home Drugs Cytomegalovirus igg 173.0 ae ml what does it mean. Positive result during pregnancy. The concept of “immunity to CMV” does not exist

Cytomegalovirus igg 173.0 ae ml what does it mean. Positive result during pregnancy. The concept of “immunity to CMV” does not exist

Cytomegalovirus: basic facts

Cytomegalovirus IGG comes from the herpesvirus family. When it enters the body, cells of various organs can be damaged - from the nervous system to the eyes. You can become infected through a blood transfusion (in Russia donor blood this virus is not tested for), organ transplantation, sexual contact, kissing or even contact with dirty hands. Babies can get this nasty element through the placenta (before birth), through mother's milk, or while passing through the birth canal. Premature babies are especially at risk because, unlike their healthier counterparts, they can get swipe on immunity.

Where is the virus found?

In fact, cytomegalovirus IGG positive has the most wide use. According to studies, more than 95% of Japanese, about 45% of Swiss residents and about 80% of Russians are carriers of it. It is considered harmless to people with good immunity, but is dangerous if “caught” during an organ transplant.

When is the virus dangerous?

To reduce the risk of infection of the fetus, it is best for pregnant women to donate blood for tests while planning pregnancy. This is due to the fact that if a woman is primarily infected (cytomegalovirus IGG positive) from 4 to 22 weeks of pregnancy, the baby may develop defects in the development of hearing, vision, mental retardation or muscle cramps.

IGG cytomegalovirus - positive or negative?

Preliminary tests can determine whether a woman was infected before pregnancy. A positive cytomegalovirus IGG indicates that antibodies have already formed in the blood. The health of the unborn child in this case is practically safe, because Negative consequences may occur in 0.1% of cases. If a potential mother is negative for cytomegalovirus, this means that antibodies are not produced and the baby may get serious illnesses in 9% of cases. Such ladies are prescribed frequent testing, enhanced hygiene measures, and reduced contact with their husband (if he has a positive factor) and with young children, who are most often carriers.

Additional indicators

If a positive cytomegalovirus IGG is detected in a pregnant patient when she first visits the doctor, then antibodies are considered based on the avidity index. With a high index and a period of up to 12 weeks, it is assumed that defensive reaction developed a long time ago, and the likelihood of risk to the fetus is minimal. A low avidity indicator means that antibodies have recently been developed and the baby may suffer. If the period is more than 12 weeks and the avidity index is high enough, then an analysis is performed amniotic fluid to clarify the results.

Medical standards

Cytomegalovirus IGG, the norm of which is up to 0.5 lgM, should be considered in conjunction with other indicators, for example, with IGM, which specifies how infected the body is and how dangerous the stage of the disease is. In some cases, a high IGG only indicates that the immune system has developed reliable protection.

Cytomegalovirus infection (CMV) is a widespread infectious diseases. The causative agent of cytomegalovirus infection belongs to the herpes family. Once in the human body, the virus multiplies inside the cell and significantly increases its size. Cytomegalovirus multiplication can result in infection of any tissue and internal organs. The fetus during pregnancy, newborns and children of the first 3-5 years of life are especially sensitive to cytomegalovirus.

Cytomegalovirus in children - causes

Cytomegalovirus in a child can be either congenital or acquired.

Congenital cytomegalovirus infection develops in a child when infected from a mother who is a carrier of the virus through the placenta during the prenatal period. If a woman catches cytomegalovirus for the first time during pregnancy, the infection can enter the child’s body through the placenta. Congenital cytomegalovirus in most cases does not manifest itself on early stages life of the child, but has the most pronounced complications later (hearing loss, decreased intelligence, speech impairment). The extent of this manifestation depends on the timing of infection of the fetus during pregnancy.

Acquired cytomegalovirus infection. Infection of a child can also occur directly during childbirth when the fetus passes through the mother’s infected birth canal or in the first days of life through contact with an infected mother or medical personnel. Also, a newborn can be infected through breast milk. With acquired cytomegaly, unlike congenital cytomegaly, the spread of infection occurs extremely rarely.

In preschool and school age cytomegalovirus enters the body through household contact or by airborne droplets when in a small space it enters the body of other children from one virus carrier or sick child. You can become infected with cytomegalovirus from the first days of life, and infection increases sharply with age. The virus can live and multiply for a long time in leukocytes and other cells of the human immune system and cause chronic carriage.

Cytomegalovirus in children - symptoms

Typically, cytomegalovirus infection in children is mild and hidden (asymptomatic) and doesn’t show itself at all. And only one in ten cases of infection will have clinical manifestations, especially if the immune system is weakened. That's why CMV symptoms depend not only on the state of the child’s immune system, but also on his age, the presence of immunity against cytomegalovirus, the presence concomitant diseases child.

Most often, cytomegalovirus in children manifests itself as an acute respiratory viral infection (ARVI).

The incubation period ranges from 15 to 60 days. During the acute phase of cytomegalovirus infection, the child develops the following symptoms:

increased body temperature (sometimes periodically and irregularly to febrile levels for three or more weeks);
runny nose, inflammation and enlargement salivary glands, with copious secretion of saliva;
enlarged cervical lymph nodes;
chills, weakness, fatigue, headache, muscle pain;
the spleen (splenomegaly) and liver enlarge;
bowel movements may be disrupted, such as constipation or diarrhea;
in the child’s blood the number of platelets decreases, the absolute and relative content of monocytes increases;
frequent “causeless” pneumonia, bronchitis;

Due to the lack of specific symptoms for cytomegalovirus, make a diagnosis based only on clinical manifestations impossible.

Laboratory methods are used to identify the pathogen and the specific immune response. The diagnosis of cytomegalomirus infection is confirmed by the presence of the virus itself in the blood and tissues, as well as the detection of antibodies to the virus in the blood. In sick people, cytomegalovirus is detected in sediments of urine, saliva, and sputum.

Antibodies to cytomegalovirus

Antibodies to cytomegalovirus begin to be produced immediately after the virus enters the human body. It is antibodies that fight viral infection, preventing cytomegalovirus from developing and causing the disease to be asymptomatic. There are several classes of antibodies - IgG, IgM, IgA, etc., each of which is responsible for certain functions of the immune system. However, for the diagnosis of cytomegalovirus infection, those that can detect antibodies belonging to the IgM and IgG classes are truly useful.

Antibodies to cytomegalovirus - IgG and IgM are detected when laboratory analysis blood.

Availability IgM antibodies usually appear in the blood first and indicates a fresh infection or reactivation of a latent (latent) infection. However, an increase in IgM antibodies may not be detected during the first 4 weeks after the onset of the disease. At the same time, titers may remain high for up to a year after recovery. In this regard, a single determination of the level of IgM antibodies is useless in assessing the severity of infection. It is important to monitor changes in the level of IgM antibodies (increase or decrease in their level).

After one to two weeks from the moment of infection with cytomegalovirus, IgG antibodies . These immunoglobulins help the doctor determine whether the baby was previously infected with cytomegalovirus, as well as a blood test for these antibodies is given to diagnose acute cytomegalovirus infection. IgG antibodies during primary infection increase in the first weeks and then can remain high for years. IgG antibodies appear during the recovery period and can persist for up to 10 years in those who have recovered, so the frequency of detection of IgG antibodies can reach 100% among various groups population.

A single determination of the antibody titer does not allow one to distinguish a current infection from a past one, since cytomegalovirus is always present in the body of the virus carrier, as are antibodies to it.

Antibodies to cytomegalovirus - IgG positive

If IgG class immunoglobulins are detected as single marker, then this indicates either infection with cytomegalovirus or the presence of immunity to this infection. The detection of antibodies to cytomegalovirus IgG in children in the first six months of life in the absence of other markers of this infection indicates their maternal origin.

Simultaneous detection in the blood serum of children specific antibodies IgM and IgG classes indicate cytomegalovirus disease.

Interpretations of the ratio of IgG and IgM antibodies:

If antibodies to cytomegalovirus are not detected, then it is concluded that the person has not previously been infected with cytomegalovirus and may be particularly susceptible to primary infection. However, the presence of Anti-IgG to cytomegalovirus does not mean protection from infection with this virus in the future. Stable immunity to cytomegalovirus (CMV) is not developed.

In addition to quantity, IgG avidity is often determined - the strength with which the antibody binds to the antigen. The higher the avidity, the stronger and faster the antibodies bind viral proteins. When a child is first infected with cytomegalovirus, his IgG antibodies have low avidity, then (after three months) it becomes high. IgG avidity indicates how long ago the initial CMV infection occurred.

Treatment of cytomegalovirus in children

There is no specific antiviral treatment for cytomegalovirus infection. It is impossible to cure cytomegalovirus; treatment should primarily be aimed at recovery protective functions body. Children are strongly encouraged to behave correctly and good nutrition, vitamin therapy. After recovery, care should be taken to ensure that the child does not become hypothermic. Children should be protected from vaccination for several weeks, and preschoolers and schoolchildren should also be protected from physical education.

To treat children of the first year of life with acute cytomegalovirus infection, antiviral drugs are used, for example Viferon-1, which do not destroy the infectious agent, but suppress its activity.

A course of treatment is required for conditions such as jaundice, hepatitis, hearing and hearing disorders. visual organs, pneumonia. Treatment usually involves the use antiviral drugs in combination with immunoglobulins. The duration of administration, as well as the dosage, are determined based on individual characteristics and the condition of the child.

It is very difficult to assess the effectiveness of treatment for cytomegalovirus, since IgG antibodies remain in the blood for life.

Methods for laboratory diagnosis of cytomegalovirus infection (CMV infection) also include carrying out serological reactions, the purpose of which is to detect antibodies to cytomegalovirus (CMV) or its antigens in the blood of the subject or in other substrates (urine, cerebrospinal fluid, saliva, washings from the trachea and bronchi , smears from the urethra and vagina).

The detection of antibodies in blood serum is based on the fact that in the laboratory (as well as in the body) they strive to contact the antigen of the pathogen to inactivate it.

Thus, if in the laboratory there are reagents containing a cytomegalovirus antigen labeled in some way, then, using them to bind to immunoglobulins in the blood serum, it is possible to calculate the antibody titer by the number of “spent” antigens. This is how direct methods of specific diagnostics work.

Indirect (indirect) methods for diagnosing CMV infection are used less frequently.

To perform the analysis, preliminary preparation is non-specific:

On an empty stomach (in order to prevent rapid blood clotting (the minimum fasting period is 4 hours)).
Better before 11 o'clock.
Do not drink alcohol the night before the test.
It is advisable not to smoke on the day of the test.

What serological tests are used to detect antibodies to CMV

The following methods can be used to detect antibodies to cytomegalovirus:

complement fixation reaction (CFR);
immunofluorescence reaction (RIF);
enzyme immunoassay (ELISA);
solid phase radiological analysis;
immunoblotting.

The last three types of serological reactions have the greatest specificity and sensitivity, and therefore are used much more often than others. We will not describe the mechanism of action of each reaction; the main thing about them is that they are all aimed at identifying immunoglobulins of class M, G and determining their avidity index.

Immunoglobulins class M (anti-CMV-IgM) in large quantities are formed during the primary immune response (the body’s response to an infectious agent (or one of the serotypes) that first entered the body and caused the disease).

Class G immunoglobulins (anti-CMV-IgG) are synthesized after IgM, causing “immune memory” in relation to a specific serotype of the infectious agent. When re-infected with the same microorganism (same serotype), the human immune system reacts by producing IgG in large quantities.

Next, it is necessary to decipher the concept of the avidity index of antibodies to cytomegalovirus, as well as its significance in the laboratory diagnosis of this infection. Avidity is the ability of immunoglobulins to bind tightly to CMV antigens. And the avidity index (AI) is an indicator that characterizes the degree of strength of the bond between antibody and antigen. Speaking about CMV infection, to clarify the degree of its activity, the avidity index of class G immunoglobulins (anti-CMV-IgG) is used. IgM avidity is not determined.

Interpretation of examination results

If class M immunoglobulins (anti-CMV-IgM) are detected in the blood serum in any titer (they also say: IgM to cytomegalovirus is positive), then the patient being examined is diagnosed with a primary cytomegalovirus infection. Further laboratory diagnostics will be aimed at identifying class G antibodies (anti-CMV-IgG) and the virus itself using PCR and/or DNA hybridization methods.
Positive IgG results against cytomegalovirus are assessed differently. The table below details various options positive serological reactions to cytomegalovirus.
To prevent overdiagnosis of CMV infection, the “paired serum method” is often used. Its essence is to determine the levels of IgG and IgM twice with an interval of 2-3 weeks between blood draws. If the quantitative content of immunoglobulins increases 4 times or more, the likelihood of acute (active) CMV infection in the subject is high.
Additionally, I would like to point out the fact that quantitative values in a single serum test are not particularly important. As a rule, significant quantitative antibody levels begin at a titer of 1:100 or higher (threshold values may differ among different laboratories).

IgM	IgG	Decoding the result
Negative	Negative	The person is not infected with cytomegalovirus and has never had contact with it; another option is low-quality or unsuitable reagents
	Positive, the avidity index (AI) is high, its value is above 42%, if titers increase over time by 4 times or more, activation of a “dormant” infection in the body is likely	The examinee once (6-12 months ago or more) suffered a cytomegalovirus infection
	Positive, AI is low, its value is up to 41%	Possible diagnostic errors, repeat after 2 weeks
Positive	Negative	Likely initial stage CMV infections, when IgG has not yet begun to be synthesized (first week of the disease), the second option is a diagnostic error, should be repeated after 2 weeks, additionally perform PCR
	Positive, AI less than or equal to 35%, increase in titers by 4 times or more	Acute stage (active stage) of CMV infection, control after 2 weeks
	Positive, AI 36-41%	Recovery stage
	Positive, AI more than 42%	The so-called “tail”, when the patient still has IgM after a CMV infection, the second option is the activation of a “dormant” infection in the body, PCR of blood serum should be performed, and, if necessary, cerebrospinal fluid

What diagnostic methods are used to detect CMV antigens

At the end of the material, it should be noted that to verify the diagnosis of CMV infection, it is not enough just to detect antibodies to the virus; it is also important to confirm the presence of individual antigens or cytomegalovirus DNA in the blood (if necessary, in the cerebrospinal fluid). If DNA or antigens are found in saliva or urine, this does not indicate the activity of CMV infection. The main laboratory methods that can confirm the presence of cytomegalovirus antigens (or DNA) are PCR and DNA hybridization.

Viruses of the herpes group accompany a person throughout his life. The degree of their danger is directly related to the level of immunity - depending on this indicator, the infection can be dormant or provoke serious illnesses. All this fully applies to cytomegalovirus (CMV). If a blood test shows the presence of IgG antibodies to this pathogen- this is not a reason to panic, but important information to maintain health in the future.

Cytomegalovirus belongs to the herpesvirus family, otherwise known as human herpes virus type 5. Once it enters the body, it remains in it forever - there is currently no way to get rid of infectious pathogens of this group without a trace.

Transmitted through body fluids - saliva, blood, semen, vaginal discharge, so infection is possible:

by airborne droplets;
when kissing;
sexual contact;
using shared utensils and hygiene supplies.

In addition, the virus is transmitted from mother to child during gestation (then we can talk about a congenital form of cytomegalovirus infection), during childbirth or through breast milk.

The disease is widespread - according to research, by the age of 50 years, 90-100% of people are carriers of cytomegalovirus. Primary infection, as a rule, is asymptomatic, however, with a sharp weakening of the immune system, the infection becomes more active and can cause pathologies varying degrees gravity.

Getting into the cells human body, cytomegalovirus disrupts their division processes, leading to the formation of cytomegaloids - huge cells. The disease can affect various organs and systems, manifesting themselves in the form atypical pneumonia, cystitis and urethritis, inflammation of the retina, diseases digestive system. More often external symptoms infection or relapse resemble seasonal colds - acute respiratory infections or acute respiratory viral infections (accompanied by fever, muscle pain, runny nose).

Primary contact with is considered the most dangerous. This can lead to intrauterine infection of the fetus and provoke pronounced deviations in its development.

Cytomegalovirus: pathogen, transmission routes, carriage, re-infection

Diagnostics

Most carriers of cytomegalovirus are not aware of its presence in the body. But if it is not possible to identify the cause of a disease, and treatment does not produce results, tests for CMV are prescribed (antibodies in the blood, DNA in a smear, cytology, etc.). Testing for cytomegalovirus infection is mandatory for pregnant women or women planning to conceive, and for people with immunodeficiency conditions. For them, the virus poses a serious danger.

There are several research methods that are successfully used to diagnose CMV infection. For a more accurate result, it is advisable to use them in combination. Since the pathogen is contained in body fluids, as biological material blood, saliva, urine, vaginal secretions and even breast milk can be used.

Cytomegalovirus in a smear is detected using PCR analysis - polymerase chain reaction. The method makes it possible to detect the DNA of an infectious agent in any biomaterial. A smear for CMV does not necessarily include discharge from the genital organs, it can be a sample of sputum, discharge from the nasopharynx, or saliva. If cytomegalovirus is detected in a smear, this may indicate either latent or active form diseases. In addition, the PCR method does not make it possible to determine whether the infection is primary or whether it is a recurrent infection.

If cytomegalovirus DNA is detected in samples, additional tests may be ordered to clarify the status. A test for specific immunoglobulins in the blood helps clarify the clinical picture.

Most often, ELISA is used for diagnosis - enzyme-linked immunosorbent assay, or CHLA - chemiluminescence immunoassay. These methods determine the presence of the virus due to the presence of special proteins in the blood - antibodies, or immunoglobulins.

Diagnosis of cytomegalovirus: research methods. Differential diagnosis cytomegalovirus

Types of antibodies

To fight the virus, the human immune system produces several types of protective proteins that differ in the timing of their appearance, structure and functions. In medicine they are designated by a special letter code. The common part in their names is Ig, which stands for Immunoglobulin, and the last letter indicates a specific class. Antibodies that detect and classify cytomegalovirus: IgG, IgM and IgA.

IgM

The largest immunoglobulins in size, the “rapid response group”. During primary infection or when a “dormant” cytomegalovirus is activated in the body, IgM is produced first. They have the ability to detect and destroy the virus in the blood and intercellular space.

The presence and amount of IgM in a blood test is an important indicator. Their concentration is highest at the beginning of the disease, in the acute phase. Then, if viral activity can be suppressed, the titer of class M immunoglobulins gradually decreases, and after about 1.5 - 3 months they completely disappear. If a low concentration of IgM remains in the blood for a long time, this indicates chronic inflammation.

Thus, a high IgM titer indicates the presence of active pathological process(recent infection or exacerbation of CMV), low – about the final stage of the disease or its chronic course. If negative, this indicates a latent form of infection or its absence in the body.

IgG

Class G antibodies appear in the blood later - 10-14 days after infection. They also have the ability to bind and destroy viral agents, but unlike IgM, they continue to be produced in the body of an infected person throughout life. They are usually coded "Anti-cmv-IgG" in test results.

IgG “remembers” the structure of the virus, and when pathogens re-enter the body, they quickly destroy them. Therefore, it is almost impossible to become infected with cytomegalovirus a second time; the only danger is a recurrence of a “dormant” infection with a decrease in immunity.

If the test for IgG antibodies to cytomegalovirus is positive, the body is already “familiar” with this infection and has developed lifelong immunity to it.

IgA

Since the virus mainly attaches and multiplies on the mucous membranes, the body produces special antibodies - IgA - to protect them. Like IgM, they stop being produced soon after the activity of the virus is suppressed, and 1-2 months after completion acute stage diseases are no longer detected in blood tests.

The combination of IgM and IgG class antibodies in the test results is of fundamental importance for diagnosing the status of cytomegalovirus.

Avidity of immunoglobulins

Another one important characteristic IgG antibodies - avidity. This indicator is measured as a percentage and indicates the strength of the bond between the antibody (immunoglobulin) and the antigen - the causative virus. The higher the value, the more effectively the immune system fights the infectious agent.

The level of IgG avidity is quite low during primary infection; it increases with each subsequent activation of the virus in the body. Testing antibodies for avidity helps distinguish primary infection from recurrent disease. This information is important for prescribing adequate therapy.

Cytomegalovirus Igg and Igm. ELISA and PCR for cytomegalovirus, avidity for cytomegalovirus

What does positive IgG mean?

A positive test result for IgG to CMV means that the person has already been infected with cytomegalovirus before and has long-term, stable immunity to it. This indicator does not indicate a serious threat and the need for urgent treatment. A “sleeping” virus is not dangerous and does not interfere with usual image life - most of humanity coexists safely with it.

Exceptions are people who are weakened, with immunodeficiency conditions, cancer patients and those who have had cancer, pregnant women. For these categories of patients, the presence of the virus in the body can pose a threat.

IgG to cytomegalovirus positive

High titer of IgG in the blood

In addition to the data whether IgG is positive or negative, the analysis indicates the so-called titer of immunoglobulins of each type. This is not the result of a “piecemeal” calculation, but rather a coefficient that gives an idea of the activity of the immune response. Quantitative determination of antibody concentration is carried out by repeated dilution of blood serum. The titer shows the maximum dilution factor at which the sample retains positive result.

The value may vary depending on the reagents used, the characteristics of the laboratory research. If the Anti-cmv IgG titer is significantly increased, this may be caused by either reactivation of the virus or a number of other reasons. A more accurate diagnosis will require a number of additional tests.

A titer that goes beyond the reference values does not always indicate a threat. To determine whether there is a need for urgent treatment, it is necessary to consider the data of all studies as a whole; in some cases it is better to repeat the analysis. The reason is the high toxicity of antiviral drugs that are used to suppress the activity of cytomegalovirus.

The infection status can be more accurately diagnosed by comparing presence of IgG with the presence and amount of “primary” antibodies in the blood - IgM. Based on this combination, as well as the immunoglobulin avidity index, the doctor will diagnose accurate diagnosis and will give recommendations for the treatment or prevention of cytomegalovirus infection. The decoding instructions will help you independently evaluate the test results.

Decoding the analysis results

If antibodies to cytomegalovirus are detected in the blood, it means there is an infection in the body. The interpretation of the examination results and the prescription of therapy (if necessary) should be entrusted to the attending physician, however, to understand the processes occurring in the body, you can use the following diagram:

Anti-CMV IgM negative, Anti-CMV IgG negative: the absence of immunoglobulins shows that the person has never been infected with cytomegalovirus, and he has no immunity to this infection.
Anti-CMV IgM positive, Anti-CMV IgG negative: this combination indicates recent infection and acute form diseases. At this time, the body is already actively fighting the infection, but the production of IgG immunoglobulins with “long-term memory” has not yet begun.
Anti-CMV IgM negative, Anti-CMV IgG positive: in this case we can talk about a hidden, inactive infection. The infection occurred a long time ago, the acute phase has passed, and the carrier has developed a strong immunity to cytomegalovirus.
Anti-CMV IgM positive, Anti-CMV IgG positive: indicators indicate either a recurrence of infection against the background favorable conditions, or about recent infection and the acute stage of the disease - during this period, primary antibodies to cytomegalovirus have not yet disappeared, and IgG immunoglobulins have already begun to be produced. The number of antibodies (titers) and additional studies will help the doctor understand more accurately.

There are many nuances in assessing ELISA results that only a specialist can understand. Therefore, in no case should you diagnose yourself; you should entrust the explanation and prescription of therapy to a doctor.

What to do if IgG to CMV is positive

The answer to this question depends on several factors. IgG antibodies to cytomegalovirus found in the blood indicate a previous infection with CMV infection. To define an algorithm further actions, it is necessary to consider the diagnostic results as a whole.

Cytomegalovirus detected - what to do?

If the totality of data obtained during the examination indicates the active phase of the disease, the doctor will prescribe special course treatment. Since it is impossible to completely get rid of the virus, therapy has the following goals:

protect internal organs and systems from damage;
reduce acute phase diseases;
if possible, strengthen the body's immune response;
reduce the activity of infection, achieve stable long-term remission;
prevent the development of complications.

The choice of methods and drugs is based on the individual clinical picture and characteristics of the body.

If the cytomegalovirus is in a hidden, latent state (only IgG is found in the blood), then it is enough to monitor your health and maintain immunity. The recommendations in this case are traditional:

full-fledged proper nutrition;
rejection of bad habits;
timely treatment of emerging diseases;
physical activity, hardening;
refusal of unprotected sexual intercourse.

These same preventive measures are relevant if no antibodies to CMV have been detected, that is, primary infection has not yet occurred. Then, when the virus enters the body, the immune system will be able to suppress the development of infection and prevent serious illnesses.

A positive test result for antibodies to cytomegalovirus IgG is not a death sentence; hidden infection in an adult healthy person does not affect quality of life. However, in order to prevent the activation of the virus and the development of complications, it is necessary to make efforts to preserve physical health- avoid overwork and stress, eat rationally and maintain immunity high level. In this case, the body’s own defenses will suppress the activity of the cytomegalovirus, and it will not be able to harm the carrier.

Cytomegalovirus infection belongs to the herpetic group. In most cases it proceeds without any external manifestations or with mild symptoms. People often do not pay attention to this disease and do not take any measures to eliminate it. But CMV during pregnancy is very dangerous because it can lead to pathologies of fetal development and interruption of the gestation process.

An infection of this kind is difficult to treat, especially during the period of waiting for a child, when the use of many antiviral drugs is prohibited. That's why great importance has diagnostics at the conception planning stage.

The question of what CMV is during pregnancy and how to protect yourself from infection interests many expectant mothers. CMV or cytomegalovirus is a pathogen that belongs to the herpes family. In the human body, it behaves in the same way as the well-known cold on the lips: most of the time it does not manifest itself in any way, but with a decrease in immunity, an aggravation occurs. After the initial infection, it is no longer possible to completely get rid of it; the person becomes a carrier of the virus for life.

Cytomegalovirus was first identified by scientists in 1956. The infection is now widespread throughout the world. In economically developed countries, antibodies in the blood are found in 40% of the population, in developing countries - in 100%. Women are more susceptible to the disease. Among infants, the prevalence of infection ranges from 8% to 60%.

Most carriers of the virus are unaware of its presence in the body. CMV is an infection that worsens during pregnancy and other conditions accompanied by decreased immunity. Therefore, expectant mothers are at risk.

The source of cytomegalovirus infection is a person with an acute form of the disease. Transmission can occur in several ways: airborne, sexual, contact, intrauterine. After infection, the virus enters cells and destroys their structure. The affected tissues fill with fluid and increase in size.

Causes

CMV during pregnancy can occur either for the first time or recur. The main causes of infection are a natural decrease in immunity, necessary to maintain pregnancy, and contact with a carrier of the virus.

After fertilization of the egg, many changes begin to occur in the woman’s body. The main ones are perestroika hormonal levels and decreased immunity.

On initial stage this is necessary for the successful fixation of the embryo in the uterus, and then for maintaining the pregnancy. The woman's immune system becomes less active and thus reduces the risk of fetal rejection, as foreign body. But as a result, a woman becomes more vulnerable to any infectious diseases.

If previously in the body expectant mother If there was no CMV, then primary infection is possible through contact with a person whose disease is in the acute stage. Transmission can occur through sexual contact, not only genital, but also oral or anal.

Less likely to become infected by everyday means: through a kiss, the use of dishes and personal hygiene items of the patient. The risk of transmission through blood is very small and is more likely to occur in people who use intravenous drugs.

Symptoms

A woman who is a carrier of CMV and/or HSV during pregnancy may not show any signs of the disease and may not even know what it is. With relatively active immune system During this period, the infection occurs latently.

If an exacerbation occurs, then most often symptoms similar to ARVI are observed. The body temperature rises, the woman feels that she has become tired faster, a runny nose appears, headaches increase. salivary glands, the tonsils may become inflamed. Often all these manifestations are mistaken for a cold and do not cause much concern. But cytomagelovirus infection lasts longer than respiratory infection (1-1.5 months).

Sometimes the symptoms of cytomegalovirus infection are similar to mononucleosis. The temperature rises sharply to 38-39° C, the tonsils and salivary glands become inflamed, the lymph nodes enlarge, pain appears in the muscles, joints, in the right and left hypochondrium, fever, chills. This condition is called mononucleosis-like syndrome and develops 20-60 days after infection. Symptoms continue for 2-6 weeks.

CMV during pregnancy in some cases occurs with complications. This disease can be accompanied by pneumonia, arthritis, pleurisy, myocarditis, encephalitis, vegetative-vascular disorders, and damage to internal organs.

It is extremely rare to observe a generalized form of infection, in which the virus spreads throughout the body. IN clinical picture may be present:

inflammation of the kidneys, adrenal glands, spleen, liver, pancreas and brain;
damage to the tissue of the lungs, eyes, digestive organs;
paralysis.

Diagnostics

Since cytomegalovirus infection often occurs in a latent form, and during exacerbations it is similar to a common cold, it is impossible to identify it yourself. Analysis for CMV during pregnancy is carried out using laboratory methods research, for this purpose blood, urine or saliva is taken from the patient. Not only cytomegalovirus is detected, but also pathogens of toxoplasmosis, rubella, herpes simplex(TORCH infections).

Three diagnostic methods are used:

PCR (polymerase chain reaction) – in special conditions under the action of enzymes, sections of the DNA of the virus are copied.
Cytological examination of sediment in urine and saliva - examination of biomaterial under a microscope to identify virus cells.
Serological examination of blood serum using enzyme-linked immunosorbent assay (ELISA) - search for antibodies specific to a given virus.

Most often, CMV during pregnancy is determined using ELISA, which detects two types of immunoglobulins: IgM and IgG. The first type is produced by the body 4-7 weeks after infection, and when an immune response is formed, its amount decreases. Immunoglobulin G increases in this phase.

How does CMV affect pregnancy?

The acute course of cytomegalovirus infection can affect the condition of the fetus and the course of pregnancy. Greatest danger represents the primary infection during pregnancy. In this case, antibodies have not yet been formed in the woman’s blood; the virus is very active and quickly penetrates the placental barrier. The probability of infection and the appearance of fetal development pathologies is 50%.

If CMV worsens during pregnancy, the prognosis is more favorable. The body already has IgG antibodies, the virus has been weakened. The probability of its penetration through the placenta is 1-2%. And even in these cases, its damaging effect is reduced.

The shorter the period at which CMV manifested itself, the more serious complications and consequences. If infection occurs in the first trimester, there is a high risk of spontaneous abortion. It is also possible that abnormalities may occur in the fetus, including those that cause intrauterine death.

When the disease manifests itself in the second and third trimesters, the danger is lower: the fetus develops normally, but there is a risk of pathologies of its internal organs, premature birth, polyhydramnios, congenital cytomegaly. It is very important to diagnose CMV at the planning stage, since during pregnancy this disease is difficult to treat and poses a danger to the unborn child.

Norms of CMV during pregnancy

Once cytomegalovirus enters the body, it remains there for life. But if the disease occurs in a latent form, then it does not cause much harm. In many women, when tested for TORCH infections, antibodies to CMV are detected. Their level indicates the characteristics of the disease and its stage.

There is no norm for CMV during pregnancy as such. Enzymatic immunoassay is a complex procedure that uses dilution of blood serum in a certain ratio. The interpretation of the result depends on the test system, its sensitivity and components.

When studying the diagnostic results, you need to pay attention to the following options:

IgM not detected CMV IgG– normal (absent) – during pregnancy is the optimal result. This means that there is no pathogen in the body and no complications will arise.
IgM was not detected, but CMV IgG was positive during pregnancy. The virus is present in the body, the infection occurred a long time ago and the disease occurs in an inactive form. The likelihood of transmission of infection to the fetus is minimal.
CMV during pregnancy, when IgM is positive, a primary CMV infection has occurred or an exacerbation of an infection that was previously hidden. At the same time, the risk of infection of the fetus is high.

How is CMV treated during pregnancy?

As already noted, it is impossible to completely get rid of the virus. Treatment of CMV during pregnancy it comes down to transferring it to an inactive state.

For this purpose:

Antiviral drugs. Reduce the number of viruses and suppress their activity.
Human immunoglobulin against CMV. The drug is made from the blood of people who have formed antibodies to the pathogen.
Immunomodulators. Increases the body's resistance to viruses, bacteria and other pathogenic microflora. The effectiveness of drugs in this group has not been fully proven.

All medicines should be selected only by a doctor, taking into account the duration of pregnancy and the characteristics of the course of the disease. In this case, you cannot self-medicate.

Should the pregnancy be terminated?

The question of whether it is necessary to terminate a pregnancy is decided individually in each case. An abortion may be recommended (but not prescribed) by a doctor in cases where the risk of infection is high and the likelihood of serious developmental anomalies is high (primary infection has occurred on early). The final decision on this issue is made by the woman. The termination can be performed up to the 22nd week of pregnancy.

With timely treatment, the risk of transmission of infection to the fetus is significantly reduced. If infection or reactivation of CMV during pregnancy occurred during later, interrupt not shown.

Consequences

The earlier the infection or reactivation of the virus occurred during pregnancy, the more serious the consequences will be. In the early stages, this can provoke a miscarriage or abnormal development of the fetus: underdevelopment of the brain, epilepsy, cerebral palsy, disorder mental functions, deafness, congenital deformities.

If the infection occurs in the later stages, then the child does not develop developmental defects, but he is born a carrier of CMV (congenital cytomegaly). The virus can affect the course of pregnancy: cause polyhydramnios, premature birth.

Prevention

Prevention of CMV involves strengthening the body and limiting contact with sick people. If, as a result of diagnosis, the presence of a virus in the body is revealed, but the infection remains hidden, then all the woman’s efforts should be aimed at activating the body’s defenses. Walking required fresh air, water procedures, proper nutrition and adherence to a daily routine, taking multivitamins.

To prevent primary infection you should:

Wash your hands thoroughly after coming home, especially if you have had contact with small children.
Use only your own dishes, do not finish eating after others (even children), and do not drink from other people’s glasses.
Don't kiss strangers.
Do not contact people who show signs of a cold.

Cytamegalovirus is present in the body of many people, but becomes dangerous in immunodeficiency states and pregnancy. The prognosis is most unfavorable when a woman is initially infected early. This can lead to miscarriage and fetal malformations. When the virus is reactivated, as well as in later stages, the consequences are less serious: a child can become a carrier of CMV, having become infected from the mother in utero or during childbirth.

Useful video: cytomegalovirus infection and its consequences

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