How does cytomegalovirus manifest itself? Cytomegalovirus infection. Cytomegalovirus - treatment
Cytomegalovirus infection
What is Cytomegalovirus Infection -
Cytomegalovirus infection(Human Cytomegalovirus Infection, CMV infection, cytomegaly, viral disease of the salivary glands, inclusion cytomegaly, disease with inclusions) is an anthroponotic opportunistic infection that usually occurs latently or easily. It is dangerous in various immunodeficiency states and pregnancy (due to the risk of intrauterine infection of the fetus).
As early as 1882, the German pathologist X. Ribbert discovered peculiar giant cells with inclusions in the nucleus in the renal tubules of a stillborn child. Subsequently, they were called cytomegalic cells (Goodpasture E., Talbot F., 1921). Later, L. Smith and W. Rowe (1956) isolated a virus that causes a disease with the development of characteristic cytomegaly. It was named cytomegalovirus (CMV) and the disease itself was called cytomegalovirus infection.
What provokes / Causes of Cytomegalovirus infection:
The causative agent of cytomegalo viral infection - DNA-genomic virus of the genus Cytomegalovirus (Cytomegalovirus hominis) subfamily Betaherpesvirinae of the family Herpesviridae. Three strains of the virus are known: Davis, AD-169 and Kerr. Slow reproduction of the virus in the cell is possible without damaging it. The virus is inactivated by heating and freezing, and is well preserved at room temperature. At - 90 °C, it remains for a long time, is relatively stable at pH 5.0-9.0, and quickly collapses at pH 3.0.
Reservoir and source of infection- a person with an acute or latent form of the disease. The virus can be found in various biological secretions: saliva, nasopharyngeal secretions, tears, urine, feces, seminal fluid, and cervical secretions.
Transmission mechanisms diverse, transmission routes- airborne, contact (direct and indirect - through household items) and transplacental. Infection is possible through sexual contact, during transplantation of internal organs (kidney or heart) and blood transfusion of an infected donor. Intranatal infection of the child is observed much more often than transplacental. The most dangerous for the fetus is infection of the mother in the first trimester of pregnancy. In such situations, the frequency of intrauterine development disorders is highest.
Natural susceptibility of people high, but widespread latent infection. Clinical manifestations of an infection attributed to opportunistic diseases are possible in conditions of primary or secondary immunodeficiency.
The main epidemiological signs of cytomegalovirus infection. The disease is recorded everywhere, its widespread is evidenced by antiviral antibodies detected in 50-80% of adults. The variety of ways of CMV infection and the polymorphism of the clinical picture determine the epidemiological and social significance of CMV infection. This disease plays an important role in transplantation, hemotransfusiology, perinatal pathology, and can be the cause of prematurity, stillbirth, congenital developmental defects. In adults, CMV infection is encountered as a concomitant disease in various immunodeficiency states. Ongoing pollution environment, the use of cytostatics and immunosuppressants contribute to an increase in the frequency of CMV infection. V last years its exacerbation in HIV-infected people has become especially relevant. In pregnant women with latent CMV infection, fetal damage does not always occur. The probability of intrauterine infection is much higher with the primary infection of a woman during pregnancy. Seasonal or professional features of morbidity have not been identified.
Pathogenesis (what happens?) during Cytomegalovirus infection:
With various transmission routes, the infection gates can be the mucous membranes of the upper respiratory tract, gastrointestinal tract or genital organs. The virus enters the blood; short-term viremia quickly ends with the localization of the pathogen when it invades leukocytes and mononuclear phagocytes, where it replicates. Infected cells increase in size (cytomegaly), acquire a typical morphology with nuclear inclusions, which are accumulations of the virus. The formation of cytomegalic cells is accompanied by interstitial lymphohistiocytic infiltration, the development of nodular infiltrates, calcifications and fibrosis in various organs, glandular structures in the brain.
The virus is able to persist for a long time and latently in organs rich in lymphoid tissue, being protected from the effects of antibodies and interferon. At the same time, it can suppress cellular immunity by direct action on T-lymphocytes. In various immunodeficiency states (in early childhood, during pregnancy, the use of cytostatics and immunosuppressants, HIV infection) and, above all, in violations of cellular immunity, further exacerbated by direct exposure to the virus, reactivation of the pathogen and its hematogenous generalization are possible with damage to almost all organs and systems . In this case, the epitheliotropy of the virus is of great importance. It is especially pronounced in relation to the epithelium of the salivary glands, which under the influence of the virus turns into cytomegalic cells.
Active CMV infection is considered as an indicator of defects in cellular immunity and is included in the group of AIDS-associated conditions.
Symptoms of Cytomegalovirus infection:
International Classification of Diseases X revision
International Statistical Classification of Diseases and Related Health Problems 10th Revision Version for 2006 does not classify cytomegalovirus infection as a sexually transmitted infection and distinguishes between the following CMV-related diseases.
B25.0 Cytomegalovirus disease
B25.0 Cytomegalovirus pneumonitis
B25.1 Cytomegalovirus hepatitis
B25.2 Cytomegalovirus pancreatitis
B25.8 Other cytomegalovirus diseases
B25.9 Cytomegalovirus disease, nonspecific
B27.1 Cytomegalovirus mononucleosis
P35.1 Congenital cytomegalovirus infection
Among the various variants of the course of CMV infection, subclinical forms and latent virus carriers predominate. Clinically expressed infection becomes in conditions of immunodeficiency. A unified clinical classification of CMV infection has not been developed. In accordance with one of the classifications, congenital CMV infection is distinguished in acute and chronic forms and acquired CMV infection in latent, acute mononucleosis or generalized forms.
Congenital CMV infection. In most cases, it is not clinically manifested in the early stages of a child’s life, however, in the later stages of its development, a variety of pathologies are revealed: deafness, chorioretinitis with atrophy of the optic nerves, decreased intelligence, and speech disorders. However, in 10-15% of cases with congenital CMV infection, the so-called overt cytomegalovirus syndrome develops. Its manifestations depend on the timing of infection of the fetus during pregnancy.
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- In early pregnancy leads to intrauterine fetal death or the birth of a child with a variety of malformations: microcephaly, micro- and macrogyria, pulmonary hypoplasia, esophageal atresia, anomalies in the structure of the kidneys, defects in the atrial and interventricular septa, narrowing of the pulmonary trunk and aorta, etc.
When the fetus is infected in late pregnancy malformations are not formed, however, from the first days of life, newborns show signs of various diseases: hemorrhagic syndrome, hemolytic anemia, jaundice of various origins (due to congenital hepatitis, cirrhosis of the liver, atresia of the biliary tract). Various clinical manifestations are possible, indicating the defeat of various organs and systems: interstitial pneumonia, enteritis and colitis, polycystic pancreas, nephritis, meningoencephalitis, hydrocephalus.
- Acute congenital CMV infection with the development of an obvious cytomegalovirus syndrome, it has a tendency to generalization, a severe course with the addition of secondary infections. Death is often inevitable during the first weeks of a child's life.
Chronic congenital CMV infection. Characterized by microgyria, hydrocephalus, microcephaly, clouding of the lens and vitreous body.
Acquired CMV infection.
- In adults and older children in most cases, it proceeds latently in the form of an asymptomatic carriage or a subclinical form with a chronic course.
- Acute form of acquired CMV infection. Often it may not have clear clinical symptoms, sometimes the main clinical manifestations are similar to influenza, infectious mononucleosis or viral hepatitis.
- In immunocompromised adults of varying severity (from physiological immunosuppression during pregnancy to HIV infection), as well as in children under 3 years of age, CMV reactivation manifests itself in the form of a generalized form with various lesions of organs and systems. The process may involve the central nervous system, lungs, liver, kidneys, gastrointestinal tract, genitourinary system, etc. The most commonly diagnosed hepatitis, interstitial pneumonia, enterocolitis, inflammatory processes of various parts of the genital organs (more often in women), encephalitis. With multiple organ lesions, the disease is characterized by a severe course, it can take on the features of sepsis. The outcome is often unfavorable.
Ulcers of the esophagus, stomach, intestines (thick and thin) may develop. Ulcers can lead to bleeding, with perforation, peritonitis develops. Cytomegalovirus hepatitis often develops. In AIDS patients, cytomegalovirus infection often results in chronic encephalitis or subacute encephalopathy. Apathy builds up and after a few weeks or months turns into dementia. Cytomegaly virus can cause the development of retinitis, which leads to blindness in AIDS patients, as well as in people who have undergone organ transplant surgery. Areas of necrosis appear on the retina, which gradually expand.
Eye lesions must be differentiated from similar changes that are observed in toxoplasmosis, candidiasis and herpes infection.
In addition to HIV-infected patients, cytomegalovirus infection is an important pathogenetic factor complicating organ transplantation operations. When transplanting kidneys, heart, liver, cytomegalovirus causes fever, leukopenia, hepatitis, pneumonia, colitis, retinitis. Most often this occurs within 1-4 months after surgery. It should be noted that with primary infection, the complication is more severe than with the activation of a latent cytomegalovirus infection. The severity of the course and clinical manifestations depend both on the degree of immunosuppression and on the immunosuppressant drugs used.
Cytomegalovirus pneumonia develops in about 20% of patients; undergoing bone marrow transplantation. Mortality in this group of patients is 88%. The maximum risk of developing the disease is observed from the 5th to the 13th week after transplantation. More severe cytomegaly occurs in the elderly. In kidney transplant recipients, cytomegalovirus infection can cause graft dysfunction.
- Manifestations of cytomegalovirus infection in pregnant women. In pregnant women, CMVI has various clinical forms. In acute infection, damage to the liver, lungs, and brain can develop. As a rule, patients complain of general malaise, headache, fatigue, mucous discharge from the nose, whitish-blue discharge from the genitals, enlargement and soreness of the submandibular salivary glands. Some characteristic symptoms are manifested in a complex: pronounced hypertonicity of the uterine body, resistant to ongoing therapy, vaginitis, colpitis, hypertrophy, cysts and premature aging of the placenta, polyhydramnios. Against this background, the weight of the fetus often exceeds the gestational age, and there is also an intimate attachment of the chorionic tissue of the placenta, premature detachment of a normally located placenta, blood loss during childbirth, reaching 1% of the woman's body weight, a clinic of latent postpartum endometritis with the development of menstrual disorders in the future.
Most often, cytomegalovirus infection occurs as a latent infection with periodic exacerbations. When making a diagnosis, the results of a laboratory examination are crucial. An auxiliary role is played by the presence of a burdened obstetric history, the threat of termination of a previous pregnancy, premature birth, the birth of sick children with malformations. In women with chronic CMVI, pseudo-erosion of the cervix, endometritis, ovarian dysfunction, extragenital diseases (hepatitis, chronic cholecystitis, pancreatitis, urolithiasis, chronic sinusitis, pneumonia, chronic diseases of the submandibular and parotid salivary glands) are more often noted.
Any manifestations of CMV infection are considered as indicative of HIV infection. In this case, it is necessary to examine the patient for antibodies to HIV.
Complications of cytomegalovirus infection
Complications are varied and depend on the clinical course of the disease: interstitial or segmental pneumonia, pleurisy, myocarditis, arthritis, encephalitis, Guillain-Barré syndrome, but they are relatively rare. After the acute phase, asthenia persists for many weeks, sometimes vegetative-vascular disorders.
Diagnosis of Cytomegalovirus infection:
Differential diagnosis of CMV infection quite difficult due to the lack or variety clinical manifestations.
For diagnosis of CMV infection it is necessary to use 2-3 laboratory tests at the same time. Examine saliva, washings obtained during bronchopulmonary lavage, urine, cerebrospinal fluid, blood, breast milk, sectional material, biopsy specimens. Due to the thermolability of the virus, the material for research must be delivered to the laboratory no later than four hours from the time of sampling.
The examination is carried out by virological, cytological, serological methods. Detection of specifically altered CMB cells is the most accessible method, however, its informative value is 50-70%. The most reliable detection in the material of the virus itself or its DNA. The virological method is still the gold standard. It is the most reliable, but its implementation requires a significant amount of time, so the retrospective nature of the diagnosis does not allow for adequate therapy and prevention.
For diagnosis, it is not necessary to isolate the virus itself, it is enough to isolate its antigen. For this, immunofluorescence reaction (RIF), enzyme immunoassay (ELISA), DNA-CMV hybridization, polymerase chain reaction (PCR) are widely used.
PCR method due to its high sensitivity, it detects even a segment of CMV DNA and is considered very progressive. Its most important advantage is the ability to diagnose early stages process, latent and persistent infection, however, it has two significant drawbacks. Firstly, low predictive value due to the fact that PCR detects virus DNA even in a latent state. Secondly, this method is not specific enough.
In recent years, the most widespread ELISA method, which allows the detection of CMV antigen and specific antibodies of classes G and M. The detection of IgG is of secondary importance. It should be carried out simultaneously with the detection of IgM, especially for the diagnosis of primary infection. With a single detection of IgG, analysis of their level of avidity (ability to retain antigen) can help in differentiating between active and persistent infection.
It must be borne in mind that specific antibodies may not be detected in persons with reduced immunity, with protein starvation, etc. The determination of IgG must be carried out in paired sera with an interval of at least 10 days.
The recurrent form of CMVI is diagnosed when the virus is re-isolated in seropositive individuals.
The diagnosis of intrauterine CMVI is established during the first three weeks of life. The presence of IgM in a newborn up to two weeks of life indicates an intrauterine infection, after - an acquired one.
Affinity and avidity of antibodies
The importance of diagnosing primary cytomegalovirus infection in pregnant women has led to the study of the properties of antibodies produced by the body in response to infection.
Two main properties of antibodies have been established:
Affinity - the degree of specific affinity of an antibody for the antigen of the pathogen
Avidity - the degree of strength of binding of an antibody molecule to an antigen molecule
A close relationship between them has been established, the higher the affinity, the stronger the antibody binds to the antigen (higher avidity). Degrees of affinity and avidity make it possible to determine the age of class G antibodies and use it to judge the duration of infection and the course of the infectious process (latent course, relapse). The primary phase of infection is judged by the presence of virus-specific IgM antibodies, the period of presence of which in the body in the body is several weeks - months. An increase in IgG levels occurs within a few weeks. Initially, low-affinity antibodies are formed, which are formed during the active reproduction of the virus in the body and persist for up to 1.5 months. from the onset of the disease. Further, the body produces high-affinity IgG antibodies that persist for a long time. High-affinity antibodies remain in the body for a long time, providing immunity from infection.
To distinguish between primary and latent infection, avidity of class G antibodies. If low avid IgG is detected in the blood, this indicates a primary infection. Detection of highly avid G antibodies indicates a latent or past infection. If highly avid G and IgM antibodies are present in the body, then reactivation of a latent infection or re-entry of the virus into the body can be assumed. speaks of a secondary immune response in the event of a pathogen entering the body or exacerbation (reactivation).
In quantitative terms, the so-called avidity index is determined.
Avidity index up to 30% indicates the presence of low-avid antibodies and, accordingly, a primary infection, 30-40% indicates a late stage of a primary infection or a recent infection, an index over 40% indicates a long-standing infection.
Treatment of cytomegalovirus infection:
Treatment of cytomegalovirus infection presents certain difficulties, since interferon and many antiviral agents (acyclovir, vidarabine, virazole) were ineffective, and in some cases their use causes paradoxical reactions. Ganciclovir slows down the development of cytomegalovirus retinitis, but has little effect on lesions of the lungs, brain, and gastrointestinal tract. Foscarnet has certain prospects. Perhaps the use of anticytomegalovirus hyperimmune human immunoglobulin. For the treatment of women with a burdened obstetric history, it is proposed to prescribe immunomodulators (levamisole, T-activin).
Mononucleosis-like forms of infection do not require specific treatment.
For the treatment of severe forms of CMVI in immunocompromised individuals and intrauterine CMVI in newborns, ganciclovir is used. It connects to the virus reproduction cycle and interrupts it. After the abolition of ganciclovir, relapses are possible. The drug has a number of side effects in the form of neutropenia, thrombocytopenia, liver and kidney damage, so it is prescribed to children for health reasons. Treatment is carried out under the control of a blood test every two days.
The appointment of interferons is considered effective.
On the present stage it is important to combine antiviral drugs with interferons, which contributes to the elimination of CMV (combination of acyclovir with a-interferon), and also mutually potentiates the antiviral effect, reduces the toxicity of drugs (ganciclovir with interferon inducers, its most successful combination with amixin). At the same time, drugs are prescribed to correct immune dysfunction.
Specific anticytomegalovirus immunoglobulin is administered intramuscularly in 3 ml daily for 10 days. It contains 60% CMV-specific antibodies.
Nonspecific immunoglobulins for intravenous administration (Sandoglobulin) are prescribed for the prevention of CMVI in immunocompromised individuals. Their effectiveness is lower than specific immunoglobulins.
Effective for the prevention of CMVI in seronegative recipients is the use of immunoglobulins in combination with acyclovir or valaciclovir.
Vaginally use 0.25% bonafton, oxolinic, rhyodoxol, 0.5% tebrofen, florenal, 1% interferon, 3-5% acyclovir ointment 3-5 times a day for 12-15 days (ointments must be changed every 10-14 days).
For the treatment of the oral cavity, the same preparations are used in the form of solutions, as well as 0.5% atonium, 1:5000 furatsilin, 1-5% aminocaproic acid; with fungal complications - 1% iodinol and 0.25% rhyodoxol ointment.
With retinitis, CNS lesions, pneumonia in immunocompromised individuals, ganciclovir or foscarnet are most effective, the course of treatment is 14-21 days.
Prevention of Cytomegalovirus infection:
Specific prophylaxis not developed. When transfusing blood, you should use the blood of healthy donors that do not contain antibodies to CMV, this also applies to transplantation of internal organs. Prophylactic use of specific hyperimmune immunoglobulin in risk groups (recipients of bone marrow, heart, kidneys and liver; patients receiving cytostatic drugs, pregnant women) is shown. In the prevention of congenital infection, the prevention of contacts between pregnant women and patients, strict adherence to the anti-epidemic regime in obstetric institutions is of great importance. Children born to mothers with CMV infection who do not show signs of infection should not be breastfed. In the case of the birth of a child with CMV infection, a second pregnancy can be recommended no earlier than after 2 years.
Measures to prevent CMV infection in pregnant women
No measures can completely eliminate the risk of infection, but following these rules will reduce the likelihood of CMV infection.
1. Wash your hands thoroughly with soap for 15-20 minutes, especially after changing diapers (pampers) for infants
2. Never kiss children under 5 on the lips.
3. Set aside separate dishes and cutlery for yourself and small children
4. If you work in children's institutions (nurseries, kindergartens), take a vacation during pregnancy or drastically limit contact with children.
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Modern statistics show that every fifth child becomes infected with cytomegalovirus infection at the age of 1 year. Among the ways of infection, the most dangerous is intrauterine infection. In this way, 5 to 7 percent of children become infected. About 30 percent of cases of transmission of the virus to the child occur during breastfeeding. The rest of the children become infected with the infection in children's groups. In adolescence, the virus occurs in 15 percent of children. At the age of 35, more than 40 percent of the population is affected by the disease, and by the age of 50, 99 percent of people become infected with the virus.
In the United States of America, a congenital infection is diagnosed in 3 percent of all newborns, of which 80 percent have clinical manifestations in the form of various pathologies. The mortality rate for congenital cytomegalovirus with complications at birth is 20 percent, which is between 8,000 and 10,000 children annually. In the absence of complications at birth, 15 percent of children infected during fetal development subsequently develop diseases of varying severity. Between 3 and 5 percent of children worldwide become infected in the first 7 days of life.
Among pregnant women, about 2 percent of women are exposed to primary infection. The probability of transmission of the virus at the time of bearing a child with primary infection is from 30 to 50 percent. Such children are born with the following deviations - neurosensory disorders - from 5 to 13 percent; mental retardation - up to 13 percent; bilateral hearing loss - up to 8 percent.
Interesting facts about cytomegalovirus infection
One of the names of cytomegalovirus is the expression "disease of civilization", which explains the widespread distribution of this infection. There are also such names as viral disease of the salivary glands, cytomegaly, disease with inclusions. At the beginning of the 19th century, this disease was romantically called "kissing disease", since at that time it was believed that infection with this virus occurs through saliva at the time of kissing. The true pathogen was discovered by Margaret Gladys Smith in 1956. This scientist was able to isolate the virus from the urine of an infected child. A year later, Weller's scientific group began to study the causative agent of the infection, and after another three years, the name "cytomegalovirus" was introduced.Despite the fact that by the age of 50, almost every person on the planet has experienced this disease, it is not recommended in any developed country in the world to conduct a study for the detection of CMV in pregnant women in the usual manner. The publications of the American College of Obstetricians and the American Academy of Pediatrics say that the diagnosis of CMV infection in pregnant women and newborns is not appropriate due to the lack of a vaccine and a specially developed treatment against this virus. Similar recommendations were published by the Royal College of Obstetricians and Gynecologists in the UK in 2003. According to representatives of this organization, the diagnosis of cytomegalovirus infection in pregnant women is not necessary, since there is no way to predict which complications will develop in a child. Also in favor of this conclusion is the fact that to date there is no adequate prevention of transmission of infection from mother to fetus.
The conclusions of the colleges of America and Great Britain boil down to the fact that a systematic examination for the determination of cytomegalovirus in pregnant women is not recommended due to the large number of unexplored factors of this disease. A mandatory recommendation is to provide all pregnant women with information that will allow them to observe precautionary and hygiene measures in the prevention of this disease.
What is cytomegalovirus?
Cytomegalovirus is one of the most common human pathogens. Once in the body, the virus can cause a clinically pronounced cytomegalovirus infection or remain dormant throughout life. To date, there are no drugs that could remove cytomegalovirus from the body. The structure of the cytomegalovirus
Cytomegalovirus is one of the largest viral particles. Its diameter is 150 - 200 nanometers. Hence its name - translated from ancient Greek - "large viral cell".An adult mature cytomegalovirus virus particle is called a virion. The virion has a spherical shape. Its structure is complex and consists of several components.
The components of the cytomegalovirus virion are:
- virus genome;
- nucleocapsid;
- protein ( protein) matrix;
- supercapsid.
The cytomegalovirus genome is located in the nucleus ( core) virion. It is a bundle of densely packed double-stranded DNA helix ( deoxyribonucleic acid), which contains all the genetic information of the virus.
Nucleocapsid
"Nucleocapsid" is translated from ancient Greek as "shell of the nucleus." It is a protein layer that surrounds the virus genome. The nucleocapsid is formed from 162 capsomeres ( shell protein fragments). Capsomeres form geometric figure with pentagonal and hexagonal faces arranged according to the type of cubic symmetry.
Protein Matrix
The protein matrix occupies the entire space between the nucleocapsid and the outer envelope of the virion. Proteins that make up the protein matrix are activated when the virus enters the host cell and are involved in the reproduction of new viral units.
Supercapsid
The outer shell of the virion is called the supercapsid. It consists of a large number glycoproteins ( complex protein structures containing carbohydrate components). Glycoproteins are located differently in the supercapsid. Some of them protrude above the surface of the main layer of glycoproteins, forming small "spikes". With the help of these glycoproteins, the virion "feels" and analyzes the external environment. When the virus comes into contact with any cell of the human body, with the help of "spikes" it attaches itself and penetrates into it.
Properties of cytomegalovirus
Cytomegalovirus has a number of important biological properties that determine its pathogenicity.The main properties of cytomegalovirus are:
- low virulence ( degree of pathogenicity);
- latency;
- slow reproduction;
- pronounced cytopathic ( cell-destroying) the effect;
- reactivation in host immunosuppression;
- instability in the external environment;
- low contagiousness ( ability to infect).
More than 60 - 70 percent of the adult population under 50 years of age and more than 95 percent of the population over 50 years of age are infected with cytomegalovirus. However, most people do not even know that they are carriers of this virus. Most often, the virus is in a latent form or causes minimal clinical manifestations. This is due to its low virulence.
Latency
Once in the human body, cytomegalovirus remains in it for life. Thanks to the immune defense of the body, the virus can exist for a long time in a latent, dormant state, without causing any clinical manifestations of the disease.
With the help of glycoprotein "thorns" the virion recognizes and attaches itself to the membrane of the cell it needs. Gradually, the outer membrane of the virus merges with the cell membrane and the nucleocapsid penetrates inside. Inside the host cell, the nucleocapsid inserts its DNA into the nucleus, leaving a protein matrix on the nuclear membrane. Using the enzymes of the cell nucleus, viral DNA multiplies. The protein matrix of the virus, which remained outside the nucleus, synthesizes new capsid proteins. This process is the longest - it takes an average of 15 hours. The synthesized proteins pass into the nucleus and combine with new viral DNA, forming the nucleocapsid. Gradually, proteins of a new matrix are synthesized, which attaches to the nucleocapsid. The nucleocapsid leaves the cell nucleus, attaches to the inner surface of the cell membrane and is enveloped by it, creating a supercapsid for itself. Copies of the virion that have left the cell are ready to penetrate into another healthy cell for further reproduction.
Reactivation in host immunosuppression
For a long time, cytomegalovirus can be in a latent state in the human body. However, under conditions of immunosuppression, when the human immune system is weakened or destroyed, the virus is activated and begins to enter the host cells for reproduction. As soon as the immune system returns to normal, the virus is suppressed and falls into "hibernation".
The main adverse environmental factors for cytomegalovirus are:
- high temperatures ( more than 40 - 50 degrees Celsius);
- freezing;
- fat dissolvers ( alcohol, ether, detergents).
With a single contact with the virus, it is almost impossible to become infected with a cytomegalovirus infection, thanks to a good immune system and protective barriers of the human body. Infection with the virus requires long-term constant contact with the source of infection.
Methods of infection with cytomegalovirus
Cytomegalovirus has a fairly low contagiousness, so several favorable factors are required for infection. Favorable factors for infection with cytomegalovirus are:
- constant, long and close contact with the source of infection;
- violation of the biological protective barrier - the presence of tissue damage ( cuts, wounds, microtrauma, erosion) at the site of contact with the infection;
- disturbances in the functioning of the body's immune system during hypothermia, stress, infection, and various internal diseases.
Methods of infection with cytomegalovirus
| Transmission routes | What is transmitted | entrance gate |
| Contact household |
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| Airborne |
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| Contact-sexual |
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| Oral |
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| Transplacental |
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| iatrogenic |
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| Transplant |
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Contact household way
The contact-household route of infection with cytomegalovirus is more common in closed groups ( family, kindergarten, camp). Household and personal hygiene items of a virus carrier or a patient become infected with various body fluids ( saliva, urine, blood). With constant non-compliance with hygiene standards, cytomegalovirus infection easily spreads throughout the team.airborne way
Cytomegalovirus is excreted from the body of a patient or carrier with sputum, saliva, tears. When coughing, sneezing, these fluids are distributed in the air in the form of microparticles. A healthy person becomes infected with the virus by inhaling these microparticles. The entrance gates are the mucous membranes of the upper respiratory tract and the oral cavity.Contact-sexual way
One of the most common ways of transmission of cytomegalovirus infection is the contact-sexual route. Unprotected sexual intercourse with a sick person or a virus carrier leads to infection with cytomegalovirus. The virus is excreted with semen, mucus of the cervix and vagina and enters the body of a healthy partner through the mucous membranes of the genital organs. With non-traditional sexual intercourse, the mucous membranes of the anus and oral cavity can become the entrance gate.oral route
In children, the most common route of infection with cytomegalovirus is the oral route. The virus enters the body through contaminated hands and objects that children constantly put into their mouths.The infection can be spread with saliva through kissing, which also applies to the oral route of transmission.
Transplacental route
When cytomegalovirus infection is activated in pregnant women, against the background of reduced immunity, the child becomes infected. The virus can enter the body of the fetus with the mother's blood through the umbilical artery, causing various pathologies of fetal development.Infection is also possible during childbirth. With the blood of a woman in labor, the virus enters the skin and mucous membranes of the fetus. If their integrity is broken, then the virus enters the body of the newborn.
iatrogenic pathway
Infection of the body with cytomegalovirus can be the result of blood transfusion ( blood transfusion) from an infected donor. A single blood transfusion usually does not lead to the spread of cytomegalovirus infection. The most vulnerable are patients who need frequent or constant blood transfusions. These include patients with various blood diseases. The body of such patients is weakened. Their immune system is overwhelmed by the underlying disease and cannot fight the virus. Continuous blood transfusions contribute to infection with cytomegalovirus.Cytomegalovirus can also enter the body through repeated use of unsterilized medical equipment.
Transplant route
Cytomegalovirus can persist for a long time in the organs and tissues of the donor. Organ transplant patients are given immunosuppressive therapy to prevent rejection. Against the background of immunosuppression, cytomegalovirus is activated and spreads throughout the patient's body.The spread of cytomegalovirus infection in the body proceeds in several stages.
The stages of the spread of cytomegalovirus infection are:
- local cell damage;
- distribution in regional lymph nodes;
- primary immune response;
- circulation in the circulatory and lymphatic system;
- dissemination ( Spread) in organs and tissues;
- secondary immune response.
Cytomegalovirus infection in most cases enters the body through the skin or mucous membranes, in which integrity is impaired.
At this time, the immune system is activated in the human body, which suppresses the spread of foreign particles through the blood and lymph. However, the immune system is not able to completely destroy the infection. Cytomegalovirus can remain latent in the lymph nodes for a long time.
In the case of immunosuppression, the body is not able to stop the reproduction of the virus. Cytomegalovirus penetrates into blood cells and spreads to all organs and tissues, affecting them.
During the secondary immune response, a large number of antibodies to the virus are produced, which suppress its further replication ( reproduction). The patient recovers, but becomes a carrier ( virus persists in lymphoid cells).
Symptoms of cytomegalovirus infection in women
Symptoms of cytomegalovirus infection in women depend on the form of the disease. In 90 percent of cases, women have a latent form of the disease without pronounced symptoms. In other cases, cytomegalovirus occurs with severe damage to internal organs. After the penetration of cytomegalovirus into the human body, an incubation period begins. During this period, the virus actively multiplies in the body, but without showing any symptoms. With cytomegalovirus infection, this period lasts from 20 to 60 days. Then comes the acute phase of the disease. Women with strong immune systems may experience this phase with mild flu-like symptoms. A slight temperature may be observed ( 36.9 - 37.1 degrees Celsius), mild malaise, weakness. As a rule, this period passes imperceptibly. However, in favor of the presence of cytomegalovirus in the body of a woman, an increase in the titer of antibodies in her blood testifies. If she makes a serological diagnosis during this period, then acute-phase antibodies to this virus will be detected ( anti-CMV IgM).
The acute phase of cytomegalovirus lasts 4 to 6 weeks. After that, the infection subsides and is activated only with a decrease in immunity. In this form, the infection can persist for life. Only with random or planned diagnostics can it be detected. In this case, in the blood of a woman or in a smear, if a PCR smear is performed, chronic phase antibodies to cytomegalovirus are detected ( anti-CMV IgG).
It is believed that 99 percent of the population is a carrier of latent cytomegalovirus infection, and these people are detected anti-CMV IgG. If the infection does not manifest itself, and the woman's immunity is strong enough for the virus to remain in an inactive form, then she becomes a virus carrier. As a rule, the virus carrier is not dangerous. But, at the same time, in women, a latent cytomegalovirus infection can cause miscarriages, the birth of dead children.
In immunocompromised women, the infection is active. In this case, two forms of the disease are observed - acute mononucleosis-like and generalized form.
Acute cytomegalovirus infection
This form of infection resembles infectious mononucleosis. It starts abruptly, with fever and chills. The main characteristic of this period is generalized lymphadenopathy ( swollen lymph nodes). As with infectious mononucleosis, there is an increase in lymph nodes from 0.5 to 3 centimeters. The nodes are painful, but not soldered together, but soft and elastic.First, the cervical lymph nodes increase. They can be very large and exceed 5 centimeters. Further, the submandibular, axillary and inguinal nodes increase. The internal lymph nodes are also enlarged. Lymphadenopathy appears first of the symptoms and the last to disappear.
Other symptoms of the acute phase are:
- malaise;
- liver enlargement ( hepatomegaly);
- increase in leukocytes in the blood;
- the appearance in the blood of atypical mononuclear cells.
Differences between cytomegalovirus and infectious mononucleosis
Unlike infectious mononucleosis, angina is not observed with cytomegalovirus. It is also extremely rare to observe an increase in the occipital lymph nodes and spleen ( splenomegaly). In laboratory diagnosis, the Paul-Bunnel reaction, which is inherent in infectious mononucleosis, is negative.
Generalized form of cytomegalovirus infection
This form of the disease is extremely rare and is very difficult. As a rule, it develops in women with immunodeficiency or against the background of other infections. Immunodeficiency states may result from chemotherapy, radiotherapy, or HIV infection. With a generalized form, internal organs, blood vessels, nerves, and salivary glands can be affected.The most common manifestations of a generalized infection are:
- liver damage with the development of cytomegalovirus hepatitis;
- lung damage with the development of pneumonia;
- damage to the retina with the development of retinitis;
- damage to the salivary glands with the development of sialadenitis;
- kidney damage with the development of nephritis;
- damage to the organs of the reproductive system.
In cytomegalovirus hepatitis, they are affected as hepatocytes ( liver cells), and the vessels of the liver. Inflammatory infiltration develops in the liver, the phenomenon of necrosis ( areas of necrosis). Dead cells are shed and fill the bile ducts. There is stagnation of bile, resulting in jaundice. The color of the skin becomes yellowish. There are complaints such as nausea, vomiting, weakness. In the blood, the level of bilirubin, hepatic transaminases increases. The liver at the same time increases, becomes painful. Liver failure develops.
The course of hepatitis can be acute, subacute and chronic. In the first case, the so-called fulminant hepatitis develops, often with a fatal outcome.
Diagnosis of cytomegalovirus infection is reduced to a puncture biopsy. In this case, with the help of a puncture, a piece of hepatic tissue is taken for further histological examination. When examining the tissue, huge cytomegalic cells are found.
Cytomegalovirus pneumonia
With cytomegalovirus, as a rule, interstitial pneumonia initially develops. With this type of pneumonia, not the alveoli are affected, but their walls, capillaries and tissue around the lymphatic vessels. This pneumonia is difficult to treat, resulting in a long course.
Very often, such prolonged pneumonia is complicated by the addition of a bacterial infection. As a rule, staphylococcal flora joins with the development of purulent pneumonia. Body temperature rises to 39 degrees Celsius, fever and chills develop. The cough quickly becomes wet with a large amount of purulent sputum. Shortness of breath develops, chest pain appears.
In addition to pneumonia, cytomegalovirus infection can develop bronchitis, bronchiolitis. The lymph nodes of the lungs are also affected.
Cytomegalovirus retinitis
Retinitis affects the retina of the eye. Retinitis is usually bilateral and may be complicated by blindness.
The symptoms of retinitis are:
- photophobia;
- blurred vision;
- "flies" before the eyes;
- the appearance of lightning and flashes before the eyes.
Cytomegalovirus sialadenitis
Sialoadenitis is characterized by damage to the salivary glands. The parotid glands are often affected. In the acute course of sialadenitis, the temperature rises, shooting pains appear in the gland area, salivation decreases and dryness is felt in the mouth ( xerostomia).
Very often, cytomegalovirus sialoadenitis is characterized by a chronic course. In this case, there are periodic pain, slight swelling in the parotid gland. The main symptom continues to be reduced salivation.
Kidney damage
The kidneys are very common in people with an active form of cytomegalovirus infection. In this case, inflammatory infiltration is found in the tubules of the kidney, in its capsule and in the glomeruli. In addition to the kidneys, the ureters and bladder can be affected. The disease proceeds with the rapid development of renal failure. A sediment appears in the urine, which consists of epithelium and cytomegalovirus cells. Sometimes there is hematuria ( blood in urine).
Damage to the organs of the reproductive system
In women, very often the infection occurs in the form of cervicitis, endometritis and salpingitis. As a rule, they proceed chronically with periodic exacerbations. A woman may complain of recurrent, mild pain in the lower abdomen, pain when urinating, or pain during intercourse. Sometimes there may be urination disorders.
Cytomegalovirus infection in women with AIDS
It is believed that 9 out of 10 AIDS patients suffer from an active form of cytomegalovirus infection. In most cases, cytomegalovirus infection is the cause of death of patients. Studies have shown that cytomegalovirus reactivates when the number of CD-4 lymphocytes becomes less than 50 per milliliter. Most often, pneumonia and encephalitis develop.Patients with AIDS develop bilateral pneumonia with diffuse lesions of the lung tissue. Pneumonia is most often prolonged, with a painful cough and shortness of breath. Pneumonia is one of the most common causes of death in HIV infection.
Also, AIDS patients develop cytomegalovirus encephalitis. Encephalitis with encephalopathy rapidly develops dementia ( dementia), which is manifested by a decrease in memory, attention, intelligence. One form of cytomegalovirus encephalitis is ventriculoencephalitis, which affects the ventricles of the brain and cranial nerves. Patients complain of drowsiness, severe weakness, impaired visual acuity.
The defeat of the nervous system in cytomegalovirus infection is sometimes accompanied by polyradiculopathy. In this case, the roots of the nerves are repeatedly affected, which is accompanied by weakness and pain in the legs. Cytomegalovirus retinitis in women with HIV infection often causes complete loss of vision.
Cytomegalovirus infection in AIDS is characterized by multiple lesions of internal organs. In the last stages of the disease, multiple organ failure is detected with damage to the heart, blood vessels, liver, and eyes.
Pathologies that cause cytomegalovirus in women with immunodeficiency are:
- kidney damage- acute and chronic nephritis ( kidney inflammation), foci of necrosis on the adrenal glands;
- liver disease hepatitis, sclerosing cholangitis ( inflammation and narrowing of the intrahepatic and extrahepatic bile ducts), jaundice ( a disease in which the skin and mucous membranes turn yellow), liver failure;
- diseases of the pancreas- pancreatitis ( inflammation of the pancreas);
- disease gastrointestinal tract - gastroenterocolitis ( joint inflammation of the small intestine, large intestine and stomach), esophagitis ( damage to the esophageal mucosa), enterocolitis ( inflammatory processes in the small and large intestine), colitis ( inflammation of the colon);
- lung disease- pneumonia ( pneumonia);
- eye diseases- retinitis ( retinal disease), retinopathy ( non-inflammatory ocular lesion). Eye problems occur in 70 percent of patients with HIV infection. About one fifth of patients lose their sight;
- spinal cord and brain damage- meningoencephalitis ( inflammation of the membranes and substances of the brain), encephalitis ( brain damage), myelitis ( inflammation of the spinal cord), polyradiculopathy ( damage to the nerve roots of the spinal cord), polyneuropathy of the lower extremities ( disorders in the peripheral nervous system), infarction of the cerebral cortex;
- diseases of the genitourinary system- cervical cancer, lesions of the ovaries, fallopian tubes, endometrium.
Symptoms of cytomegalovirus infection in children
In children, there are two forms of cytomegalovirus infection - congenital and acquired. Congenital cytomegalovirus infection in children
Almost always, infection of children with cytomegalovirus occurs in utero. Through the placenta, the virus enters the child's body from the mother's blood. In this case, the mother may suffer from a primary cytomegalovirus infection, or she may reactivate a chronic one.Cytomegalovirus belongs to the group of TORCH infections that lead to severe malformations. When a virus enters the blood of a child, a congenital infection does not always develop. According to various sources, from 5 to 10 percent of children whose blood has entered the virus develop an active form of the infection. As a rule, these are the children of those mothers who suffered a primary cytomegalovirus infection during pregnancy.
With the reactivation of a chronic infection during pregnancy, the degree of intrauterine infection does not exceed 1-2 percent. In the future, 20 percent of these children have serious pathologies.
Clinical manifestations of congenital cytomegalovirus infection are:
- malformations of the nervous system - microcephaly, hydrocephalus, meningitis; meningoencephalitis;
- Dandy-Walker syndrome;
- heart defects - carditis, myocarditis, cardiomegaly, valve malformations;
- hearing loss - congenital deafness;
- damage to the visual apparatus - cataracts, retinitis, chorioretinitis, keratoconjunctivitis;
- anomalies in the development of teeth.
In the blood of such children, there is an increase in liver enzymes, bilirubin, the number of platelets drops sharply ( thrombocytopenia). Mortality in this period is very high. Surviving children subsequently experience mental retardation, speech disorders. Most children with congenital cytomegalovirus infection suffer from deafness, and blindness is less common.
Due to damage to the nervous system, paralysis, epilepsy, and intracranial hypertension syndrome develop. Subsequently, such children lag behind not only in mental, but also in physical development.
A separate variant of congenital cytomegalovirus infection is Dandy-Walker syndrome. With this syndrome, various anomalies of the cerebellum and expansion of the ventricles are observed. Mortality in this case is from 30 to 50 percent.
The frequency of symptoms in intrauterine CMV infection in children is as follows:
- skin rash - from 60 to 80 percent;
- hemorrhages in the skin and mucous membranes - 76 percent;
- jaundice, 67 percent;
- enlargement of the liver and spleen - 60 percent;
- reduction in the size of the skull and brain - 53 percent;
- disorders of the digestive system - 50 percent;
- prematurity - 34 percent;
- hepatitis, 20 percent;
- inflammation of the brain - 15 percent;
- inflammation of blood vessels and retina - 12 percent.
Acquired cytomegalovirus infection in children
Acquired cytomegalovirus infection is one that a child becomes infected with after birth. Infection with cytomegalovirus can occur both intranatally and postnatally. Intranatal infection is one that occurs during the birth itself. Infection with cytomegalovirus in this way occurs during the passage of the child through the genital tract. Postnatal ( after birth) infection can occur through breastfeeding or through household contact from other family members.The nature of the consequences of an acquired cytomegalovirus infection depends on the age of the child and the state of his immune system. The most common consequence of the virus is acute respiratory infections ( ORZ), which are accompanied by inflammation of the bronchi, pharynx and larynx. Often there is a lesion of the salivary glands, most often in the parotid zones. A characteristic complication of acquired infection is inflammatory processes in connective tissues in the region of the pulmonary alveoli. Another manifestation of cytomegalovirus infection is hepatitis, which occurs in a subacute or chronic form. A rare complication of the virus is such damage to the central nervous system as encephalitis ( inflammation of the brain).
Symptoms of acquired cytomegalovirus infection are:
- children under 1 year old- lag in physical development with impaired motor activity and frequent convulsions. There may be lesions of the gastrointestinal tract, vision problems, hemorrhages;
- children from 1 to 2 years old- most often the disease is manifested by mononucleosis ( viral disease), the consequences of which are an increase in lymph nodes, swelling of the mucous throat, liver damage, changes in blood composition;
- children from 2 to 5 years old- the immune system at this age is not able to adequately respond to the virus. The disease causes complications such as shortness of breath, cyanosis ( bluish discoloration of the skin), pneumonia.
Acquired cytomegalovirus infection in children can also result from blood transfusions or organ transplants. In this case, the penetration of the virus into the body occurs with donated blood or organs. Such an infection usually proceeds according to the type of mononucleosis syndrome. At the same time, the temperature rises, nasal discharge and sore throat appear. At the same time, the lymph nodes are enlarged in children. The main manifestation of post-transfusion cytomegalovirus infection is hepatitis.
In 20 percent of cases after organ transplantation, cytomegalovirus pneumonia develops. After a kidney or heart transplant, the virus causes hepatitis, retinitis, and colitis.
In children with immunodeficiency ( for example, in patients with malignant diseases) cytomegalovirus infection is very difficult. As in adults, it leads to prolonged pneumonia, fulminant hepatitis, and visual impairment. Reactivation of the virus begins with a rise in temperature and chills. Often, children develop a hemorrhagic rash that affects the entire body. Such internal organs as the liver, lungs, central nervous system are involved in the pathological process.
Symptoms of cytomegalovirus infection in women during pregnancy
Pregnant women are most vulnerable to the harmful effects of cytomegalovirus, as the immune system is significantly weakened during the period of bearing a child. Both the risk of primary infection and the exacerbation of the virus increase if it is already in the patient's body. Complications can develop in both the woman and the fetus. During the initial infection with the virus or its reactivation, pregnant women may experience a number of symptoms that can manifest themselves or in combination. Some women are diagnosed with increased uterine tone, which does not respond to therapy.
Manifestations of CMV infection in pregnant women are:
- polyhydramnios;
- premature aging or placental abruption;
- improper attachment of the placenta;
- large blood loss during childbirth;
- spontaneous miscarriages.
Inflammatory processes in the genitourinary system in pregnant women with CMV are:
- endometritis (inflammatory processes in the uterus) - pain in the abdomen ( lower part). In some cases, pain may radiate to the lower back or sacrum. Also, patients complain of poor general health, lack of appetite, headaches;
- cervicitis (damage to the cervix) - discomfort during intimacy, itching in the genitals, aching pain in the perineum and lower abdomen;
- vaginitis (inflammation of the vagina) - irritation of the genital organs, an increase in body temperature, discomfort during intercourse, aching pain in the lower abdomen, redness and swelling of the external genital organs, frequent urination;
- oophoritis (inflammation of the ovaries) - a feeling of pain in the pelvis and lower abdomen, spotting that occurs after intercourse, a feeling of discomfort in the lower abdomen, pain when close to a man;
- cervical erosion- the appearance of blood in the discharge after intimacy, profuse vaginal discharge, sometimes there may be pain that is not very pronounced during intercourse.
The effect of CMV on the body of a pregnant woman
Cytomegalovirus is a viral infection that most often affects pregnant women.The consequences of the virus are:
- inflammation of the salivary glands, tonsils;
- pneumonia, pleurisy;
- myocarditis.
With severely weakened immunity, the virus can take a generalized form, affecting the entire body of the patient.
Complications of a generalized infection in women during pregnancy are:
- inflammatory processes in the kidneys, liver, pancreas, adrenal glands;
- dysfunction of the digestive system;
- vision problems;
- lung dysfunction.
Diagnosis of cytomegalovirus infection
Diagnosis of cytomegalovirus infection depends on the form of pathology. So, in the congenital and acute form of this disease, it is advisable to isolate the virus in cell culture. In chronic, periodically aggravated forms, serological diagnostics is carried out, which is aimed at detecting antibodies against the virus in the body. Cytological examination of various organs is also carried out. At the same time, changes typical for cytomegalovirus infection are found in them. Diagnostic methods for cytomegalovirus infection are:
- isolation of the virus by culturing it in cell culture;
- polymerase chain reaction ( PCR);
- linked immunosorbent assay ( ELISA);
- cytological method.
Virus isolation
Virus isolation is the most accurate and reliable method for diagnosing cytomegalovirus infection. Blood and other body fluids can be used to isolate the virus. The detection of a virus in saliva is not a confirmation of an acute infection, since the virus is shed after recovery for a long time. Therefore, the blood of the patient is most often examined.Virus isolation occurs in cell culture. Single-layer cultures of human fibroblasts are most commonly used. The studied biological material is initially centrifuged to isolate the virus itself. Next, the virus is applied to cell cultures and placed in a thermostat. There is, as it were, infection of cells with this virus. Cultures are incubated for 12 to 24 hours. As a rule, several cell cultures are infected and simultaneously incubated. The resulting cultures are then identified using various methods. Most often, cultures are stained with fluorescent antibodies and examined under a microscope.
The disadvantages of this method is the significant time spent on the cultivation of the virus. The duration of this method is from 2 to 3 weeks. At the same time, fresh material is needed to isolate the virus.
PCR
A significant advantage has such a diagnostic method as a polymerase chain reaction ( PCR). Using this method, the DNA of the virus is determined in the test material. The advantage of this method is that a slight presence of the virus in the body is necessary for the determination of DNA. It only takes one piece of DNA to identify the virus. Thus, both acute and chronic forms of the disease are defined. The disadvantage of this method is its relatively high cost.biological material
For PCR, any biological fluids are taken ( blood, saliva, urine, cerebrospinal fluid), swabs from the urethra and vagina, feces, swabs from mucous membranes.
Conducting PCR
The essence of the analysis is to isolate the DNA of the virus. Initially, a fragment of a DNA strand is found in the test material. Further, this fragment is cloned many times with the help of special enzymes to obtain a large number of DNA copies. The resulting copies are identified, that is, they are determined to which virus they belong. All these reactions take place in a special apparatus called an amplifier. The accuracy of this method is 95 - 99 percent. The method is carried out quickly enough, which allows it to be widely used. Most often, it is used in the diagnosis of latent genitourinary infections, cytomegalovirus encephalitis and for screening TORCH infections.
ELISA
Linked immunosorbent assay ( ELISA) is a method of serological testing. With it, antibodies to cytomegalovirus are determined. The method is used in complex diagnostics with other methods. It is believed that the determination of a high antibody titer, together with the detection of the virus itself, is the most accurate diagnosis of cytomegalovirus infection.biological material
The patient's blood is used to detect antibodies.
ELISA
The essence of the method is to detect antibodies to cytomegalovirus both in the acute phase and in the chronic. In the first case, anti-CMV IgM are detected, in the second, anti-CMV IgG. The analysis is based on the antigen-antibody reaction. The essence of this reaction is that antibodies ( produced by the body in response to a virus) bind specifically to antigens ( proteins on the surface of the virus).
The analysis is carried out in special tablets with wells. Biological material and antigen are placed in each well. Next, the tablet is placed in a thermostat for a certain time, during which the formation of antigen-antibody complexes occurs. After that, washing is carried out with a special substance, after which the formed complexes remain at the bottom of the wells, and the non-bound antibodies are washed off. After that, more antibodies treated with a fluorescent substance are added to the wells. Thus, a "sandwich" is formed of two antibodies and an antigen in the middle, which are processed with a special mixture. When this mixture is added, the color of the solution in the wells changes. The color intensity is directly proportional to the amount of antibodies in the test material. In turn, the intensity is determined using an apparatus such as a photometer.
Cytological diagnostics
A cytological study consists in examining pieces of tissue for the presence of specific changes in cytomegalovirus. So, under a microscope, giant cells with intranuclear inclusions, which look like the eyes of an owl, are found in the studied tissues. Such cells are characteristic exclusively for cytomegalovirus, so their detection is an absolute confirmation of the diagnosis. The method is used to diagnose cytomegalovirus hepatitis, nephritis.Treatment of cytomegalovirus infection
An important link in the activation and spread of cytomegalovirus infection in the patient's body is a decrease in immune defense. To stimulate and maintain immunity at a high level during a viral infection, immune preparations - interferons are used. Currently, natural and recombinant ( artificially created) interferons.
Mechanism of therapeutic action
Interferon preparations do not have a direct antiviral effect in the treatment of cytomegalovirus infection. They are involved in the fight against the virus, affecting the affected cells of the body and the immune system as a whole. Interferons have a number of effects in fighting infection.Activation of cellular defense genes
Interferons activate a number of genes that are involved in cellular defense against the virus. Cells become less vulnerable to the penetration of viral particles.
p53 protein activation
The p53 protein is a special protein that starts the processes of cell repair when they are damaged. If cell damage is irreversible, then the p53 protein triggers the process of apoptosis ( programmed death) cells. In healthy cells, this protein is in an inactive form. Interferons have the ability to activate the p53 protein in cytomegalovirus-infected cells. It evaluates the state of the infected cell and starts the process of apoptosis. As a result, the cell dies, and the virus does not have time to multiply.
Stimulation of the synthesis of special molecules of the immune system
Interferons stimulate the synthesis of special molecules that help the immune system recognize viral particles more easily and quickly. These molecules bind to receptors on the surface of the cytomegalovirus. Killer cells ( T-lymphocytes and natural killers) of the immune system find these molecules and attack the virions to which they are attached.
Stimulation of cells of the immune system
Interferons have the effect of direct stimulation of certain cells of the immune system. These cells include macrophages and natural killers. Under the influence of interferons, they migrate to the affected cells and attack them, destroying them together with the intracellular virus.
In the treatment of cytomegalovirus infection, various drugs based on natural interferons are used.
Natural interferons used in the treatment of cytomegalovirus infection are:
- human leukocyte interferon;
- leukinferon;
- wellferon;
- feron.
Release form and methods of using some natural interferons in cytomegalovirus infection
| Name of the drug | Release form | Mode of application | Duration of therapy |
| Human leukocyte interferon | Dry mix. | In an ampoule with a dry mixture, add distilled or boiled cold water to the mark. Shake until the powder is completely dissolved. The resulting liquid is instilled into the nose, 5 drops every one and a half to two hours. | Two to five days. |
| Leukinferon | Rectal suppositories. | 1-2 suppositories twice daily for 10 days, then the dose is reduced every 10 days. | 2 - 3 months. |
| Wellferon | Injection. | It is administered subcutaneously or intramuscularly at 500 thousand - 1 million IU ( international units) per day. | 10 to 15 days. |
The biggest disadvantage of natural preparations is their high cost, so they are used less frequently.
Currently, there are a large number of recombinant drugs of the interferon group, which are used in the complex therapy of cytomegalovirus infection.
The main representatives of recombinant interferons are the following drugs:
- viferon;
- kipferon;
- realdiron;
- reaferon;
- laferon.
Release form and methods of application of some recombinant interferons in cytomegalovirus infection
| Name of the drug | Release form | Mode of application | Duration of therapy |
| Viferon |
|
|
|
| Kipferon |
| Apply one candle every 12 hours daily for 10 days, then every other day for 20 days, then after 2 days for another 20 to 30 days. | On average, one and a half to two months. |
| Realdiron |
| It is used subcutaneously or intramuscularly at 1,000,000 IU per day. | 10 to 15 days. |
In the treatment of cytomegalovirus infection, it is important to choose the right complex therapy with the required doses of drugs. Therefore, treatment with interferons should be started only on the instructions of a specialist.
Evaluation of the treatment method
Evaluation of treatment of cytomegalovirus infection with interferons is based on clinical signs and laboratory data. A decrease in the severity of clinical manifestations to their complete absence indicates the effectiveness of the treatment. Evaluation of therapy is also carried out on the basis of laboratory tests - the detection of antibodies to cytomegalovirus. A decrease in the level of immunoglobulin M or its absence indicates the transition of an acute form of cytomegalovirus infection into a latent one.
Is treatment necessary for asymptomatic cytomegalovirus infection?
Since latent cytomegalovirus infection is not dangerous with good immunity, many experts do not consider it appropriate to treat it. Also in favor of the inexpediency of treatment is the fact that there is no specific treatment or vaccine that would kill the virus or prevent re-infection. Therefore, the main point in the treatment of asymptomatic cytomegalovirus infection is to maintain immunity at a high level.For this, it is recommended to prevent chronic infections ( especially urinary), which are the main cause of reduced immunity. It is also recommended to take immunostimulants, such as Echinacea Hexal, Derinat, Milife. They should only be taken as directed by a doctor.
What are the consequences of cytomegalovirus infection?
The nature of the consequences of cytomegalovirus is influenced by such factors as the age of the patient, the route of infection and the state of immunity. According to the severity of complications, patients with cytomegalovirus infection can be divided into several groups. The consequences of cytomegalovirus for people with normal immunity
Penetrating into the human body, the virus invades the cells, which causes an inflammatory process and a violation of the functionality of the affected organ. Also, the infection has a general toxic effect on the body, disrupts blood clotting processes and inhibits the functionality of the adrenal cortex. Cytomegalovirus can provoke the development of both systemic diseases and damage to individual organs. In some cases, CMV ( cytomegalovirus);Consequences of cytomegalovirus infection for the fetus
The nature of complications in the fetus depends on when the infection with the virus occurred. If the infection was before conception, the risk of detrimental consequences for the embryo is minimal, since antibodies are present in the woman's body that will protect it. The probability of infection of the fetus is no more than 2 percent.The possibility of developing a congenital cytomegalovirus infection increases when a woman becomes infected with the virus during pregnancy. The risk of transmitting the disease to the fetus is 30 to 40 percent. With primary infection during childbearing, gestational age is of great importance.
Depending on the moment of infection, the consequences of a cytomegalovirus infection for a developing fetus are:
- blastopathy(malformations that occur when infected during the period from 1 to 15 days of pregnancy) - death of the embryo, non-developing pregnancy, spontaneous abortion, various systemic pathologies in the fetus;
- embryopathies(when infected on the 15th - 75th day of pregnancy) – pathology of the vital systems of the body ( cardiovascular, digestive, respiratory, nervous). Some of these malformations are incompatible with fetal life;
- fetopathy(with late infection) - the infection can provoke the development of jaundice, damage to the liver, spleen, lungs.
The consequences of cytomegalovirus infection for children who have had an acute form of the disease
The most vulnerable in cytomegalovirus infection is the central nervous system, which causes brain damage and impaired motor and mental activity. Therefore, one third of infected children develop encephalitis and meningoencephalitis. The manifestations of these diseases are not always clearly expressed.The consequences of infection with cytomegalovirus in children are:
- jaundice from the first days of life occurs in 50 - 80 percent of sick children;
- hemorrhagic syndrome is registered in 65 - 80 percent of patients and is manifested by hemorrhages in the skin, mucous membranes, adrenal glands. Bleeding from the nose or umbilical wound is also possible;
- hepatosplenomegaly ( enlargement of the liver and spleen) diagnosed in 60-75 percent of children. Together with jaundice and hemorrhagic syndrome, this disease is the most common complication of CMV that develops in infected children from the first days of life;
- interstitial pneumonia manifested by symptoms of respiratory disorders;
- nephritis is a complication that develops in a third of sick children;
- gastroenterocolitis occurs in 30 percent of cases;
- myocarditis ( inflammation of the heart muscle) diagnosed in 10% of patients.
Other complications of cytomegalovirus are:
- lag in psychomotor development;
- lesions of the gastrointestinal tract;
- pathology of the organ of vision ( chorioretinitis, uveitis);
- blood disorders ( anemia, thrombocytopenia).
Unfortunately, today it is considered one of the most common in the world. Not a single person is immune from such an ailment, regardless of gender and age. It is worth noting that in some cases, the activity of this virus can lead to extremely unpleasant and even life-threatening consequences. That is why today many readers are interested in questions about what constitutes a cytomegalovirus infection. Symptoms in women, possible complications and effective methods treatment - all these points are valuable information for each reader.
Why is cytomegalovirus infection dangerous? Symptoms in women, treatment, feedback from patients who have undergone therapy - we will discuss all these and other issues in the framework of our article. But for starters, it’s still worth learning more about the nature of the pathogen.
Cytomegalovirus is a representative of the genus of herpeviruses and, when it enters the human body, leads to the development of cytomegaly. This is a DNA-genomic viral particle with a diameter of 150-200 nm, which is covered with a closed capsid consisting of 162 capsomeres.
This pathogen can stay in the human body for years without leading to any violations. Nevertheless, it should not be ignored. Cytomegalovirus infection in women (the photo shows what the virus looks like under a microscope) can lead to a host of complications. By the way, the infection retains virulence at room temperature. According to statistical studies, approximately 70% of the world's population are carriers of cytomegalovirus.
The main ways of transmission of infection
To date, several main methods of transmission of this infection are known. This diversity is due to the fact that viral particles can be released into the external environment along with blood, saliva, breast milk, semen, vaginal secretions, lacrimal fluid, etc.
Quite often, the transmission of cytomegalovirus occurs during unprotected intercourse, not only vaginal, but also anal and oral. Much less often, infection occurs by household means (as a rule, if the disease is in the active phase in a sick person). In addition, you can catch the infection through the blood, for example, during a transfusion, etc. Infection of a child can occur both during fetal development and when passing through the birth canal.
In any case, it should be understood that the occurrence of cytomegalovirus infection in women, or rather its activation and intensive formation of new viral particles, in most cases is associated with the influence of some other factors of the internal and external environment.
What can provoke the disease?
As mentioned above, the virus can exist for years in the tissues and cells of the human body without causing any damage or complications. So under the influence of what factors is activated cytomegalovirus infection in women? The reasons (the photos used in the article confirm this information), as a rule, are somehow connected with the weakening of the body's immune defenses.
For example, risk factors include inflammatory and protracted infectious diseases (in particular, syphilis, gonorrhea, chlamydia), which undermine the body's defense system. In addition, the state of immunity is affected by hormonal disruptions, severe hypothermia, physical and mental exhaustion, constant stress and nervous strain.
Activation of cytomegalovirus can occur while taking cytostatics, immunosuppressants and some other drugs. The same is often observed in oncological diseases, as well as after an organ transplant operation. Any decrease in immune activity is fraught with a host of complications, including increased reproduction of cytomegalovirus.
What organ systems are affected by the infection?
In fact, cytomegalovirus can affect almost any organ system. Most often, a high concentration of viral particles is observed in the salivary glands. In addition, the infection can affect the tissues of the intestines, lungs and respiratory tract, as well as the nervous system.
If we are talking about women, then cytomegalovirus can penetrate the organs of the reproductive system - often the result of the disease is cervical erosion.
among women
It is worth noting that the latent form of the disease proceeds without any signs - problems begin only after the activation of the virus. So what does cytomegalovirus infection look like in women? How does this disease manifest itself?
Quite often, the clinical picture resembles a common cold or flu - which is why women simply ignore the problem and refuse to see a doctor. Initially, there is an increase in temperature. In addition, patients complain of constant weakness, fatigue, body aches, pain in the joints - these are the main signs of general intoxication of the body.
What other disorders are caused by cytomegalovirus infection? Symptoms in women, men and children are also swollen lymph nodes, sore throat, which may be aggravated by swallowing. Often, patients suffer from a decrease in appetite and associated with this. Much less often, a rash appears on the lips and skin, which resembles rashes with chickenpox. Sometimes the infection affects other organ systems.
Generalized form of the disease and its features
Occasionally, a generalized cytomegalovirus infection is diagnosed during a medical examination. Symptoms in women can be different. For example, the virus can infect the eyes, resulting in poor vision. When the cells of the digestive system are damaged, abdominal pain of varying intensity, nausea, vomiting, loss of appetite appear. Much less often, patients complain of severe diarrhea and jaundice.
In the event that cytomegalovirus mainly affects tissues, patients experience a dry cough, muscle weakness, decreased appetite, chest pain, and excessive sweating.
More dangerous are cases when the virus is localized in the nervous system. Symptoms of this form of the disease include severe headaches, as well as drowsiness, impaired mobility or sensitivity of different parts of the body.
How else can cytomegalovirus infection manifest itself in women? Photos posted on specialized medical resources demonstrate that quite often the virus infects the reproductive organs. This is accompanied by the appearance of pain in the lower abdomen, soreness during urination and sexual intercourse, as well as the presence of uncharacteristic bluish whites.
What complications can the virus cause?
Quite often, during the examination, a cytomegalovirus infection is diagnosed in women. Why is such a situation dangerous? It should be said right away that cytomegalovirus usually causes severe complications in patients with a very weak immune system. For example, the risk group includes AIDS patients, as well as people who have undergone organ transplants, and patients in oncology departments.
In especially severe cases, the virus causes severe damage to various organ systems. In particular, the list of complications includes inflammation of the intestine, pleurisy and segmental pneumonia, as well as hepatitis and changes in the amount of enzymes in the liver. Extremely rare and dangerous lesions of the nervous system, in particular, encephalitis.
How dangerous is cytomegalovirus during pregnancy?
Naturally, many expectant mothers are interested in the question of how dangerous cytomegalovirus infection is in women. Signs of such a disease during pregnancy are a wake-up call signaling that the expectant mother needs immediate treatment.
To begin with, it is worth noting that the virus can be easily transmitted from mother to child during fetal development or during childbirth. Moreover, according to statistics, infection of the fetus during pregnancy is more dangerous. If cytomegalovirus is activated in a woman's body during the first trimester, then this is fraught with spontaneous abortion. Infection of the fetus at later stages is also fraught with consequences, including some birth defects, heart defects, epilepsy, and disorders of the nervous system.
Activation of the infection in the baby's body after birth can also be dangerous. In some cases, cytomegalovirus can lead to further delay in physical or mental development, progressive deafness, speech retardation, etc.
Cytomegalovirus infection during lactation
Another important question: is a cytomegalovirus infection in a woman a contraindication to breastfeeding? In fact, it is difficult to give an unambiguous answer, since this problem is solved individually and consultation with a specialist is required. After all, it all depends on the stage of the disease in a woman and whether the baby is infected. For example, if the mother is a carrier of cytomegalovirus, and it is found in a latent form in a child, then interrupt breast-feeding impractical.
Diagnosis of cytomegalovirus infection in women
If an infection is suspected, a laboratory blood test is performed. When deciphering the analysis, experts pay attention to the presence of specific immunoglobulins M and G, which are produced by the immune system only when this pathogen enters the body.
Cytomegalovirus infection in a woman in the process of laboratory research can give different results. For example, the presence in the body, along with the absence of signs of the disease, indicates a latent phase, as well as the fact that infection occurred more than three years ago. But an increase in IgG by more than four times indicates the active stage of the disease. The presence of both types of immunoglobulins in the blood confirms the secondary activation of the infection.
What methods of treatment does modern medicine offer?
Now you have read the information about what constitutes a cytomegalovirus infection, symptoms in women. Treatment, of course, exists, but, as a rule, it only makes it possible to suppress an outbreak of activity - it is almost impossible to completely cleanse the body of the virus.
Of course, in the first place, patients are prescribed antiviral drugs. For example, Acyclovir, Ganciclovir, Famciclovir, Valaciclovir, etc. are considered quite effective. Reviews of women who have used these drugs are mostly positive. But the doctor should select the medicines, since everything here depends on the severity of the patient's condition, the activity of her immune system, as well as the affected area. Often, antiviral therapy is combined with drugs containing interferon - experts say that such treatment can achieve good results.
Symptomatic therapy is what cytomegalovirus infection (symptoms in women) also requires. Treatment may include taking antipyretic, antihistamine, anti-inflammatory, pain medications, depending on the symptoms present in the patient. Naturally, doctors also recommend taking vitamin complexes and other immunomodulators that help strengthen immune defenses.
Basic Preventive Precautions
Today, questions about what constitutes a cytomegalovirus infection are becoming more and more relevant. We have listed the symptoms in women (reviews of patients and doctors indicate that there is little pleasant in this ailment), we also discussed effective methods of treatment. But is there effective prevention?
Unfortunately, there are no specific drugs that can protect the body from infection. The only thing that doctors can recommend is to carefully adhere to the rules of hygiene, avoid contact with carriers of the virus (which is almost impossible, since many people do not even suspect that they have their own problem), and also keep the immune system active. Experts convince that such measures help prevent the activation of cytomegalovirus. In addition, it is recommended to periodically take blood tests to detect certain infections, especially when it comes to pregnant women.
Cytomegalovirus- a virus from the herpesvirus family, which can be in the human body in a latent state for a long time. Once in the body, it can remain in it throughout life, excreted in saliva, urine and blood. How and under what conditions the symptoms of cytomegalovirus infection in women appear, we will consider further.
Provoking factors of cytomegalovirus infectionAs already mentioned, cytomegalovirus can live in the human body in a latent state, that is, without showing itself in any way and practically without causing harm. The transition of the disease to a clinically expressed form can occur due to the following factors:
- chronic stress;
- intercurrent diseases;
- taking immunosuppressants and cytostatics;
- hypothermia of the body;
- organ transplant operations;
- cancer;
- the presence of other infectious diseases (chlamydia, gonorrhea, syphilis, etc.).
In such cases, the immune system is weakened, and favorable conditions appear for the activation of the virus. As a result, cytomegalovirus begins to show its symptoms.
The main symptoms of cytomegalovirus infection in women
Most often, cytomegalovirus infection occurs with signs similar to the main manifestations of acute respiratory infections:
- increased body temperature;
- runny nose;
- headache;
- weakness;
- muscle pain.
A skin rash may also occur. However, the peculiarity of this disease is that it has a long duration - up to 4 - 6 weeks.
In some cases, the symptoms of cytomegalovirus infection are similar to infectious mononucleosis:
- high body temperature (up to 40 ° C);
- sore throat, aggravated by swallowing;
- swollen lymph nodes;
- severe weakness;
- pain in the right and (or) left hypochondrium.
Generalized forms of cytomegalovirus infection, which are quite rare, have the following manifestations:
- with eye damage: blurred vision, "flies" before the eyes;
- with damage to the digestive system: abdominal pain, loss of appetite, nausea, vomiting, diarrhea, jaundice;
- with lung damage: fever, dry cough, chest pain, muscle pain, weakness, increased sweating, loss of appetite;
- with inflammatory processes in the deep structures of the brain: drowsiness, fever, impaired sensitivity and mobility of various parts of the body.
Also, cytomegalovirus infection in women can be manifested by inflammatory processes in the genitourinary system. In this case, inflammation and erosion of the cervix, inflammation of the inner layer of the uterus, vagina and ovaries is possible. In such cases, the infection is manifested by such signs:
- the appearance of bluish-white discharge from the genitals;
- pain in the organs of the genitourinary system.
Such a course of cytomegalovirus infection is dangerous during pregnancy and threatens the likelihood of infection of the fetus.
Chronic cytomegalovirus - symptoms
Some patients have a chronic form of cytomegalovirus infection. Symptoms in this case are mild or almost completely absent.
Diagnosis of cytomegalovirus infection
In order to diagnose this infection, a laboratory blood test and the determination of specific antibodies to cytomegalovirus - immunoglobulins M and G are carried out. It is worth noting that cytomegalovirus IgG is positive in the absence of symptoms in almost 90% of the population. This result means that the primary infection occurred more than three weeks ago. Exceeding the norm by more than 4 times indicates the activation of the virus. The result, in which IgM and IgG are positive, indicates a secondary activation of the infection.
The name of the virus is due to the fact that when cells are infected with a virus, 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 a mild mononucleosis-like syndrome to severe systemic infections affecting the lungs, liver, kidneys and other organs.
Causes of the disease
Cytomegalovirus is ubiquitous. Infection can occur through close contact with a carrier of infection or a sick person. The virus is released into the environment with various human biological fluids: saliva, urine, feces, breast milk, semen, 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 of infection from mother to fetus during. When the fetus is infected, it can develop very serious disease congenital cytomegaly.
Infection can also occur during blood transfusion (in Russia, donor blood is not tested for the presence of cytomegalovirus) and during organ transplantation from a donor with CMV infection.
Once infected with cytomegalovirus, a person usually remains a carrier of this infection for life.
Symptoms of CMV infection
Distinguish how many variants of the course of CMV infection.
1) CMV infection in individuals 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 in self-healing. Isolation of viruses in 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 class G antibodies to CMV.
2) CMV infection in immunocompromised individuals (patients with lymphoproliferative diseases, hemoblastoses, HIV-infected patients, 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 illness - congenital cytomegaly. According to statistics, about 5% of newborns infected in utero suffer from congenital cytomegaly. Its symptoms include prematurity, enlargement of the liver, kidneys, spleen, pneumonia. In children who have had intrauterine CMV infection and avoided the generalization of the process, psychomotor developmental delay, hearing loss, visual impairment, and anomalies in the development of teeth may be detected.
Diagnostics
The diagnosis of CMV infection is based on the clinical picture and laboratory research methods.
Laboratory methods for the identification of cytomegalovirus include:
- virus isolation in cell culture;
- cytological examination (light microscopy) - detection of specific giant cells with intranuclear inclusion;
- enzyme immunoassay (ELISA) - detection in the blood of specific antibodies to cytomegalovirus classes M and G;
- polymerase chain reaction - allows you to determine the DNA of cytomegalovirus in any biological tissues.
Treatment of cytomegalovirus
Virus carrying and mononucleosis-like syndrome in persons with normal immunity does not require treatment.
Immunocompromised individuals are tried to transfuse blood products and transplant organs from CMV-negative donors.
The main prevention of fetal infection is a test 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 cytomegalovirus infection confirmed by laboratory methods, pregnancy is permissible only against the background of achieving a stable remission.