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Cytomegalovirus or CMV infection is a chronic disease with high prevalence: antibodies to the pathogen are detected in 40% of the world's population. Although the virus persists in the human body for life, it is not dangerous for most people. A special category of patients consists of people with reduced immunity, recurrent herpes and pregnant women. Generalization of infection in them can lead to serious health consequences. How does cytomegalovirus manifest itself? We’ll talk about common symptoms of the pathology in women in our review.

Epidemiology of CMV

Cytomegalovirus infection is known everywhere. If in developed countries its prevalence is at the level of 30-35%, then in developing countries it often reaches 100%. The incidence prevails among the fairer sex.

This is interesting. The causative agent of CMV was discovered only in 1956 and is considered insufficiently studied. For a long time, the characteristic symptoms that develop during infection were called “kissing disease”, since the most common route of transmission of infection is through close contacts.

The only source of infection is a sick person or a virus carrier. CMV is detected in the main biological fluids of the body (saliva, urine, semen, cervical mucus, breast milk). Powerful release of the pathogen occurs both during the initial infection and at the time of each relapse, even if it is practically asymptomatic. Newborns with cytomegaly, as well as infected persons with immunosuppression, pose a constant epidemiological danger.

Among the transmission routes are:

• contact – with prolonged and close household contacts;
• airborne - when inhaling virus particles released during sneezing and coughing;
• sexual – during unprotected sexual contacts;
• hematotransfusion - when transfusing infected blood;
• vertical - from mother to child in the womb or during childbirth.

Susceptibility to the virus is universal, meaning anyone can become infected. Females are just as susceptible to CMV infection as males.

Causes and pathogenesis

The only causative agent of the viral infection in question is CMV (CMV, Cytomegalovirus). So, what is cytomegalovirus? Several types of viruses from the herpesvirus family are combined under this name. One of them, type 5, is capable of infecting people and causing them cytomegalovirus infection.

The structure of CMV is simple: the viral particle consists of a virion with a diameter of 150-200 nm and a closed capsid.

Like other members of the family, cytomegalovirus can remain in the body for a long time (usually in the salivary glands) without manifesting itself in any way. After the initial infection, it remains with the person for life. However, the contagiousness of the virus is low: in order to “catch” it, prolonged and fairly close contact with the source of infection is required.

Nevertheless, the prevalence of the infection remains one of the highest in the world: antibodies to it are detected in 10-15% of adolescents and already in 40-45% of people over 30 years of age.

The main pathogenetic mechanism in the development of CMV infection is considered to be damage to the cytoskeleton of cells by the virus and their significant increase in size. In addition, a study conducted in 2009 established a connection between the persistence of the pathogen in the body and an increased risk of developing atherosclerosis. Therefore, symptoms of cytomegalovirus infection are often accompanied by signs of circulatory disorders.

Clinical manifestations

How does cytomegalovirus manifest itself in women? And is it possible to suspect the development of the disease in the early stages? For most people, the process of primary infection goes unnoticed. Immediately after infection, an asymptomatic incubation period begins, which lasts on average from 20 to 60 days.

The acute phase of the disease either has no clinical symptoms at all or occurs as a respiratory infection. In this case, patients complain of:

• increase in temperature indicators;
• chills;
• rapid fatigue, severe weakness;
• cranialgia and myalgia;
• catarrh of the nose and pharynx;
• discomfort, pain when swallowing;
• cough, chest pain.

Some patients also report enlargement of peripheral lymph nodes and heaviness in the right hypochondrium.

After the initial development of cytomegalovirus infection in women, the pathogen settles in the body forever. Signs of exacerbation appear only when defenses are reduced, for example, with long-term treatment with antibiotics, concomitant diseases and infections.

Among all those with cytomegalovirus, categories of patients are distinguished for whom the infection poses a particular danger. Among them: pregnant women, newborns, persons with severe immunodeficiency (recipients of donor organs after transplantation, patients with oncohematological diseases, aplastic anemia, HIV-positive patients with a critical level of T-lymphocytes).

Cytomegalovirus during pregnancy

The symptoms are of particular interest to specialists. The relevance of this problem, first of all, lies in the possibility of intrauterine infection of the fetus and the development of serious pathologies in it. That is why cytomegaly, along with herpes, rubella and toxoplasmosis, belongs to the so-called TORCH infections, for which it is advisable to be examined before pregnancy.

How dangerous is cytomegalovirus for the expectant mother and fetus? When a woman is initially infected during pregnancy, intrauterine infection of the child occurs in 40-45% of cases.

Often the very fact of infection with cytomegalovirus goes unnoticed. Rarely, pregnant women experience a short-term flu-like syndrome, which goes away on its own after 4-5 days.

Important! If a woman is infected with CMV before conception, the risk of complications developing in the baby is minimal, no more than 1-2%.

However, cytomegalovirus infection can later be recognized based on the following signs:

• threat of miscarriage;
• hypertonicity of the uterus;
• chorioamnionitis;
• premature aging of the placenta;
• oligohydramnios;
• large fruit.

CMV infection of the fetus and newborn

From a pregnant woman to a child, the virus can be transmitted through: blood (CMV passes through the blood-placental barrier), cervical canal (through membranes and complex fluid).

Thus, the fetus can become infected both in utero and during childbirth. Depending on when the infection occurred, Negative influence virus can be different:

• first weeks (1-3) of pregnancy - the fertilized egg dies, menstruation begins;
• 3-10 weeks – death of the embryo and spontaneous abortion, frozen pregnancy, severe malformations;
• 11-28 weeks – intrauterine growth retardation, anomalies in the formation of internal organs, hydrocephalus, kidney pathologies;
• 28-40 weeks – infection of the fetus without malformations: viral meningoencephalitis, myocarditis, hepatitis, pneumonitis.

In 20% of children born with manifestations of CMV, a complex of signs of congenital cytomegaly is observed. And what is it?

Congenital cytomegaly is a severe complication manifested by:

• intense icteric coloration of the skin and mucous membranes (can last up to 5-6 months);
• hepatosplenomegaly – enlargement of the liver and spleen;
• profuse rash all over the body;
• trembling of the limbs;
• convulsive activity;
• drowsiness;
• visual and hearing impairments of varying severity.

In 20-30% of cases, newborns with cytomegaly die without surviving even six months.

A woman who has given birth to a child with congenital cytomegaly is strictly prohibited from becoming pregnant for at least 2 years.

Cytomegalovirus infection in women with immunodeficiency

The symptoms of CMV infection are much more pronounced in women with various immunodeficiency conditions. Along with signs of acute respiratory infections and influenza-like syndrome, primary infection can manifest itself as damage to the genitourinary system: cervicitis, cervical erosion, endometritis, vaginitis, oophoritis.

It is this atypical course of the disease that most often poses a threat to the fetus developing in the womb.

Subsequent manifestations of infection in patients with reduced protective forces the body is characterized by the frequent development of complications:

• viral pneumonia - inflammatory damage to the pulmonary acini;
• pleurisy - inflammation of the visceral membrane of the lungs with the sweating of a large amount of exudate;
• myocarditis and heart failure;
• arthritis;
• encephalitis.

Generalized forms of CMV infection are less common. Their symptoms are:

• multiple pathological processes in internal organs (liver, spleen, adrenal glands, kidneys, pancreas, etc.);
• indigestion;
• damage to the central nervous system, the appearance of inflammatory foci in the deep subcortical structures of the brain;
• rarely - spreading paresis, paralysis.

In most cases, such serious lesions lead to death. Therefore, the search for relevant approaches to the treatment and prevention of CMV infection in patients with congenital and acquired forms of immunodeficiency is one of the primary health care tasks.

Diagnostic approaches

The main diagnostic method for detecting cytomegalovirus infection in women is an enzyme-linked immunosorbent assay. It is based on the determination of specific antibodies of the pathogen in a blood sample using various biochemical reactions.

The test detects two types of antibodies - Ig G and Ig M. The first is formed after previous infections and allows the body to quickly recognize the pathogen in case of re-infection. The second is produced in response to the first introduction of the virus or during relapses of a chronic infection and helps in the fight against it “here and now.”

Depending on the test results, we can say with confidence whether a woman is infected with CMV, and also give the patient recommendations for planning a pregnancy.

In addition, the diagnosis of CMV is made on the basis of:

• PCR studies of biological fluids (blood, saliva, urine, etc.);
• seeding of biomaterial on cell culture.

These tests not only identify the virus, but also provide information about the degree of its activity and aggressiveness. Against the background of the therapy, they allow us to judge its effectiveness.

Is it possible to cure CMV infection forever?

How to treat cytomegalovirus? Unfortunately, the medications available modern medicine, it is impossible to rid the body of the CMV pathogen forever. Instead, goals of therapy include:

• strengthening immunity;
• transfer of infection from active to latent form;
• the patient stops shedding virus;
• elimination of symptoms of the disease.

Treatment of cytomegalovirus in women requires individual approach. Thus, asymptomatic virus carriage in patients with normal immunity does not require any therapeutic measures. In case of influenza-like or mononucleosis-like syndromes, the attending physician may prescribe standard detoxification measures (plenty of warm drinks, bed rest, light food) and symptomatic medications (antipyretics, anti-inflammatory, expectorants, etc.).

In case of activation of the virus against the background of weakened immunity, self-medication is strictly prohibited. You should consult an infectious disease doctor who will prescribe therapy based on the characteristics of the patient’s body and the initial level of antibodies.

At present, no effective drug has been developed for complete eradication of the pathogen from the body. Most antiviral drugs used to treat other infections are absolutely powerless against CMV. However, developments continue, and the use of glycyrrhizic acid, obtained from licorice rhizomes, is considered promising in modern medicine.

How to treat complicated CMV infection? Complex inpatient treatment is indicated for the diagnosis of severe generalized forms of cytomegalovirus infection. Applicable:

• antiviral drugs - Ganciclovir, Foxarnet, Valganciclovir;
• anti-cytomegalovirus immunoglobulins – Cytotect;
• immunomodulators;
• symptomatic and detoxification agents.

Since antiviral drugs known to medicine have many side effects and are toxic to the body, infectious disease specialists use them only for health reasons.

Prevention

Measures for specific prevention of CMV infection have not been developed. For relatively healthy individuals with normal immunity, this infection does not pose a danger.

It is advisable for women planning a pregnancy to visit a doctor and get tested for TORCH infections. If Ig G and Ig M for cytomegalovirus are negative, it means that the patient’s body has not yet encountered the pathogen, and it is important to prevent infection during pregnancy.

CMV prevention measures include:

• limiting contacts with possible sources of the virus: preschool children, persons with confirmed presence of antibodies to the virus, people sneezing and coughing in public places;
• avoiding close household contacts and kissing infected persons;
• refusal to use others household items, dishes;
• fidelity to a regular sexual partner;
• using condoms during sexual intercourse;
• strengthening immunity:
  • daily walks in the air;
  • physical education classes;
  • good sleep;
  • nutrition rich in vitamins and nutrients;
  • timely treatment of acute infections and chronic diseases;
  • positive inner attitude.

Note! Products such as whole milk and dairy products, pears and apples are considered indispensable in the prevention of all types of herpes virus infection.

Cytomegalovirus is an asymptomatic and, in general, harmless pathology, which for some categories of the population can pose a serious threat to health and life. Careful planning of pregnancy, timely treatment of immunodeficiency conditions and adherence to the principles of a healthy lifestyle are the main methods of preventing exacerbations and relapses of infection. They will allow a woman to forget about the manifestations of CMV infection, and also to bear and give birth to healthy children.

For those who have been diagnosed with CMV, it is difficult to accept the fact that it is impossible to cure cytomegalovirus. It should be noted right away that this disease is not so dangerous and, with proper monitoring, does not cause any consequences. Although there is no cure for the infection yet, it can be suppressed and the symptoms managed.

Signs of CMV

• sensations of painful tickling skin irritation;
• hypersensitivity of the body;
• small spots or pimples.

Is it possible to cure cytomegalovirus infection forever?

When faced with CMV infection, a person wonders how it is treated, asks about the possibility of a full recovery and getting rid of the virus forever. Medicines that would completely remove this infection from the body have not yet been created, so a patient with cytomegalovirus must prevent the disease and monitor the state of the immune system. More often, the disease is asymptomatic, and medications prescribed by a doctor suppress its activity, leading to a latent state.

After treatment it does not disappear completely, but antibodies to this disease remain. If, during examination, a large amount of blood plasma protein compounds G is found in a person, then good immunity to the virus is noted. The pathogen cannot be removed without a trace because it spreads through organs and tissues with the blood. There it settles in cells and remains inactive until the defense system weakens. Then the virus begins to multiply again, causing negative symptoms.

Treatment of cytomegalovirus: methods

To combat cytomegalovirus infection, an integrated approach is used. Treatment includes drugs to support the body's immune system and drugs that directly inhibit the activity of the virus. Therapy comes down to monitoring the patient’s condition and his defense system. To prevent the virus from becoming active, the carrier must adhere to the principles of a healthy lifestyle ( healthy image life), eat a balanced diet, take vitamins in the amount the body needs.

If symptoms appear, do not self-medicate. Only a doctor prescribes measures that will help fight the virus and strengthen the immune system.

Scientists have not yet created a treatment method that can rid the body of cytomegalovirus. Therefore, research is being carried out to create effective remedy, capable of combating infections caused by type 5 herpes. A large number of medications are offered that cure other viruses, but do not kill cytomegalovirus, but only inhibit its activity.

People with an asymptomatic course may not be treated for the disease at all, since the effectiveness of therapeutic drugs that are aimed at eliminating immunodeficiency by stimulating and strengthening the immune system, for example, or Polyoxidonium, has not been proven. It is important to maintain a healthy body naturally by following basic rules hygiene, eating right and resting properly.

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

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

What it is?

Cytomegalovirus (another name is CMV infection) is an infectious disease that belongs to the herpesvirus family. This virus affects humans both in utero and in other ways. Thus, cytomegalovirus can be transmitted sexually or through airborne alimentary routes.

How is the virus transmitted?

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

There are often cases when the carrier of the virus does not even suspect it, especially in situations where symptoms hardly appear. Therefore, you should not consider every carrier of cytomegalovirus to be sick, since existing in the body, it may never manifest itself once in its entire life.

However, hypothermia and a subsequent decrease in immunity become factors that provoke cytomegalovirus. Symptoms of the disease also appear due to stress.

Cytomegalovirus igg antibodies detected - what does this mean?

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

Accordingly, if you have been found to have a positive (increased) titer of IgM antibodies against cytomegalovirus, this means:

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

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

Development of the disease

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

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

Symptoms of cytomegalovirus

Many people who carry cytomegalovirus do not show any symptoms. Signs of cytomegalovirus may appear as a result of disturbances in the functioning of the immune system.

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

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

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

Particular attention should be paid to CMV infection in the fetus (intrauterine cytomegalovirus infection), in newborns and young children. An important factor is the gestational period of infection, as well as the fact whether the pregnant woman was infected for the first time or the infection was reactivated - in the second case, the likelihood of infection of the fetus and the development of severe complications is significantly lower.

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

Cytomegalovirus infection during pregnancy

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

The patient notes complaints about:

• fatigue, headache, general weakness;
• enlargement and pain when touching the salivary glands;
• mucous discharge from the nose;
• whitish discharge from the genital tract;
• abdominal pain (caused by increased uterine tone).

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

Treatment of cytomegalovirus during pregnancy includes antiviral therapy based on intravenous injection of acyclovir; the use of drugs to correct immunity (cytotect, intravenous immunoglobulin), as well as carrying out control tests after completing a course of therapy.

Cytomegalovirus in children

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

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

Manifestation is also possible in adulthood, when the child is 3-5 years old, and usually looks like an acute respiratory infection (fever, sore throat, runny nose).

Diagnostics

Cytomegalovirus is diagnosed using the following methods:

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

Modern statistics show that every fifth child becomes infected with cytomegalovirus infection by the age of 1 year. Among the routes of infection, the most dangerous is intrauterine infection. Between 5 and 7 percent of children become infected this way. About 30 percent of cases of transmission of the virus to a child occur during breastfeeding. The remaining children become infected 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 experiences the disease, and by the age of 50, 99 percent of people become infected with the virus.

In the United States of America, 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 amounts to 8,000 to 10,000 children annually. In the absence of complications at the time of 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 during pregnancy during primary infection ranges 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

The conclusions of colleges in America and Great Britain boil down to the fact that systematic testing for the determination of cytomegalovirus in pregnant women is not recommended due to the large number of factors of this disease that have not been fully studied. 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?

The structure of cytomegalovirus

The components of the cytomegalovirus virion are:

• virus genome;
• nucleocapsid;
• protein ( protein) matrix;
• supercapsid.

Nucleocapsid
“Nucleocapsid” is translated from ancient Greek as “nucleus shell.” It is a protein layer that surrounds the genome of the virus. The nucleocapsid is formed from 162 capsomeres ( shell protein fragments). Capsomeres form a geometric figure with pentagonal and hexagonal faces arranged in 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 protea new 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 large number glycoproteins ( complex protein structures containing carbohydrate components). Glycoproteins are located differently in the supercapsid. Some of them protrude above the surface of the main layer of glycoproteins, forming small “spikes”. With the help of these glycoproteins, the virion “feels” and analyzes the external environment. When the virus comes into contact with any cell of the human body, with the help of “spikes” it attaches and penetrates into it.

Properties of cytomegalovirus

The main properties of cytomegalovirus are:

• low virulence ( degree of pathogenicity);
• latency;
• slow reproduction;
• pronounced cytopathic ( cell-destroying) Effect;
• reactivation due to immunosuppression of the host organism;
• instability in the external environment;
• low contagiousness ( ability to infect).

Latency
Once in the human body, cytomegalovirus remains in it for life. Thanks to the body's immune defenses, the virus can long time exist in a latent, dormant state, without causing any clinical manifestations of the disease.

With the help of glycoprotein “spikes,” the virion recognizes and attaches to the envelope 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 enzymes in the cell nucleus, viral DNA multiplies. The protein matrix of the virus, which remains outside the nucleus, synthesizes new capsid proteins. This process is the longest, taking on average 15 hours. The synthesized proteins pass into the nucleus and combine with new viral DNA, forming a nucleocapsid. The proteins of the new matrix are gradually synthesized, which attaches to the nucleocapsid. The nucleocapsid leaves the cell nucleus, attaches to the inner surface of the cell membrane and is enveloped by it, creating a supercapsid. Copies of the virion that leave the cell are ready to enter another healthy cell for further reproduction.

Reactivation during host immunosuppression
Cytomegalovirus can remain latent in the human body for a long time. However, under conditions of immunosuppression, when a person's immune system is weakened or destroyed, the virus is activated and begins to penetrate the host cells for reproduction. Once the immune system returns to normal, the virus is suppressed and goes into hibernation.

Main adverse factors external environment for cytomegalovirus are:

• high temperatures ( more than 40 – 50 degrees Celsius);
• freezing;
• fat solvents ( alcohol, ether, detergents).

Methods of infection with cytomegalovirus

Favorable factors for infection with cytomegalovirus are:

• constant, long and close contact with the source of infection;
• violation of the biological protective barrier - the presence of tissue damage ( cuts, wounds, microtraumas, erosions) at the site of contact with infection;
• disturbances in the functioning of the body's immune system due to hypothermia, stress, infection, and various internal diseases.

Methods of infection with cytomegalovirus

Contact and household path

Airborne path

Contact-sexual route

Oral route

Transplacental route

Iatrogenic route

Cytomegalovirus can also enter the body through repeated use of unsterilized medical equipment.

Transplantation route

The spread of cytomegalovirus infection in the body occurs in several stages.

The stages of spread of cytomegalovirus infection are:

• local cell damage;
• spread to regional lymph nodes;
• primary immune response;
• circulation in the circulatory and lymphatic system;
• dissemination ( spreading) in organs and tissues;
• secondary immune response.

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 cases of immunosuppression, the body is unable to stop the virus from multiplying. Cytomegalovirus penetrates 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 ( the virus persists in lymphoid cells).

Symptoms of cytomegalovirus infection in women

After cytomegalovirus enters the human body, an incubation period begins. During this period, the virus actively multiplies in the body, but without showing any symptoms. With cytomegalovirus infection, this period lasts from 20 to 60 days. Next comes the acute phase of the disease. In women with strong immunity, this phase may occur with mild flu-like symptoms. Slight fever may occur ( 36.9 – 37.1 degrees Celsius), slight malaise, weakness. As a rule, this period passes unnoticed. However, the presence of cytomegalovirus in a woman’s body is evidenced by an increase in the antibody titer in her blood. 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 period for cytomegalovirus lasts from 4 to 6 weeks. After this, the infection subsides and is activated only when immunity decreases. In this form, the infection can persist for life. Only with random or planned diagnosis can it be detected. In this case, chronic phase antibodies to cytomegalovirus are detected in the woman’s blood or in the smear, if a PCR smear is performed ( anti-CMV IgG).

It is believed that 99 percent of the population carries latent cytomegalovirus infection, and anti-CMV IgG is detected in these people. 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, carrying the virus is not dangerous. But, at the same time, in women, latent cytomegalovirus infection can cause miscarriages and stillbirths.

In women with weakened immune systems, the infection occurs in an active form. In this case, two forms of the disease are observed - acute mononucleosis-like and generalized form.

Acute form of cytomegalovirus infection

First, the cervical lymph nodes enlarge. They can be very large and exceed 5 centimeters. Next, the submandibular, axillary and inguinal nodes increase. The internal lymph nodes also enlarge. Lymphadenopathy is the first symptom to appear and the last to disappear.

Other symptoms of the acute phase are:

• malaise;
• liver enlargement ( hepatomegaly);
• increase in leukocytes in the blood;
• the appearance of atypical mononuclear cells in the blood.

Differences between cytomegalovirus and infectious mononucleosis
Unlike infectious mononucleosis, cytomegalovirus does not cause tonsillitis. It is also extremely rare to observe enlargement of the occipital lymph nodes and spleen ( splenomegaly). In laboratory diagnostics, the Paul-Bunnel reaction, which is inherent in infectious mononucleosis, is negative.

Generalized form of cytomegalovirus infection

The most common manifestations of 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 reproductive system.

The course of hepatitis can be acute, subacute and chronic. In the first case, so-called fulminant hepatitis develops, often with a fatal outcome.

Diagnosis of cytomegalovirus infection comes down to a puncture biopsy. In this case, a piece of liver tissue is taken using a puncture for further histological examination. Upon examination, huge cytomegalic cells are found in the tissue.

Cytomegalovirus pneumonia
With cytomegalovirus, interstitial pneumonia usually develops initially. With this type of pneumonia, it is not the alveoli that are affected, but their walls, capillaries and the tissue around the lymphatic vessels. This pneumonia is difficult to treat and, as a result, lasts a long time.

Very often, such prolonged pneumonia is complicated by the addition of a bacterial infection. As a rule, staphylococcal flora is associated with the development of purulent pneumonia. Body temperature rises to 39 degrees Celsius, fever and chills develop. The cough quickly becomes wet with the release of large amounts of purulent sputum. Shortness of breath develops, chest pain appears.

In addition to pneumonia, cytomegalovirus infection can cause bronchitis and bronchiolitis. The lymph nodes of the lungs are also affected.

Cytomegalovirus retinitis
Retinitis affects the retina of the eye. Retinitis usually occurs bilaterally and can be complicated by blindness.

Symptoms of retinitis are:

• photophobia;
• blurred vision;
• “flies” before the eyes;
• the appearance of lightning and flashes before the eyes.

Cytomegalovirus sialadenitis
Sialadenitis is characterized by damage to the salivary glands. The parotid glands are very often affected. In the acute course of sialadenitis, the temperature rises, shooting pains appear in the area of ​​the gland, salivation decreases and the mouth feels dry ( xerostomia).

Very often, cytomegalovirus sialadenitis is characterized by a chronic course. In this case, periodic pain and slight swelling in the area of ​​the parotid gland are observed. The main symptom continues to be decreased salivation.

Kidney damage
Very often, in people with an active form of cytomegalovirus infection, the kidneys are affected. In this case, inflammatory infiltration is found in the kidney tubules, in its capsule and in the glomeruli. In addition to the kidneys, the ureters and bladder can be affected. The disease progresses with rapid development of renal failure. A sediment appears in the urine, which consists of epithelium and cytomegalovirus cells. Sometimes hematuria appears ( blood in urine).

Damage to the reproductive system
In women, the infection very often occurs in the form of cervicitis, endometritis and salpingitis. As a rule, they occur chronically with periodic exacerbations. A woman may complain of periodic, mild pain in the lower abdomen, pain when urinating, or pain during intercourse. Sometimes urinary problems may occur.

Cytomegalovirus infection in women with AIDS

Patients with AIDS develop bilateral pneumonia with diffuse damage to the lung tissue. Pneumonia is most often prolonged, with a painful cough and shortness of breath. Pneumonia is one of the most common causes of death in HIV infection.

Also, patients with AIDS develop cytomegalovirus encephalitis. With encephalitis with encephalopathy, dementia quickly develops ( dementia), which is manifested by a decrease in memory, attention, and intelligence. One form of cytomegalovirus encephalitis is ventriculoencephalitis, which affects the ventricles of the brain and cranial nerves. Patients complain of drowsiness, severe weakness, and impaired visual acuity.
Damage to the nervous system during cytomegalovirus infection is sometimes accompanied by polyradiculopathy. In this case, the nerve roots are affected multiple times, 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 intrahepatic and extrahepatic bile ducts), jaundice ( a disease in which the skin and mucous membranes become stained yellow ), liver failure;
• pancreatic diseases– pancreatitis ( inflammation of the pancreas);
• diseases of the gastrointestinal tract– gastroenterocolitis ( joint inflammation of the small, large intestine and stomach), esophagitis ( damage to the esophageal mucosa), enterocolitis ( inflammatory processes in the small and large intestine), colitis ( colon inflammation);
• lung diseases- pneumonia ( pneumonia);
• eye diseases– retinitis ( retinal disease), retinopathy ( non-inflammatory damage to the eyeball). Eye problems occur in 70 percent of patients with HIV infection. About one fifth of patients lose their vision;
• lesions of the spinal cord and brain– meningoencephalitis ( inflammation of the membranes and substance 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), cerebral cortex infarction;
• diseases of the genitourinary system– cervical cancer, lesions of the ovaries, fallopian tubes, endometrium.

Symptoms of cytomegalovirus infection in children

Congenital cytomegalovirus infection in children

Cytomegalovirus belongs to the group of TORCH infections that lead to severe developmental defects. When a virus enters a child’s blood, a congenital infection does not always develop. According to various sources, from 5 to 10 percent of children whose blood has entered the virus develop an active form of infection. As a rule, these are children of those mothers who suffered a primary cytomegalovirus infection during pregnancy.
When a chronic infection is reactivated during pregnancy, the degree of intrauterine infection does not exceed 1 - 2 percent. Subsequently, 20 percent of such children develop 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, valvular malformations;
• damage to the hearing aid – congenital deafness;
• damage to the visual apparatus - cataracts, retinitis, chorioretinitis, keratoconjunctivitis;
• anomalies of dental development.

In the blood of such children, there is an increase in liver enzymes, bilirubin, and the number of platelets drops sharply ( thrombocytopenia). Mortality in this period is very high. Surviving children subsequently experience mental retardation and 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 abnormalities of the cerebellum and dilatation of the ventricles are observed. The mortality rate in this case ranges from 30 to 50 percent.

The frequency of symptoms with 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;
• digestive system disorders – 50 percent;
• prematurity – 34 percent;
• hepatitis – 20 percent;
• brain inflammation – 15 percent;
• inflammation of blood vessels and retina - 12 percent.

Acquired cytomegalovirus infection in children

The nature of the consequences of acquired cytomegalovirus infection depends on the age of the child and the state of his immune system. The most common consequence of the virus is acute respiratory diseases ( acute respiratory infections), which are accompanied by inflammation of the bronchi, pharynx and larynx. Damage to the salivary glands often occurs, most often in the parotid areas. A characteristic complication of acquired infection is inflammatory processes in the connective tissues in the area of ​​the pulmonary alveoli. Another manifestation of cytomegalovirus infection is hepatitis, which occurs in subacute or chronic form. A rare complication of the virus is damage to the central nervous system such as encephalitis ( brain inflammation).

Symptoms of acquired cytomegalovirus infection are:

• children under 1 year– retardation in physical development with impaired motor activity and frequent convulsions. Damage to the gastrointestinal tract, vision problems, and hemorrhages may occur;
• children from 1 year to 2 years– most often the disease manifests itself as mononucleosis ( viral disease), the consequences of which are enlarged lymph nodes, swelling of the throat mucosa, 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 be a consequence of blood transfusion or internal organ transplantation. In this case, the virus enters the body through donor blood or organs. This infection usually occurs as a mononucleosis syndrome. At the same time, the temperature rises, nasal discharge and sore throat appear. At the same time, children's lymph nodes become enlarged. The main manifestation of post-transfusion cytomegalovirus infection is hepatitis.

In 20 percent of cases after organ transplantation, cytomegalovirus pneumonia develops. After kidney or heart transplantation, the virus causes hepatitis, retinitis and colitis.

In children with immunodeficiency ( for example, in those suffering from malignant diseases) cytomegalovirus infection is very difficult. As in adults, it leads to prolonged pneumonia, fulminant hepatitis, and visual damage. Reactivation of the virus begins with a rise in temperature and chills. Children often develop a hemorrhagic rash that affects the entire body. The pathological process involves internal organs such as the liver, lungs, and central nervous system.

Symptoms of cytomegalovirus infection in women during pregnancy

During initial infection with the virus or its reactivation, pregnant women may experience a number of symptoms that can manifest themselves independently 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) – painful sensations in the abdomen ( lower part). In some cases, pain may radiate to the lower back or sacrum. Patients also complain of poor general health, lack of appetite, headaches;
• cervicitis (cervical lesion) – discomfort during intimacy, itching in the genitals, aching pain in the perineum and lower abdomen;
• vaginitis (vaginal inflammation) – irritation of the genital organs, 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, spotting that occurs after sexual intercourse, a feeling of discomfort in the lower abdomen, pain when being close to a man;
• cervical erosion– the appearance of blood in the discharge after intimacy, profuse vaginal discharge, and sometimes mild pain may occur during sexual intercourse.

The effect of CMV on the body of a pregnant woman

The consequences of the virus are:

• inflammation of the salivary glands, tonsils;
• pneumonia, pleurisy;
• myocarditis.

With a severely weakened immune system, the virus can take a generalized form, affecting the patient’s entire body.

Complications of generalized infection in women during pregnancy are:

• inflammatory processes in the kidneys, liver, pancreas, adrenal glands;
• digestive system dysfunction;
• vision problems;
• lung dysfunction.

Diagnosis of cytomegalovirus infection

Diagnostic methods for cytomegalovirus infection are:

• isolation of the virus by cultivating it on a cell culture;
• polymerase chain reaction ( PCR);
• linked immunosorbent assay ( ELISA);
• cytological method.

Virus isolation

Virus isolation occurs in cell culture. Single-layer cultures of human fibroblasts are most often used. The biological material under study is initially centrifuged to isolate the virus itself. Next, the virus is applied to cell cultures and placed in a thermostat. It is as if the cells are infected with this virus. Cultures are incubated for 12 – 24 hours. Typically, several cell cultures are infected and incubated simultaneously. Next, the resulting cultures are identified using various methods. Most often, cultures are stained with fluorescent antibodies and examined under a microscope.

The disadvantages of this method are the significant time required for cultivating 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

Biological material
To carry out PCR, any biological fluids are taken ( blood, saliva, urine, cerebrospinal fluid), smears from the urethra and vagina, feces, washings from mucous membranes.

Carrying out 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 material being studied. This fragment is then cloned many times using special enzymes to obtain a large number of copies of DNA. The resulting copies are identified, that is, they are determined which virus they belong to. All these reactions occur in special apparatus, which is 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

Biological material
The patient's blood is used to detect antibodies.

Carrying out ELISA
The essence of the method is to detect antibodies to cytomegalovirus both in the acute and chronic phases. In the first case, anti-CMV IgM is detected, in the second - anti-CMV IgG. The analysis is based on the antigen-antibody reaction. The essence of this reaction is that antibodies ( which are produced by the body in response to the penetration of the virus) specifically bind to antigens ( proteins on the surface of the virus).

The analysis is carried out in special plates with wells. Biological material and antigen are placed in each well. Next, the tablet is placed in a thermostat on certain time, during which the formation of antigen-antibody complexes occurs. After this, washing is carried out with a special substance, after which the formed complexes remain at the bottom of the wells, and unbound antibodies are washed off. After this, 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 treated 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 diagnosis

Treatment of cytomegalovirus infection

Mechanism of therapeutic action

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 triggers cell repair processes 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 assesses the state of the infected cell and initiates 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 killer cells) of the immune system find these molecules and attack the virions to which they are attached.

Stimulation of immune system cells
Interferons have the effect of directly stimulating certain cells of the immune system. These cells include macrophages and natural killer cells. Under the influence of interferons, they migrate to the affected cells and attack them, destroying them along 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 use of some natural interferons for cytomegalovirus infection

The biggest disadvantage of natural drugs is their high cost, which is why they are used less often.

Currently, there are a large number of recombinant drugs of the interferon group that 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 use of some recombinant interferons for cytomegalovirus infection

Evaluation of the treatment method

Is treatment necessary for asymptomatic cytomegalovirus infection?

For this purpose, it is recommended to provide prevention of chronic infections ( especially genitourinary), which are the main cause of reduced immunity. It is also recommended to take immunostimulants such as Echinacea Hexal, Derinat, Milife. They should be taken only as prescribed by a doctor.

What are the consequences of cytomegalovirus infection?

Consequences of cytomegalovirus for people with normal immunity

Depending on the moment of infection, the consequences of cytomegalovirus infection for the developing fetus are:

• blastopathies(malformations that occur during infection during the period from 1 to 15 days of pregnancy) – death of the embryo, non-developing pregnancy, spontaneous termination of pregnancy, various systemic pathologies in the fetus;
• embryopathies(when infected on days 15 - 75 of pregnancy) – pathologies vital important systems body ( cardiovascular, digestive, respiratory, nervous). Some of these malformations are incompatible with fetal life;
• fetopathy(when infected for more later ) – infection can provoke the development of jaundice, damage to the liver, spleen, and lungs.

Consequences of cytomegalovirus infection for children who have suffered an acute form of the disease

The consequences of infection with cytomegalovirus in children are:

• jaundice from the first days of life it occurs in 50–80 percent of sick children;
• hemorrhagic syndrome is registered in 65–80 percent of patients and manifests itself as hemorrhages in the skin, mucous membranes, and adrenal glands. Bleeding from the nose or umbilical wound is also possible;
• hepatosplenomegaly ( enlarged liver and spleen) diagnosed in 60–75 percent of children. Together with jaundice and hemorrhagic syndrome, this disease is the most common complication of CMV, developing in infected children from the first days of life;
• interstitial pneumonia manifested by symptoms of respiratory disorders;
• nephritis is a complication that develops in a third of sick children;
• gastroenterocolitis occurs in 30 percent of cases;
• myocarditis ( inflammation of the heart muscle) diagnosed in 10 percent of patients.

Other complications of cytomegalovirus are:

• delay in psychomotor development;
• lesions of the gastrointestinal tract;
• pathologies of the organ of vision ( chorioretinitis, uveitis);
• blood disorders ( anemia, thrombocytopenia).