Cytomegalovirus lgg positive. What is cytomegalovirus infection (CMV)

Before starting treatment for cytomegalovirus, it is necessary to accurately diagnose the disease and determine whether treatment for cytomegalovirus is necessary in your case. Since it is not always required, you need to be aware of it. In addition, diagnosing the presence of cytomegalovirus infection is not easy 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 poses an undeniable danger to the human body. Only a specialist can clearly identify such cases after visiting the sick clinic to diagnose the disease. If your body has symptoms of a generalized cytomegalovirus infection, it is extremely important to go to the clinic. A treatment regimen for cytomegalovirus can only be drawn up after a personal examination of the patient.

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

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

In what cases is treatment for cytomegalovirus really necessary?

The following manifestations are relevant to the specific circumstances according to which the attending physician determines the course of treatment for cytomegalovirus infection in adults or children:

• The presence of acquired or congenital immunodeficiency in a patient of any age.
• Generalized stage - widespread 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 aggravated course of cytomegalovirus or preparation for treatment for allogeneic organ transplantation, pneumonia, encephalitis, cancer - when using therapy that severely suppresses the immune system.
• During the first trimester of pregnancy, women with weakened immune systems may develop primary cytomegalovirus, which can potentially cause extremely severe damage to the fetus, and may also provoke miscarriage.

The generalized stage or symptomatic exacerbation of the disease with 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-related diseases or ARVI. And also with other infectious diseases. This often leads to erroneous treatment and a high risk of developing severe complications.

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

Drugs and vitamins for the treatment of cytomegalovirus infection

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

• Symptomatic remedies– provide relief, pain relief, eliminate inflammation, constrict blood vessels (nasal drops, eye drops, painkillers, anti-inflammatory, folk remedies).
• Antiviral medications- suppress the activity of infection (Ganciclovir, Panavir, Cidofovir, Foscarnet).
• Drugs for syndromic therapy- 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 can be treated quite successfully with Foscarnet. It is used for severe cases of the disease and for complex forms of possible exacerbations that can be caused by other diseases. It is advisable to use this drug in an immunocompromised patient. When the drug gets inside a 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 and quite difficult to use in practice. The drug is prescribed for the course of a disease - cytomegalovirus infection, complicated by particularly severe organ pathologies and fairly extensive inflammation. 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 herpetic infection.
3. Cytotect is an immunoglobulin. For many patients, Cytotect seems to be one of the most optimal means for treating cytomegaluvirus. The drug combines fairly effective effectiveness and an almost complete absence of general toxicity and relative contraindications. Prescribed for prophylaxis in patients with a drug-suppressed immune system. Prevents mass manifestations of the disease after infection with CMV infection. When used, the following may occur: headaches; nausea and vomiting; chills and increased body temperature; aching joints and mild back pain; sometimes decreased 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. Suppositories with antiviral action. It is used for complications of infectious diseases, for primary inflammation, as well as relapse of localized cytomegalovirus infection. The drug is administered rectally. When used, it may cause allergies in the form of skin rashes.
6. Bishofite is an anti-inflammatory drug. Available in the form of a balm (gel) in a tube or in a glass container in the form of a brine. It is used topically as therapeutic mud or mineral water.

List of vitamins

1. C – Broad-spectrum antioxidant. Stimulates the work of cells that consume bacteria and viruses in the blood. Increases the human body's resistance to various infections through cell resistance to the penetration of infectious agents.
2. B9 – for powerful support 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 this 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 absolute peace as much as possible. 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 disposal of the infection and the prevention of complications and relapses.

Treatment with folk remedies

If a person has heard that people were treated for cytomegalovirus with home medicine, then this is a misconception that, thanks to traditional medicine, it is possible to cope with such a difficult task. Treatment of such an infection and all kinds 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.

If the cytomegalovirus IgG test is positive, many people become concerned. They believe that this indicates a hidden serious illness that needs to be treated immediately. However, the presence of IgG antibodies in the blood is not a sign of developing pathology. The vast majority of people become infected with cytomegalovirus in childhood and do not even notice it. Therefore, a positive test result for antibodies (AT) to cytomegalovirus is a surprise for them.

What is cytomegalovirus infection?

The causative agent is herpes virus type 5 - cytomegalovirus (CMV). The name "herpes" is derived from the Latin word "herpes", which means "creeping". It reflects the nature of diseases caused by herpes viruses. CMV, like their other representatives, are weak antigens (the so-called microorganisms that bear the imprint of foreign genetic information).

Recognition and neutralization of antigens is the main function of the immune system. Weak are those that do not cause a pronounced immune response. Therefore, the primary often occurs unnoticed. The symptoms of the disease are mild and resemble the symptoms of a common cold.

Transmission and spread of infection:

1. In childhood, the infection is transmitted by airborne droplets.
2. Adults become infected mainly through sexual contact.
3. After the initial invasion, herpes viruses settle permanently in the body. It is impossible to get rid of them.
4. The infected person becomes a carrier of cytomegalovirus.

If a person’s immunity is strong, CMV hides and does not manifest itself in any way. If the body's defenses are weakened, microorganisms are activated. They can cause the development of serious diseases. In immunodeficiency states, various human organs and systems are affected. CMV causes pneumonia, enterocolitis, encephalitis and inflammatory processes in various parts of the reproductive system. With multiple lesions, death can occur.

Cytomegalovirus is especially dangerous for a developing fetus. If a woman is first infected during pregnancy, the pathogen is likely to cause serious developmental defects in her baby. If infection occurs in the 1st trimester of pregnancy, the virus often causes fetal death.

A recurrence of cytomegalovirus infection poses a significantly less threat to the embryo. In this case, the risk of developmental defects in the child does not exceed 1–4%. Antibodies present in a woman’s blood weaken pathogens and prevent them from attacking fetal tissue.

It is very difficult to determine the activity of cytomegalovirus infection only by external manifestations. Therefore, the presence of a pathological process in the body is detected using laboratory tests.

How the body reacts to the activation of viruses

In response to the invasion of viruses, they form in the body. They have the ability to combine with antigens according to the “key to lock” principle, linking them into an immune complex (antigen-antibody reaction). In this form, viruses become vulnerable to cells of the immune system, which cause their death.

At different stages of CMV activity, different antibodies are formed. They belong to different classes. Immediately after the penetration or activation of “dormant” pathogens, class M antibodies begin to appear. They are designated IgM, where Ig is an immunoglobulin. IgM antibodies are an indicator of humoral immunity that protects the intercellular space. They allow you to capture and remove viruses from the bloodstream.

The concentration of IgM is highest at the beginning of the acute infectious process. If the activity of the viruses has been successfully suppressed, the IgM antibodies disappear. Cytomegalovirus IgM is detected in the blood for 5–6 weeks after infection. In the chronic form of the pathology, the amount of IgM antibodies decreases, but does not completely disappear. A small concentration of immunoglobulins can be detected in the blood for a long time until the process subsides.

After class M immunoglobulins, IgG antibodies are formed in the body. They help destroy pathogens. When the infection is completely defeated, immunoglobulins G remain in the bloodstream to prevent re-infection. During secondary infection, IgG antibodies quickly destroy pathogenic microorganisms, preventing the development of a pathological process.

In response to the invasion of a viral infection, class A immunoglobulins are also formed. They are found in various biological fluids (saliva, urine, bile, lacrimal, bronchial and gastrointestinal secretions) and protect the mucous membranes. IgA antibodies have a pronounced anti-adsorption effect. They prevent viruses from attaching to the surface of cells. IgA antibodies disappear from the bloodstream 2–8 weeks after the destruction of infectious agents.

The concentration of immunoglobulins of different classes makes it possible to determine the presence of an active process and evaluate its stage. An enzyme-linked immunosorbent assay (ELISA) is used to study the amount of antibodies.

Linked immunosorbent assay

The ELISA method is based on searching for the formed immune complex. The antigen-antibody reaction is detected using a special tag enzyme. After combining the antigen with the enzyme-labeled immune serum, a special substrate is added to the mixture. It is broken down by an enzyme and causes a color change in the reaction product. The intensity of the color is used to judge the number of bound antigen and antibody molecules. Features of ELISA diagnostics:

1. The results are assessed automatically using special equipment.
2. This minimizes the influence of the human factor and ensures error-free diagnosis.
3. ELISA is characterized by high sensitivity. It allows detection of antibodies even if their concentration in the sample is extremely low.

ELISA allows you to diagnose the disease already in the first days of development. It makes it possible to detect infection before the first symptoms appear.

How to decipher ELISA results

The presence of antibodies to CMV IgM in the blood indicates the activity of cytomegalovirus infection. If the amount of IgG antibodies is insignificant (negative result), primary infection has occurred. The normal cmv IgG is 0.5 IU/ml. If fewer immunoglobulins are detected, the result is considered negative.

In cases where, simultaneously with a high concentration of IgM antibodies, a significant amount of IgG is detected, an exacerbation of the disease is observed, and the process actively develops. These results indicate that the primary infection occurred a long time ago.

If IgG appears positive in the absence of IgM and IgA antibodies, there is no need to worry. The infection happened a long time ago, and a stable immunity to cytomegalovirus has developed. Therefore, re-infection will not cause serious pathology.

When the analysis shows negative indicators of all antibodies, the body is not familiar with cytomegalovirus and has not developed protection against it. In this case, a pregnant woman needs to be especially careful. The infection is very dangerous for her fetus. According to statistics, primary infection occurs in 0.7–4% of all pregnant women. Important points:

• the simultaneous presence of two types of antibodies (IgM and IgA) is a sign of the height of the acute stage;
• the absence or presence of IgG helps distinguish primary infection from relapse.

If IgA antibodies are detected, and class M immunoglobulins are absent, the process has become chronic. It may be accompanied by symptoms or occur hidden.

For a more accurate assessment of the dynamics of the pathological process, ELISA tests are performed 2 or more times every 1–2 weeks. If the amount of class M immunoglobulins decreases, the body successfully suppresses the viral infection. If the concentration of antibodies increases, the disease progresses.

It is also defined. Many people don't understand what this means. Avidity characterizes the strength of the binding of antibodies to antigens. The higher its percentage, the stronger the connection. At the initial stage of infection, weak bonds are formed. As the immune response develops, they become stronger. The high avidity of IgG antibodies allows one to completely exclude primary infection.

Features of evaluating ELISA results

When assessing test results, you need to pay attention to their quantitative significance. It is expressed in assessments: negative, weakly positive, positive or strongly positive.

Detection of antibodies to CMV class M and G can be interpreted as a sign of recent primary infection (no more than 3 months ago). Their low indicators will indicate the attenuation of the process. However, some strains of CMV are capable of causing a specific immune response, in which class M immunoglobulins can circulate in the blood for up to 1–2 years or longer.

An increase in the titer (number) of IgG to cytomegalovirus several times indicates a relapse. Therefore, before pregnancy, it is necessary to do a blood test to determine the level of immunoglobulins G in the latent (dormant) state of the infectious process. This indicator is important, since when the process is reactivated, in approximately 10% of cases IgM antibodies are not released. The absence of class M immunoglobulins is due to the formation of a secondary immune response, characterized by overproduction of specific IgG antibodies.

If the number of immunoglobulins G has increased before conception, there is a high probability of exacerbation of cytomegalovirus infection during pregnancy. In this case, you need to consult an infectious disease doctor to reduce the risk of relapse.

According to statistics, recurrent infection (reactivation) occurs in 13% of pregnant women. Sometimes secondary infection with other strains of CMV is observed.

If IgG is positive in a newborn, it follows that the baby was infected during fetal development, during childbirth, or immediately after birth. The presence of IgG antibodies can be passed on to the child from the mother. The greatest risk to the health and life of the baby is intrauterine infection.

The active stage of cytomegalovirus infection will be indicated by a several-fold increase in IgG titer in the results of 2 tests done at an interval of a month. If you start treating the disease during the first 3-4 months of a child’s life, the likelihood of developing serious pathologies will be significantly reduced.

Other methods for detecting CMV

In sick people with immunodeficiency, antibodies are not always detected. The absence of immunoglobulins is due to the weakness of the immune system, which is unable to form antibodies. Newborns, especially premature babies, are at risk.

For people with immunodeficiency conditions, cytomegalovirus infection is especially dangerous. To detect it in them, the polymerase chain reaction (PCR) method is used. It is based on the properties of special enzymes that detect the DNA of pathogens and repeatedly copy its fragments. Due to a significant increase in the concentration of DNA fragments, visual detection becomes possible. The method allows you to detect cytomegalovirus, even if only a few molecules of this infection are present in the collected material.

To determine the degree of activity of the pathological process, a quantitative PCR reaction is performed.

Cytomegalovirus can remain in an inactive state in various organs (in the cervix, on the mucous membrane of the throat, in the kidneys, salivary glands). If the analysis of a smear or scraping using the PCR method shows a positive result, it will not indicate the presence of an active process.

If it is detected in the blood, this means that the process is active or has recently stopped.

To make an accurate diagnosis, two methods are used simultaneously: ELISA and PCR.

A cytological examination of saliva and urine sediments may also be prescribed. The collected material is studied under a microscope to identify cells characteristic of cytomegalovirus infection.

During infection by the virus, they increase many times over. This reaction to infection gave another name to cytomegalovirus infection - cytomegaly. The altered cells look like an owl's eye. The enlarged core contains a round or oval inclusion with a strip-shaped light zone.

Warning signs

In order to detect cytomegalovirus infection in time, you need to pay attention to the presence of its characteristic symptoms.

The acute form of cytomegalovirus infection is accompanied by pain and sore throat in children and adults. The lymph nodes in the neck area become enlarged. A sick person becomes lethargic and drowsy, and loses ability to work. He develops a headache and cough. Body temperature may rise and the liver and spleen may enlarge. Sometimes a rash appears on the skin in the form of small red spots.

Infants with a congenital form of cytomegaly have an enlarged liver and spleen. Hydrocephalus, hemolytic anemia, or pneumonia may be present. If cytomegalovirus hepatitis develops, the child develops jaundice. His urine becomes dark and his stool becomes discolored. Sometimes the only sign of cytomegalovirus infection in a newborn is petechiae. They are round dotted spots of a rich red-purple color. Their size ranges from a dot to a pea. Petechiae cannot be felt because they do not protrude above the surface of the skin.

Disorders of the acts of swallowing and sucking appear. They are born with low body weight. Strabismus and muscle hypotonia are often detected, followed by increased muscle tone.

If such signs are observed against the background of a positive test result for IgG antibodies, you should immediately consult a doctor.

Cytomegalovirus (Cytomegalovirus Hominis or CMV for short) is a fairly common infection: it is found in approximately 80% of people over 40 years of age. It is especially dangerous for pregnant women and patients with severe symptoms of immunodeficiency.

What is cytomegalovirus infection?

What is cytomegalovirus? CMV is a herpes infection. In total, about 80 viruses of the Herpes family are known, 8 of them are found only in humans. They are divided into the following groups:

• α-viruses, which include the first and second types of herpes simplex, chickenpox and herpes zoster. These diseases affect the human nervous system.
• β-viruses: CMV (cytomegalovirus) and herpes type 6. According to recent studies, in most cases such infections are localized in the salivary glands and kidneys.
• γ-viruses. This type includes the Epstein-Barr virus (better known as infectious mononucleosis), herpes types 7 and 8. Such diseases affect the cells of the human immune system - lymphocytes.

Depending on the etiology, cytomegalovirus infection can be congenital or acquired. Several strains of CMV are also isolated. This:

• AD169.
• Davis.
• Kerr.
• Towne.

CMV can remain pathogenic for a long time at normal room temperature, but is destroyed at 55°C and above during freezing. It is sensitive to pH fluctuations and is killed when treated with disinfectant powders or solutions.

How does CMV infection occur?

Where does acquired cytomegalovirus come from? The “entry gates” for it are the oral cavity, genitals, and gastrointestinal tract. When it enters the mucous membranes, CMV begins to actively spread and after some time is found not only in saliva, but also in breast milk, vaginal secretions in women, sperm in men, sputum, tear fluid, intestinal secretions, and urine.

Accordingly, you can become infected with cytomegalovirus infection in this way:

• While kissing.
• During sexual contact, especially unprotected.
• Through shared utensils and hygiene items.
• During blood transfusion and transplantation of organs and tissues from an infected donor.
• Extremely rarely - by airborne droplets.

During pregnancy, there is a very high risk of intrauterine infection of the fetus with cytomegalovirus infection through the placenta and amniotic fluid. However, even if this does not happen, the risk of infection remains during the passage of the child through the birth canal, during cesarean section and during breastfeeding.

Pathogenesis of cytomegalovirus infection

Cytomegalovirus easily penetrates the mucous tissue of the upper respiratory tract, digestive tract or genitourinary organs. The “target” of infection is the epithelial cells of the lungs, kidneys, salivary glands, and much less often - monocytes and lymphocytes.

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When CMV passes through the cell membrane, the DNA of the virus penetrates the cell nucleus, causing certain changes in its structure:

• The cell increases in size approximately 3.5 times.
• Immature virions are visible in the nucleus.
• In the center of the cell nucleus there is an acidophilic inclusion. It has a light tint at the edges. Due to this, in the photo under a microscope, the cell looks like a bird's eye.

Due to the increase in cell size, mononucleosis is sometimes mistakenly diagnosed instead of cytomegalovirus infection.

Once inside the cell, CMV does not cause its death. Cytomegalovirus virions become covered with cellular secretions, thereby becoming invisible to the person’s own immune system. However, the virus does not replicate either. In this latent state, the disease can last for a long time.

When the immune system is weakened, the number of CMV-affected cells begins to grow, and external manifestations of the disease are noted. Thus, with AIDS, even death cannot be ruled out as a result of the rapid development of the cytomegalovirus virus infection.

Symptoms of congenital CMV infection

What is the danger of acquired cytomegalovirus in the first trimester of pregnancy? The fact is that in this case the risk of intrauterine death of the child is very high (about 70%). In the first weeks of embryo development, the formation of almost all organs and systems occurs, so infection with cytomegalovirus during this period poses a great danger and can lead to the following pathologies:

• Reduction in head size, disruption of brain structure.
• Underdevelopment of the lungs.
• Deviations in the formation of the organs of the digestive system, especially the intestines.
• Narrowing of the main blood vessels.
• Malformations of the heart.
• Changes in the structure and size of the organs of the urinary system.

Typically, signs of cytomegalovirus infection are noticeable during ultrasound screening at 13 and 18 weeks of pregnancy. With such developmental abnormalities, the newborn requires special care, and the tactics of childbirth change radically.

Infection with CMV infection in later stages of pregnancy does not cause serious anomalies in the intrauterine formation of the fetus. But the baby is born several weeks ahead of schedule with pronounced manifestations of hypoxia. Symptoms of cytomegalovirus in newborns appear from the first days of life as follows:

• Hemorrhagic skin rash and tendency to bleed.
• Hemolytic anemia, in which a lack of hemoglobin develops against the background of the destruction of red blood cells.
• Jaundice due to congenital hepatitis, pathologies of the biliary tract, cirrhosis.
• Pneumonia.
• Inflammation of the large or small intestine.
• The presence of multiple cysts in the pancreas.
• Kidney inflammation.
• Meningoencephalitis.
• Fluid accumulation in the brain (hydrocephalus).
• Brief convulsions.
• Absence of some reflexes.

In addition, there is a danger of a secondary bacterial disease joining CMV. This is what causes death in the first 2 to 3 weeks of a baby’s life.

If infection occurs during childbirth, the disease may be asymptomatic for a long time (any of the signs of cytomegalovirus will be absent). Later, during routine examinations of the child by a pediatrician, the consequences of cytomegalovirus such as hearing, vision and speech disorders, and retardation in intellectual development are revealed.

Features of cytomegalovirus infection in pregnant women

The clinical picture of the disease during pregnancy largely depends on the woman’s own immunity. In severe cases, acute cytomegalovirus causes damage to the liver, brain, and lungs.

In mild forms of cytomegalovirus infection, a pregnant woman complains of the following manifestations:

• Constant weakness, fatigue.
• Frequent headaches.
• Whitish vaginal discharge.
• Enlargement of the submandibular lymph nodes, their soreness.
• Sinusitis.
• Increase in body temperature.

An examination by a gynecologist also reveals hypertension, colpitis or vaginitis, and pseudo-erosion of the cervix. When diagnosed, ultrasound reveals severe polyhydramnios and a discrepancy between the size of the fetus and the gestational age.

Clinical picture of acquired CMV infection

In the vast majority of cases, infection goes unnoticed by humans. Rarely, cytomegalovirus self-limiting mononucleosis may develop. It is characterized by:

• Temperature increase.
• Pain, redness of the throat.
• Runny nose.
• General weakness, malaise.
• Headache.

With a normal immune response, all these symptoms disappear without additional treatment within a few days. In this case, there is no need to consult a doctor; the disease goes into a latent form and does not manifest itself in any way in the future.

Cytomegalovirus infection is much more severe when the immune system is disrupted. This can happen due to a number of factors:

• Human immunodeficiency virus (HIV) or its next stage – AIDS.
• Taking certain groups of medications: glucocorticoids, cytostatics, immunosuppressants.
• Radiation sickness.
• Severe oncological processes.
• Severe extensive burns.
• Condition after transplantation of organs, tissues, bone marrow.
• Unfavorable environmental factors, insufficient vitamin content, constant stress.

Damage to the lymphatic system

The disease can affect individual lymph nodes (cervical, submandibular, postauricular, sublingual), salivary glands (sialoadenitis) or be generalized. Depending on this, the following forms of cytomegalovirus infection are distinguished:

• Respiratory. In approximately 1/5 of cases, from the fifth to the thirteenth week after organ transplantation from an infected donor, pneumonia begins, which is almost impossible to overcome, especially in old age. The probability of death with such a pathology is almost 90%.
• Cerebral with the development of chronic encephalitis (inflammation of the brain), general apathy and dementia.
• Gastrointestinal, which manifests itself in the form of colitis and enterocolitis, peptic ulcer. Very often, perforation of the ulcer occurs, followed by entry of gastric contents into the abdominal cavity and severe peritonitis.
• Hepatobiliary. Hepatitis is usually diagnosed; an ultrasound of the abdominal organs shows an enlarged liver.
• Renal, occurring with severe inflammation of the urinary system.
• Hematological, which is considered the most severe and manifests itself in the form of systemic sepsis.

Also, with weakened immunity, cytomegalovirus infection often affects the eyes with the development of retinitis. Small areas of necrosis appear on the retina, which increase over time, ultimately leading to blindness. Sometimes cytomegalovirus in men occurs with inflammation of the testicles; for women, the presence of colpitis, cervicitis, endometritis, and vulvovaginitis is more typical.

Diagnosis of CMV

To obtain reliable results, several laboratory tests must be performed simultaneously. For examination they take:

• Blood.
• Saliva.
• Genital smear.
• Breast milk.
• Flushing after the bronchopulmonary lavage procedure.
• I'm peeing.
• Tissue obtained by biopsy.

The most accessible way to diagnose cytomegalovirus infection is blood smear microscopy. When examining it, the presence of characteristic modified cells is revealed. However, the accuracy of this method is relatively low and is only 60–70%.

To make an accurate diagnosis, it is enough to detect antibodies to cytomegalovirus. This can be done with:

• Immunofluorescence reactions (RIF).
• Polymerase chain reaction (PCR).
• Enzyme-linked immunosorbent assay (ELISA).

PCR is the most modern method for detecting cytomegalovirus in blood in vitro. Its main advantage is the ability to detect CMV DNA in the early stages of the disease in the absence of obvious symptoms.

The diagnosis of cytomegalovirus infection using ELISA has become more widespread. It allows you to determine the concentration of immunoglobulin M (lgm) and immunoglobulin G (IgG). When deciphering the results of ELISA, the amount of cytomegalovirus M immunoglobulin is of great importance. Exceeding the norm of this indicator means that an active process is underway. The presence of class G immunoglobulin in the blood indicates latent asymptomatic carriage of cytomegalovirus.

Additionally, examinations are carried out to determine the level of the avidity index of antibodies to cytomegalovirus, which indicates the ability of the antibody to retain the antigen (AG). The interpretation of the results is given in the table:

In addition to these tests, it is also necessary to do an ultrasound to assess the functioning of the internal organs, especially the liver and kidneys, and consult a neurologist and gynecologist (or urologist for men).

Therapy for cytomegalovirus infection

It is worth emphasizing that the treatment of CMV presents certain difficulties, since this virus is resistant to almost all drugs used for herpes infections (Acyclovir, Valacyclovir, Vidarabine, Zovirax).

Therefore, for the main treatment of cytomegalovirus infection, the following is prescribed:

• Ganciclovir. The dosage of the medication is selected individually and largely depends on the age and general condition of the patient. In severe cases of the disease, as well as in young children, intravenous administration of the drug is indicated at a rate of 5–10 mg/kg per day. For adults, it can be used in tablet form (the daily dose is 3 grams, this amount is divided into 3 or 6 doses during the day). The duration of treatment ranges from several weeks to 2 – 3 months. Ganciclovir is difficult to tolerate. Doctors note that almost half of the patients experience a decrease in both platelets and granulocytes in the blood, severe headaches, convulsions, allergic rashes, and liver and kidney dysfunction.
• Foscarnet (Foscarvir) is a second-line drug, since the risk of complications with its use is even higher, in addition, it is contraindicated for the treatment of a newborn. It is poorly absorbed from the digestive tract, so it is prescribed only by injection. For adults, the daily dosage of Foscarnet is 180 mg/kg, for children – 120 mg/kg during the first three days of treatment, then the amount of the drug is reduced to 90 mg/kg. Duration of treatment – ​​2 – 3 weeks.

The principle of action of these antiviral drugs is to inhibit the replication of cytomegalovirus DNA, but they are ineffective when affecting the brain, digestive system and lungs. Such medications are contraindicated during pregnancy due to their strong teratogenic effects, so they are prescribed only when the benefit to the mother outweighs the risk to the fetus. You should also stop breastfeeding during treatment.

Additional symptomatic therapy

A good result in the treatment of cytomegalovirus infection was shown by the simultaneous administration of ganciclovir or foscarnet with recombinant interferons, which increase their effectiveness (drugs such as Reaferon, Viferon). Also, specific immunoglobulin Cytotect is used for the prevention and treatment of CMV in adults and children. To prevent the disease in people with weakened immune systems, it is administered a single dose of 1 ml/kg several weeks before organ transplantation. For therapeutic purposes, Cytotect is prescribed according to the following regimen: 2 ml/kg every other day until the symptoms of cytomegalovirus infection completely disappear.

Very often, against the background of CMV infection, a secondary bacterial infection develops, which requires treatment with broad-spectrum antibiotics. Additionally, the following are also assigned:

• Hepatoprotectors.
• B vitamins and magnesium.
• Means to improve blood circulation.
• Antioxidants.
• Neuroprotectors.

Before treating cytomegalovirus, it is necessary to determine the cause of the dysfunction of the immune system. According to reviews from doctors and patients, Anaferon, Cycloferon, Amiksin, Tiloron are the most effective for strengthening the body's defenses.

Prevention and features of management of patients with CMV

It should be noted that such a severe course of the disease is typical for patients with AIDS. Therefore, if such symptoms appear, it is definitely recommended to go through all stages of HIV testing. Prevention of cytomegalovirus infection in women planning pregnancy plays an important role. To do this, at the stage of preparation for conceiving a child, it is necessary to undergo appropriate tests and, if necessary, carry out antiviral therapy.

In the early stages of pregnancy, blood tests for so-called TORCH infections, which include analysis for cytomegalovirus, are mandatory. If it is detected in an active form, gynecologists recommend terminating pregnancies and curing the disease. Doctor E.O. Komarovsky, in numerous videos and comments on his forum, focuses on the causes of exacerbation of CMV infection and treatment tactics. He is known for his negative attitude towards the frequent prescription of antibiotics and antiviral drugs, but the doctor calls for the use of homeopathy or folk remedies only as an auxiliary therapy and high-quality prevention.

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Cytomegaly

General information

Cytomegaly– an infectious disease of viral origin, transmitted sexually, transplacentally, domestically, or by blood transfusion. Symptomatically occurs in the form of a persistent cold. There is weakness, malaise, headaches and joint pain, runny nose, enlargement and inflammation of the salivary glands, and excessive salivation. It is often asymptomatic. The severity of the disease is determined by the general state of the immune system. In the generalized form, severe foci of inflammation occur throughout the body. Cytomegaly in pregnant women is dangerous: it can cause spontaneous miscarriage, congenital malformations, intrauterine fetal death, and congenital cytomegaly.

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

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

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

Routes of transmission of cytomegalovirus

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

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

Mechanism of development of cytomegaly

Once in the blood, cytomegalovirus causes a pronounced immune reaction, manifested in the production of protective protein antibodies - immunoglobulins M and G (IgM and IgG) and an antiviral cellular reaction - the formation of CD 4 and CD 8 lymphocytes. Inhibition of cellular immunity during HIV infection leads to the active development cytomegalovirus and the infection it causes.

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

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

Forms of cytomegaly

Congenital cytomegaly

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

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

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

Acquired cytomegaly in newborns

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

Mononucleosis-like syndrome

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

• long-term (up to 1 month or more) fever with high body temperature and chills;
• aches in joints and muscles, headache;
• severe weakness, malaise, fatigue;
• sore throat;
• enlargement of lymph nodes and salivary glands;
• skin rashes resembling rubella rash (usually occurs during treatment with ampicillin).

In some cases, mononucleosis-like syndrome is accompanied by the development of hepatitis - jaundice and an increase in liver enzymes in the blood. Even less commonly (up to 6% of cases), pneumonia is a complication of mononucleosis-like syndrome. However, in individuals with normal immune reactivity, it occurs without clinical manifestations, being detected only by chest x-ray.

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

Cytomegalovirus infection in immunocompromised individuals

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

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

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

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

Diagnosis of cytomegaly

In order to diagnose cytomegalovirus infection, a laboratory determination in the blood of specific antibodies to cytomegalovirus - immunoglobulins M and G is carried out. The presence of immunoglobulins M may indicate a primary infection with cytomegalovirus or reactivation of a chronic cytomegalovirus infection. Determination of high IgM titers in pregnant women can threaten infection of the fetus. An increase in IgM is detected in the blood 4-7 weeks after infection with cytomegalovirus and is observed for 16-20 weeks. An increase in immunoglobulin G develops during the period of attenuation of the activity of cytomegalovirus infection. Their presence in the blood indicates the presence of cytomegalovirus in the body, but does not reflect the activity of the infectious process.

To determine cytomegalovirus DNA in blood cells and mucous membranes (in scraping materials from the urethra and cervical canal, in sputum, saliva, etc.), the PCR diagnostic method (polymerase chain reaction) is used. Particularly informative is quantitative PCR, which gives an idea of ​​the activity of cytomegalovirus and the infectious process it causes. The diagnosis of cytomegalovirus infection is based on the isolation of cytomegalovirus in clinical material or a fourfold increase in antibody titer. Treatment of cytomegalovirus infection in individuals at risk is carried out with the antiviral drug ganciclovir. In cases of severe cytomegaly, ganciclovir is administered intravenously, since tablet forms of the drug have only a preventive effect against cytomegalovirus. Since ganciclovir has significant side effects (causes suppression of hematopoiesis - anemia, neutropenia, thrombocytopenia, skin reactions, gastrointestinal disorders, fever and chills, etc.), its use is limited in pregnant women, children and people suffering from renal failure (only for health reasons), it is not used in patients without immunocompromise.

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

Prevention

The issue of preventing cytomegalovirus infection is especially acute for people at risk. The most susceptible to infection with cytomegalovirus and the development of the disease are HIV-infected people (especially AIDS patients), patients after organ transplantation and people with immunodeficiency of other origins.

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

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

Cytomegalovirus is a virus widespread throughout the world among adults and children, belonging to the group of herpes viruses. Since this virus was discovered relatively recently, in 1956, it is considered not yet sufficiently studied, and is still the subject of active debate in the scientific world.

Cytomegalovirus is quite common; antibodies to this virus are found in 10-15% of adolescents and young adults. In people aged 35 years or more, it is found in 50% of cases. Cytomegalovirus is found in biological tissues - semen, saliva, urine, tears. When the virus enters the body, it does not disappear, but continues to live with its host.

What it is?

Cytomegalovirus (another name is CMV infection) is an infectious disease that belongs to the herpesvirus family. This virus affects humans both in utero and in other ways. Thus, cytomegalovirus can be transmitted sexually or through airborne alimentary routes.

How is the virus transmitted?

The transmission routes for cytomegalovirus are varied, since the virus can be found in blood, saliva, milk, urine, feces, seminal fluid, and cervical secretions. Possible airborne transmission, transmission through blood transfusion, sexual intercourse, and possible transplacental intrauterine infection. An important place is occupied by infection during childbirth and when breastfeeding a sick mother.

There are often cases when the carrier of the virus does not even suspect it, especially in situations where symptoms hardly appear. Therefore, you should not consider every carrier of cytomegalovirus to be sick, since existing in the body, it may never manifest itself once in its entire life.

However, hypothermia and a subsequent decrease in immunity become factors that provoke cytomegalovirus. Symptoms of the disease also appear due to stress.

Cytomegalovirus igg antibodies detected - what does this mean?

IgM are antibodies that the immune system begins to produce 4-7 weeks after a person is first infected with cytomegalovirus. Antibodies of this type are also produced every time the cytomegalovirus remaining in the human body after a previous infection begins to actively multiply again.

Accordingly, if you have been found to have a positive (increased) titer of IgM antibodies against cytomegalovirus, this means:

• That you have been infected with cytomegalovirus recently (not earlier than within the last year);
• That you were infected with cytomegalovirus for a long time, but recently this infection began to multiply again in your body.

A positive titer of IgM antibodies can persist in a person's blood for at least 4-12 months after infection. Over time, IgM antibodies disappear from the blood of a person infected with cytomegalovirus.

Development of the disease

The incubation period is 20-60 days, the acute course is 2-6 weeks after the incubation period. Staying in a latent state in the body both after infection and during periods of attenuation - for an unlimited time.

Even after completing a course of treatment, the virus lives in the body for life, maintaining the risk of relapse, so doctors cannot guarantee the safety of pregnancy and full gestation even if a stable and long-term remission occurs.

Symptoms of cytomegalovirus

Many people who carry cytomegalovirus do not show any symptoms. Signs of cytomegalovirus may appear as a result of disturbances in the functioning of the immune system.

Sometimes in people with normal immunity this virus causes the so-called mononucleosis-like syndrome. It occurs 20-60 days after infection and lasts 2-6 weeks. It manifests itself as high fever, chills, fatigue, malaise and headache. Subsequently, under the influence of the virus, a restructuring of the body’s immune system occurs, preparing to repel the attack. However, in case of lack of strength, the acute phase passes into a calmer form, when vascular-vegetative disorders often appear, and damage to internal organs also occurs.

In this case, three manifestations of the disease are possible:

1. Generalized form- CMV damage to internal organs (inflammation of the liver tissue, adrenal glands, kidneys, spleen, pancreas). These organ lesions can cause, which further worsens the condition and puts increased pressure on the immune system. In this case, treatment with antibiotics turns out to be less effective than with the usual course of bronchitis and/or pneumonia. At the same time, damage to the intestinal walls, blood vessels of the eyeball, brain and nervous system can be observed in the peripheral blood. Externally it appears, in addition to enlarged salivary glands, a skin rash.
2. - in this case it is weakness, general malaise, headaches, runny nose, enlargement and inflammation of the salivary glands, fatigue, slightly elevated body temperature, whitish coating on the tongue and gums; Sometimes it is possible to have inflamed tonsils.
3. Damage to the genitourinary system- manifests itself in the form of periodic and nonspecific inflammation. At the same time, as in the case of bronchitis and pneumonia, inflammations are difficult to treat with antibiotics traditional for this local disease.

Particular attention should be paid to CMV infection in the fetus (intrauterine cytomegalovirus infection), in newborns and young children. An important factor is the gestational period of infection, as well as the fact whether the pregnant woman was infected for the first time or the infection was reactivated - in the second case, the likelihood of infection of the fetus and the development of severe complications is significantly lower.

Also, if a pregnant woman is infected, fetal pathology is possible when the fetus becomes infected with CMV entering the blood from outside, which leads to miscarriage (one of the most common causes). It is also possible to activate the latent form of the virus, which infects the fetus through the mother’s blood. Infection leads either to the death of the child in the womb/after birth, or to damage to the nervous system and brain, which manifests itself in various psychological and physical diseases.

Cytomegalovirus infection during pregnancy

When a woman becomes infected during pregnancy, in most cases she develops an acute form of the disease. Possible damage to the lungs, liver, and brain.

The patient notes complaints about:

• fatigue, headache, general weakness;
• enlargement and pain when touching the salivary glands;
• mucous discharge from the nose;
• whitish discharge from the genital tract;
• abdominal pain (caused by increased uterine tone).

If the fetus is infected during pregnancy (but not during childbirth), congenital cytomegalovirus infection may develop in the child. The latter leads to severe diseases and damage to the central nervous system (mental retardation, hearing loss). In 20-30% of cases the child dies. Congenital cytomegalovirus infection is observed almost exclusively in children whose mothers become infected with cytomegalovirus for the first time during pregnancy.

Treatment of cytomegalovirus during pregnancy includes antiviral therapy based on intravenous injection of acyclovir; the use of drugs to correct immunity (cytotect, intravenous immunoglobulin), as well as carrying out control tests after completing a course of therapy.

Cytomegalovirus in children

Congenital cytomegalovirus infection is usually diagnosed in a child in the first month and has the following possible manifestations:

• cramp, trembling of limbs;
• drowsiness;
• visual impairment;
• problems with mental development.

Manifestation is also possible in adulthood, when the child is 3-5 years old, and usually looks like an acute respiratory infection (fever, sore throat, runny nose).

Diagnostics

Cytomegalovirus is diagnosed using the following methods:

• detection of the presence of the virus in biological fluids of the body;
• PCR (polymerase chain reaction);
• cell culture seeding;
• detection of specific antibodies in blood serum.