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How is cytomegalovirus infection treated in children? Cytomegalovirus infection (CMV infection) in children: treatment, symptoms, diagnosis, causes

Cytomegalovirus infection (CMVI) or cytomegaly is an infectious disease of a viral nature that is caused by cytomegalovirus (CMV).

The specific pathogen is Human betaherpesvirus 5 - human herpes virus 5.

Transmission routes. As a rule, cytomegalovirus in children, especially young ones, is transmitted from the mother.

Infection of a child can occur through contact with any biological fluid - saliva, sweat, urine, feces, blood, sperm or milk, vaginal or amniotic fluid.

Based on this, the main routes of infection can be identified:

  • Airborne. Infection occurs through the air through sneezing, coughing, etc.
  • Contact. In this case, the cytomegalovirus in a child penetrates the skin through direct contact with an infected substance.
  • Parenteral. If you receive a transfusion of contaminated blood or use unsterile needles.
  • Transplacental. Through the placental circulatory system during pregnancy.

In the first three cases, they say that the child’s cytomegalovirus is secondary or acquired. Also, the cytomegalovirus virus in children can be congenital or primary; as a rule, it is a transplacental route of infection. This separation is necessary, since the clinical picture of the disease depends on the mechanism of infection.

Congenital cytomegalovirus in children. In most cases, infection of a child occurs in the womb through placental communication with the child. However, in some cases, infection can occur through aspiration (swallowing) of amniotic fluid or discharge from the genitals. Depending on the period at which the virus entered the child’s body, various disorders may occur. The most dangerous periods are days 1-14 and days 15-75. When cytomegalovirus enters fetal tissue, it most often causes irreversible changes and fetal death.

Acquired cytomegalovirus in a child. In this case, especially in a child under one year old, cytomegalovirus passes from the mother’s body through her kisses, skin contact, etc. passes from the mother’s body through her kisses, skin contact, etc. Despite the high probability of infection and a large list of potential diseases, cytomegalovirus in children under one year of age and older is asymptomatic.

Diagnostics. In order to identify the cytomegalovirus virus in children, a whole range of laboratory and instrumental research methods is often required. The main diagnostic methods are laboratory tests. Instrumental examination is often aimed at identifying potential complications and is carried out after laboratory confirmation of infection.

Please note

According to modern clinical protocols, diagnostics to determine cytomegalovirus in children (up to one year and newborns) is carried out on the basis of anamnestic and clinical data.

Clinical:

  • Symptoms of central nervous system (CNS) disorders - convulsions, micro- and hydrocephalus, focal symptoms.
  • Liver damage - jaundice, increased direct bilirubin in the blood, simultaneous increase in the size of the liver and spleen (hepatosplenomegaly).
  • Hematopoietic function disorders - decreased platelet count, hyperregenerative anemia, hemorrhagic syndrome.
  • Antenatal (prenatal) pathologies - premature birth, IUGR - intrauterine growth retardation syndrome.

Anamnestic:

  • Mononucleosis or a similar disease in the mother during pregnancy.
  • Determination of active division of cytomegalovirus in the mother during pregnancy.
  • Detection of specific antibodies to the virus in the mother’s blood.

Most of these same manifestations can serve as a basis for testing for cytomegalovirus in a child (2 years and older).

Currently, three stages or levels of research are used to detect CMV in children:

  1. Screening diagnostics. Carrying out an enzyme-linked immunosorbent assay (ELISA) to detect IgG immunoglobulins in the blood (including IgM in umbilical cord blood at birth).
  2. Repeated use of ELISA to determine IgM in older children and cytological examination to identify cytomegaly cells in saliva and urine.
  3. Study of various biological materials of a child using polymerase chain reaction (PCR). For diagnosis they can use: blood, saliva, urine, cerebrospinal fluid, tears, scrapings of epithelial cells and vaginal secretions. PCR determines the presence of viral DNA in the materials being tested, which makes it possible to reliably determine cytomegalovirus in a child.

Children as a source of disease. As a rule, children do not become sources of infection of other people with CMV. This is due to the fact that almost the entire population of the Earth is infected with it - from 99-100%. The chances of detecting cytomegalovirus in a 3-year-old child are approximately 70%. This means that most children become infected even before contact with society from their parents.

Cytomegalovirus in children under one year of age and older age groups

How cytomegalovirus manifests itself in children directly depends on when the infection occurred. According to clinical manifestations, all children can be divided into several groups.

Newborns. This category includes children with intrauterine infection and postnatal infection. In this case, the clinical picture may differ significantly, despite the fact that it was caused by the same cytomegalovirus.

In children, symptoms of intrauterine infection are manifested by the following pathological conditions:

  • Thrombocytopenic purpura.
  • Jaundice.
  • Hepatosplenomegaly.
  • Microcephaly.
  • Loss of body weight and deficiency of subcutaneous fat.
  • Hepatitis.

Children under 1 year. Cytomegalovirus in children under one year of age most often manifests itself as damage to the central nervous system. Clinically, this is manifested by suppression of physiological reflexes, including sucking and swallowing. Damage to cranial nerve pairs may occur in the form of facial asymmetry, strabismus, or nystagmus. Also occurs: alternating hyper- and hypotonicity of skeletal muscles, convulsions. In severe cases, cytomegalovirus in children under one year of age can provoke the development of encephalitis with a typical clinical picture.

In some children, CMV may cause interstitial pneumonia, which is characteristic of it, which also affects the tissue of bronchioles and small-caliber bronchi. In a third of children with severe symptoms, kidney damage is recorded, which manifests itself as nephrotic syndrome. As a rule, these diseases are resistant to traditional treatment.

In the vast majority of children (about 90%), CMV occurs without pronounced clinical symptoms. However, after 2-5-7 years, almost everyone experiences long-term complications in the form of defects in the hearing and visual apparatus, dental pathologies, mental retardation, etc.

Children of the older age group. The cytomegalovirus virus in older children is not capable of causing such serious disorders and in 99% of cases is asymptomatic. Despite this, it is also capable of causing serious diseases. The classic disease caused by cytomegalovirus in adolescent children is mononucleosis syndrome. It does not differ in clinical symptoms from ordinary mononucleosis caused by the Epstein-Barr virus.

Also, some children may experience acute respiratory diseases, such as laryngitis, tracheitis, bronchitis. Certain groups have isolated lesions of the salivary glands or interstitial pneumonia. As a rule, the course of the last two is severe and protracted, and standard treatment is ineffective. Rarely, cytomegalovirus in a child in the initial stages can manifest itself as damage to the liver tissue in the form of hepatitis, the central nervous system in the form of encephalitis, or the pancreas in the form of polycystic degeneration.

The clinical manifestations of diseases caused by CMV are not much different from their classical forms. Also, the cytomegalovirus virus in children always provokes disruption of the immune system and a decrease in the immune response to other antigens. This occurs due to damage by cytomegalovirus to T-killer and helper cells, and interleukins. Because of this, any bacterial pathology occurs in a severe form and has a tendency to generalize the process, simulating sepsis.

Cytomegalovirus in a child - methods of pharmacological and traditional treatment

It is impossible to completely cure cytomegalovirus in children. The essence of any treatment method is to relieve clinical symptoms and prevent possible complications.

Pharmacological treatment. Typically, treatment has two components: the use of antiviral drugs and the introduction of agents to stimulate the immune system.

  • Antiviral drugs. Antiherpetic drugs, namely Ganciclovir, are used as antiviral drugs. For acquired CMV infection, this drug is prescribed at a dose of 5-10 mg/kg body weight per day, 2 times a day. Duration of treatment is 2-3 weeks. After this period, the dose is minimized (to 5 mg/kg), and treatment is continued until clinical manifestations are completely relieved and laboratory markers indicating CMV activity disappear. For congenital cytomegalovirus, the same drug is used at a dose of 10-12 mg/kg body weight for 6 weeks.
  • Immunostimulation. Increasing the child’s immune status is carried out by introducing specific immunoglobulins against CMV infection. The course of treatment lasts until clinical progress towards relief of symptoms is obtained. On average it takes about 10-12 injections.

Folk remedies. Almost all recipes for folk remedies aimed at cytomegalovirus in children are based on the use of medicinal herbs.

Recipe No. 1. Ingredients: kopeck root, licorice root, leuzea root, alder fruit, succession herb and chamomile flower. Everything is mixed and 2 tablespoons of the resulting mixture are poured into a thermos with 0.5 liters of boiling water. Next, the mixture is infused for 1 night, after which it is filtered. The finished infusion is taken ¼ cup 4 times a day.

Recipe No. 2. Ingredients: thyme herb, birch buds, string herb, wild rosemary shoots, Leuzea root, yarrow herb, rhizomes with burnet roots. 2 tablespoons of mixed herbs are poured into a thermos and 0.5 liters of boiling water is poured. The thermos is infused for 12 hours. Dose and frequency of administration - 1/3 cup 3 times a day.

It is strictly forbidden to use alternative medicine recipes as the main treatment for cytomegalovirus in children. Before using any of the recipes, you should consult a specialist.

Prevention. The main prevention, as with any other pathology, is to avoid contact with the pathogen. First of all, mothers, especially pregnant women, should prevent cytomegalovirus in children. Early diagnosis of CMV in pregnant women allows one to avoid spontaneous abortions and gross malformations of the child.

Prevention of CMV infection for newborns includes the following actions by the mother:

  1. Wash your hands thoroughly for at least 15 minutes, especially after changing diapers.
  2. Avoid kissing your baby on the lips.
  3. Use separate dishes with your child.
  4. Limit your child's contact with other children as much as possible.
  5. If there is no CMV in the newborn from an infected mother, stop breastfeeding.
  6. Compliance with the anti-epidemic regime.

To prevent cytomegalovirus in an older child, it is necessary, first of all, to comply with all hygiene rules.

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

In this article you will learn everything that parents need to know to treat cytomegalovirus infection in children.

Causes of CMV

CMV is caused by cytomegalovirus, one of the -viruses. Several varieties (strains) of viruses are known. The source of infection is only a person (patient or virus carrier). All secretions of an infected person are infected: nasopharyngeal discharge and saliva; tears; urine and feces; discharge from the genital tract.

Ways of transmission of infection:

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

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

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

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

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

The virus is not stable in the external environment, is inactivated when frozen and heated to 60˚C, and is sensitive to disinfectants.

Susceptibility to the virus is high. Immunity after suffering from CMV infection is unstable. The virus affects various organs. The affected cells do not die, their functional activity is preserved.

Classification of CMV

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

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

Symptoms of CMV

Congenital cytomegaly

Manifestations of congenital CMV infection depend on the duration of infection of the fetus. If infected before 12 weeks, the fetus may die, or the child will be born with possible developmental defects.

When the fetus is infected at a later stage, the acute form of infection is most often manifested by damage to the central nervous system: hydrocephalus, strabismus, nystagmus, increased muscle tone of the limbs, trembling of the limbs, facial asymmetry. At birth, severe malnutrition is observed. The liver is especially often affected: congenital or even fusion of the bile ducts is detected.

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

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

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

The prognosis of congenital CMV infection is often unfavorable.

Acquired cytomegaly

During primary infection in a kindergarten, CMV infection can manifest itself as a disease similar to, which makes diagnosis difficult. In this case, the child develops:

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

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

At localized form(sialoadenitis) affects the salivary parotid (more often), sublingual, and submandibular glands. Symptoms of intoxication are not pronounced. Children may have trouble gaining weight.

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

Pulmonary form manifests itself in the form of a protracted course. It is characterized by: a dry hacking (reminiscent) cough, a bluish tint to the lips. Wheezing in the lungs is intermittent. The X-ray shows an increase in the pulmonary pattern; cysts may appear in the lungs. Mega cells are detected in sputum analysis.

At cerebral form meningoencephalitis develops. This form is characterized by convulsions, paresis of the muscles of the limbs, epileptic attacks, disturbances of consciousness, and mental disorders.

Kidney form quite common, but rarely diagnosed, since the manifestations of the pathology are very scarce: protein in the urine is increased, the number of epithelial cells is increased, and cytomegal cells are detected.

Hepatic form manifests itself as a subacute course of hepatitis. The child has a slight yellowness of the sclera, skin and mucous membrane of the palate for a long time. The bound fraction in the blood is increased, the activity of liver enzymes is slightly increased, but alkaline phosphatase is also sharply increased.

Gastrointestinal the form is manifested by persistent vomiting, loose frequent stools, and bloating. Delayed physical development of children is also typical. Polycystic lesions of the pancreas develop. In stool analysis there is an increased amount of neutral fat.

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

A particularly severe course of the disease is observed in children with. CMV is an AIDS-marking disease. Therefore, when a child is diagnosed with CMV infection, an HIV infection test is performed. CMV accelerates the progression of HIV infection and is often the cause of death in AIDS.

Acquired CMV infection has a long, undulating course. The unsmooth course of the disease is due to the development of complications: specific (, etc.) and nonspecific (addition of secondary infections).

In generalized forms of CMV, death is possible.

Diagnosis of CMV


A blood test for immunoglobulin levels and PCR will help confirm the diagnosis.

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

The following laboratory methods are used for diagnosis:

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

Laboratory diagnosis is especially important in the case of a latent form of the disease. The detection of IgG antibodies in a newborn may indicate maternal antibodies; It is necessary to re-test the child’s blood at 3 and 6 months. If the titer of these antibodies decreases, then congenital CMV infection can be excluded.

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

Considering that the virus is unstable in the environment, the material must be examined for virological analysis no later than 4 hours after collection.

Treatment

Treatment of CMV infection in children depends on the form of the disease, its severity and the age of the child. The latent form does not require special treatment. Parents should only provide their child with age-appropriate food.

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

Only children with acute forms of CMV require treatment. With mononucleosis-like form, specific therapy is usually not required; symptomatic treatment is used.

In case of intrauterine infection and severe manifest forms, complex treatment is carried out in a hospital setting.

Specific antiviral treatment includes:

  • antiviral drugs (Ganciclovir, Foscarnet);
  • anti-cytomegalovirus immunoglobulin (Cytotect);
  • interferons (Viferon).

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

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

In case of secondary infections, apply antibiotics.

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

In severe cases they can be used.

Considering the suppressive (immunosuppressive) effect of the virus on the immune system, it is possible to use (based on the results of an immunogram study) immunomodulators(Tactivin).

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

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


Prevention of CMV

There is currently no specific prevention for CMV infection. To prevent intrauterine infection, it is recommended that pregnant women carefully observe the rules of hygiene and screen them for TORCH infections. If CMV infection is detected in a pregnant woman, it requires adequate treatment and the introduction of a specific immunoglobulin (Cytotect) every 2-3 weeks, 6-12 ml during the first trimester.

Careful hygiene when caring for small children will protect the child from infection; it is also necessary to teach these rules to older children.

A person faces viral diseases throughout his life, many of them manifest themselves clearly, while others are practically asymptomatic, but are dangerous due to complications. The latter includes cytomegalovirus, which is especially dangerous for children. Therefore, it is important for parents to know how to recognize this infection, because timely diagnosis and treatment can protect the baby from serious consequences.

What is cytomegalovirus

Cytomegalovirus was discovered in 1956 by Margaret Gladys Smith

Cytomegalovirus is a human virus type 5 of the herpes family Herpesviridae. Back at the end of the 18th century, a case was recorded of the discovery of pathologically large cells in the organs of a child’s corpse, presumably these were tissues affected by cytomegalovirus. A full-fledged mature particle of this virus is 180–300 nm; under magnifying glasses it looks much larger and more convex than the others. The disease and its causative agent were officially identified only in 1956.

About 95% of the world's population is infected with cytomegalovirus: 10–15% of them are children under 14 years of age.

The pathogen likes to sit in the salivary glands of a person, causing their inflammation, which is often the only symptom of infection. But in an infected person, cytomegalovirus (hereinafter referred to as CMV) is found in all biological fluids:

  • sperm;
  • blood;
  • tears;
  • secretion of the cervix and vagina;
  • saliva;
  • breast milk;
  • nasopharyngeal mucus;
  • feces;
  • cerebrospinal fluid.

From this “geography” it is clear that the virus is distributed throughout the human body; in the event of a sharp decrease in immunity, it begins to harm any organ or entire system. Therefore, the virus sometimes disguises itself as a sore throat, flu or even deafness, and doctors carry out local treatment of the problem without identifying it. Only now is medicine beginning to suggest that CMV is the root of many health problems in both adults and children. Although, if you lead a correct lifestyle and avoid stress, the virus may not detect itself, the person simply becomes its carrier for life.

Of course, there are groups of people for whom CMV is extremely dangerous - these are children in the womb and children in early life. Cytomegalovirus belongs to a group of viruses that can penetrate the protective filter of the placenta and cause irreparable harm to the health of the embryo. And in newborn children, by the age of six months, maternal antibodies (maternal immunity reserves) decay, while their own immunity is finally formed only by the age of 1 year. Although protective cells still continue to come from mother's milk, they are not enough to fully repel the attack of the virus. Due to the immaturity of the immune system in both cases, the virus cells, once in the bloodstream, become the dominant invaders. CMV is activated and begins its destructive effect on the small organism.

Routes of infection

Antenatal (intrauterine) infection, although the most dangerous, is quite rare. If CMV enters the expectant mother’s body relatively long before conception, then her immune system has already accumulated a large number of antibodies, and the baby’s health is not in danger. If the mother first became infected with it during pregnancy, especially in the first half, then this threatens a number of pathologies for the embryo. As a rule, before the 3rd month of pregnancy, the woman’s body itself gets rid of the “sick” fetus - a miscarriage occurs. But if, nevertheless, the fetus is fixed, then extremely severe deviations may be observed in its development in the 1st–2nd trimester (during the formation of organs):

  • underdevelopment of the brain convolutions and its small volume;
  • disruption of the formation of the optic nerve;
  • pathologies of the development of the heart and spinal column;
  • problems with the lungs and other internal organs.

The mortality rate from early intrauterine infection is about 27–30%, and born children often suffer from serious illnesses - epilepsy, hydrocephalus, blindness, heart defects, and serious delays in mental and physical development.

Intrapartum infection (or infection during childbirth) is less dangerous for the child than intrauterine infection. This mainly occurs when passing through the birth canal or during a blood transfusion, through the secretion of the cervix and the first mother's milk. Since the incubation period (the period of time from infection to the appearance of the first signs) of CMV is about two months, its first symptoms appear after this time. The claim that if you perform a caesarean section, you can avoid infection of the fetus, it is a myth. The likelihood of infection during surgery is the same as during natural delivery.

Postnatal (postpartum) infection is caused by the baby’s immature immune system. The transmission routes are varied: from airborne droplets to contact. This could be infected mother's breast milk, kisses from a virus carrier, or any contact with infected blood during medical procedures. Infection is also especially developed in kindergartens, since airborne droplets are joined by contact - through toys, hands not washed in time after using the toilet, towels, dishes, etc. When a child visits a preschool institution, the main task of parents is to ensure good immunity for the baby. Strong immunity will not allow you to avoid CMV infection completely - the probability of infection is very high, but good immune protection will not allow symptoms of the disease to develop.

It is worth noting that there is a medical theory that the virus that has entered the body still suppresses the immune system, and even if the child does not show signs of illness, he will belong to the frequently ill category of children.

Symptoms and signs of the disease

In newborns and infants

Ulcerative skin lesions are a characteristic sign of infection with cytomegalovirus

If a baby acquires an infection in the womb, it is usually immediately detected by a neonatologist at birth. Symptoms of congenital cytomegalovirus in a newborn:

  • increased bilirubin levels;
  • jaundice (hepatitis);
  • pathologically enlarged liver, spleen, pancreas;
  • elevated temperature;
  • hemorrhages in organs;
  • muscle weakness;
  • skin rash, bleeding ulcers (pyoderma);
  • general intoxication;
  • light weight.

Clinical picture in infants:

  • sudden mood swings (drowsiness alternates with excessive agitation);
  • regurgitation, vomiting;
  • cessation of weight gain or loss;
  • muscle spasms, night cramps;
  • enlarged lymph nodes and salivary glands;
  • yellow tint to the skin and sclera of the eyes;
  • runny nose;
  • redness of the throat;
  • elevated body temperature.

In approximately 31% of cases, a more detailed laboratory examination before vaccination reveals a latent form of CMV in children under 1 year of age. It is CMV that is the root cause of damage to the nervous system after vaccinations, and not a “bad” vaccine. And if detected, it is first necessary to carry out antiviral treatment, and then vaccinate the baby according to the schedule.

In preschool children

Since one of the routes of transmission of this infection is airborne droplets, there is a high probability of cross-infection in places where children gather in large numbers - kindergartens.

If a preschool child’s own immunity fails, cytomegalovirus begins to dominate in the body. Most often, the onset of the disease manifests itself in the form of loss of mood and appetite, tearfulness, increased acetone levels and all signs of acute respiratory infections. However, if normal hypothermia goes away within 1.5–2 weeks, then CMV infection manifests itself in the form of an unusually prolonged cold with a long-lasting elevated temperature.

The insidiousness of CMV also lies in the fact that its chronic latent form may not appear immediately after the baby is born, but at 2–4 years of life or even later. Please note if the child:

  • often suffers from acute respiratory infections (ARVI) and pneumonia;
  • does not cope with bacterial infections - sinusitis, cystitis, skin diseases;
  • reacts severely to vaccination;
  • drowsy, cannot concentrate.

In school-age children and adolescents

If the infection did not occur in kindergarten, the child’s transition to school increases the chances of contracting a cytomegalovirus infection; as mentioned above, 10–15% of children under 14 years of age already have CMV antibodies in their blood.

Since cytomegalovirus is a sexually transmitted disease, high school students and teenagers are more likely to get sick through unprotected sexual contact and kissing.

Manifestations of cytomegalovirus infection in older children and adolescents are as follows:

  • general deterioration of health;
  • increase in temperature;
  • signs of acute respiratory infections - lacrimation, runny nose, severe cough;
  • swelling of the lymph glands (especially the cervical ones);
  • sore throat (or severe redness of the throat);
  • enlargement of internal organs (usually the spleen, liver);
  • blistering rashes on the face and body (on the genitals);
  • gynecological problems in girls (ovarian inflammation, etc.);
  • painful urination in guys;
  • darkening of urine color;
  • aches in muscles and joints;
  • cheesy coating on the tongue and tonsils;
  • nausea, vomiting and diarrhea.

All these signs are also symptoms of another disease of type 4 human herpes virus - infectious mononucleosis, which is caused by the Epstein-Barr virus. Only laboratory tests will help you understand whether it is an acute respiratory infection, cytomegaly or mononucleosis.

Manifestations of cytomegalovirus in the photo

Diagnostics

Laboratory diagnostic methods can detect infection with cytomegalovirus even in the absence of obvious symptoms of the disease

To determine the presence of the virus, a number of laboratory tests must be performed. Medicine offers several modern types of tests for CMV:

  • blood test for antibodies;
  • general and biochemical blood test;
  • PCR analysis of urine and blood

Testing blood serum for antibodies using the enzyme-linked immunosorbent assay (ELISA) is a fairly sensitive and accurate diagnostic method that will allow you to determine whether a child is sick. And if the baby is sick, the results of the study will show the degree of activity of the virus. Immunoglobulins IgM and IgG (also called antibodies) are proteins that adhere to the cells of the virus and destroy it, a kind of “soldiers of health.”

So, based on the results of the analysis, the following can be determined:

  • IgM and IgG antibodies were not detected - CMV never entered the body.
  • IgM antibodies are not detected, IgG are present - the person has already been sick before (possibly asymptomatic), and antibodies have been developed. But it should be remembered that these antibodies do not guarantee that the disease will never appear again. Unfortunately, absolute immunity to cytomegalovirus is not developed, and everything depends only on the strength of one’s own immunity. If it decreases, a relapse may occur.
  • IgM is present, IgG is absent - the person is in the acute stage of primary infection and needs urgent treatment.
  • both immunoglobulins IgM and IgG are present - relapse of the disease.

It should be remembered that this analysis should only be deciphered by a specialist. It is possible that after 14 days a repeat analysis may be needed (to monitor the dynamics of antibodies) or an alternative research method.

A complete blood count in the case of an active stage of the disease shows obvious lymphocytosis (an increase in the number of lymphocytes, the norm is 19–37%), as well as a decrease in the level of red blood cells. Biochemistry reveals an increase in mononuclear cells (> 10%), a decrease in hemoglobin levels and an increase in the number of neutrophils.

Analysis of urine and blood using the polymerase reaction is an ultrasensitive method and allows almost 100% probability to detect DNA cells of the causative virus. The method is quite accurate and helps detect the presence of infection even when the child does not yet show any symptoms. The study takes only 3–4 hours.

Treatment

The statement that cytomegalovirus infection can be cured is erroneous. It is impossible to cure the disease completely; once the virus enters the body, it remains in it forever. It’s just that when immunity decreases, it can wake up, but the rest of the time it doesn’t manifest itself in any way in a healthy child. The golden rule in this situation is that it is better to do nothing than to conduct the wrong therapy. It is necessary not to “treat” the virus, but to raise the baby’s immunity by all means. All therapeutic actions should be carried out only if all symptoms clearly manifest themselves.

It is impossible to treat a child in utero, so all measures are aimed at stabilizing the mother’s condition - raising immunity and suppressing the virus, in order to avoid complications in the form of fetal malformations. Used:

  • antiviral drugs - Acyclovir;
  • immunostimulants - Cytotect, immunoglobulin injections, Splenin, Dibazol.

During pregnancy, it is impossible to take all necessary measures so as not to harm the embryo. For example, the drug Ganciclovir is contraindicated during this period due to its toxicity.

Newborns and children of the first year of life, depending on the stage and nature of the disease, may be prescribed courses of interferon drugs:

  • Interferon;
  • Cytoven;
  • Leukinferon;
  • Ganciclovir (with caution);
  • Cytotect (Neocytotect);
  • Neovir.

For older children, it makes sense to use immunostimulating agents, such as:

  • Isoprinosine (from three years);
  • Thymogen (from six months);
  • Derinat;
  • Immunoflazid (can be prescribed from the first days of life).

To alleviate the general condition, symptomatic treatment is also prescribed. Possible application:

  • vasoconstrictor drops for free breathing through the nose, since breathing through the mouth negatively affects the functioning of the heart and brain (Naphthyzin for children, Sanorin);
  • antihistamines (for example, Zodak) to reduce itching in case of skin rashes;
  • antipyretic drugs based on ibuprofen or paracetamol (medicines containing aspirin are not used in pediatrics), plant-based rectal suppositories (Viburkol).

    Doctors do not recommend lowering the temperature in children below 38 degrees, so as not to disrupt the functioning of the immune system. An increase in temperature indicates that defense mechanisms are turned on and the active phase of the fight against the virus is underway.

After relief of symptoms and satisfactory final test results, the attending physician can prescribe physical therapy procedures for a small patient that will stimulate self-healing processes, for example, UHF, mud therapy, massage and other methods. This will increase the body’s defenses and prevent relapse of the disease.

There are also natural stimulants: yarrow, horsetail, eleutherococcus, ginseng, rose hips, thyme, hawthorn, lemongrass, echinacea. For example, a ready-made alcohol tincture of Echinacea or Eleutherococcus can be purchased at a pharmacy, and decoctions of other plants can be prepared at home. Herbal stimulants begin to be taken in small doses, as an allergic reaction may occur. Consultation with a pediatrician before starting herbal treatment is strictly required!

How to boost a child’s immunity - video by Dr. Komarovsky

Possible consequences and complications

In most cases, cytomegalovirus infection is asymptomatic, complications are rare but serious. The danger is that at any moment a dormant infection can “shoot” anywhere in the body. For example, its congenital form can occur without any special manifestations, and later develop into subsequent diseases, such as:

  • anemia;
  • encephalitis;
  • hepatitis;
  • neuropathy;
  • brain cancer;
  • pneumonia (may be accompanied by laryngitis, bronchitis);
  • hemorrhagic syndrome (bleeding in organs and tissues);
  • lymphocytosis (inflammation of the lymph nodes);
  • damage to internal organs of various locations (nephritis, cystitis, pancreatitis, etc.);
  • hepatitis;
  • CMV encephalitis:
  • bacterial sepsis.

Preventive measures

All preventive measures are directly related to maintaining immunity:

  • it is necessary to provide the child with proper nutrition;
  • engage in moderate physical activity (swimming, Pilates for children);
  • ensure proper rest (daytime sleep in young children);
  • take vitamin complexes;
  • walk in the fresh air more often;
  • observe the rules of hygiene.

To prevent intrauterine infection, pregnant women with no immunity to cytomegalovirus should:

  • avoid places with large crowds of people (cinemas, markets);
  • observe the rules of personal hygiene;
  • do not use other people’s combs, toothbrushes, bed linen, dishes, lipstick, etc.;
  • take specialized vitamins for pregnant women;
  • avoid stress;
  • ventilate the apartment 2 times a day.

Cytomegalovirus is one of the most common diseases on the planet, posing a threat to the child even in the womb. But knowing information about it, prevention and proper treatment will help avoid terrible consequences.

Cytomegalovirus infection (also known as inclusion disease, cytomegaly) develops in people when human herpesvirus type 5 enters the body.

For children, this infection poses the greatest danger. In terms of teratogenic effects on the fetus, it ranks second after rubella. In severe cases, the herpes virus not only causes serious pathologies in a developing person, but also leads to spontaneous abortion, fetal cardiac arrest, and stillbirth.

One percent of newborns in developed countries are infected with CMV. In developing countries, 4.5% of newborns have.

It is believed that the intensity is determined by socio-economic and living conditions, iatrogenic interference, and the surrounding environmental situation.

How is CMV transmitted to infants?

Babies can become infected with this virus both from a seropositive mother and from other persons. There are several ways a child can become infected with CMV from the mother:

  • through the placenta;
  • through an infected birth canal;
  • through breast milk;
  • through saliva (at ).

In addition, the herpesvirus strain is transmitted through household contact (dishes, toys, hygiene products) and by airborne droplets. Therefore, there is a high probability of infection from strangers, including other children.

Clinical manifestations

If it enters a child’s body, it does not immediately make itself felt. The incubation period can range from 15 days to several months. At this time, the child is an active carrier of the virus.

Signs of infection may include:

  • increased body temperature;
  • inflammation and enlargement of the salivary glands;
  • sore throat;
  • redness of the nasopharynx;
  • enlargement of the palatine tonsils;
  • poor appetite, weight loss, abdominal pain, vomiting, diarrhea;
  • jaundice, signs of liver disorders.

In severe cases, symptoms of pneumonia may occur. The occurrence of mononucleosis-like syndrome is observed in blood recipients. The generalized form of acquired herpes virus is rare.

Complications in children with CMV

The disease poses a serious danger to babies whose infection occurred in the prenatal period or before one year. Acute asymptomatic course of cytomegaly in infancy can cause neurological pathologies, brain damage, hearing and vision loss, strabismus, anorexia, and motor dysfunction in children in the future.

Babies over the age of one year tolerate cytomegalovirus infection more easily. The disease is limited to manifestations characteristic of respiratory diseases. The older the children, the faster they cope with the virus.

Diagnosis of infection

Since the symptoms of cytomegaly are similar to ARVI, and some forms are completely asymptomatic, it is difficult to diagnose. If you suspect it, you should contact your pediatrician. collect anamnesis, perform an examination and prescribe laboratory or instrumental tests.

In cases where the disease is complicated, consultation with other specialists (for example, neurologist, urologist, ophthalmologist, immunologist, gastroenterologist, otolaryngologist) may be required.

General clinical examination methods

Laboratory methods for diagnosing CMV in children include a biochemical blood test and a general urine test. They allow you to determine the amount of bilirubin and protein, determine the presence of anemia, and analyze the condition of the kidneys and liver.

If a heart defect develops, the child is given an ECG. For disorders in the central nervous system and to assess the condition of internal organs, ultrasound, MRI or CT is used. Instrumental and laboratory methods make it possible to identify pathologies in the urinary, reproductive, respiratory and other systems, and diagnose concomitant diseases.

Direct diagnosis of CMV

There are several options for studying the biomaterial of children in order to identify the causative agent of infection. For analysis in babies under three weeks of age, cerebrospinal fluid, urine, saliva.

Using the PCR or DNA hybridization method, the presence of the herpes virus and its antigens is determined. A positive result occurs in the case of active or latent infection.

You should not neglect examinations, since infection is fraught with the birth of a child with deformities, microcephaly, and severe damage to the central nervous system.

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-containing virus belonging to the herpesvirus family. The pathogen was first discovered in 1882 at 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 unfavorable 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 titer of IgG, IgM;
  • 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.