Infectionists claim that more than 95% of the adult population of the planet are carriers of various herpes viruses, which include CMV. Symptoms of cytomegalovirus are in many ways similar to ARVI, and in most cases the disease is generally asymptomatic. That is why, despite this prevalence, the diagnosis of CMV infection in medical practice is quite rare.
General characteristics of the disease
DNA-containing cytomegalovirus is type 5 herpes. In the normal state of the immune system, it successfully inhibits the development of CMV. The first information about the disease dates back to the end of the 19th century, but the virus was officially discovered only in the 60s of the 20th century. During this time, scientists have not been able to fully investigate the nature of the infection and its effect on the body. Cytomegalovirus disease is included in the subclass “Other viral diseases” and has the ICD-10 code – B25. Congenital CMVI (P35.1) and CMV mononucleosis (B27.1) are considered separately.
The pathogen remains in the body until the end of a person’s life, even after a successful course of treatment for an acute form of infection.
Its activation can occur at any time, as soon as the immunity is reduced. The acquired cytomegalovirus, as a rule, does not pose any danger to an initially healthy child or adult, because the immune system can easily cope with it. The virus is dangerous primarily for people with immunodeficiency, pregnant women and newborns. CMV can be transmitted to the fetus in utero, causing severe malformations. Therefore, women who have had the disease need special monitoring during pregnancy and tests to assess the antibody to the virus.
Causes and ways of infection
The source of CMV can be a sick person and a healthy carrier. The spread of the disease occurs regardless of age and gender.
The virus is found in all biological secretions and environments, and these are:
- urine, feces,
- breast milk,
- seminal fluid
- vaginal discharge.
CMV infection is most often possible through direct close contact with a carrier, including the virus is transmitted sexually through unprotected sex. Much less often, cytomegalovirus infection is spread by airborne droplets. The virus can enter the body of a healthy person during normal conversation only if the interlocutor sneezes or coughs. There is a high probability of infection of a newborn baby during the passage through the birth canal, as well as during breastfeeding. The microorganism is rather unstable and quickly dies in the external environment. It is susceptible to boiling, freezing, and drying.
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Development of the disease
The incubation period for CMVI can last from 20 days to 2 months. Immediately after that, depending on the state of the body and its defenses, either an acute phase occurs, or a slight malaise, or the vital activity of the virus remains unnoticed. CMV enters the human bloodstream through the mucous membranes. There it is introduced into leukocytes and phagocytes. Infected cells begin to grow and become unnaturally large. In their nuclei, you can see atypical inclusions that are nothing more than a cluster of CMV. Further, the virus is able to penetrate the lymphatic system.
An infection that develops intensively may be accompanied by:
- lymphocytic infiltration – the appearance of herpetic papules and plaques on the patient’s skin,
- infiltrates in soft tissues – nodular seals against the background of an infectious disease,
- calcifications – deposits of calcium salts at the site of inflammation.
According to statistics, the causative agent Cytomegalovirus Hominis occupies a leading position for the causes of inflammatory processes in the brain. Along with the Epstein-Barr virus (EBV), CMV can cause mononucleosis. In this case, the patient has an increase in the cervical lymph nodes, spleen and liver. Widespread inflammation begins in the pharynx. The person is very feverish, and in especially severe cases, liver rupture is possible.
Forms of the disease
CMV manifests itself or does not manifest itself depending on the general state of the body and immunity. This explains the existence of several forms of cytomegalovirus. The most common asymptomatic (latent) course of infection. A person can be infected, but never know about it. In the clinical form of the disease, CMVI most often manifests itself in the form of ARVI, mononucleosis, or fever of unknown origin. By the nature of the infection, the congenital and acquired forms are distinguished. Congenital infections have serious consequences. With a weakening of the body’s immune forces, an acute form of the disease can occur, which is sometimes accompanied by a number of complications.
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This form of the course of the disease negatively affects the central nervous system, gastrointestinal tract, liver, kidneys, lungs and genitourinary system. In the initial stages, acute CMV infection manifests itself in the form of an increase in body temperature to 38⁰, chills and muscle aches. Further, the symptoms increase, and a sharp pain in the throat joins them. In some cases, the adenoids grow significantly. The patient sweats a lot, his breathing and heart rate increase. At this stage, the disease can be mistaken for influenza or SARS.
The pathogenesis depends entirely on the nature of the spread of the virus. The patient may develop:
- Interstitial pneumonia with unproductive cough and shortness of breath.
- Persistent hepatitis and cholecystitis with liver damage. Against this background, the amount of bilirubin and cholesterol in the blood increases. The patient feels aching pain in the iliac region.
- Loose stools, flatulence and frequent vomiting with damage to the gastrointestinal tract.
- Damage to the organs of the genitourinary system. Because of this, a large amount of epithelium can be observed in the urine. In women, against the background of infection, in some cases, cystitis develops. Possibly infertility or other serious reproductive harm. If the carrier is a man, he may develop viral prostatitis.
- Rash on the skin. Sores appear all over the body, but the lips and mouth are most commonly affected.
In HIV-infected people, cytomegalovirus can lead to the death of retinal cells. Blindness progresses to complete loss of vision. This category of people is also susceptible to damage to the nervous system and the brain, in particular. In the presence of STIs (sexually transmitted infections), acute CMV develops rapidly. Surgical interventions, including organ and spinal cord transplantation, are catalysts for the development of clinical symptoms of acute infection. The reason for the exacerbation is the intake of immunosuppressants during the rehabilitation of the patient. Chemotherapy has the same effect in the treatment of cancer. The fact that a person is constantly exposed to stress can also negatively affect the course of the disease and exacerbate it.
If, after the end of the acute phase, the disease becomes chronic, then the patient’s well-being depends entirely on his general physical health. With strong immunity, the symptoms are similar to a lingering cold.
In an adult, this is expressed in:
- rapid fatigue and decreased performance,
- lack of appetite
- headaches and migraines,
- aching muscles and joints,
- enlargement and thickening of lymph nodes, often cervical or inguinal,
- long-term rhinitis that cannot be treated with standard medications,
- chronic fatigue syndrome,
- subfebrile temperature.
If such symptoms last longer than a month, and the state of health does not improve at all, then the patient should consult a doctor for advice. To obtain a more accurate picture, various laboratory tests are prescribed. In some cases, a relapse of the infection, a new exacerbation is possible. In a chronic course, reactivation of pathogenic microflora and the addition of secondary bacterial infections are often observed. Such complications should be treated with properly selected antibiotics.
Cytomegalovirus infection during pregnancy
A particular danger is the situation when cytomegalovirus develops in women during pregnancy. This is due to a decrease in the body’s immune forces. In this case, there is a high risk of fetal infection. Infection of the mother most often occurs long before pregnancy. After experiencing stress or acute respiratory viral infections, a pregnant woman infected with CMV may experience profuse vaginal discharge, which has a high viscosity and an unpleasant odor. In addition, the infection causes fever, muscle pain, rhinitis, and swelling of the parotid glands. If there are signs of damage to the organs of a pregnant woman, then the prognosis is poor. The likelihood of early miscarriage and premature birth in the third trimester is significantly increased.
If cytomegalovirus develops in the body in a chronic form, then the child, even with a successful pregnancy, will be weakened. He will most likely be born prematurely. Cytomegalovirus is transmitted to the baby by the placental route or through the ingestion of infected amniotic fluid. Such children are born with congenital chronic cytomegalovirus infection. If it is possible to avoid intrauterine damage to the fetus, the baby can still become infected when passing through the birth canal. The first manifestations of congenital CMVI may not be detected immediately, but only at 2-3 years of life. The mother can also transmit the virus through breastfeeding, through saliva through kissing, etc.
CMVI is curable, but dangerous for the fetus in that serious consequences are possible:
- disorders of the central nervous system,
- abnormal enlargement of the liver and spleen, up to their ruptures,
- hydrocephalus and microcephalus,
- violation of visual function,
- developmental lag,
- epilepsy, cerebral palsy,
- squint, facial asymmetry,
- retinitis of the eye.
When planning pregnancy, women are prescribed a comprehensive analysis for TORCH infections. In addition to cytomegalovirus, he diagnoses the presence of toxoplasma, HSV (herpes simplex virus), rubella virus, and spirochete pallidum. Detection of CMV at the stage of pregnancy planning will help to assess and reduce possible risks. If cytomegalovirus is detected during the first pregnancy, then all subsequent women must also take a smear, because it will not be possible to get rid of the virus forever. Before conception with IVF, diagnostics are also required.
Treatment of cytomegalovirus
In most cases, in order to cure a person with CMV infection, you just need to help him alleviate the symptoms (reduce the temperature, eliminate a sore throat, etc.) and create favorable conditions for the body to fight the virus on its own. Doctors practice treatment with specific antiviral drugs that act specifically on cytomegalovirus (Ganciclovir, Cytoven), only in extreme cases because of their high toxicity and considerable cost. These include the treatment of patients with transplanted organs, severe forms of the disease that developed against the background of immunodeficiency (AIDS) or congenital CMVI. They are also prescribed in the case of the patient taking drugs that suppress the immune system.
When infected with CMV, the ability of leukocytes to produce interferon is suppressed. Immunomodulators perfectly cope with this problem: Viferon, Genferon, Cycloven, Laferobion, Allokin Alpha. The drugs are effective in treating pregnant women over 12 weeks of gestation. Interferon medications have no side effects. Treatment of the acute form of cytomegalovirus is performed with Megalotect. It is a hyperimmune immunoglobulin and produces passive immunity to CMV. It acts essentially like a vaccine. The drug is effective in preparation for organ transplantation, but has a number of side effects and is contraindicated in people with a history of human immunoglobulin intolerance.
To stop the reproduction of the virus in the body, specialized antiviral drugs are used: Acyclovir, Groprinosin, Isoprinosin, Panavir, Foscarnet. These drugs promote the production of leukocytes in the blood, can be prescribed to women during pregnancy and lactation. You can also raise immunity using folk methods. They are used more often at the same time as traditional medicines. Such plants as well improve the body’s resistance:
- rose hip
Along with immunomodulating drugs, symptomatic treatment is necessary. It is prescribed by a doctor depending on how the virus will affect the body. The treatment regimen is determined by the severity of the course and the nature of the complications.
Prevention and possible complications
Due to the widespread prevalence of cytomegalovirus, no prevention will save you from infection. However, if you maintain your immune system, especially during seasonal colds, CMV will not cause any measurable harm to your health. If the carriage of the virus is confirmed, then it is necessary to prevent the exacerbation of the disease, since it will not be possible to completely defeat the virus. For this, the patient is advised to regularly drink a course of vitamins, lead a healthy lifestyle, and eat right. This does not mean at all that you need to exhaust your body with diets, it just needs to add more fruits and vegetables to the diet. Fatty and fried are recommended to be excluded.
According to laboratory studies, even a latent course of the disease significantly increases the risk of developing oncology, especially glioblastoma – brain cancer. All this is due to the fact that under the influence of the virus, the genes responsible for the timely death of cancer cells in the body are inhibited. The severe consequences of the acute form of the disease include damage to internal organs and the central nervous system. One of the most dangerous complications associated with CMV is the emergence of viable structures of the virus in the brain tissues. This provokes the development of viral encephalitis. After an infection, a person with a deficiency of the immune system may be permanently disabled.