Doctor Komarovsky about cytomegalovirus infection. Cytomegalovirus in children: general characteristics of this infectious pathology Manifestations of cytomegalovirus in children


Cytomagalovirus in children most often appears in utero. When a pregnant woman is infected, the pathogen enters the fetus with blood.

Developmental anomalies in a child appear when a pregnant woman is infected in the first trimester. Infection at other stages is not characterized by similar symptoms. Latent carriage of cytomegalovirus manifests itself after birth against the background of a decrease in the protective abilities of the immune system.

European Institute clinical researches about the frequency cytomegalovirus infection in pregnant women. The results showed that 90% of the fair half reproductive age infected with this pathogen. Absence clinical symptoms does not allow to diagnose cytomegalovirus at an early stage.

Screening tests for the pathogen have not been developed. Effective drugs against viral diseases have not been developed. The problem remains relevant for medicine in the 21st century.

The experiment revealed a high frequency of combined "cohabitation" of cytomegalovirus, ureaplasma, chlamydia, virus herpes simplex during pregnancy.

Symptoms of cytomegalovirus infection

Cytomegalovirus infection in a child is a fetal problem. The erased clinic does not allow gynecologists to identify the pathogen at the stage of pregnancy planning. When monitoring childbearing, doctors do not take cytomegalovirus infection seriously. Nosology can hide under the guise of other diseases. Timely diagnosis of the disease in pregnant women can prevent dangerous complications:

  • Fetoplacental insufficiency;
  • Spontaneous termination of pregnancy;
  • Risk of miscarriage;
  • dropsy fetus;
  • Stillbirth.

The main route of transmission of cytomegalovirus infection in adolescents is sexual. Statistics show a high frequency of a combination of cytomegalovirus and herpes simplex virus. There are cases of infection with urogenital contacts.

The latent course of infection in children is explained by lifelong immunity, which the baby acquires after contact with the pathogen. If the baby did not receive cytomegalovirus from the mother, when communicating with peers, it may well become infected.

With normal immunity, the entry of cytomegalovirus is not dangerous for the health of the child. On the contrary, infection allows the body to develop strong immunity. A single infection is sufficient for lifelong antibody protection.

It is impossible to protect children from visiting kindergartens, schools, public places. The high prevalence of the pathogen does not allow anyone to avoid cytomegalovirus infection.

Intrauterine infection is characterized by the active release of the pathogen during external environment for 5 years. Clinical manifestations can be traced only in 10% of children with reduced immunity. Symptoms are not specific to the disease:

  • General weakness;
  • Decreased appetite;
  • Skin rashes;
  • elevated temperature;
  • Headache;
  • Runny nose;
  • Sore throat.

The above symptoms are the body's reaction to viral persistence. An increase in temperature is a protective reaction aimed at accelerating biochemical reactions. Temperature response up to 38 degrees Celsius according to modern medical concepts is physiological. Symptoms of local inflammation arise due to the virion restriction reaction. The localized accumulation of viruses is destroyed by macrophages. An inflammatory response is required to remove the degradation products.

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 salivary glands Oh.

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 viruses that cause chicken pox 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. The typical location is 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. Selection with many biological fluids person. 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 environment. Inactivation of the virus occurs when heated to 60 degrees or freezing.

Transmission routes

Cytomegalovirus is not highly contagious, so transmission healthy person occurs with 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. Possible infection and 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 birth canal when the fetus comes into contact with their mucosa. Transmission can occur by contact, household, parenteral and by airborne droplets already after the birth of the 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. More often seen with parenteral route infections. 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. For more later dates 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. by the most frequent complication is congenital hepatitis or cirrhosis of the liver. Additionally, the newborn may experience:

  • jaundice skin within 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. These children have mental retardation, atrophy of the organ of Corti 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. Among characteristic symptoms stand out:

  • runny nose;
  • cough;
  • temperature increase;
  • 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. Clinical picture not very pronounced. The child may not gain weight.

Given the localization, cytomegalovirus in children causes different symptoms. 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. 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 liquid stool, vomiting, bloating. Accompanied by polycystic lesions of the pancreas.
  3. Combined. Here, in pathological process many organs are involved. This condition is typical for patients with immunodeficiency. hallmarks combined CMV infection are a generalized increase in 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. List of others characteristic features 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 cytomegalovirus for pregnant women and unborn children, but on condition that future mom encounters him 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:

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 research, including:

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 saliva, urine, feces, cerebrospinal fluid may appear.
  • 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 they were discovered IgM antibodies, then we are talking about primary infection and the acute phase of CMV infection (if they were identified in the first 2 weeks after birth, then we are talking about congenital CMV infection).
  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- this is a result indicating that a person is immune 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 identify pathological changes 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.
  • 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. special treatment does not require only a latent form of cytomegalovirus infection. 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 first couple of days the patient needs bed rest And a large number of warm liquid. 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 on the condition that the intended benefit exceeds 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. clinical manifestations 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 the appointment of 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 important conditions prevention of cytomegalovirus is hygiene. An older child needs to be explained the need for thorough handwashing. Mothers with cytomegalovirus should be discarded breastfeeding if her baby was 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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Cytomegalovirus in newborns is quite common. Infection occurs during fetal development or after childbirth. Only in 10-15% of cases, signs of the disease appear in babies immediately after birth. Children with asymptomatic cytomegalovirus syndrome are born clinically healthy. It is possible to detect an active form of cytomegalovirus infection in them only after laboratory research. The sooner to take remedial measures against the congenital form of the disease, the better the result will be.

What is cytomegalovirus infection

(cytomegaly) is viral disease, the causative agent of which is human cytomegalovirus (CMV) from the herpesvirus family. It mainly affects the salivary glands (especially the parotid). In the most severe form, the pathological process spreads to other organs - the lungs, liver, kidneys, adrenal glands, intestines, esophagus, pancreas, retina, and even the brain. Weak and premature babies have internal bleeding and cell death in the body.

Under the action of the virus, cells grow, which increase to gigantic sizes (30–40 times). A dense large intranuclear inclusion appears inside them. It makes the cell look like an owl's eye.

The virus is most dangerous for the fetus at the stage of embryonic development, if the pregnant woman was first infected with cytomegalovirus. Due to the absence of antibodies to the causative agent of the disease in the expectant mother, an unattenuated virus infects the embryo and disrupts its formation. The virus is serious and for the fetus for more late stage development. Cytomegalovirus is able to overcome the placental barrier and affect the health of the child. During the primary infection of a pregnant woman, infection of the fetus occurs in 40–50% of cases.

  1. If a woman is not infected with the virus for the first time, her antibodies weaken the pathogens and reduce their aggressive effect on the fetus. In such cases, the risk of infection of the child is no more than 1-2%.
  2. The likelihood of infection is increased by constant stress, malnutrition, a sedentary lifestyle and chronic diseases.
  3. The insidiousness of cytomegalovirus infection lies in its ability to proceed hidden or disguise itself as an acute respiratory viral infection. For this reason, the disease in pregnant women is often not diagnosed.

The detection of antibodies to CMV in newborns does not indicate their infection. Transfer of antibodies can be carried out through the placenta from mother to fetus during pregnancy. The diagnosis of cytomegalovirus infection is made by identifying pathogens in urine, blood and saliva.

Congenital cytomegalovirus infection

If a woman was infected with the virus in the first twelve weeks of pregnancy, pathogens can cause spontaneous abortion or fetal death. The embryo has serious developmental disorders that are incompatible with life. If the fetus manages to survive, the virus causes severe defects in it. Some of them are classified as genetic (Dandy-Walker syndrome).

The most serious malformations occur in children if a pregnant woman is diagnosed with cytomegaly for the first time. As a result of the infection, children develop microcephaly (a decrease in the brain), hepatosplenomegaly (an enlargement of the spleen and liver), thrombocytopenia (a decrease in the number of platelets, causing a decrease in blood clotting), and prolonged jaundice (hyperbilirubinemia).

The infection affects the fetal nervous system, causing serious illnesses(the debut of the episyndrome and treatment-resistant epilepsy, non-occlusive hydrocephalus, cerebral palsy, autism). In some cases, cytomegalovirus infection in newborns can cause deafness, visual impairment and mental retardation.

But most often the infection causes damage to the brain. People with a congenital form of cytomegalovirus infection are diagnosed with meningoencephalitis (inflammation of the membranes and substances of the brain), pathology of the brain ventricles, calcifications (salt deposits in soft tissues) and "calcification" cerebral vessels(mineralization vasculopathy). All these pathologies are accompanied by neurological disorders (cerebral changes, hypertensive-hydrocephalic syndrome). Mineralization vasculopathy often causes convulsive syndrome in the newborn.

  1. A common manifestation of cytomegalovirus infection is the blockade of the CSF pathways.
  2. It is diagnosed in 7% of cases when the brain is damaged by a viral infection.
  3. The virus infects the choroid plexus of the ventricles of the brain and causes the appearance of cysts in it.

If infection occurred in the second and third trimester of pregnancy, the virus can provoke hemorrhagic syndrome, hemolytic anemia, cirrhosis of the liver, interstitial pneumonia, enteritis, colitis, polycystic pancreas and nephritis.

Acquired form of cytomegalovirus infection

Immediately after birth, a newborn in 30% of cases is infected with cytomegalovirus from its mother through biological fluids containing the virus (saliva, breast milk, urine, genital discharge, blood). The baby can also get infected from other people.

According to pediatrician Yevgeny Komarovsky, if a child has a well-developed immune system, pathogens are unable to cause him serious illness. Premature babies, as well as babies with immunodeficiency, are vulnerable to the virus. They may develop productive peribronchitis or lingering pneumonia.

Sometimes, after infection with cytomegalovirus, weak infants increase The lymph nodes develops hepatitis. In the kidneys, cytomegalic changes in the tubular epithelium may appear. The virus can cause ulcers in the intestines of a child. Such children are difficult and take a long time to recover. They often lag behind in development.

Babies with an acquired form of cytomegalovirus infection do not develop brain damage.

Acute congenital disease

Congenital cytomegalovirus infection can occur in acute and chronic forms. At acute course disease, the first signs of the disease appear immediately after the birth of a child or during the first 24 hours.

The baby's body temperature rises. Bluish-violet spots become noticeable on the face, body and limbs. The infant may develop bleeding into the mucous membranes and blood in the stool (hemocolitis). Sometimes blood continues to ooze from the umbilical wound. The yellowness of the skin will indicate developing hepatitis.

If the brain is affected in newborns, they may experience convulsive syndrome. It lasts up to 5 days or more. jitter upper limbs occurs against the background of increased drowsiness.

Acute congenital cytomegalovirus infection can manifest as impaired coordination, hearing, and vision. Sometimes it causes blindness. The baby often develops pneumonia. Weak immunity and joining another acute infection can lead to neonatal death.

Chronic congenital disease

The chronic form of cytomegalovirus infection can be manifest and asymptomatic. Symptoms of the manifest course of the disease are manifested in the form of visual impairment. clouding of the lens and vitreous body cause deterioration or total loss visual perception. At baby find hydrocephalus, epilepsy, microgyria (structural abnormalities in the cerebral cortex), microcephaly, or signs of cerebral palsy.

kid with chronic form cytomegalovirus infection lags behind in development and gains weight poorly. At an older age, speech defects and mental retardation are found.

It is not always diagnosed in the first weeks after the birth of the baby. Therefore, the treatment of the disease is sometimes started too late. Early diagnosis and timely therapy can prevent visual impairment, stop the progression of epilepsy, hydrocephalic syndrome and other pathologies. In most cases, developmental delays can be avoided. Children with autism who have received adequate treatment are able to study in ordinary comprehensive schools.

The most difficult thing is to detect a latent form of chronic cytomegalovirus infection in a newborn. These babies do not have visible signs diseases. If laboratory tests were not carried out after the birth of the child, infection will not be detected for a long time.

A characteristic sign of defeat by cytomegalovirus is a tendency to bacterial infections. Often in the first year of a child's life, diseases of bacterial origin overcome. He is diagnosed with pyoderma (purulent skin lesions), recurrent stomatitis, otitis, sinusitis, bronchitis, pneumonia, cystitis, pyelonephritis. In some cases, symptoms of cytomegalovirus infection are detected only at school age.

Vaccinations are contraindicated for such children. Vaccination can give them autism, epilepsy, cerebral palsy, or mental retardation.

Treatment of a viral disease

Currently, with cytomegalovirus infection in newborns, injections of immunoglobulin into a vein are prescribed. Immediately after birth, the infant is injected with Cytotect hyperimmune immunoglobulin. The drug contains 10 times more than other immunoglobulins. It is made from the blood of donors who have a large number of antibodies produced by the body. "Cytotect" also contains antibodies to microbial pathogens that most often affect newborns in the postpartum period.

A significant improvement in the infant's condition is observed 7-8 days after the administration of Cytotect. The blood actively produces its own anti-cytomegalovirus and anti-herpetic antibodies.

Antibiotics are used to treat diseases caused by bacteria. Most often, a combination drug is prescribed to newborns with a wide range bactericidal action "Sulperazon". It contains 3rd generation cephalosporins (cefoperazone and sulbactam). "Sulperazon" is administered first intravenously, and then intramuscularly. The course of treatment is 8-14 days. In order for the baby to recover faster, he is also protected from other infections.

Cytomegalovirus in children (CMV) is a infectious disease caused by a specific microorganism Human betaherpesvirus 5. In most cases, the pathogen is detected in the study of blood and urine using the polymerase chain reaction method. Many children do not develop cytomegalovirus infection severe symptoms, and only under the influence of a number of factors do the first signs develop.

What is cytomegalovirus in children

Cytomegalovirus in a child is able to penetrate into the tissues of all organs, but it is most active in the salivary glands, multiplying rapidly and embedding its DNA into the nuclei of cells. When an infectious agent is introduced, lymphocytes and monocytes are affected. The disease leads to an increase in the cells of the salivary glands, which was the reason for the name of the virus (translated from Latin - "giant cells").

Infection damages not only blood vessels, but also the tissues of the internal organs of the child, disrupting their blood supply and leading to hemorrhages. The virus causes a significant change in the shape and structure of leukocytes and phagocytes, resulting in the development of signs of immunodeficiency. At healthy condition defensive forces child's body the virus is not active.

With a decrease in immunity, the disease begins to manifest itself with various symptoms.

What is dangerous for the child

The congenital form of cytomegalovirus infection can cause mental retardation in a child. Probability lethal outcome in infants is 30%. The disease leads to visual impairment and blindness. In 18% of cases, damage to the nervous system occurs. Children develop convulsive symptoms, high anxiety, weight loss, skin reactions.

Ways of infection and causes of CMV in a child


Infection of young children often occurs during contact with an infected mother. The virus can be transmitted not only with milk and saliva, but also with sweat, blood and other body fluids. The main routes of infection are:

  1. Airborne. Infection can enter the body healthy baby if there is a sick person nearby.
  2. Transplacental. The virus is transmitted from the mother during childbearing.
  3. Contact. Infection occurs when biological materials come into contact with the baby's skin.
  4. parenteral. The likelihood of infection with cytomegalovirus increases during a blood transfusion or the use of untreated medical instruments.

Types and forms of children's cytomegalovirus

There are two main types of CMV:

  • congenital;
  • acquired.

Often, infection occurs during childbearing. The virus crosses the placenta and enters the amniotic fluid, when swallowed, it invades the cells of the developing child's body.

by the most dangerous period doctors consider the first two weeks after conception.

In this case, the risk of developing irreversible changes the fetus is extremely high. Infection can cause miscarriage early term pregnancy. Cytomegalovirus is considered acquired if it is transmitted from the mother. The risk of infection increases with kissing, skin contact.

Depending on the location of the focus, the following forms of cytomegalovirus infection are distinguished:

  1. Localized. Formation takes place in one place.
  2. Generalized. The abnormal process spreads throughout the body.

Also, the disease is classified according to its course into:

  • latent:
  • acute.

Symptoms and signs

Signs of congenital cytomegalovirus infection are malformations of the child's body. The disease causes heart failure, brain activity and other abnormal processes. Doctors may suspect the presence of a congenital form of CMV with muscle hypotonia, general weakness body, lethargy, inability to digest food. In such babies, sleep disturbance occurs, there is no appetite and body weight does not increase. With severe damage to the child's body, there is a risk of death in the first month after birth.


If the fetus was infected in the third trimester, signs birth defects not visible. Complications can be diseases of the liver, blood. In some infants, the disease is accompanied by signs of hydrocephalus, an enlarged spleen, and hyperthermia. In addition to inflammation of the lymph nodes, babies develop skin rashes that can bleed.

The acquired form of cytomegalovirus infection rarely manifests itself with certain symptoms. Often it is latent and does not affect the child. This phenomenon is observed under the condition of the normal functioning of the baby's immune system. With a reduced resistance of the body, an infectious process begins to develop, which has signs resembling acute respiratory infections. The child has chest cough, sputum is secreted, body temperature rises, urination becomes more frequent. The disease is accompanied by inflammation respiratory tract, nasal congestion, pain when swallowing. In some cases, a reddish rash appears on the skin.

When the pathogen is activated in the body, the cervical lymph nodes begin to increase in the child. Usually they do not bother the baby. Enlargement of the liver, spleen is accompanied by the appearance discomfort in a stomach. At the same time, engorgement of the inguinal and axillary lymph nodes. A sign of liver damage is yellowing of the skin and eyes. Cytomegalovirus infection can manifest itself as signs of a sore throat: the child complains of pain in the joints, there is drowsiness, lethargy, hyperthermia.

If these symptoms occur, you should immediately consult a doctor.

Blood test for cytomegalovirus in a child

In addition to an external examination, if a cytomegalovirus infection is suspected, a child is prescribed blood tests. Serum contains immunoglobulins. Class M antibodies appear in the body immediately after the introduction of the virus into the cells of the organs. Protein compounds can be fixed already in the first 14 days from the moment of infection. Immunoglobulins IgM persist for six months. When they are detected, we can talk about the initial form of the disease.


Antibodies of class G are detected one month after the penetration of cytomegalovirus and remain in the blood throughout life. Thus, the immune system can effectively fight the activation of the infection.

Definition quantitative indicators antibodies allows you to monitor the dynamics of the disease and prescribe timely treatment. At severe course infectious process the synthesis of immunoglobulins is markedly reduced. Laboratory methods do not determine the amount of proteins in the blood, but reveal the degree of their activity. Serum is diluted in a ratio of 1 to 100. When exceeding normal level immunoglobulins can indicate the onset of the disease. Normal IgM< 0,5. Увеличение показателя указывает на положительный анализ.

Blood for antibodies to cytomegalovirus in a newborn is examined in without fail if mother suffered acute form diseases during pregnancy. In this case, the decoding of the analysis often shows the presence of class G immunoglobulins. This indicator does not always indicate that the infant has a congenital form of cytomegalovirus infection. The presence of IgG antibodies in the blood indicates the presence of the disease in the mother. An indicator of the infection of the baby is the excess of the norms of class M immunoglobulins. The urine and saliva of the child can serve as biological material for laboratory research. It is recommended to donate blood on an empty stomach.

Treatment

When prescribing treatment, the doctor should consider the following factors:

  1. Type of cytomegalovirus infection. Determined by enzyme immunoassay. With the acquired form of the disease, there are often no symptoms and changes in the organs and systems of the baby. The presence of the virus in normal operation the child's immunity is not dangerous.
  2. The nature of the course of the disease. When an infection occurs, the severity of the symptoms is taken into account.
  3. The state of the immune system. Not only the course of the disease, but also the speed of recovery depends on the functioning of the body's defenses.

Dr. Komarovsky about cytomegalovirus infection

Pediatrician E. Komarovsky believes that the use antibacterial agents when detecting cytomegalovirus infection is not justified, since such drugs are not able to help with this disease.

An antimicrobial drug is prescribed to a child when signs of complications appear, manifested by the development of inflammatory processes in the internal organs.


The antibiotic is selected individually, taking into account the child's body weight and the presence of chronic pathologies. The treatment of the disease is carried out in the same way as the therapy of herpesvirus. Children are assigned medicines ganciclovir, cytoven. The dosage is calculated taking into account the weight of the child (10 mg / kg), after 21 days it is reduced to 5 mg / kg. Therapy using antiviral drug carried out until the disappearance of signs of the disease and a decrease in laboratory parameters that indicate the degree of infection activity. In the congenital form, ganciclovir is used for one and a half months at a dosage of 10 mg / kg. If there are signs of intolerance to the drug, another antiviral agent is selected for the child.

If there is an exacerbation, an antipyretic medication (ibuprofen) is prescribed. During this period, the pediatrician recommends drinking plenty of fluids, multivitamin complexes. Naphthyzine, sanorin are prescribed to normalize nasal breathing. With the appearance of swelling of the mucous membranes, an antihistamine medication is prescribed.

Of great importance in the treatment of CMV is the use of immunostimulating agents. The child is injected with a preparation containing immunoglobulins against cytomegalovirus. Course - 10 injections.

After the symptoms of the disease subside, the child is shown physiotherapy (massage, UHF).

ethnoscience

The basis of most prescriptions to help cope with the disease are herbal preparations. Using folk remedies It must be remembered that the child may develop allergic reactions. The appearance of a sign of herbal intolerance by the baby's body from treatment unconventional ways must be abandoned.

With cytomegalovirus, you can use a collection consisting of licorice roots, kopeechnik, leuzea, alder seedlings, succession and chamomile flowers. The dry mixture is thoroughly mixed, 2 tablespoons are taken. plants and pour ½ liter of boiling water. For insisting, it is better to use a thermos. The remedy is given to the child 50 ml four times a day.

For the treatment of CMV, you can use a collection of thyme, birch buds, succession, wild rosemary, leuzea, yarrow, burnet roots. 2 tbsp dry plants are poured with 500 ml of boiling water. After 10 hours, the infusion is filtered and the child is given 50 ml three times a day.

As a means to strengthen the body's defenses, you can use the extract of lemongrass, ginseng, echinacea. The collection of lungwort, violet, nettle and birch leaves, plantain, rose hips, dill seeds helps to speed up recovery. 4 tsp the mixture is poured into 1 liter of boiling water and infused for 9 hours in the dark. The drug is taken three times a day, 40 ml. Children are encouraged to prepare fresh decoctions daily.

For babies up to a year when preparing medicinal infusions you need to use ½ tsp. dry herbs.

Before using funds traditional medicine for the treatment of cytomegalovirus infection in children, it is necessary to consult a pediatrician.

In the early days, it is recommended to give a minimum amount of infusion. Under the condition of normal tolerance, the dosage increases. The course of treatment with infusions is at least one month. Application folk recipes for the treatment of children is allowed with the simultaneous conduct of drug therapy.

Complications and consequences

The greatest danger of cytomegalovirus is for the fetus and children of the first years of life. The causative agent of the disease has the ability to penetrate the protective filters of the placenta. When an infection is introduced into a developing embryo, the risk of developing serious defects is very high.


The baby's own immune system begins to work actively closer to the first year of life. When activated, the infection can threaten organ damage digestive tract, hemorrhage in their tissue.

At congenital CMV in children may develop:

  • anemia;
  • encephalitis;
  • neuropathy;
  • brain cancer;
  • lymphocytosis;
  • bacterial sepsis.

With the addition of another type of infection with untimely treatment, a fatal outcome is possible.

To prevent the development of complications, it is important to constantly maintain immune system child.

The main activities are:

  1. Balanced diet. Security proper nutrition with a lot of greens, vegetables, cereals, fiber, natural dairy products helps to strengthen the body's defenses.
  2. Physical exercise. Moderate sports training needed to boost immunity. For children, classes in the pool, Pilates, aerobics are useful.
  3. Day rest. Children preschool age should sleep after dinner 1.5-2 hours. You must first ventilate and, if necessary, humidify the room.
  4. Regular walks. Fresh air and movement help restore immunity. Walking with a child is necessary away from the tracks.
  5. hygiene measures. It is important to teach the child to wash their hands before eating, after walking, visiting kindergarten. It must be remembered that the pathogen can be transmitted by contact.

The disease caused by cytomegalovirus infection can lead to serious consequences. The most dangerous is congenital form, which often leads to the development of defects and miscarriages. Treatment of the disease is based on stimulating the immune system, fighting the virus and preventing the appearance of a bacterial complication. Prevention is aimed at increasing the body's defenses. All drugs for the treatment and prevention of the development of cytomegalovirus infection are prescribed by a doctor.

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