Cytomegaloviral infection

Description:

The Cytomegaloviral infection (TsMV-infection) — one of urgent problems of obstetrics and perinatology, occupies one of the main places among pre-natal infections. According to various authors, the number of the women having IgG antibodies to TsMV varies from 55 to 88% in the different countries. In the USA about a half of pregnant women have no antibodies to TsMV.
1 — 4% of not infected mothers have primary infection during pregnancy, at the same time 30 — 40% of newborns get sick. At the birth symptoms of a disease find in 10 — 15% from them, about 20 — 30% from them die. Among survivors become disabled people of 90% and about 10% recover.
Reactivation of latent infection is observed at 3 — 28% of pregnant women. At the same time transmission frequency of a virus from mother to a fruit makes 0,15 — 0,36%. Consecutive infection, and also reactivation of already available virus leads 1% of newborns to infection. Are noted that from them about 10% have the neurologic defects connected with action of a cytomegalovirus. Incidence of a Cytomegaloviral infection is endemic and is not subject to seasonal fluctuations.

Reasons of the Cytomegaloviral infection:

The cytomegalovirus (TsMV) belongs to a subfamily of gerpesvirus. It was for the first time found in 1956, it is carried to opportunistic viruses, plays an important role in obstetrics, perinatology and pediatrics. Primary infection designates a further lifelong carriage of a virus. The disease has persistent character. Under the influence of some factors (pregnancy, diseases of internal
bodies, immunodeficient a state, administration of drugs, suppressing immunity) promote activation of a virus.
Transfer of a virus happens at contact (more often imtimny) to the infected circles of the infected person. Factors of transfer of TsMV — practically all biological secrets of the person in which there is a virus. It can be blood, saliva, urine, liquor, vulval allocations, sperm, amniotic liquid, breast milk. As a potential source of an infection consider bodies and fabrics in transplantologies, and also blood and  products of blood in transfusiology. Practically in half of cases a source of a Cytomegaloviral infection for adults are the infected children who can allocate for many years a virus with urine and saliva. Group of the increased risk make women whose work is connected with children, for example, in kindergartens and other preschool institutions.
Ways of transfer of a Cytomegaloviral infection:
- airborne;
- sexual;
- vertical;
- parenteral.
The infectious agent can be transmitted transplacental (transfer of the agent from mother to a fruit) or the ascending way of infection (from the neck of uterus affected with a virus through intact covers). The most dangerous primary infektsirovaniye in 1 and 2 trimesters of pregnancy is considered.

Symptoms of the Cytomegaloviral infection:

Depending on time of infection allocate the following forms of a Cytomegaloviral infection.
A. Inborn.
B. Acquired:
- localized;
- generalized.
Features of manifestations cause division of the TsMV-infection on the following forms:
- latent;
- subclinical;
- clinically expressed.
The last proceeds as acute, subacute or persistent infection.
Primary infection usually malosimptomna or asymptomatically. At latent and subclinical forms nonspecific symptoms which remind an easy form of flu or subfebrile condition rather usually take place. Their diagnosis is based first of all on data of laboratory researches.

The acquired infection does not affect TsNS as it is peculiar to an inborn form, and often proceeds as mononukleozopodobny option, being followed by fever, the catarral phenomena, increase in cervical and submaxillary lymph nodes, and also hypostasis and morbidity of parotid sialadens. Unlike a SARS the long current — to 4 — 6 weeks is characteristic of a Cytomegaloviral infection.
Congenital Cytomegaloviral infection
Characteristic symptoms of an inborn TsMV-infection:
■ jaundice;
■ hemorrhagic syndrome (hemorrhagic purpura, petechias);
■ gepatosplenomegaliya;
■ chorioretinitis;
■ defeat of a respiratory organs (intersticial pneumonia, bronchitis);
■ defeat of TsNS (encephalitis, nanocephalia, hydrocephaly, brain calcificats, atrophy of an optic nerve, deafness, disturbances of intellectual and motive activity).
The inborn TsMV-infection always has generalized character whereas acquired quite often proceeds in the form of the latent or localized with defeat sialadens.

Depending on gestation term if during pregnancy there was primary infection of TsMV, observe various nature of defeats (blastopatiya, embryopathies).
Infection in the first 2 weeks of a gestation is fraught with blastopatiya: death of a germ, abortion or formation of pathology of various systems of bodies, similar that at genetic diseases.
Embryopathies are observed at infection on 15 — the 75th day of fetation. Insufficiency of development at the organ or cellular level takes place (malformations) or abortions. Observe the following malformations more often:
- microgyria, nanocephalia, disturbance of very tectonics of a brain, hydrocephaly;
- malformations of cardiovascular system;
- development of defects of digestive tract, secretory and respiratory systems, the lower extremities and other bodies is not excluded.
In case of infection on 76 — the 180th day of a gestation there are early fetopathies: inflammatory reactions from the outcome in fibrous and sclerous changes of bodies (false malformations). Often - abortion.
At primary infection, since 181st day of pregnancy, various fetopathies are diagnosed: an initial inflammation with involvement of various bodies and systems  (encephalitis, hepatitis, thrombocytopenia, pneumonia, etc.).

Diagnosis:

For diagnosis of the TsMV-infection use a number of methods.
- Definition of degree of a viruria — definition of viruses in an urocheras by means of immunofluorescent antibodies that svidektelstvut about expressiveness of a viruria.
- The DNA-probe method — detection of viruses in slime of the channel of a neck of uterus.
- The PTsR method — definition of viruses in slime of the channel of a neck of uterus.
- Serological methods — definition of antibodies to viruses in blood serum of the patient (IgM, IgG). Detection at the pregnant woman of antibodies of the class IgG means that consecutive infection and consequently, it is not so dangerous to a fruit.
- At the acquired TsMV-infection in the general blood test — a leukocytosis with increase as neutrophils and atypical lymphomonocytes, in the absence of positive serological tests on an infectious mononucleosis.
Now it is impossible to establish precisely what has the damaging effect on a fruit — a virus persistention (and/or its carriage) or the aggravation is hidden the proceeding infection.
Allocation of a virus (with urine, saliva) is not a reliable indicator of activation of process as its eskretion with saliva proceeds weeks and months after primary infection. It is established that in urine and the cervical channel it remains months and years.
At suspicion of the TsMV-infection the diagnosis is confirmed with identification of a virus from the struck body and for existence of specific antibodies of IgM, IgG with increase of their caption.

Clinical diagnosis of the TsMV-infection at adults presents certain difficulties. Similar manifestations have many diseases, including:
a) infectious mononucleosis;
b) various viral infections;
c) toxoplasmosis;
d) listeriosis;
e) syphilis.

Treatment of the Cytomegaloviral infection:

Use interferonopodobny phytomeans (a cat's claw of bark extract, a purple cone-flower narrow-leaved extract, etc.).
Medicamentous therapy
Out of pregnancy at detection of antibodies of IgG (carriage) of treatment it is not required. However physiological immunosuppression during pregnancy can be risk factor of reactivation of a latent TsMV-infection therefore to pregnant women carry out immunomodulatory therapy.
At increase of an antiserum capacity of IgG intravenous administration of immunoglobulin is recommended:
- immunoglobulin of the person normal on 2,5 g 3 times every other day three times during pregnancy in I, II and III trimesters.
The course of reception of immunomodulators makes 10 days. Their use is reasonable from the 2nd trimester of pregnancy:
- interferon human recombinant alfa-2+ complex immunoglobin drug dry (candles rectal) on 1 mln units 1-2 times a day;
- interferon alfa-2 (candles rectal) on 500 000 PIECES 1-2 times a day.
Carrying out courses of metabolic therapy for the purpose of a prokfilaktika of placental insufficiency is reasonable (courses for 10 days from pererykva on 10 days):
- folic acid of 0,02 g 3 times a day;
- deproteined hemoderivative from veal blood ("Actovegin") of 0,2 g 3 times a day.
Normalization of a microbiocenosis of a vagina pro-biotic and eubiotichesky means is important.

Seronegative pregnant women are carried to group of high risk of development of primary TsMV-infection with the subsequent pre-natal infection of a fruit therefore careful control of a condition of fetoplacental system and level of antibodies is necessary.