How does cytomegalovirus manifest in children? Congenital cytomegalovirus infection in infants. Routes of infection and causes of CMV in a child

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

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

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

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

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

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

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

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

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

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

note

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

Clinical:

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

Anamnestic:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cytomegalovirus in a child - methods of pharmacological and traditional treatment

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

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

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

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

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

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

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

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

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

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

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

The disease, which is caused by the Herpesviridae virus, is similar to the herpes simplex virus. When multiplying in a cell, the cytomegalovirus virus in children leads to the formation of huge cells due to an increase in the nucleus and cytoplasm. This is a disease with polymorphic symptoms.

In general, CMV infection in children is transmitted without obvious signs. Viruses are resistant to antibiotics. Transmission occurs mainly by contact, less often by airborne droplets. Placental and parenteral (through blood) routes of transmission are possible. Fetuses and newborns are especially susceptible to the disease. Newborns can become infected through breastfeeding from their mother. The CMV virus in children is detected in saliva, cerebrospinal fluid, urine and organs.

CMV infection in children can occur due to the penetration of viruses through the placenta or during childbirth. However, not all infected children may be born with severe signs of the disease. Most often it occurs latently. Only in the salivary glands can cell changes occur (giant cell metamorphosis).

If a child is diagnosed with cytomegalovirus, but there are no symptoms, it is possible that parents should not worry. With good immunity, the virus does not pose a danger. If the disease is latent, the child will develop immunity, and the body itself will cope with the infection without consequences. But sometimes a latent infection can lead to some disorders of the central nervous system. The child develops headaches, mental retardation, insomnia, and fatigue.

Sometimes exposure to infection can cause serious complications. If the immune system is weakened and cytomegalovirus is found in the child, this is a signal to begin active therapeutic measures. With severe immune deficiency, infection leads to an unfavorable outcome.

At what age can cytomegalovirus appear in children?

Congenital cytomegalovirus in a child occurs when the placenta is damaged and the infection is generalized. If infection occurs in the first months of intrauterine development, developmental defects are possible. The child may have hydrocephalus, microcephaly, or a disorder of the structure of the brain substance. On the part of the cardiovascular system, there may be non-closure of the septum of the heart, endocardial fibroelastosis, and heart defects. Sometimes defects of the kidneys, genitals and gastrointestinal tract may appear.

If infection occurs late in life, cytomegalovirus in newborns shows symptoms after birth. The child develops jaundice, damage to the lungs and gastrointestinal tract, and hepatoleanal syndrome are detected. Sometimes the disease can manifest as hemorrhagic rashes. With CMV, newborns experience lethargy, frequent regurgitation and diarrhea. Because of this, children do not gain weight well, they have decreased tissue turgor, and increased temperature.

Jaundice may appear during the first two days. Most often it is pronounced, since there is a very high concentration of bile pigments in the blood. The child's feces are partially discolored, the spleen is enlarged, and the liver protrudes 37 cm from under the costal arch. Hemorrhagic syndrome can manifest as petechiae and vomiting. In children, hypotonia and hyporeflexia are determined. In severe cases, intoxication develops, leading to death.

Cytomegalovirus infection in an infant can be congenital or acquired. The disease in its congenital form is much more severe, since the virus manages to cause significant harm to the child’s body while still in the womb. But even when the virus is transmitted to the fetus, only 10% of children are born with obvious signs of the disease. Often cytomegalovirus does not appear in infants.

The nature of the development of the disease depends on the maturity of the fetus at the time of intrauterine infection, the mother’s immunity and the child’s immune reactivity. Symptoms of congenital CMV in an infant may include: jaundice, convulsions, abnormal development of organs and systems. Doctors can diagnose deafness and blindness.

Acquired cytomegalovirus in children under one year of age can manifest itself as damage only to the salivary glands. In response to the introduction of the virus into cells, severe dysfunction of the affected organ may occur. In severe cases, cytomegalovirus in an infant can cause adrenal insufficiency, and in case of immunosuppression, damage to all organs.

Acquired cytomegalovirus in a 1-year-old child can manifest itself as a delay in physical development. In this case, disturbances in motor activity and convulsions are observed. Depending on the state of the child’s immunity, various signs may appear: swelling of the salivary glands, hemorrhages, blurred vision, damage to the gastrointestinal tract. But more often the acquired disease can be asymptomatic.

Cytomegalovirus in a 2-year-old child can lead to either isolated damage to the salivary glands or organ damage. However, unlike the congenital form, the disease more often manifests itself as mononucleosis. The child may experience a gradual increase in temperature, sore throat, enlarged lymph nodes, hepatosplenomegaly, swelling of the throat mucosa, and abdominal pain.

The immune system of children under 5 years of age is not yet capable of providing an adequate response to infection. Cytomegalovirus in children 3 years of age may present with symptoms of interstitial pneumonia. The child develops shortness of breath, whooping cough-like persistent cough, and cyanosis. Possible addition of dysfunctions of the gastrointestinal tract and liver. Temperatures can reach 40 degrees. This condition can last from 2 to 4 weeks.

In the generalized form, almost all organs can be involved in the process. The disease is manifested by sepsis, prolonged fever, disorders of the gastrointestinal tract and cardiovascular system, parenchymal hepatitis and encephalitis. For complications of CMV in children aged five years, treatment includes the administration of immunoglobulins (Interferon) in the complex of measures. After five years, the child’s body is able to cope with the infection on its own without serious consequences.

What are the symptoms and signs of infection in children?

If cytomegalovirus affects, symptoms in children may appear depending on age and immune status. The older the child, the easier the disease will be tolerated. At the first encounter with the virus, children under 7 years of age with normal immunity develop typical symptoms:

• Hyperthermia
• Swelling of the larynx, inflammation
• Muscle weakness, malaise
• Headache

Sometimes there may be rashes on the body. If children have symptoms of cytomegalovirus, treatment is carried out with antiviral drugs, which transfer the disease to a passive form.

In case of decreased immunity, symptoms of CMV in children may appear depending on the organ damage or the form of the disease. The virus affects the intestinal glands, bile ducts, kidney capsules, etc. This leads to the occurrence of focal inflammation. Pneumonia, bronchitis, inflammation of the spleen, adrenal glands, and liver may develop. In the generalized form, all organs can be affected. In this case, the symptoms of CMV infection in children are polymorphic. The generalized form is severe and can be fatal in the first 2 weeks of life. In isolated forms of damage to any organ, it can be asymptomatic.

When is treatment for a disease necessary?

Treatment of cytomegalovirus in children involves the use of a complex of drugs depending on the affected systems. In the generalized form, the administration of corticosteroids, antiviral (Ganciclovir) and specific Cytotect is indicated. In order to restore the basic functions of the immune system (primarily the production of interferon), a course of treatment is carried out with interferon inducers (amixin, Cycloferon). These drugs activate humoral and cellular immunity. Thanks to interferons, the immune system begins to work effectively and contributes to the death of the virus.

Most often, treatment of CMV in children is carried out with the prescription of human immunoglobulin (Megalotect, Cytotect). These drugs are non-toxic and can be used to treat children of any age. In exceptional cases, more toxic antiviral drugs are prescribed for the treatment of newborns - Ganciclovir, Cidofovir. This therapy is carried out in cases of severe damage to visceral organs. However, before treating cytomegalovirus in a child with toxic drugs, the degree of complications caused by the virus should be assessed. The therapy itself and the set of drugs used for treatment must correspond to the child’s immune status.

Virus carriage itself or a mild disease (mononucleosis syndrome) in children with normal immunity does not require therapy. It is enough to use vitamins and restorative drugs to strengthen the immune system. During periods when outbreaks of infectious diseases (flu or acute respiratory infections) occur, the use of multivitamin complexes will protect the child from the virus.

How dangerous is cytomegalovirus in a child?

Usually healthy children tolerate this infection normally. The disease can be asymptomatic or with symptoms of a cold that disappear after a few days. However, in weakened children, this infection can occur with complications. The consequences of cytomegalovirus in a child can appear either immediately after birth or after previous illnesses. Asymptomatic progression may in the future cause visual impairment or mental retardation. Hearing problems or neurological abnormalities may develop over time.

Scientific studies have established the danger of fetal infection in the first half of pregnancy. Having penetrated the body, the virus exhibits a teratogenic effect. As a result, the development of the brain, hearing and vision organs, and visceral organs is impaired.

Analysis for cytomegalovirus in a child

In order to make an accurate diagnosis, you should be tested for cytomegalovirus. Several methods are used for diagnosis:

1. Virological (cytological).
2. Serological. The most accessible ELISA method is the isolation of immunoglobulins G and M.
3. Molecular biological (PCR).

The most informative test for CMV in a child is the PCR method. It is possible to detect not only CMV DNA using PCR in children, but also the activity of the virus. However, this method is one of the most expensive. Another method is used that allows one to establish antibodies to cytomegalovirus in a child - serological (ELISA). The analysis determines several types of antibodies and the stage of the disease.

There are some differences in antibodies to understand. Class M immunoglobulins are produced in response to the virus. They cannot form immunological memory, so when they disappear, protection against the virus disappears. Immunoglobulins G are produced after suppression of infection throughout life, developing stable immunity to the disease.

If anti-CMV IgG is detected in a child, but anti-CMV IgM is not detected, this indicates that the body has developed lifelong immunity to the virus. That is, this is the norm for CMV in children, which does not require treatment. If cytomegalovirus igg is positive in children, but anti cmv ​​IgG antibodies are not detected, the analysis shows that the body does not have stable immunity to the virus. Antibodies suppress the development of the virus and help transmit the disease without symptoms. If a child does not have antibodies to cytomegalovirus (cmv g), this is explained by the absence of the disease or high susceptibility to infection.

Cytomegalovirus (cmv, CMV) igg positive in a child indicates that he is infected either before birth or after. If a child has a very high titer, this is evidence of infection activation. This usually increases the concentration of iGM antibodies.

Antibodies to cytomegalovirus igg are positive in the child - this means that the disease is either in an inactive stage or in the reactivation stage. The readings of class M antibodies help to give an accurate analysis. If anti CMV igg is positive in a child and Anti CMV IgM is positive, this means that the end of the primary infection is occurring in the body, and immunity has already formed. If IgM is negative, the disease is in an inactive stage.

A positive cytomegalovirus igM in a child with a negative Anti-CMV IgG indicates a primary disease in the acute stage. If the tests do not detect antibodies of both classes, it means either the disease is absent or it is at an early stage and antibodies have not had time to develop.

Cytomagalovirus in children most often appears in utero. When a pregnant woman is infected, the pathogen travels through the blood to the fetus.

Developmental abnormalities in a child appear when a pregnant woman is infected in the first trimester. Infection at other stages is not characterized by similar symptoms. Latent carriage of cytomegalovirus manifests itself after birth against the background of a decrease in the protective abilities of the immune system.

The European Institute conducted clinical studies on the incidence of cytomegalovirus infection in pregnant women. The results showed that 90% of the fair sex of reproductive age are infected with this pathogen. The absence of clinical symptoms does not allow the diagnosis of cytomegalovirus at an early stage.

No screening tests for the pathogen have been developed. No effective drugs have been developed against viral diseases. The problem remains relevant for medicine in the 21st century.

The experiment revealed a high frequency of combined “cohabitation” of cytomegalovirus, ureaplasma, chlamydia, and herpes simplex virus during pregnancy.

Symptoms of cytomegalovirus infection

Cytomegalovirus infection in a child is a fetal problem. An erased clinic does not allow gynecologists to identify the pathogen at the stage of pregnancy planning. When monitoring pregnancy, doctors do not take cytomegalovirus infection seriously. Nosology may be hidden under the guise of other diseases. Timely diagnosis of the disease in pregnant women can prevent dangerous complications:

• Fetoplacental insufficiency;
• Spontaneous termination of pregnancy;
• Risk of miscarriage;
• Hydrops fetalis;
• Stillbirth.

The main route of transmission of cytomegalovirus infection in adolescents is sexual. Statistics show a high frequency of the combination of cytomegalovirus and herpes simplex virus. There are cases of infection through urogenital contact.

The latent course of infection in children is explained by the lifelong immunity that the baby acquires after contact with the pathogen. If the baby has not received cytomegalovirus from his mother, he may become infected when interacting with peers.

With normal immunity, exposure to cytomegalovirus is not dangerous to the child’s health. On the contrary, infection allows the body to develop lasting immunity. A single infection is enough for lifelong protection with antibodies.

It is impossible to protect children from visiting kindergartens, schools, and public places. The high prevalence of the pathogen does not allow anyone to avoid cytomegalovirus infection.

Intrauterine infection is characterized by active release of the pathogen into the external environment for 5 years. Clinical manifestations are observed only in 10% of children with reduced immunity. Symptoms are nonspecific for the disease:

• General weakness;
• Decreased appetite;
• Skin rashes;
• Fever;
• Headache;
• Runny nose;
• Sore throat.

The symptoms described above are the body’s reaction to viral persistence. An increase in temperature is a protective reaction aimed at accelerating biochemical reactions. According to modern medical concepts, a temperature reaction of up to 38 degrees Celsius is physiological. Symptoms of local inflammation arise due to the virion limitation reaction. The localized accumulation of viruses is destroyed by macrophages. An inflammatory reaction is required to remove destruction products.

But they have no idea what this disease is until they encounter it themselves. What is cytomegalovirus, how does it become infected, how does it manifest itself, how to treat it, and, most importantly, what to do if CMV is detected in a child - the answers to these and many other questions are in our article.

Cytomegalovirus is a type of herpes type 5. Since it was discovered relatively recently, scientists cannot say with certainty that it has been fully studied. At the same time, it is found in more than 40% of adults and 15% of children.

Until recently, it was believed that this disease could only be acquired through unprotected sexual contact with a carrier, but in our time other routes of transmission have been proven.

The insidious feature of this infection is that once it penetrates the body, it remains in it throughout life, but often occurs hidden and does not manifest itself in any way.

In many cases, the manifestations of the disease may be minor, but they pose a danger to children with weakened immune systems, as well as those with chronic diseases.

During pregnancy

Expectant mothers are at particular risk for cytomegalovirus. If a positive test is detected, the likelihood of infection of the fetus is extremely high. But the most dangerous cases are primary infection during pregnancy, because The body lacks the necessary antibodies to fight this disease. Therefore, the infection can manifest itself in an acute form, threatening the health of both the mother and the unborn baby.

You can become infected during pregnancy through sexual contact. Less commonly, infection occurs through contact of a pregnant woman with a carrier of the virus who is in the active stage, as well as through household items, personal hygiene, and kissing.

Therefore, every woman should be tested for antibodies to CMV before pregnancy. If they are absent, preventive measures must be taken to prevent the virus from entering the pregnant woman’s body. The doctor develops special tactics for managing such a pregnancy.

With early detection in the expectant mother and implementation of preventive measures, the likelihood of its intrauterine transmission to the fetus can be significantly reduced.

Causes of cytomegalovirus in children

Infection of babies with cytomegalovirus can occur in utero from an infected mother, or in early childhood. The source of infection is a carrier of a virus with an acute or latent (hidden) form.

CMV infection in children can be asymptomatic for a long time; sometimes signs of a cold or flu appear, but with a longer course. However, you should not perceive cytomegalovirus as a harmless disease, since it can cause irreparable damage to the baby’s health, especially against the backdrop of a weakened immune system.

A child can get cytomegalovirus in several ways:

• Transplacental. It is transmitted to the fetus from an infected mother through the placenta.
• During delivery.
• In an infant, the infection enters the body through breast milk.
• By everyday means. An actively sick person can infect a healthy person, especially if the latter has a decrease in immunity due to illness or stress. In this case, infection occurs through airborne droplets, coughing and sneezing. It is also possible to get this virus in children's groups, through shared toys, which children are sure to taste one by one.

Identification of the flow pattern

When CMV enters the body, it causes a primary infection. In some cases, it is not expressed by any symptoms, but sometimes it manifests itself acutely, with the occurrence of many complications.

The form of leakage in babies can be of three types:

• Congenital.
• Spicy.
• Generalized.

With congenital liver and spleen are enlarged. Can lead to hemorrhages of internal organs and disruption of the central nervous system.

Acute the form is detected with an acquired virus, its symptoms are similar to colds, but, as a rule, it has a severe course with the addition of secondary infections. The severity of the course directly depends on the child’s immune status.

At generalized Inflammatory processes are observed in the internal organs, pneumonia often occurs, various lesions of the brain and peripheral nervous system are observed, in many cases aggravated by the addition of a secondary bacterial infection.

Also distinguished recurrent type leakage. It manifests itself in the form of frequent colds, complicated by bronchitis and pneumonia, and enlarged lymph nodes throughout the body.

Very rarely observed atypical. It can cause damage to the reproductive system, interfere with blood clotting, and lead to hemolytic disease.

If it is congenital

Separately, the congenital form of CMV should be highlighted, since it is this that brings the most severe consequences to the health and development of the baby. From a carrier mother, the virus can enter the fetus at any stage of pregnancy. The nature of the lesions is directly related to the period at which the infection occurred. In the early stages of pregnancy (before 12 weeks), infection often leads to miscarriage.

The newborn is diagnosed with jaundice, convulsions, malformations of internal organs, and failure of the respiratory system. In especially severe cases, damage to the central nervous system, hydro- or microcephaly, complete blindness and deafness are observed. As these children grow up, in addition to developmental delays, there are dysfunctions of the musculoskeletal system and mental development.

Symptoms

Manifestations of CMV in children are directly related to the child’s age and state of health.

Often, with the congenital form, there may be no obvious symptoms, but its consequences arise later in the form of visual impairment, neurological abnormalities, and delays in growth and development. Less commonly, the disease attacks a newborn immediately after birth. In this case, the salivary glands are affected, causing jaundice, enlargement and inflammation of internal organs, skin rash, decreased hearing and vision.

When an infant is infected from mother's milk, as well as in babies under one year of age, symptoms may appear in the form of a rash and pneumonia.

A child 3 years of age or older experiences fever, fatigue, and respiratory symptoms. These conditions usually go away on their own within a few weeks. The older the baby, the easier it will be to cope with an exacerbation.

In general, symptoms after infection do not appear immediately, since the incubation period of the disease can last up to three months. Symptoms of manifestation are often mistaken for a banal ARVI or influenza condition:

• Heat.
• Redness of the throat and pain when swallowing.
• Runny nose.
• General malaise, weakness, drowsiness.
• In some cases, the lymph nodes become enlarged.
• Sometimes a rash appears in the form of red dots all over the body.

In babies with healthy immune systems, these symptoms disappear after a couple of weeks. With a decrease in immunity, weakness and body temperature may remain elevated for a long time, up to several weeks or even months.

Based on severity, the disease is divided into three categories:

• light;
• moderate;
• heavy.

At easy In this form, symptoms may be mild or absent altogether. Recovery occurs on its own, even without special treatment.

At medium-heavy form, damage to internal organs is observed, in many cases reversible.

At severe form, there are pronounced functional disturbances in the functioning of internal organs, as well as severe intoxication of the whole organism.

Diagnosis and treatment of CMV

Cytomegalovirus is diagnosed in the laboratory in several ways:

• Cytological method. Biological fluids are taken for analysis - urine or saliva, and when stained, cytomegalic cells are revealed. One of the disadvantages of this method is its low information content (50%) and the need for multiple repetitions.
• PCR method. More informative compared to cytology. Capable of detecting both active and latent viruses.
• DNA probe method. Detects the presence of a virus from the mucus of the cervical canal.
• Serological method. With this type of study, antibodies to CMV are determined - immunoglobulins M and G (lgM and lgG). This type of diagnosis is highly informative and determines the presence of a primary infection from the beginning of infection until 12 weeks after. The presence of IgG antibodies and high IgG titers indicate activation of the latent virus in the body.
• ELISA diagnostics (enzyme-linked immunosorbent assay). The most accurate diagnostic method, but very expensive. It is able to detect CMV in children's blood even in the presence of other infections in the body.

If, as a result of an analysis for antibodies to CMV, a child is found to be IgG positive, this means that the child has previously encountered this type and has received immunity from it. Antibodies of the IgG type tend to accumulate in the blood and are present in a certain concentration throughout life. The doctor may retest in a few weeks.

An increase in antibody titers several times when compared with the first test result means that the virus is in an active stage of reproduction and treatment is required. If titers do not increase and there are no symptoms, treatment is not prescribed.

Antibodies of the lgM type are actively produced 5-7 weeks after the virus has captured the body, as well as during its next activation. The presence of IgM antibodies means that the infection occurred either recently, or the virus present in the body has entered an active stage. These antibodies may be present in a blood test for 6-12 months and disappear over time.

Treatment

in children it is long-lasting and complex. Unfortunately, today a specific remedy has not yet been developed to suppress or completely cure this type of virus. Most commonly known antiviral drugs are not effective in treating CMV. Therefore, all measures are aimed at suppressing its activity, increasing the protective functions of the baby’s body and reducing the frequency of relapses.

In children with a congenital form of CMV, complex antiviral drugs are used for treatment. In addition, measures are being taken to minimize the harm caused by the virus and treat concomitant diseases depending on the severity of the lesions.

Therapy with human immunoglobulin preparations is also used, the administration of which is possible within a few hours after birth, due to their low toxicity.

CMV infection in children under one year of age is dangerous because their immunity is not yet developed enough to resist this disease, and the symptoms can be pronounced. Children with an acquired form of the virus in the latent stage, as a rule, do not require treatment.

The closest attention should be paid to those children whose immunity is reduced by other diseases. In this case, the disease can strike the internal organs, leading to their irreversible changes and malfunction in the future.

In other cases, symptomatic treatment is carried out:

• Taking antipyretics when the temperature rises.
• Bed rest.
• Drink plenty of fluids.

A doctor should monitor the condition of a sick child, since he is the one who is able to recognize signs of possible complications of the disease.

Only the attending physician should prescribe medications for treatment and select the dosage of drugs depending on the age of the child and the severity of the disease. Self-administration of medications without control will lead to unpredictable consequences and complications, which, in turn, will complicate further treatment.

Prevention

A healthy child’s immune system will not allow the virus to activate in the body, or the disease will proceed easily and without complications. Therefore, preventive measures are aimed at strengthening immune defense. Children should eat properly and balanced, harden themselves, and regularly spend time in the fresh air.

Taking multivitamin complexes gives good results, especially in winter. Decoctions of medicinal herbs - rose hips, St. John's wort, chamomile - have a positive effect on the immune system. Regular consumption of them in the form of tea will help to strengthen the children's body.

During epidemics of influenza and ARVI, you should limit the child’s communication with peers for some time, and also pay increased attention to his personal hygiene: regularly wash your hands with soap, when coming from the street, after playing and before eating. Be sure to carry out wet cleaning of the apartment and ventilation.

Sometimes, after an immunological examination of the child, to prevent complications, the doctor may prescribe immunostimulants in the form of medications. This can reduce the symptoms of the virus and transfer the disease to an inactive stage.

It is important for parents to remember that if their baby develops long-term, frequently recurring colds, they should definitely show the baby to a doctor, conduct an examination and never self-medicate. Timely preventive and treatment measures will help transform it into an inactive form and make it non-hazardous to the health and development of your child.

Who said that curing herpes is difficult?

• Do you suffer from itching and burning in the areas of the rash?
• The sight of blisters does not at all add to your self-confidence...
• And it’s somehow embarrassing, especially if you suffer from genital herpes...
• And for some reason, ointments and medications recommended by doctors are not effective in your case...
• In addition, constant relapses have already become a part of your life...
• And now you are ready to take advantage of any opportunity that will help you get rid of herpes!

There is an effective remedy for herpes. and find out how Elena Makarenko cured herself of genital herpes in 3 days!

Cytomegalovirus in children (CMV) is an infectious disease caused by a specific microorganism, Human betaherpesvirus 5. In most cases, the pathogen is detected by examining blood and urine using the polymerase chain reaction method. In many children, cytomegalovirus infection does not manifest itself with severe symptoms, and only when exposed to a number of factors do the first signs develop.

What is cytomegalovirus in children

Cytomegalovirus in a child is able to penetrate the tissues of all organs, but it shows the greatest activity in the salivary glands, quickly multiplying and integrating its DNA into the nuclei of cells. When an infectious agent is introduced, lymphocytes and monocytes are damaged. The disease leads to an increase in the cells of the salivary glands, which gave rise to the name of the virus (translated from Latin as “giant cells”).

The infection damages not only blood vessels, but also the tissues of the child’s internal organs, disrupting their blood supply and leading to hemorrhages. The virus causes a significant change in the shape and structure of leukocytes and phagocytes, resulting in the development of signs of immunodeficiency. When the child’s body’s defenses are healthy, the virus is not active.

With a decrease in immunity, the disease begins to manifest itself with various symptoms.

How dangerous it is for a child

The congenital form of cytomegalovirus infection can cause the development of mental retardation in a child. The risk of death in infants is 30%. The disease leads to vision impairment and blindness. In 18% of cases, damage to the nervous system occurs. Children develop convulsive symptoms, high anxiety, weight loss, and skin reactions.

Routes of infection and causes of CMV in a child

Infection of young children often occurs through contact with an infected mother. The virus can be transmitted not only through milk and saliva, but also through sweat, blood and other biological fluids. The main routes of infection are:

1. Airborne. The infection can enter the body of a healthy baby if there is a sick person nearby.
2. Transplacentral. The virus is transmitted from the mother during pregnancy.
3. Contact. Infection occurs when biological materials come into contact with the baby's skin.
4. Parenteral. The likelihood of infection with cytomegalovirus increases during blood transfusion or the use of untreated medical instruments.

Types and forms of childhood cytomegalovirus

There are two main types of CMV:

• congenital;
• acquired.

Often infection occurs during pregnancy. The virus penetrates the placenta and enters the amniotic fluid, when ingested it is introduced into the cells of the developing body of the child.

Doctors consider the first two weeks after conception to be the most dangerous period.

In this case, the risk of developing irreversible changes in the fetus is extremely high. Infection can cause miscarriage in early pregnancy. Cytomegalovirus is considered acquired if it is transmitted from the mother. The risk of infection increases with kissing and skin-to-skin contact.

Depending on the location of the outbreak, the following forms of cytomegalovirus infection are distinguished:

1. Localized. Formation occurs in one place.
2. Generalized. The abnormal process spreads throughout the body.

The disease is also classified according to its course into:

• latent:
• spicy.

Symptoms and signs

Signs of congenital cytomegalovirus infection are malformations of the child’s body. The disease causes disturbances in the functioning of the heart, brain activity and other abnormal processes. Doctors may suspect the presence of a congenital form of CMV if there is muscle hypotonicity, general weakness of the body, lethargy, and the inability to digest food. Such babies experience sleep disturbances, lack of appetite and do not increase body weight. If the child’s body is severely affected, there is a risk of death in the first month after birth.

If the fetus was infected in the third trimester, there are no signs of birth defects. Complications may include liver and blood diseases. In some infants, the disease is accompanied by signs of hydrocephalus, enlarged spleen, and hyperthermia. In addition to inflammation of the lymph nodes, babies develop skin rashes that can bleed.

The acquired form of cytomegalovirus infection rarely manifests itself with certain symptoms. Often it is latent and has no effect on the child. This phenomenon is observed under normal functioning of the baby’s immune system. With reduced body resistance, an infectious process begins to develop, with signs reminiscent of acute respiratory infections. The child develops a chest cough, produces sputum, increases body temperature, and increases urination. The disease is accompanied by inflammation of the respiratory tract, nasal congestion, and pain when swallowing. In some cases, a reddish rash appears on the skin.

When the pathogen is activated in the child’s body, the cervical lymph nodes begin to enlarge. Usually they do not bother the baby. An enlarged liver and spleen are accompanied by unpleasant sensations in the abdomen. In this case, engorgement of the inguinal and axillary lymph nodes is observed. A sign of liver damage is yellowing of the skin and eyes. Cytomegalovirus infection can manifest itself as signs of a sore throat: the child complains of pain in the joints, drowsiness, lethargy, and hyperthermia are observed.

If such signs occur, you should immediately consult a doctor.

Blood test for cytomegalovirus in a child

In addition to an external examination, if a child is suspected of having a cytomegalovirus infection, blood tests are prescribed. Immunoglobulins are detected in the serum. Antibodies of class M appear in the body immediately after the virus enters the cells of the organs. Protein compounds can be detected within the first 14 days from the moment of infection. IgM immunoglobulins persist for six months. When they are identified, we can talk about the initial form of the disease.

Class G antibodies are detected a month after the entry of cytomegalovirus and remain in the blood throughout life. In this way, the immune system can effectively fight the intensification of infection.

Determining the quantitative indicators of antibodies allows you to monitor the dynamics of the disease and prescribe timely treatment. In severe cases of infection, the synthesis of immunoglobulins is noticeably reduced. Laboratory methods do not determine the amount of proteins in the blood, but reveal the degree of their activity. The serum is diluted in a ratio of 1 to 100. When the normal level of immunoglobulins is exceeded, we can talk about the occurrence of a disease. IgM norm< 0,5. Увеличение показателя указывает на положительный анализ.

Blood for antibodies to cytomegalovirus in a newborn is tested without fail if the mother suffered from an acute form of the disease during pregnancy. The interpretation of the analysis often shows the presence of class G immunoglobulins. This indicator does not always indicate that the baby has a congenital form of cytomegalovirus infection. The presence of IgG antibodies in the blood indicates the presence of the disease in the mother. An indicator of a baby’s infection is an excess of class M immunoglobulin standards. The child’s urine and saliva can serve as biological material for laboratory testing. It is recommended to donate blood on an empty stomach.

Treatment

When prescribing treatment, the doctor must consider the following factors:

1. Type of cytomegalovirus infection. Determined by enzyme immunoassay. With the acquired form of the disease, there are often no symptoms or changes in the baby’s organs and systems. The presence of the virus is not dangerous if the child’s immune system is functioning normally.
2. The nature of the course of the disease. When an infection occurs, the severity of symptoms is taken into account.
3. State of the immune system. Not only the course of the disease, but also the speed of recovery depends on the functioning of the body’s defenses.

Dr. Komarovsky about cytomegalovirus infection

Pediatrician E. Komarovsky believes that the use of antibacterial agents in detecting cytomegalovirus infection is not justified, since such drugs are not able to help with this disease.

An antimicrobial drug is prescribed to a child when signs of complications appear, manifested by the development of inflammatory processes in the internal organs.

The antibiotic is selected individually, taking into account the child’s body weight and the presence of chronic pathologies. Treatment of the disease is carried out in the same way as therapy for herpesvirus. Children are prescribed the drugs ganciclovir and cytoven. The dosage is calculated taking into account the child’s weight (10 mg/kg); after 21 days it is reduced to 5 mg/kg. Therapy with an antiviral drug is carried out until signs of the disease disappear and laboratory parameters, which indicate the degree of infection activity, decrease. For the congenital form, ganciclovir is used for one and a half months at a dosage of 10 mg/kg. If signs of intolerance to the drug appear, another antiviral agent is selected for the child.

If an exacerbation occurs, an antipyretic medication (ibuprofen) is prescribed. During this period, the pediatrician recommends drinking plenty of fluids and multivitamin complexes. To normalize nasal breathing, naphthyzine and sanorin are prescribed. When swelling of the mucous membranes occurs, an antihistamine is prescribed.

The use of immunostimulating agents is of great importance in the treatment of CMV. The child is injected with a drug containing immunoglobulins against cytomegalovirus. Course - 10 injections.

After the symptoms of the disease subside, the child is recommended to undergo physiotherapy (massage, UHF).

ethnoscience

The basis of most recipes that help cope with the disease are herbal preparations. When using folk remedies, you need to remember that the child may develop allergic reactions. If a sign of intolerance to herbs appears in the baby’s body, treatment using unconventional methods should be abandoned.

For cytomegalovirus, you can use a collection consisting of the roots of licorice, kopeck, leuzea, alder fruit, string and chamomile flowers. The dry mixture is thoroughly mixed, take 2 tbsp. plants and pour ½ liter of boiling water. For infusion, it is better to use a thermos. The healing agent is given to the child 50 ml four times a day.

To treat CMV, you can use a collection of thyme, birch buds, string, wild rosemary, leuzea, yarrow, and burnet roots. 2 tbsp. dry plants are poured with 500 ml of boiling water. After 10 hours, the infusion is filtered and the child is given 50 ml three times a day.

Extracts of lemongrass, ginseng, and echinacea can be used as a means to strengthen the body's defenses. A collection of lungwort, violet, nettle and birch leaves, plantain, rose hips, and dill seeds helps speed up recovery. 4 tsp The mixture is poured into 1 liter of boiling water and left for 9 hours in the dark. The product is taken three times a day, 40 ml. Children are recommended to prepare fresh decoctions daily.

For babies under one year old, when preparing medicinal infusions, you need to use ½ tsp. dry herbs.

Before using traditional medicine to treat cytomegalovirus infection in children, you should consult a pediatrician.

In the first days, it is recommended to give a minimum amount of infusion. Provided normal tolerance, the dosage is increased. The course of treatment with infusions is at least one month. The use of folk recipes for the treatment of children is allowed with simultaneous drug therapy.

Complications and consequences

Cytomegalovirus poses the greatest danger to the fetus and children in the first years of life. The causative agent of the disease has the ability to penetrate the protective filters of the placenta. When an infection enters a developing embryo, the risk of developing serious defects is very high.

The baby's own immune system begins to work actively closer to the first year of life. When activated, the infection can lead to damage to the digestive tract and hemorrhage into their tissues.

With congenital CMV, children may develop:

• anemia;
• encephalitis;
• neuropathy;
• brain cancer;
• lymphocytosis;
• bacterial sepsis.

If another type of infection occurs, death may result if not treated in a timely manner.

To prevent the development of complications, it is important to constantly support the child’s immune system.

The main activities are:

1. Balanced diet. Providing proper nutrition with plenty of greens, vegetables, cereals, fiber, and natural dairy products helps strengthen the body's defenses.
2. Physical exercise. Moderate sports training is necessary to improve immunity. Pool activities, Pilates, and aerobics are useful for children.
3. Day rest. Preschool children should sleep after lunch for 1.5-2 hours. It is first necessary to ventilate and, if necessary, humidify the room.
4. Regular walks. Fresh air and movement help restore immunity. You need to walk with your child away from the highways.
5. Hygiene measures. It is important to teach a child to wash his hands before eating, after a walk, or after visiting kindergarten. It must be remembered that the pathogen can be transmitted by contact.

The disease caused by cytomegalovirus infection can lead to serious consequences. The most dangerous is the congenital form, which often leads to the development of defects and miscarriages. Treatment of the disease is based on stimulating the immune system, fighting the virus and preventing the occurrence of bacterial complications. Prevention is aimed at increasing the body's defenses. All drugs for the treatment and prevention of cytomegalovirus infection are prescribed by a doctor.