Cytomegalovirus is a type of herpesvirus. This disease tends to spread easily, due to which it often occurs in both young and adults. This type of virus in its inactive state can be in the human body for a long time. And if the immunity is strong, then it does not pose any danger, manifesting itself as a common cold disease, causing general malaise.
But with poor health and during pregnancy, cytomegalovirus can pose a serious danger. The virus rapidly infects tissues of important organs, destroying their cells and disrupting normal functioning. The external manifestation of the disease resembles an ulcer or pneumonia with concomitant enlargement of lymph nodes. And in this case, the person is in a serious condition, which sometimes ends in death. Therefore, it is imperative to know how to treat cytomegalovirus to avoid serious complications.
Basics of treatment
The main task of therapy for cytomegalovirus is to mitigate and suppress the negative effects of a viral infection on the human body. If we are talking about strong immunity, then the initial outbreak of the virus is quite tolerable and there is no need to go to the hospital.
When the disease proceeds with all the accompanying symptoms and significantly changes the usual state of the body, then you should pay a visit to the doctor who prescribes a set of tests that confirm or deny the preliminary diagnosis. And if cytomegalovirus is detected, then complex treatment is prescribed.
It will not be possible to completely cure cytomegalovirus.
Usually, all therapeutic measures are aimed at eliminating painful symptoms, strengthening the immune system and significantly reducing subsequent relapses of the disease.
The main goal of treatment is to suppress the activity of the virus itself, which, even after extensive therapy, still remains in the human body forever. In this case, you will have to completely reconsider your lifestyle, adjust your diet. In addition, you will have to constantly take vitamin complexes.
In some cases, the attending physician prescribes hospitalization of the patient with cytomegalovirus. At the same time, it is recommended to limit any contact with other people, observe the rules of personal hygiene and adhere to a therapeutic diet for a certain period.
Drug therapy
Medicines will help eliminate symptoms and block the development of cytomegalovirus. Treatment in this case consists of:
- symptomatic remedies;
- medications against the virus;
- drugs of a syndromic nature;
- immunoglobulins and immunomodulators;
- vitamin and mineral complexes.
Symptomatic remedies instantly stop the inflammation focus, reduce it and relieve painful sensations. These can be vasoconstrictor drops and various pain relievers. Medicines that fight the virus suppress the very activity of the infection present in the body. These are Panavir, Ganciclovir, Foscarnet, Tsidofovir.
Panavir will be able to suppress the infection and stop the spread of the virus itself
Many drugs have contraindications and cause side effects, so you cannot calculate the dosage yourself and self-medicate. The most commonly used treatment for the disease is Ganciclovir. This drug intervenes and interrupts the cycle of the virus. At the same time, blood tests are done every two days.
Syndromic drugs accelerate the recovery of damaged tissues and organs, especially if the disease proceeded with complications. Such medicines are prescribed in the form of suppositories, capsules and tablets, injections and various ointments. Immunoglobulins destroy viral particles in the body by binding them together. These funds include:
- Cytotect;
- Neocytect;
- Megalotect.
Usually, specific intramuscular injections are used, which are given over five days. However, when prescribing immunoglobulin, a number of contraindications are also taken into account. These are diabetes mellitus, the body's predisposition to allergic reactions, renal failure, pregnancy and breastfeeding. Also, if during the period of treatment of cytomegalovirus, a person simultaneously undergoes the prescribed course of other vaccinations, then immunoglobulin therapy is canceled.
The additional connection of interferons allows to enhance the effectiveness of treatment with antiviral drugs. Immunomodulators have a positive effect on the immune system, strengthening and stimulating it several times. These are Neovir, Leikinferon, Viferon, Genferon. These drugs have worked well for treating infections during pregnancy (after 12 weeks) and in children.
Vitamin and mineral complexes subsequently support the body and its immunity, preventing recurrence of the disease to manifest itself again. Therapy using such funds lasts up to several weeks.
Treatment of cytomegalovirus for women and men may be different. Representatives of the stronger sex are always prescribed immunoglobulins with antiviral drugs (Ganciclovir, Foscarnet). Cytomegalovirus in women is treated with anti-inflammatory drugs. Usually it is Acyclovir and Genferon.
To reduce the temperature that always accompanies this type of virus, Paracetamol should be used. But it is not recommended to take Aspirin, as unwanted side effects may occur.
Treatment of cytomegalovirus in children and pregnant women
The choice of therapy when cytomegalovirus develops in children will depend on the age of the child. Conservative treatment helps children under six years of age to get rid of unpleasant symptoms, but older children can already be given antiviral drugs. They will suppress the activity of a dangerous infection.
If the retina or lungs are affected by CMVI, potent drugs (Foscarnet or Cidofovir) are prescribed. But they are highly toxic and have a negative effect on the kidneys. Therefore, they are used to treat a child only when he is in danger. Usually, in such cases, a council is convened, at which the question of the appropriateness of antiviral therapy is decided.
Foscarnet will effectively cope with the disease, but it has a number of side effects
Treatment of cytomegalovirus in a pregnant woman is also carried out with caution, since increased attention is paid to the health of the unborn baby. If the virus proceeds in an acute form, then for seven days the woman takes Cytotect (2 ml per 1 kg of body weight). If the infection has managed to reach the canals of the cervix, then Viferon is prescribed. The duration of treatment with this drug is 21 days.
The applied therapy can be shortened or lengthened, depending on the degree of side effects and on the general clinical picture. With negative dynamics, the antiviral drug is replaced. When cytomegaly proceeds secretly and passively, then during pregnancy this disease is not treated.
Features of therapy depending on immunity
Treatment of cytomegalovirus in men and women with normal immunity does not require any specific measures. The therapy will be similar to that prescribed for colds. It is based on antipyretic and pain relievers. And to eliminate the intoxication of the body, it is recommended to observe an abundant drinking regime.
It will be necessary to treat cytomegalovirus infection in those patients who have malignant tumors or have undergone organ transplantation in an inpatient setting. The main drugs are based on ganciclovir. But they usually provoke a number of side effects, so this therapy is not used during pregnancy, as well as for those who suffer from kidney failure. But for those who have a strong immune system, drugs that contain ganciclovir are prohibited from using to treat the virus.
In HIV-infected patients, cytomegaly is treated with a drug such as Foscarnet. In this case, regular observation by a doctor is mandatory, since he, if necessary, adjusts the dosage of the drug. Sometimes there are side reactions from the body such as nausea, impaired urination and electrolyte metabolism.
Using traditional medicine recipes
Treatment of cytomegalovirus should be based on the use of medications. It is useless to try to cope with such a disease only with traditional medicine. But you can support the immune system with healing recipes.
A tea made from raspberry and black currant leaves gives a good result. You can add a little honey to it. Such a drink will help a weakened body to recover and get stronger.
Boiled raspberry and currant leaves will give strength to a weakened body
Medicinal herbs and plants can be used to prevent infection. In equal proportions, birch buds, wild rosemary, leuzea and succession, yarrow, burnet and thyme should be mixed. Take 10 g from the resulting mixture and pour a liter of boiled water. Let the broth steep in a thermos during the day. A ready-made home medicine is taken, 50 ml, three times a day at the time of a meal.
In a similar way, a decoction is prepared from leuzea, alder and licorice, pharmacy chamomile and string, kopeck. And you can mix flax seeds, marshmallow root, raspberry leaves and coltsfoot, elecampane and cinquefoil. All components are taken in equal proportions, licorice root is added to them (four times more) and the resulting composition is brewed for three hours. It is taken 60 ml before meals.
With CMVI, it is very beneficial to include garlic and onions in the diet. These products should only be consumed fresh. And if you do it regularly, then you can reduce the risk of contracting an infection several times.
If someone close to you has already caught cytomegalovirus, then you can stop the spread of this infection by spraying tea tree oil in the air. This should be done in the room where the patient is.
Prevention of CMVI
Since cytomegalovirus is transmitted by airborne droplets, as well as sexually, experts advise using condoms with an unverified partner as a preventive measure, and also avoiding kissing with a person who has signs of CMVI. These symptoms include weakness, runny nose and sore throat, high fever.
Pregnant women should be especially careful in this case. Since an infection of this kind, caught in this important period, poses a serious threat to the baby. Viral and colds should be treated promptly. It is very important to strengthen your body and its immune system. To do this, you can use the following techniques:
- taking dietary supplements;
- personal hygiene;
- drawing up the right diet.
Additionally, during the day, you can drink brewed lemongrass or echinacea. And if you add ginseng to these components, then the resulting drink will have a tonic and immunostimulating effect.
Everyone who has encountered the described disease is concerned about the question of whether cytomegalovirus can be cured. But in fact, it will not be possible to completely get rid of the infection. But with the help of complex therapy and subsequent preventive measures, the virus can be contained, and it will remain in a passive state for the rest of the time.
Cytomegaly
General information
Cytomegaly- an infectious disease of viral genesis, sexually transmitted, transplacental, household, blood transfusion. Symptomatically takes the form of a persistent cold. Weakness, malaise, headaches and joint pains, runny nose, enlargement and inflammation of the salivary glands, profuse salivation are noted. Often asymptomatic. The severity of the disease is due to the general state of immunity. In the generalized form, severe foci of inflammation occur throughout the body. Cytomegaly of pregnant women is dangerous: it can cause spontaneous miscarriage, congenital malformations, intrauterine fetal death, congenital cytomegaly.
Other names for cytomegaly found in medical sources are cytomegalovirus infection (CMV), inclusion cytomegaly, viral salivary gland disease, and inclusion disease. The causative agent of cytomegalovirus infection - cytomegalovirus - belongs to the family of human herpes viruses. Cells affected by cytomegalovirus multiply in size, therefore the name of the disease "cytomegalovirus" is translated as "giant cells".
Cytomegalovirus is a widespread infection, and many people, being carriers of cytomegalovirus, do not even know about it. The presence of antibodies to cytomegalovirus is detected in 10-15% of the adolescent population and in 50% of adults. According to some sources, the carriage of cytomegalovirus is determined in 80% of women of childbearing period. First of all, this refers to the asymptomatic and asymptomatic course of cytomegalovirus infection.
Not all people with cytomegalovirus are sick. Often, cytomegalovirus is in the body for many years and may never manifest itself or harm a person. The manifestation of a latent infection occurs, as a rule, with a weakening of the immune system. Cytomegalovirus poses a threat in its consequences in persons with reduced immunity (HIV-infected, who have undergone bone marrow or internal organ transplantation, taking immunosuppressants), with congenital cytomegaly, in pregnant women.
Ways of transmission of cytomegalovirus
Cytomegaly is not a highly contagious infection. Usually, infection occurs through close, prolonged contact with carriers of cytomegalovirus. Cytomegalovirus is transmitted by the following routes:
- airborne: when sneezing, coughing, talking, kissing, etc.;
- sexually: during sexual intercourse through semen, vaginal and cervical mucus;
- blood transfusion: with blood transfusion, leukocyte mass, sometimes - with organ and tissue transplantation;
- transplacental: during pregnancy from mother to fetus.
The mechanism of development of cytomegaly
Once in the blood, cytomegalovirus causes a pronounced immune response, manifested in the production of protective protein antibodies - immunoglobulins M and G (IgM and IgG) and an antiviral cellular reaction - the formation of CD 4 and CD 8 lymphocytes. Inhibition of cellular immunity in HIV infection leads to active development cytomegalovirus and the infection it causes.
The formation of immunoglobulins M, indicating a primary infection, occurs 1-2 months after infection with cytomegalovirus. After 4-5 months, IgM are replaced by IgG, which are found in the blood throughout subsequent life. With strong immunity, cytomegalovirus does not cause clinical manifestations, the course of the infection is asymptomatic, hidden, although the presence of the virus is determined in many tissues and organs. Affecting cells, cytomegalovirus causes an increase in their size; under a microscope, the affected cells look like an "owl's eye". Cytomegalovirus is determined in the body for life.
Even with an asymptomatic course of infection, the carrier of cytomegalovirus is potentially infectious for uninfected individuals. The exception is the intrauterine transmission of cytomegalovirus from a pregnant woman to the fetus, which occurs mainly during the active course of the process, and only in 5% of cases causes congenital cytomegaly, in the rest it is asymptomatic.
Forms of cytomegaly
Congenital cytomegaly
In 95% of cases, intrauterine infection of the fetus with cytomegalovirus does not cause the development of the disease, but is asymptomatic. Congenital cytomegalovirus infection develops in newborns whose mothers have had primary cytomegalia. Congenital cytomegaly can manifest itself in newborns in various forms:
- petechial rash - small skin hemorrhages - occurs in 60-80% of newborns;
- prematurity and intrauterine growth retardation - occurs in 30% of newborns;
- chorioretinitis is an acute inflammatory process in the retina of the eye, often causing a decrease and complete loss of vision.
Mortality in intrauterine infection with cytomegalovirus reaches 20-30%. Most of the surviving children have mental retardation or hearing and vision disabilities.
Acquired cytomegaly in newborns
When infected with cytomegalovirus during childbirth (with the passage of the fetus through the birth canal) or in the postpartum period (with household contact with an infected mother or breastfeeding), in most cases, an asymptomatic course of cytomegalovirus infection develops. However, in premature infants, cytomegalovirus can cause lingering pneumonia, which is often accompanied by a concomitant bacterial infection. Often, with cytomegalovirus infection in children, there is a slowdown in physical development, an increase in lymph nodes, hepatitis, and a rash.
Mononucleosis-like syndrome
In persons who have left the neonatal period and have normal immunity, cytomegalovirus can cause the development of a mononucleosis-like syndrome. The clinical course of mononuclease-like syndrome does not differ from infectious mononucleosis caused by another type of herpesvirus - the Ebstein-Barr virus. The course of the mononucleosis-like syndrome resembles a persistent cold infection. At the same time, it is noted:
- prolonged (up to 1 month or more) fever with high body temperature and chills;
- aching joints and muscles, headache;
- severe weakness, malaise, fatigue;
- sore throat;
- enlarged lymph nodes and salivary glands;
- a skin rash that resembles a rubella rash (usually seen with ampicillin).
In some cases, mononucleosis-like syndrome is accompanied by the development of hepatitis - jaundice and an increase in the blood of liver enzymes. Even less often (up to 6% of cases), pneumonia is a complication of mononucleosis-like syndrome. However, in individuals with normal immune reactivity, it proceeds without clinical manifestations, being detected only during radiography of the lungs.
The duration of the course of mononucleosis-like syndrome is from 9 to 60 days. Then a complete recovery usually occurs, although residual effects such as malaise, weakness, and enlarged lymph nodes may persist for several months. In rare cases, activation of cytomegalovirus causes recurrence of infection with fever, sweating, hot flashes, and malaise.
Cytomegalovirus infection in immunocompromised individuals
Weakening of immunity is observed in persons suffering from congenital and acquired (AIDS) immunodeficiency syndrome, as well as in patients who have undergone transplantation of internal organs and tissues: heart, lung, kidney, liver, bone marrow. After organ transplantation, patients are forced to constantly take immunosuppressants, leading to a pronounced suppression of immune reactions, which causes the activity of cytomegalovirus in the body.
In patients who have undergone organ transplantation, cytomegalovirus causes damage to donor tissues and organs (hepatitis - with liver transplant, pneumonia with lung transplant, etc.). After bone marrow transplantation, cytomegalovirus can lead to the development of pneumonia with a high mortality rate in 15-20% of patients (84-88%). The most dangerous situation is when a donor material infected with cytomegalovirus is transplanted to an uninfected recipient.
Cytomegalovirus infects almost all HIV-infected people. At the onset of the disease, malaise, joint and muscle pain, fever, and night sweats are noted. In the future, cytomegalovirus lesions of the lungs (pneumonia), liver (hepatitis), brain (encephalitis), retina (retinitis), ulcerative lesions and gastrointestinal bleeding may join these signs.
In men, cytomegalovirus can affect the testes, prostate, in women - the cervix, the inner layer of the uterus, vagina, ovaries. Complications of cytomegalovirus infection in HIV-infected patients can be internal bleeding from the affected organs, loss of vision. Multiple organ damage by cytomegalovirus can lead to their dysfunction and death of the patient.
Diagnosis of cytomegaly
In order to diagnose cytomegalovirus infection, a laboratory determination of specific antibodies to cytomegalovirus - immunoglobulins M and G - is carried out in the blood. The presence of immunoglobulins M may indicate primary infection with cytomegalovirus or reactivation of chronic cytomegalovirus infection. Determination of high titers of IgM in pregnant women may threaten the infection of the fetus. An increase in IgM is detected in the blood 4-7 weeks after infection with cytomegalovirus and is observed for 16-20 weeks. An increase in immunoglobulins G develops during the period of attenuation of the activity of cytomegalovirus infection. Their presence in the blood indicates the presence of cytomegalovirus in the body, but does not reflect the activity of the infectious process.
To determine the DNA of cytomegalovirus in blood cells and mucous membranes (in the materials of scrapings from the urethra and cervical canal, in sputum, saliva, etc.), the method of PCR diagnostics (polymerase chain reaction) is used. Especially informative is quantitative PCR, which gives an idea of \u200b\u200bthe activity of cytomegalovirus and the infectious process caused by it. The diagnosis of cytomegalovirus infection is based on the isolation of cytomegalovirus in clinical material or with a fourfold increase in the antibody titer. Treatment of cytomegalovirus infection in persons at risk is carried out with the antiviral drug ganciclovir. In cases of severe cytomegalovirus, ganciclovir is administered intravenously, since the tablet forms of the drug have only a prophylactic effect against cytomegalovirus. Since ganciclovir has severe side effects (it causes inhibition of hematopoiesis - anemia, neutropenia, thrombocytopenia, skin reactions, gastrointestinal disorders, fever and chills, etc.), its use is limited in pregnant women, children and people suffering from renal failure (only for health reasons), it is not used in patients without impaired immunity.
For the treatment of cytomegalovirus in HIV-infected people, the most effective drug is foscarnet, which also has a number of side effects. Foscarnet can cause electrolyte disturbance (decrease in blood plasma magnesium and potassium), genital ulceration, urinary disorders, nausea, kidney damage. These adverse reactions require careful use and timely dose adjustments.
Prevention
The issue of preventing cytomegalovirus infection is especially acute in persons at risk. The most susceptible to infection with cytomegalovirus and the development of the disease are HIV-infected (especially patients with AIDS), patients after organ transplantation and persons with immunodeficiency of a different genesis.
Nonspecific methods of prevention (for example, personal hygiene) are ineffective against cytomegalovirus, since it can even be infected by airborne droplets. Specific prophylaxis of cytomegalovirus infection is carried out with ganciclovir, acyclovir, foscarnet among patients at risk. Also, to exclude the possibility of infection with cytomegalovirus in recipients during organ and tissue transplantation, careful selection of donors and control of donor material for the presence of cytomegalovirus infection is required.
Cytomegalovirus is especially dangerous during pregnancy, as it can provoke miscarriage, stillbirth, or cause severe congenital malformations in a child. Therefore, cytomegalovirus, along with herpes, toxoplasmosis and rubella, is one of those infections for which women should be examined prophylactically, even at the stage of pregnancy planning.
To avoid undesirable consequences, treatment of cytomegalovirus with folk remedies must be combined with drug therapy. This type of herpes is the most common; for a long period of time, a person is a carrier and is unaware of it. Even after a course of treatment, the virus remains in the human body in a "latent" form, but in the future it manifests itself if there are provoking factors.
Causes and symptoms
An infectious disease, after full recovery, the carrier is potentially dangerous to others, but manifests itself in different ways, this is due to immune resistance. It is impossible to detect the presence of a virus without laboratory tests, since the incubation period lasts from one month, then the body produces antibodies. Cytomegalovirus IgG positive indicates that infection occurred within one month intervals. If the amount of IgG is increased by 4 times, then the virus is in the active phase. In the case of a weakened immune system, the following symptoms appear:
- flu condition;
- decreased physical activity, rapid fatigue;
- pain in muscles and joints;
- inflammation of the lymph nodes.
The virus is transmitted to the fetus through the placenta. Symptoms in women and in men are the same, the listed symptoms are typical for people who do not suffer from congenital immunodeficiency, otherwise an increased body temperature, inflammation of the nasopharynx and severe headaches join. An urgent doctor's help is needed, since CMV infection affects an internal organ, which complicates treatment. With a congenital disease, the baby manifests itself:
- enlargement of the liver and spleen;
- pneumonia, bronchitis;
- delayed physical and mental development;
- dysfunction of the visual apparatus;
- improper formation of teeth;
- lack of weight.
With intrauterine infection at an early stage, the fetus dies or is born with pathological changes.
Indications for treatment
The disease is dangerous for patients with low immunity. In medicine, there are a number of cases in which the treatment of CMVI is necessary. It will not be possible to eradicate the virus, but it is possible to reduce the impact on the body. Among the indications for treatment are:
- Extensive damage to internal organs, develops against the background of parallel bacterial and viral infections. The disease manifests itself at any age.
- It is imperative to treat CMVI in case of complications arising in newborns, they manifest themselves in the form of pneumonia or encephalitis. Lack of timely therapy leads to serious developmental disabilities or death.
- The virus is treated in preparation for surgery, organ and tissue transplantation, and the fight against oncological formations when the immune system is suppressed, and favorable conditions are created for the progression of the disease.
- Even the initial manifestations are dangerous for people with congenital immunodeficiency.
- Cytomegaly, which predominantly develops in children, requires treatment, healthy cells are affected and greatly increase in size.
- Treatment of cytomegalovirus infection is important during pregnancy when there is a risk of fetal infection.
Drug treatment
Drug treatment has a toxic effect on internal organs. The treatment regimen for cytomegalovirus is multicomponent, the appointment is made by the doctor taking into account the patient's history, symptoms and development of the disease. Therapy is aimed at reducing the aggressiveness of the herpes virus and increasing the body's resistance. It is worth noting that drugs are toxic and in most cases cause side effects, so self-medication is fraught with consequences.
Antiviral drugs
Drugs for the treatment of cytomegalovirus infection:
- "Ganciclovir" medicine is prescribed for severe disease, when complications spread to the internal organs and there is a threat to the patient's life, it is also used for herpes in children. "Acyclovir" in cytomegalovirus is its analogue, it is less effective, therefore it has been improved. "Ganciclovir" is presented in the form of a powder, which is taken dry or in the form of injections. The doctor prescribes a course of treatment with taking drugs 2-3 times a day, depending on the age and weight of the patient.
- "Foscarnet" is similar to the previous drugs in action and toxicity to the body. The drug is injected by injection 2-3 times a day. The active substance not only suppresses the effect of CMV infection, but also has a detrimental effect on all internal systems. Forbidden to women carrying a child and nursing.
- Panavir is a less effective remedy, it acts softer in comparison with the drugs already presented. You can buy solution for injection and gel for external use. Despite its safety, it is not recommended for pregnant women (especially in the first trimester) and young children.
- "Cytotect" is the best option for treatment, is highly effective and safe for all groups of people. Prescribed to newborns and difficult patients who have high sensitivity. It is injected into a vein per kilogram of body weight, on average, 3 to 6 applications are required.
- - antiviral pills designed to treat various herpes infections. The bioavailability of the drug is high, but for greater efficiency, equal intervals between doses should be observed. Valvir is not intended for the treatment of children.
Immunomodulators for the treatment of CMV
The drug increases the body's immune resistance. To reduce the effect of the CMV virus on the body, immunomodulators are often prescribed, which increase immune resistance and stimulate the production of antibodies. But such drugs are not used to treat infants, as they are ineffective, since the immune system is not fully formed. Among the most common drugs are: "Cycloferon", "Viferon", "Roferon", "Neovir".
The cytomegaly virus affects many organs and systems of the human body, has several transmission mechanisms and entry gates, but the priority remains for the suppression of the immune system. Therefore, treatment of cytomegalovirus infection (CMV) should primarily be aimed at correcting and restoring the cellular link of immunity. When cytomegalovirus first enters the body, it persists for a long time in target cells, disrupting the normal immune response.
The mechanism of transmission and pathogenesis of the disease
Getting infected with CMV is not easy. This requires very close contact. Usually, infection occurs in collectives and crowded places. The source of this infection is only a person - a sick manifest form or a virus carrier (asymptomatic course).
Transfer factors:
- saliva (highest concentrations);
- urine;
- female milk;
- discharge of the genital tract: mucus of the cervical canal, sperm;
- blood;
- cerebrospinal fluid.
The main ways of penetration of the virus into the human body:
The virus has an affinity for the following types of human cells:
- monocytes;
- macrophages;
- epithelium;
- vascular endothelium;
- neurons;
- hepatocytes.
CMV target organs:
- salivary glands;
- kidneys;
- bile ducts;
- pancreas;
- intestines;
- bronchioles and alveoli;
- thyroid;
- brain;
- liver
If it gets on mucous membranes or skin, the virus enters the bloodstream. Then it settles in "favorite cells", the immune system is activated and tries to destroy the pathogen. Clinically, this period may be accompanied by inflammation of the salivary glands or mononucleosis-like syndrome. But most often this stage proceeds without any manifestations. Then the cytomegalovirus infection goes into a latent state. The virus persists in the body with its preservation in tissues and organs for life.
Reactivation of the infection occurs when exposed to the following provoking factors:
The greatest danger of cytomegalovirus in women is during pregnancy, since the initial encounter with CMV or its reactivation can lead to congenital cytomegaly.
It is at the stage of reactivation that cytomegalovirus must undergo antiviral and immunomodulatory treatment. Finding it in immunocompetent cells during persistence causes suppression of immunity. Clinicians classify this infection as congenital and acquired.
Manifestations of acquired CMV
80% of the adult population has a positive test for the presence of antibodies to this infection. CMV is considered a childhood infection, since most people encounter the virus in childhood. The first contact with CMV is often asymptomatic for a person, but the virus remains with him for life. With a decrease in the body's defenses, the infection reactivates with the manifestation of clinical symptoms.
The incubation period lasts from 15 days to 3 months. The CMV clinic depends on the state of the immune system.
In people with normal immune systems, infection manifests itself as follows:
In individuals with a reduced immune response, as well as in infants, this infection occurs with damage to many organs:
The younger the age, the more likely it is to have symptoms of the disease. In adolescents and adults, cytomegaly is often latent.
Manifestations of congenital CMV
The manifestations and degree of fetal damage are largely determined by the mother's immunity, as well as the timing of infection. A pregnant woman can transmit the infection to a child in 2 cases:
Congenital CMV can manifest itself in a manifest or latent form. Chronic infection occurs when infection occurs early in pregnancy. The child is born small in weight with gross malformations: microcephaly, blindness and deafness.
The virus enters the fetus at a time when its immune system is immature and cannot adequately respond to the antigen. Children are often born small. At birth, even with a latent infection, suppression of the cellular link of immunity, jaundice and a slight increase in the liver and spleen are observed.
Diagnostics and treatment
PCR is performed to detect CMV DNA. Examine not only blood, but also other biological fluids: urine, saliva, cerebrospinal fluid, smear material from the urethra and cervical canal. Since the treatment of cytomegalovirus should be accompanied by a decrease in the number of virions, it is imperative to determine the viral load using PCR. With positive dynamics, the load is reduced.
In order to determine the degree of the immune response, a blood test is performed for antibodies to the virus:
A cultural method is also used to study biological fluids for the presence of a virus.
In the general analysis of blood, there is a decrease in leukocytes, platelets, an increase in monocytes, lymphocytes. After 2-3 weeks from the onset of the disease, atypical mononuclear cells appear in an amount of up to 10%.
It is not possible to cure cytomegalovirus forever, but it is possible to suppress an active infection and ensure long-term remission with the help of an arsenal of modern medicines.
Antiviral chemotherapy drugs
The most effective means of fighting CMV are antiviral drugs. They inhibit the replication of the virus by inhibiting one of the enzymes - DNA polymerase:
Chemotherapy is indicated for the generalized form of CMV with the inclusion of the retina and lungs in the process. The drugs are very toxic, so their use is limited. Medicines have a negative effect on the kidneys, dividing cells, have carcinogenic and teratogenic properties.
Therefore, they are not used in children and pregnant women. In exceptional cases, when the child's life is in danger, the attending physician may convene a council at which the question of how to treat cytomegalovirus infection in a child with antiviral agents is decided.
Contraindications:
- decrease in hemoglobin below 80 g / l;
- the level of platelets is below 250 thousand * 10 /² g / l;
- the absolute index of the content of neutrophils is below 500 cells per microliter;
- age up to 12 years;
- pregnancy;
- severe renal failure.
Side effects:
There is a method of implanting a capsule of Ganciclovir into the vitreous body of the eye to treat retinitis.
Interferons
CMV causes a weak natural production of interferon by leukocytes, therefore, the treatment regimen for cytomegalovirus should be supplemented with interferon preparations to restore the normal level of this substance in the blood. If cytomegalovirus infection is mild, then isolated treatment with interferon suppositories is carried out.
Immunomodulators should be included in any treatment regimen. The most commonly used interferon preparations are:
- Viferon;
- Genferon;
Hyperimmune Human Immunoglobulin Cytotect
The product contains ready-made cytomegalovirus antibodies. This medication is very effective in the treatment of CMV: it creates a passive immunity to infection.
The drug is approved for use in pregnant women and children. Indications for treatment with Cytotect are generalized and clinically expressed forms of CMV.
For the prevention of CMV infection during organ transplantation, 1 injection of Cytotect is performed before the operation at a dosage of 1 ml / 1 kg.
Side effects:
- anaphylactic shock;
- head and joint pain;
- nausea and vomiting;
- lowering blood pressure.
A history of allergy to human immunoglobulin is a contraindication.
Modern complementary methods of CMV treatment. These methods significantly increase the activity of the cellular link of immunity:
- Autoplasma cryomodification: the method allows excluding antibodies and inflammatory mediators from the patient's blood.
- Extracorporeal immunopharmacotherapy: leukocytes are isolated from the blood, treated with immunomodulators, and then returned to the bloodstream.
The name of the virus is associated with the fact that when a virus infects cells, they increase in size (translated as giant cells).
Depending on the state of the immune system, infection with cytomegalovirus can cause various changes: from an asymptomatic course and mild mononucleosis-like syndrome to severe systemic infections with damage to the lungs, liver, kidneys and other organs.
Causes of the disease
Cytomegalovirus is ubiquitous. Infection can occur through close contact with a carrier of the infection or a sick person. The virus is released into the external environment with various human body fluids: saliva, urine, feces, breast milk, sperm, vaginal discharge. The routes of transmission include airborne, food, sexual. A newborn baby can become infected from the mother through breast milk. It should be noted the vertical route of transmission from mother to fetus during. When the fetus is infected, a very serious disease, congenital cytomegaly, can develop.
Infection can also occur during blood transfusion (in Russia, donor blood is not tested for cytomegalovirus) and during organ transplantation from a donor with CMV infection.
Once infected with cytomegalovirus, a person usually remains the carrier of this infection for life.
Symptoms of CMV Infection
Distinguish how many variants of the course of CMV infection.
1) CMV infection in persons with normal immunity.
Most often, primary infection is manifested by a mononucleosis-like syndrome. The incubation period is 20-60 days, the duration of the disease is 2-6 weeks. As a rule, there is fever, weakness, swollen lymph nodes,. With a sufficient immune response, the body produces antibodies against the virus and the disease ends with self-healing. The release of viruses with body fluids continues for months and years after recovery. After primary infection, cytomegalovirus can be in the body for decades in an inactive form or spontaneously disappear from the body. On average, 90-95% of the adult population has antibodies of class G to CMV.
2) CMV infection in persons with weakened immunity (patients with lymphoproliferative diseases, hemoblastosis, HIV-infected, patients after transplantation of internal organs or bone marrow).
In such patients, generalization of the infection may occur, the liver, kidneys, lungs, retina, pancreas and other organs are affected.
3) Congenital cytomegalovirus infection.
Intrauterine infection of the fetus for up to 12 weeks, as a rule, ends; if infected after 12 weeks, the child may develop a serious disease - congenital cytomegaly. According to statistics, congenital cytomegaly affects about 5% of infected intrauterine newborns. Its symptoms include prematurity, enlarged liver, kidneys, spleen, pneumonia. Children who have had CMV infection in utero and who have avoided generalization of the process may have psychomotor retardation, hearing loss, visual impairment, and dental anomalies.
Diagnostics
The diagnosis of CMV infection is based on the clinical picture and laboratory research methods.
Laboratory methods for identifying cytomegalovirus include:
- isolation of the virus in cell culture;
- cytological examination (light microscopy) - detection of specific giant cells with intranuclear inclusion;
- enzyme immunoassay (ELISA) - detection of specific antibodies to cytomegalovirus of classes M and G in the blood;
- polymerase chain reaction - allows you to determine the DNA of cytomegalovirus in any biological tissues.
Treatment of cytomegalovirus
Carriage of viruses and mononucleosis-like syndrome in persons with normal immunity does not require treatment.
People with weakened immunity are trying to transfuse blood products and transplant organs from CMV-negative donors.
The main prevention of fetal infection is testing for the presence of cytomegalovirus infection before pregnancy. Antiviral therapy during pregnancy is not used, as it is toxic and has a potential risk to the fetus. If a woman has a laboratory-confirmed cytomegalovirus infection, pregnancy is permissible only against the background of achieving a stable remission.