in most cases. Conservative and drug therapy are the only ways to correct the condition of patients with CMVI. Pharmaceutical forms are numerous: ointments (liniments) for external use, tablets for oral use, injections for intravenous administration, drops, suppositories.

To eliminate exacerbations of a viral disease, the following groups of drugs are prescribed:

• symptomatic (pain relief, elimination of inflammatory foci, vasoconstriction in the nose, in the sclera);
• antiviral (the main task is to suppress the pathogenic activity of the virus: Panavir, Cidofovir, Ganciclovir, Foscarnet);
• drugs to eliminate complications (multiple groups and pharmacological forms);
• immunomodulators (strengthening and restoration of the immune system, stimulation of the body's natural defenses: Viferon, Leukinferon, Neovir);
• immunoglobulins (binding and removal of viral particles: Cytotect, Neocytotect).

Drugs for the treatment of cytomegalovirus are prescribed in a complex manner. Additionally, vitamin complexes with an enriched mineral composition are prescribed to restore the overall resistance to colds and other chronic pathologies that lead to a decrease in immunity. In systemic autoimmune diseases, as a rule, lifelong drug therapy is prescribed.

Important! With cytomegaly in men, a high therapeutic effect was proved by Ganciclovir, Foscarnet, Viferon, in women - Acyclovir, Cycloferon and Genferon.

Drug treatment has a number of disadvantages due to side effects. The toxicogenic effect is often expressed in dyspeptic disorders, decreased appetite, and the appearance of allergies. Iron deficiency anemia often develops.

Antivirals

To achieve the maximum therapeutic effect, guanosine analogues are prescribed:

• Virolex;
• Acyclovir;
• Zovirax.

The active substance quickly penetrates the cells of the virus, destroys their DNA. These drugs are characterized by high selectivity and low toxicogenic properties. The bioavailability of Acyclovir and its analogues varies from 15 to 30%, and with increasing doses it decreases by almost 2 times. Medicines based on guanosine penetrate into all cellular structures and tissues of the body, in rare cases causing nausea, local allergic manifestations, and headaches.

In addition to Acyclovir, its analogues are prescribed Ganciclovir and Foscarnet. All antiviral agents are often combined with immunomodulators.

Interferon inducers

Interferon inducers stimulate the secretion of interferons within the body. It is important to take them in the first days of an exacerbation of the infection, since on day 4-5 or later their use is practically useless. The disease is running, and the body is already producing its own interferon.

Inductors inhibit the development of CMV, are often well tolerated by the body, promote the synthesis of immunoglobulin G, natural interferons, interleukins. Known drugs containing interferon include Panavir. The drug has a pronounced anti-inflammatory effect, helps with severe pain, reduces the intensity of unpleasant symptoms.

Viferon also helps with viral activity, has a convenient form of suppositories for rectal administration, which is convenient in the treatment of children of any age. Of the interferon inducers, Cycloferon, Inosine-pranobex and its analogues Isoprinosine, Groprinosin are isolated. The latter drugs have a low degree of toxicity, suitable for the treatment of children and pregnant women.

Immunoglobulin preparations

Immunoglobulins are protein compounds in the human body and warm-blooded animals, which, during biochemical interaction, transport antibodies to pathogenic agents. When exposed to CMV, a specific immunoglobulin Cytotect is prescribed, which contains antibodies to cytomegalovirus. Among other things, the composition of the drug includes antibodies to the herpes virus type 1.2, to the Epstein-Barr virus. Therapy with immunoglobulins is necessary to restore the general protective resources of the body to the penetration of viral agents.

To achieve maximum therapeutic results, immunoglobulins are prescribed in the form of injections (Pentaglobin). Medicines in the form of injections directly affect the root of the problem, quickly eliminate the symptoms of a generalized manifestation of the disease. In addition, the chemical composition of new generation drugs is not disturbed before interacting with altered cells.

List of the most effective drugs

Despite the wide range of remedies for the relief of CMV symptoms, doctors always build individual therapeutic tactics. Before prescribing a specific medicine, it should be clarified which symptoms of the infection are present in a particular patient. This takes into account: the patient's clinical history, age, weight, general somatic status, complications and other factors that may interfere with proper treatment.

For therapy, the following popular means are used:

Be sure to use vitamins and other tonics that stimulate the work of many internal structures of the body. The most necessary for viral infections include vitamins C and B9.

Vitamin C is a powerful antioxidant, has regenerative properties, restores cells that are involved in the inhibition of the activity of pathogenic agents. B vitamins are necessary for the normal functioning of the nervous system, support the normal function of the bone marrow, and are responsible for the resistance of the immune system to external or internal negative factors.

Timely diagnosis and detection of severe forms of infection will reduce the level of complications, prevent the generalization of the pathological process. When stopping an exacerbation with a medical method, it is important to take into account a number of important criteria, to conduct a differential diagnosis. Preventive measures during a woman's pregnancy, in young children, as well as the correct treatment tactics will save patients from unpleasant manifestations of cytomegalovirus for a long time.

Cytomegalovirus is a fairly common viral disease, which, meanwhile, is not known to everyone. Cytomegalovirus, the symptoms and characteristic features of which are determined primarily by the state of the immune system, in its normal state, may not manifest itself at all, without having any harmful effect on the body of the virus carrier. It is noteworthy that in this case, the only feature of the virus carrier is the possibility of transmitting cytomegalovirus infection to another person.

general description

Cytomegalovirus is actually a relative of the common one, because it belongs to the group of herpesviruses, which includes, in addition to herpes and cytomegalovirus, two more diseases like and. The presence of cytomegalovirus is noted in blood, semen, urine, vaginal mucus, and also in tears, which determines the possibility of infection by it through close contact with these types of biological fluids.

Given the fact that human tears in extremely rare cases enter the body, most of the infection occurs through sexual contact and even with a kiss. At the same time, it is important to note that although this virus is extremely common, it still does not belong to particularly contagious infections - in order to acquire this virus, it is necessary to try extremely intensively and for a long time to mix your own fluids and those of the carrier of the virus. Given these features, it is not necessary to exaggerate the danger posed by cytomegalovirus, however, precautions should not be neglected either.

Cytomegalovirus: the main types of the disease

It is extremely difficult to determine the duration of the course of the disease we are considering in a latent form, because it is impossible to determine the moment that is noted during the course of the disease as the initial one. Conventionally, it is designated within the interval of one or two months. As for the varieties of cytomegalovirus, here experts distinguish the following possible options:

• Congenital cytomegalovirus infection , the symptoms of which are manifested for the most part in the form of an enlarged spleen and liver. In addition, the danger of the disease lies in the possible hemorrhage that occurs against the background of infection, occurring in the internal organs. Such features of the course lead to disturbances in the work of the central nervous system, in addition, in women, the infection can provoke or miscarriage.
• Acute cytomegalovirus infection. As the main ways of infection here, mainly sexual contact is determined, however, infection is also possible during blood transfusion. The features of the symptomatology, as a rule, are similar to the manifestations characteristic of the common cold, in addition, there is also an increase in the salivary glands and the formation of white plaque on the gums and tongue.
• Generalized cytomegalovirus infection. In this case, the manifestations of the disease are expressed in the formation of inflammatory processes in the spleen, kidneys, adrenal glands, pancreas. As a rule, inflammatory processes occur due to a decrease in immunity, while their course proceeds in combination with a bacterial infection.

Common symptoms of cytomegalovirus infection

Medical practice defines three possible options that characterize the course of cytomegalovirus, which, accordingly, determines the features of its symptoms. In particular, the following possible flow options are distinguished:

• Cytomegalovirus infection, which manifests itself in a normal state that characterizes the functioning of the immune system. The duration of the latent course of the disease is about two months. Symptoms of cytomegalovirus infection are manifested in the form of fever, muscle pain and general weakness. In addition, there is also an increase in lymph nodes. As a rule, the disease in this case goes away on its own, which becomes possible thanks to the antibodies produced by the body itself. Meanwhile, cytomegalovirus can be in it for a long time, remaining in an inactive state during the period of stay in the body.
• Cytomegalovirus infection, manifested at the time of weakening the state of the body's immune system. In this case, we are talking about a generalized form, in accordance with the characteristics of which the disease manifests itself. In particular, the symptoms include damage to the lungs, liver, pancreas, kidneys and retina. Due to the peculiarities of the state of the immune system, cytomegalovirus infection manifests itself in patients after bone marrow transplantation or any internal organ, as well as in patients with diseases that are lymphoproliferative in nature (leukemia) and patients with tumors formed due to hematopoietic cells (hemoblastosis).
• Congenital cytomegalovirus infection. Its manifestations occur against the background of intrauterine infection, with the exclusion of miscarriages. The symptoms characteristic of the disease in this form are expressed in manifestations of prematurity, which implies a developmental delay, as well as problems with the formation of the jaw, hearing and vision. There is also an increase in the spleen, kidneys, liver and some other types of internal organs.

Cytomegalovirus: symptoms in men

Cytomegalovirus infection in men is found in the body mainly in an inactive form, and as the main reason for its activation, a decrease in defenses can be identified, which the body encounters in stressful situations, nervous exhaustion and colds.

Stopping on the symptoms of cytomegalovirus in men, the following manifestations can be distinguished:

• temperature rise;
• chills;
• headaches;
• swelling of the mucous membranes and nose;
• enlarged lymph nodes;
• runny nose;
• skin rash;
• inflammatory diseases that occur in the joints.

As you can see, the listed manifestations are similar to the manifestations noted in acute respiratory infections and. Meanwhile, it is important to take into account that the symptoms of the disease occur only after 1-2 months from the moment of infection, that is, after the end of the incubation period. The main difference, due to which it becomes possible to separate this disease from the common cold, is the duration of its characteristic clinical manifestations. So, the symptoms of cytomegalovirus persist for four to six weeks, while ARI traditionally lasts no more than one to two weeks.

From the moment of infection, the patient immediately acts as an active carrier of the virus, remaining so for a period of about three years. In addition, some cases indicate that cytomegalovirus also affects the genitourinary organs, which, in turn, leads to the appearance of inflammatory diseases in the organs of the genitourinary system and testicular tissues. Actual lesions in cytomegalovirus in this area lead to unpleasant sensations during urination.

A critical drop in immunity leads to a greater severity of cytomegalovirus, which, in turn, causes damage to internal organs, as well as disorders in the activity of the central nervous system, pleurisy, myocarditis, encephalitis. Rare cases indicate that the presence of a number of infectious diseases in a patient can lead to the fact that the inflammatory process causes paralysis formed in the brain tissues, which, accordingly, leads to death.

As in other cases, the natural level of susceptibility to the infection we are considering in men, in particular, is extremely high, while the infectious process itself can proceed with various symptoms. Meanwhile, again, under the condition of the normal functioning of the immune system, the course of the disease is not accompanied by any pronounced manifestations. Cytomegalovirus in an acute form occurs in current immunodeficient physiological conditions, as well as in the presence of a congenital or acquired type of immunodeficiency.

Cytomegalovirus and pregnancy: symptoms

During pregnancy, cytomegalovirus can provoke serious violations regarding the development of the child or even lead to the death of the fetus. It should be noted that the risk of transmission through the placenta of infection is extremely high.

The most serious consequences are noted in the case of primary infection, which the fetus is exposed to when the pathogen enters the mother's body when carrying a child for the first time. Given this feature, those women who did not have antibodies to cytomegalovirus in their blood before conception should be especially attentive to their own health - in this case they are at risk.

The possibility of infection of the fetus is noted in the following situations:

• at conception (if there is a pathogen in the male seed);
• through the placenta or through the fetal membranes during fetal development;
• during childbirth during the passage of the baby through the birth canal.

In addition to these situations, infection of a newborn is also possible during feeding, which occurs due to the presence of a virus in mother's milk. It is noteworthy that infection of a child during labor, as well as during the first months of his life, is not as dangerous for him as for the fetus during its intrauterine development.

When the fetus is infected during the course of pregnancy, the possibility of taking various directions by the development of the pathological process is noted. Some cases indicate that cytomegalovirus may not cause any symptoms, respectively, without affecting the health of the child. This, in turn, significantly increases the chances that the baby will be born healthy.

It also happens that such children have a low birth weight, which, meanwhile, does not entail any special consequences - after a while, in most cases, both the weight and the level of development of children come to the indicators of their peers. Some children, in accordance with a number of indicators, may lag behind in development. Newborns, thus, become, like the majority of people, passive carriers of cytomegalovirus infection.

In the case of intrauterine infection with cytomegalovirus infection of the fetus, as a result of the development of the infectious process, its death may occur, in particular, such a forecast becomes relevant in the early stages of pregnancy (up to 12 weeks). If the fetus survives (which mainly happens if it is infected at a time later than the period defined as critical for infection), then the baby is born already with a congenital cytomegalovirus infection. The manifestations of its symptoms are noted immediately, or it becomes noticeable by the second to fifth years of life.

If the disease manifests itself immediately, then it is characterized by a course in combination with a number of malformations in the form of underdevelopment of the brain, its dropsy, as well as diseases of the liver and spleen (, jaundice, an increase in the size of the liver). In addition, a newborn may have congenital malformations, heart disease, the possibility of developing deafness, muscle weakness, cerebral palsy, becomes relevant for him. The risk of diagnosing a child with a delay in the level of mental development becomes possible.

With regard to the possibility of manifestation of symptoms characteristic of cytomegalovirus at a later age, the consequences of infection during pregnancy are manifested in this case in the form of hearing loss, blindness, retarded speech, psychomotor disorders and mental retardation. Due to the severity of the consequences that can be triggered by infection with the virus in question, its appearance during childbearing can act as an indication for artificial termination of pregnancy.

The final decision in this matter is made by the doctor on the basis of taking into account the results obtained during ultrasound, virological examination, as well as taking into account the actual complaints of the patient.

As we have already noted, the most severe consequences of infection of the fetus with cytomegalovirus infection are observed almost exclusively in the case of primary infection with the mother during the course of pregnancy. In the woman's body, only in this case there are no antibodies that prevent the pathogenic effects of the virus. Thus, in its unweakened state, cytomegalovirus without any difficulty penetrates the fetus through the placenta. It should be noted that the probability of possible infection of the fetus is 50% in this case.

Prevention of primary infection is possible by limiting contact with a significant number of people as much as possible, especially with children who, in the presence of the virus, shed it into the environment before the age of five years. The presence of antibodies in the body of a pregnant woman determines the possibility of an exacerbation of the disease in the event of a decrease in immunity, as well as in the presence of a concomitant type of pathology and the use of certain medications, the action of which suppresses the protective forces inherent in the body.

Now let's look at the symptoms. Cytomegalovirus, the symptoms in women during pregnancy, which proceed by analogy with the symptoms, is expressed, respectively, in a slight increase in temperature and in general weakness. It is also important to note that for the most part the course of the infectious process can be characterized by a complete absence of symptoms, and the virus is detected only as a result of appropriate laboratory tests. For an accurate diagnosis, it is necessary to conduct a blood test for the presence of intrauterine infections.

Treatment of a pregnant woman with an acute cytomegalovirus detected in her or with the relevance of primary infection requires the use of antiviral medications, as well as immunomodulators.

It is noteworthy that timely treatment determines the possibility of minimizing the risk of intrauterine development of the fetus. In the event that a pregnant woman acts as a virus carrier, treatment is not performed. The only thing that the doctor can recommend in this case is the attentive attitude of the mother to her own immunity, and, accordingly, to maintaining it at an appropriate level. At the birth of a child with a congenital form of cytomegaly, it is recommended to postpone the planning of the next pregnancy for a period of about two years.

Cytomegalovirus: symptoms in children

The reason that provokes the occurrence of cytomegalovirus infection in children is their infection in the process of intrauterine development through the placenta. When infected for up to 12 weeks, as we have already noted, there is a high risk of fetal death, and if infection occurs at a later date, the fetus survives, but certain disturbances in its development are noted.

Only about 17% of the total number of infected children experience various symptoms corresponding to cytomegalovirus infection. Cytomegalovirus infection in children, the symptoms of which are manifested in the form of jaundice, an increase in internal organs in size (spleen, liver), and changes in the composition of the blood at the biochemical level, in severe forms of its course, can provoke disorders in the central nervous system. In addition, as we have noted earlier, damage to the hearing aid and eyes may develop.

In frequent cases, the appearance of a profuse rash in children is noted already during the first hours (days) from the moment of birth if they have an infection. It affects the skin in the torso, face, legs and arms. In addition, cytomegalovirus, the symptoms of which in a child are often accompanied by hemorrhages under the skin or mucous membranes, is often accompanied by bleeding of the umbilical wound along with the detection of blood in the feces.

Damage to the brain leads to trembling of the hands and to convulsions, there is increased drowsiness. Cytomegalovirus infection, the symptoms of which, also in its congenital form, are manifested in the form of visual impairment or in its complete loss, can also occur in combination with developmental delays.

If the mother has an acute form of cytomegalovirus at the time of the birth of the baby, her blood is tested for the presence of antibodies against the pathogen, which is done during the first weeks / months of life. Determination in laboratory diagnosis of the presence of cytomegalovirus infection does not indicate the inevitability of the development of an acute form of this disease.

Meanwhile, this can be both a cause for concern, because the likelihood of late manifestations characteristic of the infectious process is greatly increased. Given this feature, babies in this situation require constant monitoring by specialists, which will allow in the early stages to identify the symptoms corresponding to the disease, as well as to carry out the necessary treatment.

Sometimes it also happens that the first symptoms of cytomegalovirus appear by the third or fifth years of life. In addition, it has been proven that the transmission of infection occurs in the environment of preschool groups, which occurs through saliva.

In children, the symptoms of cytomegalovirus infection are similar to the manifestations of acute respiratory infections, which is expressed in the following:

• temperature rise;
• enlarged lymph nodes;
• runny nose;
• chills;
• increased sleepiness.

In some cases, there is a possibility of developing a disease up to pneumonia, in addition, diseases of an endocrine nature (pituitary gland, adrenal glands), diseases of the gastrointestinal tract become relevant. With a latent course of the disease, there are no violations of the immune system, while it is quite common and, as practice shows, there are no threats to the health of the child in this case.

Diagnosis of cytomegalovirus

Diagnosis of the disease is made using a number of specific studies focused on the detection of the virus in question. This includes not only laboratory methods, but also the study of clinical features:

• cultural sowing. With its help, the possibility of detecting the virus in the taken samples of saliva, semen, blood, urine, and a general smear is determined. Here, not only the relevance of the presence of the virus is revealed, but also a comprehensive picture is drawn up, indicating its activity. In addition, by conducting this analysis, it becomes clear how effective the therapy used against the action of the virus is.
• Light microscopy. Using this method, using a microscope in it, it is possible to detect cytomegalovirus giant cells that have a specific type of intranuclear inclusions.
• ELISA. This method is based on the detection of antibodies to cytomegalovirus infection. With immunodeficiency, it is not used, because this condition excludes the possibility of producing antibodies.
• DNA diagnostics. The tissues of the body are examined to detect the DNA of the virus in question. It is possible to obtain only information regarding the presence of the virus in the body, however, with the exception of information regarding its activity.

Given the many different forms in which cytomegalovirus can reside in the body, making a diagnosis involves the use of a combination of different methods, because using only one of the research methods to make an accurate diagnosis is not enough.

Treatment of cytomegalovirus

To date, there is no method of treatment by which cytomegalovirus is completely eliminated from the body. In the normal state of the immune system and the absence of activity from the virus, treatment, as such, is not required.

If a cytomegalovirus infection is detected in the body, it is not necessary to use antiviral therapy without fail. Moreover, the effectiveness of the use of immunotherapeutic drugs in combination with it has not been proven, as well as the effectiveness of antiviral therapy in the presence of a congenital infection.

A course of treatment is required without fail in the following conditions:

• hepatitis;
• disorders of the auditory and visual organs;
• pneumonia;
• encephalitis;
• jaundice, subcutaneous hemorrhages and prematurity (in the case of a congenital form of cytomegalovirus).

Treatment, as a rule, involves the use of drugs in the form of suppositories (Viferon), as well as a number of antiviral drugs. The duration of administration, as well as the dosage, are determined based on the individual characteristics and condition of the patient.

To diagnose cytomegalovirus based on the presence of appropriate symptoms, you must contact a venereologist or a dermatovenereologist.

The cytomegalovirus affects many organs and systems of the human body, has several transmission mechanisms and entry gates, but the priority remains for the suppression of the immune system. Therefore, the treatment of cytomegalovirus infection (CMV) should primarily be aimed at correcting and restoring the cellular link of immunity. Cytomegalovirus, upon initial entry into the body, persists for a long time in target cells, disrupting the normal immune response.

The mechanism of transmission and pathogenesis of the disease

Getting infected with CMV is not easy. This requires very close contact. Usually infection occurs in groups and crowded places. The source of this infection is only a person - a sick manifest form or a virus carrier (asymptomatic course).

Transfer factors:

• saliva (highest concentrations);
• urine;
• women's milk;
• secretions of the genital tract: mucus of the cervical canal, sperm;
• blood;
• cerebrospinal fluid.

The main routes of entry of the virus into the human body:

The virus has an affinity for the following types of human cells:

• monocytes;
• macrophages;
• epithelium;
• vascular endothelium;
• neurons;
• hepatocytes.

CMV target organs:

• salivary glands;
• kidneys;
• bile ducts;
• pancreas;
• intestines;
• bronchioles and alveoli;
• thyroid;
• brain;
• liver

Upon contact with the mucous membranes or skin, the virus enters the bloodstream. Then settles in "favorite cells", the immune system is activated and tries to destroy the pathogen. Clinically, this period may be accompanied by inflammation of the salivary glands or a mononucleosis-like syndrome. But most often this stage proceeds without any manifestations. Then the cytomegalovirus infection goes into a latent state. The virus persists in the body with its preservation in tissues and organs for life.

Reactivation of the infection occurs when exposed to the following provoking factors:

The greatest danger of cytomegalovirus in women is during pregnancy, since the initial meeting with CMV or its reactivation can lead to congenital cytomegaly.

It is at the stage of reactivation that cytomegalovirus should undergo antiviral and immunomodulatory treatment. Its presence in immunocompetent cells during persistence causes immune suppression. Clinicians classify this infection into congenital and acquired.

Manifestations of acquired CMV

Positive analysis for the presence of antibodies to this infection has 80% of the adult population. CMV is considered a childhood infection, since the majority of people encounter the virus in childhood. The first contact with CMV is often asymptomatic for a person, but the virus remains with him for life. With a decrease in the body's defenses, the reactivation of the infection occurs with the manifestation of clinical symptoms.

The incubation period lasts from 15 days to 3 months. The CMV clinic depends on the state of the immune system.

In people with a normal immune system, the infection manifests as follows:

In persons with a reduced immune response, as well as in infants, this infection occurs with damage to many organs:

The younger the age, the more likely it is to have symptoms of the disease. In adolescents and adults, cytomegaly often occurs latently.

Manifestations of congenital CMV

The manifestations and degree of damage to the fetus are largely determined by the immunity of the mother, as well as the timing of infection. A pregnant woman can pass the infection to her baby in 2 cases:

Congenital CMV can manifest itself in a manifest or latent form. Chronic infection develops when infected in early pregnancy. The child is born underweight with gross malformations: microcephaly, blindness and deafness.

The virus enters the fetus at a time when its immune system is immature and cannot adequately respond to the antigen. Children are often born small. At birth, even with a latent infection, inhibition of the cellular link of immunity, jaundice and a slight increase in the liver and spleen are observed.

Diagnosis and treatment

To detect CMV DNA, PCR is performed. Examine not only blood, but also other biological fluids: urine, saliva, cerebrospinal fluid, smear material from the urethra and cervical canal. Since the treatment of cytomegalovirus should be accompanied by a decrease in the number of virions, the viral load must be determined using PCR. With positive dynamics, the load decreases.

In order to determine the degree of immune response, a blood test for antibodies to the virus is performed:

A cultural method for examining biological fluids for the presence of a virus is also used.

In the general blood test, there is a decrease in leukocytes, platelets, an increase in monocytes, lymphocytes. After 2-3 weeks from the onset of the disease, atypical mononuclear cells appear in an amount of up to 10%.

It is not possible to cure cytomegalovirus forever, but it is possible to suppress an active infection and ensure long-term remission with the help of an arsenal of modern medicines.

Antiviral chemotherapy drugs

The most effective means in the fight against CMV are antiviral drugs. They inhibit viral replication by inhibiting one of the enzymes - DNA polymerase:

Chemotherapy is indicated for the generalized form of CMV with the involvement of the retina and lungs in the process. The drugs are very toxic, so their use is limited. Medicines have a negative effect on the kidneys, dividing cells, have carcinogenic and teratogenic properties.

Therefore, they are not used in children and pregnant women. In exceptional cases, when the child's life is in danger, the attending physician may convene a council to decide how to treat a cytomegalovirus infection in a child with antiviral agents.

Contraindications:

• decrease in hemoglobin below 80 g / l;
• platelet count below 250 thousand * 10¹² g / l;
• the absolute value of neutrophils is below 500 cells per microliter;
• age up to 12 years;
• pregnancy;
• severe renal failure.

Side effects:

There is a method of implanting a Ganciclovir capsule into the vitreous body of the eye to treat retinitis.

Interferons

CMV causes a weak natural production of interferon by leukocytes, so the treatment regimen for cytomegalovirus should be supplemented with interferon preparations to restore the normal level of this substance in the blood. If the cytomegalovirus infection proceeds in a mild form, then isolated treatment with interferon suppositories is carried out.

Immunomodulators should be included in any treatment regimen. The most commonly used interferon preparations are:

• Viferon;
• Genferon;

Hyperimmune human immunoglobulin Cytotect

The tool contains ready-made cytomegalovirus antibodies. This medication is very effective in the treatment of CMV: it creates passive immunity to infection.

The drug is approved for use in pregnant women and children. Indications for treatment with Cytotect are generalized and clinically expressed forms of CMV.

To prevent CMV infection during organ transplantation, 1 injection of Cytotect is performed before surgery at a dosage of 1 ml / 1 kg.

Side effects:

• anaphylactic shock;
• headaches and joint pains;
• nausea and vomiting;
• lowering blood pressure.

A contraindication is the presence of an allergy to human immunoglobulin in history.

Modern additional methods of treatment of CMV. These methods significantly increase the activity of the cellular link of immunity:

1. Cryomodification of autoplasma: the method allows to exclude antibodies, inflammatory mediators from the patient's blood.
2. Extracorporeal immunopharmacotherapy: leukocytes are isolated from the blood, treated with immunomodulators, and then returned to the bloodstream.

In fact, cytomegalovirus infection is a chronic infectious disease that develops in a person after infection with the virus of the same name.

The causative agent belongs to the family of herpetic viruses, a distinctive feature of which is "eternal residence" in the body of an infected patient.

This fact makes the disease chronic, although in the main percentage of infected people, the infection may not manifest itself outwardly at all. In other cases, a wide range of manifestations is possible, up to cytomegalovirus disease.

Infection with cytomegalovirus infection is very dangerous for pregnant women - the consequences for the fetus can be the most tragic.

At birth, manifestations of this infection are recorded in 0.5 - 2.5% of infants. Often they can lead to severe neonatal pneumonia, requiring treatment in the intensive care unit for the youngest.

The relevance of this issue is especially high, because. the prevalence of cytomegalovirus infection in adult women can reach 50-70%. However, primary infection during pregnancy is especially dangerous, when the patient had not previously encountered this virus.

This is due to the lack of protective antibodies in her blood that limit the virus. Therefore, it easily penetrates directly to the fetus through the placenta. However, first things first…

Causes of the disease

The cause of the disease is the entry of an infectious agent into the body with its subsequent reproduction, which leads to damage to the cells of many organs.

Persons with disorders of the immune system (HIV, various immunodeficiencies) or due to its immaturity (fetus, newborns, older children) are most at risk of getting sick.

What is CMVI? This is a classic anthroponotic infection, i.e. The "supplier" of the pathogen will always be a person, i.e. it is not possible to get infected from animals or in any other way.

It should be borne in mind that the greatest danger is represented by persons who do not have clear clinical manifestations.

Therefore, others do not even realize that they are in contact with a potential source of the disease, the prevalence of which is very high.

So, in Russia, cytomegalovirus infection of adults is detected in 73-98% of the population, in children these figures are lower.

However, the development of the disease is possible in the presence of those factors:

• Encounter with the virus;
• Implementation of infection pathways in a certain infectious dose, i.e. the virus can only penetrate through specific entrance gates and not every amount of it will be dangerous;
• Reduced immunity - the body is not able to eliminate the penetrated viral particles and cause their inactivation (death).

Transmission of cytomegalovirus is possible in the following ways:

• during pregnancy through the placenta (vertical);
• during childbirth (the virus is in the mucous membrane of the birth canal);
• by inhalation of infected saliva during kissing, close contact;
• during sexual intimacy (the condom is a means of protection);
• parenterally, i.e. through infected blood (blood transfusions, intravenous injections, organ transplants). Therefore, blood and organ donors must be examined for the carriage of cytomegalovirus.

In the external environment, a long-term preservation of virus activity is possible at normal, room temperature. It loses its infecting ability when frozen only at -20 ° C, heated to 56 ° C.

Therefore, seasonality is not typical for this infection - cases of the disease are recorded throughout the year.

Symptoms of cytomegalovirus infection in children and adults

Symptoms of cytomegalovirus infection, photo 1

Symptoms of cytomegalovirus infection can be divided into manifestations of primary pathology (when the virus enters the blood for the first time) and cytomegalovirus disease, the signs of which indicate the progress of the disease (the virus multiplies uncontrollably in the body and leads to numerous lesions of internal organs).

Signs of primary infection are similar to those of infectious mononucleosis.

Therefore, the doctor necessarily conducts a differential diagnosis with this disease using additional examination methods. Of the clinical manifestations indicating cytomegalovirus infection, it should be noted such as:

• high body temperature - it lasts for a long time (more than two weeks), accompanied by headache, muscle and joint pain;
• general malaise, increased fatigue, which is not associated with severe physical and mental stress;
• swollen lymph nodes, their slight soreness;
• enlargement of the liver and spleen, in severe cases, the development of hepatitis and hypersplenism (increased activity of the spleen with the destruction of blood cells, leading to anemia and immunodeficiency) is possible.

Unlike adults, cytomegalovirus infection in children is accompanied by sialodenitis, a specific change in the salivary glands.

Signs of such damage are:

• increased salivation, which can lead to maceration of the skin of the mouth and the formation of ulcers;
• pain during eating, against the background of which the child often refuses it;
• visually determined increase in glands in the submandibular region.

With the development of acute CMVI after a blood transfusion (after 2-8 weeks) or organ transplant (after 8-12 weeks), the following can be observed:

• sudden increase in body temperature up to 39-40°C;
• sore throat;
• weakness;
• enlarged lymph nodes;
• muscle pain;
• development of pneumonia, pleurisy, inflammation of the joints, hepatitis, nephritis.

Without treatment, primary infection after transplantation in 70-80% leads to death. Therefore, patients after organ transplantation are carefully monitored with a comprehensive examination.

It helps to identify a possible infection and treat it in time. This is especially true, because in the vast majority of cases, primary cytomegalovirus infection rarely has symptoms.

Progressing, cytomegalovirus infection in adult women and men is characterized in the literature as a disease of the same name. It starts with CMV syndrome.

Its symptoms are as follows:

• prolonged "incomprehensible" elevated body temperature (38 ° C or more degrees);
• weakness;
• night sweats;
  weight loss that is not associated with a targeted restriction in food.

These symptoms develop gradually, over several weeks. After 1-3 months, pathological changes in different organs begin.

Therefore, various diseases and pathological processes can be diagnosed:

• pneumonia;
• hepatitis;
• ulcerative lesions of the gastrointestinal tract;
• dysfunction of the adrenal glands;
• radiculitis;
• headaches;
• damage to the retina up to loss of vision;
• inflammation of the heart muscle;
• deterioration of blood clotting ability.

Identification of specific symptoms of cytomegalovirus infection, the treatment of which will be carried out purposefully, is impossible without laboratory and instrumental diagnostics.

The choice of these or those methods will be determined by the doctor after a detailed survey of the patient. During it, a specialist can reveal important facts, namely:

• the presence of contacts with patients with CMVI;
• unprotected sex;
• episodes of blood transfusions, organ transplants within six months.

All these circumstances require exclusion or confirmation of CMVI.

Therefore, the patient is organized:

1. Special laboratory diagnostics. It consists in conducting a PCR study (the presence of viral DNA), a serological study (the presence of antibodies to the virus in the blood).
2. Instrumental diagnostics. It allows you to detect signs of CMV disease. To do this, use x-ray of the chest cavity, ultrasound, ECG, electroneuromyography. It is important to conduct timely ultrasound diagnostics in pregnant women in order to detect violations in the development of the fetus.

Treatment of cytomegalovirus infection

The phases of the course of the disease, the symptoms of cytomegalovirus infection in women and men are similar, and the treatment is based on 3 important points:

• the end of the life of the virus inside the body;
• prevention of the development of CMV disease;
• prevention of complications and disability.

Patients with severe clinical manifestations should be treated in a hospital.

During pregnancy in women, treatment depends on how great the possibility of infection of the fetus. A very careful attitude and monitoring of the health of both mother and child is required.

The main drugs used in the treatment of CMVI are Valganciclovir and Ganciclovir.

These are their international names (they are written in small letters on the packaging), branded ones may be different depending on the manufacturer. In the active form of the infection with the presence of severe symptoms, any one drug is prescribed for a period of 21 or more days.

Such a duration of therapy is necessary to completely block the virus reproduction cycle.

The criteria for successful treatment is the disappearance of clinical symptoms and the appearance of a negative one.

Therapy can be extended for prophylactic purposes. For this, a smaller dose of the drug is used for an average duration of one month. If the symptoms of cytomegalovirus infection reappear, treatment must be repeated in full.

In a situation where, according to the results of the analysis, virus DNA is present in the blood, but there are no symptoms of the disease, a smaller dose of medication is prescribed for 1 month, after which the blood is checked for the presence of viral nucleic acid (DNA).

Cytomegalovirus infection in pregnant women has the most adverse effects when the fetus is infected in the early stages.

If the mother did not have a virus in the body before conception, but at the same time the infection occurred before 20 weeks of pregnancy, this is regarded as a primary infection. It is the most dangerous, because. in this case, the probability of transmitting the virus to the fetus is high (40%).

If a woman had a virus in her body before pregnancy or she was re-infected with it, the risk of infection of the fetus through the placenta is much lower - 0.2-2.2%.

The result of early infection of the fetus can be:

• the possibility of spontaneous early termination of pregnancy;
• fetal death;
• delay/stop its development;
• stillbirth;
• the formation of defects.

Infection of the fetus in the later stages and during childbirth will result in the child receiving the virus. The further development of the disease depends on the functioning of the immune system. If it is full-fledged, then the virus will be destroyed and the disease will not develop.

In pregnant women, the treatment of cytomegalovirus infection consists in the use of specific anticytomegalovirus immunoglobulin, which is administered intravenously.

The drug is also prescribed to prevent infection of the fetus if the mother has this virus (only the results of PCR analysis are taken into account, serological testing is less informative), and there are no symptoms of acute CMVI.

The use of similar drugs during pregnancy is possible. However, it does not have proven effectiveness due to the insufficient number of studies conducted on this issue.

It is possible that new proven publications on the treatment of CMVI in pregnant women will appear very soon.

Disease prevention

There is no prophylactic vaccine against cytomegalovirus infection. Prevention of infection is possible if the general hygiene principles are observed:

1. sexual intercourse only with the use of condoms;
2. avoiding close contact with an infected person (no kissing during the active period, only your own dishes and hygiene products, etc.);
3. frequent hand washing after using items that may contain the patient's saliva or urine (toys, diapers).

Since cytomegalovirus infection in women is dangerous for the possibility of transmitting the virus to the fetus during pregnancy, it is necessary to examine the blood for the presence of viral DNA and corresponding antibodies. These studies are best done at the stage of pregnancy planning.

An analysis for cytomegalovirus is part of the so-called TORCH study, which is mandatory for pregnant women up to the 20th week. The question of the need for treatment should be decided individually, depending on how previous pregnancies ended.

Cytomegalovirus infection, microbial code 10

According to the international classification of diseases, CMVI is designated by the code:

ICD-10: Class I - B25-B34 (other viral diseases)

Cytomegalovirus disease (B25)

• B25.0 Cytomegalovirus pneumonitis (J17.1*)
• B25.1 Cytomegalovirus hepatitis (K77.0*)
• B25.2 Cytomegalovirus pancreatitis (K87.1*)
• B25.8 Other cytomegalovirus diseases
• B25.9 Cytomegalovirus disease, unspecified

Additionally:

B27.1 Cytomegalovirus mononucleosis

P35.1 Congenital cytomegalovirus infection