Carrier tsmvi liver inflamed what to treat. Cytomegalovirus hepatitis in children. The course of the disease Cytomegalovirus hepatitis

CMV hepatitis is a liver disease caused by cytomegalovirus that becomes most active in people with reduced immunity. About 80% of the world's population are carriers of this virus. Once in the body, the infection remains in it forever and manifests itself at the time of weakening of the immune system. One of the indicators that cytomegalovirus is in the active stage is cytomegalovirus hepatitis. The disease changes the liver cells, disrupting its work. Diagnosis of the disease is difficult, since the symptoms are in many ways similar to other diseases. A person who has a strong immune system can often deal with acute CMV hepatitis on their own. Treatment of weakened people is usually lengthy and not always effective.

The infection belongs to the family of herpes-like DNA viruses and has several varieties. It is transmitted in various ways - by airborne droplets, through touch and household items, sexually, during organ transplants and blood transfusions. The virus is able to cross the placenta, however, infection of newborns occurs more often during childbirth. Infection up to 3 months of pregnancy is especially dangerous. In this case, there are usually serious violations in the intrauterine development of the child.

Having penetrated into the host cells, CMV causes their growth by 2-4 times compared to healthy ones. Infected cells become a "home" for the virus, which, multiplying, suppresses their immunity. At the same time, in a person with a strong protective reaction, cytomegalovirus infection does not cause health problems.

Attention! Main danger hidden for infants, as well as people with a weakened immune system, such as those diagnosed with HIV, who have undergone organ transplants or participated in blood transfusions.

The virus affects all organs and systems of life. It provokes the development of the following major diseases:

• pneumonia - characterized high temperature, dry cough, chest pains, the skin of newborns becomes cyanotic, breathing becomes difficult;
• hepatitis;
• retinitis - affects the retina, which either dies or exfoliates, while the treatment only stops the process, and the changes themselves are irreversible.

What is CMV hepatitis and its forms

CMV hepatitis accounts for 1% of all cases acute hepatitis. If the cytomegalovirus has reached the liver cells, then it causes their degeneration. An increase in size negatively affects the ability of hepatocytes to perform their functions. First of all, there is intrahepatic cholestasis when the flow of bile into the duodenum is reduced. In the process of aging, enlarged cells die and block the lumen of the bile ducts, causing obstructive jaundice. CMV-affected hepatocytes are modified to such an extent that a syndrome of cytolysis occurs - dystrophic or necrotic liver damage.

There are 2 forms of CMV hepatitis - congenital and acquired, while the liver always undergoes certain changes.

Acquired form

The penetration of cytomegalovirus does not occur during pregnancy and not during childbirth. There are 2 types of hepatitis - acute and chronic.

The incubation period of acute CMV hepatitis lasts 2-3 months. The disease can be characterized by anicteric, mild, moderate and serious condition. Symptoms do not differ from the manifestations of others viral hepatitis:

1. In the preicteric period, the disease develops gradually and is manifested by a decrease in appetite, intoxication, in rare cases, the temperature rises to 38 degrees. The phase lasts 3-7 days.
2. The icteric period is characterized by an increase in intoxication, while all other symptoms, including laboratory manifestations, are similar to other types of hepatitis. The phase lasts 2-4 weeks.
3. During the post-icteric period, the state of health normalizes, the size of the liver and spleen become normal, the activity of enzymes decreases.

“In 35% of patients, acute CMV hepatitis ends in recovery - the human immune system is able to cope with this disease on its own, however, in 65% of patients, the disease becomes chronic”

Usually the disease develops in patients with HIV; people being treated with immunosuppressive drugs; after a liver transplant. At the same time, chronic cytomegalovirus hepatitis can affect the liver of children and adults who do not have a weakened immune system.

Acquiring a chronic form, CMV hepatitis is not manifested by special clinical signs and has no distinctive laboratory indicators. The disease proceeds sluggishly or moderately actively, while in 75% of patients growth of connective tissue liver - fibrosis. While the disease subsides, the level of intoxication drops to almost zero, the size of the liver and spleen decrease, however, never become normal. During examination, the edge of the liver is found protruding from behind the rib by 1-2 cm. During remission enzymatic activity is in the norm.

congenital form

The infection enters the body of an unborn child through the placenta or during passage through birth canal. Cytomegalovirus in newborns can cause biliary cirrhosis, from which infants die within the first year of life.

Attention! The earlier CMV entered the baby's body, the more severe the malformations and general state child after birth.

Hepatitis is accompanied by the following changes in the health of the infant caused by CMV:

• deviations in the development of the nervous system that are visible immediately after birth - the Apgar scale is used;
• hyper- or hypotonicity of underdeveloped muscles;
• short-term convulsions;
• sluggish congenital reflexes.

The child refuses the breast, suffers from nosebleeds, the skin has a hemorrhagic rash characteristic of CMV. Coughing may join and breathing become difficult. In the future, hydro- or microcephaly, developmental delay, oligophrenia, lesions visual function and internal organs.

Hepatitis can be directly manifested by the following signs - jaundice is detected in the first 2 days, intensifies and lasts for about 2 months, a blood test shows a low protein content when increased activity liver enzymes, hepatosplenomegaly is diagnosed (simultaneous increase in the size of both the liver and spleen).

The icteric form of CMV hepatitis can proceed in two directions:

1. Favorable with a gradual recovery - there is a slight yellowing of the integument and mucous membranes, increased rates bilirubin and liver enzymes, dark urine with colored feces, hepatosplenomegaly, CMV markers are necessarily detected. After 2-3 months, jaundice subsides.
2. Progressive development with the onset of biliary cirrhosis, often leading to lethal outcome.

Hepatitis in newborns caused by CMV may not produce yellowing at all. In this case, the symptoms are almost not noticeable, and the condition of children is often considered satisfactory. Specialists pay attention to the enlarged liver and after a series of tests, elevated values liver enzymes (aminotransferases).

Diagnosis of CMV hepatitis

With suspicions of CMV hepatitis, it is necessary to contact an infectious disease specialist or a hepatologist. The main task for specialists is to differentiate the disease from colds and other types of hepatitis. The difficulty in this process is the lack of specific symptoms with liver damage by cytomegalovirus infection.

A comprehensive diagnostic approach includes:

• careful collection of information about how the disease proceeds, according to the patient - anamnesis;
• conducting blood tests - general and biochemical, which will show hyperenzymemia and direct hyperbilirubinemia;
• confirmation of CMV infection by analysis for markers;
• serological method, which will show the presence of antibodies to CMVI;
• a cytological method that will show the presence of cytomegalic cells in the urine sediment;
• liver biopsy - allows you to detect huge cells specific structure: they have a large nucleus surrounded by a narrow cytoplasm;
• instrumental examinations of the liver include ultrasound, MRI, elastometry, X-ray.

CMV hepatitis treatment and prevention

Treatment of the disease is reduced to two tasks - reducing the activity of CMV in a patient and restoring liver function. For this, antiviral drugs are used, which people with immunodeficiency can take for life. Only unconditional adherence to the instructions of the doctor helps. In addition to taking medications, it is necessary to establish a diet - the use of products that facilitate the work of the liver, the exclusion of bad habits, as well as maintaining the work of the body by taking hepatoprotectors, is suitable.

There is no specific prevention of hepatitis caused by CMV infection. Currently, scientists are actively working on the creation of a vaccine. Effective measures to prevent the spread of infection are measures to reduce the likelihood of infection during transplants and blood transfusions. They consist in the correct sterilization of the instrument, the use of disposable needles. Ideally, transfused blood should be tested for cytomegalovirus DNA, but this has not yet been done.

Summing up

Most of the world's population is a carrier of CMV. When immunity is weakened, the infection begins to actively multiply in the body, disrupting the work of many organs. The virus invades the cells and provokes their growth, and hence the dysfunction. The main complications that CMV causes are pneumonia, retinal detachment or death, and hepatitis. most dangerous form liver disease is congenital CMV hepatitis, as early dates pregnancy, cytomegalovirus causes irreversible disturbances in the intrauterine development of the fetus.

If the patient has a strong immune system, then he is able to cope with the disease on his own. People who are temporarily or permanently immunocompromised should be treated antiviral drugs. Sometimes patients take these medicines for the rest of their lives. Prevention of the disease in everyday life does not exist, and the diagnosis of CMV hepatitis is difficult due to the similarity of symptoms with other diseases.

Hepatitis B virus and cytomegalovirus, like HIV, cause chronic infection. These viruses are transmitted through blood and genital secretions. They are characterized by injection and transplacental mechanisms, as well as sexual transmission of the infection. Cytomegalovirus can be transmitted through saliva. The hepatitis C virus is transmitted primarily through the blood. Sexual transmission of the hepatitis C virus is also allowed, but its role is small. Most sexual partners of individuals virus-infected hepatitis C is not infected. All of these viruses cause primary infection, which in most cases is asymptomatic. It is followed by chronic infection, which can lead to severe complications within a few years or decades. In contrast, the hepatitis A virus usually causes acute hepatitis, very rarely chronic. The hepatitis A virus is characterized by a fecal-oral mechanism of infection transmission. It is not transmitted through the blood.

HepatitisA

In the US, 125,000 - 200,000 cases of hepatitis A are registered annually. Antibodies to the hepatitis A virus are detected in 15-25% of Americans. This disease is characterized by a fecal-oral transmission mechanism, especially among children. The sexual route of infection with the hepatitis A virus is typical for homosexual and bisexual men. This group accounts for the majority of hepatitis A cases among adults.

Clinical picture

The incubation period is usually 3-5 weeks. In adults, the disease in most cases proceeds with a clinical picture. In children, 90% of cases of hepatitis A are asymptomatic. The main manifestations include jaundice and hepatomegaly. Resolution of symptoms and normalization of biochemical indicators of liver function usually occur within 6 weeks from the onset of the disease (sometimes up to 3 months). Sometimes there is fulminant hepatitis with liver failure.

Diagnostics

Diagnosis is based on the clinical picture and biochemical indicators liver function (AST, ALT) plus serological studies for antibodies to the hepatitis A virus. There are no methods for detecting hepatitis A virus antigens yet. IgM to the hepatitis A virus indicates a fresh infection; it is detected in the period from 3 weeks to 4 months from the moment of infection. IgC to the hepatitis A virus is detected 6 weeks after infection; it persists indefinitely.

Prevention

Active hepatitis A immunization is indicated (for hepatitis A serologically negative): (1) homosexual and bisexual men; (2) at high risk exposure (for example, before traveling to countries with a high incidence of hepatitis A); (3) after contact with a patient with hepatitis A. Active immunization for adults is carried out twice with an interval of 6-12 months. In addition, after contact with a patient with hepatitis A (no later than 2 weeks), immunoglobulin against hepatitis A is prescribed, 0.02 ml / kg body weight / m. The use of condoms and the avoidance of sexual contact, in which the fecal-oral mechanism of infection is possible, helps prevent infection through sexual contact.

Hepatitis B

Epidemiology and routes of infection

Incidence and prevalence can be very different. In the United States, 140,000 - 320,000 new cases of hepatitis B are registered annually. In total, there are about 750,000 patients with chronic hepatitis B in the United States. Injection and transplacental mechanisms, as well as sexual transmission of the infection, are characteristic. During sexual intercourse, the risk of infection is maximum when anal sex. The highest incidence is observed among homosexual and bisexual men, as well as among injection drug addicts. In the US, 45% of hepatitis B infections are due to heterosexual intercourse; 15% of cases are homosexual.

Clinical picture

The incubation period is usually 6-12 weeks. In most cases (36-70%), the primary infection is symptomatic, but symptoms are usually nonspecific. These include nausea, anorexia, jaundice, and hepatomegaly. In 15-20% of cases, prodromal events of the type of serum sickness are observed, including rash, polyarthritis, symptoms of cryoglobulinemia. Chronic hepatitis B is usually asymptomatic until cirrhosis or hepatocellular carcinoma develops. At the same time, biochemical and histological (with a biopsy) signs of active hepatitis may not be.

Diagnostics

Diagnosis is usually based on serological tests. Detect hepatitis B surface antigen (HbsAg); antibodies to the surface antigen of the hepatitis B virus (anti-HbsAg antibodies); hepatitis B core antigen (HbcAg). HbsAg indicates acute or chronic active hepatitis B; a patient with HbsAg is contagious. Anti-HbsAg antibodies usually indicate past hepatitis B. The hepatitis B E antigen (HbeAg) is detected in serum during the period of active virus replication; while the patient is highly contagious.

Prevention

The basis of prevention is immunization against hepatitis B. For adults, the hepatitis B vaccine is administered at a dose of 20 mg IM; repeat after 1 and 6 months. While there is no immunization in childhood, it is given to all adolescents, adults with STDs, and medical workers. Injection drug users, homosexuals and bisexual men are actively immunized against hepatitis B with negative serological reactions. In this case, it is advisable to administer the first dose of the vaccine on the day of blood sampling for serological studies. The introduction of subsequent doses depends on the results of serological reactions. The use of condoms helps prevent infection through sexual contact.

Hepatitis C

Epidemiology and routes of infection

In the US, hepatitis C accounts for 15% of all acute hepatitis. In the United States, 30,000 - 40,000 new cases of hepatitis C are registered annually. The disease is detected in 40% of patients with cirrhosis of the liver. In the United States, between 8,000 and 10,000 people die each year from hepatitis C and its complications. Liver failure caused by hepatitis C is the most frequent indication for liver transplant. The injection mechanism of transmission of infection and infection during blood transfusion are characteristic. Infection through sexual contact is possible, but rare.

Clinical picture

Acute hepatitis C is asymptomatic. Two-thirds of hepatitis C cases develop chronic hepatitis, which is usually asymptomatic until cirrhosis or liver failure develops.

Diagnostics

To detect antibodies to the hepatitis C virus is usually used linked immunosorbent assay. For confirmation positive result using immunoblotting. Reverse polymerase chain reaction allows you to estimate the "viral load". In addition, assess the function and degree of inflammation of the liver (AlAT, biopsy).

Prevention

The basis of prevention is the examination of donors for antibodies to the hepatitis C virus, as well as the reduction of contact with other people's blood (the fight against drug addiction; measures to reduce the use of shared syringes by injection drug addicts). The use of condoms is ineffective in the prevention of hepatitis C. Mass screening for hepatitis C is indicated for drug addicts and representatives of other risk groups. Examination of sexual partners of patients with hepatitis C is impractical.

Cytomegalovirus

Epidemiology and routes of infection

Cytomegalovirus infection is ubiquitous. Infection is possible through the secretions of the genital organs, saliva or blood. Perhaps intrauterine infection and infection during childbirth. Antibodies to cytomegalovirus are detected in 10-15% of adolescents. By the age of 35, they are already detected in half of the people. These figures vary widely across regions and different groups population. Superinfection with other strains of cytomegalovirus is possible.

Clinical picture

In most cases, cytomegalovirus infection is asymptomatic. Sometimes there is granulomatous hepatitis or a syndrome resembling mononucleosis. Intrauterine infection of a child, usually occurring during primary infection in a pregnant woman, can cause severe systemic disease and congenital pathology CNS (eg, sensorineural hearing loss). The role of cytomegalovirus infection in the development of atherosclerosis has not been fully elucidated. In patients with AIDS and in people with severe immunodeficiency of another nature, severe, sometimes life threatening, the course of cytomegalovirus infection (retinitis, pneumonia, esophagitis, colitis, encephalitis).

Diagnostics

Examination of blood, urine, and genital secretions by culture, antigen determination, or DNA amplification methods is of limited practical value. Serological studies are used. Histological and cytological studies are detected with a cytomegalovirus infection that occurs with a clinical picture. Interpretation of histological and cytological studies often complex.

Prevention

Condoms prevent infection through sexual contact. Prevention of primary cytomegalovirus infection in pregnant women (use of condoms, avoidance of casual sex) helps to prevent intrauterine infection of the child. Mass examinations and examination of sexual partners are not shown.

Other viruses

Human herpesvirus type 8

Human herpesvirus type 8 is a new virus from the herpesvirus family that causes Kaposi's sarcoma in HIV-infected people. Epidemiological data and the detection of this virus in semen indicate the possibility of its transmission through sexual contact, especially in homosexual and bisexual men. However, other mechanisms of transmission of human herpesvirus type 8 are not excluded.

AT hepatitis virusD

The hepatitis D virus is an "incomplete" virus, disease-causing only in the presence of the hepatitis B virus. Infection with the hepatitis D virus in a patient with hepatitis B is clinically manifested by an exacerbation of chronic hepatitis. Hepatitis D is transmitted through the blood. Infection through sexual contact is rare.

Epstein-Barr virus

Epstein-Barr virus - causative agent infectious mononucleosis can be sexually transmitted. However, in most cases, infection with this virus is not associated with sexual contact and occurs through saliva. In an HIV-infected person, Epstein-Barr virus reactivation causes hairy leukoplakia of the mouth.

Human T-lymphotropic virus 1

Human T-lymphotropic virus type 1 causes adult T-cell leukemia-lymphoma and spastic paraparesis. The clinical picture of infection caused by human T-lymphotropic virus type 2 has not yet been elucidated. The epidemiology of human T-lymphotropic virus types 1 and 2 is similar to the epidemiology of hepatitis B and C. Injection and transplacental mechanisms are characteristic, as well as sexual transmission of the infection.

Enteroviruses

Enteroviruses are usually transmitted through sexual contact, in which the fecal-oral mechanism of infection is possible.

adenovirus type 19

Adenovirus type 19 causes acute conjunctivitis in combination with urethritis. Can be sexually transmitted.

Hunter Handsfield

Sexually transmitted diseases. Color atlas-reference book. - M.: "Publishing house BINOM", 2006.-296 p.: ill.

Cytomegalovirus is one of the most common pathogens infectious diseases that are exclusive to humans.

The virus inevitably destroys the liver, but usually manifests itself mildly or without symptoms. And if there are signs of the disease, then they are most often very similar to other ailments.

The peculiarity of this virus is that once it enters the body, it no longer leaves it, but exists in it in a hidden form, making itself felt during a decrease in immunity. Also, like, this virus enters the body and adversely affects it from the inside.

What happens to the body during illness

The disease can be transmitted through direct contact with contaminated saliva, urine, and even blood, especially through transfusion. Moreover, the latter option is the most common. Rarely, infection occurs by airborne droplets.

In addition, it has been proven that the transmission of the virus can occur from an infected mother to the fetus - through the placenta. Usually the fetus and newborns are most susceptible to the virus. If a person has a weak immune system, then the disease usually resolves with complications and is similar to the common cold.

without taking necessary analyzes it is impossible to determine the development of this disease only by symptoms, so many people do not even suspect that they are carriers of the virus and, as a result, do not receive treatment on time.

Symptoms of the disease

Cytomegalovirus infection is difficult to diagnose due to the similarity of symptoms with various diseases. The infection can manifest itself in the form of SARS, as well as severe complications immune system. It may be asymptomatic, but sometimes it is expressed as a mononucleosome syndrome, or in other words, an acute form of the disease. Unlike diseases like, it cannot be seen externally.

The characteristic signs of a mononucleosis-like syndrome are more often the usual catarrhal symptoms:

• feeling weak, tired;
• Strong headache;
• increase in body temperature.

But with a weak immune system, the disease will proceed with other, more severe symptoms: an inflammatory process of internal organs occurs. This leads to serious complications:

• inflammation of the retina;
• gospel's disease;
• cytomegalovirus encephalitis;
• hemorrhage;
• pneumonia.

With immunodeficiency, the treatment of this disease takes a long time and is rather difficult, and a person does not always manage to recover. Often, patients with such a diagnosis die, but not from the virus itself, but from its complications.

There are two types of cytomegalovirus hepatitis in infants:

• congenital, when the infection was transmitted from mother to fetus;
• acquired when the baby received viral infection during childbirth.

In children, congenital hepatitis occurs with serious complications and is accompanied by inflammation in the internal organs, hemorrhages. As a consequence, it is possible mental retardation, loss of hearing or vision.

In infants, the acquired form of the disease is usually asymptomatic, but occasionally leads to pneumonia. This option is possible if the baby was premature.

Causes of the disease

Cytomegalovirus hepatitis begins to develop when the pathogen enters the body. Carriers of the virus can develop a severe infection with high mortality.

The cause of cytomegalovirus hepatitis is a virus of the Nerpesviridae family, isolated in the middle of the 20th century by M. Smith. The causative agent is classified as human type 5. resistant to room temperatures and aggressive to disinfectants. It occurs only in humans, the fetus and infants are most susceptible to infection.

How does the disease progress in adults?

Most often when available strong immunity the body is able to independently fight the virus, does not allow it to manifest itself and is in a latent form. But with a weak immune system, symptoms resembling mononucleosis are observed: sore throat, body trembling, accompanied by high body temperature, fatigue.

Developing, the virus has an effect on the base of the cell, resulting in an increase in its size. Cytomegalovirus enters the body through the mucous membrane of the mouth, nose, genitals. The infection spreads rapidly circulatory system where the virus begins to multiply rapidly. After that, it can penetrate into the lymphoid tissue, where it remains in a latent form for an unlimited amount of time. If there is a weakening of the immune system, the virus is activated and begins to actively develop, accompanied by serious complications.

But, most often, the virus is contained in the liver, where it penetrates with the help of the blood stream. Cytomegalovirus disrupts the functioning of blood vessels, biliary tract destroys liver cells. As a result, the normal permeability of bile through the organ is disturbed and jaundice develops.

How does CMV progress in children?

Unlike an adult, whose immune system is able to resist the virus itself, a child's weak body is most susceptible to this disease and the effect of the infection on it is more aggressive. For babies, he is the most terrible because of his lack of natural defensive reactions organism. The baby can become infected both directly at birth and while still in the womb.

The congenital form is considered the most dangerous, due to the fact that the child, as a result of the disease, has a developmental delay, internal hemorrhages, and also serious lesions internal organs.

One of the results of cytomegalovirus hepatitis in newborns is the appearance of jaundice, which is accompanied by the following symptoms:

• yellow skin color that persists for a couple of months;
• stool discoloration, dark color urine;
• high concentration of bilirubin;
• enlargement of the liver and spleen.

At good immunity The body is able to cope with the virus on its own, but it needs support. Depending on the complications, appropriate drugs are prescribed. With angina - antipyretics, with gastroenteritis - a one-day diet, etc.

It must be said that these measures are aimed at eliminating complications, but not the virus itself, since drugs against it are still under development.

With good immunity, the latent form of cytomegalovirus infection does not pose a particular danger, but you should continue to support immune system on the high level. Therefore, it is necessary to carry out preventive actions against chronic forms of diseases (especially those associated with genitourinary system). It is recommended to take drugs that stimulate the immune system: Echinacea Hexal, Derinat.

Once a virus enters the body, it stays there for life. Long lasting effect from treatment is possible only with constant monitoring and recommendations of the hepatologist.

Delay in treatment can cost a person's health, since having discovered this virus, as a rule, a whole bunch of diseases are attached to it.

In adults, pneumonia is accompanied by fever, dry cough, shortness of breath. Children have blue skin. Temperature fluctuations are observed. Delay in treatment this case can cost a person's life.

With retinitis, problems occur with the retina of the eye, as a result of which there is a high probability of losing vision in just six months.

Meningitis is known for inflammation of the brain and spinal cord. Its symptoms are headaches, nausea, vomiting, loss of consciousness. Noticeable in children.

With the defeat of the intestinal virus, the development of gastroenteritis is observed. The main symptoms are abdominal pain, vomiting, blood in the stool. Baby given form complications are much more severe than in adults.

The most effective way to avoid the complications of an infection is to identify the disease in time and start a treatment course.

Disease prevention

There are currently no special preventive measures because there are no drugs against cytomegalovirus hepatitis. People most susceptible to this disease are advised to take antiviral drugs, but only as prescribed by a doctor.

During a blood transfusion or organ transplant, instructions must be strictly followed to avoid infection. It is recommended that clinicians use disposable needles, syringes and other surgical supplies.

If someone in the family found this infection, it is recommended that the rest of its members also undergo an examination. They may also need treatment.

Cytomegalovirus hepatitis is an acute form of manifestation of cytomegalovirus infection, leading to irreversible pathological changes hepatic tissue and biliary tract. The disease does not have a clearly defined endemic zone, it is equally common in all social groups. As a rule, it does not have its own pronounced symptoms, therefore it can be mistaken for hepatitis.

The nature of the disease

The causative agent of the disease - cytomegalovirus (Cytomegalovirus hominis) - human herpes virus type V, HHV5, has several strains. This DNA virus is well preserved in room temperature, sensitive to heat and freezing. Currently widely distributed. According to latest research, about 80% of the world's population have specific antibodies in their blood. After the defeat, the virus can live in the host's body for a long time without manifesting itself in any way, and remains in the human DNA throughout life.

Etiology

Cytomegalovirus affects only humans, especially newborns and people with reduced immunity. It can be found, as a rule, in the secrets of salivary and lacrimal glands, nasopharynx, genital organs and feces. The main ways of transmission of the virus:

• domestic;
• airborne;
• sexual;
• organ transplantation and blood transfusion;
• from mother to child - in utero and through milk during feeding.

Pathogenesis

HHV5 virus, when it enters the body, bypasses lymphatic system and immediately penetrates into the blood. At the same time, it acts on T-lymphocytes, suppressing immunity, and causes the growth of affected cells due to the growth of the nucleus and an increase in the volume of the cytoplasm. In hepatitis, the cytomegalovirus integrates into the cells of the biliary tract and liver (hepatocytes), turning them into cytomegaloviruses. Around such cells, foci of inflammation are formed, called mononuclear infiltrates. Due to this, intrahepatic cholestasis is born - a decrease or cessation of bile secretion with its stagnation in the liver tissues. Often CMV infection progresses to the development of necrosis.

Concomitant diseases and possible complications

CMV virus provokes not only hepatitis. Spreading through the bloodstream throughout the body, it damages the spleen, kidneys, lungs, spinal cord and causes serious complications, often leading to death. Against the background of cytomegalovirus hepatitis, the development of pneumonia is possible. It is characterized by localization inflammatory process in both lungs, dry cough with a possible admixture of blood. Another common complication is cytomegalovirus retinitis, an inflammation of the retina. It manifests itself in the form of a decrease in visual acuity and pain, first in one, and then in both eyes. Improper treatment can lead to vision loss. Hitting the head and spinal cord The virus causes meningoencephalitis. It's heavy acute illness causes migraines, convulsions, paralysis, mental disorders often ends in death.

Symptoms of CMVI

Given that the latent form of cytomegalovirus infection is more common, a person may not be aware of the presence of the virus in the body. CMV type hepatitis can occur in acute or chronic form. acute form becoming ill, in turn, has an icteric or anicteric character. With an anicteric course, the patient suffers, first of all, from a mononucleosis syndrome, similar to the signs of SARS, which manifests itself:

• loss of strength, reduced performance;
• headache;
• elevated body temperature;
• growth of lymph nodes;
• increased sweating.

The icteric form of the disease is evidenced, first of all, by a change in the color of the skin and the white of the eyes, the so-called jaundice. Staining or discoloration of urine occurs and stool, increased levels of bilirubin in the blood, heaviness or pain in the right hypochondrium. On palpation, the liver is enlarged. The acute form of cytomegalovirus hepatitis manifests itself during the first 2-3 months after infection, then the patient feels better, a decrease in the size of the liver is observed. However, in the absence of proper treatment in incubation period, the disease becomes chronic. This trend is observed in 65% of patients. During the period of remission, the disease manifests itself only in a slight increase in the size of the liver and spleen.

Congenital CMV-type hepatitis

Cytomegalovirus hepatitis can also be congenital. It occurs in newborn babies due to infection of the mother in the first trimester of pregnancy, is diagnosed in the first months of life. It is of a primary chronic nature, as a rule, does not have pronounced symptoms. There is a compaction of the structure of the liver and the walls of the gallbladder, obstruction of the biliary tract. In infants suffering from this disease, the risk of developing fibrosis and cirrhosis of the liver increases significantly.

Diagnosis of cytomegalovirus infection and hepatitis

Only highly qualified infectious disease specialists and hepatologists can make a diagnosis of cytomegalovirus hepatitis after a thorough study of the anamnesis and several laboratory research. For detection in blood IgG antibodies and IgM use a serological diagnostic method. In addition, a biochemical blood test is shown to study CMVI markers and enzymes. In patients CMV hepatitis there is significant hyperfermentation. efficient laboratory method diagnosis is considered PCR method- polymerase chain reaction. It allows you to isolate the DNA of the virus in the carrier genome. Through cytological studies in the urine, cytomegalic cells can be detected. The final confirmation of the diagnosis is often possible after a liver biopsy. Pathological hepatocytes take the form of an "owl's eye", they show specific inclusions.

Cytomegalovirus hepatitis is the leading clinical manifestation of congenital cytomegalovirus infection. Liver damage in cytomegalovirus infection is always a sign of a generalized process.

What provokes / Causes of Cytomegalovirus hepatitis:

The causative agent of cytomegalovirus infection- DNA-genomic virus of the genus Cytomegalovirus (Cytomegalovirus hominis) subfamily Betaherpesvirinae of the family Herpesviridae. Three strains of the virus are known: Davis, AD-169 and Kerr. Slow reproduction of the virus in the cell is possible without damaging it. The virus is inactivated by heating and freezing, and is well preserved at room temperature. At - 90 °C, it remains for a long time, is relatively stable at pH 5.0-9.0, and quickly collapses at pH 3.0.

Reservoir and source of infection- a person with acute or latent form diseases. The virus can be found in various biological secretions: saliva, nasopharyngeal secretions, tears, urine, feces, seminal fluid, and cervical secretions.

Transmission mechanisms diverse, transmission routes- airborne, contact (direct and indirect - through household items) and transplacental. Infection is possible through sexual contact, during transplantation of internal organs (kidney or heart) and blood transfusion of an infected donor. Intranatal infection of the child is observed much more often than transplacental. The most dangerous for the fetus is infection of the mother in the first trimester of pregnancy. AT similar situations the greatest frequency of violations of intrauterine development.

Natural susceptibility of people high, but widespread latent infection. Clinical manifestations infections attributed to opportunistic diseases are possible in conditions of primary or secondary immunodeficiency.

The main epidemiological signs of cytomegalovirus infection. The disease is recorded everywhere, its widespread is evidenced by antiviral antibodies detected in 50-80% of adults. Diversity of CMV infection routes and polymorphism clinical picture determine the epidemiological and social significance CMV infections. This disease plays important role in transplantology, hemotransfusiology, perinatal pathology, can be the cause of prematurity, stillbirth, congenital developmental defects. In adults, CMV infection is seen as comorbidity in various immunodeficiency states. Ongoing pollution environment, the use of cytostatics and immunosuppressants contribute to an increase in the frequency of CMV infection. AT last years its exacerbation in HIV-infected people has become especially relevant. In pregnant women with latent CMV infection, fetal damage does not always occur. Probability intrauterine infection significantly higher in the primary infection of a woman during pregnancy. Seasonal or professional features morbidity has not been identified.

Pathogenesis (what happens?) during Cytomegalovirus hepatitis:

At different ways transmission gates of infection may be the mucous membranes of the upper respiratory tract, gastrointestinal tract or genital organs. The virus enters the blood; short-term viremia quickly ends with the localization of the pathogen when it invades leukocytes and mononuclear phagocytes, where it replicates. Infected cells increase in size (cytomegaly), acquire a typical morphology with nuclear inclusions, which are accumulations of the virus. The formation of cytomegalic cells is accompanied by interstitial lymphohistiocytic infiltration, the development of nodular infiltrates, calcifications and fibrosis in various organs, glandular structures in the brain.

The virus is able to persist for a long time and latently in organs rich in lymphoid tissue, being protected from the effects of antibodies and interferon. At the same time, it can suppress cellular immunity by direct action on T-lymphocytes. In various immunodeficiency states (in early childhood, during pregnancy, the use of cytostatics and immunosuppressants, HIV infection) and, above all, in violations cellular immunity, additionally aggravated by the direct effect of the virus, reactivation of the pathogen and its hematogenous generalization with damage to almost all organs and systems are possible. Wherein great importance has the epitheliotropy of the virus. It is especially pronounced in relation to the epithelium salivary glands, under the influence of the virus turning into cytomegalic cells.

Liver pathology occupies a special place in CMVI. Cytomegalovirus hepatitis, which develops in response to the introduction of CMV, is characterized by the degeneration of the epithelium of the biliary tract and hepatocytes, stellate endothelial cells and vascular endothelium. They form cytomegalic cells, surrounded by inflammatory mononuclear infiltrates. The combination of these changes leads to intrahepatic cholestasis. Cytomegalic cells desquamate, fill gaps bile ducts, causing the mechanical component of jaundice. At the same time, CMV-derived hepatocytes are destructively altered up to necrosis, causing the development of cytolysis syndrome. It should be noted that with CMV hepatitis, which has a prolonged, subacute or chronic course, the leading value belongs to the syndrome of cholestasis.

Symptoms of cytomegalovirus hepatitis:

Cytomegalovirus hepatitis can proceed in anicteric and icteric form.

anicteric form CMV hepatitis proceeds with very poor clinical symptoms the condition of the children remains satisfactory. Identification of the anicteric form of hepatitis is possible due to the detection of hepatomegaly and advanced level aminotransferases. The activity of aminotransferases increases slightly (1.5-2.0 times) with the predominance of AsAT over AlAT.

In the icteric form of hepatitis, two groups of patients were distinguished: one with a favorable course and gradual recovery, and the other group with progressive liver disease and the formation of biliary cirrhosis due to the development of obliterating cholangitis.

The condition of children with icteric form of CMV hepatitis is not significantly disturbed. They have hepatosplenomegaly. Jaundice in most children was found in the first days after birth.

icteric form CMV hepatitis with a favorable course is characterized by mild jaundice of the skin, dark urine and colored feces, hepatosplenomegaly, moderate hyperenzymemia with a predominance of AST over ALT, an increase in the level of bilirubin with a predominance of the direct fraction, and the presence of markers of active CMV replication.

One of the variants of cytomegalovirus liver damage in congenital CMVI is formation of biliary cirrhosis of the liver leading to death, usually in the second half of the first year of life.

Children born with cytomegalovirus hepatitis have low Apgar scores (a scale that reflects the state of the child's nervous system at the time of birth), insufficient muscle development, increased or decreased muscle tone. There may be short-term muscle twitches or convulsions, the child does not take the breast, all congenital reflexes are reduced. In general, the condition of such a child will be severe, hemorrhagic syndrome will be pronounced (bleeding from the nose, gastrointestinal bleeding, hemorrhagic rash on the skin and mucous membranes), the number of red blood cells and platelets in the blood will decrease, the central nervous system. Yellowness of the skin, mucous membranes and sclera appears in the first day or two, gradually increasing, it lasts for 1-2 months. On examination, the liver is enlarged, the spleen is also enlarged. Often involved respiratory system, children cough, there is shortness of breath. Soon, signs of hydrocephalus or microcephaly, oligophrenia, lesions optic nerves, kidneys, stomach and intestines. In the blood, hepatocellular enzymes will be sharply increased, protein and albumin protein fraction will be lowered. This course of the process often ends fatally. With a benign course, jaundice remains for 2-3 months, after which it begins to subside.

Diagnosis of Cytomegalovirus hepatitis:

Diagnosis of cytomegalovirus hepatitis was established on the basis of anamnestic, clinical and biochemical data with mandatory confirmation of the diagnosis by the detection of CMVI markers. All patients were examined for markers of parenteral viral hepatitis.

In the diagnosis of cytomegalovirus hepatitis, the results are of great importance needle biopsy liver (detection in the punctate of giant, 25-40 microns in diameter, cytomegalic cells in the form of an owl's eye with a huge nucleus and a narrow border of the cytoplasm), as well as a cytological method (detection of cytomegalic cells in the urine sediment) and a serological method (detection of antibodies - Ig M to CMVI). Differential diagnosis CMV hepatitis is carried out with other viral hepatitis: B, Epstein-Barr, herpetic hepatitis.

AT biochemical analysis blood reveals a distinct hyperfermentemia with a predominance of AST (160.0±25.6 µmol/min.l) over ALT (120.0±25.6 µmol/min.l) and hyperbilirubinemia (112.0±8.5 µmol/l ) with a predominance of the direct fraction (62.0±6.7 µmol/l).

Which doctors should you contact if you have Cytomegalovirus hepatitis:

Are you worried about something? Do you want to know more detailed information about Cytomegalovirus hepatitis, its causes, symptoms, methods of treatment and prevention, the course of the disease and diet after it? Or do you need an inspection? You can book an appointment with a doctor– clinic Eurolaboratory always at your service! The best doctors examine you, study the external signs and help identify the disease by symptoms, advise you and provide needed help and make a diagnosis. you also can call a doctor at home. Clinic Eurolaboratory open for you around the clock.

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