Cytomegalovirus infection - Causes, Symptoms and Treatment .MF .

August 12, 2017 17:52 | Infectious Diseases

Cytomegalovirus infection - a disease caused by a cytomegalovirus - a virus of the herpesvirus subfamily, which also includes the herpes simplex viruses 1 and 2, varicella zoster, Ebstein-Barr virus and human herpes viruses type 6.7and 8.

prevalence of cytomegalovirus infection extremely high.Once penetrated into the body, CMV infection does not leave it - often it exists in a latent form and occurs only at lower immunity.

victims cytomegalovirus infection become infected with HIV as well as people who have undergone transplantation of internal organs or bone marrow and taking drugs that suppress the immune response.

However, the primary infection may be acute infectious disease.Often infection occurs even in the neonatal period and early childhood, most often it occurs in developing countries, where the prevalence of cytomegalovirus infection among young people is much higher than in developed countries.

most dangerous form intrauterine cytomegalovirus infection , which is characteristic of

children whose mothers during pregnancy suffered a primary CMV infection.Congenital cytomegalovirus infection often leads to developmental delay, as well as to the many adverse consequences, including mental retardation and deafness.

How is infection with cytomegalovirus infection

Cytomegalovirus infection is not very contagious.To transfer it takes a long close contact or multiple contacts.

  • Airborne path: when talking, coughing, sneezing, kissing, etc.
  • Sexual way: through sexual contact transmission risk is very large, because the virus is shed in semen, vaginal and cervical mucus.
  • blood transfusion and its components containing leukocytes.
  • from mother to fetus - mostly in primary CMV infection or reactivation of latent infections during pregnancy.

How does the virus cytomegalovirus infection

virus enters the blood of healthy people and causes a pronounced immune response, which is the formation of antibodies - specific protective proteins - immunoglobulin M (Anti - CMV - IgM), as well as the main protective response against viruses -cell.

lymphocytes CD 4 and CD 8 have potent activity against cytomegalovirus.Therefore, if inhibition of a cellular immune response, for example by formation violation CD 4 lymphocytes in AIDS, cytomegalovirus infection actively develops and leads to reactivation of latent infection earlier.

Immunoglobulins M against cytomegalovirus formed after about 4-7 weeks after infection, and are found in the blood for 16-20 weeks.Finding them in the blood of these terms may be evidence of primary CMV infection.Then immunoglobulin are replaced by M immunoglobulins G (Anti - CMV - IgG), which are present in the blood in varying degrees throughout the entire life.

In most cases, normal immunity cytomegalovirus infection are asymptomatic, although it remains in the body for a long time in the form of latent infection.Where exactly is kept unknown virus, its presence is expected in many organs and tissues.

cells infected with cytomegalovirus, have a characteristic appearance - they increase in size (which determined the name of the virus), and under the microscope like "owl eye".

Even asymptomatic carriers can transmit the virus to an uninfected person.An exception is the transmission of the virus from mother to fetus, which is mainly active only in the infectious process, but only 5% of cases leads to congenital cytomegalovirus, the rest of newborn CMV infection is also asymptomatic.

mononucleosis syndrome

mononucleosis syndrome - the most common form of cytomegalovirus infection in people with normal immunity, emerged from the newborn period.Mononucleosis Clinical manifestations of the syndrome can not be distinguished from infectious mononucleosis, which is caused by a different herpes virus - the virus Ebstein-Barr virus.

incubation period is 20-60 days.The disease occurs in the form of flu-like illness:

  • prolonged high fever, sometimes with chills;
  • Severe fatigue, malaise;
  • pain in muscles, joints, headache;
  • Sore throat;
  • Increased lymph nodes;
  • Skin rash similar to hives with rubella is rare, most often in the treatment of ampicillin.

Sometimes primary cytomegalovirus infection accompanied by signs gepatita- jaundice is rare, however, elevation of liver enzymes in the blood often occurs.

Rarely (in 0-6% of cases) mononucleosis syndrome complicated by pneumonia.However, immunologically healthy people it is asymptomatic and only detected on chest radiography.

disease lasts for 9-60 days.The majority of patients recover completely, although residual effects in the form of weakness and malaise, sometimes increasing the lymph nodes are stored for several months.Recurrences of infections accompanied by fever, malaise, hot flashes, sweating and rarely occur.

Congenital cytomegalovirus infection

Intrauterine infection of the fetus is not always a cause of congenital cytomegalovirus, in most cases it is asymptomatic, and only 5% of newborns leads to the development of the disease.Congenital salivary gland disease occurs in infants whose mothers had suffered a primary CMV infection.

manifestations of congenital cytomegalovirus vary widely:

  • Petechiae - skin rashes, which are small hemorrhages occur in 60-80% of cases;
  • Jaundice;
  • intrauterine development, prematurity occurs in 30-50% of cases;
  • Chorioretinitis - inflammation of the retina, often leading to the reduction and loss of vision;

Mortality in congenital cytomegalovirus infection is 20-30%.Most of the surviving children are lagging behind in mental development or hard of hearing.

Acquired cytomegalovirus infection in the newborn When

cytomegalovirus infection during labor (when the birth canal) or after birth (through breastfeeding or casual contact), in most cases the infection remains asymptomatic.

However, for some, especially in preterm and LBW infants cytomegalovirus infection manifests development lingering pneumonia, which is often accompanied by the addition of concomitant bacterial infection.

also possible slowing of physical development, rash, swollen lymph nodes, hepatitis.

Persons with weakened immune systems

Persons with weakened immune systems include:

  • persons with different variants of congenital immunodeficiency.
  • persons with acquired immunodeficiency syndrome (AIDS).
  • face transplant internal organs: kidneys, heart, liver, lung, and bone marrow.

severity of clinical manifestations depends on the degree of immunosuppression, but chronic administration of immunosuppressive drugs leads to more severe manifestations.

Cytomegalovirus infection after undergoing transplantation:

  • especially cytomegalovirus often affects themselves transplanted organs, causing hepatitis transplanted liver, pneumonia, lung transplant, etc.
  • After bone marrow transplantation in 15-20% of patients developed CMV pneumonia, from which 84-88% of patients die.
  • greatest risk for CMV infection is available in the case, if the donor is infected, and the recipient - not.

Cytomegalovirus infection in HIV-infected patients:

CMV infection affects almost all AIDS patients.

  • Home infections usually subacute: develop fever, malaise, night sweats, muscle aches and joint pain
  • Pneumonia - to the initial signs of the disease are joined cough, shortness of breath
  • esophageal ulcers, stomach, intestine, which can lead to bleeding andbreak wall
  • Hepatitis
  • encephalitis - inflammation of the brain substance.It may manifest AIDS dementia syndrome or cranial nerves, drowsiness, disorientation, nystagmus (rhythmic movements of the eyeballs)
  • Rita - inflammation of the retina of the eye - a common cause of vision loss in patients with reduced immunity.
  • multiple organ failure - defeat the virus almost all organs, leading to their dysfunction.Often the cause of death of cytomegalovirus infection.

prevention of cytomegalovirus infection

Prevention of cytomegalovirus infection advantageously carried out in people at risk.These include HIV-infected individuals, particularly AIDS;persons who have undergone transplantation of internal organs;persons suffering from immunodeficiency due to other causes.

personal hygiene, even the most careful, not to avoid infection with cytomegalovirus, since viruses are ubiquitous and transmitted by airborne droplets.Therefore, prevention in patients with risk groups carried antiviral drugs: ganciclovir, foscarnet, acyclovir.

also recommended careful selection of donors with regard to their infection with cytomegalovirus infection in order to reduce the likelihood of CMV infection among recipients of internal organs and bone marrow.

diagnosis of cytomegalovirus infection

Laboratory diagnosis of cytomegalovirus infection is based on serological surveys - the definition of specific blood for cytomegalovirus antibodies.

  • Immunoglobulins M - Anti - CMV - IgM;

is a marker of acute infection: primary CMV infection or reactivation of chronic infection.When a high antibody titers in pregnant women are at risk of infection of the fetus.Increased only after 4-7 weeks after infection.Remain elevated for 16-20 weeks

  • Immunoglobulin G - Anti - CMV - IgG;

titer of this type of immunoglobulins is increased in the period of decreased activity of the infectious process.The presence of blood in the Anti - CMV - IgG only indicates the presence of cytomegalovirus in the body, but does not reflect its activity.

  • polymerase chain reaction;

PCR based on the determination of viral DNA in the blood or in mucosal cells (scraping with a urethral, ​​cervical canal, as well as saliva, sputum, etc.).It is recommended to perform quantitative PCR reaction, which gives an indication of the degree of the reproduction of the virus, which means that the activity of the inflammatory process.

treatment of cytomegalovirus infection

mononucleosis syndrome in patients with uncomplicated special treatment is not required.Enough traditional treatments like the common cold.Importantly do not forget to drink plenty of fluids.

drug of choice for the treatment of cytomegalovirus infection in patients at risk is ganciclovir (Cymevene).For treatment intravenous form of the preparation.Tablets are effective only for prevention.

Side effects of ganciclovir:

  • Inhibition of blood cells (neutropenia, anemia, thrombocytopenia).It develops in 40% of cases.
  • diarrhea (44%), vomiting, loss of appetite.
  • Temperature increase (48% patients), accompanied by chills, sweating.
  • Itching.

Warnings:

  • Ganciclovir not be used in people with no immunity disorders.
  • The use of ganciclovir in pregnant women and children is possible only in life-threatening situations.
  • necessary to adjust the dose in people with impaired renal function.

For treatment also use foscarnet, which is considered to be more effective in patients with HIV infection.

Side effects:

  • Electrolyte disturbances: decrease in blood potassium, and magnesium.
  • genital ulcers.
  • dysuria.
  • Nausea.
  • Renal disease: nephrotoxic drug, so in the case of renal failure must be careful and use a correction dose.