Ab CMV igg blood is positive. Cytomegalovirus (Inclusion disease, Viral salivary gland disease, Inclusion cytomegaly, Cytomegalovirus infection (CMV)). CMV Igg positive during pregnancy and newborns: what to do

The presence of positive results when taking tests that detect cytomegalovirus IgG means that the human body has antibodies that block the activity of the virus. This means that this person acts as a carrier of the infection. Having immunity to this type of infection allows you not to be afraid of possible complications that threaten the patient’s life.

In this matter, the quality of the body’s protective functions and the patient’s physical health play an important role. Increased attention should be paid if the result of such a test performed during pregnancy is negative. This fact can threaten the child’s health, since the developing body does not have antibodies against this infection.

Cytomegalovirus is one of the most common infections in the world

Cytomegalovirus IgG antibodies detected, what does this mean? To answer this question, we need to consider the research procedure itself. During this procedure, the genetic material submitted for research is studied in order to search for specific antibodies to cytomegalovirus. The term Ig in this case is short for the word “immunoglobulin”. This trace element is a protective protein that is synthesized by the immune system to fight various viruses.

The human body's immune system produces dozens of types of special antibodies, the purpose of which is to fight various types of infection. At the end of puberty, several dozen types of immunoglobulins are present in the internal environment of the body. The letter G in the combination in question denotes a class of antibodies that are responsible for fighting certain pathogens. Each of these classes is designated using letters of the Latin alphabet.

It should also be said that if a person has not previously encountered cytomegalovirus, then the internal environment does not contain the antibodies necessary to fight the disease. Based on this, we can say that a positive test result can act as evidence that this type of infection was previously present in the body. In addition, you should pay attention to the fact that immunoglobulins that are part of the same class, but have different purposes, have noticeable differences. Based on this, testing for cytomegalovirus IgG allows you to obtain the most accurate results.

How are analyzes deciphered?

A characteristic feature of cytomegalovirus is that after penetration into the internal environment of the human body, the infection remains in it forever. To date, medicine does not have an answer to the question of how to remove this strain of the virus completely from the body. This type of infection is in an inactive state and is stored in the secretions of the salivary glands, the composition of the blood, and also in the cells of some organs. It should be noted here that some people are not even aware of the presence of the infection and that they are carriers.

In considering the question of cytomegalovirus IgG positivity, what does that mean, we should take a slight detour and look at some of the differences between antibody classes. The IgM class includes antibodies that are large in size. They are produced by the immune system in order to reduce the activity of a viral infection within a short period of time. This class of antibodies does not have the ability to create immunological memory. This means that after a certain period of time, the reproduced antibodies disappear and the body's defenses are compromised.

Polymer chain reaction studies and a positive response to these studies indicate that the human body has antibodies to cytomegalovirus. If there are antibodies from group M in the blood, one can judge the amount of time that has passed since the moment of infection. The presence of these antibodies is a kind of evidence that this virus is at the peak of its activity and the body is actively fighting the infection. To obtain more detailed information, you should pay attention to additional data.

What to pay attention to

The polymer chain reaction test allows you to detect not only the presence of IgG to cytomegalovirus, but also a lot of other useful information. The attending physician is engaged in deciphering the data of the analyzes performed, however, knowledge of certain terms will allow you to independently familiarize yourself with the information provided. Below is a list of the most common terms:

1. “IgM positive, IgG negative”- means that the immune system actively produces antibodies, the action of which is aimed at fighting viruses. The presence of this result indicates that the infection has occurred recently, and the immune system has not yet had time to develop antibodies from the class "G".
2. “IgM negative, IgG positive”- the infection is in an inactive state. Infection with citalomegavirus took place a long time ago, and the immune system completely protects the body. If infected again, antibodies will prevent the infection from spreading.
3. "IgM negative, IgM negative"- this result indicates that there are no antibodies in the internal environment of the body that suppress the activity of cytomegalovirus, since this strain of infection is not yet known to the body.
4. "IgM positive, IgG positive"- this status indicates reactivation of the virus and exacerbation of the disease.

Sometimes in such results the following line appears: “Anti CMV IgG is increased.” This means that the amount of antibodies needed to fight the citalomegavirus exceeds the norm. In order to understand what value indicates the norm, let's consider such an indicator as the antibody avidity index:

1. 0 index– means the absence of infection in the body.
2. ≤50% - this result is evidence of primary infection.
3. 50-60% - uncertain data. Upon receipt of this result, it is necessary to undergo a second examination procedure after fifteen days.
4. ≥60% - indicates that the body has antibodies that protect a person from reactivation of the infection. However, this status may mean that the disease itself has acquired a chronic form.

If you have a strong immune system and the absence of chronic diseases that affect the quality of the immune system, a positive test result for the presence of antibodies should not cause concern for your own health. In most cases, the impact of the immune system on the virus leads to an asymptomatic course of the disease. In more severe cases, cytomegalovirus with strong immunity can manifest itself in the form of symptoms such as:

• sore throat;
• slight increase in temperature;
• decrease in performance.

Despite the fact that there may be no signs of infection activity, an infected person during the acute course of the disease should be in isolation. Experts recommend visiting public places as little as possible and completely avoiding close contact with pregnant women and young children. Being in this stage of the disease, a person is an active source of infection, therefore, in order to shorten the period of the acute stage of infection, therapy should be started without delay.

Positive results from tests performed during pregnancy

If the test result is positive for the presence of IgM antibodies, several conclusions can be drawn. This result may indicate both primary infection with cytomegalovirus and relapse of the disease. If this class of immunoglobulins is detected in the first trimester of pregnancy, treatment for the disease must be started immediately. Delay in taking the necessary measures may result in the infection having a teratogenic effect on the development of the fetus.

In a situation where the disease relapses during pregnancy, the risk of developing possible complications is significantly reduced. However, as in the previous case, lack of therapy can cause a congenital infectious disease in a newborn. It is also necessary to take into account the risk of infection of the child during passage through the birth canal.

The treatment strategy is determined by the doctor accompanying the process of gestation.

In order to determine the nature of the infection, you should pay attention to the level of immunoglobulins belonging to the class "G". The presence of these bodies is a confirmation of immunity to secondary infection. Symptoms characteristic of cytomegalovirus, in this situation, indicate a decrease in the quality of the protective functions of the body. If the result of the PCR procedure is negative, the doctor should regard the damage to the body as primary and take all necessary measures to reduce the risk of complications for the fetus.

To prescribe a treatment regimen, you will need to analyze the patient’s medical history in detail. Along with this, various factors are taken into account, including existing chronic diseases. The presence of immunoglobulins from class M is a kind of sign of the danger of the disease. However, it should be noted that a result such as negative Anti cmv ​​IgM in the absence of antibodies from class G may pose a certain threat. In this situation, a pregnant woman needs to take all measures that will protect her body from primary infection.

Positive result in infants

The presence of antibodies from class G in a newborn child is a kind of evidence that the infection occurred during the intrauterine development of the embryo. In order to obtain unambiguous evidence, you will need to take several samples at intervals of one month. The presence of a congenital infection can be determined by microscopic examination of the blood composition.

In most cases, the development of cytomegalovirus infection occurs latently. However, in such a situation there is a risk of developing serious complications that pose a threat to the baby’s health. Such complications include liver dysfunction, hepatitis and pneumonia. In addition, there is a risk of developing chorioretinitis, which in the future can cause complete loss of vision.

If there is suspicion of cytomegalovirus activity in a newborn, it is necessary to immediately begin treatment in order to avoid possible complications. In the first days after birth, an infected baby must be constantly cared for.

Treatment method

In most cases, antibodies to cytomegalovirus independently eliminate the exacerbation of the disease. However, in some situations, the use of potent medications is required to eliminate the infection. The use of such drugs unnecessarily is extremely undesirable, due to the high risk of developing side effects of the drugs. Among the various drugs used in the treatment of cytomegaloviruses, drugs such as Ganciclovir, Foscarnet, and Panavir should be highlighted. Despite possible side effects in the form of disruption of the kidneys and gastrointestinal tract, these drugs eliminate the activity of the infection in a short time.

In addition, drugs from the interferon group, as well as immunoglobulins obtained from donors who are immune to infection, are used as part of complex treatment. The use of the above medications is permitted only after prior consultation with a specialist. These potent medications have their own characteristics, which only specialists from the field of medicine and pharmacology know about.

In conclusion, it must be said that a positive result of the PCR procedure for the presence of cytomegalovirus infection indicates that the human body contains antibodies that prevent the development of the disease. In order for the immune system to continue to protect the body, it is necessary to pay increased attention to the state of your health.

In contact with

Cytomegalovirus is a herpetic type infection, diagnosed in a child or adult by a blood test for igg, igm antibodies. Carriers of this infection are 90% of the world's population. It manifests itself with a significant decrease in immunity and is dangerous for intrauterine development. What are the symptoms of cytomegaly, and when is drug treatment necessary?

What is cytomegalovirus infection

Cytomegalovirus infection is a herpetic type virus. It is called hepres type 6 or CMV. The disease caused by this virus is called cytomegaly. With it, infected cells lose the ability to divide and greatly increase in size. Inflammation develops around the infected cells.

The disease can be localized in any organ - the sinuses (rhinitis), bronchi (bronchitis), bladder (cystitis), vagina or urethra (vaginitis or urethritis). However, the CMV virus more often chooses the genitourinary system, although its presence is found in any fluid media of the body ( saliva, vaginal discharge, blood, sweat).

Conditions of infection and chronic carriage

Like other herpes infections, cytomegalovirus is a chronic virus. It enters the body once (usually in childhood) and is stored there for the rest of one’s life. The form of storage of the virus is called carriage, while the virus is in a latent, dormant form (stored in the ganglia of the spinal cord). Most people do not realize they carry CMV until their immune system fails. Then the dormant virus multiplies and forms visible symptoms.

Unusual situations lead to a significant decrease in immunity in healthy people: organ transplant operations (accompanied by taking medications that purposefully reduce immunity - this prevents rejection of a transplanted foreign organ), radiation and chemotherapy (in the treatment of oncology), long-term use of hormonal drugs (contraceptives), alcohol.

Interesting fact: the presence of cytomegalovirus infection is diagnosed in 92% of the examined people. Carriage is a chronic form of the virus.

How the virus is transmitted

Just 10 years ago, cytomegalovirus infections were considered sexually transmitted. CMV was called " kissing disease", believing that the disease is transmitted through kisses. Modern research has proven that cytomegalovirus is transmitted in various household situations- using shared utensils, towels, and shaking hands (if there are cracks, abrasions, or cuts on the skin of the hands).

The same medical studies have found that children are most often infected with cytomegalovirus. Their immunity is at the stage of formation, so viruses penetrate the child’s body, cause illness or form a carrier state.

Herpetic infections in children manifest visible symptoms only with low immunity ( for frequent illnesses, vitamin deficiency, serious immune problems). With normal immunity, exposure to the CMV virus is asymptomatic. The child becomes infected, but no symptoms (fever, inflammation, runny nose, rash) follow. The immune system copes with foreign invasion without raising the temperature (forms antibodies and remembers the program for their production).

Cytomegalovirus: manifestations and symptoms

External manifestations of CMV are difficult to distinguish from ordinary acute respiratory infections. The temperature rises, a runny nose appears, and the throat hurts. Lymph nodes may become enlarged. The complex of these symptoms is called mononucleosis syndrome. It accompanies many infectious diseases.

CMV can be distinguished from a respiratory infection by the protracted duration of the disease. If a common cold goes away in 5-7 days, then cytomegaly lasts longer - up to 1.5 months.

There are special signs of cytomegalovirus infection (they rarely accompany ordinary respiratory infections):

• Inflammation of the salivary glands(in them the CMV virus multiplies most actively).
• In adults - inflammation of the genital organs(for this reason, CMV has long been considered a sexually transmitted infection) - inflammation of the testicles and urethra in men, uterus or ovaries in women.

Interesting to know: Cytomegalovirus in men often occurs without visible symptoms if the virus is localized in the genitourinary system.

CMV has a long incubation period. When infected with herpes infection type 6 ( cytomegalovirus) signs of the disease appear 40-60 days after the virus enters.

Cytomegaly in infants

The danger of cytomegaly for children is determined by the state of their immunity and the presence of breastfeeding. Immediately after birth, the child is protected from various infections by the mother’s antibodies (they entered his blood during intrauterine development, and continue to do so during breastfeeding). Therefore, in the first six months or a year (the time of predominantly breastfeeding), the baby is protected by the mother’s antibodies. Cytomegalovirus in children under one year of age does not cause any symptoms due to the presence of maternal antibodies.

Infection of a child becomes possible by reducing the number of breastfeedings and incoming antibodies. The source of infection becomes the closest relatives (when kissing, bathing, general care - let us remind you that the majority of the adult population is infected with the virus). The reaction to primary infection can be strong or invisible (depending on the state of immunity). So by the second or third year of life, many children form their own antibodies to the disease.

Is cytomegalovirus dangerous in an infant?

With normal immunity - no. With a weak and insufficient immune response - yes. It can cause long-term extensive inflammation.

Dr. Komarovsky also speaks about the connection between CMV symptoms and immunity: “ Cytomegalovirus in children does not pose a threat if the immune system is normal. Exceptions from the general group are children with special diagnoses - AIDS, chemotherapy, tumors».

If the child was born weakened, if his immunity is impaired by taking antibiotics or other potent drugs, infection with cytomegalovirus causes an acute infectious disease - cytomegaly(symptoms of which are similar to long-term acute respiratory infections).

Cytomegaly in pregnant women

Pregnancy is accompanied by a decrease in maternal immunity. This is a normal reaction of the female body, which prevents the rejection of the embryo as a foreign organism. Row physical and chemical processes and hormonal changes are aimed at reducing the immune response and limiting the action of immune forces. Therefore, it is during pregnancy that dormant viruses are able to activate and cause relapses of infectious diseases. So if the cytomegalovirus did not manifest itself in any way before pregnancy, then during gestation it can raise the temperature and form inflammation.

Cytomegalovirus in a pregnant woman may be the result of a primary infection or a secondary relapse. The greatest danger to the developing fetus is the primary infection.(the body does not have time to give a decent response and the CMV virus penetrates through the placenta to the child).

Recurrences of infection during pregnancy are not dangerous in 98% of cases.

Cytomegaly: danger and consequences

Like any herpes infection, the CMV virus is dangerous for a pregnant woman (or rather, for a child in her womb) only during the initial infection. Primary infection forms various malformations, deformities or defects of the brain, pathologies of the central nervous system.

If infection with the CMV virus or another herpes-type pathogen occurred long before pregnancy (in childhood or adolescence), then this situation is not terrible for a child in the womb, and even useful. During the initial infection, the body produces a certain amount of antibodies that are stored in the blood. In addition, a program of protective reaction to this virus is developed. Therefore, the relapse of the virus is brought under control much faster. For a pregnant woman, the best option is to contract CMV during childhood and develop certain mechanisms to fight the infection.

The most dangerous situation for a child is the sterile body of a woman before conception. You can get infections anywhere (more than 90% of the world's population is carriers of herpes-type viruses). At the same time, infection during pregnancy causes a number of disturbances in the development of the fetus, and infection in childhood passes without serious consequences.

Cytomegaly and uterine development

The CMV virus poses the greatest danger to a child in the womb. How does cytomegalovirus affect the fetus?

Infection of the fetus is possible during initial exposure to the virus during pregnancy. If infection occurs before 12 weeks, a miscarriage occurs in 15% of cases.

If infection occurs after 12 weeks, a miscarriage does not occur, but the child develops symptoms of the disease (this happens in 75% of cases). 25% of children whose mothers become infected with the virus during pregnancy for the first time are born completely healthy.

Cytomegalovirus in a child: symptoms

What symptoms can be used to suspect congenital cytomegaly in a child:

• Retarded physical development.
• Severe jaundice.
• Enlarged internal organs.
• Foci of inflammation (congenital pneumonia, hepatitis).

The most dangerous manifestations of cytomegaly in newborns are damage to the nervous system, hydrocephalus, mental retardation, loss of vision and hearing.

Analyzes and decoding

The virus is found in any body fluid - blood, saliva, mucus, urine in children and adults. Therefore, an analysis to determine CMV infection can be taken from blood, saliva, semen, as well as in the form of a smear from the vagina and pharynx. In the samples taken, they look for cells affected by the virus (they are large in size, they are called “huge cells”).

Another diagnostic method examines the blood for the presence of antibodies to the virus. If there are specific immunoglobulins that are formed as a result of the fight against the virus, it means there has been an infection and there is a virus in the body. The type of immunoglobulins and their quantity can indicate whether this is a primary infection or a relapse of an infection that was previously ingested.

This blood test is called enzyme immunoassay (abbreviated as ELISA). In addition to this analysis, there is a PCR test for cytomegalovirus. It allows you to reliably determine the presence of infection. For PCR analysis, a vaginal smear or amniotic fluid sample is taken. If the result shows the presence of infection, the process is acute. If PCR does not detect the virus in mucus or other secretions, there is no infection (or relapse of infection) now.

Analysis for cytomegalovirus: Igg or igm?

The human body produces two groups of antibodies:

• primary (they are designated M or igm);
• secondary (they are called G or igg).

Primary antibodies to cytomegalovirus M are formed when CMV first enters the human body. The process of their formation is not related to the severity of symptoms. Infection may be asymptomatic, but igm antibodies will be present in the blood. In addition to the primary infection, type G antibodies are formed during relapses when the infection got out of control and the virus began to actively multiply. Secondary antibodies are produced to control the dormant virus stored in the ganglia of the spinal cord.

Another indicator of the stage of infection formation is avidity. It diagnoses the maturity of antibodies and the primacy of infection. Low maturity (low avidity - up to 30%) corresponds to primary infection. If the analysis for cytomegalovirus shows high avidity ( more than 60%), then this is a sign of chronic carriage, the latent stage of the disease. Average indicators ( from 30 to 60%) - correspond to a relapse of infection, activation of a previously dormant virus.

Note: deciphering a blood test for cytomegalovirus takes into account the number of antibodies and their type. These data make it possible to draw conclusions about the primary or secondary nature of the infection, as well as about the level of the body’s own immune response.

Blood for cytomegalovirus: interpretation of results

The main test to determine the presence of CMV infection is a blood antibody test (ELISA). Almost all women are tested for cytomegalovirus during pregnancy. The results of the analysis look like a list of types of antibodies and their quantities:

• Cytomegalovirus igg igm - “-” (negative)- this means that there has never been contact with the infection.
• "Igg+, igm-"- this result is obtained in most women when they are examined when planning pregnancy. Since CMV carriage is almost universal, the presence of group G antibodies indicates familiarity with the virus and its presence in the body in a dormant form. “Igg+, igm-” - normal indicators, which allow you not to worry about possible infection with a virus while carrying a baby.
• “Igg-, igm+” - presence of acute primary disease(igg is absent, which means that the body has encountered an infection for the first time).
• “Igg+, igm+” - presence of acute relapse(against the background of igm there are igg, which indicates an earlier acquaintance with the disease). Cytomegalovirus G and M are signs of relapse of the disease and the presence of decreased immunity.

The worst result for a pregnant woman is cytomegalovirus igm positive. During pregnancy, the presence of group M antibodies indicates an acute process, primary infection or relapse of infection with the manifestation of symptoms (inflammation, runny nose, fever, enlarged lymph nodes). It’s even worse if, against the background of igm+, the cytomenalovirus igg has a “-”. This means that this infection entered the body for the first time. This is the most depressing diagnosis for an expectant mother. Although the probability of complications in the fetus is only 75%.

Interpretation of ELISA analysis in children

Cytomegalovirus igg in children is usually detected in the first year of life, especially in breastfed babies. This does not mean that the child became infected with CMV from the mother. This means that, along with milk, maternal immune bodies enter his body, which protect against acute manifestations of infection. Cytomegalovirus igg in a breastfed child is the norm, not a pathology.

Is it necessary to treat cytomegalovirus?

Healthy immunity itself controls the amount of CMV and its activity. If there are no signs of illness, treatment for cytomegalovirus is not necessary. Therapeutic measures are necessary when an immune failure occurs and the virus becomes active.

Chronic cytomegalovirus during pregnancy is characterized by the presence of type G antibodies. This is a chronic carriage and is present in 96% of pregnant women. If cytomegalovirus igg is detected, treatment is not necessary. Treatment is necessary in the acute stage of the disease when visible symptoms appear. It is important to understand that a complete cure for the CMV virus is impossible. Therapeutic measures are aimed at limiting the activity of the virus, transferring it to a dormant form.

The titer of group G antibodies decreases over time. For example, cytomegalovirus igg 250 is detected if the infection occurred in the last few months. A low titer means that the primary infection occurred quite a long time ago.

Important: a high titer of the immunoglobulin g test for cytomegalovirus indicates a relatively recent infection with the disease.

From the point of view of the pharmaceutical industry, it is necessary to treat everyone who has antibodies to CMV (of any type and titer). After all, this is primarily profit. From the point of view of a woman and her child in the womb, treating a dormant infection in the presence of igg antibodies is not beneficial, and possibly harmful. Drugs to support immunity contain interferon, which is not recommended for use during pregnancy without special indications. Antiviral drugs are also toxic.

How to treat cytomegalovirus during pregnancy

Treatment of cytomegalovirus occurs in two directions:

• Means for general immunity boosting (immunostimulants, modulators) - drugs with interferon (Viferon, Genferon).
• Specific antiviral drugs (their action is directed specifically against herpes virus type 6 - CMV) - foscarnet, ganciclovir.
• Vitamins (injections of B vitamins) and vitamin-mineral complexes are also indicated.

How to treat cytomegalovirus in children? The same drugs are used (immune stimulants and antivirals), but in reduced dosages.

How to treat cytomegalovirus with folk remedies

To treat any viruses, traditional medicine uses natural antimicrobial agents:

• garlic, onion;
• propolis (alcohol and oil tinctures);
• silver water;
• hot spices
• herbal treatment - garlic greens, raspberry leaves, wormwood, echinacea and violet flowers, ginseng rhizomes, rhodiola.

Antibodies to cytomegalovirus IgG, CMV IgG quantitative- allows you to determine the presence of IgG antibodies to cytomegalovirus (CMV or CMV), which indicates a current or recent infection.

The duration of the incubation period ranges from 15 days to 3 months. With this infection, non-sterile immunity occurs (that is, complete elimination of the virus is not observed). Immunity to cytomegalovirus infection (CMVI) is unstable and slow. Reinfection with an exogenous virus or reactivation of a latent infection is possible. Due to long-term persistence in the body, the virus affects all parts of the patient’s immune system. When a person comes into contact with CMV, his immune system exhibits a protective response by producing IgM and IgG antibodies against CMV.

IgG antibodies to cytomegalovirus are specific immunoglobulins that are produced in the human body during the period of pronounced clinical manifestations of cytomegalovirus infection and indicate current or recent infection.

Cytomegalovirus infection is a widespread viral infection of the body, which belongs to the so-called opportunistic infections, which usually occur latently. Clinical manifestations are observed against the background of physiological immunodeficiency states (children in the first 3–5 years of life, pregnant women - more often in the 2nd and 3rd trimester), as well as in persons with congenital or acquired immunodeficiencies (HIV infection, use of immunosuppressants, oncohematological diseases, radiation, diabetes and so on.).

Cytomegalovirus- is part of the herpes virus family. Like other representatives of this group, it can persist in a person throughout his life. The risk group includes children 5–6 years old, adults 16–30 years old, as well as people who practice anal sex. Children are susceptible to airborne transmission from parents and other children with latent forms of infection. For adults, sexual transmission is more common. The virus is found in semen and other body fluids. Vertical transmission of infection (from mother to fetus) occurs transplacentally and during childbirth.

In healthy people with normal immunity, the primary infection occurs without complications (and is often asymptomatic). In rare cases, a picture of infectious mononucleosis develops (about 10% of all cases of infectious mononucleosis), clinically indistinguishable from mononucleosis caused by the Epstein-Barr virus. Replication of the virus occurs in the tissues of the reticuloendothelial system, epithelium of the urogenital tract, liver, mucous membrane of the respiratory tract and digestive tract. When immunity is reduced after organ transplantation, immunosuppressive therapy, HIV infection, as well as in newborns, CMV poses a serious threat, since the disease can affect any organ. The development of hepatitis, pneumonia, esophagitis, gastritis, colitis, retinitis, diffuse encephalopathy, fever, leukopenia is possible. The disease can be fatal.

Cytomegalovirus in immunodeficiency states
Cytomegalovirus is dangerous in cases of immunodeficiency and during pregnancy is potentially dangerous for the development of the fetus. Therefore, 5-6 months before a planned pregnancy, it is necessary to undergo a TORCH examination in order to assess the state of immunity in relation to these viruses, if necessary, carry out treatment, or provide prevention and control.

When a pregnant woman is initially infected with cytomegalovirus (in 35–50% of cases) or the infection is reactivated during pregnancy (in 8–10% of cases), an intrauterine infection develops. Confirming or excluding the fact of recent infection is especially important when examining pregnant women, since it is with primary infection during pregnancy that the risk of vertical transmission of infection and the development of fetal pathology is high.

If an intrauterine infection develops before 10 weeks, there is a risk of developmental defects and possible spontaneous termination of pregnancy. When infected at 11–28 weeks, intrauterine growth retardation and hypo- or dysplasia of internal organs occur. If infection occurs at a later date, the lesion may be generalized, affecting a specific organ (for example, fetal hepatitis) or appear after birth (hypertensive-hydrocephalic syndrome, hearing impairment, interstitial pneumonia, etc.). Manifestations of infection also depend on maternal immunity, virulence and localization of the virus.

To date, a vaccine against cytomegalovirus has not been developed. Drug therapy allows you to increase the period of remission and influence the recurrence of infection, but does not eliminate the virus from the body.

It is impossible to completely cure this disease: cytomegalovirus cannot be removed from the body. But if you promptly, at the slightest suspicion of infection with this virus, consult a doctor and carry out the necessary tests, then you can keep the infection in a “dormant” state for many years. This will ensure a normal pregnancy and the birth of a healthy child.

Laboratory diagnosis of cytomegalovirus infection is of particular importance in the following categories of subjects:

Women preparing for pregnancy

1. Latent course of the disease
2. Difficulty in differential diagnosis of primary infection and recurrent infection during examination during pregnancy
3. Severe consequences of intrauterine infection in newborns

Pregnant women

1. Severe consequences of intrauterine infection in newborns
2. Immunodeficiency states (generalized forms)

Consecutive repeated determination of the level of IgG antibodies in newborns makes it possible to distinguish congenital infection (constant level) from neonatal infection (increasing titers). If the titer of IgG antibodies does not increase during repeated (after two weeks) analysis, then there is no reason for alarm; if the titer of IgG increases, the issue of abortion should be considered.

CMV and TORCH
CMV infection is part of the group of TORCH infections (the name is formed by the initial letters in the Latin names - Toxoplasma, Rubella, Cytomegalovirus, Herpes), which are considered potentially dangerous for the development of a child. Ideally, a woman should consult a doctor and undergo laboratory testing for TORCH infection 2–3 months before a planned pregnancy, since in this case it will be possible to take appropriate therapeutic or preventive measures, and, if necessary, compare the results of studies before pregnancy in the future with the results of examinations during pregnancy.

Indications:

• preparation for pregnancy;
• signs of intrauterine infection, feto-placental insufficiency;
• state of immunosuppression due to HIV infection, neoplastic diseases, taking cytostatic drugs, etc.;
• clinical picture of infectious mononucleosis in the absence of infection caused by the Epstein-Barr virus;
• hepato-splenomegaly of unknown nature;
• fever of unknown etiology;
• increased levels of liver transaminases, gamma-GT, alkaline phosphatase in the absence of markers of viral hepatitis;
• atypical course of pneumonia in children;
• miscarriage (frozen pregnancy, recurrent miscarriages).

Interpretation of results
Units of measurement: UE*

A positive result will be accompanied by an additional comment indicating the sample positivity rate (SP*):

• CP >= 11.0 - positive;
• KP<= 9,0 - отрицательно;
• CP 9.0–11.0 - doubtful.

• CMV infection;
• intrauterine infection is possible, the likelihood of its occurrence is unknown.

• No CMV infection was detected;
• infection occurred within the previous 3–4 weeks;
• intrauterine infection is impossible (except in the presence of IgM).

*Positivity rate (PR) is the ratio of the optical density of the patient's sample to the threshold value. CP - positivity coefficient, is a universal indicator used in enzyme immunoassays. CP characterizes the degree of positivity of the test sample and can be useful to the doctor for the correct interpretation of the result obtained. Since the positivity rate does not correlate linearly with the concentration of antibodies in the sample, it is not recommended to use CP for dynamic monitoring of patients, including monitoring the effectiveness of treatment.

Pregnancy is a responsible event and you need to take it seriously - do not forget to examine your body and do the necessary tests. What does it mean if it turns out that cytomegalovirus IgG is positive during pregnancy, will this affect its course and the development of the fetus? This infection belongs to the herpetic group, therefore, like all diseases of this group, it is often asymptomatic or the symptoms are not pronounced.

But it is very important to establish, if the test is positive, whether there are antibodies to cytomegalovirus in the blood.

After all, any pathological process during pregnancy can lead to a negative effect on the child’s body. The main thing in treatment is to remember that you need to consult a doctor in everything, do not self-medicate!

In this article you will learn:

Positive IgG

If the result for cytomegalovirus IgG is positive, this does not mean that the patient’s health is threatened or that a pathological process is actively occurring in the body. In most cases, this means that a person has immunity to this infection, but he is a carrier of it. Once infected with cytomegalovirus, it remains in the body for life, even after treatment.

In the manifestation of this virus, the state of the immune system and the body’s resistance to diseases are of great importance. If the level of health and immunity remains at a high level, then the virus may not manifest itself throughout life. It is necessary to test for antibodies to CMV in a pregnant woman, since the child’s body is not yet capable of producing them against infections.

Primary infection

During pregnancy, cytomegalovirus can manifest itself both in the form of a primary infection and in case of relapse; this is primarily due to a decrease in the woman’s immunity, an increased load on her body and a decrease in resistance to antigens.

If the tests turn out to be positive IgM, this means that a primary cytomegalovirus infection has occurred. After all, this type of immunoglobulin is produced by the body a short time after infection in order to be the first to fight the infection. It is believed that primary infection is more dangerous because the body has not yet developed antibodies to the virus that can fight the infection and for this it needs a lot of energy and high immunity.

The infection is transmitted by airborne droplets, contact, sexual and intrauterine routes, that is, it is possible to infect a child even before his birth. Unfortunately, this can affect the development of the fetus. Therefore, if antibodies are detected in the first 12 weeks of pregnancy, it is necessary for the doctor to urgently prescribe treatment.

Relapse of the disease

The situation when the mother had CMV before pregnancy is most often more favorable. This is due to the fact that the resistance of immunity to a specific type of pathogen is high; antibodies are already circulating in the blood, which are ready to fight and protect the body of the mother and fetus.

The presence of a relapse is indicated by the appearance of IgG in the blood, which exists throughout life and is often produced after the infection has been cured.

Interpretation of a blood test for TORCH infection

TORCH infections are a group of toxoplasmosis (T), rubella (R), cytomegalovirus infection (C) and herpes (H), the letter “O” denoting other infections that may affect the child. These diseases are combined because of their danger to the fetus during pregnancy. The purpose of them is to calculate the presence of IgG in a woman. In their absence, the expectant mother must take precautions and be observed by a doctor throughout her pregnancy.

The result of the analysis for cytomegalovirus is obtained after performing an enzyme-linked immunosorbent assay (ELISA), which detects early (M) and late (G) antibodies. Ideally, a woman should have these tests done before she plans to become pregnant.

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Simplified explanation:

• The absence of both IgG and IgM means the absence of immunity, that is, there was no early contact with this pathogen. Prevention is important so that this meeting does not take place for the first time during pregnancy;
• No IgG, but the presence of IgM indicates the onset of the disease, recent infection;
• If the results are positive for both IgG and IgM, we can say that the disease is in the acute stage, with a high risk of infection of the fetus. Additional antibody avidity testing is required;
• The presence of only IgG indicates a previous acquaintance with the infection, which, as mentioned above, is good, immunity has been developed and the risk for the baby is minimal.

Only the attending physician should decipher the analysis and explain its meaning to the patient.

IgG class

A positive result for produced IgG to cytomegalovirus indicates the presence of immunity to this disease. This is the best option during pregnancy, the risk that the woman will get sick is small and the threats to the child are minimal.

They are synthesized by the body itself and protect the human body throughout life. They are produced later, after the acute process and even after treatment.

IgM class

Depending on whether there is any, the risk of fetal abnormalities is assessed. These immunoglobulins are quickly produced to fight infection. But they do not have memory and die after some time, thus not creating immune protection against the pathogen.

Avidity of immunomodulins

Avidity characterizes the strength of the connection between antigens and antibodies specific to them. The avidity of IgG increases over time, making it possible to estimate how long ago the infection with the pathogen occurred.

The results can be assessed as follows:

• A negative test means no infection in the absence of IgG and IgM;
• Less than 50% – infection occurred for the first time;
• 50-60% – you need to repeat the test after some time;
• 60% or more – there is immunity, the person is a carrier of the infection, or the process is chronic.

Congenital cytomegalovirus infection

This form of CMV occurs as a result of intrauterine infection of a child. In most cases, it does not manifest itself, and children remain carriers of the infection. In some children, symptoms appear in the first years, and even months, of life.

They may appear as:

• Anemia;
• Hepatosplenomegaly (enlarged spleen and liver);
• Nervous system disorders;
• Jaundice, that is, liver damage will be indicated by the yellow color of the child’s skin;
• The appearance of blue spots on the skin.

These characteristics may also indicate other diseases; for this reason, it is important to monitor the health of the newborn, examine and study the condition of its organs at some intervals. In addition, other damage to the body is possible, the development of developmental anomalies, heart defects, deafness, cerebral palsy or mental disorders.
The presence of cytomegalovirus infection in an infant is indicated by a fourfold increase in the IgG titer in tests done with an interval of one month. In infants, the presence of CMV can be seen with muscle weakness, if they suck milk poorly, have little weight, often experience vomiting, tremors, convulsions, decreased reflexes, and so on. In older children, at 2-5 years of age, one can notice a lag in mental and physical development, disturbances in sensory systems and speech.

How is CMV infection treated in children and adults?

A person who has had cytomegaly remains a carrier of its pathogen for the rest of his life, because even today medicine can only reduce the manifestation of symptoms.

Therapy is complex and depends on how affected the body is.

1. Vitamin, immunomodulatory and antiviral drugs are prescribed. Only the attending physician determines which medicine is needed;
2. In some cases, symptomatic treatment is carried out to improve the general condition of the patient;
3. It is important to eat rationally and lead a healthy lifestyle to strengthen the immune system;
4. The doctor should prescribe antiviral drugs only if the patient’s condition is serious;
5. Specific antimegalovirus immunoglobulin and interferon are prescribed;

It is important to establish the presence of the virus in the body in time in order to begin treatment as early as possible. By doing this, the patient will not only take care of her health, but will also protect her baby from future health problems and the development of organ defects.

Cytomegalovirus infection is the leading disease among congenital viral infections of newborns. This virus can be a silent lifelong cohabitant in the human body or become a potential killer under certain conditions. This is one of the most dangerous viruses for newborns, since CMV infection can cause mental retardation and death in children. Both primary infection with the virus during pregnancy and reactivation of an infection already living in the body are dangerous.

The concept of “immunity to CMV” does not exist!

Cytomegalovirus was discovered relatively recently - in 1956, and has not yet been sufficiently studied. It belongs to the group of herpes viruses. Carriers of the CMV virus aged 30 to 40 years are 50-90% of the population. IGG antibodies to cytomegalovirus are also detected in people who did not have any symptoms of herpetic diseases at the time of examination.

CMV is transmitted from person to person through contact with infected blood, saliva, urine, breast milk, and also through sexual intercourse. The virus is not very contagious and requires close contact to become infected through household contact. However, he feels great in the salivary glands, and any, even the most innocent kiss, a sip of water from a shared bottle or a cup of coffee “for two” can turn out to be fatal.

The latent (incubation) period lasts from 28 to 60 days. The likelihood of infection increases with, and this condition is natural during pregnancy. That's why Pregnant women are much more likely to become infected with this virus. And it is even higher in pregnant women undergoing immunosuppressive therapy (receiving metipred).

Primary infection occurs in 0.7-4% of all pregnant women. Return infection (reactivation) can occur in 13% of infected pregnant women. In some cases, secondary infection is observed, but with other strains of cytomegalovirus (a total of 3 strains have been registered).

The majority of people (95-98%) infected with CMV do not have clear symptoms during primary infection - usually the disease occurs under the guise of an acute respiratory viral infection. Symptoms include fever, muscle pain, and diarrhea. The main difference between cytomegalovirus infection and the common cold is that the course of cytomegaly is usually longer - up to 4-6 weeks.

With a generalized (general, severe) form of cytomegalovirus infection damage to internal organs is possible. This form of cytomegaly usually occurs against the background of a sharp decrease in immunity. In this case, a layered septic bacterial infection is possible, which is usually difficult to cure. The parotid and submandibular salivary glands may enlarge, inflammation of the joints occurs, and the skin becomes covered with a rash. About a third of patients will have cervical lymphadenitis (tender neck lymph nodes), pharyngitis (sore throat), and splenomegaly (enlarged spleen). Changes in the blood: decreased hemoglobin level, leukopenia (decrease in the level of white blood cells), increased number of lymphocytes (observed with any viral exacerbation), thrombocytopenia (decreased level of platelets), transaminases (a special substance in the blood) are moderately increased in more than 90% of patients.

Genital cytomegalovirus infection in women may be characterized by the development of inflammatory reactions in the form of vulvovaginitis, colpitis, inflammation of the inner layer of the uterus, salpingoophoritis. Patients are concerned about discharge from the genital tract and rectum of a whitish-bluish color. During examination, seals with a diameter of 1-2 mm are often found, located on the labia minora and majora. The mucous membrane is usually hyperemic (reddened) and edematous.

In men, a generalized form of cytomegalovirus infection affects the testicles, causes inflammation of the urethra and discomfort when urinating.

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After infection with CMV, an immune restructuring occurs in the human body, which adapts the body to new conditions. pursues the virus in the blood, driving it, as a rule, into the salivary glands and kidney tissue, where the virus becomes inactive and “sleeps” for many weeks and months.

How does a fetus become infected with cytomegalovirus?

At primary infection infection of the fetus with cytomegalovirus occurs in 30-40% of cases, and according to some data from European scientists, infection of the fetus can be observed in 75% of cases. At reactivation of current infection transmission of the virus to the fetus is observed in only 2% of cases, although there is evidence indicating a much higher likelihood of damage. Congenital CMV infection is present in 0.2-2% of all newborns.

There are three main mechanisms of transmission of the virus to the fetus:

1. the embryo may be infected with a virus from the sperm;
2. cytomegalovirus can penetrate from the endometrium or cervical canal through the fetal membranes and infect the amniotic fluid, and then the fetus;
3. cytomegalovirus can infect the fetus transplacentally.
4. Possible infection during childbirth.

(Different studies estimate the likelihood of one or another route of infection differently.)

The CMV infection virus is transmitted to the fetus through the placenta in any period of pregnancy in the same way (although the likelihood of reactivation of a latent infection in the maternal body is higher in the third trimester). If the mother is infected in the first trimester, then in 15% of these women the pregnancy ends in spontaneous miscarriage without viral infection of the embryo itself, that is, the infectious process is found only in the placenta. Therefore, there is an assumption that the placenta is infected first, which nevertheless continues to act as a barrier in the transmission of CMV to the fetus. The placenta also becomes a reservoir for CMV infection. It is believed that CMV multiplies in the placental tissue before it infects the fetus.

In the early stages of pregnancy, spontaneous miscarriage due to cytomegalovirus infection occurs 7 times more often than in the control group.

How is cytomegalovirus infection dangerous for the fetus? What are the consequences of infection with cytomegalovirus for the fetus?

Transmission of the virus to the fetus in some cases leads to

• birth of a low birth weight child,
• development of infection with intrauterine fetal death (miscarriage, spontaneous abortion, stillbirth - up to 15%),
• the birth of a child with congenital CMV infection, which is manifested by developmental defects (microcephaly, jaundice, enlarged liver, spleen, hepatitis, heart defects, inguinal hernia, congenital deformities),
• the birth of a child with congenital CMV infection, which does not appear immediately, but in 2-5 years of life (blindness, deafness, speech inhibition, mental retardation, psychomotor impairment).

It is possible to exclude transmission of cytomegalovirus to the fetus if both partners who are CMV carriers undergo a course of therapy before conceiving the child.

Cytomegalovirus infection can provoke the appearance of antiphospholipids in the mother’s body, which will attack the cells of her body (autoaggression). This is a very dangerous complication of CMV. Antiphospholipids can damage placental vessels and disrupt uteroplacental blood flow.

Diagnosis of CMV. Analysis for cytomegalovirus

Over the past thirty years, many laboratories around the world have developed many diagnostic methods for detecting CMV in the human body. Diagnostic testing in pregnant women is important at the slightest suspicion for the presence of cytomegalovirus infection, especially with an unfavorable outcome of a previous pregnancy and with clinical manifestations (symptoms) of CMV infection.

Clinical manifestations of cytomegalovirus infection

• If a person has both the herpes simplex virus and CMV in the body at the same time, they often become aggravated at the same time. Therefore, a “cold” on the lip is a reason to be examined for CMV.
• White-bluish discharge from the vagina.
• Any rash on the skin (even isolated ones). They differ from pimples in that they appear simultaneously and do not have a purulent head - just red dots.
• The appearance of small hard subcutaneous formations on the labia minora or majora.
• In some cases, the only sign of the disease is inflammation of the salivary glands, where the cytomegalovirus feels most comfortable.

If you have at least one of these symptoms during pregnancy, you need to urgently start testing for cytomegalovirus!

Toxicosis in the first half of pregnancy and spotting in the second can be associated with cytomegalovirus.

Test for antibodies to cytomegalovirus (ELISA - enzyme-linked immunosorbent assay)

The test for antibodies to CMV includes the determination of two specific immunoglobulins: IgM and IgG. For IgM they write “positive” or “negative” (qualitative characteristic), while for IgG the titer is determined (quantitative characteristic).

IgM antibodies appear in the blood during primary infection (always, but their appearance may be delayed for up to 4 weeks) and upon activation of an existing infection (in 10% of cases). If the CMV test says “IgM positive,” this means the infection is active. You cannot become pregnant against the background of active CMV!!! In this case, you should determine the level of IgM antibodies over time (quantitative method) to find out whether your IgM titers are rising or falling, and, accordingly, at what stage the infection is at. A rapid drop in IgM titers indicates a recent infection/exacerbation; a slow drop indicates that the active phase of the infection has passed. If IgM is not found in the blood serum of an infected person, then this indicates that the infection occurred at least 15 months before the time of diagnosis, but does not completely exclude the current reactivation of the virus in the body, that is, the absence of IgM in the blood test does not give reason to believe that that you can start conceiving! More research is required (see below). Question: why then take this test at all? Answer: it is still able to detect the active form of the virus and is inexpensive. In some situations, as a result of the very high sensitivity of the tests, false positive results are possible when determining IgM.

If a person has never encountered CMV, the IgG titer will be lower than the reference value indicated on the analysis form. This means there is a high risk of CMV infection during pregnancy. Women who do not have an IgG titer to CMV are at risk!

After primary infection with CMV, IgG antibodies remain in the blood for life. But this - not immune to cytomegalovirus! The presence of IgG allows for the possibility of reactivation of the infection against the background of weakened immunity by pregnancy. After infection/reactivation, IgG titers increase (activation of CMV is indicated by an increase in titer of 4 or more times relative to the baseline level characteristic of a given patient), then fall VERY SLOWLY.

The level of latent IgG antibodies depends both on the state of the virus at the moment and on the state of the person’s immunity, therefore a single analysis that shows the presence of Ig G antibodies in the body, even at values ​​several times higher than the reference value, does not clearly indicate an exacerbation of CMV.

What do IgM and IgG antibodies show against cytomegalovirus?

Primary infection or reactivation? If IgM is positive, the avidity of IgG antibodies should be determined. Avidity (lat. - avidity)- characteristic of the strength of the connection of specific antibodies with the corresponding antigens. During the body's immune response, IgG antibodies initially have low avidity, that is, they bind the antigen quite weakly. Then the development of the immune process gradually (this can be weeks or months) moves towards the synthesis by lymphocytes of high-avidity IgG antibodies, which bind more firmly to the corresponding antigens. Low-avidity IgG antibodies (avidity index (AI) up to 35%), on average, are detected within 3-5 months from the onset of infection (this may depend to some extent on the determination method), but are sometimes produced over a longer period. In itself, the detection of low-avidity IgG antibodies is not an unconditional confirmation of the fact of fresh infection, but serves as additional confirmatory evidence among other serological tests. The high avidity of specific IgG antibodies (avidity index greater than 42%) allows us to exclude recent primary infection.

However, a blood test for antibodies, especially a single one, cannot provide sufficient information about the course of cytomegalovirus infection in the body. If the result of an antibody test is positive, one of the other methods is usually used, both to confirm the presence of antibodies and to determine the presence of the active virus itself.

Polymerase chain reaction (PCR) method for diagnosing cytomegalovirus

This method of diagnosing cytomegalovirus is based on identifying the DNA of the infectious agent, since cytomegalovirus is a DNA-containing virus. The material for research may be discharge from the urethra, cervix, vagina, urine, saliva, cerebrospinal fluid. The time from taking material for research to obtaining results is usually 1-2 days, and this is the main advantage of the PCR method over the method of cultural diagnostics (seeding).

The PCR method, due to its high sensitivity, detects even a segment of CMV DNA and is considered very progressive. Its most important advantage is the ability to diagnose early stages of the process, latent and persistent infection, but it has a low predictive value due precisely to the fact that PCR detects viral DNA even in a latent state. In other words, this method does not distinguish between an active virus and a dormant one.

Qualitative and quantitative determination of CMV DNA in almost any fluid of the human body has an accuracy of up to 90-95% - if the virus is currently present in this tissue. A feature of CMV is its optional presence in all biological fluids at once.

Detection of CMV by PCR in human biological tissues does not make it possible to determine whether the infection is a primary infection or a reactivation of a current infection.

Isolation of cell culture (seeding) for the diagnosis of CMV

This is a diagnostic method in which the test material, taken from blood, saliva, semen, discharge from the cervix and vagina, amniotic fluid, is placed in a special nutrient medium favorable for the growth of microorganisms. The disadvantage of this method is that obtaining results requires a lot of time: a week or more.

A positive test (“the virus has been detected”) has 100% accuracy; a negative test may be false.

Cytology for the diagnosis of cytomegalovirus

Cytological examination reveals typical giant cells with intranuclear inclusions, but is not a reliable method for diagnosing CMV infection.

Probability of fetal infection and antibody levels

The likelihood of fetal infection is directly proportional to the concentration of the virus in the blood. It does not matter whether it is a primary infection or reactivation, it is the concentration of the virus that is important. The concentration of the virus is determined by the level of protective antibodies: the more antibodies, the lower the concentration of the virus. People who are exposed to CMV for the first time do not have antibodies, and therefore the concentration of the virus is high, which means that infection of the fetus is most likely. Carriers of CMV have antibodies, and the concentration of the virus in the blood is lower. An exception is for pregnant women receiving immunosuppressive therapy (usually metipred). Metypred suppresses the production of all types of antibodies in the body, which means that protection against CMV is weaker than it would be in the absence of Metypred, and the likelihood of transmitting the virus to the fetus increases.

There is another aspect related to the degree of damage that the virus causes to the fetus. IgG antibodies penetrate the placenta and in the blood of the fetus are able to fight the cytomegaly virus. The level of antibodies in the fetus's body is determined by the level of antibodies in the mother's body. If this level is high enough, the harm caused by CMV may be reduced to zero: a child infected with CMV in utero may not show signs of CMV infection either immediately or later.

The most severe lesions occur in children whose mothers were primarily infected with CMV. In second place are those whose mothers received immunosuppressive therapy. The third group includes cases of CMV reactivation during pregnancy that were not detected and treated. The latter includes cases of reactivation in pregnant women not receiving immunosuppressive therapy, in whom reactivations were detected and who received treatment in the form of intravenous infusion of immunoglobulins.

Management of pregnancy, childbirth and the postpartum period in women with CMV infection. Necessary tests for CMV in pregnant women

In conditions of risk of exacerbation of CMV, it is necessary to carry out a quick and, most importantly, reliable diagnosis in order to start using the necessary drugs on time and prevent the virus from spreading in the body. The method for determining antibodies is not suitable, since antibodies are formed with a long delay. The PCR method gives an answer almost instantly, but cannot distinguish a live virus from a dead one. The only way out is sowing, although it takes a long time.

In this case, it is worth doing blood cultures at least twice - at the beginning and at the end of the first trimester, since infection of the fetus during this period is most dangerous.

The length of pregnancy has a significant influence on the incidence of infection in the mother. In the early stages of pregnancy, the production of cytomegalovirus is suppressed, but this suppression decreases as pregnancy progresses, and the likelihood of cytomegalovirus release as a consequence of reactivation of the infection increases. Therefore, it is a good idea to do a blood culture in both the second and third trimester, since intrauterine infection is possible at any stage.

Activation of CMV in the body of a pregnant woman does not mean intrauterine infection of the fetus. Carefully selected powerful therapy and strict adherence to the doctor’s recommendations can significantly reduce the risk of transmission of infection to the child, which directly depends on the activity of the virus in the mother’s body. I’ll say right away that the only cure for the virus during pregnancy is immunoglobulin.

Against the background of cytomegaly, the weight of the fetus often exceeds the gestational age, and partial accretion of the child’s place, premature abruption of a normally located placenta, blood loss during childbirth, reaching 1% of the woman’s body weight, and clinical manifestations of latent postpartum endometritis with the development of menstrual irregularities in the future are also observed.

Infection of a child can occur during childbirth when he ingests cervical mucus and vaginal discharge from the mother. This virus is also found in breast milk, so more than half of breastfed children become infected with CMV infection in the first year of life. Intranatal or early postnatal transmission of cytomegalovirus occurs 10 times more often than transplacental transmission.

Women who actively shed the virus during pregnancy can give birth on their own, since a cesarean section does not provide any benefit in protecting the baby from infection in this case.

Obstetricians often face the question: should a woman infected with cytomegalovirus continue pregnancy or should she consider it contraindicated? This issue must be resolved on the basis of dynamic monitoring using ultrasound monitoring of fetal development (malformations), prenatal study of anti-cytomegalovirus IgM antibodies in the fetus when collecting amniotic fluid by amniocentesis.

After birth, it is important to confirm the diagnosis of congenital CMV infection within the first two weeks, and to carry out a differential diagnosis with primary infection during childbirth during passage through the birth canal or infection through milk in the first days of breastfeeding.

Diagnosis of CMV infection in the fetus

Determination of IgM in fetal blood is not a reliable diagnostic method, since the appearance of these antibodies can be greatly delayed. However, the detection of IgM in umbilical cord blood is unambiguous evidence of infection of the fetus, since these antibodies, due to their significant molecular weight, do not penetrate the placental barrier.

Currently, detection of a virus culture in amniotic fluid (culture) and polymerase chain reaction (PCR) make it possible to make a correct diagnosis in 80-100% of cases. The level of all virological parameters (viremia, antigenemia, DNAemia, etc.) in the blood of fetuses with developmental abnormalities is higher than in fetuses in which no abnormalities were found. Also, the level of specific IgM immunoglobulins in normally developing fetuses is much lower than the level of these antibodies in children with developmental disabilities. These data suggest that congenital CMV infection in infected fetuses with normal biochemical, hematological and ultrasound features, as well as low levels of the viral genome and antibodies to it, has a more favorable outcome.
Determination of viral DNA in amniotic fluid can be a good prognostic factor: its level is lower if no developmental abnormalities are found in the fetus.
Negative test results are not a reliable sign of the absence of infection in the fetus.
The risk of transmission of the virus from mother to child during diagnostic procedures when the mother has active virus is small.

Treatment of cytomegalovirus

CMV infection in a latent state generally does not require treatment.

In certain cases, antiviral drugs may be prescribed. The effect of these drugs on the body of a pregnant woman and the fetus has not been fully studied. The use of antiviral drugs is also limited in pediatrics due to the high toxicity of the drugs.

Treatment with immunomodulators usually lasts for several weeks; they are prescribed only by a doctor.

Specific anticytomegalovirus immunoglobulin is administered intravenously (dropper). It contains 60% CMV-specific antibodies. Intramuscular administration of immunoglobulin is allowed, but this significantly reduces its effectiveness. It should be noted that the use of immunoglobulin only reduces the likelihood of infection of the fetus or reduces the negative consequences of this infection, however, even such an inferior result gives a gain in the health of children, so a specific immunoglobulin should definitely be used, especially considering the complete harmlessness of the drug.

Nonspecific immunoglobulins for intravenous administration are prescribed for the prevention of CMV infection in immunocompromised individuals. However, their effectiveness is much lower than that of specific immunoglobulins. However, they can also help in the fight against cytomegalovirus infection.

The cytomegalovirus is almost insensitive to the action of , which is an important factor determining the significant frequency of latent cytomegalovirus infection. At the same time, cytomegalovirus interferes with the production of interferon in conditions of mixed infection, one of the components of which is a virus that has interferonogenic activity in monoinfection. Thus, it is known that in patients with cytomegaly, influenza occurs in a more severe form.

Leukocyte interferon introduced into tissue culture protects cells from extracellular cytomegalovirus, but does not have a protective effect against intracellular one.

So, the drug of choice during pregnancy is immunoglobulin. The level of damage to the fetus directly depends on the level of antibodies in the mother’s blood.