Cytomegalovirus infection. Cytomegalovirus (aka CMV) Cytomegalovirus infection how to determine the acute form

16.02.2022

(other name - CMV infection ) is an infectious disease that belongs to the family herpesviruses . This virus infects a person both in utero and in other ways. So, cytomegalovirus can be transmitted sexually, by airborne droplets through the alimentary route.

According to the existing statistical study, antibodies to cytomegalovirus are found in approximately 10-15% of adolescents. Already at the age of 35, the number of such people increases to 40%.

Cytomegalovirus was discovered by scientists in 1956. A feature of this virus is its affinity for the tissues of the salivary glands. Therefore, if the disease has a localized form, then the virus can be detected exclusively in these glands. This virus is present in the human body for life. However, cytomegalovirus is not highly infectious. As a rule, in order to become infected with the virus, prolonged and repeated contacts, close communication with the carrier are necessary.

Today, there are three groups of people for whom control over the activity of cytomegalovirus is a particularly topical issue. These are pregnant women, people who have recurrent herpes and patients with compromised immune responses.

Causes of cytomegalovirus

A person can become infected with cytomegalovirus in many ways. So, infection can occur by contact, through the use of infected things, in the process of organ transplantation, as well as blood transfusion from a donor previously infected with cytomegalovirus. The disease is transmitted, moreover, through sexual intercourse, by airborne droplets, during pregnancy, in utero and during childbirth. The virus is found in blood, saliva, breast milk, semen, and secretions from the female genital organs. But the virus that enters the human body cannot be recognized immediately, because in this case the duration of the incubation period is about 60 days. These days, the virus may not appear at all, but after the incubation period, the onset of the disease occurs abruptly. Hypothermia and the subsequent decrease in immunity become factors provoking cytomegalovirus. Symptoms of the disease are also manifested due to stress.

Symptoms of cytomegalovirus

If the virus enters the body, then the restructuring of the immune system begins in it. And after the acute phase of the disease is over, the manifestation of vegetative-vascular disorders and asthenia for a long time is possible.

In people with immunodeficiency (people who have undergone chemotherapy, HIV-infected people, and people undergoing immunosuppressive therapy for organ transplants), the presence of cytomegalovirus can provoke the manifestation of very serious diseases. The lesions that occur in such patients can be fatal.

Diagnosis of cytomegalovirus

When diagnosing, one should take into account the fact that the presence of cytomegalovirus can only be detected in the case of special studies of urine, saliva, blood, semen, as well as smears from the genital organs during the initial infection with the disease or during an exacerbation of the infection. If the virus is detected at another time, then this is not decisive for diagnosis.

After this infection enters the body, it begins to produce - antibodies to cytomegalovirus. They stop the development of the disease, as a result of which it is asymptomatic. In the course of a laboratory blood test, such antibodies can be detected. However, a single identification of antibody titer does not make it possible to distinguish between a current infection and a past infection. Indeed, in the body of the carrier of the virus, both cytomegalovirus and antibodies are constantly present. In this case, antibodies do not prevent infection, and immunity to cytomegalovirus is not produced. In case of ineffective diagnosis, the patient must be tested again after a few weeks.

Treatment of cytomegalovirus

If a person is diagnosed with cytomegalovirus, the treatment of the disease will be aimed at strangling all forms of manifestation of the disease and eliminating unpleasant symptoms. After all, today doctors do not have a tool that destroys the virus in the human body completely.

If symptoms do not appear in patients who have been diagnosed with cytomegalovirus, treatment of the disease is not required. After all, this indicates the normal immunity of the virus carrier.

If a virus is detected in the blood, in this case, therapy involves supporting and strengthening the immune system. Therefore, it is necessary to carry out immunomodulatory, as well as restorative treatment. Vitamin complexes are also prescribed.

In the treatment of cytomegalovirus in children and adults, it is important to use an integrated approach to prescribing therapy. As a rule, the treatment is prescribed to take drugs with antiviral and immune effects. With the right approach to treatment, the body's defenses are activated, and the activation of the latent form of the disease is further controlled.

It is very important to undergo all the necessary examinations and timely determine the exacerbation of the disease during . Accordingly, if a cytomegalovirus is detected in a pregnant woman, the treatment is selected taking into account all the individual characteristics of her body. If the case is severe, it is sometimes recommended to resort to termination of pregnancy. Such a conclusion is based on information obtained as a result of virological studies, clinical indications, ultrasound of the placenta and fetus.

Treatment aimed at maintaining immunity includes procedures to strengthen and harden the body. So, bath procedures are often recommended in this case, and those who have some training can periodically bathe in ice water.

There are many medicinal herbs, decoctions of which stimulate the improvement of the general condition of the body. The use of herbs with a choleretic effect is suitable: dog rose, corn stigmas, immortelle, yarrow. You can rinse your mouth with a weak solution .

The doctors

Medications

Prevention of cytomegalovirus

Prevention of cytomegalovirus is mainly in the careful observance of the rules of both personal and sexual hygiene. It is important to exercise due care when coming into contact with infected people. Care should be taken most carefully during pregnancy: in this case, casual sexual intercourse should not be allowed. Another important point in the issue of the prevention of cytomegalovirus is the support of immunity. You should lead a physically active life, eat right, walk in fresh clean air, take vitamins, and avoid stressful situations. Children need to be taught to the right way of life and hygiene from the first years of life.

Cytomegalovirus in children

When children are infected with cytomegalovirus, the incubation period can last from 15 days to 3 months or even more. Allocate congenital and acquired cytomegalovirus infection. Very often, cytomegalovirus in children occurs without severe symptoms. In the congenital form of the disease, the fetus becomes infected during fetal development, becoming infected from the mother. From the mother's blood, the virus enters the placenta, after which it enters the blood of the fetus and then penetrates into the tissue of the salivary glands. If the fetus was infected in the early stages of pregnancy, it may die. Otherwise, the child is born with a number of severe defects. So, cytomegalovirus in children can cause microcephaly , , as well as other brain pathologies with subsequent development mental retardation . Perhaps the birth of children with pathology of the cardiovascular system, gastrointestinal tract, lungs, respiratory tract. Also, cytomegalovirus in children causes convulsions , .

If the infection of the child occurred at a later date, then the newborn does not have pronounced defects, however, the disease is expressed by severe jaundice , the child's spleen and liver are enlarged, damage to the lungs and intestines is possible.

If there is an acute course of cytomegalovirus infection, then the newborn has a number of symptoms: poor appetite, fever may rise, the child is not gaining weight well, has an unstable stool. Possible hemorrhagic rashes on the skin. After a certain time, due to poor recruitment, it develops anemia , hypotrophy . In general, a very severe course of cytomegalovirus infection is noted, and as a result, it often ends in the death of a child in the first month of life.

If the disease is chronic or asymptomatic, then the child's condition remains satisfactory.

With the acquired form of the disease, the child becomes infected during childbirth, or gets an infection already in the first days of life during contact with the carrier of the infection.

There are two options for the course of cytomegalovirus in children in this case: either the salivary glands are affected in isolation, or several or one organ is affected. As symptoms, the child manifests a high temperature, an increase in lymph nodes both on the neck and in other places. The mucous membrane of the pharynx swells, the tonsils, spleen, liver increase. The child refuses to eat, the stool is disturbed - either diarrhea appears. Lesions of the lungs, gastrointestinal tract, yellowness of the sclera, trembling of the extremities are manifested. Possible and sepsis , but the effect of therapy with antibacterial drugs is not manifested. The course of the disease is long, the diagnosis, as a rule, is difficult to establish, because cytomegalovirus is sometimes not detected in the blood and saliva.

Also, when a child is infected with cytomegalovirus, cytomegalovirus hepatitis . Such children are born with severe hemorrhagic syndrome and a number of malformations described above. Very often, the course of the disease ends in death.

Cytomegalovirus in pregnant women

However, the most serious complications of this disease occur in women who are expecting a baby. Cytomegalovirus and pregnancy is a rather dangerous combination, because infection with this disease sometimes even leads to premature birth. It is cytomegalovirus that is one of the most frequently manifested causes of abortion.

In addition, a child of a sick mother can be born with low body weight, as well as with serious damage to the lungs, liver and central nervous system. Cytomegalovirus and pregnancy is a risk that the child may not survive at all. So, according to various estimates, 12–30% of such newborns die. In children who survived, in about 90% of cases, a number of late complications are observed: they can lose their hearing, sometimes speech disorders are present, and the optic nerves atrophy.

Therefore, a very important step is the screening for the presence of cytomegalovirus infection in the process of planning the birth of a child. If you correctly approach the use of both therapeutic and preventive measures, then the negative impact of cytomegalovirus on the course of pregnancy and the likelihood of pathologies in the child can be prevented.

Diet, nutrition with cytomegalovirus

List of sources

Krasnov V.V., Malysheva E.B. Cytomegalovirus infection. Nizhny Novgorod: Publishing House of NGMA, 2004;
Isakov, V.A., Arkhipova E.I., Isakov D.V. Human herpesvirus infections: a guide for physicians. - St. Petersburg: Special Lit., 2006;
Samokhin P.A. Cytomegalovirus infection in children. - M.: Medicine, 1987;
Borisov L.B. Medical microbiology, virology, immunology: M.: Medical Information Agency LLC, 2002.

State Health Institution "Samara Regional Bureau of Forensic Medical Examination".

Head of the Bureau - Doctor of Medical Sciences, Professor, Head of the Department of Forensic Medicine, Samara State Medical University of Roszdrav

Ardashkin Anatoly Panteleevich.

1. Filippenkova Elena Igorevna, doctor - forensic medical expert of the histological department of the State Health Institution "Samara Regional Bureau of Forensic Medical Examination", experience of expert work 10 years, 1 qualification category.

Glass preparations were provided by the Department of Forensic Medicine of the Izhevsk State Medical Academy.

CYTOMEGALOVIRUS INFECTION.

Cytomegalovirus infection in the clinic of internal diseases

V. V. Skvortsov, R. G. Myazin, D. N. Emelyanov

Volgograd State Medical University, Volgograd

One of the leading places among diseases caused by viruses of the family herpesviridae, is occupied by cytomegalovirus infection (CMVI), the increase in the prevalence of which is currently noted in all countries of the world. Over the past decade, the list of diseases has significantly expanded, one of the causes of which is also cytomegalovirus (CMV). The concept of CMVI covers the problems of intrauterine infection, seronegative mononucleosis, hepatitis, diseases of the gastrointestinal tract, post-transfusion syndrome, organ and tissue transplantation, oncogenesis, HIV infection, since CMVI is defined by WHO experts as AIDS indicator disease. The following definition of this disease seems to be the most successful: “Cytomegalovirus infection is a widespread viral disease mainly in young children, characterized by a wide variety of clinical manifestations and a standard two-component morphological picture, including peculiar, similar to an owl’s eye, cytomegalic cells and lymphohistiocytic infiltrates.”

Etiology

CMVI was first described in 1881 by the German pathologist M. Ribbert, who discovered cytomegalic cells (CMCs) in kidney tissue in congenital syphilis. E. Goodpasture and F. Talbot in 1921 proposed the name "children's cytomegaly", which is still used today. CMV was isolated from cell culture by M. Smith in 1956.

The diameter of CMV virions is 120-150 nm. The virion is covered with a glycoprotein-lipid membrane. The CMV virus has the form of an ixahedron, the protein coat of which (capsid) consists of 162 symmetrically arranged capsomeres. The CMV genome is represented by double-stranded DNA. CMV is thermolabile, inactivated at a temperature of +56°C, its optimal pH is 7.2-8.0. Currently, three CMV strains have been isolated: Davis, AD 169, Kerr.

Epidemiology

CMV reservoir in nature is an only human. The virus is shed from an infected organism urine, saliva and lacrimal fluid. CMV transmission factors can be maternal blood, cervical and vaginal secretions, breast milk and semen. The prevalence of CMVI depends on the socio-economic and hygienic conditions of people's lives. Screening studies using enzyme-linked immunosorbent assay (ELISA) revealed antibodies to CMV in 33% of children under 2 years of age and in 50% of adults in countries with a high standard of living. In developing countries, specific antibodies are present in 69% of children and 100% of adults.

The main source of infection of children are mothers - carriers of CMV. Intrauterine infection of the fetus can occur at any time of antenatal development. Transplacental hematogenous infection of the fetus is facilitated by reactivation of CMVI in pregnant women and insufficient barrier function of the placenta. The risk of infection penetrating the placental barrier increases with prolonged viremia and the chronic nature of the infection. In the cervical secret, CMV is found in the first trimester of pregnancy in 2% of women, in the second - in 7%, in the third - in 12%. The fetus can aspirate amniotic fluid infected with CMV, damage to the external integument of the fetus can also serve as the entrance gate of CMV infection. 5% of newborns are infected intranatally. Infection of the fetus in the early stages of intrauterine development is the greatest danger and often accompanied by spontaneous abortion or disorders of organo- and histogenesis. In those infected with CMV, later after birth, there are cytomegaly syndrome, transient jaundice, hepatosplenomegaly. In the future, from 10 to 30% of these children suffer from brain damage, expressed in microcephaly with ventricular calcification, atrophy of the auditory nerve and mental retardation.

Infants may become infected through breast milk. However, with mother's milk, the child receives secretory IgA, which does not cross the placenta and is not produced in the child in the first months of postnatal life. Secretory IgA increases the resistance of the newborn to viral and bacterial infections, therefore, children infected through mother's milk suffer only a latent form of CMVI.

With close contact between mother and child, the factor in the transmission of the virus to him can be saliva. There is evidence that half of children under 3 years of age attending kindergartens become infected with CMV from their peers, and then infect their mothers.

The source of CMV for adults and children can be urine of a patient or virus carrier.

The most common route of infection is sexual, since the virus is contained in the semen in high concentrations for a long time.

There is also airborne route of infection. In patients with severe ARVI, which is often caused by CMVI, cytomegalovirus is found in swabs from the nasopharynx.

Blood transfusions, infusion therapy, organ and tissue transplantation are also dangerous, since biological preparations or tissues from CMV-infected donors are often introduced into the recipient's body. The use of immunosuppressants and cytostatics in patients after organ transplantation not only promotes the reactivation of a previously acquired latent infection, but also increases their susceptibility to primary CMVI infection.

The presence of antigenically different strains of CMV explains the possibility of reinfection with the development of a manifest form of the disease at any age.

Pathogenesis

CMV has pronounced tropism to the tissues of the salivary glands. With a latent form of the course, the virus is found only in the epithelium of the salivary tubules Therefore, sometimes CMVI is rightly called the "kissing disease."

CMV causes significant dysregulation of the immune response, which are based on damage to the interleukin system. As a rule, the ability of infected immunocompetent cells to synthesize interleukins is suppressed due to excessive production of prostaglandins, and the reactions of target cells to IL-1 and IL-2 also change. Developing virus-induced immunosuppression with a sharp inhibition of the function of natural killers.

CMV penetrated into the blood reproduces in leukocytes and the system of mononuclear phagocytes or persists in lymphoid organs. CMV virions are adsorbed on cell membranes, penetrate into the cytoplasm and induce cytomegalic cell metamorphosis. Viral RNA is found in T-helpers and T-suppressors even in the long term of convalescence.

Pathoanatomy

The characteristic pathological sign of CMV is giant cells found in tissues, saliva, sputum, urine sediment and cerebrospinal fluid. Cells have intranuclear and cytoplasmic inclusions and contain a multiplying virus. Changes in the nucleus of the cell give it a resemblance to an owl's eye. Giant cells are localized mainly in the epithelium of the excretory ducts of the salivary glands, in the epithelium of the distal nephron in the kidneys, in the epithelium of the bile ducts in the liver, and in the epithelium of the ependymal ventricles of the brain.

In response to exposure to CMV in the surrounding interstitial tissue, lymphohistiocytic infiltrates sometimes having the character of nodules. In the generalized form, damage to the lungs, kidneys and intestines is more often observed, less often - to the liver and other organs. Along with giant cells and lymphohistiocytic infiltrates, a picture of interstitial pneumonia is found in the lungs, interstitial nephritis in the kidneys, ulcerative enterocolitis in the intestines, and cholestatic hepatitis in the liver.

Congenital generalized CMVI is also characterized by hemorrhagic rashes on the skin and mucous membranes, hemorrhages in the internal organs and brain, significant anemia, and the development of foci of myeloblastosis in the liver, spleen and kidneys. Eye damage is also noted - uveitis, clouding of the lens and subatrophy of the iris.

Rice. 1-6. Salivary gland tissue. Focal venous-capillary plethora. In the stroma of the gland, there are focal round-cell (lymphoid) infiltrates. In the epithelium of the ducts, there are groups of large rounded cytomegalic cells, similar to an "owl's eye", with a large rounded nucleus and a narrow rim of light cytoplasm. Stain: hematoxylin-eosin. Magnification x250, subsequent computer processing of the image in the form of cropping a fragment.

CMVI classification (A.P. Kazantsev, N.I. Popova, 1980):

congenital CMVI - acute form, chronic form;
acquired CMVI - latent form, acute mononucleosis-like form, generalized form.

Clinic of CMVI in children

Acute form of congenital CMVI. The clinic of the acute form of CMVI is characterized by the most severe course with severe signs of toxicosis, enlargement of the liver and spleen, thrombocytopenia, hemorrhagic syndrome, changes in the blood count and CNS damage. This form of the disease is often called fetal cytomegalovirus syndrome. Children are born premature, with low body weight, reflexes are depressed, sometimes there are disorders of sucking and swallowing. Occurs in 60% of cases jaundice, possible causes of which may be CMV hepatitis or increased hemolysis of red blood cells. Jaundice resembles physiological, but the intensity of the disease gradually increases, and it persists for 1-2 months. In 90% of children, the liver is enlarged and protrudes 3-5 cm below the edge of the costal arch. The spleen is enlarged in 42% of cases, it is dense, painless. In the blood, 70% of children have thrombocytopenia, elevated bilirubin levels, as well as an increase in transaminase activity - up to 150 IU / l and alkaline phosphatase - up to 28 IU.

The acute form of CMVI occurs under the guise of hemolytic disease of the newborn. Often also found gastrointestinal lesions, dominated dyspeptic syndrome and progressive dystrophy.

In the acute form of congenital CMVI, the death of children occurs in the first weeks or months of life, most often from associated bacterial infections.

Chronic form of congenital CMVI. In children who have had an acute form of the disease, there is an undulating course of the chronic form of CMVI. Often formed congenital malformations of the central nervous system, in particular microcephaly- in 40% of cases. Can develop chronic hepatitis, in rare cases turning into cirrhosis. Changes in the lungs in 25% of children are characterized by the development pneumosclerosis and fibrosis.

The differential diagnosis of congenital CMVI is carried out with rubella, listeriosis, toxoplasmosis, as well as with hemolytic disease of the newborn, congenital syphilis and sepsis.

Latent form of acquired CMVI. The latent form is not clinically manifested in any way and is detected only during a virological examination.

Acute mononucleosis-like form of acquired CMVI. The acute form in clinical manifestations in older children resembles infectious mononucleosis and often occurs after blood transfusions. The disease is characterized by an acute onset with a rise in temperature and the appearance of symptoms of intoxication. Lymphadenopathy, tenderness on palpation of the parotid region, symptoms of acute respiratory infections, hepatomegaly are recorded. Characterized by leukocytosis, an increase in the number of neutrophilic granulocytes and atypical mononuclear cells. It is recommended to set up the Paul-Bunnel and Hoff-Bauer reactions, which are positive in the case of infectious mononucleosis and negative in cytomegalovirus mononucleosis-like syndrome.

Generalized form of acquired CMVI. The generalized form is characterized by lymphadenopathy, intoxication, fever. First of all, symptoms of damage to the respiratory organs are detected: dry, agonizing cough, shortness of breath of a mixed type. Auscultation of the lungs revealed dry and moist rales. Developing pneumonia is characterized by a protracted course, which determines the severity of the underlying disease. Due to the layering of bacterial and fungal infection, it can be difficult to isolate the symptoms of generalized CMVI.

Often CMVI occurs in association with other diseases of viral or bacterial etiology. The combination of CMVI and ARVI is especially common, in which cytomegalovirus is isolated in 30% of sick children. This flu is more severe and contributes to the activation of CMVI by suppressing immune responses.

Clinic of CMVI in adults

CMVI in adults occurs in a latent (localized) and generalized form. latent form usually does not show clear clinical symptoms. Sometimes observed mild flu-like illness, unclear subfebrile condition. Diagnosis of this form of CMVI is based on the results of laboratory tests.

Generalized form acquired CMVI in adults is observed seldom. As a rule, its clinical signs are detected against the background of some other disease that sharply reduces immunity: after major surgical operations, against the background of leukemia or neoplasms. In these cases, the use of various immunosuppressants in the treatment of patients has pathogenetic significance. Generalized CMVI in adults is manifested by sluggish pneumonia or a kind of acute infectious disease characterized by fever, enlargement and tenderness of the liver, an increase in the number of mononuclear cells in the blood (mononucleosis caused by CMV), and damage to the gastrointestinal tract. Lymphadenopathy and tonsillitis are absent.

It is difficult to diagnose the disease. In women, latent CMVI can be suspected with repeated miscarriages and stillbirths. The diagnosis is based on the data of cytological and virological studies.

Liver pathology occupies a special place in CMVI. Cytomegalovirus hepatitis, which develops in response to the introduction of CMV, is characterized by the degeneration of the epithelium of the biliary tract and hepatocytes, stellate endothelial cells and vascular endothelium. They form cytomegalic cells, surrounded by inflammatory mononuclear infiltrates. The combination of these changes leads to intrahepatic cholestasis. Cytomegalic cells are desquamated, filling the gaps of the bile ducts, being the cause of the mechanical component of jaundice. At the same time, degenerate CMV hepatocytes are destructively changed, up to necrosis, which leads to the development cytolysis syndrome. It should be noted that in CMV hepatitis, which has a prolonged, subacute or chronic course, the leading role belongs to cholestasis syndrome. In diagnostics CMV hepatitis of great importance are the results of a puncture biopsy of the liver (detection in the punctate of giant, 25-40 microns in diameter, cytomegalic cells in the form of an owl's eye with a huge nucleus and a narrow border of the cytoplasm), as well as cytological (detection of cytomegalic cells in the urine sediment) and serological (detection of antibodies IgM to CMVI) methods. Differential diagnosis of CMV hepatitis is carried out with other viral hepatitis: B, Epstein-Barr, herpetic hepatitis.

With CMVI, salivary glands are usually affected. They show mononuclear infiltrates. sialadenitis wears chronic. Simultaneously with the defeat of the salivary glands, degeneration of the epithelium of the stomach and intestines is observed with the development of erosions and ulcers and lymphohistiocytic infiltrates in the thickness of the intestinal wall.

The defeat of the lymph nodes is characteristic of CMVI. At the same time, all the signs typical of this infection are preserved. It is the pathology of the lymphatic system that exacerbates the organ and systemic manifestations of CMVI.

The defeat of the respiratory system in CMVI is characterized by the development interstitial pneumonia, bronchitis, bronchiolitis. At the same time, the epithelium of the alveoli, bronchi, bronchioles and surrounding lymph nodes undergoes specific changes. In the peribronchial tissue, infiltrates are formed from mononuclear cells, macrophages and plasma cells. CMV pneumonia often occurs with a staphylococcal layer, accompanied by purulent bronchiolitis and abscess formation. The presence of CMV is confirmed by the detection of cytomegalic cells. Often, CMV pneumonia is combined with pneumocystosis with an extremely severe course of the disease.

Kidney damage in CMVI is also observed frequently. In this case, cells of the epithelium of the convoluted tubules, the epithelium of the capsules of the glomeruli, as well as the ureters and the bladder, undergo a specific ("giant cell") change. This explains the detection of cytomegalic cells in the urine sediment.

CNS involvement in adults is rare and occurs in the form of subacute encephalitis.

Eye lesions in CMVI are characterized by the development chorioretinitis. Chorioretinitis is very often combined with CMV encephalitis.

Laboratory diagnostics

Currently, there are several reliable methods for determining CMV.

Traditional isolation of the virus on the culture of embryonic fibroblasts and the culture of human diploid cells, in which CMV exhibits its cytopathic effect. The method is the most reliable and sensitive (determination time is 2-3 weeks).
Accelerated virus culture method for 6 hours using monoclonal antibodies to indicate early antigens.
The method of cytoscopy of urine and saliva sediments, as well as light and electron microscopy of histological preparations, in particular liver biopsy, which makes it possible to identify giant CMV cells in the form of an owl's eye, with a narrow border of cytoplasm and a large nucleus.

Various methods are used to determine antibodies to CMV.

Complement fixation reaction (RSC). The most common way to study specific humoral immunity in CMVI. The method is not sensitive enough, since only total antibodies are detected. RSK with a titer of 1:4 is negative, 1:8 is weakly positive, 1:16 is positive, 1:32 is sharply positive.
Immunofluorescent analysis. Determines the increase in the titer of antibodies Ig classes M and G to CMV. This method is more sensitive than RSC.
ELISA (peroxidase) analysis.
Solid phase radioimmunoassay. It also allows you to determine Ig classes M and G.
Immunoblotting. Using polyacrylamide gel electrophoresis, it evaluates antibodies to CMV of various classes. This the most modern method of specific diagnostics, it can be used to determine the entire spectrum of antibodies to CMV.

With congenital CMVI with CNS damage, the prognosis is unfavorable, while with acquired generalized CMVI, it is determined by the underlying disease. With a latent form of acquired CMVI, the prognosis is favorable.

Prevention

It is necessary to exclude the contact of pregnant women with children with congenital CMVI. If a woman gives birth to a child with congenital CMVI next pregnancy can be recommended not earlier than 2 years later(term of persistence of the virus in localized acquired CMVI).

Currently, an active search for vaccines against CMVI is underway. Already established in the US and UK live vaccines currently undergoing clinical trials.

It is important to remember that CMVI requires physicians to be aware of various fields of medicine and to be creative in order to effectively use proven methods of diagnosis, treatment and prevention. Early detection of CMVI contributes to an increase in the effectiveness of care for this category of patients, as well as timely recognition of cases of HIV infection and AIDS.

Literature

. Rakhmanova A. G., Isakov V. A., Chaika N. A. Cytomegalovirus infection and AIDS. - L .: Research Institute of Epidemiology and Microbiology. Pasteur, 1990.
Demidova S. A., Semenova E. I., Zhdanov V. M., Gavrilov V. I. Human cytomegalovirus infection. — M.: Medicine, 1976.
Farber N. A. Cytomegalovirus infection in clinical medicine //Ter. Archive, 1989. - No. 11.
Farber N. A. Cytomegalovirus infection and pregnancy // Obstetrics and Gynecology. - 1989. - No. 12.
Samokhin P.A. Cytomegalovirus infection in children. — M.: Medicine, 1987.
Kazantsev A.P., Popova N.I. Intrauterine infectious diseases and their prevention. - L .: Medicine, 1980.
Report of the WHO scientific group "Immunological deficiency". — M.: Medicine, 1980.
Kozlova S. I., Semanova E., Demikova N. S., Blinnikova O. E. Hereditary syndromes and genetic counseling. - L .: Medicine, 1987.
Harrison J. Guide to Internal Medicine: In 10 volumes - 1998. - V. 5.
Lawlor Jr G, Fisher T, Adelman D. Clinical Immunology and Allergology. — M.: Practice, 2000.

The structure of lethal outcomes and pathological anatomy

in patients with HIV infection in Moscow

Infectious Clinical Hospital No. 2

Federal Center for Prevention and Control of AIDS of the Ministry of Health of the Russian Federation, Institute of Human Morphology of the Russian Academy of Medical Sciences, Moscow

Materials and methods

In the period from 1991 to 2003. 537 adults with HIV infection died and were admitted to the pathoanatomical department of ICH No. 2. Mortality was registered in all age groups, 65% were persons under the age of 40 years. Among the dead patients, 75% were men. In all cases of autopsies, a complete macroscopic and microscopic examination was performed using a wide range of histological stains, bacteriological and virological methods.

Cytomegalovirus infection (CMVI) occupies the second place in the frequency of detection in dead patients with HIV infection over a 13-year observation period - 85 cases (15.8%). Until 1999 annually at least a quarter of the deceased patients suffered from CMV infection. The highest proportion of CMVI, according to sectional studies, was recorded in 1997. - 35.8% of cases. From 2000 to 2002 the frequency of CMVI as a cause of death decreased and ranged from 9.7% to 6.5% per year, which may have been the result of timely detection of the fact of active CMV replication in an HIV-infected patient and drug prevention of the manifest forms of the disease, as well as - timely etiotropic therapy of patients with clinically expressed CMVI. In 2003 the frequency of CMVI in dead patients increased again to 14.5%, primarily due to patients who first sought medical help, already having a severe generalized disease of cytomegalovirus etiology. A wide range of organ lesions have been associated with CMVI, including pathology of the lungs, intestines, esophagus, adrenal glands, retina, brain and spinal cord, liver, stomach, lymph nodes, kidneys, spleen, heart, and pancreas. With a wide variety of lesions, cytomegalovirus etiology, there is a peculiar morphology of lesions that is not found in other well-known infectious diseases. An important link in the pathogenesis of CMVI in patients with HIV infection is a generalized lesion of the vascular endothelium by cytomegalovirus, which occurs in all affected organs and leads to chronic ischemia. Also, a characteristic feature of the disease should be considered the development widespread fibrosis with various variants of dysregenerative and precancerous changes. Particular attention should be paid to frequent and often the only detectable extensive lesion of the adrenal glands in patients with CMVI at autopsy. In all cases, the pathological process had bilateral character, in a number of observations capturing all layers of the cortex and the medulla with complete destruction of the tissue of the organ. Despite the high frequency and severity of adrenal damage, clinical diagnosis of adrenal insufficiency was not made in any case. At the same time, in two patients, acute adrenal insufficiency was the direct cause of death.

Cytomegalovirus is a widespread infection caused by a special type of herpesvirus. This disease can affect both adults (regardless of age) and infants, that is, be congenital or acquired.

It is important to note that this type of herpes has much in common with other herpesviruses, since, like them, it is capable of provoking latent and chronic infections in the patient's body. Despite this, it is CMV that has the stronger genome.

Symptoms of such a disease can be a variety of signs, from acute respiratory infections to a rash. CMV is considered especially dangerous for women during pregnancy, newborns, and people with weakened immune systems. It is in such cases that the virus can cause serious harm to the health of the patient. Moreover, sometimes CMV threatens with dangerous disorders in the systems of the human body and becomes a real threat to the life of a carrier of cytomegalovirus.

igg antibodies are found in approximately 50% of infected people. This suggests that there is a lifelong persistence in the body, which was affected by the cytomegalovirus. What it is, not everyone knows. With all this, it should be understood that the spread of this disease is not at all affected by the social status of a person and his lifestyle. Infection with cytomegalovirus usually occurs through close contact with infected biological secretions.

There are the following possible ways of transmission of CMV:

Sexual contact with sperm, vaginal secretion.
Salivary transmission occurs with a kiss.
Intrauterine infection of the fetus from the mother.
The way the virus is transmitted through the blood (during blood transfusion, injections, medical manipulations).
Infection of the child through mother's milk.
Airborne transmission (occurs when coughing, sneezing, close conversation).
With organ transplants.

Based on the foregoing, at an increased risk of infection are people with weakened immune systems, pregnant women, patients undergoing surgery, as well as lovers of unprotected sex.

Despite this, the virus is very actively transmitted by airborne droplets, therefore, in addition to the human immune system, in this case it will not be able to protect anything.

In order to identify cytomegalovirus, a series of smears, ELISA analysis and avidity (a study of antibodies to this virus) are usually practiced during pregnancy. Upon receipt of the test results, the results may show that cytomegalovirus igg antibodies are detected.

What does it mean? First of all, this will indicate that a woman has already encountered this type of infection before, and the infection was even before pregnancy (in general, more than 95% of all people on the planet are infected with CMV). With this indicator, you should not worry, since in this case pregnancy is not endangered, this is a relative norm.

The situation changes when the test results show Ig M in the blood. This is a sign of a recent infection. In this case, it remains only to find out exactly when the infection occurred: before pregnancy or already during gestation.

In the event that a woman is examined before pregnancy, then she is recommended to refrain from conceiving a child for 2-3 months in order to be able to control the development of the virus. If a woman does not have antibodies to cytomegalovirus at all, she has a high risk of developing various types of pathologies in children that CMV can cause.

In addition to the above method, the following types of studies are also often used to detect cytomegalovirus:

Cytological examination (detection of giant cells of the virus).
PCR method or diagnosis of virus DNA in patient tissues. It is this method of research that is considered the most accurate today. It can be used for both adults and newborns. At the same time, if IgM is detected in the baby in the first two weeks of life, this will indicate the presence of an intrauterine infection (the virus was transmitted from the mother). If this indicator appears after this period, then most likely the virus is acquired.

In some children with strong immunity, cytomegalovirus can cause the so-called mononucleosis-like syndrome. Usually, its clinical course is practically no different from traditional infectious mononucleosis, which provokes the Epstein-Barr virus.

The generalized form of this syndrome is accompanied by the following manifestations:

Fever.
Chills and fever for a month.
Sore throat.
The appearance of disorders in the genitourinary system.
Cervical lymphadenitis (enlarged lymph nodes).
The appearance of a skin rash.
Weakness.
Muscle pain.

In more severe cases, mononucleosis-like syndrome can cause organ dysfunction, jaundice, and hepatitis. Rarely, there is an increase in liver parameters and enzymes, as well as pneumonia. The total time of the course of this syndrome is usually from ten days to two months.

After that, a person may have severe weakness and malaise. As a preventive measure of the disease on his forum, Dr. Komarovsky advises timely diagnosis. Traditional treatment is carried out by prescribing drugs of the interferon group.

More about the disease

Cytomegalovirus infection during pregnancy: manifestations, consequences

Infection with the causative agent of cytomegalovirus infection during pregnancy is the worst option for the course of this virus. This is especially dangerous when the expectant mother does not have developed antibodies to the virus, which means she is completely unprotected.

In this case, the virus can penetrate the placenta into the intrauterine birth bladder and begin to damage the fetus. The probability of passing the disease from mother to child is 60%. In addition, cytomegalovirus infection can penetrate into the fetal membranes through the cervix, as well as during the birth itself (through the birth canal). In the event that a woman, even before the moment of conception, was affected by a cytomegalovirus infection and she has developed antibodies, the likelihood of a negative impact on the development of the fetus is much less.

If the fetus becomes infected with a cytomegalovirus infection in the future (with the congenital form of the virus), the following anomalies may occur:

Stillbirth risk.
Risk of miscarriage.
The formation of severe anomalies in the development of the baby's brain.
Pathologists of visual or auditory function.
Epilepsy.
Hypotrophy.
Various congenital malformations.
Cerebral paralysis.
Various forms of heart defects.
Anthroponotic skin diseases.
Violation of motor skills and general development of the child.
Damage to the central nervous system of the fetus.

If infection with cytomegalovirus infection occurred late in the course of pregnancy (in the third trimester), then it is more likely that the newborn will have serious liver pathologies, jaundice, anemia, an enlarged spleen, and even hepatitis. Cytomegalovirus infection is considered very dangerous precisely when it is first infected during pregnancy.

If a woman has not yet caught this virus, then she needs to follow all preventive measures:

limit contact with frequent sources of the pathogen, especially preschool children;
have protected sex;
use personal hygiene products.

In addition, it is very important for a woman to strengthen her immune system (eat right, have a healthy sleep, good rest, avoid nervous strain). You can also get vaccinated against herpesvirus. To strengthen the immune state, it is useful to drink decoctions of medicinal herbs (viburnum, rosehip, chamomile, lemon balm).

In most cases, pregnant women do not observe any clinical signs of cytomegalovirus infection. Quite rarely, there are symptoms that are a bit like the flu (chills, cough, fever, weakness, muscle pain).

Cytomegalovirus: symptoms in women, men and children

If a woman has strong immunity, then this disease is generally asymptomatic. Only when the patient has immune disorders, the virus will make itself felt.

Sometimes (in women with a normal immune status), cytomegalovirus causes a mononucleosis-like syndrome. It manifests itself in the form of fever, chills, fever, weakness and pain in the head. This subtype of mononucleosis can last from two to six weeks.

Sometimes such a disease is very difficult to diagnose and say that it is cytomegalovirus. Its symptoms are often disguised as a common cold (runny nose, cough, sore throat, inflammation of the tonsils, fever). At the same time, the main difference between a simple ARVI and this herpesvirus is that the latter lasts much longer (up to one and a half months).

Only during the period of exacerbation or active spread of the disease in the body, women may experience the following cytomegalovirus symptoms:

Lung damage.
The appearance of severe inflammation in the kidneys, spleen and pancreas.
Disturbance of the digestive system.

Cytomegalovirus symptoms in men are extremely rare, since in more than 90% of all cases in the stronger sex, this virus is in an inactive form. A sharp decrease in the defenses of a man's body (illness, severe nervous strain, stress, physical exhaustion) can provoke the activation of the virus.

In this case, the man will experience the following symptoms:

Headaches and chills.
Joint pain.
Swelling of the nasal mucosa.
Temperature rise.
Pain when urinating.
The appearance of inflammatory diseases of the genitourinary system of a man.
The appearance of a skin rash.
The development of inflammatory diseases of the joints.

From the moment of initial infection with the virus, a man is its active carrier for three years. If the patient's immunity drops sharply, then he runs the risk of getting pneumonia, pleurisy, myocarditis, and even encephalitis. Between this, again, if the protective functions of the body are strong, then the person will not suffer from any manifestations of CMV.

Symptoms of cytomegalovirus in children depend on what form of infection the disease was originally - congenital or acquired.

If the pathology was congenital (transmitted from the mother), then the child has a risk of jaundice, an increase in internal organs and changes in the composition of the blood. In more severe cases, pathologies of development and the central nervous system are observed. Rarely there is a rash on the face, trunk and arms. In addition, there are fixed cases of subcutaneous hemorrhages, detection of blood in the stool and loss of vision.

It is important to note

CMV may sometimes not immediately manifest itself, but for some time remain in an inactive form.

Only by the age of three or four years of a child's life will she begin to "show herself." At the same time, children may experience excessive drowsiness, irritability, convulsions, manifestations of acute respiratory viral infections, various pathologies of the gastrointestinal tract and the endocrine system. If the infection is acquired, but remains in a latent form, and the baby has strong immunity, then there are no visible risks to his health.

Cytomegalovirus: treatment of the disease

Acute cytomegalovirus, the treatment of which is important to begin immediately after diagnosis, provides for individually selected antiviral therapy. The attending physician should describe the treatment regimen in each case.

To suppress the virus during pregnancy, the treatment of cytomegalovirus is carried out with the following drugs:

Immunoglobulin is normal.
A specific group of immunoglobulins.
Preparations of the interferon group (Viferon).

Those women who have an active virus during pregnancy can give birth naturally, since even a caesarean section cannot protect the fetus from infection. Treatment of cytomegalovirus in adults involves the appointment of potent antiviral drugs in the form of injections (Virazole, Acyclovir).

The purpose of the drug Ginciclovir is practiced to suppress the activity of the virus and inhibit its reproduction. Treatment with interferon preparations is considered very effective, which contribute to the activation of the patient's immunity and help to cope with the infection. Nonspecific immunoglobulins can be prescribed to a person for the prevention of CMV.

Cytomegaly: what is it, causes and treatment

Cytomegaly is an acute infectious disease, infection of which can occur through household, sexual and transplacental routes through blood, saliva and other biological fluids.

The causative agent of cytomegaly is an infection belonging to the class of human herpesviruses. At the same time, its characteristic feature is that the cells affected by intranuclear cytomegalovirus are constantly increasing in size, therefore the name "cytomegaly" itself is translated as "giant cells". Symptoms of cytomegaly may include weakness, headaches, runny nose, dry cough, and excessive salivation. Often this pathological process proceeds without any manifestations at all.

The severity of the flow of cytomegaly is determined by the general state of the patient's immune system. With the inclusion form of the disease, inflammatory foci can develop throughout the body. Such an infection is especially dangerous for pregnant women, as it can cause miscarriage, intrauterine death of a child, or congenital cytomegaly in a baby.

Based on statistics, cytomegaly is an extremely common infection, the presence of which many people are not even aware of. Moreover, antibodies to CMV are detected in adults in almost 50%. In pregnant women, before preparing for childbirth, DNA analysis for cytomegaly shows the result of "carriage" in almost 80% of all cases.

Cytomegalovirus infection is related to the subfamily of herpes viruses. Primary infection means further carriage of the virus throughout life. Its activation is facilitated by:

pregnancy;
diseases of internal organs;
immunodeficiency states;
the use of drugs that weaken the immune system.

Symptoms of cytomegalovirus infection

Usually, cytomegalovirus infection is characterized by signs similar to those of acute respiratory infections:

heat;
runny nose;
swollen lymph nodes in the neck;
headache;
weakness;
muscle pain.

In addition, the appearance of rashes on the skin is possible. A distinctive feature of this disease is that CMV infection has a long duration - 1-1.5 months.

Cytomegalovirus infection in women can be expressed by inflammation of the genitourinary system. In this case, such a disease has the following symptoms:

bluish-white discharge from the vagina;
pain in the organs of the genitourinary system.

In the chronic form of cytomegalovirus infection, symptoms are mild or almost completely absent.

Diagnosis of CMV infection

Cytomegalovirus infection is established and described in detail after blood, urine, saliva, and semen tests. Research methods:

polymerase chain reaction;
sowing on culture;
serodiagnosis.

Polymerase chain reaction establishes CMV DNA and confirms their presence. However, the existence of cells does not mean their activity. After this analysis, it becomes clear whether further examination is necessary.

For many laboratories, inoculation is the main method, it does not require special equipment. With the help of this study, the type of virus and the level of its aggressiveness are determined. In addition, the selection of the most effective method of treatment is performed on the culture colony.

Serodiagnostics involves the search for a virus, as well as antibodies produced by the human body, if their presence exceeds the norm, this indicates the existence of CMVI. The diagnosis of cytomegalovirus infection is confirmed in the case of diagnosing the virus itself or identifying patterns of growth in the number of IgG antibodies. Therefore, the analysis is given several times every 10-15 days. If the figure exceeding the norm of the content of antibodies is constant, a diagnosis of a latent state of the disease can be established.

Precise evidence of the acute form, which is characteristic of the primary infection, is the presence of antibodies of the acute stage of IgM.

Cytomegalovirus infection in women

In women, CMV infection can be a factor in the development of inflammation of the internal genital organs, as well as cervical erosion. During these diseases, there are no pronounced clinical symptoms.

Cytomegalovirus infection belongs to the TORCH infections for which pregnant women are screened, as they are dangerous for the embryo. In some cases, the virus can enter the placenta and change so that it begins to pass the infection to the embryo. With the existence of infections of this group, pregnancy often passes with complications - miscarriages, the threat of interruption, ectopic pregnancy.

When considering the results after a laboratory blood test, the following should be noted:

If IgM is absent, and IgG is within the normal range, this means that the body has never encountered cytomegalovirus. These results can be called the norm.
IgM is absent, and IgG exceeds the norm - the body has already encountered this virus, but the cytomegalovirus infection is in an inactive state. If there are no provoking factors that weaken the immune system, the risk of infection of the embryo is small.
IgM exceeds the norm - it means that there was a primary infection with the virus already during pregnancy or the reactivation of the virus in the body begins. With such indicators, there is a high risk of infection of the fetus.

The norm of IgG in different women may be different, so it would be correct to take tests before pregnancy in order to be able to compare the antibody titer of a pregnant woman with preliminary results.

In approximately 10% of cases, IgM is not detected, then the level of IgG is looked at, especially when the titer of these antibodies rises more than 4 times.

The source of infection of the child is the mother. Approximately 2% of women are first infected during pregnancy. In the blood of a pregnant woman, antibodies to CMV did not have time to form, and, naturally, the transmission of the infection to the embryo is much easier than in the body of a previously immunized mother. Primary infection during pregnancy and reactivation of a protracted infection poses a great danger to the embryo.

In pregnant women with a latent form, the embryo does not always become infected. A prerequisite for infection is an exacerbation in pregnant women of a latent viral infectious disease with the onset of viremia and further damage to the fetus.

About 60% of children become infected in the womb of women who are initially infected during pregnancy. Approximately 30% of newborns are infected at birth and up to 7% are infected through breast milk. Newborns develop chronic diseases, rashes occur. In 15% of cases, newborns with an asymptomatic infection later develop severe consequences, various deficiencies and pathologies.

Cytomegalovirus: consequences

Cytomegalovirus infection poses a threat with reduced immunity (in HIV-infected people suffering from leukemia undergoing anticancer therapy) and with intrauterine infection. In adults, CMV infection causes the following diseases:

gastroenteritis;
hepatitis (accompanied in this case by jaundice);
retinitis;
encephalitis.

If the immune system is in good condition, then the effects are not observed.

Cytomegalovirus infection during pregnancy can have the following consequences for the child:

hearing loss;
pathology / loss of vision;
mental underdevelopment;
convulsions.

Infection treatment

Today, the combination of antiviral agents with interferons is important, this contributes to the treatment of CMV in adults (combining acyclovir with a-interferon), increases the antiviral effect and reduces the toxicity of drugs (ganciclovir with amixin). At the same time, drugs are prescribed to increase immunity.

For the treatment of women with a severe obstetric history, it is recommended to use immunomodulators.

Bonafton, oxolinic, rhyodoxol, tebrofen, florenal, interferon, acyclovir ointments are used vaginally for 2 weeks.

For the treatment of the oral cavity, the same agents are used in the form of solutions. With retinitis, diseases of the central nervous system, pneumonia in immunocompromised adults, ganciclovir or foscarnet are most effective.

Cytomegalovirus infection in adults, which proceeds without complications, does not require specific therapy. Treatment is symptomatic.

To successfully treat cytomegalovirus infection, you need to restore and strengthen the immune system. During the treatment of cytomegalovirus infection in the diet, fatty foods, meat and dairy products, and sugar should be excluded. An outbreak of virus revival was very often observed with the introduction of meat and chicken broths into food. It is helpful to drink plenty of fluids, especially juices.

Treatment of children consists of immunoglobulin therapy, taking vitamins K, C, P, B to help the development of the baby and eliminate the manifestations of hemorrhagic syndrome. In infants, in addition to the direct effect on the virus, symptomatic treatment is used to eliminate the consequences caused by the disease. Most often, these children are in intensive care, and then receive additional care.

Human cytomegalovirus infection (CMV infection, CMVI) is an infectious anthroponotic disease that affects various organs and systems of the body, characterized by polymorphic symptoms and variability of the course - from an asymptomatic and mild mononucleosis-like syndrome to severe systemic infections affecting the lungs, liver, kidneys and other organs. The most dangerous cytomegalovirus infection in immunodeficiency and during pregnancy (the risk of intrauterine infection of the fetus).

Historical data

In 1882, the German pathologist H. Ribbert discovered in the renal tubules of children who died from various diseases, peculiar giant cells with inclusions in the nucleus. Later, L. Smith and W. Rowe isolated a virus that causes a disease with the development of characteristic cytomegaly, and the disease itself was called cytomegalovirus infection.

Etiology

Pathogen belongs to DNA-genomic viruses, differs in large sizes (virion diameter is about 180-300 nm), belongs to the genus Cytomegalovirus hominis of the herpesvirus family. To date, several strains of the virus are known: Davis, AD-169, Kerr. These strains are registered in international catalogs, in addition, the little-studied strain Towne 125 is known.
Often the virus reproduces without damaging the cell. Capable of normal life at room temperature, quickly deactivated when heated and exposed to disinfectant solutions.