CMV g is positive. Cytomegalovirus infection: symptoms, diagnosis, treatment

Cytomegalovirus is a virus belonging to the herpesvirus family. This virus has a high prevalence in the human population.

Ten to fifteen percent of adolescents and forty percent of adults have antibodies to cytomegalovirus in their blood.

The incubation period is quite long - up to two months. During this period, the disease is always asymptomatic. Then a pronounced manifest beginning. Which is provoked by stress, hypothermia or simply reduced immunity.

Symptoms are very similar to acute respiratory infections or SARS. The body temperature rises, the head hurts a lot and there are phenomena of general discomfort. An untreated virus can result in inflammation of the lungs and joints, brain damage, or other dangerous diseases. The infection is in the body all human life.

The year of discovery of the virus is 1956. It is still being actively studied, its action and manifestations. Every year brings new knowledge.

The contagiousness of the virus is low.

Ways of transmission: sexual, contact-household (through kisses and saliva), from mother to child, through blood products.

Infected people are usually asymptomatic. But sometimes, in those who suffer from poor immunity, the disease manifests itself as a mononucleosis-like syndrome.

It is characterized by an increase in body temperature, feelings of chills, fatigue and general malaise, and severe pain in the head. A mononucleosis-like syndrome has a happy ending - recovery.

There is a particular danger for two categories of people - those who have weak immunity and babies infected in utero from a sick mother.

An increase in the titer of antibodies in the blood to cytomegalovirus by four times and even more indicates the activation of cytomegalovirus.

What does cytomegalovirus IgG positive mean?

At positive interpretation analysis for the determination of IgG antibodies to cytomegalovirus infection, what is the conclusion?

The human immune system successfully coped with a cytomegalovirus infection about a month ago, or even more.

This organism has formed a lifelong stable immunity. Carriers are about 90% of people, so there is no norm for antibodies to this virus. There is also no concept of increased or decreased level.

Determination of antibodies to cytomegalovirus is only necessary to establish the correct diagnosis.

Cytomegalovirus infection is considered the presence of a virus in PCR analysis when examining material containing certain DNA.

From the tenth to the fourteenth day after infection, appear in the blood IgG antibodies to cytomegalovirus infection. Antibodies easily pass through the placenta. Therefore, newborns are not always infected, it can be maternal immunoglobulins.

The level of immunoglobulin in the blood is checked after three weeks to clarify the diagnosis and the severity of the process. The process is considered active if the level of immunoglobulins increases.

Cytomegalovirus in children

Cytomegalovirus infection is very similar to herpetic. And she also happens often.

Even if the infection occurred in early childhood, but a person has a good stable immunity all his life, then a cytomegalovirus infection may never manifest itself. A person is only a virus carrier all his life.

There are children who suffer greatly from cytomegalovirus:

• exposed to intrauterine infection, since the placental barrier is not an obstacle to cytomegalovirus;
• newborns, with weak and unstable immunity;
• at any age, with a greatly weakened immune system, or, for example, in patients with AIDS.

Infection is most often diagnosed by ELISA ( enzyme immunoassay). This method can determine not only the presence of cytomegalovirus infection in the child's body. But also to say for sure whether it is congenital or acquired.

For newborns, cytomegalovirus is Infectious mononucleosis. Amazed lymphatic system- the lymph nodes increase, the palatine tonsils become inflamed, the liver and spleen increase, it becomes difficult to breathe.

In addition, congenital infection is characterized by:

• prematurity;
• strabismus;
• jaundice in newborns;
• violations of the swallowing and sucking reflexes.

Violation of nasal breathing threatens with such symptoms:

• loss of appetite and weight loss;
• sleep disorders;
• crying and anxiety.

Congenital infection of a child often occurs even in utero. But sometimes through the birth canal of the mother or breast milk when feeding.

Most often there is a very dangerous asymptomatic course of cytomegalovirus infection. Even two months after birth.

For these children, complications are possible:

• 20% of children with asymptomatic active cytomegalovirus months later are characterized by severe convulsions, abnormal movements of the limbs, changes in the bones (for example, in the skull), insufficient body weight;
• after five years, 50% have speech impairment, intellect suffers, the cardiovascular system is affected, and vision is severely affected.

If the child became infected at a later time, and not during the neonatal period, when the immune system is already well formed, then there are practically no consequences.

Most often asymptomatic or reminiscent of the classic children's SARS.

Characterized by:

• lethargy and drowsiness;
• cervical lymphadenitis;
• pain in the musculoskeletal system (muscles and joints);
• chills and subfebrile temperature.

It lasts two weeks - two months. Ends in self-healing. Very rarely, if the disease does not go away for two to three months, medical consultation and treatment is necessary.

The earliest diagnosis of cytomegalovirus infection and timely treatment significantly reduce the risk of complications. It is best to start treatment within seven to nine days after infection. Then the cytomegalovirus infection will not leave a trace.

Cytomegalovirus in women

Cytomegalovirus infection in females occurs in chronic form. Most often it is asymptomatic, but sometimes there are symptoms. A weak immune system contributes to the active manifestation of the disease.

Cytomegalovirus infection, unfortunately, affects women at any age. Provoking factors are cancer, HIV infection or AIDS, gastrointestinal pathology. Another effect is observed from taking anticancer drugs and antidepressants.

In the acute form, the infection is characterized by damage to the cervical lymph nodes.

Then there is an increase in the submandibular, axillary and inguinal lymph nodes. As I already said, such clinical picture similar to infectious mononucleosis. It is characterized by headache, feeling unwell, hepatomegaly, atypical mononuclear cells in the blood.

Immunodeficiency (for example, HIV infection) causes a severe generalized form of cytomegalovirus infection. Internal organs, blood vessels, nerves and salivary glands. There is cytomegalovirus hepatitis, pneumonia, retinitis and sialadenitis.

Nine out of ten women with AIDS have cytomegalovirus infection. They are characterized by bilateral pneumonia and encephalitis phenomena.

Encephalitis is characterized by dementia and memory loss.

Women with AIDS and cytomegalovirus suffer from polyradiculopathy. Such women are characterized by damage to the kidneys, liver, pancreas, eyes and organs of the MPS.

Cytomegalovirus during pregnancy

An infection from a person who has an acute form of the disease is the worst option for pregnant women.

There are no antibodies in the pregnant woman's blood.

The active virus of the infecting person easily passes through all barriers and adversely affects the child. According to statistics, this happens in half of the cases of infection.

If the factors that weaken the immune system exacerbate the latent virus carrier, then this is a less dangerous situation.

There are already immunoglobulins (IgG) in the blood, the virus is weakened and not so active. The virus is dangerous by infecting the fetus in only two percent of cases. Early pregnancy is more dangerous in terms of infection. Pregnancy often ends in spontaneous miscarriage. Or the fetus develops abnormally.

Infection with cytomegalovirus infection later in pregnancy results in polyhydramnios or preterm labor (“congenital cytomegalovirus”). Unfortunately, it is impossible to completely destroy cytomegalovirus in the body. But you can make it inactive. Therefore, pregnant women and those planning to become pregnant should be especially attentive to their health. Cytomegalovirus is very dangerous for the fetus.

Cytomegalovirus IgM positive

IgM is the first protective barrier against all kinds of virus. They do not have a specification, but they are produced urgently as a response to the penetration of a cytomegalovirus infection into the body.

IgM analysis is carried out to determine:

• primary virus infection (maximum antibody titer);
• stages of aggravated cytomegalovirus (the number of the virus grows and the number of IgM grows);
• reinfection (a new strain of cytomegalovirus has produced infection).

Later, specific IgG antibodies are formed from IgM. If the strength of immunity does not fall, then IgG fights cytomegalovirus all their lives. The IgG antibody titer is highly specific. It can be used to determine the specification of the virus. Given that the analysis for IgM shows the presence of any virus in the test material.

The number of cytomegalovirus is subject to control by immunoglobulin G without allowing the picture of an acute illness to develop.

An IgM positive result with an IgG negative result indicates acute recent infection and lack of permanent immunity against CMV. aggravation chronic infection indicators are characteristic when IgG and IgM are present in the blood. The body is in a stage of serious deterioration of immunity.

There has already been infection in the past (IgG), but the body can not cope, and non-specific IgM appear.

The presence of positive IgG and negative IgM is the best test result in a pregnant woman. She has specific immunity which means that the child will not get sick.

If the situation is reversed, with positive IgM and negative IgG, then this is also not a problem. This indicates a secondary infection, which is being fought in the body, which means that there should be no complications.

Worse, if there are no antibodies at all, both classes. It speaks of a special situation. Although this situation is very rare.

In modern society, almost all women are infected with the infection.

Treatment of cytomegalovirus and treatment results

If a person has a healthy immune system, then he himself will cope with a cytomegalovirus infection. You can not carry out any therapeutic actions. Immunity will only be weakened if treated for a cytomegalovirus infection that does not manifest itself. Medical treatment necessary only when the immune defense fails and the infection is actively increasing.

Pregnant women also do not need to be treated if they have specific IgG antibodies in their blood.

With a positive analysis for IgM, to translate an acute condition into a latent course of the disease. It must always be remembered that drugs for cytomegalovirus infection have many side effects. Therefore, only a knowledgeable specialist can prescribe them, self-medication should be avoided.

The active stage of infection is the presence of positive IgM. Other test results must also be taken into account. It is especially necessary to monitor the presence of antibodies in the body of pregnant women and immunodeficient people.

[07-017 ] Cytomegalovirus, IgG

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Antibodies of the IgG class to cytomegalovirus are specific immunoglobulins produced in the human body during the period of pronounced clinical manifestations cytomegalovirus infection and being a serological marker of this disease, as well as past cytomegalovirus infection.

Russian synonyms

Antibodies of the IgG class to cytomegalovirus (CMV).

English synonyms

Anti-CMV-IgG, CMV Antibody, IgG.

Research method

Electrochemiluminescent immunoassay (ECLIA).

Units

U / ml (unit per milliliter).

What biomaterial can be used for research?

Venous, capillary blood.

How to properly prepare for research?

Do not smoke for 30 minutes prior to the study.

General information about the study

Cytomegalovirus (CMV) belongs to the herpes virus family. Just like other representatives of this group, it can persist in a person for a lifetime. At healthy people with normal immunity, the primary infection is uncomplicated (and often asymptomatic). However, cytomegalovirus is dangerous during pregnancy (for a child) and with immunodeficiency.

Cytomegalovirus can be infected through various biological fluids: saliva, urine, semen, blood. In addition, it is transmitted from mother to child (during pregnancy, childbirth or while feeding).

As a rule, cytomegalovirus infection is asymptomatic. Sometimes the disease resembles infectious mononucleosis: the temperature rises, the throat hurts, the lymph nodes increase. In the future, the virus remains inside the cells in an inactive state, but if the body is weakened, it will begin to multiply again.

It is important for a woman to know if she has been infected with CMV in the past, because this is what determines whether there is a risk of pregnancy complications. If it has already been infected before, then the risk is minimal. During pregnancy, an old infection may worsen, but this form usually does not cause serious consequences.

If a woman has not yet had CMV, then she is at risk and should be given Special attention prevention of CMV. It is the infection that the mother contracted for the first time during pregnancy that is dangerous for the child.

With a primary infection in a pregnant woman, the virus often enters the child's body. This does not mean that he will get sick. As a rule, CMV infection is asymptomatic. However, in about 10% of cases, it leads to congenital pathologies: microcephaly, cerebral calcification, rash and enlargement of the spleen and liver. This is often accompanied by a decrease in intelligence and deafness, even death is possible.

Thus, it is important for the expectant mother to know if she has been infected with CMV in the past. If yes, then the risk of complications due to possible CMV becomes negligible. If not, you need to be especially careful during pregnancy:

• avoid unprotected sex
• do not come into contact with the saliva of another person (do not kiss, do not share utensils, toothbrushes, etc.),
• observe hygiene rules when playing with children (wash hands if saliva or urine gets on them),
• take an analysis for CMV with signs of general malaise.

In addition, cytomegalovirus poses a danger when weakened immune system(for example, due to immunosuppressants or HIV). In AIDS, CMV is severe and is common cause death of patients.

The main symptoms of cytomegalovirus infection:

• inflammation of the retina (which can lead to blindness),
• colitis (inflammation of the colon),
• esophagitis (inflammation of the esophagus),
• neurological disorders (encephalitis, etc.).

The production of antibodies is one way to fight a viral infection. There are several classes of antibodies (IgG, IgM, IgA, etc.).

Antibodies of class G (IgG) are present in the blood in the greatest amount (compared to other types of immunoglobulins). In primary infection, their levels increase in the first weeks after infection and may then remain high for years.

In addition to quantity, IgG avidity is also often determined - the strength with which the antibody binds to the antigen. The higher the avidity, the stronger and faster the antibodies bind viral proteins. When a person is first infected with CMV, their IgG antibodies have low avidity, then (after three months) it becomes high. IgG avidity measures how long ago the initial infection with CMV occurred.

What is research used for?

• To determine if a person has been infected with CMV in the past.
• For the diagnosis of cytomegalovirus infection.
• To establish the causative agent of the disease, which is similar to cytomegalovirus infection.

When is the study scheduled?

• During pregnancy (or during its planning) - to assess the risk of complications (testing study), with symptoms of cytomegalovirus infection, with violations in the fetus according to the results of ultrasound.
• For symptoms of cytomegalovirus infection in immunocompromised people.
• With symptoms of mononucleosis (if the tests did not reveal the Epstein-Barr virus).

What do the results mean?

Reference values

Concentration: 0 - 0.5 U / ml.

Result: negative.

Negative pregnancy result

• A woman has not been infected with CMV before - there is a risk of acquiring a primary CMV infection. However, if no more than 2-3 weeks have passed since the moment of infection, then IgG might not have appeared yet. To exclude this option, you need to pass the analysis again after 2 weeks.

Positive before pregnancy

• The woman has already been infected with CMV in the past - the risk of complications is minimal.

Positive result during pregnancy

• It is impossible to draw an unambiguous conclusion. It is possible that CMV entered the body before pregnancy. But it is possible that the woman became infected recently, at the beginning of pregnancy (a few weeks before the test). This option is dangerous for the child. For an accurate diagnosis, the results of other tests are needed (see table).

When trying to identify the causative agent of an unknown disease, a single IgG test provides little information. It is necessary to take into account the results of all analyzes.

Test results in different situations

Important Notes

• Sometimes you need to find out if a newborn baby is infected with cytomegalovirus. However, the analysis for IgG in this case is not informative. IgG can cross the placental barrier, so if the mother has antibodies, then the baby will also have them.
• What is reinfection? In nature, there are several varieties of CMV, so it is possible for a person already infected with one type of virus to become infected again with another.

Who orders the study?

Doctor general practice, therapist, infectious disease specialist, gynecologist.

Literature

• Adler S. P. Screening for cytomegalovirus during Pregnancy. Infect Dis Obstet Gynecol. 2011:1-9.
• Goldman's Cecil Medicine. 24th ed. Goldman L, Schafer A.I., eds. Saunders Elsevier; 2011.
• Lazzarotto T. et al. Why is cytomegalovirus the most frequent cause of congenital infection? Expert Rev Anti Infect Ther. 2011; 9(10): 841-843.

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

What is a cytomegalovirus infection

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

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

Cytomegalovirus infection, depending on the etiology, is congenital or acquired. Several strains of CMV are also isolated. It:

• AD169.
• Davis.
• Kerr.
• Towne.

CMV can long time retain their pathogenicity at normal room temperature, but are destroyed at 55°C and above during freezing. It is sensitive to pH fluctuations and dies when treated with disinfectant powders or solutions.

How does CMV infection occur?

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

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

• While kissing.
• During sexual intercourse, especially unprotected.
• Through common dishes, hygiene items.
• With blood transfusion and transplantation of organs and tissues from an infected donor.
• Extremely rare - by airborne droplets.

During pregnancy, the risk of intrauterine damage to the fetus by cytomegalovirus infection through the placenta and amniotic fluid is very high. However, even if this did not happen, the risk of infection remains even when the child passes through the birth canal, during caesarean section and at breastfeeding.

The pathogenesis of cytomegalovirus infection

Cytomegalovirus easily penetrates through the mucous tissue of the upper respiratory tract, digestive tract or urinary organs. The "target" of the infection is the cells of the epithelium of the lungs, kidneys, salivary glands, much less often - monocytes and lymphocytes.

How to defeat cytomegalovirus

Herpes, Cytomegalovirus, virus Epstein Barr. Who is to blame and what to do.

Cytomegalovirus Igg and Igm. ELISA and PCR for cytomegalovirus. Avidity for cytomegalovirus

Elena Malysheva. Symptoms and treatment of cytomegalovirus

CYTOMEGALOVIRUS - symptoms, treatment, prevention. Encyclopedia of sexually transmitted diseases.

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

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

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

Once inside the cell, CMV does not cause its death. Cytomegalovirus virions are covered with cellular secretion, thereby becoming invisible to the human immune system. However, virus replication also does not occur. In such a latent state, the disease can proceed for a long time.

When immunity is weakened, the number of CMV-affected cells begins to grow, and external manifestations of the disease are noted. So, with AIDS, even a lethal outcome is not ruled out as a result of the rapid development of the cytomegalovirus virus - an infection.

Symptoms of congenital CMV infection

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

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

Usually, signs of infection with cytomegalovirus are noticeable during ultrasound screening at 13 and 18 weeks of pregnancy. With such deviations in the development of the newborn, special care is needed, the tactics of conducting childbirth are radically changing.

Infection with CMV - an infection at later stages of pregnancy does not cause serious anomalies in the intrauterine formation of the fetus. But the child is born a few weeks ahead of schedule with severe manifestations of hypoxia. Symptoms of cytomegalovirus in newborns appear from the first days of life in this way:

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

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

If infection occurred during childbirth, then the disease may be asymptomatic for a long time (any of the signs of cytomegalovirus will be absent). Later at scheduled examinations a pediatrician reveals such consequences of cytomegalovirus as hearing, vision and speech impairments, intellectual development lag.

Features of cytomegalovirus infection in pregnant women

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

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

• Constant weakness, rapid fatigue.
• Frequent headaches.
• White discharge from the vagina.
• Enlarged submandibular lymph nodes, their soreness.
• Sinusitis.
• Increase in body temperature.

On examination, a gynecologist also reveals hypertonicity, colpitis or vaginitis, pseudo-erosion of the cervix. When diagnosing an ultrasound, a pronounced polyhydramnios is revealed, a discrepancy between the size of the fetus and the gestational age.

Clinical picture of acquired CMV infection

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

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

With a normal immune response, all these symptoms disappear without additional treatment within a few days. In this case, you do not need to consult a doctor, the disease goes into a latent form and does not manifest itself in any way in the future.

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

• The human immunodeficiency virus (HIV) or its next stage is AIDS.
• Taking certain groups of drugs: glucocorticoids, cytostatics, immunosuppressants.
• Radiation sickness.
• Severe oncological processes.
• Severe extensive burns.
• Condition after transplantation of organs, tissues, bone marrow.
• Adverse environmental factors, lack of vitamins, constant stress.

Damage to the lymphatic system

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

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

Also, with a weakened immune system, cytomegalovirus infection often affects the eyes with the development of retinitis. Small areas of necrosis appear on the retina, which enlarge over time, eventually leading to blindness. Sometimes cytomegalovirus in men occurs with inflammation of the testicles, for women the presence of colpitis, cervicitis, endometritis, vulvovaginitis is more characteristic.

Diagnosis of CMV

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

• Blood.
• Saliva.
• A swab from the genitals.
• Breast milk.
• Flushing after bronchopulmonary lavage.
• Urine.
• Biopsy tissue.

Most accessible way diagnosis of the disease cytomegalovirus - infection is microscopy of a blood smear. When it is examined, the presence of characteristic modified cells is detected. However, the accuracy of this method is relatively low and is only 60 - 70%.

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

• Immunofluorescence reactions (RIF).
• Polymerase chain reaction(PCR).
• Enzyme immunoassay (ELISA).

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

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

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

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

Therapy for cytomegalovirus infection

It should be emphasized that the treatment of CMV presents certain difficulties, since this virus is resistant to almost all medicines used for herpetic infections (Acyclovir, Valaciclovir, Vidarabine, Zovirax).

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

• Ganciclovir. The dosage of the drug is selected individually and largely depends on age and general condition sick. In severe cases of the disease, as well as in young children, it is indicated intravenous administration drug at the rate of 5 - 10 mg / kg per day. For adults, it is possible to use in the form of tablets (the daily dose is 3 grams, this amount is divided into 3 or 6 doses during the day). Duration of treatment - from several weeks to 2 - 3 months. Ganciclovir is difficult to tolerate. Doctors note that almost half of the patients have a decrease in both platelets and granulocytes in the blood, severe headaches, convulsions, allergic rash, disorders of the liver and kidneys.
• Foscarnet (Foscarvir) is medicine the second stage, since the risk of complications against the background of its use is even higher, in addition, it is contraindicated for the treatment of a newborn. It is poorly absorbed from the digestive tract, therefore it is prescribed only in the form of injections. For adults, the daily dosage of Foscarnet is 180 mg / kg, for children - 120 mg / kg during the first three days of treatment, then the amount of the drug is reduced to 90 mg / kg. Duration of treatment - 2 - 3 weeks.

The principle of action of these antiviral drugs is to inhibit cytomegalovirus DNA replication, but they are ineffective in damage to the brain, organs of the digestive system and lungs. Such medications are contraindicated during pregnancy due to a strong teratogenic effect, so they are prescribed only if the benefit to the mother outweighs the risk to the fetus. Also, during treatment, you need to stop breastfeeding.

Additional symptomatic therapy

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

Very often, a secondary bacterial infection develops against the background of CMV infection, which requires broad-spectrum antibiotic therapy. Additionally, there are also:

• Hepatoprotectors.
• B vitamins and magnesium.
• Means for improving blood circulation.
• Antioxidants.
• Neuroprotectors.

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

Prevention and management of patients with CMV

It should be noted that such a severe course of the disease is typical for AIDS patients. Therefore, when such symptoms appear, it is always recommended to go through all the stages of an HIV test. An important role is played by the prevention of cytomegalovirus - infections in women planning a pregnancy. To do this, at the stage of preparation for the conception of a child, it is required to pass the appropriate tests and, if necessary, conduct antiviral therapy.

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

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One of the most common infections of the TORCH complex is cytomegalovirus infection (CMVI). According to WHO, antibodies to CMVI are found in 40-80% of the adult population, 2% of newborns and 50-60% of children under the age of 1 year. The disease is ubiquitous, has no seasonality, with professional activity person is not connected.

Etiology and epidemiology

The causative agent of CMVI is a virus of the genus Cytomegalovirus of the Herpesviridae family.

The reservoir and source of cytomegalovirus (CMV) is a person (carrier or patient). It is transmitted by airborne droplets, direct and indirect contact and transplacental. There is evidence of infection of the recipient when an infected organ is transplanted to him and when infected blood is transfused. Newborns are usually infected from the mother during passage through the birth canal, that is, intranatally. Cases of transplacental infection of the fetus are not uncommon. Of particular danger to the fetus is the infection of the expectant mother on early term(up to 12 weeks) pregnancy – very likely severe violations intrauterine development of the baby.

50% of newborns become infected by eating infected breast milk.

Despite the high natural susceptibility of people to CMV, infection is possible only through repeated close contact with infected secretions of the patient.

The pathogenesis of cytomegalovirus infection

The entrance gates of CMV are the mucous membranes of the upper respiratory tract, organs of the digestive system and genital tract. Tellingly, when this virus invades the body, there are no changes at the site of the infection gate. The virus has a tropism (affinity) for the tissues of the salivary glands, therefore, in the case of localized forms of the disease, it is found only in them. Once in the body, the virus persists in it throughout a person's life. In persons with an adequate immune response, CMV does not cause any signs of the disease, they occur only if the body is exposed to debilitating factors (taking cytostatics, chemotherapy, severe concomitant diseases, HIV).

The fetus of an infected pregnant woman will become infected with CMV only if she has an exacerbation of the latent form, and with the primary infection of the expectant mother, the likelihood of infection of the fetus increases dramatically.

Clinical manifestations of cytomegalovirus infection

Depending on the ways of infection and clinical manifestations, CMV is usually divided into congenital (acute and chronic) and acquired cytomegalovirus infection. The latter, in turn, has 3 forms: latent, acute mononucleosis and generalized. So.

Congenital CMVI

It may not manifest itself immediately after birth, but as the baby grows, deviations will become noticeable: decreased intelligence, deafness, speech impairment, chorioretinitis.

• Acute congenital CMVI. When a future mother becomes infected during pregnancy up to 12 weeks, fetal death in utero or the birth of a child with defects that are often incompatible with life (pathology of the development of the brain, kidneys, heart defects) is possible. When the mother is infected with late term pregnancy, severe malformations in the fetus are not formed, however, there are diseases that appear immediately after the birth of the baby ( hemolytic anemia, hemorrhagic syndrome, jaundice, interstitial pneumonia, polycystic pancreas, hydrocephalus, meningoencephalitis). In 10-15% of newborns infected in utero, there is a so-called obvious cytomegalovirus syndrome with a tendency to generalization - many organs and systems are affected simultaneously, due to which the newborn dies within 1-2 weeks.
• Chronic congenital CMVI. This form is characterized by a pathology of brain development in the form of microgyria, as well as micro-, hydrocephalus, clouding of the vitreous body and lens.

Acquired CMVI

• latent form. The most common form occurs in adults and children with normally functioning immunity. Asymptomatic or subclinical.
• Acute mononucleosis form. Similar to influenza viral hepatitis and infectious mononucleosis.
• generalized form. Occurs in immunocompromised individuals. It is characterized by simultaneous damage to most organs and systems of the body: heart, lungs, kidneys, digestive tract, urogenital, nervous systems. The outcome of this form of the disease is often unfavorable.

In 20% of persons who have undergone bone marrow transplantation, development is possible, mortality from which is noted in approximately 85% of cases.

CMVI in pregnant women

When a woman is infected during pregnancy, in most cases she develops an acute form of the disease. Possible damage to the lungs, liver, brain. The patient complains about:

• fatigue, headache, general weakness;
• increase and soreness when touching the salivary glands;
• discharge from the nose of a mucous nature;
• whitish discharge from the genital tract;
• abdominal pain (due to increased uterine tone).

After a series of examinations, a woman is diagnosed with diseases such as polyhydramnios, premature aging placenta and its cysts, colpitis, vaginitis. There is a risk of premature detachment of the placenta, bleeding during childbirth, endometritis.

Diagnosis of cytomegalovirus infection

In order to diagnose CMVI, it is necessary to examine several biological fluids in parallel (washing water of the bronchi, saliva, blood, urine, breast milk, tissue biopsies). Since the CMVI pathogen dies under the influence of environmental factors, studies should be carried out no later than 4 hours from the moment the material was taken.

The following diagnostic methods are used:

• cytological (detection of specific cells under a microscope);
• serological (detection of antibodies to the virus by RIF, ELISA, PCR);
• virological.

The presence in the blood of a newborn under the age of 14 days of IgM to CMVI is evidence of intrauterine infection.

Treatment of cytomegalovirus infection

• With latent and subclinical forms of the disease, therapy is not carried out.
• The mononucleosis-like form of CMVI does not require specific treatment; if necessary, symptomatic drugs are prescribed.
• With intrauterine infection in newborns and in individuals with severe CMVI, the drug of choice is Ganciclovir. Since this is a fairly serious drug with side effects in the form of damage to the kidneys, liver, blood system, it is prescribed to children only when the benefit outweighs the potential risk. During therapy, control is necessary every 2 days. general analysis blood.
• The combination of an antiviral drug with interferons is considered effective - this mutually enhances their effect and reduces toxicity.
• In order to correct immunity, specific anticytomegalovirus immunoglobulin is used.
• For the treatment of processes localized in the oral cavity, solutions of Furacilin, aminocaproic acid are used.
• When the genital tract is affected, women use oxolinic, rebrofen, acyclovir and interferon ointments.

Prevention of cytomegalovirus infection

To prevent the development of the disease in people with reduced immunity, intravenous administration of nonspecific immunoglobulin - Sandoglobulin is used.

To avoid infection, it is necessary to avoid contact with sick people, observe the rules of personal hygiene.

In order to prevent infection of the newborn with CMVI, it is required timely diagnosis and adequate treatment of the pregnant woman.

During heat treatment (72C) for 10 seconds of breast milk, the virus is completely inactivated, and beneficial features milk remains the same.

The issue of creating a vaccine against CMVI is being addressed.

Which doctor to contact

Often, the gynecologist who observes the expectant mother deals with the diagnosis of CMV infection. if it is necessary to treat the disease, an infectious disease consultation is indicated. A newborn child with a congenital infection is treated by a neonatologist, then by a pediatrician, a neurologist, an ophthalmologist, and an ENT doctor observe. In adults, when CMV infection is activated, it is necessary to consult an immunologist (often this is one of the signs of AIDS), a pulmonologist and other specialized specialists.

One of the most common viral diseases today is cytomegalovirus. It infects about 90% of the population. It belongs to the herpesvirus family. This disease is mostly latent, but under certain conditions it can be fatal.

Usually a person is infected with cytomegalovirus before the age of 12. The disease is hidden and he does not even realize that he has it. However, with a significant decrease in immunity, it can become active and affect various organs and cause severe complications, up to death.

The danger exists for people who have suffered. A person with immunodeficiency or HIV gets into the risk group.

But cytomegalovirus is especially dangerous during childbearing. During pregnancy, immunity decreases, so activation of the disease can occur. But the most dangerous is the primary infection.

In this case, there is a high probability of infection of the fetus, which can lead to its pathologies and even death. The severity of the consequences depends on the period at which it happened.

A child can become infected during childbirth and breastfeeding. However, if it is full-term, then usually this does not lead to any consequences. A large percentage of children become infected with cytomegalovirus in the first six months of life.

Today it is diagnosed mainly by PCR. In the first case, the presence, that is, the reaction of the body's immune system to the infection, is determined. If a person has cytomegalovirus IgG positive, then more than 3 weeks have passed since the initial infection. If the IgG titer exceeds the norm by more than 4 times, then this may indicate the activation of the virus.

This, as well as primary infection, is indicated by an increased amount. Usually, the concentration of these two immunoglobulins is checked. Then the results can be interpreted as follows:

• IgG (+), IgM (-) - the virus is dormant;

• IgG (+), IgM (+) - activation of the virus, or recent infection;

• IgG (-), IgM (+) - recent infection (less than 3 weeks);

• IgG (-), IgM (-) - no infection.

Cytomegalovirus IgG norm (in IU / ml):

• more than 1.1 - positive;

• less than 0.9 - negative.

The PCR method allows you to detect the virus in saliva, semen, urine, vaginal discharge and cervix. Its appearance in these fluids indicates primary infection or activation of the virus. PCR is a very highly sensitive method, it can detect even one DNA in the preparation.

Cytomegalovirus belongs to the group of TORCH infections. It also includes herpes, toxoplasmosis, rubella, and recently chlamydia has been added there. what they have in common is that they are very dangerous for the fetus. They can lead to serious illness and even death.

Therefore, all women who wish to become pregnant are advised to take a TORCH test. If cytomegalovirus IgG is positive before conception with negative IgM, this is good, since it excludes primary infection during the gestation of the baby.

If IgM is positive, then pregnancy should be postponed until the titer returns to normal. In this case, you need to consult a doctor, perhaps he will prescribe treatment.

Women who are cytomegalovirus IgG and IgM negative need to be extremely careful not to become infected. They should wash their hands well, avoid contact with children (especially not kiss them), if the husband is infected, then avoid kissing with him.

Cytomegalovirus is transmitted by sexual, airborne and household routes. Infection occurs through contact with fluids (urine, saliva, semen, secretions) in which it is contained.

Cytomegalovirus IgG is positive in 90% of the population. Therefore, when an adult receives such a result, it is rather the norm than the exception.

The largest number people become infected at the age of 5-6 years. After infection, children can shed the virus for a long time, so it is better for pregnant women without immunity to it not to contact them.

Thus, cytomegalovirus IgG is positive in almost all adults. It is desirable that such a result be in women who want to conceive a baby in the near future. The probability of developing serious pathologies in the fetus when the mother is infected during pregnancy is 9%, and when the virus is activated, it is only 0.1%.