Cytomegalovirus infection in children symptoms. Congenital cytomegalovirus infection in infants. Ways of infection of the fetus in utero or a newborn baby

Cytomegalovirus infection (CMVI) is one of the most common, non-seasonal infectious diseases among TORCH infections. Specific antibodies to it are detected in newborns (2%) and in children under one year old (up to 60% of children). Treatment of this infection is quite complicated and depends on the form of the disease.

In this article, you'll learn everything parents need to know to treat cytomegalovirus infection in children.

Causes of CMVI

CMVI causes cytomegalovirus from among the β-viruses. Several varieties (strains) of viruses are known. The source of infection is only a person (sick or virus carrier). All secretions of an infected person are infected: nasopharyngeal discharge and saliva; tears; urine and stool; secretions from the genital tract.

Ways of transmission of infection:

• airborne;
• contact (direct contact and use of household items);
• parenteral (through the blood);
• transplacental;
• when transplanting an infected organ.

A newborn child can become infected from the mother not only in utero (through the placenta), but also directly during childbirth (intranatal) during the passage of the birth canal. The fetus becomes infected in case of acute illness or exacerbation of the disease in the mother during pregnancy.

It is especially dangerous if the infection of the fetus occurs in the first 3 months of pregnancy, because this entails its death or the occurrence of defects in various organs and deformities. But in 50% of cases, children get the infection with mother's milk.

Children can also become infected from other infected children in kindergartens and schools, because the airborne route of infection is the main route for CMVI. It is known that children of this age can pass a bitten apple or candy, chewing gum to each other.

Entrance gates for the virus are the mucous membranes of the respiratory, digestive and genital tracts. There are no changes at the site of the introduction of the virus. The virus, once entering the body, remains in it all its life in the tissue of the salivary glands and lymph nodes. With a normal immune response of the body, there are no manifestations of the disease and can appear only with adverse factors (chemotherapy, a serious illness, taking cytostatics,).

The virus is not stable in the environment, is inactivated by freezing and heating up to 60°C, and is sensitive to disinfectants.

Susceptibility to the virus is high. Immunity after the transferred CMVI is unstable. The virus infects various organs. Affected cells do not die, their functional activity is preserved.

CMVI classification

CMVI is characterized by a variety of forms: latent and acute, localized and generalized, congenital and acquired. Generalized has many varieties, depending on the predominant organ damage.

The form depends on the route of penetration of the virus (acute - with parenteral, latent - with other routes), from (when a generalized infection develops).

Symptoms of CMVI

congenital cytomegaly

Manifestations of congenital CMVI depend on the period of infection of the fetus. If infected before 12 weeks, the fetus may die, or the child will be born with possible malformations.

When the fetus is infected at a later date, the acute form of the infection is more often manifested by CNS damage: hydrocephalus, strabismus, nystagmus, increased muscle tone of the limbs, trembling of the limbs, facial asymmetry. At birth, marked malnutrition is noted. The liver is especially often affected: congenital or even infection of the biliary tract is detected.

In such children, severe yellowness of the skin lasts up to 2 months, small punctate hemorrhages on the skin are noted, an admixture of blood may appear in the stool, vomit, bleeding of the umbilical wound.

Hemorrhages in the internal organs and the brain are possible. and spleen, increased activity of liver enzymes. In the blood, an increase in the number of leukocytes and a decrease in platelets are noted. The salivary glands are necessarily affected.

But not always the congenital form appears immediately after birth. Sometimes it is detected at preschool or school age in the form of chorioretinitis (damage to the retina), atrophy of the Corti's organ of the inner ear, mental retardation. These lesions can lead to the development of blindness, deafness.

The prognosis of congenital CMVI is often unfavorable.

Acquired cytomegaly

With primary infection in kindergarten, CMVI can manifest itself in the form of a disease similar to, which makes diagnosis difficult. In this case, the child appears:

• temperature rise;
• runny nose;
• redness in the throat;
• small;
• , weakness;
• in some cases .

Latent period (from the moment of infection to the onset of symptoms of the disease): from 2 weeks to 3 months. Most often, however, a latent form develops without obvious symptoms, which is detected by chance during a serological blood test. With a decrease in immunity, it can turn into an acute localized or generalized form.

At localized form(sialadenitis) salivary parotid (more often), sublingual, submandibular glands are affected. Symptoms of intoxication are not pronounced sharply. Children may not gain weight well.

Generalized mononucleosis-like form has an acute onset. There are symptoms of intoxication (weakness and headache, muscle pain), enlargement of the cervical lymph nodes, spleen and liver, fever with chills. Sometimes reactive hepatitis develops. In the blood, an increase in the number of lymphocytes and more than 10% of atypical cells (mononuclear cells) are found. The course of the disease is benign, recovery occurs.

Pulmonary form manifests itself in the form of having a protracted course. It is characterized by: dry, hoarse (resembling) cough, bluish tint of lips. Wheezing in the lungs is unstable. On the x-ray, there is an increase in the pulmonary pattern, cysts may appear in the lungs. Sputum analysis detects mega cells.

At cerebral form meningoencephalitis develops. This form is characterized by convulsions, paresis of the muscles of the extremities, seizures of epilepsy, impaired consciousness, and mental disorders.

renal form quite common, but rarely diagnosed, since the manifestations of pathology are very poor: protein in the urine, the number of epithelial cells are increased, and cytomegalo cells are found.

Liver form manifested by subacute hepatitis. The child has a slight yellowness of the sclera, skin and palate mucosa for a long time. In the blood, the bound fraction is increased, the activity of liver enzymes is slightly increased, but alkaline phosphatase is also sharply increased.

Gastrointestinal the form is manifested by persistent vomiting, liquid frequent stools, and bloating. The delay in the physical development of children is also characteristic. A polycystic lesion of the pancreas develops. In the analysis of feces, an increased amount of neutral fat.

At combined form many organs and systems with their characteristic features are involved in the process. More often it develops in an immunodeficient state. Its clinical signs are: severe intoxication, high fever with daily temperature fluctuations of 2-4 ° C for a long period, generalized enlargement of lymph nodes, enlargement of the liver and spleen, damage to the salivary glands, bleeding.

A particularly severe course of the disease is observed in children with. CMVI refers to AIDS marker diseases. Therefore, when a child is diagnosed with CMVI, an examination for HIV infection is carried out. CMVI accelerates the progression of HIV infection and is often the cause of death in AIDS.

Acquired CMVI has a long undulating course. The uneven course of the disease is due to the development of complications: specific (, etc.) and nonspecific (attachment of secondary infections).

With generalized forms of CMVI, a lethal outcome is possible.

Diagnosis of CMVI

Given the nonspecific symptoms of CMVI, it should be differentiated from a number of diseases, such as: hemolytic disease of the newborn, toxoplasmosis, lymphogranulomatosis, tuberculosis.

The following laboratory methods are used for diagnosis:

• virological (detection of a virus in saliva, blood, and other fluids);
• PCR (detection of virus DNA and viral load);
• cytoscopy (detection of characteristic cytomegalo cells in saliva, sputum under a microscope);
• serological (detection of specific antibodies of the IgM and IgG classes in the blood);
• Ultrasound of the fetus (detection of intracranial calcifications and malformations in the fetus).

Laboratory diagnosis is especially important in the case of a latent form of the disease. Detection of IgG class antibodies in a newborn may indicate maternal antibodies; it is necessary to re-examine the child's blood at 3 and at 6 months. If the titer of these antibodies decreases, then congenital CMVI can be excluded.

The detection of a virus in urine or saliva does not confirm the activity of the disease: it can be excreted in urine for years, and in saliva for many months. In this case, the main will be the increase in the titer of antibodies of class M and G in dynamics. Intrauterine infection is evidenced by the detection of IgM in the blood during the first 2 weeks of a child's life.

Given that the virus is unstable in the environment, it is necessary to examine the material for virological analysis no later than 4 hours after sampling.

Treatment

Treatment of CMVI in children depends on the form of the disease, the severity of its course and the age of the child. The latent form does not require special treatment. Parents should only provide the child according to age.

Vitamin complexes and probiotics will help prevent and ensure normal digestion. Timely visits to the dentist and ENT doctor will help to identify and promptly cure chronic foci of infection. All these measures are aimed at strengthening the general state of health and immunity in order to prevent the activation of the disease.

Only children with acute CMVI need treatment. With a mononucleosis-like form, specific therapy is usually not required, symptomatic treatment is used.

With intrauterine infection and with severe manifest forms, complex treatment is carried out in stationary conditions.

specific antiviral treatment includes:

• antiviral drugs (Ganciclovir, Foscarnet);
• anticytomegalovirus immunoglobulin (Cytotect);
• interferons (Viferon).

Antiviral drugs have a pronounced toxic side effect on the blood system, kidneys and liver. Therefore, they are prescribed to children if their effect exceeds the potential risk of side effects. Some decrease in toxicity is observed with the combined use of antiviral drugs with interferons.

Unfortunately, antiviral drugs will not save the child from the virus, they will not lead to a complete recovery. But their use will help prevent the development of complications and transfer the disease to a latent, inactive stage.

In case of accession of secondary infections, apply antibiotics.

With generalized forms, it matters vitamin therapy, symptomatic detoxification therapy.

In severe cases, they can be used.

Given the overwhelming (immunosuppressive) effect of the virus on immunity, it is possible to use (according to the results of an immunogram study) immunomodulators(Taktivin).

In some cases, they are used alternative medicine methods(folk remedies, homeopathy, acupuncture).

Traditional medicine is aimed at increasing immunity. Traditional medicine suggests using decoctions and infusions from wild rosemary leaves, string, alder cones, birch buds, licorice root and elecampane, flax seeds and others - there are many recipes, but their use in children must be agreed with the attending physician.

Prevention of CMVI

There is currently no specific prevention of CMVI. To prevent intrauterine infection, it is recommended that pregnant women carefully observe the rules of hygiene and examine them for TORCH infections. If CMVI is detected in a pregnant woman, it is necessary to adequately treat it and administer a specific immunoglobulin (Cytotect) every 2-3 weeks, 6-12 ml, during the first trimester.

It will protect the child from infection and careful hygiene when caring for young children, it is also necessary to teach these rules to older children.

Cytomegalovirus (CMV) in children is discovered quite by accident. Very often, after examining a child for infections, the mother hears a mysterious phrase from the doctor: antibodies to cytomegalovirus were found in the blood.

Most of the children are infected with it, but the infection behaves secretly and does not manifest itself until a certain point.

Infection is activated in children against the background of a decrease in immunity and its consequences can be very sad: loss of vision, hearing, impaired intelligence and even death. What are the symptoms of cytomegaly and why is the disease considered so dangerous?

Causes of pathology - DNA-containing virus, one of the family. Having penetrated once into the body, the pathogen remains in it for life. If there are no manifestations of the disease, then this form of infection is called carriage. According to statistics, 80-90% of adults are infected with cytomegalovirus, and the first encounter with the pathogen occurs in childhood.

Once in the bloodstream, the virus seeks to penetrate the cells of the salivary glands - this is a favorite localization of the pathogen.

The virus infects the respiratory tract, liver, spleen, brain, gastrointestinal tract, kidneys.

In cages it inserts its DNA into the nucleus, after which the production of new viral particles begins. The infected cell greatly increases in size, which gave the name to the pathogen: in Latin it means "giant cells".

Usually cytomegalovirus in children not causes vivid symptoms and proceeds secretly. The disease causes serious damage when immune defenses are weakened, which occurs in the following groups of babies:

• premature and weakened;
• In children with congenital defects;
• HIV-infected;
• with disorders in the immune system;
• with chronic diseases (diabetes mellitus, glomerulonephritis).

How is it transmitted?

A carrier or a sick person releases the virus into the environment with saliva, breast milk, urine, mucus from the genital tract.

Infection of a child can occur in the following ways:

• Vertical - occurs during fetal development. The virus is able to cross the placenta into the bloodstream of the fetus from the mother's body. The risk of infection is especially high if a woman has had an acute form of infection during pregnancy.
• With mother's milk - if a woman is ill with an acute form of infection or became infected during lactation.
• Contact, airborne - when passing through the birth canal and at an older age, when the baby communicates with infected people.

Kinds

There is no generally accepted classification of cytomegalovirus infection. Doctors divide the disease both by the time of infection (congenital, acquired) and by prevalence (generalized, localized). In a separate group, infection in HIV-infected children is isolated.

congenital

Congenital is an infection that a child received from mother during pregnancy. If infection occurs in the first trimester, the pregnancy is terminated or a baby is born with severe malformations. Infection in the later stages occurs in a milder form.

Downstream, congenital cytomegalovirus infection can be:

• acute;
• chronic.

The acute form appears immediately after birth, while the chronic form develops gradually during the first months of life.

Acquired

Acquired cytomegalovirus infection baby becomes infected during breastfeeding from the mother or through contact with a sick person. In infants, the disease can be severe, in children of preschool and school age - according to the type of SARS.

Along the course, the disease can be:

• latent - localized form (the virus lives in the salivary glands);
• acute - according to the type of SARS with an increase in temperature;
• generalized - a severe form with damage to many organ systems.

Symptoms

Symptoms will depend on the form of the disease, the age and immune status of the child.

Newborn

Cytomegalovirus in children of the first days of life affects the liver, which manifests itself as icteric coloration of the skin and eyes. Normally, jaundice in newborns disappears within a month, while in infected children it lasts up to six months. May be disturbed digestion, the child does not gain weight well, worries.

Damage to the hematopoietic system leads to a decrease in the number of platelets- blood cells responsible for clotting. As a result, the child's skin is easy bruises appear, may be small hemorrhagic rash. Possible symptoms such as bleeding from the navel, blood in the stool and in the vomit.

Infection in newborns causes inflammation of the brain tissue(encephalitis) with subsequent formation of dense calcified inclusions in the lesions. The baby may have symptoms such as convulsions, loss of consciousness, neurological disorders.

An increase in head size is the result of dropsy of the brain due to increased production of cerebrospinal fluid against the background of an inflammatory reaction.

Damage to the central nervous system is usually combined with visual impairment. The virus penetrates the structures of the eye and damages them, which is why the baby the lens may become cloudy, the shape and color of the iris, pupil may change. Often the consequences of cytomegaly are a permanent visual impairment.

Cough, shortness of breath, bluish skin color newborn - symptoms of cytomegalovirus pneumonia. Decreased amount of urine, unusual color or strong odor talk about kidney damage with an acute form of infection.

congenital infection leads to very serious consequences, up to deep disability and death of the child. Treatment with folk remedies will not help here, serious drug therapy is required.

For a one year old or older

In children one year and older, the infection is usually acquired. The disease manifests itself as inflammation of the upper respiratory tract. The baby is worried cough, pain when swallowing, fever body. Can join rash all over body in the form of red spots.

The child has enlarged lymph nodes on the neck, under the lower jaw, in the armpits, groin. Swollen lymph nodes are painless, the surface of the skin is of a normal color.

Sometimes the child complains about abdominal pain, in its right half or on both sides. Causes of pain - an increase in the liver and spleen in size. There may be a small yellowness of the skin and eyes- symptoms of liver damage.

Although the disease is similar to a common ARVI, treatment with folk remedies will not completely cure the child.

Diagnostics

Diagnosing such a disease in children is not an easy task, since the manifestations are nonspecific and resemble the course of many other diseases. The doctor will examine the child, after which he will prescribe the necessary tests and studies to confirm cytomegaly.

Analyzes

The following tests will help detect an infection in a child:

• Blood tests for antibodies to the pathogen - the protective protein Ig M indicates an acute infection, and IgG indicates a chronic or latent form.
• PCR of urine and saliva - allows you to detect the pathogen itself in the material.
• Complete blood count - the child has a reduced number of red blood cells (anemia), platelets and white blood cells.
• Biochemical blood tests - liver enzymes ALT and AST increase, with kidney damage, the concentration of urea and creatinine will increase.

The urine sediment must be examined under a microscope for the presence of giant cells with an owl-eye nucleus will confirm the diagnosis of cytomegaly.

Instrumental Methods

They are prescribed depending on which system in the child is affected:

• chest x-ray - if the lungs are affected, the picture will show signs of pneumonia;
• Ultrasound of the abdominal cavity - will reveal an increase in the liver and spleen, possible hemorrhages in them;
• Ultrasound or MRI of the brain - will detect foci of inflammation or calcifications.

With a generalized infection, the doctor will prescribe an examination of the fundus by an ophthalmologist. This will allow timely detection of damage to the structures of the eye and, possibly, preserve vision, subject to competent treatment.

Treatment

How and how to treat the disease? Treatment is carried out by an infectious disease specialist together with a pediatrician. If necessary, the child will be observed by a neurologist, ophthalmologist, nephrologist or urologist.

Preparations

A drug that completely eliminates cytomegalovirus from the body has not been developed. Initially, there were attempts to treat him with antiherpetic drugs, but this scheme was not very successful.

The doctor may prescribe ganciclovir, although in babies it is used only in desperate situations due to its high toxicity. The drug can only be used in older children in case of severe infection.

In case of a severe infection, human immunoglobulin is administered intravenously to the child - protective antibodies that will help prevent the negative consequences of the disease.

If the cytomegalovirus in a child proceeds according to the type of ARVI, then the doctor will prescribe drugs that will alleviate the symptoms of the disease:

• antipyretic - at temperatures above 38 degrees C;
• expectorant - when coughing with viscous sputum;
• immunomodulatory - for children over 5 years old to accelerate the production of protective antibodies;
• vitamin and mineral - to increase the body's resistance to disease.

• Be sure to read:

During an acute infection, the doctor will prescribe bed rest, large amounts of warm liquid(tea with honey, fruit drink, compote), treatment with folk remedies: gargling with antiseptics(chamomile, soda, iodine) - this will not eliminate the causes of the disease, but will greatly facilitate the manifestations.

Prevention

Prevention of infection includes the observance of the rules of personal hygiene by the child, since the virus is transmitted by contact. Outdoor walks, a varied menu, a rational daily routine - all this will strengthen the baby's immunity and make it easy to survive the attack of the virus.

To protect the child from congenital cytomegaly, a woman during pregnancy planning should take an antibody test. If antibodies are not detected, the doctor will prescribe a prophylactic vaccination to the expectant mother.

The vaccine will form immunity to the pathogen, protect the woman during pregnancy from infection.

Treatment of folk remedies for acute infection during pregnancy is ineffective, you should definitely consult a doctor if you have any symptoms of SARS. The consequences of congenital cytomegaly are too serious to neglect the possible danger.

Cytomegalovirus is one of the most common infectious agents in the human population and occurs in more than half of the world's children at some age or another.

The penetration of the virus into the body of a child usually does not pose a particular danger, since most often it is asymptomatic and does not require treatment. However, the danger arises when infected during the period of gestation, the first weeks after birth, or a significant decrease in the activity of the baby's immune system ...

The penetration of the virus into the child's body

In the development of cytomegalovirus infection, the mechanism of the introduction of the virus and the age of the child play a special role.

There are the following ways of penetration of cytomegalovirus into the children's body:

• antenatal (through the placenta during intrauterine development);
• intranatal (during childbirth);
• postnatal (after birth).

The most severe consequences for the health of the child occur when infected through the placenta. In this case, the virus is in the amniotic fluid and in large quantities enters the digestive system and lungs of the child, from where it penetrates almost all organs and tissues.

With the primary infection of the expectant mother during pregnancy, the probability of penetration of the virus into the amniotic fluid reaches 50%.

Sometimes during pregnancy there is a decrease in the overall resistance of the body, against the background of which an exacerbation of a latent infection is possible. However, the mother's body already has specific antibodies that reduce the risk of infection of the fetus to 2%, and also protect the body of the unborn child from the development of serious complications.

If the mother has antibodies to the virus without any signs of the disease, the risk of developing a congenital infection in the child is practically absent.

Primary infection or activation of a chronic infection in the mother in the 1st and 2nd trimesters of pregnancy poses the greatest threat to the health of the developing fetus, and sometimes leads to miscarriage. During this period, the fetus does not produce its own antibodies, and maternal antibodies are not enough for effective protection. In the third trimester, the fetus develops its own antibodies of classes M and G, so the risk of complications is minimal.

Infection during childbirth plays a minor role in the transmission of cytomegalovirus: the probability does not exceed 5% for the birth of a child by a mother with an active infection.

In the postnatal period, babies can become infected from their parents through kissing and other close contact. When breastfeeding infected mothers in 30-70% of cases, the virus is transmitted to the child.

Most often, infection occurs at the age of 2 to 5-6 years. During this period, the child, as a rule, attends preschool institutions, where there is a high probability of transmission of the pathogen from staff and from other children. In carriers, the virus can be present in blood, saliva, urine, and other secretions and be transmitted through close contact, sneezing, violation of hygiene requirements, and the use of shared toys. The frequency of infection in preschool institutions is 25-80%. From an infected human body, the virus can actively stand out for about two years.

Cytomegalovirus infection in children aged 2 to 6 years is most often asymptomatic and does not lead to any negative consequences. After 5-6 years, the activity of the immune system in babies becomes stable, and the potential risk of developing severe cytomegaly decreases to almost zero.

Cytomegalovirus infection in newborns

There are congenital and acquired forms of CMV infection.

The congenital form is manifested during intrauterine infection of the fetus and has a more severe course. Despite the high frequency of transmission of the virus from a sick mother to her fetus, only about 10% of children are born with a congenital infection. Of these, more than 90% have no signs of the disease.

Symptoms of a congenital infection include prematurity, jaundice, drowsiness, and impaired swallowing and sucking. Often there is an increase in the spleen and liver, convulsions, strabismus, blindness, deafness, microcephaly, hydrocephalus. Sometimes anomalies in the development of the cardiovascular, digestive and musculoskeletal systems are found.

The absence of these symptoms in a newborn with suspected congenital CMV infection does not yet indicate the health of the child. Perhaps a later manifestation of the disease in the first 10 years of life in the form of mental retardation, impaired tooth formation, decreased visual acuity and hearing.

Acquired infection develops when infected during childbirth and in the first weeks of life. Symptoms of the disease appear 1-2 months after birth. There is a lag in mental and physical development, reduced or increased motor activity, convulsions, swelling of the salivary glands, visual impairment, subcutaneous hemorrhages. Pneumonia, pancreatitis, diabetes, hepatitis can develop. However, in most cases, the acquired infection is asymptomatic and goes into a latent form.

Normal course of the disease in children

As a rule, the child's body copes with cytomegalovirus quite effectively without any external manifestations. In some cases, a mononucleosis-like syndrome manifests itself. Its main symptoms are similar to SARS: fatigue, muscle and joint pain, headache, chills, fever, runny nose. Sometimes there is an increase in lymph nodes, increased salivation, whitish coating on the gums and tongue.

The disease lasts from two weeks to two months. The duration of symptoms may serve as an indirect indication of CMVI. Hospitalization and specific treatment are not required.

Occasionally encountered complications

Lack of control over the course of infection in an apparently healthy child with suspected congenital infection can lead to delayed onset of complications.

Approximately 17% of asymptomatic children infected with cytomegalovirus have convulsions, movement disorders, abnormal skull sizes (micro- or hydrocephalus), and insufficient body weight a few months after birth. At the age of 5-7 years, 10% of babies show disorders of the nervous system, speech impairment, mental retardation, and underdevelopment of the cardiovascular system. About 20% of children at this age rapidly lose their sight.

Acquired infection most often does not give severe complications. However, when observing symptoms of a mononucleosis-like disease for more than two months, you should consult a doctor.

Forms of CMV infection and their features

The first entry of CMV into the body causes a primary infection. With normal activity of the immune system, it is asymptomatic, with a reduced immune status - acutely, with signs of a mononucleosis-like syndrome. Liver damage, pneumonia can also be recorded.

With a weakened immune system, a recurrent infection develops. It manifests itself in the form of frequent bronchitis, pneumonia, multiple inflammation of the lymph nodes, chronic fatigue and general weakness. Inflammation of the adrenal glands, kidneys, pancreas, spleen may develop. In severe relapses, the fundus, retina, intestines, nervous system, and joints are affected. Often there is an attachment of bacterial infections.

The atypical course of cytomegalovirus infection is rare and can be manifested by small skin rashes, damage to the reproductive system, paralysis, hemolytic anemia, dropsy of the abdomen, decreased blood clotting, enlargement of the brain ventricles or the formation of cysts in them.

How to identify cytomegalovirus in a child: diagnostic methods

Diagnosis of CMVI is possible by several methods:

• cultural: virus isolation in culture of human cells. The method is the most accurate and allows you to determine the activity of the virus, but takes about 14 days;
• Cytoscopic: Detection of characteristic owl-eye giant cells in urine or saliva. The method is not informative enough;
• Enzyme immunoassay (ELISA): detection of immunoglobulins M (IgM) in the blood indicates a primary infection. If immunoglobulins G (IgG) are detected, a second examination is carried out with an interval of at least two weeks. An increase in antibody titers indicates the activation of the infection. It is possible to obtain false positive results;
• Polymerase chain reaction (PCR): A fast and accurate method to detect the DNA of a virus and its rate of reproduction in the body.

The most common is enzyme immunoassay. When using it, it is necessary to determine several types of antibodies at once, which makes it quite expensive. However, it allows you to determine the stage of the infection. The accuracy of the method is about 95%.

Due to the high cost, the PCR method is not available to every laboratory, but if possible, it should be preferred due to its high accuracy (99.9%).

A short video on how enzyme immunoassay is done

Features of the fight against infection

With asymptomatic CMVI and mononucleosis-like syndrome, treatment is not required. In the second case, drinking plenty of water is recommended to reduce signs of intoxication.

Treatment is necessary for severe symptoms of a congenital infection or complications. The list and dosage of drugs is determined by the doctor, taking into account the severity of the disease, the age and body weight of the child. Antiviral drugs are used for treatment: Ganciclovir, Viferon, Foscarnet, Panavir, Cidofovir. As well as immunoglobulin preparations - Megalotect and Cytotect.

Self-treatment is categorically contraindicated due to the high likelihood of developing severe side effects.

A few words about prevention

Means of specific prevention of cytomegalovirus infection are absent. A vaccine is under development.

To protect the child from the possible consequences of infection, it is necessary, first of all, to take a serious approach to planning pregnancy. The expectant mother should be tested for the presence of specific antibodies. In the absence of immunity to the virus, a pregnant woman must use separate dishes, avoid frequent contact with small children, and carefully observe the rules of personal hygiene. During pregnancy, a double examination for the presence of antibodies to the virus is mandatory for the timely detection of a primary infection or a recurrence of a chronic one.

In the first months after birth, the child should be protected from close contact with adults and children under 6 years old, and kissing the newborn should be avoided. 2-3 months after birth, the child's immune system is already able to protect him from the development of severe forms of infection, so in the future it is enough to provide the baby with proper care. After 6 years, the formation of the immune system is completed. From this age, the body of a normally growing child is able to effectively cope with cytomegalovirus without the development of clinical manifestations.

In the future, it is enough to instill in the baby the necessary hygiene skills, provide a balanced diet and harden the body.

Content

Many viruses in a child's body do not appear immediately. One of these is cytomegalovirus, which is detected by chance during a blood test. Infection occurs even before birth - through the uterus or placenta in utero. Sometimes cytomegalovirus is also acquired, but the congenital type causes more complications and is more severe. The causative agent of the disease is a virus belonging to the group of herpes viruses. It is more likely to be found in the salivary glands.

What is cytomegalovirus

This is the abbreviation for cytomegalovirus infection (CMVI), which has no seasonality. Its other names are: cytomegalovirus, CMV infection, CMV. The disease belongs to the herpesvirus family along with the viruses that cause chickenpox and herpes simplex. The difference between CMV is that it can affect the child's body both in utero and in other ways.

Cytomegalovirus (Cytomegalovirus hominis) belongs to the family of DNA-containing viruses of the fifth type. Under a microscope, it looks like a round, prickly shell of a chestnut fruit. On the cut, the pathogen resembles a gear. Cytomegalovirus causes the infection of the same name. The activator has the following distinctive properties:

1. Asymptomatic course of infection caused by a virus. The causative agent is not aggressive. This is confirmed by the fact that after entering the body, the virus may not manifest itself for a long time, which is why CMV is called conditionally pathogenic.
2. A characteristic localization site is the salivary glands, from where CMV can “travel” throughout the body.
3. Indestructibility. After a single entry into the human body, the virus introduces its genetic material into different cells, from where it can no longer be eliminated.
4. Ease of transfer. The virus quickly and actively spreads among people even against the background of low infecting abilities.
5. Isolation with many human body fluids. The virus is contained in lymphocytes - cells of the immune system and epithelial tissue. For this reason, it is excreted with saliva, seminal fluid, vaginal secretions, blood, tears.
6. Low resistance to the environment. Inactivation of the virus occurs when heated to 60 degrees or freezing.

Transmission routes

Cytomegalovirus is not highly contagious, so transmission to a healthy person occurs through close contact with a carrier or already sick. The sexual route of infection is typical for adults. In children, infection often occurs through kissing and other contact with the patient. So, the main ways of transmission of cytomegalovirus are as follows:

• Airborne. Infection occurs when talking with the patient or as a result of his sneezing.
• Contact. Infection occurs through direct contact while feeding a child, with a kiss, treatment of wounds with unprotected hands. Infection is also possible in the household way when using clothes and other personal belongings of the patient. In the first days of his life, a newborn can become infected through breast milk.
• parenteral. A person becomes infected during a blood transfusion or transplant of an infected organ.
• Transplacental. The virus is transmitted through the placental barrier or the walls of the birth canal from mother to fetus. The result - a congenital cytomegalovirus develops in a child.

Kinds

According to the main classification, cytomegalovirus infection is congenital or acquired. In the first case, the newborn becomes infected while still inside the womb through the placenta. Acquired cytomegalovirus develops when the fetus passes through the birth canal, when the fetus comes into contact with their mucosa. Transmission can occur by contact, household, parenteral and airborne droplets after the birth of a child. According to the prevalence of the disease is divided into the following types:

• Generalized. It has many varieties, taking into account the predominant damage to organs. Often observed in immunodeficiency.
• Localized. In this case, the virus is found only in the salivary glands.

A separate species is cytomegalovirus infection in HIV-infected children. According to the nature of the course, the disease is divided into 3 forms:

• Sharp. It is more often observed with the parenteral route of infection. The infection occurs in a person for the first time and there are no antibodies to it in his blood. In response to the virus, the body produces antibodies that limit the spread of pathology. A person may not even feel the process.
• Latent. This form means that the virus is in an inactive state in the body. The produced antibodies cannot eliminate CMV cells completely, so some of the pathogenic cells remain. The virus in this state does not multiply and does not spread throughout the body.
• Chronic. Periodically, the virus can become active from inactive. At the same time, it begins to multiply and spread throughout the body. A blood test during reactivation of the virus shows an increase in the level of antibodies to it.

Symptoms

Congenital cytomegalovirus infection in children can manifest itself in different ways. If infected before 12 weeks, fetal death or the formation of malformations is possible. At a later date, CMV infection is accompanied by symptoms such as:

• convulsions;
• hydrocephalus;
• nystagmus;
• facial asymmetry;
• trembling of the limbs of the child.

After birth, doctors diagnose hypotrophy in the baby. The most common complication is congenital hepatitis or cirrhosis of the liver.. Additionally, the newborn may experience:

• yellowness of the skin for 2 months;
• petechial hemorrhages on the skin;
• blood impurities in feces and vomit;
• bleeding of the umbilical wound;
• hemorrhages in the brain and other organs;
• an increase in the size of the liver and spleen;
• increased activity of liver enzymes.

The congenital form can also manifest itself in preschool age. Such children have mental retardation, atrophy of the Corti's organ of the inner ear, chorioretinitis (damage to the retina). The prognosis of congenital CMVI is often poor. The acquired one proceeds according to the type of SARS, which makes it difficult to diagnose. Typical symptoms include:

• runny nose;
• cough;
• temperature rise;
• liquid stool;
• redness of the pharynx;
• lack of appetite;
• slight enlargement of the cervical lymph nodes.

The incubation period of CMV infection lasts from 2 weeks to 3 months. Most patients have a latent course of the disease, which is not accompanied by obvious symptoms. Against the background of a decrease in immunity, the infection can pass into 2 forms:

• Generalized mononucleosis-like form. Has an acute onset. The main signs of intoxication are: muscle and headaches, weakness, swollen lymph nodes, chills, fever.
• Localized (sialadenitis). The parotid, submandibular or sublingual glands are infected. The clinical picture is not very pronounced. The child may not gain weight.

Given the localization, cytomegalovirus causes different symptoms in children. In the pulmonary form, CMV infection proceeds according to the type of pneumonia, as indicated by the following signs:

• dry hacking cough;
• dyspnea;
• nasal congestion;
• pain when swallowing;
• rash on the body in the form of red spots;
• wheezing in the lungs;
• bluish lip color.

The cerebral form of CMV infection is meningoencephalitis. With it, convulsions, seizures of epilepsy, paresis, mental disorders and impaired consciousness are noted. There are other forms of localized cytomegalovirus:

1. Renal. It proceeds according to the type of subacute hepatitis. Accompanied by yellowness of the sclera and skin.
2. Gastrointestinal. Differs in frequent loose stools, vomiting, bloating. Accompanied by polycystic lesions of the pancreas.
3. Combined. Here, many organs are involved in the pathological process. This condition is typical for patients with immunodeficiency. The hallmarks of combined CMV infection are a generalized enlargement of the lymph nodes, severe intoxication, bleeding, fever with a daily temperature range of 2–4 degrees.

For a child under one year old

Cytomegalovirus in children of the first days of life causes icteric staining of the skin, sclera and mucous membranes. In healthy babies, this goes away within a month, and in infected babies it lasts up to six months. The child often worries, his weight increases badly. A list of other characteristic signs of cytomegalovirus under the age of one year includes:

• easy bruising on the skin;
• punctate hemorrhagic rash;
• bleeding from the navel;
• admixture of blood in vomit and feces;
• convulsions;
• neurological disorders;
• loss of consciousness;
• visual impairment;
• clouding of the lens of the eye;
• change in the color of the pupil and iris;
• shortness of breath
• cyanotic skin color (with pulmonary form);
• decrease in the amount of urine.

Why is cytomegalovirus dangerous for a child

CMV is detected in 50-70% of people by the age of 35-40. By retirement age, even more patients are immune to this virus. For this reason, it is difficult to talk about the danger of CMV infection, since for many it has gone completely unnoticed. More dangerous is cytomegalovirus for pregnant women and unborn children, but on condition that the expectant mother encounters it for the first time. If she had previously had CMV infection, then her body contains antibodies to cytomegalovirus. Under such conditions, there is no harm to the child.

The most dangerous for the fetus inside the womb is the primary infection of the mother. The child either dies or acquires serious malformations, such as:

• mental retardation;
• deafness;
• hydrocephalus;
• epilepsy;
• cerebral paralysis;
• microcephaly.

When a child is infected during passage through the birth canal, he may develop pneumonia, encephalitis, meningitis. After infection during breastfeeding or blood transfusion in the first days after birth, cytomegaly may go unnoticed, but in some cases it causes lymphocytosis, anemia, pneumonia. The newborn at the same time gains weight poorly and lags behind in development.

Diagnostics

All examination methods are prescribed by a pediatrician who consults with an infectious disease specialist. Already after the detection of cytomegalovirus, an oculist, urologist, neurologist, nephrologist can take part in the treatment. To confirm the diagnosis, a complex of laboratory and instrumental studies is used, including:

• general and biochemical blood tests;
• linked immunosorbent assay;
• X-rays of light;
• Ultrasound of the brain and abdominal cavity;
• examination of the fundus by an oculist.

Blood test for viruses in a child

Of the laboratory diagnostic methods, the doctor is the first to prescribe a general and biochemical blood test. The first reflects reduced levels of red blood cells, white blood cells, and platelets, which indicates inflammation in the body. Biochemical analysis reveals an increase in AST and ALT. An increase in urea and creatinine indicates kidney damage. To isolate the virus itself, the following methods are used:

• PCR (polymerase chain reaction). Using this method, CMV DNA is detected in the blood. Biological material can be saliva, urine, feces, cerebrospinal fluid.
• Linked immunosorbent assay. It involves the detection of specific antibodies to cytomegalovirus infection. The basis of the method is the antigen-antibody reaction. Its essence is that the antibodies produced by the body during the penetration of the virus bind to proteins on the surface of CMV - antigens. The study is serological. The results of the ELISA are decoded as follows:

1. If IgM antibodies were detected, then we are talking about primary infection and the acute phase of CMV infection (if they were detected in the first 2 weeks after birth, then we are talking about congenital CMVI).
2. Detected lgG antibodies up to 3 months of life are considered transmitted from the mother, therefore, at the age of 3 and 6 months, a second study is carried out (if the titer has not increased, then CMVI is excluded).
3. Cytomegalovirus IgG positive is a result indicating that the person has immunity to this virus and is its carrier (pregnant women have a chance of transmitting the infection to the fetus).

Cytomegalovirus in newborns can be detected even without the determination of specific antibodies. In this case, 2 blood samples are taken at an interval of 30 days, in which the IgG level is assessed. If it has increased by 4 or more times, then the newborn is considered infected. When specific antibodies are detected in the first days of a small patient's life, then he is diagnosed with congenital cytomagelovirus.

Instrumental Methods

Hardware diagnostic methods are used to detect pathological changes in internal organs and systems. This allows you to determine the degree of damage to the body by CMV infection. The following procedures are often prescribed in this case:

• X-ray. In the resulting picture, you can see signs of pneumonia or other lung diseases in the pulmonary form of CMVI.
• Abdominal ultrasound. Sets an increase in the size of the spleen and liver. Additionally displays hemorrhages in the organs, disorders of the urinary system and digestion.
• Ultrasound and MRI of the brain. These studies show the presence of calcifications and inflammatory processes in the brain tissue.
• Examination of the fundus by an ophthalmologist. It is prescribed for the generalized form of CMVI. The study reveals changes in the structure of the visual apparatus.

Treatment of cytomegalovirus in children

Therapy is prescribed taking into account the type and severity of the disease. Only the latent form of cytomegalovirus infection does not require special treatment. With it, the child must be provided with:

• daily walks in the fresh air;
• rational nutrition;
• hardening of the body;
• psycho-emotional comfort.

With reduced immunity, the introduction of nonspecific immunoglobulin - Sandoglobulin is prescribed. In the case of acute CMVI, the patient needs bed rest and a large amount of warm liquid for the first couple of days. The basis of treatment are antiviral and some other drugs, such as:

• Foscarnet, Ganciclovir, Aciclovir - antiviral;
• Cytotect - anticytomegalovirus immunoglobulin;
• Viferon is a drug from the category of interferons.

Antivirals are highly toxic, and therefore have many side effects. For this reason, they are prescribed to children only if the intended benefit outweighs the possible risk. The toxicity of antiviral drugs is somewhat reduced if they are used with interferon preparations, so this combination is often used in practice. Ganciclovir treatment regimens look like this:

• With acquired CMVI, the course is 2-3 weeks. The drug is prescribed at a dosage of 2-10 mg / kg of body weight 2 times a day. After 2-3 weeks, the dose is reduced to 5 mg/kg and the course of treatment is continued until complete relief of the clinical manifestations of CMVI.
• The congenital form of the infection is treated with a double dosage - 10-12 mg / kg of body weight. The course of therapy in this case lasts 6 weeks.

Associated secondary infections are treated with antibiotics. The generalized form of CMVI requires the appointment of vitamin therapy. Symptomatic treatment consists in prescribing the following drugs:

• expectorants (Bromhexine) - with a pulmonary form, accompanied by a cough with viscous sputum;
• antipyretic (Paracetamol) - in case of temperature rise above 38 degrees;
• immunomodulating (Isoprinosine, Viferon, Taktivin) - at the age of 5 years to accelerate the production of protective antibodies.

Prevention

One of the important conditions for the prevention of cytomegalovirus is hygiene. An older child needs to be explained the need for thorough handwashing. A mother with cytomegalovirus should stop breastfeeding if her baby is born healthy. Prevention measures also include the following rules:

• strengthen the baby's immunity;
• provide him with good nutrition, hardening and regular exercise;
• limit the contact of the child with sick people;
• when planning a pregnancy, take an analysis for antibodies to CMV in order to get vaccinated on time if necessary;
• avoid kissing on the lips with an infant.

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Mostly, cytomegalovirus in children is detected by chance, when antibodies to CMVI (Cytomegalovirus infection) are present during a blood test. Almost 60% of children are infected with CMVI, but the virus is in a latent phase (in sleep mode) until a certain time, namely, until the immune system decreases, without showing itself. Below we will talk about the causes and treatment of this disease, as well as how cytomegalovirus infection manifests itself in children.

Common Causes

Initially, the pathogen enters the respiratory system, digestive system or genital organs through the mucous membranes of the mouth and nose. In the field of CMVI introduction in children, modifications (changes) usually do not occur. The virus, once in the body, continues to exist there forever, being in a latent phase until the immunity of the child's body decreases.

Causes of immune deficiency can be:

• chemotherapy;
• frequent colds - acute respiratory infections, acute respiratory viral infections, tonsillitis;
• the use of cytostatics (drugs that suppress cell division);
• HIV AIDS;
• severe illnesses.

The source of infection with cytomegalovirus in children is only the virus carrier - a person with CMVI. Consider several options for transmission of infection:

• transplacental - the infection is transmitted to the fetus by the penetration of the virus through the placenta from an infected mother;
• contact route of transmission of infection - when kissing with the help of saliva, it enters the mucous membranes of the mouth and throat, through the larynx into the upper respiratory system;
• airborne transmission line - when the virus carrier sneezes or coughs while communicating with him, as well as with the help of saliva;
• household way of transmission of infection - with the general use of household items.

Cytomegalovirus infection in a child, as a rule, most often occurs at the age of two years. Children already go to kindergarten or school, but personal hygiene is not yet more scrupulous. In addition, they like to exchange different items or share food and different goodies.

Ways of infection of the fetus in utero or a newborn baby

A newborn baby can be infected by a sick mother during childbirth (intranatal) or breastfeeding (50% of cases of infection). Cytomegalovirus in a child can occur when the mother has an acute or exacerbated cytomegalovirus disease. In this case, infection of the fetus leads to the development of congenital cytomegaly in children.

A particularly serious danger is when a viral infection of the fetus occurs at the beginning of pregnancy, approximately in the first three months. This can lead to the death of the child, and cytomegalovirus infection in newborns can be reflected in the occurrence of defects of a different plan - deformity or pathology of internal organs.

Classification of cytomegalovirus in children

CMVI is characterized by a numerous variety of forms:

• latent (sleep mode) or acute;
• localized (place of formation of the pathological process);
• generalized (spread of an abnormal process throughout the body or a separate organ from the focus of infection);
• acquired;
• congenital.

As a rule, CMVI in newborns occurs in utero. Most often this happens when a woman becomes infected with this disease before conceiving a child or during pregnancy. The fetus becomes infected through the placenta. If infection occurs at an early stage of pregnancy, then most often the pregnancy ends in miscarriage.

Symptoms

Signs of congenital cytomegalovirus

With neonatal (newborn period) infection, the symptoms of cytomegalovirus in children may be malformations of further development. The virus assists in the formation of heart disease, a pathological deviation in the formation of the brain and other severe abnormal processes in the child's body.

The first symptoms of the actual presence of cytomegalovirus infection in children are the following signs:

• hypotonicity (reduced tone) of muscles;
• general weakness;
• lethargy;
• restless sleep;
• inability to digest food;
• reduced appetite.

In rather severe cases, death is likely, possibly in the first weeks after birth.

When infected in the third trimester, in children, as a rule, congenital malformations are completely absent. But there may be complications that are expressed by jaundice (disease of the liver and biliary tract), hemolytic anemia (blood disease), hydrocephalus (dropsy of the brain) and other serious pathologies.

Signs of Acquired Cytomegalovirus

Acquired cytomegalovirus can manifest itself in extremely rare cases. Basically, it is in a latent phase, showing no effect on the baby's body, which indicates the high work of the child's immunity. This means that the immune system prevents the reproductive activation of this virus.

If children have low immune defense, then the disease will be expressed by frequent colds. These can be acute respiratory viral infections, acute respiratory infections with high body temperature and inflammation of the lymph nodes.

In chronic immune deficiency, the body of children is often exposed to infection. In this situation, possible complications are localized (located) in some systems of the child's body:

• nervous system;
• digestive system;
• the cardiovascular system;
• urinary system.

The form of this virus is treated for a long time, most often unsuccessfully. But CMVI of a complicated type is very rare. Signs of the disease and methods of treatment are vital information. Parents who care about the physical health of their children will without fail strive to prevent the permissible negative consequences of cytomegalovirus.

Diagnostics

Correctly diagnosing cytomegalovirus infection in children is very difficult, because the manifestations visually resemble some colds. The attending physician carefully examines the children, if necessary, gives directions for testing for research.

Analyzes

To detect cytomegalovirus in children, it is necessary to pass tests:

1. blood for the presence of immunoglobulins of class M and G to cytomegalovirus. Detection in the blood of class M immunoglobulins to CMV indicates primary infection, and if immunoglobulins G are detected, it indicates a chronic course of the disease;
2. using PCR of urine and saliva, you can consider the presence of the pathogen itself;
3. with a general blood test in children, the number of erythrocytes, platelets, and also leukocytes is examined;
4. biochemical blood tests to examine liver enzymes.

Methods of instrumental research

This examination is appropriate for:

1. Ultrasound of the abdominal cavity for the study of the liver and spleen;
2. MRI or ultrasound of the brain to study foci of inflammation.

With a generalized infectious disease, children are referred to an ophthalmologist for examination of the fundus.

Treatment

Treatment of cytomegalovirus infection in children greatly depends on the age of the baby, the form of the disease and its severity. The dormant form (latent form) of the virus does not require special treatment. In this case, children need more special attention in terms of the full provision of the following aspects:

• balanced diet;
• daily walks in the fresh air;
• easy hardening of the child's body;
• increased psychological comfort.

Probiotics (apathogenic bacteria for humans, ensure the restoration of microflora) and vitamin complexes help prevent dysbacteriosis and maximize digestion improvement.

Treatment of cytomegalovirus is required only for children with acute CMV. The mononucleosis-like form of the disease does not require special treatment, but symptomatic treatment is actively used.

With intrauterine cytomegalovirus, as well as with severe obvious (manifest) forms, inpatient complex treatment is usually carried out and antiviral treatment is included in the form of:

• antiviral drugs (Ganciclovir, Foscarnet);
• anticytomegalovirus Immunoglobulin (Cytotect);
• interferons (Viferon).

Antiviral drugs have a pronounced toxic side effect on the circulatory system, as well as on the kidneys and liver. In this case, these drugs are prescribed to children in case of a significant excess of their therapeutic effect over a high risk of side effects. Some decrease in toxicity is often recorded with the combined use of antiviral drugs with interferon.

Unfortunately, antiviral drugs do not save children from the virus, do not lead to the most complete cure. But their practical use in a timely manner will prevent the formation of complications and literally transfer the virus into a latent mode and a completely inactive form.

In order not to harm the health of the baby, you need a mandatory consultation with a pediatrician to find out how to treat cytomegalovirus and how. If necessary, the attending physician will give directions for examinations to such specialized specialists as:

• infectious disease physician;
• neurologist;
• nephrologist;
• urologist;
• ophthalmologist (oculist);
• hepatologist;
• gastroenterologist;
• dentist;
• pulmonologist;
• immunologist.

Summing up, it is worth recalling that cytomegalovirus infection, with certain forms of flow, does not always need treatment. It should also be noted that self-medication with CMVI is not allowed, especially for newborns. Therefore, at the first suspicion of an infection, immediately contact pediatrics.