How to treat cytomegalovirus in women drugs. Modern methods of treatment of cytomegalovirus infection
One of the most common infections of the TORCH complex is cytomegalovirus infection (CMVI). According to WHO, antibodies to CMVI are found in 40-80% of the adult population, 2% of newborns and 50-60% of children under the age of 1 year. The disease is ubiquitous, has no seasonality, and is not associated with a person's professional activity.
Etiology and epidemiology
This is what the causative agent of cytomegalo looks like viral infection is a virus from the herpesvirus family.The causative agent of CMVI is a virus of the genus Cytomegalovirus of the Herpesviridae family.
The reservoir and source of cytomegalovirus (CMV) is a person (carrier or patient). It is transmitted by airborne droplets, direct and indirect by contact and transplacentally. There is evidence of infection of the recipient during transplantation of an infected organ and during transfusion infected blood. Newborns usually become infected from their mother while passing through birth canal i.e. intranatally. Cases of transplacental infection of the fetus are not uncommon. Of particular danger to the fetus is the infection of the expectant mother at an early stage (up to 12 weeks) of pregnancy - severe violations are very likely prenatal development crumbs.
50% of newborns become infected by eating contaminated breast milk.
Despite the high natural susceptibility of people to CMV, infection is possible only through repeated close contact with infected secretions of the patient.
The pathogenesis of cytomegalovirus infection
The entrance gates of CMV are the mucous membranes of the upper respiratory tract, organs of the digestive system and genital tract. Tellingly, when this virus invades the body, there are no changes at the site of the infection gate. The virus has a tropism (affinity) for the tissues of the salivary glands, therefore, in the case of localized forms of the disease, it is found only in them. Once in the body, the virus persists in it throughout a person's life. In persons with an adequate immune response, CMV does not cause any signs of illness, they occur only in case of exposure to the body of debilitating factors (taking cytostatics, chemotherapy, severe concomitant diseases, HIV).
The fetus of an infected pregnant woman will become infected with CMV only if she has an exacerbation of the latent form, and with the primary infection of the expectant mother, the likelihood of infection of the fetus increases dramatically.
Clinical manifestations of cytomegalovirus infection
Depending on the ways of infection and clinical manifestations, CMV is usually divided into congenital (acute and chronic) and acquired. cytomegalovirus infection. The latter, in turn, has 3 forms: latent, acute mononucleosis and generalized. So.
Congenital CMVI
It may not manifest itself immediately after birth, but as the baby grows, deviations will become noticeable: decreased intelligence, deafness, speech impairment, chorioretinitis.
- Acute congenital CMVI. When a future mother is infected during pregnancy up to 12 weeks, fetal death in utero or the birth of a child with defects that are often incompatible with life (pathology of the development of the brain, kidneys, heart defects) is possible. When the mother is infected in late pregnancy, severe malformations in the fetus are not formed, however, there are diseases that appear immediately after the birth of the baby ( hemolytic anemia, hemorrhagic syndrome, jaundice, interstitial pneumonia, polycystic pancreas, hydrocephalus, meningoencephalitis). In 10-15% of newborns infected in utero, there is a so-called obvious cytomegalovirus syndrome with a tendency to generalization - many organs and systems are affected simultaneously, due to which the newborn dies within 1-2 weeks.
- Chronic congenital CMVI. This form is characterized by a pathology of brain development in the form of microgyria, as well as micro-, hydrocephalus, clouding of the vitreous body and lens.
Acquired CMVI
- latent form. The most common form occurs in adults and children with normally functioning immunity. Asymptomatic or subclinical.
- Acute mononucleosis form. Similar to influenza viral hepatitis and infectious mononucleosis.
- generalized form. Occurs in immunocompromised individuals. It is characterized by simultaneous damage to most organs and systems of the body: heart, lungs, kidneys, digestive tract, genitourinary, nervous systems. The outcome of this form of the disease is often unfavorable.
In 20% of persons who have undergone bone marrow transplantation, development is possible, mortality from which is noted in approximately 85% of cases.
CMVI in pregnant women
When a woman is infected during pregnancy, in most cases she develops an acute form of the disease. Possible damage to the lungs, liver, brain. The patient complains about:
- fatigue, headache, general weakness;
- increase and soreness when touching the salivary glands;
- discharge from the nose of a mucous nature;
- whitish discharge from the genital tract;
- abdominal pain (due to increased uterine tone).
After a series of examinations, a woman is diagnosed with diseases such as polyhydramnios, premature aging of the placenta and its cysts, colpitis, vaginitis. There is a risk of premature detachment of the placenta, bleeding during childbirth, endometritis.
Diagnosis of cytomegalovirus infection
In order to search for cytomegalovirus, not only blood is examined, but also other biological fluids - saliva, bronchial washings, urine, and others. In order to diagnose CMVI, it is necessary to examine several biological fluids in parallel (washing water of the bronchi, saliva, blood, urine, breast milk tissue biopsy). Since the CMVI pathogen dies under the influence of environmental factors, studies should be carried out no later than 4 hours from the moment the material was taken.
Are used following methods diagnostics:
- cytological (detection of specific cells under a microscope);
- serological (detection of antibodies to the virus by RIF, ELISA, PCR);
- virological.
The presence in the blood of a newborn under the age of 14 days of IgM to CMVI is evidence of intrauterine infection.
Treatment of cytomegalovirus infection
- With latent and subclinical forms of the disease, therapy is not carried out.
- The mononucleosis-like form of CMVI does not require specific treatment; if necessary, symptomatic drugs are prescribed.
- With intrauterine infection in newborns and in individuals with severe CMVI, the drug of choice is Ganciclovir. Since this is a rather serious drug with side effects in the form of kidney, liver, and blood system damage, it is prescribed to children only when the benefit outweighs the potential risk. During therapy every 2 days it is necessary to control the complete blood count.
- The combination of an antiviral drug with interferons is considered effective - this mutually enhances their effect and reduces toxicity.
- In order to correct immunity, specific anticytomegalovirus immunoglobulin is used.
- For the treatment of processes localized in oral cavity, use solutions of Furacilin, aminocaproic acid.
- When the genital tract is affected, women use oxolinic, rebrofen, acyclovir and interferon ointments.
Prevention of cytomegalovirus infection
To prevent the development of the disease in people with reduced immunity, intravenous administration of nonspecific immunoglobulin - Sandoglobulin is used.
To avoid infection, it is necessary to avoid contact with sick people, observe the rules of personal hygiene.
In order to prevent infection of the newborn with CMVI, timely diagnosis and adequate treatment of the pregnant woman is required.
At heat treatment(72C) within 10 seconds of breast milk, the virus is completely inactivated, and the beneficial properties of milk remain at the same level.
The issue of creating a vaccine against CMVI is being addressed.
Which doctor to contact
Often, the gynecologist who observes the expectant mother deals with the diagnosis of CMV infection. if it is necessary to treat the disease, an infectious disease consultation is indicated. newborn baby with congenital infection a neonatologist treats, then a pediatrician, a neurologist, an ophthalmologist, an ENT doctor observes. In adults, when CMV infection is activated, it is necessary to consult an immunologist (often this is one of the signs of AIDS), a pulmonologist and other specialized specialists.
Infectious diseases caused by viruses are widespread among people of all ages. At the same time, some of them are asymptomatic for a long time and can lead to the appearance of pronounced clinical manifestations only when the immune system is weakened in humans.
A similar disease can be caused by the cytomegalovirus virus. Cytomegalovirus (CMV) infection is detected in a large number of people, however, as a rule, it has a latent course and does not lead to complaints.
In this regard, many people ask doctors if it is necessary to treat cytomegalovirus if there is no harm to health from it? Therapy for such an infection is prescribed in a number of cases when viral particles begin to damage internal organs.
Cytomegalovirus infection occurs in a large number of people, most of whom do not have any manifestations of the disease. In this case, the virus is easily passed from person to person with saliva, urine, breast milk, etc.
It is important to note that herpes and CMV in semen and vaginal lubrication can also lead to transmission. Separately, it is worth mentioning the vertical transmission of viral particles, which occurs from a sick mother to a developing fetus.
In this case, the baby may experience various birth defects. varying degrees severity, up to stillbirth. A characteristic feature of cytomegalovirus infection is the chronic nature of the course with the impossibility of a complete cure.
Carrying out a course of treatment of cytomegalovirus can only suppress the reproduction of viral particles in the body and reduce their number in the blood, however, they can persist for a long time in various organs, most often in nerve formations.
The spread of infection against the background of immunodeficiency leads to severe damage to internal organs, primarily the liver, kidneys, bronchopulmonary system, retina, etc. In this regard, when clinical manifestations of CMV infection appear, you should immediately seek medical help.
Main symptoms
Cytomegalovirus infection, like herpes on the body, persists for a long time in the body of a sick person. Moreover, diseases are highly dependent on the level of activity. immune system. The following variants of the course of the disease are distinguished:
- In persons with normal immunity, primary CMV infection is manifested by an intoxication syndrome that persists for several weeks. During this period, a person may complain of pain in the muscles and head, an increase in body temperature, a feeling of general weakness and an increase in peripheral lymph nodes. As a rule, the human immune system quickly copes with infections and it is not required to use pills for cytomegalovirus infection. However, for many years, the patient continues to excrete the virus in saliva, blood, mucus, semen, etc. It is important to note that almost 90% of adults have antibodies to CMV, which indicates a past infection.
- In violation of the functions of immunity, viral particles quickly spread throughout the body and lead to severe damage to internal organs. As a rule, liver and kidney tissue, organs of the respiratory system, pancreas, eye structure, etc. are quickly affected. Clinical manifestations in this case depend on the defeat of a particular internal organ.
- With congenital cytomegalovirus infection, an increase in the size of the liver, kidneys, inflammation of the middle membrane of the eye and retina, as well as bronchitis and pneumonia are noted. In addition, developmental delays, hearing and vision problems, and dental defects are often observed.
Any suspicion of CMV should be a reason to consult a doctor. The attending physician will select examination methods that allow for an accurate diagnosis, and will also treat CMV infection using various medications.
Purpose of therapy
Treatment of cytomegalovirus infection is always carried out according to strict indications. At the same time, the methods of treatment and the timing of recovery from cytomegalovirus strongly depend on the characteristics of the patient's body, as well as the severity of damage to internal organs.
Therapy using various medications is prescribed in the following situations:
- the spread of viral particles with the bloodstream and the development of lesions in the internal organs. As a rule, this form of the disease occurs with immunodeficiency, concomitant infectious disease and other negative factors. It is important to say that a similar form of CMV infection can occur in a patient of any age;
- the development of complications of the disease, which is very often observed in newborns. Against the background of the presence of cytomegalovirus, such patients develop clinical manifestations of pneumonia, encephalitis and retinitis, which requires an urgent selection of therapy. Otherwise, the rapid development of organ failure and death is possible.
- treatment of CMV with isoprinosine and kipfren, as well as other drugs, should be carried out in those patients who will be forced to undergo therapy leading to immunosuppression. For example, similar treatment patients should receive before a course of chemotherapy, taking immunosuppressants, etc.;
- the appearance of symptoms of infection in a pregnant woman, especially in early pregnancy;
- diagnosed in a patient with congenital or acquired immunodeficiency.
Treatment of cytomegalovirus should always be prescribed in these situations. It is important to note that only the attending physician should choose the therapy regimen, as well as the dosage of drugs. Otherwise, the progression of an infectious disease or the development of side effects of medications is possible.
Can cytomegalovirus be cured?
Unfortunately no. However, with proper therapy, viral particles disappear from the bloodstream and may not appear there for decades.
Selection of medicines
With cytomegalovirus infection, just as in the treatment of herpes on the back or any other part of the body, it is used A complex approach to therapy. Widely used the following drugs from cytomegalovirus:
- antiviral agents that stop the formation of new viral particles, for example, Panavir, Ganciclovir, etc.;
- immunoglobulins and inducers of the formation of immunoglobulins that directly bind to the virus and destroy it: Megalotect, Cytotect;
- general immunostimulating drugs for cytomegalovirus: Viferon, Cycloferon, Polyoxidonium, etc.;
- if internal organs are damaged, additional medicines must be used. For example, in case of violation of the liver, hepatoprotectors are used (Essentiale, Legalon, etc.);
- symptomatic treatment includes the use of painkillers, anti-inflammatory drugs, etc.
The treatment regimen for cytomegalovirus is always individual, since the course of the disease in different patients varies significantly.
Use of antivirals
Doctors are well aware of whether it is necessary to treat cytomegalovirus in adult patients and children. In this regard, drugs that block the reproduction of viral particles are actively used.
Since cytomegalovirus belongs to the family of herpes viruses, herpes tablets are actively used. The most effective in this case is Ganciclovir, which blocks the key enzymes of the viral particle.
Ganciclovir is used in case of generalization infectious process, with congenital infection, as well as for the prevention of exacerbation of the disease in patients with congenital or acquired immunodeficiencies.
It is most optimal to use Ganciclovir for oral administration or for intravenous infusion. Treatment of CMV infection with droppers allows you to achieve good therapeutic effect.
The dosage of the drug is calculated on the body weight of the patient - 5 mg of Ganciclovir per 1 kg. In this case, the introduction should be carried out twice a day. The duration of therapy is 14-21 days, depending on the severity of clinical manifestations.
Upon completion of the main course of treatment, they switch to maintenance administration of the drug. For this purpose, it is administered in the same dosage, but once a day.
For the treatment of CMV retinitis, high doses of the drug are used: 3 grams per day, divided into several doses (at least 3). It is important to note that the drug has a large number of side effects, and therefore, its use should be under strict medical supervision.
In addition to Ganciclovir, Panavir can be used, which has a milder effect on the body. However, efficiency this drug still inferior to its counterpart. Panavir is produced in the form of gels for external use and in the form of injection solutions, which allows you to influence the viral focus of various localization.
Treatment of cytomegalovirus infection with Panavir should be done by intravenous administration. The average therapeutic dose is 1 ampoule of the drug three times a week with an interval of two days. In the second week of therapy, the interval is increased to three days. Such a drug allows you to clear the bloodstream of viral particles and prevent their spread.
Is it possible to cure cytomegalovirus forever with the help of these antiviral agents? Viral particles can completely disappear from the bloodstream, however, in peripheral tissues and in nerve formations, they can persist for decades, causing infection of other people and possible exacerbations of the infection.
Lavomax and Isoprinosine in the treatment of CMV
The drug Lavo from CMV, called Lavomax, belongs to the group of interferon inducers. The main active ingredient of the drug is tilorone.
The latter is able to increase the synthesis of interferon in the body of a sick person, which leads to increased antiviral protection and stimulates the immune system.
According to the reviews of patients and doctors, this interferon inducer is well tolerated by patients in different ages and has a good therapeutic effect.
It should be noted that the use of this drug for the treatment of CMV should be carried out under strict medical supervision, due to the possible development of various side effects.
Isoprinosine is a synthetic immunostimulant that allows you to increase the activity of your own immune system. At the same time, the drug is active not only in cytomegalovirus infection, but in any viral diseases.
How to take Isoprinosine with cytomegalovirus?
The drug is used according to the following schemes: in adults - 5-7 tablets per day, in children - half a tablet for every five kilograms of body weight per day. Only a doctor should prescribe such treatment and monitor its effectiveness.
It is impossible to completely cure cytomegalovirus infection with this approach. However, the use of Lavo can reduce the duration of the disease, as well as reduce the risks, which is especially important in case of illness in childhood.
Interferon preparations
Doctors know how to treat CMV and how to cure cytomegalovirus with interferon-based drugs. These drugs have high antiviral activity and can provide rapid clinical recovery of the patient.
For this purpose, it is possible to use Leukinferon, Viferon and other similar medicines at 500 thousand IU every two days for 28-31 days. This approach is often combined with the simultaneous use of interferon inducers, which allows you to quickly increase the level of interferons in the patient's body.
ethnoscience
Many patients practice the treatment of cytomegalovirus with folk remedies. Such an approach may seem effective, however, the destruction of viral particles in this case occurs by the immune defenses, and not by the methods used.
Treatment with folk remedies is contraindicated, since such approaches do not have proven efficacy and safety in patients of any age. Any therapy should always be prescribed by the attending physician, in no case should you use the services of healers, traditional healers etc.
Cytomegalovirus infection can be asymptomatic for decades. However, against the background of a decrease in the activity of the immune system as a result of exposure to adverse factors, viral particles lead to damage to various internal organs.
How to treat cytomegalovirus in this case?
Doctors recommend the use of combination therapy, which includes antiviral drugs (Ganciclovir and others), interferons and their inducers, as well as symptomatic remedies to get rid of headaches, fever and other unpleasant clinical manifestations.
Treatment should always be prescribed only by a doctor, as otherwise, the infection can progress rapidly or side effects of self-administered drugs may occur.
Cytomegalovirus, whose standard treatment regimens can only eliminate the symptoms of infection, poses a potential threat to human health. The virus is one of the most common opportunistic pathogens. When exposed to certain factors, it is activated and causes a bright clinical picture cytomegaly. In some people, the virus is in an opportunistic state throughout life, not manifesting itself at all, but causing disturbances. immune protection.
The disease is especially dangerous for infants and toddlers. early age when the virus covers all organs or systems, leading to serious complications up to the death of the patient. There are still no known effective drugs for the complete expulsion of the virus from the body. If you are infected with cytomegalovirus, drug treatment is carried out to achieve long-term therapeutic remission when chronic course and elimination of local manifestations of infection.
The nature of the pathology
Cytomegaly appears to be an infectious disease of viral etiology. In some sources, there is a different name - cytomegalovirus infection (in the abbreviation CMV).
Cytomegalovirus is a member of a large group of herpesviruses. The cells affected by the viral agent increase significantly in size, hence the name of the disease - cytomegaly (translated from Latin - "giant cell"). The disease is transmitted through sexual, domestic or blood transfusion routes. The most unfavorable is the transplacental route of transmission.
The symptom complex resembles the development of a persistent cold, which is accompanied by a runny nose, malaise and general weakness, pain in the articular structures, increased salivation due to inflammation of the salivary glands. Pathology rarely has vivid symptoms, mainly proceeding in the latent phase. In generalized forms of damage to the body, viral agents are prescribed drug treatment and antiviral drugs. Alternative effective treatment does not exist.
Many people are carriers of cytomegalovirus infection without even knowing it. Only 30% of the viral disease has a chronic course, exacerbated by local symptoms in the form of a herpetic rash, as well as general malaise. Antibodies to cytomegalovirus exist in 13-15% of adolescents, 45-50% in adult patients. The viral agent is often activated after exposure to factors that reduce immunity. Cytomegalovirus poses a great danger to persons who have undergone organ or bone marrow transplantation, who have congenital forms of the disease or HIV status. The condition is dangerous during pregnancy, leads to serious consequences for the fetus: anomalies in the development of internal organs or systems, deformities and physical disability, miscarriage.
Treatment tactics and indications
The feasibility of therapy is proportional to the severity of the course and the potential danger to the patient's body. After some diagnostic measures the risks of a possible threat are determined, an assessment of the pathological process is given. With signs of generalization, drug correction is prescribed. With a short episode of virus activation and while maintaining the patient's normal state of health, no special treatment is carried out. With a burdened clinical history of the patient, the doctor monitors the general condition, controls the level of antigen in the blood as part of laboratory diagnostics.
Often a completely healthy person who has been ill with a virus without any consequences acquires strong immunity. The viral agent itself, at the same time, remains in the body forever, transforms into a conditionally pathogenic form. There is a chronization of the pathology with periods of short-term exacerbations, subject to a pronounced decrease in immune defense. The goals of drug correction of the disease are:
- reducing the negative impact of the virus;
- relief of existing symptoms;
- ensuring stable remission in chronic disease.
Important! People in the background absolute health the virus is asymptomatic, and the disease stops on its own. Many patients do not notice when the virus is activated and when its pathogenic activity is reduced.
Main indications
Unfortunately, cytomegalovirus is not treated completely. Medications can only strengthen local immunity and prevent new episodes of exacerbation. For therapy, it is important to observe the following indications:
- immunodeficiency diseases of any origin;
- generalized spread of the viral agent;
- preparation of organ transplantation, for chemotherapy in oncological diseases;
- complicated clinical history of the patient (pathology of internal organs or system);
- pregnancy of a woman (often the first trimester);
- preparation for the treatment of encephalitis, meningeal infections.
Before determining treatment tactics, differential diagnosis cytomegalovirus infection with influenza conditions, SARS and other infectious diseases. It is the similarity of the symptoms of cytomegaly with the classic manifestations of the common cold and untimely or inadequate treatment that provokes the development of severe complications.
Medical therapy
So, during the examination, cytomegaloverus was diagnosed: drugs will be prescribed in most cases. Conservative and drug therapy is the only way to correct the condition of patients with CMVI. Pharmaceutical Forms numerous: ointments (liniments) for external use, tablets for oral use, injections for intravenous administration, drops, suppositories. To eliminate exacerbations of a viral disease, the following groups of drugs are prescribed:
- symptomatic (pain relief, elimination of inflammatory foci, vasoconstriction in the nose, in the sclera);
- antiviral (the main task is to suppress the pathogenic activity of the virus: Panavir, Cidofovir, Ganciclovir, Foscarnet);
- drugs to eliminate complications (multiple groups and pharmacological forms);
- immunomodulators (strengthening and restoration of the immune system, stimulation of the body's natural defenses: Viferon, Leukinferon, Neovir);
- immunoglobulins (binding and removal of viral particles: Cytotect, Neocytotect).
Drugs for the treatment of the disease are prescribed in a complex. Additionally, vitamin complexes with an enriched mineral composition are prescribed to restore the overall resistance to colds, other chronic pathologies leading to a decrease in immunity. In systemic autoimmune diseases, as a rule, lifelong drug therapy is prescribed.
Important! With cytomegaly in men, a high therapeutic effect was proved by Ganciclovir, Foscarnet, Viferon, in women - Acyclovir, Cycloferon and Genferon.
Medical treatment has whole line shortcomings due to side effects due to the influence of active substances. The toxicogenic effect is often expressed in dyspeptic disorders, decreased appetite, and the appearance of allergies. Iron deficiency anemia often develops.
Features of pharmacological groups
All pharmaceutical groups against cytomegalovirus infection have their own advantages and disadvantages. With a complicated clinical history of the patient, with a generalized form of cytomegaly with a pronounced decrease in the function of internal organs or systems, an additional consultation is carried out with specialists on the appropriate medical profile. For this, a collegial decision of the attending pediatrician and other narrow specialists is necessary.
Antivirals
To achieve the maximum therapeutic effect, guanosine analogues are prescribed:
- Virolex;
- Acyclovir;
- Zovirax.
The active substance quickly penetrates the cells of the virus, destroys their DNA. These drugs are characterized by high selectivity and low toxicogenic properties. The bioavailability of Acyclovir and its analogues varies from 15 to 30%, and with increasing doses it decreases by almost 2 times. Medicines based on guanosine penetrate into all cellular structures and tissues of the body, in rare cases causing nausea, local allergic manifestations, and headaches.
In addition to Acyclovir, its analogues are prescribed Ganciclovir and Foscarnet. All antiviral agents are often combined with immunomodulators.
Interferon inducers
Interferon inducers stimulate the secretion of interferons within the body. It is important to take them in the first days of an exacerbation of the infection, since on day 4-5 or later their use is practically useless. The disease is running, and the body is already producing its own interferon.
Inductors inhibit the development of CMV, are often well tolerated by the body, promote the synthesis of immunoglobulin G, natural interferons, interleukins. To known medicines containing interferon include Panavir. The drug has a pronounced anti-inflammatory effect, helps with severe pain, reduces the intensity of unpleasant symptoms.
Viferon, also helps with viral activity, has a convenient form of suppositories for rectal administration which is convenient in the treatment of children of any age. Of the interferon inducers, Cycloferon, Inosine-pranobex and its analogues Isoprinosine, Groprinosin are isolated. The latter drugs have a low degree of toxicity, suitable for the treatment of children and pregnant women.
Immunoglobulin preparations
Immunoglobulins are protein compounds in the human body and warm-blooded animals, which, during biochemical interaction, transport antibodies to pathogenic agents. When exposed to CMV, a specific immunoglobulin Cytotect is prescribed, which contains antibodies to cytomegalovirus. Among other things, the composition of the drug includes antibodies to the herpes virus type 1.2, to the Epstein-Barr virus. Therapy with immunoglobulins is necessary to restore the general protective resources of the body to the penetration of viral agents.
Another effective remedy for cytomegalovirus is Intraglobin (III generation), Octagam or Alphaglobin (IV generation). The latest types of drugs meet the most stringent requirements, suitable for patients with severe renal dysfunction (including the pre-dialysis and dialysis period).
To achieve maximum therapeutic results, immunoglobulins are prescribed in the form of injections (Pentaglobin). Medicines in the form of injections directly affect the root of the problem, quickly eliminate the symptoms of a generalized manifestation of the disease. Besides, chemical composition new generation drugs are not disturbed prior to interaction with altered cells.
List of effective drugs
Despite a wide range of means for stopping the symptoms of CMV, doctors always build an individual therapeutic tactics. Before prescribing a specific medicine, it should be clarified which symptoms of the infection are present in a particular patient. This takes into account: the patient's clinical history, age, weight, general somatic status, complications and other factors that may interfere with proper treatment.
For therapy, the following popular means are used:
- Foscarnet. Refers to antiviral drugs for the treatment of severe forms of pathology complicated by cytomegaly. It is prescribed for reduced immunity. The active substance destroys the pathogenic cell, breaks the biological chain of the virus, stops the reproduction of viral agents.
- Ganciclovir. Antiviral agent for the treatment of cytomegalovirus with a complicated course (diseases of the kidneys, liver, respiratory organs, generalized inflammatory foci). It is widely used to prevent congenital infections, especially if the virus in the mother's body is in the phase of active reproduction. Release form tablets and crystalline powder.
- Cytotec. Being an immunoglobulin, the drug is prescribed for the complex elimination of the infection. The tool compares favorably with low toxicity, the absence of specific and absolute contraindications. The drug is used to prevent large-scale damage by cytomegalovirus in various social groups. Side effects include back pain, hypotension, joint stiffness, dyspeptic disorders. When negative states the drug is suspended and the doctor is consulted for an alternative appointment.
- Neovir. Refers to large group immunomodulators. Available in solution for injection. It is used for therapeutic correction and prevention of the disease in children or adults with autoimmune diseases, other pathologies that greatly reduce local immunity during an exacerbation. The dosage is determined individually in each case.
- Viferon. Widely used in pediatric practice. Available in the form of suppositories for rectal administration. It is used in the complex therapy of infectious diseases of any origin, complicated or simple in course. Effective for pneumonia, bronchitis, colds as a prevention of possible CMV. Among the side effects are allergic manifestations (itching in the perianal region, urticaria).
- Bischofite. Anti-inflammatory agent for the prevention and treatment of cytomegaly, herpes infection. Available as a gel in a tube or a balm in a glass container. Can be used as local remedy to eliminate blisters, rashes and inflammation. When applied externally, it resembles the effect of use mineral water, healing mud.
Be sure to use vitamins and other restorative means, which stimulate the work of many internal structures of the body. The most necessary for viral infections include vitamins C and B9.
Vitamin C is a powerful antioxidant, has regenerative properties, restores cells that are involved in the inhibition of the activity of pathogenic agents. B vitamins are necessary for the normal functioning of the nervous system, support the normal function of the bone marrow, and are responsible for the resistance of the immune system to external or internal negative factors.
Timely diagnosis and detection of severe forms of infection will reduce the level of complications, prevent the generalization of the pathological process. When stopping an exacerbation with a medical method, it is important to take into account a number of important criteria, to conduct a differential diagnosis. Preventive measures during a woman's pregnancy, in young children, as well as the correct treatment tactics will save patients from unpleasant manifestations of cytomegalovirus for a long time.
With the diagnosis of cytomegalovirus, drug treatment is not always justified. If a person has strong immunity, in most cases it does not cause any symptoms. Sometimes there are minor ailments, similar topics that accompany an acute respiratory viral disease. Carrying the virus does not pose a danger to a healthy person. Infection allows him to acquire a strong immunity to pathogens for life. Treatment of the infection is carried out in cases where it becomes the cause of critical conditions.
When is treatment for cytomegalovirus infection indicated?
Many people do not realize how dangerous cytomegalovirus (CMV) is for humans. With a strong weakening of immunity, it can cause serious damage to internal organs and the central nervous system (generalized form).
- A generalized form of cytomegalovirus infection can develop after a major surgical operation or against the background of an oncological disease. It manifests itself in the form of sluggish pneumonia, hepatitis, encephalitis, retinitis (inflammation of the retina of the eye), or diseases gastrointestinal tract.
- Acquired cytomegaly often affects young children, especially weak and premature newborns. Developing pneumonia causes them severe intoxication of the body. The disease is accompanied by a dry painful cough and shortness of breath.
With a generalized form of the disease, immunosuppression (immune suppression) develops. This condition is dangerous to human health and life. The acquired generalized form of cytomegaly requires treatment.
For infants, a congenital generalized form of the disease is of particular danger. The infection affects the fetus when a pregnant woman becomes infected with a cytomegalovirus infection. Severe malformations occur in the embryo if a woman was infected with cytomegalovirus during pregnancy for the first time.
In the congenital form, hydrocephalus, cerebral palsy, autism are diagnosed, in addition, hearing and vision disorders. Therefore, pregnant women must be prescribed treatment for cytomegalovirus infection, even if the symptoms of the disease are minor. It reduces the risk of developing pathologies in the fetus.
It is important to diagnose the congenital form of the disease in a child as early as possible. If the treatment was started in the first 3-4 months after birth, it is possible to stop the progression of pathologies, restore vision and hearing.
Drugs for the treatment of cytomegalovirus infection are prescribed at the stage of preparation for a procedure that requires immunosuppression (organ and tissue transplantation). Therapy is necessary for people with congenital or acquired immunodeficiency.
With a positive analysis for cytomegalovirus, you should consult a doctor. He will tell you in which cases treatment is necessary.
With cytomegalovirus infection, the acyclic analogue of guanosine Acyclovir (Zovirax, Virolex) is most often prescribed. The drug easily penetrates into virus-infected cells, inhibits the synthesis of viral DNA and prevents the reproduction of the pathogen. It is characterized by high selectivity and low toxicity. However, the bioavailability of Acyclovir ranges from 10-30%. With increasing dosage, it becomes even less.
Acyclovir penetrates into almost all body fluids (breast milk, cerebrospinal fluid, amniotic fluid). The medicine rarely causes side effects. Sometimes observed headache, nausea, diarrhea and skin rash.
The antiviral agent Valacyclovir (Valtrex) is the L-valine ester of Acyclovir. Its bioavailability is much higher than that of Acyclovir. It reaches 70% when taken orally. Adverse reactions with the use of Valaciclovir are rare. The drug does not have infusion dosage forms, therefore, it is not used in severe forms of cytomegaly.
One of the most powerful antiviral drugs is Ganciclovir (Cymeven). According to the mechanism of action, it is similar to the drug Acyclovir. But Ganciclovir is 50 times superior to Aciclovir in terms of its effect on CMV. According to studies, Ganciclovir causes suppression of the virus in 87% of cases. The disadvantage of the drug is its high toxicity. Therefore, it is prescribed only in cases of emergency.
In the treatment of varieties of cytomegalovirus infection resistant to Ganciclovir, Foscarnet is used. The drug is an inhibitor of viral DNA polymerase and, to some extent, RNA polymerase. Treatment of cytomegaly with Foscarnet gives good results. Tablet forms of the drug are rarely used. Foscarnet is poorly absorbed from the gastrointestinal tract (no more than 12–22%). When administered intravenously, bioavailability is 100%. Foscarnet is used to treat cytomegaly according to strict indications. The drug can cause impaired renal function.
To increase the therapeutic effect, antiviral drugs are combined with drugs that strengthen the immune system.
Interferon preparations and inducers
The drug Panavir is an interferon inducer. Such drugs stimulate the synthesis of their own interferons in the body. The drug Panavir also has pronounced antiviral properties and effective against CMV. It protects cells from viruses, blocks the synthesis of viral proteins and increases the viability of infected cells. Panavir has an anti-inflammatory and analgesic effect. To obtain the desired therapeutic effect, the doctor prescribes both intravenous administration and rectal suppositories.
Viferon is often used for cytomegalovirus. The drug contains recombinant interferon alfa-2b. It also contains antioxidants (a-tocopherol acetate and ascorbic acid). Antioxidants enhance the antiviral activity of the drug by 10 times. Viferon stimulates the immune system and helps it fight CMV. It is characterized by high efficiency and safety. The drug is prescribed for pregnant women, in addition, patients with a high frequency of exacerbations. Commonly used for cytomegaly rectal suppositories Viferon.
Currently, the most studied of the interferon inducers is Cycloferon. Studies have confirmed the ability of the drug to suppress the reproduction of CMV. Its tablet form is well tolerated and does not cause adverse reactions. Cycloferon effectively stimulates the production of interferon a / b and, to a lesser extent, g. As medical practice shows, cytomegaly is better cured when Cycloferon is combined with Acyclovir.
Inosine-pranobex (Isoprinosine, Groprinosin) has been successfully used to treat cytomegalovirus infection. The drug is a synthetic complex derivative of purine. It has a high bioavailability (over 90%). The drug has an antiviral and immunomodulatory effect, stimulating the production of immunoglobulin G, interferons and interleukins (IL-1, IL-2). With weakened immunity, Inosine-pranobex restores the functions of lymphocytes. The antiviral effect of the drug is based on blocking viral RNA and the enzyme dihydropteroate synthetase. Imported tablets are low toxic and do not cause adverse reactions. They are allowed to be used to treat children from the age of three.
Therapy with immunoglobulins
Immunoglobulins are human or animal proteins that carry antibodies to pathogens. In the treatment of cytomegalovirus, a specific anti-cytomegalovirus immunoglobulin Cytotect containing antibodies to CMV is used. The medicine also contains antibodies to the Epstein-Barr virus, in addition, to bacteria that most often cause illness in newborns and women in childbirth.
Therapy with Cytotect can significantly improve the condition of sick people and strengthen their immunity. Cytotect is used to treat pregnant women infected with CMV, to reduce the risk of developing pathologies in the fetus, in addition, for treatment and prevention. AT medical practice NeoCytoTect is often used. It differs from Cytotect in greater efficiency. NeoCytotec contains 10 times more antibodies than other immunoglobulins.
- If specific CMV immunoglobulins are not available, then standard drugs are used for cytomegalovirus infection.
- Third-generation immunoglobulins (Intraglobin) are characterized by a high degree of viral safety.
- Fourth generation drugs (Alphaglobin, Octagam) meet even more stringent requirements. As stabilizers, they contain substances that are safe for patients with impaired carbohydrate metabolism and kidney dysfunction.
However, the use of standard immunoglobulins does not always achieve the desired therapeutic effect in sick people with a generalized form of cytomegalovirus infection. The best result can be achieved with Pentaglobin enriched with Ig M. The increased amount of class M immunoglobulin makes the drug extremely effective in the treatment of severe forms of infectious diseases. It has a pronounced anti-inflammatory effect.
In the treatment of cytomegaly, intravenous immunoglobulins are predominantly used. The likelihood of adverse reactions in the treatment of immunoglobulins depends on the rate of their administration. Therefore, it is necessary to strictly adhere to the rules for the use of drugs.
Cytomegaly treatment regimens
Cytomegalovirus infection is difficult to treat. At mild form cytomegaly, the attending physician prescribes interferon preparations for 10 days. Candles Viferon are administered rectally daily. The doctor determines the dosage depending on the age and condition of the patient.
The treatment regimen for cytomegalovirus in the generalized form contains several drugs: antiviral drugs, immunoglobulin and interferon preparation.
During the first 3 weeks, the patient makes daily intravenous infusions of Ganciclovir and twice a day injects Viferon rectal suppositories.
On the fourth week, Viferon is canceled, and Ganciclovir is administered for another 7 days, reducing the dosage. If resistance of the virus to Ganciclovir is found, 3 intravenous injections of Foscarnet are given instead (1 time per week). Cytotect is administered intravenously every 2 days until the symptoms of the disease disappear.
It is recommended to treat cytomegalovirus in women during pregnancy with Cytotect. It is administered intravenously every 48 hours for a week. If a patient has CMV in the cervical canal, Viferon suppositories are used (twice a day for 3 weeks).
Complementary Therapy
In the treatment of patients with cytomegaly, symptomatic agents are used. To reduce body temperature, antipyretic drugs (Paracetamol, Ibuprofen) are used. Rhinitis is treated with drugs with vasoconstrictor action (Galazolin, Farmazolin, Otrivin). To improve sputum discharge when coughing, expectorant drugs (Mukaltin, ACC) are prescribed.
In severe generalized forms of cytomegaly, antibiotics are used. They are mandatory component treatment of cytomegalovirus infection in newborns. In infants, all infectious diseases are caused by a mixed viral-bacterial microflora. The most commonly used combined antibiotic Sulperazon. It contains 3rd generation cephalosporins - Cefoperazone and Sulbactam. To enhance the effect of Sulperazon in severe forms of pathology, the aminoglycoside Netromycin is prescribed. Ceftriaxone, which has an interferon-stimulating effect, is also used.
Antibiotics are administered intravenously and intramuscularly. Antibiotic therapy can speed up recovery, reduce the risk of secondary infection and recurrence of the disease.
The development of critical conditions. If cerebral edema occurs, dehydration drugs (Mannitol) are administered in combination with glucocorticosteroids (Dexazon), which normalize blood pressure. epileptic seizures stop with the help of anticonvulsant therapy (Diazepam, sodium thiopental, Sibazon). To improve cerebral perfusion and energy metabolism in brain tissues, vascular agents(Pentoxifylline, Actovegin, Instenon).
Considering the infectious-allergic nature of the lesion of the central nervous system in people with cytomegalovirus infections, antihistamines(Suprastin, Diphenhydramine, Diazolin, Claritin).
In the presence of paresis of the extremities, drugs are used that reduce muscle tone (Mydocalm, Baclofen, Cyclodol, Sirdalud).
Hemorrhagic syndrome is treated with hemostatic medicines(Vikasol, Sodium etamsylate, Calcium gluconate).
With cytomegalovirus infection, it is necessary to prescribe vitamin preparations(ascorbic acid, vitamins E and group B).
Vaccine against cytomegalovirus infection
Since the disease can cause severe fetal malformations, young women would benefit from a cytomegalovirus vaccine. It would be advisable to do it before planning a pregnancy. Cytomegalovirus infection is widespread, so it is almost impossible to avoid infection. Treatment of cytomegalovirus can reduce the likelihood and degree of exposure to the virus in the child, but it is not always carried out on time.
Therapy harms the growing organism. Attempts to create an effective vaccine against CMV have not yet led to the desired result. The current vaccine against cytomegalovirus infection can only protect against infection in 50% of cases.
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. Approximately 30 percent of cases of transmission of the virus to a child occur during feeding mother's milk. 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 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. Virion has 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 a 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 shell of the virion. Proteins that make up the protein matrix are activated when the virus enters the host cell and participate in the reproduction of new viral units.
Supercapsid
The outer shell of the virion is called the supercapsid. It consists of a large number of 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) 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 body's immune defense, the virus can exist in a latent, dormant state for a long time 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 emerges from the cell nucleus and attaches to inner surface 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- 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 ( a 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 persistent failure to comply 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. Healthy man 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 frequent way 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. During organ transplantation, patients are prescribed 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, incubation period. 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 ( increase 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. 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 bile ducts. There is stagnation of bile, resulting in jaundice. Color skin takes on a yellowish tint. 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 liver 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 area 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 may be affected, bladder. 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 is reactivated 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 death due to 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 biliary tract ), jaundice ( a disease in which the skin and mucous membranes become stained yellow ), liver failure;
- diseases of the pancreas- pancreatitis ( inflammation of the pancreas);
- diseases of the 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. At the same time, 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 active form infections. 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;
- defeat hearing aid- congenital deafness;
- defeat visual apparatus- cataract, 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. Most frequent consequence viruses are acute respiratory diseases ( 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 acquired infection are 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. Rare complication virus is such a lesion of 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 impairments motor activity and frequent seizures. 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, those who suffer 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 have 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. Patients also complain about poor general well-being, 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 genitalia, frequent urination;
- oophoritis (inflammation of the ovaries) - a feeling of pain in the pelvis and lower abdomen, bloody issues that occur after intercourse, a feeling of discomfort in the lower abdomen, pain during intimacy with a man;
- cervical erosion- the appearance of blood in the discharge after intimacy, abundant 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 form diseases. 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 titer of antibodies, together with the detection of the virus itself, is the most accurate diagnosis 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 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 the immune system high level used for viral infections immune preparations- interferons. 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. | Add distilled or boiled cold water to the ampoule with the dry mixture up 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 natural preparations is their high cost, so they are used less often.
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, correctly selected complex therapy with the necessary doses of drugs is important. 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.To this end, it is recommended that preventive 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 inflammatory process and dysfunction of the affected organ. Also, the infection has a general toxic effect on the body, disrupts the processes of blood coagulation and inhibits the functionality of the adrenal cortex. Cytomegalovirus can cause the development of both systemic diseases, and defeat individual bodies. 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 great importance gives gestational age.
Depending on the moment of infection, the consequences of cytomegalovirus infection for 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. Along with jaundice and hemorrhagic syndrome this disease is the most common complication of CMV, developing in infected children from the first days of life;
- interstitial pneumonia manifests itself with symptoms 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).
