Cytomegalovirus: blood test, prevention, diagnosis, treatment

The most common method for detecting CMV (cytomegalovirus infection) is a blood test for cytomegalovirus. There are various pathogen detection techniques that can reliably determine the presence of the pathogen. Most tests are based on the detection of specific antibodies produced by the body in response to the pathogen. PCR diagnostics are also possible, which provides information about the presence of pathogen DNA in the blood, allows one to assess the activity of the infectious process and the degree of spread of the pathogen in the body.

Human cytomegalovirus infection is a viral anthroponotic disease that affects almost the entire body. It is characterized by a wide variability of forms and symptoms - from asymptomatic carriage to severe damage to the respiratory, excretory and other body systems.

Causative agents of infection, its sources

Cytomegalovirus (Cytomegalovirus hominis) belongs to the genus of DNA viruses, is distinguished by its large virion size (up to 300 nm), and is part of the herpesvirus family. Several strains of the pathogen have been registered:

The source of infection is the patient or the carrier. The pathogen is detected in biological fluids and secretions. Routes of entry of the virus:

Davis.
Kerr.
AD-169.
Towne 125.

Most strains are little studied, but it is reliably known that all of them can reproduce without destroying the host cell. The virus can survive for a long time at room temperature, but is sensitive to heat and the action of disinfectants.

Airborne.
Contact.
Food.
Parenteral and transplacental.

According to statistics, the infection rate is up to 95%, depending on the region and country.

How common is cytomeglovirus infection?

Infection with cytomegalovirus can occur in several ways:

Airborne
During a kiss
Contact and household
Sexually
During blood transfusion
In utero from mother to fetus
In childbirth from mother to baby
When breastfeeding through mother's milk to the baby

Airborne transmission, according to doctors, is quite rare. Therefore, ordinary communication with a patient or carrier does not pose a great danger. Most often, people become infected through household contact, sexual contact and through kissing.

Classification

There is no globally accepted classification system for cytomegalovirus infection (CMVI). In practice, the classification developed in 1980 is used. According to this system, CMVI is divided into:

Congenital, can be acute, chronic.
Acquired, can be acute, latent, generalized.

CMV infection is classified according to the duration of its course:

Spicy.
Protracted
Chronic
Recurrent.

Depending on the severity of the course, there are mild, moderate, and severe forms of the course.

Traditional recipes for cytomegalovirus infection.

Folk remedies prevent exacerbation of cytomegalovirus infection. They can be included in complex treatment, but in no case exclude antiviral drugs. Here are some useful recipes:

Multi-component infusion, including 7 herbs. It includes wild rosemary, birch buds, yarrow, leuzea, thyme, string and burnet. You should take the same amount of each ingredient. Then add 10 g of the herbal mixture from the total mass, pour in a liter of boiling water and leave in a thermos for 12 hours. Drink a quarter glass with meals.
A collection of leuzea, licorice, kopeck, alder, chamomile and string in equal parts is brewed and drunk in the same way as in the previous recipe.
Take 4 parts of licorice root and 1 part each of flax seeds, marshmallow root, coltsfoot and raspberry leaves, cinquefoil and elecampane. Pour a liter of boiling water and leave for 3 hours. Drink a quarter glass three times a day.
Very useful for viral infections, including CMV, garlic and onions. If you add one clove of garlic and a sixth of an onion to your dishes every day, the risk of infection and worsening the infection drops by 30%
To prevent airborne infection, tea tree oil can be sprayed in the room where the patient is located. It is best to use an alcohol solution for this purpose, which is sold in pharmacies. Pure oil can be added to the aroma lamp.

The mechanism of the onset and development of the disease

The virus enters the body through the mucous epithelium of various organs. The free presence of viral particles in the bloodstream quickly ends with the introduction of the pathogen into mononuclear-type phagocytes. The initial replication of cytomegalovirus occurs in them.

Infected cells enlarge, and large intranuclear inclusions, which are accumulations of viral bodies, can be found in them. An increase in the number of affected cells is manifested by the development of multiple nodular infiltrates or calcifications in the tissues. The pathogen reproduces especially actively in the salivary glands , where it is easiest to detect.

The pathogen can persist in cells for a long time; the only manifestation of infection is suppression of cellular immunity. In most, the disease proceeds latently and becomes an asymptomatic carrier.

Exacerbation of CMV infection occurs in patients with suppressed immunity. The most common reasons for weakening the body's defenses:

Taking immunosuppressants.
HIV infection.
Pregnancy.

As a result, the virus is activated, active reproduction of the pathogen begins in all organs and tissues, and the clinic of one of the forms of the disease develops. Severe CMV infections are in most cases associated with HIV infection.

Pathogenesis

Once infected, CMV enters the bloodstream and spreads throughout the body. Initially, humoral immunity responds to infection with the formation of immunoglobulin M - this reaction is maintained for two months. Approximately six months after infection, immunocompetent cells secrete specific immunoglobulin G, which remains in the host’s body throughout life. Lymphocytes (CD8 and CD4) are also responsible for suppressing the activity of the virus. In patients with reduced immunity, CMV immediately begins to show its virulence.

Most healthy people infected with cytomegalovirus after birth have no symptoms. In rare cases, a clinical picture resembling infectious mononucleosis develops: a mild form of hepatitis, fever and sore throat. These pathological signs quickly pass, after which the virus does not manifest itself in any way until reactivation.

Regardless of the form of the disease, CMV affects the body's tissues. The so-called cytomegaly develops, characterized by a significant increase in cells. Such morphological changes can be explained by the destruction of the cytoskeleton and the active synthesis of viral particles that become cellular inclusions. During a histological examination of the affected tissue, a specialist can detect fibroblasts that resemble an owl's eye in appearance.

Risk group for developing active infection:

newborns;
aged people;
patients with leukemia;
HIV-infected;
people with congenital immunodeficiency;
patients with cancer;
patients who require hemodialysis or immunosuppressants.

In HIV-infected patients, the manifestation of cytomegalovirus infection may indicate the development of acquired immunodeficiency syndrome (AIDS), since in this case the number of T-lymphocytes decreases.

Clinical picture

The duration of the incubation period remains unclear since the initial forms of CMV infection occur latently. Characteristic clinical symptoms develop as a result of exposure to factors that weaken the immune system.

Congenital CMV infection in children in early periods of life also occurs as an asymptomatic carriage. Then it manifests itself in the form of various severe complications, the most common:

Deafness.
Chorioretinitis.
Cytomegalovirus syndrome.

In particularly severe cases, congenital CMV infection leads to secondary pathologies and death in the first weeks of life. You can avoid these consequences by doing a blood test for cytomegalovirus before conceiving a child.

Acute congenital CMV

It is a consequence of primary infection of the mother during pregnancy. Develops in approximately 5% of children infected with CMV infection in utero. In other cases, it occurs hidden and does not lead to serious consequences. The mortality rate of acute congenital CMV infection is high, accounting for up to 30% of cases. Surviving children often suffer severe consequences, including:

Delay in physical and mental development.
Chronic jaundice.
Hydrocephalus.
Polycystic pancreas.

If a child is infected in the early stages of embryogenesis, the fetus is highly likely to die. Survivors have serious defects and developmental anomalies:

Microcephaly.
Lung hypoplasia.
Defects in the structure of the kidneys of the heart and aorta.
Esophageal atresia.
Chronic congenital CMV

Mortality during the development of this form of infection is low; it is characterized by the development of severe pathologies of the child’s organs and systems. These include: hydro- and microcephaly, lens opacity, deafness, microgyria (underdevelopment of the convolutions of the brain).

Acquired CMV infection

In the majority of infected people, it occurs without a pronounced clinical picture, in the form of a subclinical form or latent virus carriage. The transition to a clinically expressed disease is observed with various disturbances in the functioning of the immune system arising under the influence of various risk factors.

In this case, acute acquired CMV infection develops, the symptoms of which are similar to viral hepatitis or infectious mononucleosis. It can occur secretly and is detected accidentally during a screening blood test for cytomegalovirus.

Another common form of acquired CMV infection is mononucleosis-like syndrome. The clinical manifestations of this form are almost identical to another disease caused by the Epstein-Barr herpesvirus - infectious mononucleosis.

The incubation period can last up to 60 days. The active phase of the disease begins with flu-like symptoms: prolonged fever, chills, severe muscle and joint pain, severe fatigue. Patients often complain of a sore throat, enlarged regional lymph nodes, and skin rashes.

Rarely, symptoms of hepatitis such as jaundice may occur. Blood tests show an increase in liver enzymes (ALAT, AST). Pneumonia may develop, the probability of lung damage is 5-6%.

The duration of the disease can be up to 1-2 months, after which most patients experience a complete recovery. Some symptoms last longer, for example, enlarged lymph nodes can persist for up to six months.

Acquired cytomegalovirus infection in newborns

It develops as a result of infection of a newborn during the passage of the birth canal or in the initial stages of life - during breastfeeding, contact with carriers of the virus. Most children are asymptomatically converted to the carrier form.

Clinical symptoms appear in cases of severe prematurity or low birth weight. The infection occurs in the form of long-term pneumonia, often accompanied by bacterial damage to the respiratory system. The development of hepatitis, enlarged lymph nodes, and delays in mental and physical development are possible. During pregnancy, it is necessary to undergo a lot of tests that help identify the presence of not only CMV infection, but also toxoplasmosis.

Treatment of cytomegalovirus: medications used in therapy

To date, there is no single treatment method or “pill” with which the virus is completely eliminated from the body. Scientists have not yet invented a cure for cytomegalovirus that would permanently get rid of the disease. But today there are already antiviral drugs, the use of which helps relieve symptoms of the disease and improve well-being.

Since an important link in the activation and spread of this infection in the patient’s body is a decrease in immune defense, drugs containing interferons are used to maintain immunity at the required level. One of these drugs is the broad-spectrum complex antiviral immunomodulatory drug VIFERON for children and adults. It has a double effect - it helps block the virus and restore immunity. The original formula of the drug includes a combination of interferon alpha-2b and highly active antioxidants (vitamins C, E). The drug belongs to the group of cytokines and has a universal effect in the treatment of a wide range of viruses and other pathogens.

VIFERON Suppositories for cytomegalovirus

VIFERON in the form of suppositories (suppositories) for the treatment of cytomegalovirus in adults can be used during pregnancy (from the 14th week), as well as during breastfeeding. The drug is also approved for children, including newborns and premature babies. VIFERON helps reduce the frequency of relapses1 and is used as part of complex therapy to combat a number of diseases, including infectious and inflammatory diseases of the urogenital tract in adults (human papillomavirus, chlamydia, cytomegalovirus infection, ureaplasmosis, trichomoniasis, gardnerellosis, bacterial vaginosis, recurrent vaginal candidiasis , mycoplasmosis).

Generalized form of CMV infection

Develops in infected people with extremely weakened immune systems. It is characterized by serious damage to the liver, nervous system, gastrointestinal tract, and lungs. The severity of the pathology depends on the state of the immune system; especially severe manifestations are observed in those taking immunosuppressants and patients with AIDS.

The main clinical manifestations of generalized CMV infection:

Subacute onset. It is characterized by: severe loss of strength, fever, increased sweating at night, patients complain of pain in the joints and muscles.
Ulcers of the stomach, intestines and esophagus manifest themselves in the form of abdominal pain and dyspeptic symptoms. They can lead to internal bleeding and perforations in the walls of the gastrointestinal tract.
Hepatitis. There is jaundice, tenderness and enlargement of the liver.
Pneumonia. Chest pain, cough, and respiratory rate increase.
Encephalitis. Main manifestations: nystagmus (rhythmic twitching of the eyes), drowsiness, damage to one or more pairs of cranial nerves, disorientation. People who are HIV positive may develop AIDS dementia syndrome.
Retinitis. Leads to complete or partial blindness.
Multiple organ failure. The most common cause of death in a generalized infectious process. It manifests itself in the form of dysfunction of all organs and systems of the body affected by the virus.

1.What is cytomegalovirus and methods of infection?

Cytomegalovirus

is a herpes virus.
It occurs very often. By the age of 40, approximately 80% of people are infected with cytomagalovirus. But usually the virus lies dormant and does not cause any concern to most people. A healthy immune system easily suppresses the manifestation of cytomegalovirus.
However, cytomegalovirus can cause severe illness in people with HIV (human immunodeficiency virus). The virus becomes active when the immune system is weakened, which is why it is called an opportunistic infection. The most common illness that cytomegalovirus can cause is retinitis, an eye infection that can lead to blindness.

How can you become infected with cytomegalovirus?

Infection with cytomegalovirus from accidental touch of a carrier of the virus is unlikely. But you can become infected by touching your eyes, nose or mouth after contact with saliva, semen, vaginal secretions, blood, urine, or breast milk of an infected person. In addition, you can become infected with cytomegalovirus through sexual contact, blood transfusion and organ transplantation.

A baby can become infected with cytomegalovirus before birth. Children also receive the virus through breast milk. This usually occurs if a woman becomes infected with cytomegalovirus for the first time during pregnancy.

A must read! Help with treatment and hospitalization!

Diagnosis of infection

In a routine blood test, patients suffering from CMV infection observe:

Severe lymphocytosis.
Atypical mononuclear cells (up to 10% or more).
The total number of white blood cells rarely falls outside the normal range. In newborns, thrombocytopenia and a decrease in the number of red blood cells may be detected. In a biochemical blood test, an increase in the activity of liver enzymes is observed.

In samples of cerebrospinal fluid from patients with central nervous system damage, an increase in protein components, neutrophilic pleocytosis and a significant decrease in glucose levels are detected.

Treatment

It is based on conducting serological blood tests for cytomegalovirus - antibodies specific to this infection are detected. These include:
Immunoglobulin M. These are markers of an acute infectious process during primary infection or the development of an exacerbation. They go beyond normal limits only 1-2 months after the virus enters the body. Increased rates can persist for up to six months. A high IgM titer in pregnant women means that there is a risk of infection of the embryo.
Immunoglobulin G. An unimportant type of immunoglobulin. It rises quite late, during the period of attenuation of the infectious process. Serves to detect cytomegalovirus in the body.
PCR. Allows you to accurately identify the genetic material of the virus in blood, other biological fluids, and tissues. Its variety, quantitative PCR, makes it possible to monitor the activity of the development of the infectious process as it provides data on the magnitude of virion reproduction.
Direct microscopy. Based on direct observation of infected cells with a specific morphology. Materials obtained from biopsy, urine sediment, saliva, and blood are suitable for analysis. They are distinguished by their enormous size, large intranuclear inclusion, which is surrounded by a light rim, this is the so-called “owl's eye”. Microscopy is the simplest and most accessible method for detecting CMV infection.

When the test for cytomegalovirus IgG, IgM and DNA is positive: transcript

Testing for IgG, IgM antibodies to cytomegalovirus and its DNA in adults is the most reliable way to identify the infection and start treatment on time.

It is especially important to determine infection in pregnant women. If the test result for cytomegalovirus IgG is positive, the risk of intrauterine infection cannot be excluded. Its likelihood is higher if IgG antibodies to cytomegalovirus are detected together with IgM, and also if the IgG concentration exceeds the reference values, which range from 0 to 6 U/ml.

If the cytomegalovirus IgG test result is positive, contact with the virus is confirmed. If the test for cytomegalovirus IgG is positive together with IgM, then we can think about an acute period of infection. If the test for cytomegalovirus IgG is positive, and IgM is positive in a titer of 1:200 or more, the likelihood of a recent primary infection is very high.

A negative result for both antibodies allows one to exclude infection or suspect a seronegative version of it, and may also indicate severe immune suppression.

Prevention

Subclinical forms of CMV infection and latent carriage are extremely common, and therefore in most cases do not require specific treatment, even if specific antibodies are detected. Treatment of such forms of cytomegalovirus is aimed at strengthening the body's defenses with the help of immunomodulators and preventing risk factors that lead to exacerbation of the disease.

To treat clinically active forms of CMV infection, 3 drugs are used that are quite effective:

Ganciclovir. Administered by intravenous infusion twice a day. The course of treatment lasts 2-3 weeks. It is especially effective in combination with Citotect, a specific immunoglobulin, which is also administered intravenously.
Foscarnet. Used if treatment with ganciclovir was not effective enough. It is administered intravenously three times a day, by slow administration (infusion duration is at least 2 hours).
Cidofovir. Another drug of choice for CMV infection, which is used for resistance to ganciclovir. Administered intravenously, 1 time per week.

These drugs are contraindicated for use by pregnant women. In this case, pathogenetic therapy is prescribed. It includes a variety of interferon preparations (viferon, roferon) as well as inducers of the production of their own interferons - cycloferon, neovir.

The administration of interferons and other immunomodulatory drugs occurs under the control of the immunological status. If immunomodulators are ineffective, it is possible to prescribe a course of human immunoglobulin, which is administered by intramuscular injection in an amount of 3 to 5 with an interval of 2-3 days.

Various forms of CMV infection can masquerade as diseases with similar symptoms. Therefore, differential diagnosis is required with:

Sepsis.
Infectious mononucleosis.
Bacterial meningitis.

2. Symptoms of the disease

Most people who are infected with cytomegalovirus do not know it. The virus usually does not cause any symptoms. However, mild symptoms such as fatigue, swollen glands, and fever may occur due to cytomegalovirus.

These symptoms of cytomegalovirus can easily be confused with signs of other diseases.
If cytomegalovirus is left untreated, it can spread throughout the body and cause a range of different symptoms:

Eyes
– blurred vision, blind spots, moving black spots and even blindness;
Intestines:
diarrhea or abdominal pain;
Throat
: difficulty or painful swallowing;
Spine:
pain, weakness, numbness at the base of the spine, problems walking;
Brain
(in rare cases): headaches, problems concentrating;
Mild
(rare): difficulty breathing or dry cough.

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Specific diagnostics

The main direction in the prevention of CMV is compliance with the rules of personal hygiene, individual protection when in contact with patients with cytomegalovirus. It is especially important to follow preventive recommendations for people at risk:

Patients who have undergone transplantation.
Pregnant women.
HIV-infected.
Patients suffering from immunodeficiencies.

Means for specific prevention are under development. The only drug that allows prophylaxis in patients after transplantation is letermovir. It has not yet found widespread use; it is recommended for use only in the USA.

Examination for cytomegalovirus infection at Medart

The laboratory of the Medart clinic is equipped with modern high-precision equipment that allows you to perform any type of diagnosis of cytomegalovirus infection and other types of serological diagnosis of infectious diseases (diagnosis for HIV, syphilis, hepatitis, giardiasis, Helicobacter pylory, toxoplasmosis).

A blood test for cytomegalovirus is included in a set of tests for STIs (sexually transmitted infections). It is also possible to diagnose CMV infection based on individual indicators, for example, when planning pregnancy.

If necessary, test results can be obtained on the day the material is submitted. This is especially important in severe forms of CMV infection, when the speed of diagnosis and effective treatment is critical. Advantages of the clinic:

Ability to perform a full range of diagnostic procedures.
Optimal pricing policy.
Qualified specialists.

Patients of the Medart clinic receive a full range of medical services - from preliminary consultation and laboratory diagnosis of cytomegalovirus to the prescription of effective therapy and receiving recommendations for prevention and rehabilitation after the disease.