What is CMV infection in a child? Cytomegalovirus in children - is the “beast” dangerous? What is cytomegalovirus infection

Once viruses enter a baby’s body, they do not manifest themselves immediately. They are waiting for the right moment. A factor in the development of infection is a decrease in resistance - the body's resistance. Cytomegalovirus infection acts in a similar way. The virus is usually discovered by chance during a blood test.

The child receives CMV from the outside or becomes infected before birth, through the placenta. The congenital type of the disease is more difficult to tolerate and has a lot of complications, as a result of which the functioning of various organs and systems is disrupted. Treatment of the disease depends on the method of infection.

Why do children get cytomegalovirus?

CMV belongs to the DNA virus – Cytomegalovirus, which belongs to the herpesvirus family. It penetrates into all human organs, but is mainly isolated from the salivary glands, where it actively multiplies and integrates its DNA into the cell nucleus. Due to the foreign element, the cells of the salivary glands increase in size. This is where the name of the virus came from (translated from Latin as “giant cells”).

If the child has good immunity, the “IgG positive” cytomegalovirus is in an inactive state. This means that the child is only a carrier of the infection, but is not sick himself. When the body's resistance decreases, the virus begins to actively multiply, the body secretes specific antibodies and certain symptoms appear.

Additional factors that reduce the body's resistance are digestive problems and heavy loads on a fragile child's body, leading to increased fatigue. With a weakened immune system, the body becomes an easy target for infectious agents.

Factors that reduce immunity are:

• rehabilitation of the body after a protracted illness (for example, influenza);
• allergic reactions;
• birth injuries;
• vitamin deficiency;
• improper use of medications;
• bad ecology;
• short period of breastfeeding of newborns.

Types and symptoms of the disease

Congenital infection

With intrauterine infection, clinical signs appear in children after birth. Symptoms of CMV infection include:

• Yellowness of the skin. Indicates hepatitis. Blood tests reveal increased bilirubin.
• As a result of hepatitis, the liver and spleen may become enlarged, as they are the first to respond to an infectious agent in the body.
• High body temperature.
• Muscle weakness.
• There is a rash on the skin, and bleeding ulcers are possible.
• Signs of general intoxication of the body.
• Enlarged lymph nodes (we recommend reading:).

• Swollen larynx, possibly enlarged tonsils.
• Deterioration of breathing.
• Skin cyanosis (cyanosis).
• Sucking and swallowing reflexes are impaired.
• Digestive disorders, accompanied by vomiting and diarrhea.
• Loss of vision or hearing.
• Possible pneumonia.
• Underweight.

Congenital cytomegalovirus infection in children can cause mental retardation. Sometimes the virus is fatal. The mortality rate of infected newborns reaches 30%. Also, due to infection, vision deteriorates to the point of blindness. If children with congenital cytomegalovirus do not show clinical symptoms, then 10-15% of these children will subsequently have hearing impairment.

Acquired infection

You can only get cytomegalovirus from a patient or a carrier of the virus. Clinical symptoms of the disease appear when the body's resistance decreases. Often the disease resembles a common ARVI, as it is accompanied by signs of inflammation of the upper respiratory tract, cough and pain when swallowing. Nasal congestion and increased body temperature are also possible. As an additional clinical sign, a rash may appear all over the body in the form of red spots.

The lymphatic system responds to the proliferation of the infectious agent by enlarging the lymph nodes in the neck and under the lower jaw. They are painless, the skin over them looks unchanged.

If the baby complains of pain in the tummy, this is a symptom of an enlarged liver and spleen. Nearby lymph nodes - inguinal and axillary - may also enlarge. Yellowness of the whites of the eyes and skin indicates liver damage.

The sick baby becomes lethargic and drowsy. All signs of tonsillitis begin to develop. Children complain of pain in muscles and joints. Complications may include pneumonia or hepatitis. This picture is accompanied by neurological abnormalities in behavior.

How is CMV transmitted and who is the carrier?

In children, cytomegalovirus enters the external environment along with biological fluids: saliva, discharge from the genital openings. Children become infected in the following ways:

• In utero. If the expectant mother becomes infected during pregnancy, the cytomegalovirus infection enters the fetus through the placenta through the blood from the mother.
• With breast milk, if the nursing mother is acutely ill or became infected during breastfeeding.
• By airborne droplets when communicating with infected people or carriers of infection.
• Contact. A child can get the virus from the mother while moving through the birth canal.

For the virus to enter the body, you may not even have contact with a sick person. Biological secretions also pose a great threat to the baby's health. The infection can be transmitted on dishes, personal hygiene items, door handles, etc. Contact transmission does not pose a threat to the life and health of the baby.

A carrier of infection is a person who has no visible signs of the disease. However, it is dangerous for other people with reduced resistance. The infection is in a latent state in the body and waits for the right moment when the child’s immunity decreases. Then the virus begins to actively multiply and infect the child’s body.

How is the disease detected?

To make a diagnosis, it is not enough just to conduct an examination. The attending physician prescribes a number of tests:

• A serological blood test that identifies specific antibodies. The release of IgM antibodies means that the infection has become acute (the latent type is characterized by the IgG protein).
• PCR will help detect the virus in saliva, urine and other biological fluids.
• General blood analysis. It will show a decrease in the number of red blood cells, platelets and leukocytes (we recommend reading:).
• Biochemistry of blood. ALT and AST levels will be elevated, and kidney damage will be indicated by an increase in creatinine and urea.
• Microscopic analysis of urine sediment for the presence of giant cells.

A positive cytomegalovirus IgG indicates a chronic course of the disease. Additional diagnostic methods include:

• X-rays for complications in the lungs will show pneumonia;
• An abdominal ultrasound will show an enlarged spleen and liver;
• An MRI of the brain will reveal areas of inflammation.

An examination by an ophthalmologist is also possible. It reveals changes in the structures of the eye during fundus examination during generalized infection.

Is cytomegalovirus infection dangerous for children?

The infection is very dangerous for children who have it in infancy or were infected in utero. In 20% of cases, in those children whose infection is not accompanied by specific symptoms, the functioning of the nervous system is disrupted - anxiety, convulsions, and involuntary muscle contractions appear. Such children quickly lose weight, and skin rashes are possible.

The consequences of cytomegalovirus can appear in a child at 2 and 4 years old, as well as after several years in the form of delayed speech and mental development, diseases of the cardiovascular system, dysfunction of the ear and visual apparatus, up to complete loss of vision and partial loss of hearing. In older children, against the background of infection, the body's resistance sharply decreases. This provokes the development of bacterial microflora and causes other diseases, such as pneumonia or bronchitis.

How to cure the disease?

It is impossible to completely get rid of the virus, you can only bring it into an inactive state, so therapy is aimed at eliminating the activity of the virus and reducing the consequences of infection of the body by pathogenic bacteria. used in pediatrics:

1. Ganciclovir. Active against many viruses, including CMV. The active substance of the drug is integrated into the DNA of the virus and suppresses its synthesis.
2. Acyclovir. Successfully fights all herpes viruses, including chickenpox. The principle of action is similar to antibiotics - slowing down and interrupting the chain of viral DNA reproduction.

The duration of treatment with antiviral drugs is 2-3 weeks. When clinical manifestations are completely stopped and test results show an inactive state of the virus, therapy is stopped.

Another group of drugs used in the complex treatment of cytomegalovirus are immunostimulants:

1. Isoprinosine (we recommend reading:). Stimulator of the body's immune forces. Suppresses the reproduction of RNA viruses. Activates the work that destroys abnormal cells, which is why it is used even in oncology. In the treatment of cytomegalovirus, it is often prescribed in parallel with Acyclovir to complement the action of the latter.
2. Viferon. A drug based on artificially synthesized human interferon. Effective against herpes viruses. Available in the form of rectal suppositories and ointments and is used in cases where oral medications are contraindicated due to complications on the liver and digestive system.

As an addition to medication treatment, there are folk remedies. However, official medicine believes that they are useless in the fight against cytomegalovirus, so doctors do not recommend these recipes.

Preventative measures to prevent consequences

To avoid infection, you need to limit contact with sick people. It is necessary to instill in the child the rules of hygiene and explain the need for thorough hand washing. If a mother infected with cytomegalovirus gives birth to a healthy child, you should completely stop breastfeeding.

In order for a child’s immunity to be resistant to infections, it must be strengthened with a balanced diet containing all the essential vitamins and microelements. Children with reduced resistance are given nonspecific immunoglobulin, which contains antibodies to the virus.

You need to strengthen your immune system in other well-known ways: a healthy lifestyle, hardening, active recreation. Physical activity should be feasible - sport for the sake of results is as harmful as a sedentary lifestyle.

The fight against the disease is carried out by an infectious disease doctor, who should show the child if a virus is suspected. For various complications, it is also necessary to consult a neurologist, gastroenterologist, ENT specialist, ophthalmologist, nephrologist, pulmonologist. Complex treatment depends on the type of complications.

In conclusion, we can say that you should not let the situation take its course and self-medicate. This will aggravate the disease and give a lot of complications that will affect the development of the child. It is also important to be tested for cytomegalovirus carriage during pregnancy and undergo appropriate therapy.

Cytomegalovirus infection is considered one of the most common diseases associated with the penetration of a viral infection into a child’s body. According to statistics, it is diagnosed in more than half of minors. In most cases, cytomegalovirus in children is asymptomatic and does not cause any particular harm to health.

If the baby’s immunity is weakened or not yet fully formed, the consequences can be severe. Therefore, every parent needs to remember the features of this disease and the sequence of its treatment.

What is a virus?

Cytomegalovirus infection in children is caused by the penetration of a special virus into the blood, which belongs to the group of herpes viruses. It will not be possible to get rid of it forever. Even after full therapy, it does not leave the body, but exists in a latent state. The disease in its latent form is diagnosed in 80% of people. In this case, infection occurs in early childhood or during pregnancy of a woman.

After the virus enters the baby’s blood, it immediately rushes to the cells of the salivary glands. It is in this area that its localization is most often detected. The disease affects various organs and systems of the body: respiratory tract, liver, brain, gastrointestinal tract.

Cytomegalovirus has the ability to integrate its DNA into the nucleus of a cell in the human body. This leads to the formation of new dangerous particles. Subsequently, they grow significantly. This is where the name cytomegaly comes from, which can be translated as giant cell.

The disease is especially dangerous for children with insufficiently strong immunity. The risk group includes:

• Premature newborns.
• Children with congenital developmental pathologies.
• Children with HIV infection.
• Children suffering from chronic diseases, such as diabetes, glomerulonephritis.

If a child with a strong immune system becomes infected, then nothing bad happens. The disease does not show any symptoms.

How does infection occur?

In the progression of cytomegalovirus in children, the route of infection into the body is important. There are three main methods of infection:

• Intrapartum. The infection enters the baby's body as it passes through the birth canal. If the mother has the virus in the active phase, then in 5% of cases it is transmitted to the child during delivery.
• Antenatal. Cytomegalovirus penetrates the placental barrier while the baby is in the womb. With this course of events, the most severe consequences for the child’s health are observed. The virus lives in the amniotic fluid of an infected mother. It affects the digestive and respiratory systems of the fetus. If infection occurs in the first two trimesters, then there is a high probability of congenital pathologies of the baby or miscarriage.
• Postnatal. Children become infected after birth. A baby can become infected through direct contact with an infected person. The disease can also be transmitted through the milk of a sick mother. At a later age, cytomegalovirus occurs in a child through contact with saliva, blood and other biological secretions of infected people. This situation often occurs in kindergarten, school and other crowded places.

In adult children, compliance with the rules of individual hygiene plays an important role in maintaining health. Parents should teach their child to wash their hands as often as possible, not to put various objects in their mouth, and not to use other people’s hygiene devices.

Normal course of the disease

Cytomegalovirus is not as scary as it might seem. If the child's immune system is healthy, the disease does not cause any harm. It doesn't show itself at all. In rare cases, symptoms similar to the course of ARVI are observed. The following symptoms appear:

• Painful sensations in the muscles.
• Headache.
• The child quickly becomes tired, lethargic and drowsy.
• Chills appear.
• Runny nose.
• Lymph nodes increase in size.
• Increased salivation.
• A whitish coating may appear on the tongue and gums.

This condition does not entail any dangers. After a couple of weeks, the symptoms of cytomegalovirus in children completely disappear. Simple antiviral drugs will help speed up the process, allowing you to transfer the cytomegalovirus to a passive stage. Medication therapy for an infant should be carried out under the strict supervision of a specialist. Such carriage of infection lasts until the end of life.

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Main symptoms and modern treatment of cytomegalovirus in women

What symptoms might there be?

Symptoms and treatment are determined by how the infection enters the body. With a congenital disease that formed during the intrauterine development of the fetus, the following symptoms appear: hearing loss, neurological abnormalities, decreased visual acuity, problems with the nervous system.

The manifestation of the virus immediately after birth is determined by the following signs:

• Visual and hearing impairment.
• Skin rashes.
• Cramps.
• The liver increases in size. The spleen also changes.
• Jaundice begins to appear.
• The child is developmentally delayed compared to his peers.

The cytomegalovirus virus may not be diagnosed in older children. If the child’s immunity is weakened, then negative symptoms begin to appear:

• Painful sensations in the joints.
• Intense headaches.
• Increased body temperature.
• Fatigue, drowsiness, loss of performance.

Symptoms may appear all at once or only some.

Diagnostic measures

Acquired and congenital cytomegalovirus can be accurately diagnosed only after a set of measures has been carried out. A key role is played by laboratory tests of samples of biological material taken from the child. Most often, doctors use the following methods:

• Cultural. It involves isolating cytomegalovirus from human cells. This method is considered the most accurate. It allows not only to detect the presence of the virus, but also to assess its activity. The only drawback of the technique is its duration. All studies take about two weeks.
• Cytoscopic. This method detects enlarged cells in the patient's saliva. A urine sample may also be used for testing. This method is considered uninformative and is therefore not used often. It is not always possible to detect cells in urine.
• Linked immunosorbent assay. The method allows you to detect the presence of immunoglobulins M in the blood. Their presence in an infant indicates the initial stage of infection. If immunoglobulin G is detected, additional studies are prescribed. If there is an increase in the number of antibody titers, then we can talk about the progression of cytomegalovirus.
• Polymerase chain reaction (PCR) method. Considered the fastest. The result is considered as accurate as possible. Using polymerase chain reaction, it is possible to detect the presence of DNA of a pathogenic virus. It is also possible to estimate the rate of its reproduction.
• X-ray examination of the chest. In the pictures, the attending physician will be able to examine the signs of emerging pneumonia.
• Ultrasound of the abdominal organs. For CMV in children, during the study the doctor determines the condition of the liver and spleen. Their increase in volume indicates the presence of cytomegalovirus. Children under one year old have their own characteristics of the location of the liver.
• MRI of the brain. As the disease develops, the images will reveal a focus of inflammation.

If a virus is detected during the study, the doctor decides how to treat cytomegalovirus. Parents must strictly adhere to all the specialist’s recommendations.

Correct treatment

An integrated approach is used to treat cytomegalovirus in children. Experts recommend the combined use of antiviral and immunomodulatory drugs. This therapy is considered safe for children over 3 years of age. In children under one year of age, treatment is also carried out with the help of medications, but their dosage is calculated in a special way.

According to the recommendations of experienced specialists, including Dr. Komarovsky, treatment of cytomegalovirus infection in children is carried out using the following drugs:

• Cycloferon, Viferon, Laferon and other analogues. They contain interferon.
• Among the immunomodulatory agents, the most effective are Imunofan, Ribomunil, and Thymogen.
• Preparations of specific immunoglobulins. This group includes Neocytotect, Cytoga, Megalotect.
• Medicines containing nonspecific immunoglobulins: Intraglobin, Sandoglobulin.

If a doctor discovers a cytomegalovirus infection in a newborn, which entered the body after birth, then a symptomatic treatment regimen can be used. It includes the use of the following drugs:

• Antibacterial agents. Used only if an inflammatory process is found.
• Antipyretic medications. For one-year-old babies, such products must be dosed carefully. It is best to use drugs that come in the form of suppositories.
• Hepatoprotectors. Together with CMV, a newborn may develop hepatitis. With the help of hepatoprotectors, liver cells are protected from damage.
• Vitamin and mineral complexes. They are designed to support the body's immune system.

Doctor Maria Nikolaeva

Cytomegalovirus infection is one of those infections that a person encounters at an early age. It is caused by a virus from the herpes family, under the influence of which specific changes occur in all tissues and organs. Cytomegalovirus in children can be congenital and acquired - the clinical picture of these forms varies significantly.

If a child's blood test reveals antibodies to cytomegalovirus, this means that he has been infected with this infection. Often the disease is asymptomatic, so it is difficult to determine the moment of infection.

After entering the body, the pathogen invades the cells. This causes the development of an inflammatory process and dysfunction of the affected organ. Cytomegalovirus causes general intoxication, disrupts the blood clotting process, and suppresses the functioning of the adrenal cortex. The main location of cytomegalovirus is the salivary glands. In the blood, the pathogen infects lymphocytes and monocytes.

The nature of the disease depends on several factors:

• age;
• state of the child’s immune status;
• the presence of concomitant pathology.

Often, cytomegalovirus fixes itself in cells and becomes dormant without causing any symptoms. Activation of the virus occurs when conditions favorable to it arise – first of all, this is a decrease in the body’s resistance. This will determine how to treat cytomegalovirus infection in children.

Some useful facts about CMV:

• an inactive virus located in cells cannot be treated with medication, a person remains its carrier forever;
• in older children, cytomegalovirus causes mild acute respiratory infections;
• most dangerous in newborns and children with reduced immunity;
• Diagnosis of inactive CMV infection is quite difficult;
• low immunity contributes to the generalization of the infectious process.

Detection of CMV in children is not always an indication for emergency treatment. Therapy is prescribed only if clinical symptoms are obvious.

Cytomegalovirus detected - what to do?

Causes of the disease in children

The cause of the disease is infection with a pathogen called cytomegalovirus. It is a member of the herpesvirus family. The virus is widespread throughout the globe and is easily transmitted between people. Therefore, a person becomes infected with the infection in the first years of life. The most sensitive to cytomegalovirus are fetuses during intrauterine development and newborns.

Cytomegalovirus appears in a child upon contact with any biological fluids. The spread of the virus occurs through airborne droplets and contact. You can also become infected through a transfusion of infected blood. In utero, the fetus becomes infected when the virus passes through the placenta or during childbirth. Infection with cytomegalovirus in children under one year of age occurs through breast milk. The pathogen is very stable in the environment. It dies under the influence of high temperatures or freezing, and is sensitive to alcohol.

How does cytomegalovirus manifest itself?

The course of cytomegalovirus infection in a child is cyclical - incubation period, peak, recovery period. The infection can be localized and generalized, congenital and acquired. Also, an infectious disease in a child is often asymptomatic. Clinically, cytomegalovirus manifests itself in 30-40% of children.

The incubation period of cytomegalovirus infection is variable - from 15 days to 3 months. During this period there are no signs of illness, but the baby is already a source of cytomegalovirus infection.

Symptoms of cytomegalovirus

Congenital and acquired CMV in children - what is the difference?

The difference between congenital and acquired forms of CMV in children is in the nature of the course. The congenital form of the disease occurs in a generalized manner. Acquired cytomegalovirus is characterized by damage to one of the body systems, less often it is generalized. CMV is most dangerous for a baby in its generalized form.

Congenital

Congenital cytomegaly is characterized by intrauterine infection of the fetus. Infection occurs through the placenta during acute or chronic CMV infection in the mother. The virus is localized in the salivary glands of the fetus. Here it multiplies, enters the blood and causes a generalized process. The congenital disease occurs in 0.3-3% of newborns. The risk of CMV infection of a fetus from a sick mother is 30-40%.

If infection occurs in the first trimester of pregnancy, the outcome is fetal death and spontaneous miscarriage. Less often, the fetus remains viable, but it develops numerous malformations:

• central nervous system– microcephaly (underdevelopment of the brain) or hydrocephalus (accumulation of fluid in the brain tissue) develops;
• the cardiovascular system– various congenital heart defects;
• gastrointestinal tract– underdevelopment of the liver and intestines.

If infection occurs in the second half of pregnancy, the baby is born without malformations. Symptoms of the disease in this case:

• jaundice – persists for two months;
• enlarged liver and spleen;
• pneumonia;
• intestinal inflammation.

The baby is born premature, with low body weight. There is inhibition of reflexes, sucking and swallowing processes. The baby's condition with congenital cytomegalovirus infection is serious. There is persistent fever and lack of appetite. The child is lethargic, grows poorly and hardly gains weight. There is darkening of the urine and light, loose stools. Dotted hemorrhages appear on the skin.

The acute course of cytomegalovirus disease leads to the death of the baby within several weeks.

The most common manifestations of congenital CMV infection:

• hemorrhagic rash – 76%;
• yellowness of the skin – 67%;
• enlargement of the liver and spleen – 60%;
• underdevelopment of the brain – 52%;
• low body weight – 48%;
• hepatitis – 20%;
• encephalitis – 15%;
• damage to the optic nerve – 12%.

Table. Manifestations of CMV depending on the period of intrauterine infection.

The most common manifestation of CMV infection in children is hepatitis. Occurs in icteric or anicteric forms. The latter is characterized by scanty clinical symptoms, the child’s condition is satisfactory. In the icteric form, hepatosplenomegaly, moderate staining of the skin, dark urine and light feces are noted.

Rarely, the outcome of hepatitis is the formation of biliary cirrhosis, from which children die in the second year of life.

Pneumonia ranks second after hepatitis. Characterized by increased body temperature, cough with sputum. Children experience shortness of breath on exertion and at rest. A feature of pneumonia caused by cytomegalovirus is its protracted course.

Retinitis is damage to the optic nerve by cytomegalovirus. Characterized by decreased vision, floaters and color spots in front of the eyes. The baby has photophobia and lacrimation.

Sialadenitis is a lesion of the salivary glands. It manifests itself as fever, pain in the cheeks and ears, and difficulty swallowing.

Acquired

Infection of a baby occurs at the time of birth, or in the following days and months through contact with a sick person or a virus carrier. Generalization of the process occurs very rarely. The disease in this case is nonspecific - a rise in temperature, enlarged lymph nodes, signs of inflammation of the tonsils. Possible stool upset and abdominal pain. Appetite worsens and increased salivation is noted.

More often, a localized form of infection is observed - with damage to any one system of the body:

• respiratory – development of severe pneumonia (cough, shortness of breath, profuse sputum);
• intestinal damage by cytomegalovirus - diarrhea, nausea, vomiting;
• urinary system - lower back pain, changes in urine analysis.

The disease lasts a long time and is accompanied by high fever. The diagnosis is quite difficult to make.

In children of the first three years In life, several clinical options for the course of the disease are possible:

• sialadenitis – damage to the salivary glands;
• interstitial pneumonia;
• acute nephritis – kidney damage;
• acute intestinal infection;
• hepatitis;
• encephalitis with damage to the optic nerve, convulsive syndrome.

In older children, with already formed immunity, CMV disease proceeds as an acute respiratory disease with a mild course:

• moderate increase in temperature;
• malaise;
• enlarged lymph nodes in the neck;
• sore throat.

Recovery occurs within 7-10 days without the development of complications.

If infection occurs through breast milk, the baby will only become ill with a latent form of infection, which is mild. This is due to the fact that with milk, children also receive specific immunoglobulin, which protects them from viral and bacterial infections.

Children attending organized child care institutions receive cytomegalovirus through saliva. This is usually accomplished by airborne droplets.

Diagnostics

The diagnosis is made based on the clinical picture, epidemiological history, and laboratory test results. Since the clinical picture is nonspecific and similar to many other diseases, mandatory laboratory diagnosis is required to confirm CMV infection.

The diagnosis is considered confirmed if either the virus itself or antibodies to it were detected in any biological fluids of the baby. Cytomegalovirus cells are found in the urine, saliva, sputum, and gastric lavage of a child. The most effective diagnostic method is PCR (polymerase chain reaction) - this method allows you to detect the genetic material of the virus in the test liquid.

If congenital CMV infection is suspected, detection of the virus or testing for antibodies to it in the child’s mother is of diagnostic importance.

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.