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CMV infection in children: symptoms and treatment. Congenital cytomegalovirus infection in infants

Cytomegaly is a fairly common viral disease. Cytomegalovirus in children can cause serious problems, especially if infected before birth. Fortunately, in most healthy people the disease is asymptomatic and the patient is not even aware of accidental contact with the virus. The symptoms and treatment of cytomegalovirus themselves depend on the patient’s condition and the form of the disease.

Virus prevalence

Cytomegaly is a viral infection belonging to the Herpesviridae family. Infection occurs through contact with saliva, tears, or sexual relations with a patient or carrier of CMV.

A separate route of infection is from mother to unborn child. How easy it is to become infected with the virus and how widespread it is is illustrated by estimates that approximately 40% of healthy adults in Europe may have antibodies to CMV.

The virus uses host cells to replicate (reproduce). It is characteristic that it can remain in them for many years, waiting in a hidden form for the appearance of favorable circumstances for the re-development of the infection.

These include all conditions that compromise the immune system, such as HIV infection, immunosuppressive treatment and cancer.

According to Dr. Komarovsky, cytomegaly during pregnancy poses a great danger to the fetus, especially if infection with the virus occurs in the first trimester. The consequence could even be a miscarriage. And if the pregnancy continues to develop, the virus can lead to many birth defects in the child.

Infection is common because it occurs in the human environment. There are many sources and ways in which cytomegalovirus spreads. The incidence of infection is estimated at 40–80% and even 100% among people of low social status.

10–70% of preschool children living in large groups become infected with the virus from their peers. It is observed that on average 1% of children are infected with CMV at the time of birth.

Infection during pregnancy

Cytomegalovirus is increasingly a problem for pregnant patients who have reduced immunity. Here we are talking about either the resumption of the activity of a microorganism dormant in the body during pregnancy, or the infection of a woman with a new type of pathogen. Primary CMV infection in women carrying a baby is usually asymptomatic. Rarely, during the course of cytomegalovirus infection, pregnant women experience sore throat and head, cough and fever.

Cytomegalovirus infection in the third trimester of pregnancy can lead to premature birth. Infection of newborns rarely occurs during this process. Prematurity and fetal dystrophy increase the risk of development.

If an infected mother is breastfeeding, her baby may acquire the pathogen in the first months of life. About 40–60% of newborns are infected through breast milk. The infection, however, is asymptomatic and does not leave any consequences for the child’s health.

Symptoms of congenital pathology

In newborns who have been exposed to infection in utero, symptoms of the disease may appear in the long term in the form of damage to the central nervous system, hearing and vision defects. If CMV develops in a woman in the first months of pregnancy, complications may occur in the child. Cytomegalovirus is also dangerous because of the consequences it carries. First of all this:

If infection occurs during the final stage of pregnancy, there is a risk of disease of the body organs, which can lead to liver damage, thrombocytopenia, purpura or interstitial inflammation of the lungs. However, even if the baby was infected during or after childbirth, the disease does not give obvious symptoms.

Pathology can develop in approximately 10–15% of babies immediately after birth or within two weeks after it.

Symptoms in children and adolescents:

Newborns and infants who exhibit the above symptoms should be referred as soon as possible to specialized centers with appropriate personnel and laboratory equipment that can perform tests to confirm or rule out cytomegalovirus in children.

The most common symptoms of congenital cytomegalovirus include elevated liver enzymes, jaundice, and an enlarged liver. Meanwhile, thrombocytopenia is sometimes accompanied by changes in the skin.

When inflammation spreads to the macula of the eye, there is a risk of vision loss, strabismus, or damage to the optic nerve. Hearing impairment occurs in 50% of children. Due to congenital cytomegalovirus, 10% of newborns die. Those children who survive usually have varying degrees of mental retardation, balance problems, hearing and vision defects, and learning difficulties.

Symptoms of cytomegalovirus in older children

Approximately 99% of cases of CMV in older children are asymptomatic. Cytomegaly begins with a period of uncharacteristic flu-like symptoms. The period of development of infection for individual routes of transmission of the virus is not precisely known, but it can be assumed that on average it is 1–2 months.

Signs of the disease in childhood:

  • high temperature;
  • musculoskeletal pain;
  • skin rash;
  • feeling of general weakness and fatigue.

This is sometimes accompanied by an enlargement of the liver and spleen, pharyngitis, as well as enlargement of the lymph nodes, especially the cervical ones.

Relatively often, cytomegalovirus infection in children leads to inflammation of the liver, including jaundice and an increase in the concentration of organ enzymes in laboratory tests.

Previous infections of the original type are not completely eliminated from the body. CMV has the ability to remain for many years in a latent form in the host's cells, where it awaits the emergence of favorable circumstances, such as HIV infection, the condition after an organ transplant, taking medications that suppress the immune system, or cancer.

The secondary form of infection, i.e. reactivation of a latent infection, causes much more severe symptoms.

Among them are:

Symptoms of infection, both acquired and congenital, are varied and at the same time similar to problems with other diseases. For each patient in whom a pathogen is suspected, specific laboratory tests should be performed to identify it. Studies are widely performed to detect specific antibodies of various classes.

The basis is serological blood tests for the presence of specific antibodies belonging to two classes - IgM and IgG.

These antibodies are present in the blood from the very beginning of the infection and can persist long after the symptoms of the disease have disappeared. Their examination is most often carried out twice with an interval of 14–28 days. An active CMV infection is indicated by the detection of a high titer of IgM antibodies and confirmation of at least a fourfold increase in the concentration of IgG antibodies.

Other laboratory methods for confirming infection include identifying the genetic material of the virus using the PCR method. The material for research is most often blood or urine, saliva, or amniotic fluid.

It is necessary to screen women for IgM and IgG antibodies before pregnancy. Positive results in both cases indicate infection with the CMV virus. If only the result is , it means the virus is in dormant mode (carriage). Positive IgM may indicate a recent infection or viral reactivation.

In the case of newborns, especially those born prematurely (immaturity of the immune response in the first months of life), and people with reduced resistance, the study of exclusively specific antibodies may not be sufficient to establish a diagnosis. It is necessary to use other methods of detecting the virus.

Of great importance in establishing a diagnosis is the assessment of the child by various specialists (neurologist, ophthalmologist, otolaryngologist and others, depending on the indications) and the performance of subsequent studies, especially assessing the function of the liver, kidneys, bone marrow, construction and activity of the central nervous system. Among them:

  • ultrasound examination (ultrasound);
  • computed tomography;

Treatment of cytomegalovirus in children

Antiviral treatment for cytomegalovirus in children is only recommended if their immune system is not fighting off the infection properly.

In such situations, Ganciclovir is most often used, a drug that inhibits the action of DNA polymerase, i.e., an enzyme necessary for the functioning of the virus. Treatment for CMV usually lasts 2 to 4 weeks. Other antiviral drugs used include Foscarnet and Cidofovir. However, due to the potential risk of side effects of the most commonly used drugs, antiviral treatment and intravenous administration of these medications in children under one year of age are limited.

In young children (up to 5 years), therapy includes the administration of drugs aimed at combating symptoms, reducing fever, reducing the severity of pain and disinfecting the throat.

Much more important is to prevent the occurrence of pathology, avoiding being in the company of people after immunosuppression, patients with influenza or mononucleosis, as well as preschool children. The ideal solution would be to introduce compulsory vaccination for girls before puberty. Unfortunately, a vaccine for CMV has not yet been invented. There are no medications that can be effective in combating the virus in pregnant women.

Cytomegalovirus in a child, as in adolescents and adults, cannot be completely cured, since the pathogen remains in the body in the latency phase after the acute form. Unfavorable conditions (significant immunity disorders) can lead to increased infection.

Cytomegalovirus is one of the most common infectious agents in the human population, and is found in more than half of children worldwide at one age or another.

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

Penetration of the virus into the child’s body

In the development of cytomegalovirus infection, the mechanism of 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 child’s body:

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

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

When an expectant mother is initially infected during pregnancy, the probability of the virus entering the amniotic fluid reaches 50%.

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

If the mother has antibodies to the virus without any signs of 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% when a child is born to a mother with an active infection.

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

Most often, infection occurs between the ages of 2 and 5-6 years. During this period, the child usually 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 the blood, saliva, urine, and other secretions and can be transmitted through close contact, sneezing, poor hygiene, or sharing toys. The incidence of infection in preschool institutions is 25-80%. The virus can be actively released from an infected human body 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 children 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 occurs 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 the fetus, only about 10% of children are born with congenital infection. Of these, more than 90% have no signs of the disease.

Symptoms of congenital infection include prematurity, jaundice, drowsiness, and difficulty swallowing and sucking. Enlargement of the spleen and liver, convulsions, strabismus, blindness, deafness, microcephaly, hydrocephalus are often observed. Sometimes abnormalities in the development of the cardiovascular, digestive and musculoskeletal systems are detected.

The absence of these symptoms in a newborn with suspected congenital CMV infection does not indicate the health of the child. There may be a late 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, decreased or increased motor activity, convulsions, swelling of the salivary glands, blurred vision, and subcutaneous hemorrhages. Pneumonia, pancreatitis, diabetes, and hepatitis may develop. However, in most cases, acquired infection is asymptomatic and becomes latent.

Normal course of the disease in children

As a rule, the child’s body copes quite effectively with cytomegalovirus without any external manifestations. In some cases, mononucleosis-like syndrome occurs. Its main symptoms are similar to ARVI: fatigue, pain in muscles and joints, headache, chills, fever, runny nose. Sometimes there is an enlargement of the lymph nodes, increased salivation, a 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 CMV infection. Hospitalization and specific treatment are not required.

Sometimes 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 experience seizures, movement disorders, abnormal skull sizes (micro- or hydrocephalus), and low body weight several months after birth. At the age of 5-7 years, 10% of children develop 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 vision.

Acquired infection most often does not cause severe complications. However, if you observe 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 it is acute, with signs of mononucleosis-like syndrome. Liver damage and pneumonia may also be recorded.

With a weakened immune system, recurrent infections develop. 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, and spleen may develop. In severe relapses, the fundus of the eye, retina, intestines, nervous system, and joints are affected. Bacterial infections are often observed.

The atypical course of cytomegalovirus infection is rare and can manifest itself as small skin rashes, damage to the reproductive system, paralysis, hemolytic anemia, abdominal dropsy, decreased blood clotting, enlarged ventricles of the brain or the formation of cysts in them.

How to identify cytomegalovirus in a child: diagnostic methods

Diagnosis of CMV infection is possible using several methods:

  • cultural: isolation of the virus in human cell culture. 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-linked immunosorbent assay (ELISA): detection of immunoglobulin M (IgM) in the blood indicates primary infection. If immunoglobulin G (IgG) is detected, re-examination is carried out at intervals of at least two weeks. An increase in antibody titers indicates activation of the infection. It is possible to obtain false positive results;
  • Polymerase chain reaction (PCR): a fast and accurate method that reveals the DNA of the virus and how quickly it multiplies 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, this allows the stage of infection to be determined. The accuracy of the method is about 95%.

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

A short video about how enzyme immunoassay is done

Features of infection control

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

Treatment is necessary if congenital infection symptoms or complications are severe. The list and dosage of medications is determined by the doctor, taking into account the severity of the disease, 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 strictly contraindicated due to the high likelihood of developing severe side effects.

A few words about prevention

There are no specific means of preventing cytomegalovirus infection. The vaccine is under development.

To protect the child from the possible consequences of infection, it is necessary, first of all, to take pregnancy planning seriously. The expectant mother should be tested for the presence of specific antibodies. If there is no immunity to the virus, a pregnant woman must use separate utensils, avoid frequent contact with small children, and carefully observe personal hygiene rules. During pregnancy, it is necessary to be tested twice for the presence of antibodies to the virus for the timely detection of a primary infection or relapse 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 of age, 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 only enough to provide the baby with adequate 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 developing 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.

Cytomegalovirus infection is a widespread disease among the population throughout the world. According to the clinical course, cytomegalovirus in children differs in its pronounced clinical picture, laboratory test data and prognosis depending on the age of the child.

About the pathogen

The causative agent of cytomegalovirus infection is the pathogen Citomegalovirus hominis, a DNA virus belonging to the herpesvirus family. The pathogen was first discovered in 1882 during a postmortem autopsy of the fetus, during which the scientist H. Ribbert discovered atypical cells. Later, the disease received the name “cytomegaly” due to specific changes in cellular structures, an increase in their size due to viral damage.

Cytomegalovirus is not stable in the external environment and dies quickly under conditions of high or low temperatures. The virus loses pathogenicity in an acidic environment, when exposed to alcohol-containing chemical solutions. Outside the carrier, the viral cell dies in the external environment for a short time and reacts to humidity and dry air. The pathogen circulates and is transmitted with all biological fluids in the human body. Invasion occurs through the mucous membranes:

  • upper respiratory tract;
  • gastrointestinal tract;
  • genitourinary organs.

People become infected after internal organ transplants and blood transfusions. In generalized forms, CMV infection is transmitted transplacentally from mother to fetus. The vertical route of infection occurs during childbirth; delivery by cesarean section does not reduce the risk of infection.

Penetration into the body

Cytomegalovirus infection in children after primary infection affects leukocyte blood cells and mononuclear cells. The location of the primary focus of infection is the salivary glands, which is due to the epitheliotropy of the pathogen. The entrance gates of infection remain intact; in the presence of a history of immunodeficiency conditions, acute respiratory infection syndromes develop.

After cytomegalovirus enters the blood, the affected immune cells increase in size and lose their function. As the disease progresses, pathological accumulations form inside the cells, which occurs as a result of viral reproduction. Cells that have irretrievably lost their function migrate with the bloodstream to the lymphoid organs and tissues of the central nervous system, where the virus further multiplies.

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Cytomegalovirus in a child is asymptomatic with sufficient immune activity and a high level of body resistance to factors of external aggression. Generalization of the disease, transition to a severe stage occurs as after the influence of adverse factors on the child’s body. Symptoms of the disease can be caused by:

  • secondary bacterial infection;
  • decreased immunity;
  • immunodeficiency state;
  • injuries;
  • intercurrent diseases;
  • treatment with immunosuppressants, cytostatics, chemotherapy;
  • oncology;
  • severe stress.

In its latent form, cytomegalovirus persists in the human body for life; IgG class antibodies regulate the reproduction of the pathogen at one level, at which no symptoms of the disease occur. Clinically proven treatment methods that will completely cope with cytomegalovirus in children have not yet been developed.

Congenital cytomegaly

The latent course of the disease leads to the fact that many women do not know about the presence of cytomegalovirus in their body. This leads to intrauterine infection of the fetus during a woman’s pregnancy at different stages. With early infection before 12 weeks, there is a high risk of miscarriage, spontaneous abortion or miscarriage.

The developed comprehensive examinations of pregnant women are aimed at determining the antibody titer and identifying the pathogen in blood and urine tests. For pregnant women, screening examinations have been developed at 12, 20, 33 weeks of pregnancy, which include both laboratory tests and ultrasound examinations.

Timely examination and testing allows you to detect the infection in time and undergo a course of specific antiviral therapy. This prevents the invasion of the virus through the uteroplacental bloodstream into the child’s body.

With instrumentally proven generalized damage to the fetus, doctors in some situations recommend termination of pregnancy for medical reasons. Intrauterine cytomegaly causes severe damage to the child, defects of internal organs, and leads to delayed growth and development. Intrauterine cytomegaly is characterized by damage to internal organs, which includes:

  • damage to parenchymal organs (hepatitis, splenitis, pancreatitis);
  • adrenal gland damage;
  • cerebral edema;
  • hemorrhages in the bone marrow;
  • severe anemia.

If the expectant mother undergoes a course of antiviral therapy, this has a beneficial effect on the prognosis of pregnancy and upcoming birth. In the first weeks of life, a newborn child undergoes complex virus-inhibitory therapy in a neonatal department under the supervision of specialist doctors. Suppression of the virus, suppression of its activity leads to the absence of symptoms of the disease in the child. With favorable prognosis, congenital cytomegalovirus infection in children can be asymptomatic, but requires periodic specific therapy.

In children under one year old

Cytomegalovirus in children under one year of age develops as a result of infection through breast milk or the upper respiratory tract. Extrauterine infection is confirmed by linear laboratory enzyme immunoassays in the maternity hospital, which do not reflect an increase in the titer of IgM and IgG antibodies. After the neonatal period, a child has the opportunity to become infected with cytomegalovirus through contact with infected people who are carriers in a latent form.

The infant’s underdeveloped immunity causes symptoms that are most often attributed to an acute respiratory infection or a cold. The following symptoms develop:

  • nasal congestion;
  • sneezing;
  • breathing disorders, sucking;
  • cough;
  • mild tubo-otitis;
  • hoarseness of voice;
  • temperature rise.

The child becomes restless, whiny, and as the temperature rises, children with increased convulsive activity develop fibril spasms. Violation of the act of sucking breast milk leads to colic, bloating, and hiccups. As a result, the child loses weight, sleep becomes restless, and sometimes a rash appears on the body. The mild form of acute cytomegaly takes a period from 2 weeks to 2 months, the symptoms of cytomegalovirus are replaced one after another until they disappear completely.

If the disease becomes severe, massive generalization of pathological foci occurs with the development of hepatitis and inflammation of the spleen. The virus spreads throughout all organs and systems, leading to severe damage to the hematopoietic organs and the development of a secondary immunodeficiency state. This is manifested by high fever, chills, and convulsions. The condition is dangerous due to the development of life-threatening complications, including cerebral edema.

In children from one to 7 years old

If a child is diagnosed with a cytomegalovirus infection after the first year of life, the disease manifests itself in a latent form. This is due to the high activity of immune cells, the formation of the compliment system, and the high protective ability of the macrophage system. Often, the disease is detected only after the antibody titer is detected in a blood test as a result of a routine examination before kindergarten or school.

Unlike newborns and infants, older children tolerate cytomegalovirus infection much easier. Symptoms of the disease manifest themselves as mild colds, which are relieved by classical antiviral or symptomatic treatment. In children aged five years, against the background of a physiological restructuring of the immune system, an exacerbation of cytomegaly often occurs, which occurs in a mononucleosis-like form with the following manifestations:

  • enlarged lymph nodes;
  • enlargement of adenoids I-III degrees;
  • tonsillitis;
  • lethargy;
  • fatigue;
  • hypersalivation;
  • stomatitis.

The mononucleosis-like form of cytomegaly takes up to 4 weeks without a positive effect on specific treatment. Antibody titers increase in the blood, which indicates both an exacerbation of the viral infection and the risk of generalized damage. Such a course is dangerous due to the depletion of the child’s body’s immunoprotective mechanisms, which leads to the development of severe generalized forms with damage to internal organs. The older the child, the lower the risk of complications from cytomegalovirus infection.

Normally, with high activity of the protective properties of the immune system, a stable level of specific antibodies is maintained in the child’s body, which is not clinically manifested. Outside of an exacerbation, the virus is found in saliva in minimal quantities; this condition is not signs or acute symptoms of the disease.

For children over 12

Children over twelve years of age are characterized by the same course of cytomegalovirus infection as in adults. This is due to the complete maturation of the immune system and the high activity of immunoenzyme systems. Intracellular persistence of the virus in the child’s body does not cause pathological changes in internal organs and tissues, with the exception of a slight enlargement of the lymph nodes. A positive blood test for IgG antibodies confirms the chronic form of the disease.

For school-age children, priority is given to such preventive measures as hardening (including Komarovsky), taking vitamin complexes, and playing sports to increase the body’s resistance. If there are chronic diseases, parents should regularly examine their child with a pediatrician and take courses of preventive treatment to prevent exacerbation of the pathology. Methods of preventive effects on the children's body are presented in the public domain, video and photo instructions, and medical articles.

It is impossible to completely cure the disease; specific therapy is aimed at eliminating the acute phase and preventing the spread of infection. Symptomatic therapy for children over 12 years of age is aimed at eliminating the symptoms of anemia, lethargy or increased fatigue of the child.

Treatment

Treatment of cytomegalovirus in children begins after a positive test for detection of the virus in biological fluids and an acute picture of the disease. The latent form does not require antiviral therapy if there is a sufficient concentration of IgG in the child’s blood. The criteria for starting treatment are such deviations as:

  • markers of active pathogen replication;
  • viremia;
  • DNAemia;
  • increase in IgG, IgM titer;
  • seroconversion;
  • antigenemia.

Detection of viral replication markers in the cerebrospinal fluid is an absolute criterion for initiating antiviral therapy. For congenital cytomegaly, children are administered specific anti-cytomegalovirus immunoglobulins, ganciclovir, in an individual dosage, which is calculated based on the child’s body weight. The drug is administered every 12 hours for one month. Ganciclovir is used in neonatal practice to a limited extent due to the high number of complications (impaired erythropoiesis, immunosuppression). Complex therapy reduces the toxicity of the drug and inhibits the intracellular proliferation of the pathogen.

Anticytomegalovirus drugs are characterized by severe toxicity, which is often compared to chemotherapy. Such treatment is carried out only in a hospital setting under the supervision of a pediatrician and regular laboratory tests. For children older than one year, the following drugs are used:

  • foscarnet;
  • foscavir;
  • zirgan;
  • flavozide;
  • Cymeven.

The older the child, the easier he tolerates the therapy. To reduce side effects, symptomatic medications are used, and traditional medicine is often used. Exposure of tissue to ganciclovir inhibits intracellular replication of the virion and reduces the risk of damage to the nervous tissue and hematopoietic organs of the child. Anticytomegalovirus therapy is carried out only in severe forms of the disease, generalized damage to the internal organs and systems of the child.

After discharge from the hospital, a course of maintenance therapy is prescribed, which is aimed at restoring immune functions and increasing resistance to an aggressive external environment. Before returning to classes, the child undergoes outpatient treatment, the duration of which depends on the test results. The disease is characterized by rapid extinction of symptoms after etiotropic treatment and the presence of stable remission lasting up to five years.

Almost all parents know about this disease, which often does not manifest itself in children, and the infectious disease can be detected only after a blood test in which antibodies to cytomegalovirus are found. How dangerous this disease is for a child’s body and how to behave if it manifests itself will be discussed in this article.

What is cytomegalovirus infection?

Cytomegalovirus is an infectious disease belonging to the herpes group. It is most often asymptomatic in the initial stages; in children, symptoms are more pronounced than in adults. This is why virologists’ patients are predominantly children.

The infection may be congenital or acquired. Congenital is more severe and causes more complications. The disease can provoke disruptions in the functioning of individual organs or systems or worsen the general condition of the body.

Due to the sharp deterioration of the environment, parents are increasingly asking the question: why is it dangerous? Symptoms and treatment depend on the method of infection of the child. As a rule, the infection manifests itself only when immunity decreases; before that, it can be in a latent form and not harm the baby’s health.

Localization of the virus

After an infection enters the body, it strives to reach the salivary glands through the bloodstream. This is where the virus inserts its DNA into the nucleus of healthy cells and promotes the production of new viral particles.

As a result, the cell increases significantly in size. This is where the name of the disease comes from, since cytomegaly is translated from Latin as “giant cells.” Healthy children whose immune systems function well do not develop cytomegalovirus infection. Symptoms in children with immunodeficiency, HIV, developmental defects and premature babies can have varying degrees of severity.

Congenital cytomegalovirus

It enters the child's body directly from the mother, through the placenta. This happens when a woman gets sick for the first time and there are no antibodies to this virus in her body. For a baby, the most dangerous infection is congenital cytomegalovirus infection.

Symptoms in children may include visual or hearing impairment, frequent seizures, and developmental delays (mental, physical). Another possibility is the period of childbirth or breastfeeding. In this case, there will be no dangerous consequences for the child and the disease may never appear.

Acquired cytomegalovirus

It enters the child's body in preschool and school institutions. Since the virus is transmitted by airborne droplets, it can enter the body of all children in the same room. Such an infection will not cause any harm to the child’s health.

Cytomegalovirus infection in children acquired at school age does not contribute to disturbances in the development of body systems and does not slow down the overall development of the child. But with a decrease in immunity, it can manifest itself as frequent colds.

Symptoms of congenital cytomegalovirus

With neonatal infection of the fetus (especially before the 12th week of pregnancy), the child is born with numerous malformations. The virus contributes to the presence of heart defects, brain pathologies and other dangerous diseases or pathological processes in the baby’s body.

The first sign of CMV in a child is muscle hypotonicity, lethargy, restless sleep, poor appetite, and problems with digestion. In especially severe cases, death is possible in the first weeks after birth.

When infected in the third trimester, the child does not have any developmental defects. In this case, the symptoms of the disease will manifest themselves as jaundice, hemolytic anemia, hydrocephalus and other dangerous pathologies.

After childbirth, the disease may not manifest itself, but as the child grows up, minor developmental delays will begin to appear, which will be provoked by cytomegalovirus infection. Symptoms in children 3 years of age are manifested by the presence of various neurological disorders and diseases.

Symptoms of acquired cytomegalovirus

The acquired virus manifests itself in rare cases; most often it lies dormant, without having any effect on the child’s body. This indicates good functioning of the immune system, which prevents the activation of the virus. In the case when the child has weak immune defense, the disease will manifest itself with frequent colds (with inflammation of the lymph nodes, runny nose and elevated body temperature).

If a child has a chronic immunodeficiency, his body will be very often exposed to infection. In this case, complications from the disease will be localized in many body systems - cardiovascular, nervous, digestive, genitourinary.

Treatment of this form of the virus is very long and in most cases unsuccessful. Fortunately, complicated cytomegalovirus infection is quite rare. Symptoms in children, treatment, reviews - all this is important information for parents who care about the health of their baby and strive to prevent possible negative consequences of the disease.

Diagnosis of the disease

Diagnosing the virus has certain difficulties. To detect the pathogen, it is necessary to carry out a number of specific analyzes and tests. The main ones are the collection of saliva, urine and feces from the child.

A blood test looks for the presence of antibodies. IgG can be transmitted from mother to child and does not indicate the presence of the virus, as it will disappear over time without drug treatment. If IgM is detected in the blood, this is direct confirmation of the presence of the virus in the child’s body.

The presence of antibodies to this virus in the blood is not yet a reason for concern. A cytomegalovirus infection in a child, the symptoms of which do not appear, can remain in a latent state all his life, without affecting the condition of the body and without causing complications.

Hardware diagnostics of CMVI

To diagnose the affected body systems, the doctor may prescribe additional examinations that will determine the degree of damage to the body by the virus:

  • chest x-ray - if the lung tissue is damaged, the image will show signs of pneumonia or other diseases of the respiratory system;
  • MRI or ultrasound of the brain shows the presence of calcifications or inflammatory processes in the brain;
  • Ultrasound of the abdominal cavity makes it possible to determine an increase in the size of the liver and spleen, the presence of hemorrhages in the organs or disruption of the digestive and urinary systems.

If a child has an infection, the doctor will necessarily refer you for examination by an ophthalmologist to identify damage to the fundus and structures of the visual apparatus. This will allow timely identification of structural changes and prescribing competent treatment that can preserve the child’s vision, which is directly affected by cytomegalovirus infection in children. Symptoms, reviews from parents and doctors make it possible to more rationally prescribe treatment based on the experience of past patients.

The examination methods are prescribed by the pediatrician together with the infectious disease specialist. After the localization of the virus is detected, a nephrologist, urologist, neurologist or ophthalmologist takes part in the treatment of the child.

Treatment of congenital cytomegalovirus

Features and methods of treatment depend directly on the form of infection and the complexity of the infection.

Pay attention! It is impossible to completely kill this virus in the body. Treatment is aimed only at improving the general condition of the child and normalizing vital processes in the body.

Drug therapy for CMV infection involves the use of interferon and immunoglobulin, which directly affects cytomegalovirus infection. If inflammatory processes are present in the body, suitable antibiotics and agents to enhance the body’s immune defense must be prescribed.

In some cases, a great effect of therapy can be seen when prescribing homeopathic remedies, acupuncture or manual therapy. The treatment method is selected individually, depending on how much the cytomegalovirus infection has affected the body. Symptoms in children and photographs of the manifestation of the disease will allow you to identify the virus in time and seek help from a doctor.

Treatment of acquired cytomegalovirus

The acquired form of cytomegalovirus can be treated at home. In this case, after the examination, the doctor selects the appropriate treatment, and parents can carry it out independently, following all the doctor’s recommendations.

Cytomegalovirus infection in children, the symptoms of which are manifested by diarrhea, requires the use of adsorbent agents, thanks to which not only the problem with the functioning of the intestines will be solved, but also all pathogenic bacteria will be removed from it. All this will have a positive effect on the result of complex treatment.

Infected children should receive adequate nutrition and drink plenty of clean drinking water. This will quickly remove bacteria from the body and restore metabolic processes.

Cytomegalovirus infection: symptoms in children, “Cytotect” as a way to increase immunity

"Cytotect" is a specific immunoglobulin aimed at eliminating pathogens of CVM in children. The drug is used to treat or prevent a disease accompanied by a decrease in the body's immune defense. Preventive measures are necessary during organ transplantation, when the immune system is artificially suppressed to prevent rejection of the transplanted organ.

Prevention is the main way to protect against cytomegaly. After all, maintaining personal hygiene, leading a healthy lifestyle and taking the necessary medications as prescribed by a doctor is much easier than then treating the disease, especially if there are complications.

Consequences of cytomegalovirus infection

Newborns and children suffering from immunodeficiency are more susceptible to the development of complications. It is worth noting that not everything depends on the timeliness and effectiveness of treatment, since the disease can progress silently and cause serious health problems.

The most common complications include:

  • damage to the nervous system;
  • encephalitis - inflammation of the brain;
  • cytomegalovirus pneumonia;
  • eye diseases, in particular chorioretinitis, which leads to strabismus in children and blindness.

The effectiveness of treatment largely depends on the state of the child’s natural immune defense. Since the drugs can only suppress the spread and aggressiveness of the virus. If a child, in addition to CMV, has cancer or leukemia, the symptoms will be much more pronounced, and treatment will be much more difficult and lengthy.

Prevention of CMV infection in children

The main way of prevention is to strengthen the child’s immune system. This task includes not only a balanced diet, but also the moderate physical activity necessary for the child, hardening, active rest and many other factors.

After an illness (especially a serious infectious disease), you should not immediately take your child to kindergarten or school, since his body has not yet fully recovered, and his immunity is too weak. In this condition, there is a high probability that the child may become infected with CMV.

If his condition worsens, it is necessary to consult a doctor, undergo the necessary tests and be examined. Parents' attentive attitude to the health of their child will allow them to avoid the dangerous consequences of the disease by stopping the virus at an early stage.

The child was diagnosed with cytomegalovirus. Despite the widespread distribution of this agent across the planet, ordinary people have virtually no knowledge about it. At best, someone once heard something, but they can’t remember what exactly. Dr. Evgeniy Komarovsky explained in an accessible manner that this is a virus, why it is dangerous, and what to do if this “terrible beast” is found in a child’s blood tests. We give you the opportunity to get information from a renowned doctor.

About the virus

Cytomegalovirus belongs to the family of herpes viruses type 5. It is quite interesting when looked at through a microscope - its shape resembles the round, prickly shell of a chestnut fruit, and in cross-section it looks like a gear.

When this virus infects humans, it causes cytomegalovirus infection. However, it is not so aggressive: after entering the body, it can exist there quite peacefully for a long time, without indicating its presence in any way. For this “tolerance” it is called an opportunistic virus, which reproduces and causes disease only under certain factors. The main one is weakened immunity. The most susceptible to infection are people who take a lot of medications for any reason, live in an environmentally polluted area, and often use household chemicals in large quantities.

Cytomegalovirus loves to settle in the salivary glands. From there it travels throughout the body.

By the way, the body gradually produces antibodies to it, and if enough of them have accumulated, even a weakened immune system can no longer cause a cytomegalovirus infection.

Transmission routes

If for adults the main route of infection is sexual, then for children it is through kissing, contact with the saliva of a person infected with the virus, which is why it is sometimes called the kiss virus.

Also, a mother with a large cytomegalovirus infection transmits it to the fetus during pregnancy, and this can cause quite serious defects in its development. A child can become infected during childbirth through contact with the mucous membranes of the birth canal. In addition, the baby can get an infection through mother's milk in the first days of his life.

Another route of transmission of cytomegalovirus is blood. If the baby has had replacement blood transfusions from a donor who has such a virus, as well as organ transplantation operations from an infected donor, then the child will definitely become a carrier of cytomegalovirus.

Danger

Evgeny Komarovsky cites the following fact: on the planet, 100% of elderly people have had contact with cytomegalovirus in one way or another. Among adolescents, about 15% of those who already have antibodies to this agent are found (that is, the disease has already been suffered). By the age of 35-40, antibodies to CMV are found in 50-70% of people. By retirement, the number of people who are immune to the virus is even higher. Thus, it is quite difficult to talk about any excessive danger of the type 5 virus, because many people who have recovered do not even know about such an infection - it went completely unnoticed for them.

The virus is only dangerous for pregnant women and their unborn children, but also provided that the expectant mother encountered CMV for the first time during pregnancy. If a woman has previously been ill and antibodies are found in her blood, then there is no harm to the child. But primary infection during pregnancy is dangerous for the baby - he may die or there is a high risk of congenital malformations.

If the baby is infected during pregnancy or immediately after childbirth, then doctors talk about congenital cytomegalovirus infection. This is a pretty serious diagnosis.

If a child caught the virus already in his adult life, they speak of an acquired infection. It can be overcome without much difficulty or consequences.

Parents most often ask the question: what does it mean if antibodies to cytomegalovirus (IgG) are found in the baby’s blood test and CMV is set to +? There is nothing to worry about, says Evgeny Komarovsky. This does not mean that the child is sick, but indicates that his body has antibodies that will prevent the cytomegalovirus from doing its “dirty deed.” They developed independently, since the child had already had contact with this virus.

You should start to worry if your child’s blood test results show IgM+. This means that the virus is in the blood, but there are no antibodies yet.

Symptoms of infection

The presence of cytomegalovirus infection in a newborn is determined by doctors in the children's department of the maternity hospital. Immediately after the baby is born, they do an extensive blood test.

In the case of acquired infection, parents should be aware that the incubation period lasts from 3 weeks to 2 months, and the disease itself can last from 2 weeks to one and a half months.

The symptoms, even for a very attentive mother, will not cause the slightest doubt or suspicion - they are very reminiscent of a common viral infection:

  • body temperature rises;
  • respiratory symptoms appear (runny nose, cough, which quickly turns into bronchitis);
  • signs of intoxication are noticeable, the child has no appetite, he complains of headache and muscle pain.

If everything is in order with the child’s immune system, then it will powerfully fight back the virus, its spread will be stopped, and the same IgG antibodies will appear in the baby’s blood. However, if the toddler’s own defense is not enough, the infection can “lurk” and acquire a sluggish, but deep-seated form, in which internal organs and the nervous system are affected. In the generalized form of cytomegalovirus infection, the liver, kidneys, adrenal glands, and spleen are affected.

Treatment

It is customary to treat cytomegalovirus infection by analogy with herpes infection, except that you choose drugs that affect not herpes in general, but cytomegalovirus in particular. There are two such drugs - Ganciclovir and Cytoven, both of which are quite expensive.

During the acute phase of the disease, the child is prescribed plenty of fluids and vitamins. For uncomplicated cytomegalovirus infection, antibiotics are not needed because antimicrobials do not help against viruses.

Antibacterial agents can be prescribed by a doctor in case of a complicated course of the disease, when there are inflammatory processes in the internal organs.

Prevention

The best prevention is strengthening the immune system, good nutrition, hardening, and playing sports. If a pregnant woman has not had cytomegaly and does not have antibodies to this virus when registering, she will automatically be at risk.

This virus is young (it was discovered only in the middle of the 20th century), and therefore little studied. To date, the effectiveness of the experimental vaccine is approximately 50%, which means that half of vaccinated pregnant women will still get CMV.

Dr. Komarovsky’s video will help you learn more about cytomegalovirus infection.