Congenital cytomegalovirus infection in infants. Cytomegalovirus in children - why and how to get rid of it? Cytomegalovirus in a child symptoms treatment

Cytomegalovirus infection (CMVI) is a viral infectious disease. It is caused by a DNA virus - Cytomegalovirus hominis, which belongs to the herpesvirus family, which includes Epstein-Bar, chickenpox and others. The CMV virus can be found in various parts of the human body, but CMV is most likely to settle in the salivary glands.

The causative agent of the disease, after entering the human body, multiplies in the cells of the infected person. HCMV is species-specific for humans, characterized by slow replication, reduced virulence, and low interferon-producing activity. The virus is heat labile, but remains virulent at room temperature.

Why is cytomegalovirus dangerous in children?

When a child is healthy, cytomegalovirus often does not manifest itself. However, the virus is deadly for people with immunodeficiency conditions: HIV patients, people with established transplants, expectant mothers and newborns. After infection, the cytomegalovirus virus can remain hidden in the body for a long time (latent form). It is practically impossible for a person to suspect that he has this infection, but he is a carrier of cytomegalovirus. Cytomegalovirus provokes such life-threatening complications as: inflammation of the brain (encephalitis); diseases of the respiratory system (for example, viral pneumonia); inflammatory and viral diseases in the gastrointestinal tract (enterocolitis, hepatitis) and so on.

The worst outcome of the latent course of CMV infection is malignant neoplasms.

This viral disease affects both children and adults. The child often becomes infected in the womb, through the uterus or placenta. When primary infection with CMV infection occurs in the early stages of pregnancy, this can quickly lead to the death of the fetus; in the later stages, the child continues to grow, but CMV infection, in one way or another, affects the quality of its intrauterine development. Congenital cytomegalovirus infection may develop, or infection may occur during childbirth. If the infection recurs, the risk of fetal infection is lower, but treatment is required. In accordance with each specific case, appropriate pregnancy management tactics should be developed.

Cytomegalovirus infection in a child: symptoms and treatment

Cytomegalovirus in children is widespread on the planet, but it is somewhat more common in developing countries with a low standard of living. The virus is detected in a wide variety of biological fluids of the human body: blood, saliva, urine, breast milk, vaginal secretions and semen. Once in the body, the pathogen remains there for the rest of its life. Usually, CMV infection is not noticeable externally.

The signs of illness in infants are very similar to the symptoms of a common cold: increased fatigue, fever, inflammation in the pharynx, hypertrophy of the tonsils.

Usually, with a good state of immunity, cytomegalovirus is latent, without showing any clinical signs. Whereas during the period of decreased immunity, generalized forms of the disease develop.

Congenital cytomegalovirus in a child: symptoms

Clear signs of intrauterine infection with cytomegalovirus do not appear immediately after the baby is born, but only at 3-5 years of age. In addition, in children under one year of age, infection with cytomegalovirus occurs through close contact, both from relatives with whom the child lives, and from peers in various preschool institutions.

In both children and adults, the manifestations of CMV often look like an ordinary acute respiratory infection. Symptoms are usually the following: runny nose, fever, swollen lymph nodes, swelling of the pharynx, sometimes pneumonia, severe fatigue, manifestations of disorders in the endocrine glands, liver, and gastrointestinal tract.

Another consequence of cytomegalovirus is the disease mononucleosis, accompanied by fever, weakness, and fatigue. In the most severe cases, the disease affects all major organs.

Congenital infection with CMV infection in a child leads to impairments in physical and mental development. In addition, cytomegalovirus often leads to death, illness during the perinatal period and delayed disorders in organs and systems. About 40-50% of newborns from mothers who were primarily infected with CMV during pregnancy have an intrauterine infection, of which in 5-18% clinical manifestations appear from the first hours of life. In 25-30% of cases of congenital infection with cytomegalovirus, death occurs. 80% of those who survive have significant neurological impairment. However, the majority of infants infected with cytomegalovirus in the womb do not have pronounced clinical symptoms of the disease at birth, but unfortunately, in 10-15% of them, the consequences will manifest themselves later in the form of impaired hearing functions, deterioration of vision to complete blindness, and delayed intellectual development , seizures.

Cytomegalovirus in children: causes and routes of infection

The virus can hide in the human body for a long time without showing itself. But in a situation where there is a failure in the immune system, cytomegalovirus wakes up and causes disease.

In adults, the virus is transmitted sexually, and children become infected with it while still in the womb or during the birth canal. But you can become infected later: transmission occurs in domestic conditions with blood or saliva.

According to WHO statistics, about 2.5% of newborns are infected with cytomegalovirus in Europe. In Russia, the figures are higher - about 4% of children born with symptoms of the disease. Children born to mothers suffering from cytomegalovirus infection for the first time and in an acute form are immediately prescribed a test for antibodies to CMV. Intrauterine infection with cytomegalovirus is statistically detected in 0.4-2.3% of children born.

Signs and diagnosis of cytomegalovirus in an infant

In most newborns with congenital cytomegalovirus infection, signs of positive cytomegalovirus are not visible externally. They have temporary signs of the disease, which, after a certain time, will go away without a trace. Only a few people have symptoms of congenital CMV that persist for life.

Diagnosing cytomegalovirus in an infant is difficult, therefore, if infection is suspected, a blood test for antibodies is performed to detect antibodies to CMV.

The diagnosis is made by an infectious disease specialist or therapist, guided by the results of special studies. For example, polymerase chain reaction. Blood, saliva, vaginal and cervical samples, and amniotic fluid (during pregnancy) can be tested. Another method of testing for the presence of cytomegalovirus is immune, based on the reaction of the child’s immune system. Testing for cytomegalovirus infection is recommended for women planning to become pregnant.

Sometimes a positive cytomegalovirus has signs that are noticeable immediately during the birth process, although more often the consequences are detected months or even years later. Usually this is complete loss of vision and hearing.

Temporary signs of the disease include: damage to the liver, spleen of the lungs, yellowing of the mucous membranes of the eyes and skin, violet-bluish spots on the skin, reduced weight.

Constant signs of CMV infection in newborns are: blindness, deafness, small head, mental retardation, impaired coordination, death.

CMV infection should be distinguished from herpes type 6. Despite the similarity in the clinical manifestations of these two types of herpes viruses, type 6 herpes has serious differences. It is important not to miss the following warning signs:

1. An increase in temperature to 39-40 C, which does not decrease steadily for three to five days.
2. There are no signs of acute respiratory viral infection or intestinal infection.
3. Roseola causes red rashes to appear on the body.
4. Convulsions due to high temperature.
5. ARVI on the tonsils - herpetic sore throat.
6. Inflammation such as stomatitis in the oral cavity.
7. Neurological disorders.

If the manifestations of herpes virus type 6 are not noticed in a timely manner, the child runs the risk of severe damage to the spinal cord or brain. In infants, complications from herpes type 6 lead to death. It is necessary to urgently call a doctor in order to start the necessary medical care for the child in a timely manner.

Diagnosis of cytomegalovirus infection in children

Whether a child has an infection can only be determined by a laboratory blood test for the presence of antibodies to CMV. If the analysis shows congenital cytomegalovirus, then an acute form of the disease is not necessarily expected and the child is guaranteed to be in danger. Cytomegalovirus IgG is positive, what does this mean? If antibodies to cytomegalovirus in the form of IgG are detected in a child in the first three months of life, most likely they were transferred to the baby from the mother who carried the virus and will soon disappear on their own. In an adult and an older child, this may indicate the development of stable immunity to infection. But if positive antibodies of the IgM class are found in the baby’s blood, giant cells that the body produces in order to respond to the invasion of the virus as quickly as possible, an acute form of cytomegalovirus disease is evident.

How to treat cytomegalovirus infection in children

It is impossible to completely cure cytomegalovirus. However, symptoms can be removed by using antiviral drugs: Panavir, Acyclovir, Cytotect, etc. With these medications the virus will be under control.

For sick expectant and nursing mothers and children, immunity is increased and specialized antiviral drugs are prescribed. In this case, the main emphasis is on increasing immunity. Why are medicinal plants-immunostimulants (such as echinacea, leuzea, ginseng and others), dietary supplements (for example, Immunal), medicinal plants-immunostimulants (such as echinacea, leuzea, ginseng and others), balanced nutrition (minerals) prescribed? and microelements), which necessarily includes fresh vegetables and fruits (vitamins), frequent walks in the fresh air and regular physical activity. To prevent children from becoming infected with cytomegalovirus, it is necessary to provide them with proper nutrition, exercise with them, avoid contact with sick people and maintain hygiene.

Treatment of cytomegalovirus in children with traditional methods

In folk recipes there is no specific treatment aimed at eliminating cytomegallovirus infection, but there are many means to improve the condition of the immune system. Here are some recommendations:

1. A mixture of licorice root, alder cones, kopeck root, leuzea root, chamomile flowers, string grass - in equal shares. Prepare two tablespoons of a mixture of crushed herbs, pour 0.5 liters of boiled water and leave in a thermos overnight. Reception: a third to a quarter of a glass, 3-4 times a day.
2. Garlic and onions help children cope with the virus, especially during the autumn-winter cold season. At this time, it is recommended to add a clove of garlic or several onion rings to your food every day.
3. Aromatherapy - spraying tea tree oil in an apartment creates a microclimate favorable to health.
4. Take aspen and alder bark, as well as dandelion root, one to one. Pour 0.6 liters of boiling water over a tablespoon of the mixture and simmer over low heat for five minutes. Dosage: 2 tablespoons twice a day before meals.

After entering the body, it begins to actively multiply and settles in nerve cells.

The manifestation of symptoms occurs only during a period of weakened immunity, while in healthy children the presence of CMV in the body is not dangerous.

Routes of infection

The specificity of CMV is that it is found in almost all liquid media of the body (blood, urine, saliva, sputum, sweat, vaginal mucous secretions, sperm), so it is very easy for a small, unprotected organism to become infected. Routes of transmission of herpes type 5:

• antenatal – transplacental from mother to fetus;
• intrapartum - from mother to child during passage through the birth canal;
• postnatal - by airborne droplets or contact, through blood transfusion, through mother's breast milk.

Transplacental infection is considered the most dangerous, since the virus penetrates the amniotic fluid and affects almost all organs and systems of the fetus.

Symptoms of infection

• fever, chills;
• runny nose;
• cough;
• enlarged lymph nodes;
• muscle and headache;
• fast fatiguability;
• enlargement of the palatine and pharyngeal tonsils.

Such symptoms can last from 2 weeks to several months and do not require hospitalization or specific treatment.

Features of the course in children of different age groups

The most severe course of cytomegalovirus infection in children is observed in the congenital form of the disease. The immune system of newborns is very weak, so the virus can easily infect the baby’s body and cause disorders and defects that will last a lifetime.

During the postpartum period, infection most often occurs from parents and is asymptomatic. Most become carriers of CMV between the ages of 2 and 6 years, when they begin to have more contact with other children and go to preschool. The course of the disease during this period is more reminiscent of ARVI, and only if symptoms persist for a long time can a suspicion of herpes type 5 arise.

After 6-7 years, the immune system finally stabilizes and can actively resist various infections. Primary infection during this period is often asymptomatic, after which the virus remains in the body in a “dormant” form.

Why is CMV dangerous for children?

For a healthy child with a strong immune system, type 5 herpes is not dangerous; the virus simply lives in the body and does not interfere with its carrier. CMV is dangerous for children with a congenital form of infection, a weakened immune system, or immunodeficiency.

Complications

Children with asymptomatic congenital infection and active CMV in the blood are most susceptible to the development of complications. Within a few months after birth, they may experience the following complications:

• convulsions;
• impairment of motor activity;
• underweight;
• damage to the heart and liver;
• micro- or hydrocephalus.

If the virus has penetrated the vital systems of the body, then serious disorders may occur in the first 10 years of life:

• mental retardation;
• partial or complete deafness and blindness;
• violation of tooth formation;
• speech disorder;
• hepatitis;
• neuromuscular disorders;
• poor development of the cardiovascular system.

The acquired form of infection does not cause such complications in children with strong immunity. If the body is weakened, the virus can affect the lungs, liver, heart and kidneys, and the disease itself becomes chronic and relapsing.

The famous doctor Komarovsky considers CMV not dangerous for children, except in cases of congenital infection, which can cause. is also carried out, but the main method of combating type 5 herpes is to maintain the normal immunity of a pregnant woman.

Under normal conditions, the expectant mother's immune system is able to produce enough antibodies that will protect both her and the baby.

Diagnostic measures

Diagnosis cannot be based only on the clinical picture of the disease, since in many cases the infection is asymptomatic

General clinical examination methods

Examination for CMV begins with an examination by a doctor, who will conduct a differential diagnosis with similar diseases (rubella, pneumonia, etc.) and prescribe the following laboratory tests:

• general ;
• general urine analysis;
• cytoscopy of urine or saliva;
• virological culture from a urine or throat sample.

General urine and blood tests will show the intensity of the inflammatory process in the body, cytoscopy will show the presence of cells of a characteristic giant size in the samples being studied, and culture of viruses will tell about their activity.

Serological examination methods

To clarify the diagnosis, determine the infection and the degree of CMV activity, serological tests are carried out. These include:

1. ELISA()– detection of protective antibodies Ig G and Ig M in the blood serum. The presence of both immunoglobulins indicates the presence of immunity to the virus, the presence of Ig M indicates primary infection, and Ig G indicates virus carriage. If, upon repeated analysis, the amount of Ig G is increased, this indicates activation of herpes. The absence of protective antibodies indicates that CMV has not been detected in the blood.
2. PCR (polymerase chain reaction)– examination of various patient biomaterials (blood, urine, saliva) for the presence of herpes type 5 DNA. Allows you to determine the level of virus reproduction in the body.

It allows you to detect CMV even with asymptomatic infection, therefore it plays an important role in diagnosing the congenital form of the disease.

Treatment methods

Like all CMV, it cannot be cured completely. Therefore, all therapeutic actions are aimed at reducing the activity of the virus, increasing the body’s immune defense and eliminating concomitant diseases. Specific treatment of herpes type 5 is carried out strictly under supervision for the congenital form of the disease and severe acquired infection.

Antiviral specific treatment

In children, antiviral drugs (Ganciclovir, Cytoven,) and are used to combat. The main emphasis is on increasing the activity of the immune system, since many antiviral drugs are very toxic to the child’s body.

Syndromic treatment

If a child has serious disorders of the lungs, liver, heart or other systems, additional treatment is prescribed, which is aimed at eliminating the pathologies. To alleviate the manifestations of the acquired form, symptomatic treatment can be prescribed to reduce the symptoms of intoxication: antipyretics, vasoconstrictor drops for the common cold, plenty of fluids and cough syrups.

Prevention methods

The main way to prevent the congenital form of cytomegalovirus infection is to plan conception and maintain immunity in pregnant women. The expectant mother should take care of her health, undergo routine examinations, avoid close contacts with unfamiliar people and carefully observe the rules of personal hygiene.

Prevention of the acquired form of herpes should be carried out by parents from the moment the child is born. Comprehensive care, constant strengthening of the immune system and hardening of the child’s body are the best ways to effectively combat CMV.

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

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

Penetration of the virus into the child’s body

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

There are the following ways of penetration of cytomegalovirus into the child’s body:

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

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

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

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

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

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

Infection during childbirth plays a minor role in the transmission of cytomegalovirus: the probability does not exceed 5% when a child is born to a mother with an active infection.

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

Most often, infection occurs between the ages of 2 and 5-6 years. During this period, the child usually attends preschool institutions, where there is a high probability of transmission of the pathogen from staff and from other children. In carriers, the virus can be present in the blood, saliva, urine, and other secretions and can be transmitted through close contact, sneezing, poor hygiene, or sharing toys. The incidence of infection in preschool institutions is 25-80%. The virus can be actively released from an infected human body for about two years.

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

Cytomegalovirus infection in newborns

There are congenital and acquired forms of CMV infection.

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

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

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

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

Normal course of the disease in children

As a rule, the child’s body copes quite effectively with cytomegalovirus without any external manifestations. In some cases, mononucleosis-like syndrome occurs. Its main symptoms are similar to ARVI: fatigue, pain in muscles and joints, headache, chills, fever, runny nose. Sometimes there is an enlargement of the lymph nodes, increased salivation, a whitish coating on the gums and tongue.

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

Sometimes encountered complications

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

Approximately 17% of asymptomatic children infected with cytomegalovirus experience seizures, movement disorders, abnormal skull sizes (micro- or hydrocephalus), and low body weight several months after birth. At the age of 5-7 years, 10% of children develop disorders of the nervous system, speech impairment, mental retardation, and underdevelopment of the cardiovascular system. About 20% of children at this age rapidly lose their vision.

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

Forms of CMV infection and their features

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

With a weakened immune system, recurrent infections develop. It manifests itself in the form of frequent bronchitis, pneumonia, multiple inflammation of the lymph nodes, chronic fatigue and general weakness. Inflammation of the adrenal glands, kidneys, pancreas, and spleen may develop. In severe relapses, the fundus of the eye, retina, intestines, nervous system, and joints are affected. Bacterial infections are often observed.

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

How to identify cytomegalovirus in a child: diagnostic methods

Diagnosis of CMV infection is possible using several methods:

• cultural: isolation of the virus in human cell culture. The method is the most accurate and allows you to determine the activity of the virus, but takes about 14 days;
• Cytoscopic: detection of characteristic owl-eye giant cells in urine or saliva. The method is not informative enough;
• Enzyme-linked immunosorbent assay (ELISA): detection of immunoglobulin M (IgM) in the blood indicates primary infection. If immunoglobulin G (IgG) is detected, re-examination is carried out at intervals of at least two weeks. An increase in antibody titers indicates activation of the infection. It is possible to obtain false positive results;
• Polymerase chain reaction (PCR): a fast and accurate method that reveals the DNA of the virus and how quickly it multiplies in the body.

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

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

A short video about how enzyme immunoassay is done

Features of infection control

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

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

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

A few words about prevention

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

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

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

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

One type of viral infection that initially does not have clear symptoms is cytomegalovirus (CMVI). Pathology can only be detected through an appropriate blood test. The causative agent of the disease belongs to the group of herpes viruses (Human betaherpesvirus 5). The infection has no seasonality and affects the child’s body in various ways, but most often during fetal development. The disease in many children is asymptomatic, becoming more active only against the background of weakened immunity.

What is cytomegalovirus

This is an infectious disease transmitted through saliva and mother's milk during pregnancy (from mother to child). The pathogen has the following distinctive features:

• causes an asymptomatic course of the disease, not manifesting itself in any way for a long time;
• localized mainly in the salivary glands;
• once the virus has entered the body, it cannot be completely destroyed;
• easily transmitted from a sick person to a healthy person.

Invading a child’s body, cytomegalovirus quickly multiplies, integrating its DNA into the nuclei of cells. Blood vessels and tissues of internal organs are damaged, the shape and structure of leukocytes and phagocytes changes, causing signs of immunodeficiency.

How dangerous it is for children

Cytomegalovirus is especially dangerous for newborns, as it can cause the following pathologies in them:

• mental retardation;
• deterioration of vision, and possibly blindness;
• nervous system disorder;
• convulsions;
• hearing problems;
• skin reactions in the form of redness, rash.

The infection can also cause weight loss and increased anxiety in children. In approximately 30% of cases, the disease is fatal to infants.

Types and forms of childhood cytomegalovirus

According to the main classification, the disease can be congenital or acquired. In the first case, infection occurs during intrauterine development (through the placenta). The acquired infection is transmitted to the newborn as it passes through the birth canal. Also, a child can become infected after birth (through household contact or airborne droplets).

Based on prevalence, cytomegalovirus is classified into two main types:

• localized- formed in one place (usually in the salivary glands);
• generalized- can spread throughout the body, affecting internal organs (kidneys, pancreas, spleen); it is often found along with immunodeficiency.

CMV infection is identified as a separate type in HIV-infected children.

Based on the nature of the course, the following forms of the disease are distinguished:

• Latent— the virus remains dormant in the body for the time being. The pathogen does not reproduce, there are no symptoms of cytomegalovirus. But when the immune system is weakened, the virus can quietly become active and begin to spread throughout the body.
• Spicy— the infection is more often transmitted parenterally (for example, the virus penetrates through lesions on the skin, as a result of blood transfusion from an infected person to a healthy person, as well as through the use of medical instruments that have undergone insufficient treatment and disinfection), while the necessary antibodies have not yet been formed in the body, that would fight the pathogen and limit the spread of pathology. Therefore, the disease progresses and is characterized by vivid symptoms: signs of a cold appear and the salivary glands enlarge.
• Chronic— periodically, from a dormant state, the virus enters the active phase, beginning to rapidly multiply and spread throughout the cells and tissues of the body. Then a period of calm begins again and the symptoms of cytomegalovirus become dull. These phases can alternate throughout life.

If a latent form of CMV is present, the child is still considered a carrier of the infection. Therefore, certain precautions must be taken.

Routes of infection and causes of development

• airborne- a baby can catch an infection when interacting with a sick person, especially when he sneezes;
• parenteral— infection with cytomegalovirus occurs through a blood transfusion, a visit to the dentist (when the doctor uses poorly processed instruments during treatment), through organ transplantation from an infected person;
• contact- a child becomes infected during breastfeeding, when treating wounds on the skin with dirty hands (without prior disinfection), as well as when using personal hygiene items shared with parents (towel, toothbrush, soap);
• transplacental(congenital) - the virus is transmitted to the fetus through the placenta or birth canal of the mother during childbirth.

The pathogen penetrates through the digestive system or respiratory organs and, once in the body, is present there for life in the latent phase. Activation of cytomegalovirus occurs only against the background of immunodeficiency. A decrease in immunity, in turn, occurs for a number of the following reasons:

• severe hypothermia and frequent colds (acute respiratory infections, ARVI, tonsillitis, influenza);
• long courses of chemotherapy;
• AIDS and HIV infection;
• taking antibiotics for a long time.

Therefore, if a cytomegalovirus infection is detected in the body, it is necessary to strengthen the immune system (eat properly, drink vitamin complexes, carry out hardening procedures) and avoid colds.

Symptoms of infection

The clinical symptoms of cytomegalovirus are nonspecific and therefore are often confused with other diseases. Common signs of CMV infection include:

• periodic fever (for no reason);
• minor pain in the limbs;
• enlarged lymph nodes;
• cough, runny nose;
• sore throat, redness of the throat;
• the presence of a small rash on the face and body.
• An increase in body temperature to 39 degrees or higher (observed in acute forms of infection);
• the child has no appetite;
• diarrhea (watery stools more than 3 times a day).

Congenital cytomegalovirus manifests itself quite differently:

• a hemorrhagic rash (blue-pink or purple spots) and pinpoint hemorrhages appear on the body;
• signs of jaundice appear (the skin becomes yellowish, the liver and spleen become enlarged);
• there is a significant decrease in body weight (regardless of nutrition);
• the child has a small skull size;
• the umbilical wound periodically bleeds;
• from time to time there are convulsions and trembling of the limbs;
• there are traces of blood in the stool and vomit;
• in some cases there is facial asymmetry;
• the retina of the eyes becomes inflamed;
• there are signs of pneumonia in the child (shortness of breath, dry cough, wheezing in the lungs, nasal congestion).

The incubation period usually lasts from 2 weeks to 3 months. The infection then becomes latent or acute.

Blood test for cytomegalovirus

After a visual examination, the child is sent for general and biochemical blood tests. The first shows the level of leukocytes, red blood cells, platelets - if their number is below normal, the presence of infection is suspected. Biochemical analysis reflects creatinine and urea, the concentration of which will be increased with kidney damage from CMV infection. It is also recommended to donate blood and test for the presence of antibodies to the pathogen. Thus, the presence of the IgM protein suggests an acute form of infection, and IgG indicates a latent form of infection.

The baby's blood must be tested for appropriate antibodies if the mother was diagnosed with an acute form of cytomegalovirus infection during pregnancy. It is recommended to take the test on an empty stomach.

Treatment options

Treatment is prescribed taking into account the type and form of the disease. Only the latent form of CMV does not require special therapy. In this case, the child is advised to take daily walks in the fresh air, proper nutrition (the diet should contain foods high in vitamins and minerals), moderate hardening of the body and a favorable psychological environment in the family. In other cases, children are prescribed medication and proven folk remedies.

Drug therapy

In acute or chronic forms of the disease, the child is prescribed the appropriate groups of medications:

• antiviral drugs (Acyclovir, Foscavir, Foscarnet, Cymevene) - are intended directly for the treatment of viral infections, are highly toxic, so they are prescribed to children with great caution, only in severe cases of the disease;
• interferons (Altevir, Viferon) - help fight infection, enhancing the body's protective properties;
• antibiotics in case of secondary infections (Klacid, Azitral, Sumamed) - used to suppress the growth and reproduction of pathogenic cells;
• immunoglobulin preparations (Cytotect) - combine well with antibiotics and increase the effectiveness of treatment;
• immunomodulators (Merkurid, Timalin, Isoprinosine) - promote the production of protective antibodies;
• corticosteroids (Prednisolone, Medopred) - used for severe disease;
• vitamin complexes (Pikovit, Immunokind) - used as an addition to the main therapy, help strengthen the immune system.

If a child has CMV infection, self-medication is contraindicated. The dosage of drugs and the course of treatment are selected strictly on an individual basis (taking into account the severity of the disease and existing contraindications). Uncontrolled use of antibiotics and antiviral drugs can cause serious damage to a child’s body, completely weakening the immune system.

Folk remedies

Traditional medicine is used as an additional therapy to the main treatment:

• Herbal collection- mix dried licorice root, chamomile flowers, string, kopeck and alder cones (50 grams of each). Next 2 tbsp. l. The resulting collection is placed in a thermos and 0.5 liters of boiling water is poured. The finished broth is allowed to brew for a day, then filtered and given to the child 50 ml 4 times a day. Course of therapy: 2 weeks.
• Red rowan infusion- 1 tbsp. l. crushed ripe berries, pour 8 cups of boiling water, place the container in a warm place, leave for 2 hours and filter. The resulting infusion is given to children before each meal (100 ml). Course of treatment: 1 month.

If a child has an allergic reaction to the herbal decoction (rash and red itchy spots on the skin), treatment should be stopped and contact a medical facility.

Prevention

One of the important conditions for the prevention of cytomegalovirus infection in children is hygiene. It is necessary to carefully ensure that the child washes his hands regularly (especially before eating). Also, an infected mother should stop breastfeeding if the baby is born healthy. In addition, there are other preventive rules:

• complete balanced nutrition;
• regular exercise;
• strengthening immunity;
• limiting the child’s contact with infected people;
• use of individual personal hygiene items;
• no touching the baby’s skin with your lips and feeding from separate dishes (if one of the parents is sick with CMV).

Possible complications

If the disease is detected late or there is no adequate treatment, there is a high probability of serious complications, for example:

• the appearance of hepatitis;
• the occurrence of encephalitis with subsequent organic changes in the brain;
• development of cytomegalovirus pneumonia;
• damage to the gastrointestinal tract, characterized by persistent digestive disorders.

To avoid possible consequences, parents need to monitor the child’s health condition, and in case of the slightest changes, immediately contact a pediatrician.

Cytomegalovirus in children is a serious viral disease that is not difficult to catch. The pathology is insidious in that in most cases it is asymptomatic or externally resembles a cold, so parents put off visiting the doctor, believing that it will soon go away on its own. If you suspect CMV infection, you need to take a blood test to check for the presence of certain antibodies. And, if the diagnosis is confirmed, the specialist will prescribe appropriate treatment for the child. Otherwise, the disease will begin to progress, leading to serious consequences.

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Cytomegalovirus occurs quite often in children. The disease, which belongs to type 5 herpes, can lead to serious consequences. The virus is difficult to diagnose because in the early stages the infection often causes no symptoms. The diagnosis in most cases is not fatal. However, complications can be avoided only if a course of therapy is started in a timely manner under the supervision of a physician.

Symptoms

With congenital cytomegaly, the child experiences pathologies in the development of internal organs. These include heart defects, damage to the urinary tract, and liver dysfunction. External signs indicating the possibility of developing CMV in an infant:

• decreased muscle tone;
• weak appetite;
• restless sleep;
• irritability;
• slow weight gain;
• frequent and prolonged crying for no apparent reason.

Since cytomegalovirus affects the nasopharynx, which is the route of infection into the body, rashes in the oral cavity, damage to the respiratory system and salivary glands, into the cells of which the DNA of the pathogen is embedded, cannot be ruled out. In newborns and infants in the first year of life, the activity of liver enzymes increases. Leukocytes and neutrophils are increased in the blood. Thrombocytopenia develops.

In preschool children and adolescents, the infection may not manifest itself in any way for a long time.

However, the virus is a persistent pathology; in this case, repeated reactivation occurs during a period of weakened immunity.

The younger the child, the more severe the symptoms of acute infection.

It is accompanied by fever and headache. Children suffer from cough and runny nose. Almost always in young patients there is an enlargement of the lymph nodes, damage to the liver and gastrointestinal tract occurs. A dysfunction of the central nervous system cannot be ruled out.

At an older age, the disease manifests itself with frequent acute respiratory infections, lethargy and increased fatigue. Symptoms of CMV are a reason to immediately consult a doctor to conduct a special diagnosis and begin treatment.

Causes

Cytomegalovirus occurs in a child for various reasons and progresses differently, depending on the route of infection. There are several of them:

• Intrauterine. Infection of the fetus occurs during pregnancy if the woman first suffered an acute form of the disease.
• Transmission of the virus from a carrier. A child can become infected during childbirth from the mother, through breast milk or through contact with a sick person.

The incubation period lasts from 2 weeks to several months. During this time, damage to various internal organs may occur, which leads to severe complications of infection.

Treatment

Cytomegalovirus in children cannot be cured. The virus remains in the body for life. Therapy is aimed at transferring the infection to a latent stage and preventing the development of severe complications. The course of treatment includes taking antiviral drugs and a set of measures to increase immunity.

Diagnostics

It is possible to identify type 5 herpes using saliva, urine and blood tests. The latter type of biomaterial is most often used. The list of studies includes:

• virological analysis;
• enzyme immunoassay (ELISA);
• polymerase chain reaction (PCR).

The ELISA method detects the presence of antibodies to the pathogen. Positive IgG with negative IgM - infection occurred more than 21 days ago. But if the first immunoglobulin is 4 times higher than normal, it means that the infection has reactivated. In this case, the transcript of the analysis shows an increased number of neutrophils and leukocytes.

Antiviral drugs

The treatment regimen for CMV infection in children is prescribed by a doctor and depends on the age of the child, the form of the disease and general health. Complex therapy includes antiviral agents such as Ganciclovir, Foscarnet. These medications are used in conjunction with interferon-based medications (Viferon).

In severe cases of infection, the doctor may prescribe a special immunoglobulin, Cytotect, which helps resist cytomegalovirus.

At a younger age, antiviral medications are used in the form of injections and suppositories. In older people - in the form of tablets and suspensions.

Prevention

Preventive measures to prevent the development of herpes type 5 in a child are recommended to be taken before and during pregnancy. The expectant mother must carefully observe hygiene, because the virus can be in any biological fluids (urine, saliva, blood, genital secretions). A woman needs to maintain her immunity, monitor her diet and often be in the fresh air.

In addition, during the entire pregnancy it is necessary to undergo testing for TORCH infections twice. If the analysis confirms the acute form of the pathology, the patient will be prescribed immunoglobulin.

After the birth of a child, strengthening the body's defenses is also of great importance.

A nutritious diet, daily walks, moderate physical activity and hardening are measures that help maintain the normal functioning of the immune system.

Complications and consequences

Type 5 herpes, like the Epstein-Barr virus, can cause severe complications in children. Against the background of a generalized form of infection, damage to internal organ systems develops. In young patients, hepatitis, liver cirrhosis, biliary tract infection, and kidney pathologies may occur. With the chronic course of the herpes virus, a strong decrease in immunity occurs. The body becomes vulnerable to various types of diseases.

For newborns

Congenital cytomegalovirus infection has the most unfavorable prognosis. Intrauterine infection in early pregnancy leads to miscarriages.

If the virus enters a woman’s body in the second half of pregnancy, the baby almost always develops severe developmental defects.

This type of herpes is especially dangerous for premature babies and infants with immunodeficiency.

If infection occurs during childbirth or before one year of age, the virus threatens jaundice, pneumonia, neurological disorders, intellectual, mental and physical retardation.

Doctor Komarovsky's opinion

Popular pediatrician Evgeny Komarovsky claims that a child’s best defense against any disease is a strong immune system. Cytomegalovirus infection in children occurs in a milder form when the body’s defense system operates normally.

The doctor believes that the danger of pathology in children is greatly exaggerated, with the exception of intrauterine infection of the fetus during pregnancy. To avoid serious consequences, E. O. Komarovsky recommends hardening, walks in the fresh air, physical activity according to age and a proper daily routine, including good nutrition and sleep.