Sexually transmitted infections. Intimacy and kissing

Cytomegaly

General information

Cytomegaly– infection viral genesis, transmitted sexually, transplacental, household, blood transfusion. Symptomatically proceeds in the form of persistent cold. There is weakness, malaise, headaches and joint pain, runny nose, enlargement and inflammation of the salivary glands, profuse salivation. Often asymptomatic. The severity of the disease is determined general condition immunity. In the generalized form, severe foci of inflammation occur throughout the body. Pregnant cytomegaly is dangerous: it can cause spontaneous miscarriage, birth defects development, intrauterine fetal death, congenital cytomegaly.

Other names for cytomegaly found in medical sources are cytomegalovirus infection (CMV), inclusive cytomegaly, viral disease salivary glands, inclusion disease. The causative agent of cytomegalovirus infection, cytomegalovirus, belongs to the human herpesvirus family. Cells affected by cytomegalovirus multiply in size, so the name of the disease "cytomegaly" is translated as "giant cells".

Cytomegaly is a widespread infection, and many people who are carriers of cytomegalovirus are not even aware of it. The presence of antibodies to cytomegalovirus is detected in 10-15% of the population in adolescence and in 50% of adults. According to some sources, the carriage of cytomegalovirus is determined in 80% of women of the childbearing period. First of all, this refers to the asymptomatic and oligosymptomatic course of cytomegalovirus infection.

Not all people who carry cytomegalovirus are sick. Often, cytomegalovirus is in the body for many years and may never manifest itself and not harm a person. The manifestation of a latent infection occurs, as a rule, when the immune system is weakened. Threatening in its consequences, cytomegalovirus poses a danger in people with reduced immunity (HIV-infected, who underwent bone marrow transplantation or internal organs taking immunosuppressants), with a congenital form of 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 in the following ways:

• airborne: when sneezing, coughing, talking, kissing, etc.;
• sexually: during sexual contact through semen, vaginal and cervical mucus;
• blood transfusion: with blood transfusion, leukocyte mass, sometimes - with transplantation of organs and tissues;
• 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 the rest of life. With strong immunity, cytomegalovirus does not cause clinical manifestations, the course of infection is asymptomatic, hidden, although the presence of the virus is determined in many tissues and organs. By infecting 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 contagious to uninfected individuals. An exception is the intrauterine route of 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, while 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 cytomegalovirus. 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 - acute inflammatory process in the retina, often causing a decrease and complete loss of vision.

Mortality in intrauterine infection with cytomegalovirus reaches 20-30%. Of the surviving children, most have a mental retardation or a hearing and vision disability.

Acquired cytomegaly in newborns

When infected with cytomegalovirus during childbirth (during the passage of the fetus through the birth canal) or in postpartum period(during household contact with an infected mother or breastfeeding) in most cases, an asymptomatic course of cytomegalovirus infection develops. However, in preterm infants, cytomegalovirus can cause persistent pneumonia, which is often accompanied by concomitant bacterial infection. Often, with the defeat of cytomegalovirus in children, there is a slowdown in physical development, swollen lymph nodes, hepatitis, rash.

Mononucleosis-like syndrome

In individuals who have left the neonatal period and have normal immunity, cytomegalovirus can cause the development of a mononucleosis-like syndrome. The clinical course of a mononuclease-like syndrome does not differ from infectious mononucleosiscaused by another type of herpes virus - the Ebstein-Barr virus. The course of a mononucleosis-like syndrome resembles a stubborn cold infection. It notes:

• prolonged (up to 1 month or more) fever with high temperature body and chills;
• aching joints and muscles, headache;
• pronounced weakness, malaise, fatigue;
• sore throat;
• enlarged lymph nodes and salivary glands;
• skin rashes resembling rubella rash (usually occurs during treatment with ampicillin).

AT individual cases mononucleosis-like syndrome is accompanied by the development of hepatitis - jaundice and an increase in liver enzymes in the blood. 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 when X-rays of the lungs are performed.

The duration of the mononucleosis-like syndrome is from 9 to 60 days. Then, a complete recovery usually occurs, although residual effects in the form of malaise, weakness, and enlarged lymph nodes may persist for several months. Rarely, cytomegalovirus activation causes recurrences of the infection with fever, sweating, hot flashes, and malaise.

Cytomegalovirus infection in immunocompromised individuals

Weakened immunity is observed in persons suffering from congenital and acquired immunodeficiency syndrome (AIDS), 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 severe suppression 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 in liver transplants, pneumonia in lung transplants, etc.). After bone marrow transplantation, in 15-20% of patients, cytomegalovirus can lead to the development of pneumonia with high mortality (84-88%). The greatest danger is the situation when a cytomegalovirus-infected donor material 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, night sweats. In the future, these signs may be accompanied by lesions of the lungs (pneumonia), liver (hepatitis), brain (encephalitis), retina (retinitis), ulcerative lesions and gastrointestinal bleeding.

In men, cytomegalovirus can affect the testicles, prostate, in women - the cervix, the inner layer of the uterus, vagina, ovaries. Complications of cytomegalovirus infection in HIV-infected people can be internal bleeding from the affected organs, loss of vision. Multiple damage to organs 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 a primary infection with cytomegalovirus or a reactivation of a chronic cytomegalovirus infection. Determination of high titers of IgM in pregnant women may threaten 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 the quantitative PCR, which gives an idea of ​​the activity of cytomegalovirus and the infectious process it causes. The diagnosis of cytomegalovirus infection is based on the isolation of cytomegalovirus in clinical material or with a fourfold increase in antibody titer. Treatment of cytomegalovirus infection in individuals at risk is carried out with the antiviral drug ganciclovir. In cases severe course cytomegaly, ganciclovir is administered intravenously, since the tablet forms of the drug have only preventive effect for cytomegalovirus. Since ganciclovir has severe side effects (causes hematopoiesis suppression - anemia, neutropenia, thrombocytopenia, skin reactions, gastrointestinal disorders, fever and chills, etc.), its use is limited in pregnant women, children and in people suffering from renal insufficiency (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 may cause disturbance electrolyte metabolism(decrease in plasma magnesium and potassium), ulceration of the genital organs, impaired urination, nausea, kidney damage. Data adverse reactions require careful use and timely adjustment of the dose of the drug.

Prevention

The issue of prevention of cytomegalovirus infection is especially acute in individuals at risk. The most susceptible to infection with cytomegalovirus and the development of the disease are HIV-infected (especially AIDS patients), patients after organ transplantation and persons with immunodeficiency of a different origin.

Non-specific methods of prevention (for example, personal hygiene) are ineffective against cytomegalovirus, since infection with it is possible even by airborne droplets. Specific prophylaxis cytomegalovirus infection is carried out with ganciclovir, acyclovir, foscarnet among patients at risk. Also, to exclude the possibility of infection of recipients with cytomegalovirus during organ and tissue transplantation, careful selection of donors and monitoring of donor material for the presence of cytomegalovirus infection is necessary.

Cytomegalovirus is of particular danger during pregnancy, as it can provoke a miscarriage, stillbirth, or cause severe congenital deformities in a child. Therefore, cytomegalovirus, along with herpes, toxoplasmosis and rubella, is one of those infections that women should be examined for prophylactically, even at the stage of pregnancy planning.

Chemotherapy for malignant neoplasms, immunosuppressive therapy for internal organ transplantation) CMV causes severe disease (damage to the eyes, lungs, digestive system and brain), which can lead to death.

Prevalence and ways of infection with cytomegalovirus

• in everyday life: by airborne droplets and by contact - with saliva when kissing
• sexually: contact - with sperm, mucus of the cervical canal
• in blood transfusion and organ transplantation
• transplacental route - intrauterine infection of the fetus
• child infection during childbirth
• infection of the child in the postpartum period through breast milk from a sick mother.

Clinical manifestations of cytomegalovirus

Duration incubation period cytomegalovirus is from 20 to 60 days. The acute phase of the disease lasts from 2 to 6 weeks: fever and signs of general intoxication, chills, weakness, headache, muscle pain, bronchitis. In response to the primary introduction, an immune restructuring of the body develops. After the acute phase, asthenia persists for many weeks, sometimes vegetative-vascular disorders. Multiple lesions of internal organs.

The most common CMV infection manifests itself as:

• SARS (acute respiratory viral infection). In this case, patients complain of weakness, general malaise, fatigue, headaches, runny nose, inflammation and enlargement of the salivary glands, with copious saliva and whitish deposits on the gums and tongue.
• Generalized form of CMV infection with damage to internal (parenchymal) organs. There is inflammation of the liver tissue, adrenal glands, spleen, pancreas, kidneys. This is accompanied by frequent "causeless" pneumonia, bronchitis, poorly amenable to antibiotic therapy; there is a decrease immune status decreases the number of platelets in peripheral blood. Frequent damage to the vessels of the eye, intestinal walls, brain and peripheral nerves. Enlargement of the parotid and submandibular salivary glands, inflammation of the joints, skin rash.
• Organ damage genitourinary system in men and women it is manifested by symptoms of chronic non-specific inflammation. If the viral nature of the existing pathology is not established, the diseases do not respond well to antibiotic therapy.

Pathology of pregnancy, fetus and newborn are the most serious complications of CMV infection. The maximum risk of developing this pathology occurs when the fetus is infected during pregnancy. However, it must be remembered that problems often arise in pregnant women with the activation of a latent infection with the development of viremia (the release of the virus into the blood) with subsequent infection of the fetus. Cytomegalovirus is one of the most common causes miscarriage.

Intrauterine CMV infection of the fetus leads to the development of severe diseases and lesions of the central nervous system(mental retardation, hearing loss). In 20-30% of cases, the child dies.

Treatment of cytomegalovirus

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Treatment should be comprehensive, include immune and antiviral therapy. Cytomegalovirus quite quickly leaves the periphery and ceases to be excreted from biological fluids (blood, saliva, breast milk) - a latent phase of infection sets in, - well-conducted immunotherapy activates the body's defense mechanisms that control the activation of latent CMV infection in the future.

Diagnosis of CMV infection

Diagnosis of herpesvirus (HSV and CMV) infections:

1. Diagnosis of HSV and CMV - infections can be diagnosed (especially with asymptomatic, atypical and latent forms of herpes) only on the basis of detection of the virus in biological fluids organism (blood, urine, saliva, genital tract discharge) by PCR or by special inoculation on cell culture. PCR answers the question: the virus is detected or not, but does not give an answer about the activity of the virus.
2. Seeding on cell culture not only detects the virus, but also provides information about its activity (aggressiveness). Analysis of the results of sowing against the background of treatment allows us to make a conclusion about the effectiveness of the therapy.
3. IgM antibodies may indicate either a primary infection or an exacerbation of a chronic infection.
4. IgG antibodies- they only say that the person met the virus, the infection occurred. IgG in herpesvirus infections persist for life (unlike, for example, from chlamydia). There are situations in which IgGs are of diagnostic value.

Cytomegalovirus is a virus that is widespread throughout the world among adults and children, belonging to the group of herpes viruses. Since this virus was discovered relatively recently, in 1956, it is considered not yet sufficiently studied, and in the scientific world it is still the subject of active discussion.

Cytomegalovirus is quite widespread, antibodies of this virus are found in 10-15% of adolescents and young people. In people aged 35 years and over, it is found in 50% of cases. Cytomegalovirus is found in biological tissues - semen, saliva, urine, tears. When it enters the body, the virus does not disappear, but continues to live with its host.

What it is?

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

How is the virus transmitted?

The routes of transmission of cytomegalovirus are diverse, since the virus can be found in blood, saliva, milk, urine, feces, seminal fluid, and cervical secretions. Possible airborne transmission, transmission by blood transfusion, sexual contact, possibly transplacental intrauterine infection. An important place is occupied by infection during childbirth and when breastfeeding with the milk of a sick mother.

There are frequent cases when the carrier of the virus does not even suspect about it, especially in situations where the symptoms are almost not manifested. Therefore, you should not consider every carrier of cytomegalovirus as sick, since existing in the body, it may never manifest itself in a lifetime.

However, hypothermia and the subsequent decrease in immunity become factors provoking cytomegalovirus. Symptoms of the disease are also manifested due to stress.

Cytomegalovirus igg antibodies detected - what does this mean?

IgM are antibodies that the immune system begins to produce 4-7 weeks after a person is first infected with cytomegalovirus. Antibodies of this type are also produced every time when the cytomegalovirus, which has remained in the human body after a previous infection, begins to multiply actively again.

Accordingly, if a positive (increased) titer of IgM antibodies against cytomegalovirus was detected in you, then this means:

• that you have recently been infected with cytomegalovirus (not earlier than within the last year);
• That you were infected with cytomegalovirus for a long time, but recently this infection began to multiply again in your body.

A positive titer of IgM antibodies can persist in human blood for at least 4-12 months after infection. Over time, IgM antibodies disappear from the blood of a person infected with cytomegalovirus.

Development of the disease

The incubation period is 20-60 days, acute course 2-6 weeks after the incubation period. Being in the body in a latent state both after infection and during periods of attenuation is an unlimited time.

Even after the course of treatment, the virus lives in the body for life, maintaining the risk of relapse, so doctors cannot guarantee the safety of pregnancy and full bearing even if a stable and prolonged remission occurs.

Symptoms of cytomegalovirus

Many people who are carriers of cytomegalovirus do not show any symptoms. Signs of cytomegalovirus may appear as a result of malfunctions immune system.

Sometimes in persons with normal immunity, this virus causes the so-called mononucleosis-like syndrome. It occurs 20-60 days after infection and lasts 2-6 weeks. It manifests itself as high, chills, fatigue, malaise and headache. Subsequently, under the influence of the virus, the body's immune system is restructured, preparing to repel the attack. However, in case of lack of strength, the acute phase passes into a calmer form, when vascular-vegetative disorders often appear, and internal organs are also damaged.

In this case, three manifestations of the disease are possible:

1. Generalized form- CMV damage to internal organs (inflammation of the liver tissue, adrenal glands, kidneys, spleen, pancreas). These organ damage can cause, which further worsens the condition and has high blood pressure on the immune system. In this case, antibiotic treatment is less effective than with the usual course of bronchitis and / or pneumonia. However, it can be observed in the peripheral blood, damage to the walls of the intestines, blood vessels eyeball, brain and nervous system. Outwardly manifested, in addition to enlarged salivary glands, skin rash.
2. - in this case, it is weakness, general malaise, headaches, runny nose, enlargement and inflammation of the salivary glands, fatigue, a little fever body, whitish plaques on the tongue and gums; sometimes it is possible to have inflamed tonsils.
3. Damage to the organs of the genitourinary system- manifests itself in the form of periodic and non-specific inflammation. At the same time, as in the case of bronchitis and pneumonia, inflammation is difficult to treat with traditional antibiotics for this local disease.

Particular attention should be paid to CMVI in the fetus (intrauterine cytomegalovirus infection), in the newborn and children early age. An important factor is the gestational period of infection, as well as the fact whether the infection of the pregnant woman occurred for the first time or the infection was reactivated - in the second case, the probability of infection of the fetus and the development of severe complications is much lower.

Also, in the case of infection of a pregnant woman, fetal pathology is possible, when the fetus becomes infected with CMV that enters the blood from outside, which leads to miscarriage (one of the most common causes). It is also possible to activate a latent form of the virus that infects the fetus through the mother's blood. Infection leads either to the death of the child in the womb / after childbirth, or to damage to the nervous system and brain, which manifests itself in various psychological and physical diseases.

Cytomegalovirus infection during pregnancy

When a woman becomes infected during pregnancy, in most cases she develops acute form diseases. Possible damage to the lungs, liver, brain.

The patient complains about:

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

If the fetus is infected during pregnancy (but not during childbirth), the development of congenital cytomegalovirus infection in a child is possible. The latter leads to severe diseases and lesions of the central nervous system (mental retardation, hearing loss). In 20-30% of cases, the child dies. Congenital cytomegalovirus infection occurs almost exclusively in children whose mothers first become infected with cytomegalovirus during pregnancy.

Treatment of cytomegalovirus during pregnancy includes antiviral therapy based on intravenous injection acyclovir; the use of drugs for the correction of immunity (cytotect, intravenous immunoglobulin), as well as conducting control tests after the course of therapy.

Cytomegalovirus in children

Congenital cytomegalovirus infection is usually diagnosed in a child in the first month and has the following possible manifestations:

• cramp, trembling of the limbs;
• drowsiness;
• visual impairment;
• problems with mental development.

The manifestation is also possible at an older age, when the child is 3-5 years old, and usually looks like an acute respiratory disease (fever, sore throat, runny nose).

Diagnostics

Cytomegalovirus is diagnosed using the following methods:

• detection of the presence of the virus in body fluids;
• PCR (polymerase chain reaction);
• sowing on cell culture;
• detection of specific antibodies in blood serum.

Photo: Cytomegalovirus in the lungs under a microscope

Cytomegalovirus is so widespread among people that this infection can be attributed to sexual infections with a big stretch. Although it is transmitted precisely through close physical contact through body fluids - saliva, tears, mucus, semen, blood. The herpesvirus family is number 5, the name is often abbreviated to CMV or CMV.

For healthy people completely safe - manifestations, if any, are similar to a cold, go away on their own without treatment and without consequences. Antibodies remain in the blood, which will now protect the body from re-infection for the rest of its life.

In people with bad condition immunity, the disease is severe. In them, CMV can cause irreversible damage to the nervous, respiratory, genitourinary and other systems. At risk are unborn or premature babies, pregnant women who have not previously encountered cytomegalovirus, patients HIV and AIDS and those undergoing immunosuppressive therapy.

Ways of transmission of cytomegalovirus

In external environment cytomegalovirus is quite stable - it can survive for hours, and even days. You can pick it up through any repeated close contact with a person who has an infection in active phase. Kisses, shared towels, dishes, hygiene products are contagious.

Babies get infected from their mothers through breast milk, older children from their parents in the household way and from other children during games. Adults - during sex and in the household way. Rarely - with blood transfusion, organ transplantation.
The incubation period ranges from several days to several weeks.

The course of the disease in people with normal immunity

The virus is primarily targeted epithelial cells lining the mucous membranes. Also lives in glandular tissue, multiplying in salivary glands, prostate and pancreas. May affect nervous tissue.

The course of the disease is highly dependent on the initial state of immunity. If the health is excellent, the symptoms of cytomegalovirus may be completely absent. But more often, the primary infection is similar to the common cold: sore throat, malaise, weakness, cough, pain in the muscles and joints, fever up to 38-39 degrees. The disease lasts 2-3 weeks and goes away on its own, after which the pathogen goes into a dormant state, being under the control of the immune system.

It is impossible to completely get rid of CMV. In a dormant state, he is beyond the reach of protective forces. But in the event of a reactivation of the virus or a new contact with it from the outside, the body will be ready for defense immediately. The antibodies remaining in the blood serum after the first time will now cope with it so effectively that a person will not notice anything, and it will be possible to establish the fact of the disease only by the results of the tests.

Bad news for those at risk: during the reactivation period, such a person, without knowing it, is still contagious. In Russia, 60% of the population over 6 years old are carriers, and all of them are potentially dangerous for those who should not be exposed to cytomegalovirus. Among the elderly, the carrier rate reaches 91%.

Cytomegalovirus in people with immunodeficiency

In all pregnant women, the body deliberately weakens the immune system - this is how it protects itself from the fact that the fetus can be mistaken for a foreign object. Primary infection during the gestation period is especially dangerous for the baby, but the mother may also have health consequences.

Under certain conditions, weakening of the immune system is prescribed by doctors: autoimmune diseases, conditions after organ transplantation, chemotherapy treatment for oncological pathology.

And the infected HIV AIDS) know that they have to be afraid of any foreign microbes.

For all these people, cytomegalovirus infection is a particular danger. Complications can be serious:

• inflammation of the liver tissue (hepatitis), including fulminant, resulting in organ failure with rapidly progressive liver failure;
• inflammation of the retina of the eye, which without treatment leads to blindness;
• inflammation of the lining of the colon (viral colitis);
• inflammation of the lungs (pneumonia);
• inflammation of the lining of the esophagus (viral esophagitis);
• white inflammation and gray matter brain (encephalitis) or spinal cord(myelitis), inflammation of the membranes of the brain ( viral meningitis), inflammation of nerve fibers (polyneuropathy), neuritis of the auditory nerve, etc.

Without treatment, these conditions can pose a threat to life and health, cause irreversible processes. In such cases, antiviral drugs are used as a preventive measure. Cytomegalovirus is treated with valganciclovir, ganciclovir, or cidofovir. Be sure to constantly monitor the titer (amount) of antibodies and viral load. They also conduct a course of immunostimulating therapy, prescribe vitamins, immunomodulators (interferon is most often used). Even during pregnancy, the potential risk from prescribing drugs is lower than the risk associated with intrauterine infection of the child.

Most women experience CMV for the first time before conception. If this fact is known reliably, you can not be particularly afraid of it. In case of reactivation of the infection during the period of gestation, the risk of its transmission from mother to child is 1%, the risk of pathologies in the fetus is 0.1%. Yes, the numbers are non-zero, but against the background of other dangers, these probabilities are not serious.

If you are planning a child, or just thinking about it, or even just being among the women of childbearing age with a constant sex life- check in advance if you have antibodies to cytomegalovirus. To do this, it is enough to pass a single analysis on hidden infections. Save the result.

The most unfavorable is the primary infection of a woman during pregnancy. Then the virus is transmitted to the baby in 40% of cases, and the risk of pathologies is 9%.

On average, one child per 150 newborns is born with a congenital form of cytomegalovirus infection. 80% of these children do not have severe symptoms of cytomegalovirus. But the absence of symptoms does not protect against long-term consequences.

The outcome depends on the period at which the infection occurred. In the first trimester, cytomegalovirus is one of the common causes of missed or non-developing pregnancy. The reason is the anomalies in the development of the fetus, incompatible with life. The body itself prevents the birth of a seriously ill child. If this defense mechanism fails, the birth of a child with developmental anomalies is possible, the severity of which can vary widely. The most serious pathologies are the absence of the brain (anencephaly), microcephaly (an abnormally small head), etc.

Congenital cytomegalovirus in children also causes jaundice, skin rashes, viral pneumonia, and seizures. Possible birth weight loss, delayed prenatal development, convulsive syndrome, blindness, deafness, mental retardation. With absence serious illnesses health problems may show up later in life. Children who have had congenital CMV infection are more likely to have problems with coordination, learning, and lag behind their peers.

Diagnosis of cytomegalovirus

The basis for the diagnosis of cytomegalovirus is linked immunosorbent assay(IFA). The method is based on the detection in the blood of specific antibodies produced by the body in response to the invasion of the pathogen. The more aggressive the disease, the higher the antibody titer.

In the acute phase, an increase in antibody titer occurs due to class M immunoglobulins. The presence of anti-CMV-IgM in the blood serum indicates that the virus is in the active phase. In the body remain from 1 to 3 months after treatment.

In chronic infection, the titer of antibodies to class G cytomegalovirus (anti-CMV-IgG) increases.

Doctors recommend testing immediately when symptoms of SARS occur in women in position. In the presence of a high titer of immunoglobulins M, preventive treatment via antiviral drugs. This strategy prevents severe complications at the fetus.

Above, we described why it is so important to establish whether the primary infection occurred during or before pregnancy. Not everyone is tested for latent infections in advance. Gestation lasts 9 months, while class M immunoglobulins are not present in the blood for long. In such cases, an ELISA analysis is performed for the avidity of IgG to cytomegalovirus. The method allows you to clarify the timing of infection and the activity of the virus. Its principle is based on indicators of the "strength" of antibodies. The longer the microbe is present in the body, the more the immune system has the ability to resist the disease. Over time, antibodies improve their ability to bind the pathogen. Conversely, brand new, still "green" antibodies do not fight the virus very effectively.

Avidity is displayed as the percentage of highly avid CMV antibodies. The higher the %, the longer the penetration of the microbe occurred. High avidity (more than 85-90%) makes it possible to exclude primary infection in the last 3 months.

A more accurate, but more expensive method for diagnosing CMV using PCR (polymerase chain reaction, PCR) is also used. For the study, saliva, discharge from the genital organs, washings from the bronchi, cerebrospinal fluid, and blood serum are suitable. Pregnant women take cervical mucus. The method is based on the determination of the genetic information of the pathogen in the samples. The sequence of genes in each bacterium or virus is unique, like the pattern of the retina. In the presence of genetic information characteristic of the pathogen, the method allows to determine the fact of infection ( qualitative analysis), approximate quantity pathogen in the body and the degree of its activity / replication (viral load, quantitative analysis).

Prevention of cytomegalovirus

Prevention is relevant only for people with immunodeficiencies and pregnant women without class G antibodies. They will have to:

• Pay special attention to hygiene. For example, washing hands not as usual, but very carefully, turning off the tap through a napkin and holding the handle in in public places gloved.
• Avoid contact with children. They are contagious in the first place.
• Refuse intimacy and even kissing if the partner is immune to CMV. At any moment, he may have a reactivation of the virus, and then he will become contagious.

Kissing disease - this was the name of a cytomegalovirus infection a few decades ago, a disease that affects more than 70% of the entire population of the Earth to one degree or another. According to WHO statistics, this infection is found in almost 100% of the adult population of the earth. This high activity is due to the fact that the virus can be transmitted by almost all known to medicine ways: sexually, airborne, household, from mother to fetus, through mother's milk and through saliva when kissing (hence the original name of the infection).

Until 2006, cytomegalovirus infection (CMVI) was included in the number, but later it was included in the list of dangerous viral infections, which can be contracted not only through sexual contact.

CMV is a subspecies related to herpes that remains viable only under favorable conditions for it. But even this does not reduce the speed of its development and spread among people.

Cytomegalovirus infection can affect almost any cell human body. Penetrating into them, it remains there forever, and at the first opportunity strikes - it causes the cells to increase many times in size, but at the same time taking away their ability to divide natural way. Even the most modern treatment cytomegalovirus infection in adults and children cannot completely free the body from the disease.

This disease is a close “relative” of the herpes virus. It can attack any tissue in the body.

In about 80% of patients, cytomegalovirus does not show symptoms at all, and only 20% of those infected begin to suffer from the consequences of the infection. A kind of trigger mechanism for it is a significant decrease in immunity for various reasons:

Often, cytomegalovirus infection is mistaken for the long-term consequences of other diseases and they do not go to the doctor about this.

As mentioned earlier, cytomegalovirus symptoms in women and men show only during a period of reduced immunity. Sometimes they go unnoticed because the duration of the spike in infection activity is usually short-lived. In general, the picture depends on which tissues were affected by the virus:

• with infection of the mucous membranes respiratory tract(most often the nose) the patient is concerned about a short runny nose without exudate.
• when internal organs are damaged, there are signs of malfunctions in their functioning - intestinal disorders, insufficient or excessive secretory activity, etc.;
• when the genitourinary system is affected, symptoms of endometritis, cervicitis, vaginitis appear (depending on the location of cells changed by cytomegalovirus), expressed in pulling pains in the lower abdomen and vagina, menstrual irregularities.

It is necessary to treat the infection comprehensively

It is with its diversity that cytomegalovirus infection is unique - the symptoms entirely depend on the organ in which the pathological processes occur. This disease is especially dangerous for pregnant women. The virus at the time of infection in any trimester with a high degree of probability can penetrate into the fetus, while affecting a huge number of cells. If intrauterine infection occurs, the chance of happy outcome remains only in 30% of newborns.

Microcephaly - one of the consequences of infection with cytomegalovirus intramorning

In other cases, children are born with serious congenital pathologies:

• microcephaly;
• hydrocephalus;
• severe pathologies of internal organs.

In newborns, cytomegalovirus infection is manifested by general depression, periodic fever up to 38-39 degrees, and rashes on the body. To suspect that this is not diathesis and other diseases characteristic of babies, but cytomegalovirus, allows the lack of effect from the therapy used.

Diagnostics

It is virtually impossible to unambiguously recognize cytomegalovirus in women and men. In 90% of cases, this infection is regarded by patients as a common cold or disorder of the internal organs. A virus can be suspected by the only feature - exacerbations of symptoms are observed too often and last up to one and a half months.

According to statistics, primary cytomegalovirus infection more often worries mature people.

The first thing that is recommended to do if you suspect the presence of a cytomegalovirus infection in the body is to contact. He will prescribe the necessary diagnostics to determine the diagnosis. The list of 100% reliable methods for detecting the virus includes and. As the material under study can be used:

• blood;
• semen and discharge from cervix and vagina;
• amniotic fluid;
• saliva.

With this help, you can determine the activity of the virus, its variety. Only then can treatment of cytomegalovirus infection in adults and young patients be started.

Treatment Methods

Currently not found 100% effective drugs to completely eliminate the infection from the body. Even when using modern drugs she continues to live in human body waiting for the right moment to activate. However, when a cytomegalovirus infection is detected, treatment in women and men makes it possible to contain the virus, preventing it from negatively affecting the internal organs.

Cytomegalovirus infection requires constant intake of various medicines to maintain a high level of immunity

Therapy is based primarily on drug treatment. Experts recommend using the following types of drugs:

• Antivirals.
• Immunomodulators and interferon.
• External antiviral drugs.

Worth remembering. Since CMV in women and men can be treated with separate drugs (most antiviral agents are ineffective), only a doctor can prescribe them.

Additionally, drugs that can restore the functions of the affected organs and systems may be required. They are also prescribed by a doctor based on considerations of effectiveness and safety for the patient.