CMV disease. Cytomegalovirus infection

It is hardly possible to meet a person who has never been sick in his life. Sometimes it's difficult to determine the cause feeling unwell. The causative agents of a wide variety of ailments, including CMV (cytomegaloviruses), are disguised as the common cold.

Cytomegalovirus is a member of the human herpesvirus family. Many people are familiar with the disgusting “fever” on the lips. It is caused by simplexvirus, a cousin of CMV. Distinctive feature CMV from brothers is that it amazes internal organs human - kidneys, heart, liver.

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

Who is he?

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

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

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

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

• -infected;
• Taking medications that weaken the immune response;
• Transplanted bone marrow or internal organs.

Cytomegalovirus can be both a consequence and a cause of decreased immunity.

More dangerous form CMV infections – intrauterine.

Probable modes of transmission of CMV

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

Main routes of infection:

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

We are all in a society of our own kind, who cough and sneeze, are born from infected women, have several sexual partners, receive blood and organs from donors or become so themselves. Therefore, you can assume a 90 percent chance of detecting CMV in a smear, blood, breast milk, saliva, etc.

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

Options for the development of infection

1) In people with normal immunity

“Uninvited guests” can go unnoticed for a long time. Sometimes symptoms resembling ARVI are observed. The first signs of the disease appear 20–60 days after the virus enters the body. But there is a global difference between CMV and a respiratory disease: if ARVI goes away in the worst case in a week, then a cytomegalovirus infection can last a month or more. And the symptoms, at first glance, are very similar:

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

It should be emphasized that all these manifestations are a normal immune response to CMV activity. After all elevated temperature fatal to the virus. And the places of inflammation are last refuge DNA particles. If you completely get rid of the symptoms, the disease becomes protracted. It is necessary to combat the consequences of infection only if they develop dangerously.

Good immunity promotes the formation of antiviral antibodies, that leads to quick recovery. However, viruses have been found in human biological fluids for a long time. For many years, pathogenic pathogens remain in the body in an inactive form. Their sudden disappearance is also possible.

2) In people with weak immune systems

Weak immunity is a haven for a “dormant” virus. In such an organism he does whatever he wants. The disease in patients with reduced immunity may progress with varying degrees gravity. Possible complications include:

1. Pleurisy;
2. Pneumonia;
3. Arthritis;
4. Damage to internal organs;
5. Myocarditis;
6. Encephalitis;
7. Vegetovascular disorders.

Sometimes you may experience:

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

In women, the disease manifests itself as cervical erosion, inflammation genitourinary system . If a woman turns out to be pregnant, then real threat for the fetus. In men it may be affected urethra, testicular tissue.

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

3) Congenital CMV infection

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

Diagnostic methods

To diagnose CMV infection, the patient’s complaints, signs of the disease and results are studied laboratory analysis. To make a diagnosis, several tests are carried out laboratory tests simultaneously. Researched:

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

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

Basic research methods:

• Detection of antibodies to cytomegalovirus ().

The most affordable laboratory technique– sowing It does not require complex equipment. Using the culture method, not only the presence of a pathogenic pathogen is determined, but also its type, degree of aggressiveness, and form. A very useful addition to the study is the test medicinal drugs directly on the colony of the resulting culture. After all, each case of infection is individual.

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

The advantage of the PCR method is to detect infection:

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

Disadvantages of the technique:

1. Low predictive value;
2. Low specificity.

IN Lately ELISA method is often used (enzyme immunoassay). With its help, CMV antigen is detected, as well as. If, as a result of a blood test, class M antibodies were detected, then a conclusion is made about primary infection. With intrauterine infection, IgM antibodies are detected in the first 2 weeks of a child’s life. Subsequent positive test speaks of an acquired infection.

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

Algorithm for ELISA studies for suspected CMV

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

It is worth noting that antibodies of classes M and G are not always detected. They may not be detected in the blood of patients with reduced immunity.

How to treat CMV?

Unfortunately, it is impossible to completely destroy viruses in the body.. And it's not necessary. 95% of earthlings have CMV pathogens, and many people simply do not notice them. They don’t notice while the CMV is “sleeping.” And in order to “wake them up”, you have to try very hard - to reach extreme levels of vitamin deficiency, protein starvation, or contract HIV.

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

In what cases is treatment prescribed?

• In case of primary infection with obvious symptoms of pathology;
• If an immunodeficiency state is detected;
• Pregnant or planning pregnancy during primary infection or in case of exacerbation of the disease.

CMV infection must be treated strictly according to indications. Detection of a virus in the body cannot be the basis for drug therapy. Self-medication medicines unacceptable!

Can be assigned antiviral drugs, such as ganciclovir, foscarnet, famciclovir. However, they have a hepatotoxic effect and are poorly tolerated by patients. They should not be prescribed to infants and pregnant women. Therefore, drugs from the group of interferons are more actively used: roferon, intron A, Viferon.

To prevent relapses are prescribed Panavir And neovir.

When treating CMV infection, immunoglobulin enriched with antibodies to this pathogen can be prescribed. Such drugs include cytotect, neo-cytotect.

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

Video: cytomegalovirus in the program “Live Healthy!”

Specifics of the development of CMV infection in children

Most often, a person’s first encounter with CMV occurs in childhood. This does not always happen during intrauterine development. The child grows up among numerous virus carriers, communicates with children and adults. It is almost impossible to avoid infection in such conditions.

But that's a good thing. Kids, having met with pathogenic factors in early childhood, acquires immunity to them.

Only 15% of healthy children show symptoms of cytomegalovirus infection. May be noted various signs ailments.

How to determine infection in newborns?

Often, a child is born seemingly healthy, without any symptoms of infection. Sometimes there are some temporary symptoms that pass safely.

Manifestations and complications of CMV infection and in newborns in general

Temporary symptoms include:

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

However, a small number of newborns experience more permanent problems that may last a lifetime.

Among the permanent CMV symptoms can be distinguished:

• Visual impairment;
• Mental retardation;
• Small head;
• Poor motor coordination;
• Hearing impairment.

Sometimes persistent symptoms CMVs take several years to appear.

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

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

Why is CMV dangerous for children?

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

Most severe consequences infections in such children:

1. Damage to the central nervous system. Signs of encephalitis appear: convulsions, increased drowsiness. Possible hearing damage (to the point of deafness).
2. Chorioretinitis is an inflammatory eye disease. The retina is predominantly affected. May lead to blindness.
3. Cytomegalovirus pneumonia. It is considered the main cause of death in patients with immunodeficiency.
4. Severe encephalitis can lead to the death of a child.

The virus poses a threat to children with leukemia and other cancers, as well as those preparing for organ transplantation. Such children must be diagnosed with CMV infection. The study is especially necessary during exacerbations of infection symptoms.

How to prevent the development of CMV infection in children?

After reading this article, Parents of healthy children do not need to run to the pharmacy for antiviral drugs! Only babies with a low immune response should be protected from CMV. If the mother has been diagnosed with a primary infection, then she should take immunoglobulins. And breast milk transports them into the baby’s body.

But still, nothing better has been invented yet than developing and maintaining children’s own immunity through hardening, physical activity, eating vegetables and fruits. For children leading healthy image life, a pathogenic pathogen that has entered the body is not dangerous.

Video: pediatrician about cytomegalovirus infection

Cytomegalovirus infection(CMVI, inclusion cytomegaly) is a very common viral disease, usually characterized by a hidden or mild course.

For a normal adult, the infectious agent does not pose a threat, but it can be deadly for newborns, as well as people with immunodeficiencies and transplant patients. Cytomegalovirus during pregnancy often leads to intrauterine infection of the fetus.

Note:It is believed that long-term persistence (survival in the body) of the virus is one of the reasons for the development of oncological diseases such as mucoepidermoid carcinoma.

CMV has been found in all regions of the planet. According to statistics, it is present in the body of approximately 40% of people. Antibodies to the pathogen, indicating its presence in the body, are found in 20% of children in the first year of life, in 40% of people under the age of 35, and in almost every person aged 50 years and older.

Although most of those infected are latent carriers, the virus is by no means harmless. Its persistence negatively affects the immune system and in the long term often leads to increased morbidity due to reduced body reactivity.

It is currently impossible to completely get rid of cytomegalovirus, but it is quite possible to minimize its activity.

Classification

There is no single generally accepted classification. Congenital cytomegalovirus infection is conventionally divided according to its forms into acute and chronic. Acquired CMV infection can be generalized, acute mononucleosis, or latent (without active manifestations).

Etiology and pathogenesis

The causative agent of this opportunistic infection belongs to the family of DNA-containing herpesviruses.

The carrier is a person, i.e. CMV is an anthroponotic disease. The virus is found in the cells of a wide variety of organs rich in glandular tissue (which explains the absence of specific clinical symptoms), but most often it is associated with the salivary glands (it affects their epithelial cells).

Anthroponotic disease can be transmitted through biological fluids (including saliva, semen, cervical secretions). It can be contracted through sexual contact, through kissing and through the use of shared hygiene items or utensils. If the level of hygiene is not high enough, the fecal-oral route of transmission cannot be ruled out.

Cytomegalovirus is transmitted from mother to child during pregnancy (intrauterine infection) or through breast milk. There is a high probability of infection during transplantation or blood transfusion (blood transfusion) if the donor is a carrier of CMV infection.

note: CMV infection was once widely known as the “kissing disease” because it was believed that the disease was transmitted exclusively through saliva during a kiss. Pathologically altered cells were first discovered during post-mortem examination of tissues at the end of the 19th century, and cytomegalovirus itself was isolated only in 1956.

Once on the mucous membranes, the infectious agent penetrates through them into the blood. This is followed by a short period of viremia (the presence of the CMV pathogen in the blood), which ends with localization. The target cells for cytomegalovirus are mononuclear phagocytes and leukocytes. The process of replication of the DNA genomic pathogen takes place in them.

Once it enters the body, cytomegalovirus, unfortunately, remains there for the rest of a person’s life. The infectious agent can actively reproduce only in some cells and under optimal conditions. Thanks to this, with a sufficiently high level of immunity, the virus does not manifest itself in any way. But if the protective forces are weakened, the cells, under the influence of an infectious agent, lose the ability to divide and greatly increase in size, as if swelling (i.e., cytomegaly itself occurs). The DNA genomic virus (3 strains have been discovered so far) is capable of reproducing inside the “host cell” without damaging it. Cytomegalovirus loses activity at high or low temperatures and is characterized by relative stability in alkaline environment, but acidic (pH ≤3) quickly leads to its death.

Important:decreased immunity may be a consequence of AIDS, chemotherapy using cytostatics and immunosuppressants, carried out with oncological diseases, as well as ordinary hypovitaminosis.

Microscopy reveals that the affected cells have acquired characteristic appearance"owl's eye" They contain inclusions (inclusions), which are clusters of viruses.

On tissue level pathological changes manifested by the formation of nodular infiltrates and calcifications, the development of fibrosis and tissue infiltration by lymphocytes. Special gland-like structures can form in the brain.

The virus is resistant to interferons and antibodies. Direct impact on cellular immunity due to suppression of the generation of T lymphocytes.

Symptoms of cytomegalovirus infection

Certain clinical manifestations may occur against the background of primary or secondary immunodeficiencies.

Symptoms of cytomegalovirus infection are nonspecific, that is, the disease can manifest itself differently, depending on which cells are predominantly affected.

In particular, when the mucous membranes of the nose are damaged, nasal congestion appears and develops. Active reproduction of cytomegalovirus in organ cells gastrointestinal tract causes diarrhea or constipation; It is also possible that pain or discomfort in the abdominal area and a number of other unclear symptoms may occur. Clinical manifestations of exacerbation of CMV infection, as a rule, disappear on their own after several days.

note: active infection can serve as a kind of “indicator” of the failure of cellular immunity.

Often, the virus can infect the cells of the mucous membranes of the genitourinary system.

Cytomegalovirus infection: symptoms in men

In men, the virus multiplies in the organs reproductive system in most cases it does not manifest itself in any way, i.e. we are talking about an asymptomatic course.

Cytomegalovirus infection: symptoms in women

In women, CMV infection manifests itself inflammatory diseases genitals.

The following pathologies may develop:

• (inflammatory lesion of the cervix);
• endometritis (inflammation of the uterine endometrium - inner layer organ walls);
• vaginitis (inflammation of the vagina).

Important:in severe cases (usually early age or against the background of HIV infection), the pathogen becomes very active and spreads through the bloodstream into different organs, i.e., hematogenous generalization of the infection takes place. Multiple organ lesions are characterized by a severe course, similar to. In such cases, the outcome is often unfavorable.

Damage to the gastrointestinal tract leads to the development of bleeding, in which bleeding is frequent and perforation is not excluded, which results in life-threatening inflammation of the peritoneum (peritonitis). Against the background of acquired immunodeficiency syndrome, there is a possibility of encephalopathy with a subacute course or chronic (inflammation of brain tissue). Damage to the central nervous system short time causes dementia.

To the number possible complications CMV infections also include:

• vegetative-vascular disorders;
• inflammatory joint lesions;
• myocarditis;
• pleurisy.

In AIDS, cytomegalovirus in some cases affects the retina of the eyes, causing gradually progressive necrosis of its areas and blindness.

Cytomegalovirus during pregnancy

Cytomegalovirus infection in women during pregnancy can cause intrauterine (transplacental) infection of the fetus, which does not exclude developmental defects. It should be noted that if the virus persists in the body for a long time, and, despite physiological immunosuppression, there are no exacerbations during pregnancy, then the likelihood that the unborn child will be harmed is extremely low. The likelihood of damage to the fetus is significantly higher if infection occurs directly during pregnancy (infection in the first trimester is especially dangerous). In particular, prematurity and stillbirth cannot be excluded.

At acute course CMV infection in pregnant women may cause the following symptoms:

• whitish (or bluish) discharge from the genitals;
• increased fatigue;
• general malaise;
• mucous discharge from the nasal passages;
• hypertonicity of the uterine muscles (resistant to drug therapy);
• polyhydramnios;
• early aging of the placenta;
• the appearance of cystic neoplasms.

Manifestations often occur in combination. Placental abruption and very significant blood loss during labor cannot be ruled out.

Possible fetal malformations with CMV infection include:

• cardiac septal defects;
• atresia (fusion) of the esophagus;
• abnormalities of the kidney structure;
• microcephaly (underdevelopment of the brain);
• macrogyria (pathological enlargement of brain convolutions);
• underdevelopment of the respiratory organs (pulmonary hypoplasia);
• narrowing of the aortic lumen;
• clouding of the lens of the eye.

Intrauterine infection is observed even less frequently than intrapartum infection (when a child is born while passing through the birth canal).

During pregnancy, the use of immunomodulatory drugs - T-activin and Levamisole - may be indicated.

Important: to prevent Negative consequences, even at this stage and in the future, according to the recommendations of the gynecologist, a woman should take tests for.

Cytomegalovirus infection in children

CMV infection for newborns and children younger age poses a serious threat, since the immune system in children is not fully formed, and the body is not able to adequately respond to the introduction of an infectious agent.

Congenital CMV infection, as a rule, does not manifest itself in any way at the beginning of the baby’s life, but the following are possible:

• jaundice of various origins;
• hemolytic anemia (anemia due to the destruction of red blood cells);
• hemorrhagic syndrome.

The acute congenital form of the disease in some cases leads to death in the first 2-3 weeks.

Over time, serious pathologies such as

• speech disorders;
• deafness;
• atrophy optic nerve against the background of chorioretinitis;
• decreased intelligence (with damage to the central nervous system).

Treatment of cytomegalovirus infection

Treatment for CMV infection is generally ineffective. We are not talking about complete destruction of the virus, but the activity of cytomegalovirus can be greatly reduced with the help of modern drugs.

The antiviral drug Ganciclovir is used to treat newborns with vital signs. In adult patients, it is able to slow down the development of retinal lesions, but with lesions of the digestive, respiratory and central nervous system practically does not give positive result. Discontinuation of this drug often leads to relapses of cytomegalovirus infection.

One of the most promising drugs for the treatment of CMV infection is Foscarnet. The use of specific hyperimmune immunoglobulin may be indicated. Interferons also help the body quickly cope with cytomegalovirus.

A successful combination is Acyclovir + A-interferon. Ganciclovir is recommended to be combined with Amiksin.

Konev Alexander, therapist

The clinical picture of cytomegalovirus infection (CMV infection) largely depends on the state of immunity of the infected person. However, cytomegalovirus (CMV) can affect any organs and systems, and also has an affinity for cells of the immune system (leukocyte immunity).

For whom is cytomegalovirus most dangerous?

Several groups can be distinguished in which clinical manifestations of CMV infection occur more often than in others.

• children in the prenatal period of life (in utero);
• children from the newborn period to approximately 3 years;
• pregnant women;
• persons with established immunodeficiency due to HIV, oncology, or taking cytostatics;
• young people at the beginning of sexual activity and during the period of high activity (approximately 15-30 years).

It should be noted that even in these categories of citizens, cytomegalovirus infection is often asymptomatic or low-symptomatic, causing prolonged evening or round-the-clock low-grade fever (temperature rise to 37.5 degrees), unmotivated weakness and lethargy.

Main symptoms of CMV infection

Clinical manifestations of cytomegalovirus infection may include:

1. Damage to the nervous system, most often of the type of meningitis or meningoencephalitis, polyradiculopathy and neuropathy in adults, especially those with immunodeficiency. In newborns with intrauterine infection, hydrocephalus, microcephaly, and calcifications located around the cerebral ventricles can be detected.
2. Eye damage (usually retinitis type ( inflammatory process in the retina of the eye)).
3. Damage to the gastrointestinal tract: such as enterocolitis, enteritis, and the liver and spleen are also involved in the process, which is accompanied by an increase in their size and jaundice.
4. Pneumonia (inflammation lung tissue, usually interstitial). Pneumonia with CMV infection has a protracted, sluggish nature.
5. Hemorrhagic syndrome, characterized by a skin rash in the form of petechiae and possible bleeding.
6. A symptom complex reminiscent of ARVI: in this case, the disease resembles Infectious mononucleosis. The patient’s temperature rises to febrile levels (i.e. above 38 degrees), the fever is abnormal - rises and falls in temperature do not have any pattern. There is an increase in the lymph nodes, especially the anterior cervical ones; catarrhal phenomena may include hyperemia (redness) of the oropharynx, tonsillitis, and scanty mucous discharge from the nasal cavity. There is also an increase in the parotid (less often submandibular) salivary glands against the background of their inflammation (sialoadenitis) and symptoms of general intoxication - weakness, myalgia, drowsiness and loss of appetite.
7. Kidney damage, usually by type interstitial nephritis, With nephrotic syndrome(proteinuria more than 2.5 g/day, peripheral and central edema up to anasarca).
8. In women, symptoms of vaginitis, cervicitis, endometritis, urethritis. Cytomegalovirus can provoke the appearance of erosions in the vaginal area, cause inflammatory reaction with copious mucous discharge, itching, pain during sexual intercourse. Urethritis is usually sluggish, i.e. possible discomfort and moderate pain and pain when urinating, which, however, does not force the woman to seek medical help.
9. In men, cytomegalovirus infection can occur with symptoms of urethritis and prostatitis. The clinical picture of urethritis and prostatitis caused by cytomegalovirus is also not acute.

The table below contains information about which categories of the population have certain symptoms more often.

Thank you

The site provides background information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Currently cytomegalovirus infection is one of the most common infections. However, with a high percentage of infection among the population of 90 - 95%, only a small number of infected people develop this disease. Diagnostics diagnosis of this disease is based on the study of the patient’s symptoms and complaints, as well as on the results of laboratory tests.

Laboratory diagnosis of cytomegalovirus infection

Usually, infectious diseases are diagnosed through a serological blood test, which determines specific antibodies to a given pathogen. In the case of cytomegalovirus infection, standard serological diagnostic methods are not so informative. It is necessary to determine in more detail the quantity and types of antibodies. We will write more about this in the continuation of the article.

Serological studies

Serology – type of laboratory blood tests to identify immunoglobulins ( antibodies). Antibodies are divided into several classes based on their structure - in the context of diagnosing CMV, we are interested in IgG And IgM . Also, antibodies of the same class may differ in specificity in relation to any disease - for example, antibodies to the hepatitis virus, to the herpes virus, to cytomegalovirus. In a number of cases, during the diagnostic process it becomes necessary to study some functional features antibodies - such as affinity And avidity (more on that later).

IgG detection indicates a past infection and contact of the immune system with virus. However, the diagnostic value this analysis does not have. Quantitative analysis has great diagnostic value IgG – an increase in antibody titer by 4 times the initial level is a sign of active infection or primary lesion.

Detection of IgM is a sign of active infection or primary lesion. This class of antibodies is the first to be synthesized by immune cells in response to contact with an infectious agent. This happens a few days after initial contact.
However, quantitative analysis on IgG allows us to identify active process or primary infection only during a series of tests over a long period of time ( assessment of antibody titer dynamics), and with this disease the diagnosis should be made as quickly as possible. Therefore, in a serological examination, the following properties of antibodies are revealed: affinity And avidity .

Affinity – the degree of affinity of the antibody to the antigen ( virus component). In other words, how specific the antibody is to the pathogen.

Avidity – strength of connection in the antibody-antigen complex.
There is a direct relationship between these concepts - the better the antibodies match the antigen, the stronger their connection during interaction. Both avidity and affinity help determine the age of antibodies - the older the antibody, the lower these indicators. On early stage diseases, the body produces low-affinity antibodies and IgM , which remain active for several months. At the next stage, immune cells synthesize high-affinity IgG , which can remain in the blood for years, but with age, the affinity of these antibodies also decreases. Therefore, by analyzing the properties of antibodies, it is possible to identify the duration of infection, the form and stage of the disease.
Serological examination is carried out using the enzyme immunoassay method, using additional laboratory tests of the properties of antibodies.

Culture examination

At this method examination, biomaterial is collected, in which a high concentration of the pathogen is expected ( saliva, blood, sperm, cervical mucus, amniotic fluid). Next, the collected material is placed on a special medium. This is followed by incubation - for a week or more, the nutrient medium is placed in a thermostat, where the necessary conditions for the virus to multiply. Next, the nutrient medium and cellular material of the nutrient medium are studied.

Polymerase chain reaction (PCR)

This test searches for the genetic material of the virus. However, in case of a positive result, this examination does not allow distinguishing primary infection from the recurrent course of the disease in the acute stage. Although the reliability and sensitivity of the method is high and allows one to detect an infection even with low activity.

From the information provided it is clear that laboratory diagnostics It makes sense if the symptoms of the disease are not specific or it is necessary to determine whether the disease has been cured after a course of treatment. It is also advisable to test both future parents for CMV infection at the pregnancy planning stage, because this infection poses the greatest danger to the fetus during pregnancy.

Deciphering the analysis for cytomegalovirus, taking into account the risk to the fetus

Treatment of cytomegalovirus infection

You need to know that cytomegalovirus infection cannot be treated with medication. That is, for this disease, drug treatment can only help the immune system fight the virus, but once the virus has infected a person, as a rule, it always remains in the host’s body. There is nothing wrong with this - after all, infection with this virus reaches 95% of the entire world population.

The state of the patient’s immune system is important in determining the timing of treatment and prevention; for women it is great importance preparation for pregnancy or developing pregnancy. Regarding pregnancy, it is worth noting that only primary infection during pregnancy or conception, as well as exacerbation of the disease during pregnancy, pose a threat to the development of the baby. In a high percentage of cases, this disease leads to spontaneous abortion or development birth defects and newborn deformities.

Indications for treatment:
1. Detection of primary infection with severe symptoms of the disease.
2. Detection of exacerbation of the disease or primary infection when planning pregnancy or developing pregnancy.
3. Among people with immunodeficiency.

Principles of CMV treatment:

1. Maintaining immunity at a high level. This condition necessary to successfully fight the virus. The fact is that all the medications used do not destroy the virus on their own, but only help the immune system fight it. Therefore, the outcome of the disease will depend on how the immune system is prepared. To improve immunity, it is important to lead an active healthy lifestyle, eat rationally, and maintain a rational work and rest schedule. Also, the psycho-emotional mood has an important influence on the state of immunity - overwork, frequent stress significantly reduce immunity.

2. Use of immunomodulatory drugs. These medications optimize the immune system and increase activity immune cells. However, the effectiveness of these drugs is disputed by many experts due to the rather modest effect of the treatment. Therefore, the use of these drugs is more suitable for the prevention of immunodeficiency than for the treatment of the disease in the acute period.

3. Antiviral drugs. These medications interfere with the processes of virus reproduction and infection of new cells. Purpose this treatment necessary when severe forms diseases due to the high toxicity of these drugs and high risk development of side effects.

In conclusion, I would like to add that a cytomegalovirus infection that is detected in laboratory tests but does not manifest itself does not require treatment. Percentage of people infected ( in whom it is detected IgG to this virus) reaches 95%, so it is not surprising that you too will be infected. Treatment and prevention of the disease in most cases are measures to stimulate and maintain immunity. This disease poses a threat to people with immunodeficiency and pregnant women.

Is cytomegalovirus treated? Treatment of exacerbation

Antiviral drugs for cytomegalovirus: Acyclovir, Valtrex, Amiksin, Panavir

Interferons Viferon, Kipferon, Ergoferon, Imunofan for cytomegalovirus. Homeopathy for CMV

Before use, you should consult a specialist.

Cytomegalovirus (CMV) infection is a viral disease that is associated with human infection with cytomegalovirus. This pathogen is classified as herpesvirus type 5 and is widespread in the population. 50–80% of all people in the world are infected with CMV. Once infected, a person is infected forever, but for healthy people this is not dangerous. The virus increases its activity only if there is a decrease in immunity. This is a common situation with HIV infection or when taking immunosuppressive (immune-lowering) drugs.

If a woman first becomes infected with cytomegalovirus infection during pregnancy, this can lead to serious pathology of the fetus.

Causes and risk factors

Cytomegalovirus is transmitted through close person-to-person physical contact. This can occur through body fluids:

• saliva
• blood (including blood transfusions and organ transplants)
• breast milk
• seminal fluid and vaginal secretions.

During pregnancy, infection occurs through the placenta or directly during childbirth.

Infection is possible through a kiss or through contact with objects that contain particles of saliva or urine of a sick person. Most people become infected in childhood, usually in nurseries or kindergarten, i.e. where there is a lot of contact between children. Less commonly, infection occurs between the ages of 10 and 35 years.

What happens with CMV

The first encounter with the virus is most often asymptomatic. Only in 2% of cases do symptoms similar to ARVI occur (fever, sore throat, joint and muscle pain, swollen lymph nodes). In people with normal immunity, the infection usually does not cause serious complications.

Congenital cytomegalovirus infection is much more dangerous. Most often, pregnant women receive CMV from sick young children. Various congenital pathologies diagnosed in 10% of children infected during fetal development. The virus significantly increases the risk of premature birth, intrauterine growth retardation, and spontaneous abortion.

CMV belongs to the group of so-called TORCH infections, most often associated with fetal developmental anomalies and pregnancy pathologies. Infection with the virus can occur before pregnancy or directly during the fetal development of the child. In the first case no clinical manifestations, and only specific “late” antibodies are detected in the blood. This situation is not dangerous for either the fetus or the woman, the risk of complications does not exceed 1%.

Primary infection of the mother during pregnancy is associated with a high risk for the fetus (30–50%). As a result, 10–15% of children may have hearing or vision impairment, seizures, intrauterine growth retardation, and microcephaly (reduction in brain size). Possible after birth neurological symptoms, mental retardation and physical development, liver damage, which most often manifests itself as jaundice, enlarged spleen.

Symptoms of CMV

There are several types of pathologies that are caused by cytomegalovirus infection. In healthy people, the disease may not manifest itself in any way and the person may not even know that he has become infected. Less commonly, the disease occurs in the form of an acute cytomegalovirus infection, with symptoms reminiscent of infectious mononucleosis:

• swollen lymph nodes
• body temperature above 38 degrees
• weakness, fatigue, lack of appetite
• pain in muscles and joints
• strong pain in the throat, inflammation of the tonsils
• headache.

As a rule, recovery occurs within 2 weeks.

In severe cases, liver damage, jaundice, pain in the chest, cough, shortness of breath, diarrhea, abdominal pain.

In patients with immunodeficiency, cytomegalovirus infection is more severe, as the virus quickly spreads throughout the body and causes:

• damage to the central nervous system with possible convulsions, coma
• severe diarrhea
• pneumonia, breathing difficulties
• retinitis (retinal damage)
• hepatitis (liver damage).

Newborns who become infected with CMV in utero may have:

• jaundice
• pneumonia
• pinpoint purple rash
• enlarged liver and spleen
• low birth weight
• small head size.

Diagnosis of CMV

An infection can be suspected by general analysis blood, where the level of lymphocytes exceeds 50%, and atypical lymphocytes make up up to a tenth of all these blood cells.

Accurate diagnosis of cytomegalovirus infection is usually carried out using the analysis of biological fluids PCR method(polymerase chain reaction) or ELISA (enzyme-linked immunosorbent assay). Other diagnostic methods, such as growing a CMV culture, are currently almost never used. PCR determines the presence of CMV-specific DNA regions in saliva samples, breast milk etc. ELISA allows you to detect antibodies to cytomegalovirus in blood serum. As a rule, the presence of immunoglobulins - IgG and IgM - is assessed. High level IgM (immunoglobulin class M) in the patient’s blood usually indicates a primary infection. When the virus is reactivated, the amount of IgM may also increase, but not as much as the first time. If class G immunoglobulins (IgG) are determined, then this is not the first time the body has encountered CMV; these antibodies remain for life. Their number can increase when the virus is activated. The test results are deciphered by a doctor, since the appearance of specific antibodies to the virus can lag behind infection for up to 4 weeks.

Cytomegalovirus belongs to the group of herpes viruses, and if present in the body Epstein-Barr virus(also from the herpesvirus family), the result may be false positive.

To diagnose liver damage, the levels of bilirubin, AST, and ALT are determined.

Treatment

Patients with normal immunity specific treatment not required. The disease goes away on its own, like ARVI, within a few weeks.

If you're worried heat, severe muscle pain, then use anti-inflammatory drugs: paracetamol or ibuprofen. It is important to drink plenty of fluids; this will not only reduce the symptoms of the disease, but will also help you avoid dehydration.

Patients with immunodeficiencies are prescribed antiviral drugs. These medications cannot completely remove CMV from the body and cure the infection, but they can slow down the replication of the virus. Treatment regimen for cytomegalovirus infection in patients with weakened immune system may include:

• ganciclovir
• valganciclovir
• foscarnet
• cidofovir (not registered in the Russian Federation).

Antiviral drugs have side effects, therefore treatment requires medical supervision. Accept antivirals at least 14 days.

Newborns with CMV infection are treated in specialized departments perinatal centers where antiviral therapy with ganciclovir or valganciclovir is administered. After discharge, such babies need constant monitoring of vision and hearing, observation by a neurologist.

Prevention of CMV

There is no specific prevention of cytomegalovirus infection. There is no effective and safe vaccine against CMV yet. The virus is transmitted through sexual contact, kissing, sharing cutlery, toys, and toothbrushes. Therefore, compliance general rules hygiene, washing your hands with soap before preparing food, after going to the toilet or changing a diaper will help prevent infection. Upon contact with biological fluids(sperm, urine) you must use rubber gloves.

Vulnerable groups of patients - for example, those taking immunosuppressants after an organ transplant or pregnant women - need to be more careful about hygiene rules. If possible, you should avoid contact with small children (especially under 5 years old) and especially not kiss them or eat from the same dishes with them.

Before organ transplantation or blood transfusion, the CMV status of a potential donor is examined.

Complications

Primary infection during pregnancy leads to disruption of intrauterine development, microcephaly, damage to the liver, lungs, and central nervous system of the fetus. In newborns with symptoms of damage to organs and systems, in 30% of cases it is possible death. 40–90% of them have neurological disorders(delay mental development, hearing loss, visual impairment, epilepsy).

In patients with HIV infection, cytomegalovirus can cause the following complications:

• chorioretinitis (combined inflammation choroid and retina)
• pancreatitis, hepatitis, colitis
• Guillain-Barre syndrome
• encephalitis
• peripheral nerve damage
• viral pneumonia
• heart muscle damage
• skin damage.

Complications rarely occur in healthy people. Most often it is diarrhea, pain in the abdomen and muscles.