Cytomegalovirus infection in children: features of the course and treatment of the disease. Cytomegalovirus in children - routes of infection, symptoms, diagnosis, treatment methods, consequences and prevention Cytomegalovirus treatment in a child

The danger of cytomegalovirus (CMV) in children is often exaggerated. Some doctors claim that it untimely treatment can lead to fatal outcome, others reassure that the problem is easily diagnosed and quickly treated. Dr. Komarovsky, whose opinion is considered the most authoritative today, will help clarify the situation.

What is a virus?

Cytomegalovirus infection in children develops due to the penetration of a virus into the body that belongs to the herpes family. First of all, it hits salivary glands. If the course is unfavorable, the infection quickly spreads to all internal organs. If the baby’s body is weakened and unable to resist the disease, lesions form internal bleeding, which is life-threatening.

A special feature of cytomegalovirus is its ability to increase cell size several tens of times. Such giant formations have a dense intranuclear inclusion. Because of this, the cage looks like an owl's eye.

The most dangerous virus is cytomegalovirus, which enters the fetus through the placenta from the mother. At the same time, the formation of the baby’s tissues and organs is disrupted. Such children can be born with all sorts of defects. In junior age group and more late age the virus is transmitted to a child from an infected person. Outbreaks of this infection are often observed in kindergartens and schools. This occurs due to contact healthy body with biological material of the carrier.

Cytomegalovirus lies dormant in a child’s body for a long time. It can be activated a sharp decline immunity, hypothermia, change in climate or diet. Vivid symptoms appear after long stay in a stressful situation.

Types of disease

The disease is classified based on the duration of infection. The following types of CMV are distinguished:

• Congenital. The virus penetrates the placental barrier to the fetus from an infected mother. Complications up to complete hearing loss or developmental delays are observed in only 10% of total number sick children during this period of life. For others, the disease may not manifest itself in any way and be asymptomatic.
• Perinatal. Cytomegalovirus is transmitted when a baby passes through the birth canal or during breastfeeding. Symptoms often do not appear, since the baby is protected by antibodies contained in breast milk. This form of the disease does not have neurological consequences.
• Postnatal. Infection occurs at a late age. The development of infection is facilitated by a sharp decrease in immunity. IN infectious process Several organs can be activated simultaneously.

To exclude the possibility of congenital CMV, expectant mothers are advised to undergo regular medical examinations and eliminate all identified problems. After the baby is born, the cut also needs to be examined for infection.

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Clinical manifestations

Symptoms cytomegalovirus infection in a child will largely be determined by the age at which infection occurred. Infection at the stage of intrauterine development manifests itself in a decrease in the size of the skull, thinning of the cerebral cortex, and improper formation of its convolutions. IN severe cases Newborns may develop developmental defects that are incompatible with life.

If the infection occurs after the baby is born, the following symptoms may appear:

• Pneumonia.
• Enlargement of the spleen.
• Microscopic hemorrhages on the skin.
• Jaundice.

In the postnatal period, in almost 95% of cases, cytomegalovirus occurs without significant symptoms. In rare cases, the following appear:

• Increased body temperature.
• Loss of appetite.
• Runny nose.
• Increased size of lymph nodes.
• Pain in the abdominal area.

In an older child, CMV symptoms may resemble the clinical picture common cold. Therefore, parents try to stop it themselves. Doing this is strictly prohibited. At the first warning signs you need to see a doctor.

What does Komarovsky think about the danger of CMV?

Komarovsky voiced his opinion on cytomegalovirus more than once. He believes that the virus was transferred to early childhood much safer than as an adult. In newborns, the disease rarely occurs with complications. At the same time, the body develops a strong immunity that lasts for a lifetime.

100% of all inhabitants of the globe are recognized as carriers of such an infection. But it doesn’t appear in everyone. The activation of the virus is influenced by a combination of many factors: decreased immunity, use of potent medications, poor nutrition, contact with chemicals.

Cytomegalovirus enters the child's body during the gestation stage. The appearance of complications and clinical symptoms will depend on the activity of the virus. Pregnant women need to maintain their immune system at the proper level, avoid stressful situations, psychological and physical overload, eat right, spend more time in the fresh air.

How is the problem diagnosed?

It is possible to develop a treatment method for cytomegalovirus for newborns and older children only after diagnosis accurate diagnosis. To do this, experts use the following methods:

• Study of saliva, urine or blood using polymerase chain reaction.
• Serological study of biological material. It allows you to determine the presence of antibodies in the sample.
• General blood analysis. It is used only in addition to others diagnostic techniques. The presence of an inflammatory process is indicated increased ESR and decreased platelet levels.

The earlier cytomegalovirus is diagnosed, the greater the likelihood of a quick cure. In some cases, according to doctors, treatment may not be carried out at all. This is determined individually for each patient.

Cytomegalovirus is a fairly common type of infection. But, in 90% of cases, the person who is its carrier is not even aware of its presence. Until it turns out in the process medical research, or no obvious symptoms of the disease will appear.

Signs of CMV

In order for an infection to manifest itself, a number of provoking factors must appear. Namely:

• regular stress;
• use of a cytostatic or immunosuppressant;
• systematic hypothermia;
• HIV infection.

Most often, signs of cytomegalovirus manifest themselves in the form of a banal respiratory disease with standard symptoms: low body temperature, general malaise, headaches. A little less often, the virus can make itself felt with more serious ailments: arthritis, pneumonia, encephalitis.

A clear sign of CMV infection may be a lesion internal organs. In this case, the kidney tissue, adrenal glands, spleen, and pancreas become inflamed. In turn, such processes are accompanied by frequent pneumonia, low rate platelets in the blood, enlargement of the parotid and submandibular salivary glands. In addition, inflammation of the joints and rashes on the skin may occur.

Signs of cytomegalovirus include inflammation of organs genitourinary system. In women, it manifests itself as inflammation and erosion of the cervix, vagina, and ovaries. In this case, the patient experiences severe pain.

In men, from the genital organs, the disease is asymptomatic. Only in rare cases does inflammation of the testicles occur or urethra, accompanied painful sensations during hygiene procedures.

Can CMV cause fever?

Often, when a patient has cytomegalovirus, there is an increase in body temperature. This usually happens after incubation period, which takes place over a period of 20 to 60 days. Most often this symptom is characteristic acute form diseases.

As a rule, the thermometer readings in this case will vary from 37.5 degrees to 38. Very rarely, but it still happens if before infection with the virus the human immune system was too weakened, the temperature with CMV can rise even higher. But, after some time, this indicator returns to normal without medical intervention.

Sometimes, fever with cytomegalovirus may be accompanied by other symptoms colds, sore throat.

Skin rash due to cytomegalovirus

A rash is also a common sign of CMV. The rashes have a reddish-brown tint. Most frequent places their concentration is the face, legs, arms, oral cavity. However, a skin rash due to cytomegalovirus can also be located in other areas.

The size and intensity of the spots depends on many factors. Starting from individual characteristics body, and pumping up the degree of infection.

This symptom is typical when a woman’s genitourinary system is affected. Typically, it causes cercivitis (inflammation, erosion of the cervix), endometritis (infection of the inner layer of the uterus, ovaries or vagina). The disease is extremely dangerous during pregnancy. It can lead to all sorts of fetal malformations.

Cytomegalovirus discharge has a white-blue tint and comes from the genitals.

It is also one of the symptoms of CMV infection. In medicine there is even a special term “cytomegalovirus pneumonia”. In almost all patients, the cough is paroxysmal and dry. By its nature, it is very similar to the cough of whooping cough.

This sign of CMV may also be accompanied by shortness of breath. Initially, it appears only occasionally. Moreover, with only intense physical activity. And subsequently, the symptom begins to appear even with minimal movements.

In addition to shortness of breath, cough with cytomegalovirus may be accompanied by sharp jumps temperatures from 35 to 38.5 degrees. If you don't take any medical measures and do not treat cytomegalovirus, the patient's condition will worsen significantly.

The cough will become systematic, signs of intoxication become more obvious. Temperatures with CMV reach a peak of 40 degrees. There is also severe weakness, sweating, especially at night, and a sharp decrease in body weight.

The problem of cytomegalovirus infection remains relevant today. In what cases should you be afraid of it? What should you pay attention to? AND main question: is it worth treating cytomegalovirus in children?

What is cytomegalovirus infection?

Cytomegalovirus is an opportunistic virus of the herpesvirus family, subfamily of β-herpesviruses.

Cytomegalovirus (CMV) is ubiquitous. The source of infection is a person, especially during the period of virus activation during primary infection or during the period of exacerbation of a sluggish disease.

• The pathogen can be transmitted through blood transfusions (blood transfusions), organ and tissue transplantation, as well as through close (direct or indirect) contact with biological secretions: saliva and urine (kissing, hugging, caring for children and persons with disabilities
• , contact with patient secretions in medical institutions);
• with genital secretions (sperm, cervical and vaginal secretions);

breast milk.

Classification

1. According to the timing of infection, they are distinguished:
2. Congenital (intrauterine).
3. Perinatal.

Postnatal CMV infection.

Congenital, or intrauterine, CMV infection It develops as a result of transmission of the virus during pregnancy from mother to child through the placenta with a primary (acute) infection or with reactivation of an existing disease.

Only 0.2–2% of newborns are infected with CMV. At primary infection A pregnant woman has a 40% chance of transmitting the virus to her child, 10–15% of whom will have clinical manifestations, including serious violations

hearing and psychomotor development. The remaining 85–90% of children will not have any symptoms of the disease. Most often, the pathogen does not manifest itself at all. Relevance congenital pathology

• hearing impairment;
• mental and behavioral disorders;
• delayed motor development;
• cerebral palsy;
• visual impairment.

In various countries, congenital CMV infection is the leader among non-hereditary causes of hearing loss in children.

Perinatal

Develops as a result of transmission of a virus:

• during childbirth:
  • through the placenta;
  • upon contact with cervical secretions;
• in the neonatal period:
  • when breastfeeding;
  • during blood transfusion, etc.

Most perinatally infected newborns are asymptomatic (protected by maternal antibodies). Clinically significant illness possible in premature babies, especially if they are transfused with leukocyte-containing blood components from a donor whose body already has the pathogen. There are no neurological consequences.

Postnatal

In persons with good immunity postnatal infection is often asymptomatic, with the exception of rare cases of CMV mononucleosis (usually found in adolescents), and does not lead to clinically significant consequences.

About 1/3 of children aged one year are infected with the virus. Prevalence is higher among people with lower socioeconomic status and in regions where close household contacts are traditional (including countries in Eastern and Southern Europe).

The virus is sensitive to many cells of the body, which makes it possible to involve many organs and systems in the infectious process. After primary infection, CMV persists in the human body for life with alternating periods of activation and remission (temporary weakening or disappearance of symptoms).

The places where the virus is located during the absence of manifestations of the disease are most often lymphocytes and monocytes peripheral blood. During the period of re-activation, an asymptomatic pathogen is almost always released with biological secretions, for example, saliva, urine. Moreover, in these liquids its concentration is 3–5 times higher than in blood, which causes them highly infectious, and also explains their use as a material for laboratory research.

Symptoms and signs in newborns, infants and adolescents

Clinical manifestations in newborns depend on the timing of infection:

1. When infected during embryogenesis (4–10 weeks of intrauterine development), the virus causes damage to neurons in the brain, which can lead to:
   • to microcephaly (reduction in the size of the skull and, as a consequence, the brain);
   • to thinning of the cerebral cortex;
   • to microgyria (impaired development of brain convolutions);
   • to miscarriage (due to both defects incompatible with life and the manifestation of placental insufficiency).
2. When infected in the early fetal period (11–28 weeks of intrauterine development), when the fetal body responds to damage inflammatory reaction, organ malformations are formed:
   • microcephaly;
   • underdevelopment of the cerebellum;
   • cysts in the brain;
   • increase in the size of the spleen;
   • calcifications in internal organs;
   • ascites (accumulation of fluid in abdominal cavity);
   • accumulation of fluid in the pleural cavity;
   • hydrops fetalis;
   • high or low water levels;
   • insufficiency in the blood circulation of the placenta.
3. When infected in the late fetal period, closer to childbirth, the pathology of the newborn develops in the form of an inflammatory process in the organs:
   • CMV pneumonia;
   • pinpoint hemorrhages in the skin (as a manifestation hemorrhagic syndrome due to decreased platelet levels);
   • enlarged spleen;
   • jaundice.

As for the manifestations of the disease in children infected in the postnatal period, in 95–99% the disease is asymptomatic. The clinic develops very rarely mononucleosis-like syndrome

The true one is caused by the Epstein-Barr virus, which belongs to the same family as CMV; it occurs as a common respiratory viral infection.

It is characterized by:

• temperature rise to 38°C;
• decreased appetite in a child;
• weakness, lethargy, drowsiness;
• redness of the throat;
• enlarged lymph nodes;
• stomach ache.

Laboratory diagnostics

The following methods are most often used to diagnose the disease:

• determination of CMV DNA by PCR. The material for research can be saliva, urine, and less often - blood;
  

  CMV DNA determination - gold standard laboratory diagnostics diseases.

• serological tests to determine the antibody response are the determination of anti-CMV IgM and IgG by ELISA. Detection of anti-CMV IgM may indicate either a primary (acute) infection or re-activation of an existing disease. In those newly infected, IgM persists for 6–9 months. CMV DNA can be detected during the entire period that the virus is in the body: during primary infection (maximum content of the virus in the blood), during the period of re-activation, but may not be detected during the period of “hibernation”.

results general analysis blood tests are not specific for diagnosis, that is, changes in them will be the same as with other infections: possibly an increase in leukocytes, a decrease in platelets, an increase relative to the norm.

Treatment

Therapy for CMV infection is absolutely indicated for persons with reduced immunity and patients after organ transplantation. The main goal of treatment congenital disease consider the prevention of near and distant neurological consequences, therefore the provision of medical care necessary for any disorders of the nervous system. There is still no consensus on whether lung therapy is necessary clinical forms

and asymptomatic intrauterine CMV infection.

• Main drugs for treatment:
• Ganciclovir;
• Valganciclovir;
• Foscarnet;
• Cidofovir;
• Isoprinosine;

Interferon.

How to detect and defeat cytomegalovirus - video

Prevention

• Since the most dangerous infection is for women during pregnancy, they are examined and subsequently treated. If a diagnosis of CMV infection has been established in a relative or friend, you must:
• carefully observe the rules of personal hygiene;
• carry out daily cleaning of premises using disinfectants;
• regularly ventilate rooms; use personal protective equipment ( face masks

which must be changed every 3 hours).

Do not forget about increasing and maintaining your own immunity; it is recommended to take vitamin and mineral complexes. A vaccine against the disease is under development.

Doctor Komarovsky about increasing immunity in children - video

Consequences of cytomegalovirus in children

1. The consequences of infection are most often absent, but in some cases they may develop:
   • Deviations from the central nervous system:
   • motor dysfunction;
   • mental disorders;
   • behavioral disorders;
2. cerebral palsy.
   • Violations by other authorities:
   • damage to the hearing organs (deafness);

vision (blindness). Like any other infection, cytomegalovirus can either lead to unfavorable outcomes or go completely unnoticed. Compliance preventive measures

will help reduce the risk of infection. Health to you and your baby!

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...

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

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

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

The most severe consequences for the health of the child occur when infected through the placenta. In this case, the virus is in the amniotic fluid and in large quantities Fall into digestive system and the child’s 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 development severe complications.

If the mother has antibodies to the virus without any signs of the disease, the risk of developing congenital infection the child has practically no

Primary infection or activation 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 to 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, or hygiene requirements, using shared toys. Frequency 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 manifests itself during intrauterine infection of the fetus and has more severe course. Despite high frequency 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 mental retardation and physical development, decreased or increased physical activity, convulsions, swelling of the salivary glands, blurred vision, 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 not required.

Sometimes encountered complications

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

Approximately 17% of asymptomatic infants infected with cytomegalovirus develop seizures several months after birth. movement disorders, abnormal dimensions of the skull (micro- or hydrocephalus), insufficient body weight. At the age of 5-7 years, 10% of children develop disorders of the nervous system, speech disorders, mental retardation, underdevelopment of cardio-vascular 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. At normal activity immune system, it is asymptomatic, with a reduced immune status - 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, retina, intestines, nervous system, joints. The addition of bacterial infections is often observed.

The atypical course of cytomegalovirus infection is rare and may manifest itself in small skin rashes, damage to the reproductive system, paralysis, hemolytic anemia, dropsy of the abdomen, 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 detects the DNA of the virus and its rate of reproduction in the body.

The most common is enzyme immunoassay. When using it, it is necessary to determine several types of antibodies at once, which makes it quite expensive. However, 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, it is recommended drinking plenty of fluids to reduce signs of intoxication.

Treatment is necessary when severe symptoms congenital infection or complications. 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. Used for treatment antiviral drugs: 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

Facilities specific prevention there are no cytomegalovirus infections. The vaccine is under development.

To protect the child from possible consequences 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 mandatory to be tested twice for the presence of antibodies to the virus. timely detection primary infection or chronic relapse.

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 developing severe forms infections, so in the future it is enough just 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 balanced diet and hardening of the body.

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

What is cytomegalovirus

This is the abbreviated name for cytomegalovirus infection (CMVI), which has no seasonality. Its other names: cytomegalovirus, CMV infection, CMV. The disease belongs to the herpesvirus family, along with viruses that cause chicken pox and herpes simplex. The difference between CMV is that it can infect a child’s body both in utero and in other ways.

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

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

Transmission routes

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

• Airborne. Infection occurs when talking to a patient or as a result of his sneezing.
• Contact. Infection occurs through direct contact while feeding a child, kissing, or treating wounds with unprotected hands. Possible infection and by everyday means when using clothes and other personal belongings of the patient. In the first days of his life, a newborn can become infected through breast milk.
• Parenteral. A person becomes infected during a blood transfusion or transplantation of an infected organ.
• Transplacental. The virus is transmitted through the placental barrier or the walls of the birth canal from mother to fetus. The result is that a child develops congenital cytomegalovirus.

Kinds

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

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

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

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

Symptoms

Congenital cytomegalovirus infection in children can manifest itself in different ways. If infected before 12 weeks, fetal death or developmental defects may occur. At later stages, CMV infection is accompanied by symptoms such as:

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

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

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

The congenital form can manifest itself in preschool age. Such children experience mental retardation, atrophy of the organ of Corti of the inner ear, and chorioretinitis (damage to the retina). The prognosis of congenital CMV infection is often unfavorable. The acquired one proceeds like an acute respiratory viral infection, which causes difficulties in diagnosis. Among the characteristic symptoms are:

• runny nose;
• cough;
• temperature increase;
• loose stools;
• redness of the throat;
• lack of appetite;
• slight enlargement of the cervical lymph nodes.

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

• Generalized mononucleosis-like form. It has an acute onset. The main signs of intoxication are: muscle and headaches, weakness, swollen lymph nodes, chills, fever.
• Localized (sialoadenitis). The parotid, submandibular or sublingual glands become infected. Clinical picture not too pronounced. The child may not gain weight.

Taking into account the localization, cytomegalovirus in children causes different symptoms. At pulmonary form CMV infection occurs as pneumonia, as indicated by the following signs:

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

The cerebral form of CMV infection is meningoencephalitis. It causes convulsions, epileptic attacks, paresis, mental disorders and disturbances of consciousness. There are other forms of localized cytomegalovirus:

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

In a child under one year old

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

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

How dangerous is cytomegalovirus for a child?

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

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

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

If a child becomes infected while passing through the birth canal, he may develop pneumonia, encephalitis, and meningitis. After infection during breastfeeding or during a blood transfusion in the first days after birth, cytomegaly may go unnoticed, but in some cases it causes lymphocytosis, anemia, and pneumonia. At the same time, the newborn does not gain weight well and lags behind in development.

Diagnostics

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

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

Blood test for viruses in a child

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

• PCR (polymerase chain reaction). Using this method, CMV DNA is detected in the blood. Biological material Saliva, urine, feces, and cerebrospinal fluid may appear.
• Linked immunosorbent assay. Involves identifying specific antibodies to cytomegalovirus infection. The basis of the method is the antigen-antibody reaction. Its essence is that the antibodies produced by the body when the virus penetrates bind to proteins on the surface of CMV - antigens. The study is serological. ELISA results are interpreted as follows:

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

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

Instrumental methods

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

• X-ray. In the resulting image, you can see signs of pneumonia or other lung diseases in the pulmonary form of CMV.
• Ultrasound of the abdominal cavity. Establishes an increase in the size of the spleen and liver. Additionally, it displays hemorrhages in organs, disorders of the urinary system and digestion.
• Ultrasound and MRI of the brain. These studies show the presence of calcifications and inflammatory processes.
• Fundus examination by an ophthalmologist. Prescribed for the generalized form of CMV infection. The study reveals changes in the structure of the visual apparatus.

Treatment of cytomegalovirus in children

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

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

In case of reduced immunity, the administration of nonspecific immunoglobulin – Sandoglobulin – is prescribed. In the case of acute CMV infection, the patient needs bed rest and plenty of warm fluids for the first couple of days. The basis of treatment is antiviral and some other drugs, such as:

• Foscarnet, Ganciclovir, Acyclovir - antiviral;
• Cytotect – anticytomegalovirus immunoglobulin;
• Viferon is a drug from the interferon category.

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

• For acquired CMVI, the course is 2-3 weeks. The drug is prescribed in a dosage of 2-10 mg/kg body weight 2 times a day. After 2-3 weeks, the dose is reduced to 5 mg/kg and the course of treatment is continued until the clinical manifestations of CMV infection are completely relieved.
• Congenital form infections are treated with a double dosage - 10-12 mg/kg body weight. The course of therapy lasts 6 weeks.

Associated secondary infections are treated with antibiotics. The generalized form of CMV requires vitamin therapy. Symptomatic treatment is the purpose the following drugs:

• expectorants (Bromhexine) - for the pulmonary form, accompanied by a cough with viscous sputum;
• antipyretics (Paracetamol) – if the temperature rises above 38 degrees;
• immunomodulatory (Isoprinosine, Viferon, Taktivin) - from the age of 5 years to accelerate the production of protective antibodies.

How to detect and defeat cytomegalovirus - video

One of important conditions Prevention of cytomegalovirus is hygiene. An older child should be taught the need to wash their hands thoroughly. A mother with cytomegalovirus should avoid breastfeeding if her child was born healthy. Preventive measures also include the following rules:

• strengthen the baby's immunity;
• provide him good nutrition, hardening and regular sports;
• limit the child’s contact with sick people;
• when planning pregnancy, get tested for antibodies to CMV in order to get vaccinated on time if necessary;
• Avoid kissing your baby on the lips.

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