The child was diagnosed with cytomegalovirus. Despite the widespread distribution of this agent across the planet, ordinary people have virtually no knowledge about it. At best, someone once heard something, but they can’t remember what exactly. Dr. Evgeniy Komarovsky explained in an accessible manner that this is a virus, why it is dangerous, and what to do if this “terrible beast” is found in a child’s blood tests. We give you the opportunity to get information from a renowned doctor.

About the virus

Cytomegalovirus belongs to the family of herpes viruses type 5. It is quite interesting when looked at through a microscope - its shape resembles the round, prickly shell of a chestnut fruit, and in cross-section it looks like a gear.

When this virus infects humans, it causes cytomegalovirus infection. However, it is not so aggressive: after entering the body, it can exist there quite peacefully for a long time, without indicating its presence in any way. For this “tolerance” it is called an opportunistic virus, which reproduces and causes disease only under certain factors. The main one is weakened immunity. The most susceptible to infection are people who take a lot of medications for any reason, live in an environmentally polluted area, and often use household chemicals in large quantities.

Cytomegalovirus loves to settle in the salivary glands. From there it travels throughout the body.

By the way, the body gradually produces antibodies to it, and if enough of them have accumulated, even a weakened immune system can no longer cause a cytomegalovirus infection.

Transmission routes

If for adults the main route of infection is sexual, then for children it is through kissing, contact with the saliva of a person infected with the virus, which is why it is sometimes called the kiss virus.

Also, a mother with a large cytomegalovirus infection transmits it to the fetus during pregnancy, and this can cause quite serious defects in its development. A child can become infected during childbirth through contact with the mucous membranes of the birth canal. In addition, the baby can get an infection through mother's milk in the first days of his life.

Another route of transmission of cytomegalovirus is blood. If the baby has had replacement blood transfusions from a donor who has such a virus, as well as organ transplantation operations from an infected donor, then the child will definitely become a carrier of cytomegalovirus.

Danger

Evgeny Komarovsky cites the following fact: on the planet, 100% of elderly people have had contact with cytomegalovirus in one way or another. Among adolescents, about 15% of those who already have antibodies to this agent are found (that is, the disease has already been suffered). By the age of 35-40, antibodies to CMV are found in 50-70% of people. By retirement, the number of people who are immune to the virus is even higher. Thus, it is quite difficult to talk about any excessive danger of the type 5 virus, because many people who have recovered do not even know about such an infection - it went completely unnoticed for them.

The virus is dangerous only for pregnant women and their unborn children, but also on the condition that the expectant mother encountered CMV for the first time during pregnancy. If a woman has previously been ill and antibodies are found in her blood, then there is no harm to the child. But primary infection during pregnancy is dangerous for the baby - he may die or there is a high risk of congenital malformations.

If the baby is infected during pregnancy or immediately after childbirth, then doctors talk about congenital cytomegalovirus infection. This is a pretty serious diagnosis.

If a child caught the virus already in his own adult life, they speak of an acquired infection. It can be overcome without much difficulty or consequences.

Parents most often ask the question: what does it mean if antibodies to cytomegalovirus (IgG) are found in the baby’s blood test and CMV is set to +? There is nothing to worry about, says Evgeny Komarovsky. This does not mean that the child is sick, but indicates that his body has antibodies that will prevent the cytomegalovirus from doing its “dirty deed.” They developed independently, since the child had already had contact with this virus.

You should start to worry if your child’s blood test results show IgM+. This means that the virus is in the blood, but there are no antibodies yet.

Symptoms of infection

The presence of cytomegalovirus infection in a newborn is determined by doctors in the children's department of the maternity hospital. Immediately after the baby is born, they do an extensive blood test.

In the case of acquired infection, parents should be aware that the incubation period lasts from 3 weeks to 2 months, and the disease itself can last from 2 weeks to one and a half months.

The symptoms, even for a very attentive mother, will not cause the slightest doubt or suspicion - they are very reminiscent of a common viral infection:

• body temperature rises;
• respiratory symptoms appear (runny nose, cough, which quickly turns into bronchitis);
• signs of intoxication are noticeable, the child has no appetite, he complains of headache and muscle pain.

If everything is in order with the child’s immune system, then it will powerfully fight back the virus, its spread will be stopped, and the same IgG antibodies will appear in the baby’s blood. However, if the toddler’s own defense is not enough, the infection can “lurk” and acquire a sluggish, but deep-seated form, in which internal organs and the nervous system are affected. In the generalized form of cytomegalovirus infection, the liver, kidneys, adrenal glands, and spleen are affected.

Treatment

It is customary to treat cytomegalovirus infection by analogy with herpes infection, except that you choose drugs that affect not herpes in general, but cytomegalovirus in particular. There are two such drugs - Ganciclovir and Cytoven, both of which are quite expensive.

During the acute phase of the disease, the child is prescribed plenty of fluids and vitamins. For uncomplicated cytomegalovirus infection, antibiotics are not needed because antimicrobials do not help against viruses.

Antibacterial agents can be prescribed by a doctor in case of a complicated course of the disease, when there are inflammatory processes in the internal organs.

Prevention

The best prevention is strengthening the immune system, good nutrition, hardening, and playing sports. If a pregnant woman has not had cytomegaly and no antibodies to this virus are detected during registration, she will automatically be at risk.

This virus is young (it was discovered only in the middle of the 20th century), and therefore little studied. To date, the effectiveness of the experimental vaccine is approximately 50%, which means that half of vaccinated pregnant women will still get CMV.

Dr. Komarovsky’s video will help you learn more about cytomegalovirus infection.

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

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

Penetration of the virus into the child’s body

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

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

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

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

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

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

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

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

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

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

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

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

Cytomegalovirus infection in newborns

There are congenital and acquired forms of CMV infection.

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

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

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

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

Normal course of the disease in children

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

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

Sometimes encountered complications

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

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

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

Forms of CMV infection and their features

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

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

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

How to identify cytomegalovirus in a child: diagnostic methods

Diagnosis of CMV infection is possible using several methods:

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

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

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

A short video about how enzyme immunoassay is done

Features of infection control

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

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

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

A few words about prevention

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

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

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

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

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).

Traditional medicine

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.

As a means to strengthen the body's defenses, you can use extracts of lemongrass, ginseng, and echinacea. 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. 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.

A person faces viral diseases throughout his life, many of them manifest themselves clearly, while others are practically asymptomatic, but are dangerous due to complications. The latter includes cytomegalovirus, which is especially dangerous for children. Therefore, it is important for parents to know how to recognize this infection, because timely diagnosis and treatment can protect the baby from serious consequences.

What is cytomegalovirus

Cytomegalovirus was discovered in 1956 by Margaret Gladys Smith

Cytomegalovirus is a human virus type 5 of the herpes family Herpesviridae. Back at the end of the 18th century, a case was recorded of the discovery of pathologically large cells in the organs of a child’s corpse, presumably these were tissues affected by cytomegalovirus. A full-fledged mature particle of this virus is 180–300 nm; under magnifying glasses it looks much larger and more convex than the others. The disease and its causative agent were officially identified only in 1956.

About 95% of the world's population is infected with cytomegalovirus: 10–15% of them are children under 14 years of age.

The pathogen likes to sit in the salivary glands of a person, causing their inflammation, which is often the only symptom of infection. But in an infected person, cytomegalovirus (hereinafter referred to as CMV) is found in all biological fluids:

• sperm;
• blood;
• tears;
• secretion of the cervix and vagina;
• saliva;
• breast milk;
• nasopharyngeal mucus;
• feces;
• cerebrospinal fluid.

From this “geography” it is clear that the virus is distributed throughout the human body; in the event of a sharp decrease in immunity, it begins to harm any organ or entire system. Therefore, the virus sometimes disguises itself as a sore throat, flu or even deafness, and doctors carry out local treatment of the problem without identifying it. Only now is medicine beginning to suggest that CMV is the root of many health problems in both adults and children. Although, if you lead a correct lifestyle and avoid stress, the virus may not detect itself, the person simply becomes its carrier for life.

Of course, there are groups of people for whom CMV is extremely dangerous - these are children in the womb and children in early life. Cytomegalovirus belongs to a group of viruses that can penetrate the protective filter of the placenta and cause irreparable harm to the health of the embryo. And in newborn children, by the age of six months, maternal antibodies (maternal immunity reserves) decay, while their own immunity is finally formed only by the age of 1 year. Although protective cells still continue to come from mother's milk, they are not enough to fully repel the attack of the virus. Due to the immaturity of the immune system in both cases, the virus cells, once in the bloodstream, become the dominant invaders. CMV is activated and begins its destructive effect on the small organism.

Routes of infection

Antenatal (intrauterine) infection, although the most dangerous, is quite rare. If CMV enters the expectant mother’s body relatively long before conception, then her immune system has already accumulated a large number of antibodies, and the baby’s health is not in danger. If the mother first became infected with it during pregnancy, especially in the first half, then this threatens a number of pathologies for the embryo. As a rule, before the 3rd month of pregnancy, the woman’s body itself gets rid of the “sick” fetus - a miscarriage occurs. But if, nevertheless, the fetus is fixed, then extremely severe deviations may be observed in its development in the 1st–2nd trimester (during the laying of organs):

• underdevelopment of the brain convolutions and its small volume;
• disruption of the formation of the optic nerve;
• pathologies of the development of the heart and spinal column;
• problems with the lungs and other internal organs.

The mortality rate from early intrauterine infection is about 27–30%, and born children often suffer from serious illnesses - epilepsy, hydrocephalus, blindness, heart defects, and serious delays in mental and physical development.

Intrapartum infection (or infection during childbirth) is less dangerous for the child than intrauterine infection. This mainly occurs when passing through the birth canal or during a blood transfusion, through the secretion of the cervix and the first mother's milk. Since the incubation period (the period of time from infection to the appearance of the first signs) of CMV is about two months, its first symptoms appear after this time. The claim that if you perform a caesarean section, you can avoid infection of the fetus, it is a myth. The likelihood of infection during surgery is the same as during natural delivery.

Postnatal (postpartum) infection is caused by the baby’s immature immune system. The transmission routes are varied: from airborne droplets to contact. This could be infected mother's breast milk, kisses from a virus carrier, or any contact with infected blood during medical procedures. Infection is also especially developed in kindergartens, since airborne droplets are joined by contact - through toys, hands not washed in time after the toilet, towels, dishes, etc. When a child visits a preschool institution, the main task of parents is to ensure good immunity for the baby. Strong immunity will not allow you to avoid CMV infection completely - the probability of infection is very high, but good immune protection will not allow symptoms of the disease to develop.

It is worth noting that there is a medical theory that the virus that has entered the body still suppresses the immune system, and even if the child does not show signs of illness, he will belong to the frequently ill category of children.

Symptoms and signs of the disease

In newborns and infants

Ulcerative skin lesions are a characteristic sign of infection with cytomegalovirus

If a baby acquires an infection in the womb, it is usually immediately detected by a neonatologist at birth. Symptoms of congenital cytomegalovirus in a newborn:

• increased bilirubin levels;
• jaundice (hepatitis);
• pathologically enlarged liver, spleen, pancreas;
• elevated temperature;
• hemorrhages in organs;
• muscle weakness;
• skin rash, bleeding ulcers (pyoderma);
• general intoxication;
• light weight.

Clinical picture in infants:

• sudden mood swings (drowsiness alternates with excessive agitation);
• regurgitation, vomiting;
• cessation of weight gain or loss;
• muscle spasms, night cramps;
• enlarged lymph nodes and salivary glands;
• yellow tint to the skin and sclera of the eyes;
• runny nose;
• redness of the throat;
• elevated body temperature.

In approximately 31% of cases, a more detailed laboratory examination before vaccination reveals a latent form of CMV in children under 1 year of age. It is CMV that is the root cause of damage to the nervous system after vaccinations, and not a “bad” vaccine. And if detected, it is first necessary to carry out antiviral treatment, and then vaccinate the baby according to the schedule.

In preschool children

Since one of the routes of transmission of this infection is airborne droplets, there is a high probability of cross-infection in places where children gather in large numbers - kindergartens.

If a preschool child’s own immunity fails, cytomegalovirus begins to dominate the body. Most often, the onset of the disease manifests itself in the form of loss of mood and appetite, tearfulness, increased acetone levels and all signs of acute respiratory infections. However, if normal hypothermia goes away within 1.5–2 weeks, then CMV infection manifests itself in the form of an unusually prolonged cold with a long-lasting elevated temperature.

The insidiousness of CMV also lies in the fact that its chronic latent form may not appear immediately after the baby is born, but at 2–4 years of life or even later. Please note if the child:

• often suffers from acute respiratory infections (ARVI) and pneumonia;
• does not cope with bacterial infections - sinusitis, cystitis, skin diseases;
• reacts severely to vaccination;
• drowsy, cannot concentrate.

In school-age children and adolescents

If the infection did not occur in kindergarten, the child’s transition to school increases the chances of contracting a cytomegalovirus infection; as mentioned above, 10–15% of children under 14 years of age already have CMV antibodies in their blood.

Since cytomegalovirus is a sexually transmitted disease, high school students and teenagers are more likely to get sick through unprotected sexual contact and kissing.

Manifestations of cytomegalovirus infection in older children and adolescents are as follows:

• general deterioration of health;
• increase in temperature;
• signs of acute respiratory infections - lacrimation, runny nose, severe cough;
• swelling of the lymph glands (especially the cervical ones);
• sore throat (or severe redness of the throat);
• enlargement of internal organs (usually the spleen, liver);
• blistering rashes on the face and body (on the genitals);
• gynecological problems in girls (ovarian inflammation, etc.);
• painful urination in guys;
• darkening of urine color;
• aches in muscles and joints;
• cheesy coating on the tongue and tonsils;
• nausea, vomiting and diarrhea.

All these signs are also symptoms of another disease of type 4 human herpes virus - infectious mononucleosis, which is caused by the Epstein-Barr virus. Only laboratory tests will help you understand whether it is an acute respiratory infection, cytomegaly or mononucleosis.

Manifestations of cytomegalovirus in the photo

Diagnostics

Laboratory diagnostic methods can detect infection with cytomegalovirus even in the absence of obvious symptoms of the disease

To determine the presence of the virus, a number of laboratory tests must be performed. Medicine offers several modern types of tests for CMV:

• blood test for antibodies;
• general and biochemical blood test;
• PCR analysis of urine and blood

Testing blood serum for antibodies using the enzyme-linked immunosorbent method (ELISA) is a fairly sensitive and accurate diagnostic method that will allow you to determine whether a child is sick. And if the baby is sick, the results of the study will show the degree of activity of the virus. Immunoglobulins IgM and IgG (also called antibodies) are proteins that adhere to the cells of the virus and destroy it, a kind of “soldiers of health.”

So, based on the results of the analysis, the following can be determined:

• IgM and IgG antibodies were not detected - CMV never entered the body.
• IgM antibodies are not detected, IgG are present - the person has already been sick before (possibly asymptomatic), and antibodies have been developed. But it should be remembered that these antibodies do not guarantee that the disease will never appear again. Unfortunately, absolute immunity to cytomegalovirus is not developed, and everything depends only on the strength of one’s own immunity. If it decreases, a relapse may occur.
• IgM is present, IgG is absent - the person is in the acute stage of primary infection and needs urgent treatment.
• both immunoglobulins IgM and IgG are present - relapse of the disease.

It should be remembered that this analysis should only be deciphered by a specialist. It is possible that after 14 days a repeat analysis may be necessary (to monitor the dynamics of antibodies) or an alternative research method.

A complete blood count in the case of an active stage of the disease shows obvious lymphocytosis (an increase in the number of lymphocytes, the norm is 19–37%), as well as a decrease in the level of red blood cells. Biochemistry reveals an increase in mononuclear cells (> 10%), a decrease in hemoglobin levels and an increase in the number of neutrophils.

Analysis of urine and blood using the polymerase reaction is an ultrasensitive method and allows almost 100% probability to detect DNA cells of the causative virus. The method is quite accurate and helps to detect the presence of infection even when the child does not yet show any symptoms. The study takes only 3–4 hours.

Treatment

The statement that cytomegalovirus infection can be cured is erroneous. It is impossible to cure the disease completely; once the virus enters the body, it remains in it forever. It’s just that when immunity decreases, it can wake up, but the rest of the time it doesn’t manifest itself in any way in a healthy child. The golden rule in this situation is that it is better to do nothing than to conduct the wrong therapy. It is necessary not to “treat” the virus, but to raise the baby’s immunity by all means. All therapeutic actions should be carried out only if all symptoms clearly manifest themselves.

It is impossible to treat a child in utero, so all measures are aimed at stabilizing the mother’s condition - raising immunity and suppressing the virus, in order to avoid complications in the form of fetal malformations. Used:

• antiviral drugs - Acyclovir;
• immunostimulants - Cytotect, immunoglobulin injections, Splenin, Dibazol.

During pregnancy, it is impossible to take all necessary measures so as not to harm the embryo. For example, the drug Ganciclovir is contraindicated during this period due to its toxicity.

Newborns and children in the first year of life, depending on the stage and nature of the disease, may be prescribed courses of interferon drugs:

• Interferon;
• Cytoven;
• Leukinferon;
• Ganciclovir (with caution);
• Cytotect (Neocytotect);
• Neovir.

For older children, it makes sense to use immunostimulating agents, such as:

• Isoprinosine (from three years);
• Thymogen (from six months);
• Derinat;
• Immunoflazid (can be prescribed from the first days of life).

To alleviate the general condition, symptomatic treatment is also prescribed. Possible application:

• vasoconstrictor drops for free breathing through the nose, since breathing through the mouth negatively affects the functioning of the heart and brain (Naphthyzin for children, Sanorin);
• antihistamines (for example, Zodak) to reduce itching in case of skin rashes;
• antipyretic drugs based on ibuprofen or paracetamol (medicines containing aspirin are not used in pediatrics), plant-based rectal suppositories (Viburkol).
  

  Doctors do not recommend lowering the temperature in children below 38 degrees, so as not to disrupt the functioning of the immune system. An increase in temperature indicates that defense mechanisms are turned on and the active phase of the fight against the virus is underway.

After relief of symptoms and satisfactory final test results, the attending physician can prescribe physical therapy procedures for a small patient that will stimulate self-healing processes, for example, UHF, mud therapy, massage and other methods. This will increase the body’s defenses and prevent relapse of the disease.

There are also natural stimulants: yarrow, horsetail, eleutherococcus, ginseng, rose hips, thyme, hawthorn, lemongrass, echinacea. For example, a ready-made alcohol tincture of Echinacea or Eleutherococcus can be purchased at a pharmacy, and decoctions of other plants can be prepared at home. Herbal stimulants begin to be taken in small doses, as an allergic reaction may occur. Consultation with a pediatrician before starting herbal treatment is strictly required!

How to boost a child’s immunity - video by Dr. Komarovsky

Possible consequences and complications

In most cases, cytomegalovirus infection is asymptomatic, complications are rare but serious. The danger is that at any moment a dormant infection can “shoot” anywhere in the body. For example, its congenital form can occur without any special manifestations, and later develop into subsequent diseases, such as:

• anemia;
• encephalitis;
• hepatitis;
• neuropathy;
• brain cancer;
• pneumonia (may be accompanied by laryngitis, bronchitis);
• hemorrhagic syndrome (bleeding in organs and tissues);
• lymphocytosis (inflammation of the lymph nodes);
• damage to internal organs of various locations (nephritis, cystitis, pancreatitis, etc.);
• hepatitis;
• CMV encephalitis:
• bacterial sepsis.

Preventive measures

All preventive measures are directly related to maintaining immunity:

• it is necessary to provide the child with proper nutrition;
• engage in moderate physical activity (swimming, Pilates for children);
• ensure proper rest (daytime sleep in young children);
• take vitamin complexes;
• walk in the fresh air more often;
• observe the rules of hygiene.

To prevent intrauterine infection, pregnant women with no immunity to cytomegalovirus should:

• avoid places with large crowds of people (cinemas, markets);
• observe the rules of personal hygiene;
• do not use other people’s combs, toothbrushes, bed linen, dishes, lipstick, etc.;
• take specialized vitamins for pregnant women;
• avoid stress;
• ventilate the apartment 2 times a day.

Cytomegalovirus is one of the most common diseases on the planet, posing a threat to the child even in the womb. But knowledge of information about it, prevention and proper treatment will help avoid terrible consequences.

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

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

Routes of infection

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

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

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

Symptoms of infection

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

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

Features of the course in children of different age groups

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

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

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

Why is CMV dangerous for children?

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

Complications

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

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

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

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

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

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

Under normal conditions, the immune system of the expectant mother is capable of producing a sufficient amount of antibodies that will protect both her and the baby.

Diagnostic measures

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

General clinical examination methods

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

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

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

Serological examination methods

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

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

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

Treatment methods

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

Antiviral specific treatment

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

Syndromic treatment

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

Prevention methods

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

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