Viral diseases in children are quite common. One of these pathologies is cytomegalovirus infection. How dangerous this disease can be, this article will tell.
What it is?
The causative agents of cytomegalovirus infection (CMVI) are cytomegaloviruses. These microorganisms belong to the group of DNA viruses. These microbes, by their nosological affiliation, belong to herpes viruses. This morphological structure determines the peculiarity of the action exerted by microbes.
Cytomegalovirus can be found in a variety of biological fluids and secrets. The maximum concentration is observed in saliva and salivary glands. Carriage of viruses is quite often observed. In this case, viruses are present in the child's body, but adverse symptoms do not develop. The maximum risk is observed in children with severe immunodeficiency states.
Some scientists say that long-term carriage of cytomegalovirus infection can lead to the development of malignant neoplasms in the future. These data are very contradictory and not recognized by all medical professionals. Cytomegaloviruses are found all over the world. Even in economically developed and prosperous states, there is a fairly high prevalence of these microorganisms.
According to statistics, almost 3% of children have viruses in their blood. Quite often, these babies are carriers of the disease, but they themselves do not get sick. There are also congenital forms of CMVI. In this case, the future baby becomes infected during its intrauterine development. The first unfavorable signs of the disease can occur already in newborn babies.
Scientists nevertheless note that the greatest prevalence of this infection is noted in economically developing countries. Many doctors believe that the high incidence of cytomegalovirus infection leads to an overall increase in mortality. The impact of these microorganisms on the immune system of babies leads to the development of acquired immunodeficiency states, which contribute to the acquisition of concomitant chronic diseases of internal organs.
There are several forms of this infection. In children, the most common generalized variant of the course of the disease. According to statistics, it occurs in 85% of babies with cytomegalovirus in their blood.
There is also an asymptomatic form of the disease. In this case, adverse symptoms can only be noticed many years after infection.
The peculiarity of viruses is that they perfectly penetrate into cells. This leads to the fact that these microorganisms can be found in the future in a variety of internal organs. Once in a child's body and settling in cells, they begin to actively multiply and develop in them. As a result, the number of viral particles in the child's body increases many times over.
Ultimately, the damaged cells acquire their characteristic appearance. They resemble "owl eyes" in appearance. The large size of the nucleus and the protoplasm pushed to the periphery of the cell determine the characteristic appearance of the damaged cells. Also during the disease is noted lymphocytic infiltration... This clinical condition suggests that the immune system was already involved in the inflammatory process.
At the very beginning of the disease, the rate of spread of the formation of new viral particles is insignificant. This is largely due to the characteristics of the immune system, which actively copes with viruses. After some time, the immunity of the infected baby begins to weaken. This leads to the fact that cytomegaloviruses begin to multiply actively, and the disease becomes active.
Symptoms
The incubation period for cytomegalovirus infection can be different. It largely depends on the initial state of immunity of the child's body. Premature babies or babies with persistent anatomical developmental defects are at increased risk. Older children with chronic diseases of internal organs are also susceptible to mild infection. In most cases the incubation period for CMVI is from 2 weeks to 3 months.
The adverse symptoms of this disease can be very different. The most common are:
Skin rashes. The most common symptom. These skin rashes appear as a petechial rash. In appearance, they resemble small hemorrhages that are common on the skin. This symptom occurs in 75-80% of cases.
Petechial eruptions. Manifested by thrombocytopenic purpura. This clinical condition occurs in 75% of cases. It is characterized by the appearance of multiple bruises that are located on different parts of the body. This symptom is extremely unfavorable and is quite common in babies aged 2-3 years.
Yellowing of the skin. The appearance of this symptom is associated with damage to the liver tissue. This clinical sign occurs in 60-70% of cases.
Enlargement of the liver and spleen. This condition is associated with the involvement of the immune system in the inflammatory process, as well as vital organs.
Hypotrophy. This clinical symptom manifests itself quite well in babies up to one year old.
Prematurity. Intrauterine infection of the fetus contributes to the violation of placental blood flow and various pathologies of internal organs. Ultimately, this contributes to the birth of babies much earlier than the due date.
Brain damage. This clinical sign is manifested, as a rule, by the development of encephalitis. It occurs in 15-20% of cases.
Inflammation of the retina and internal structures of the eye. As a rule, this is manifested by chorioretinitis.
Infection can occur in different ways. Quite often, babies become infected from adults. Also, children become infected from each other in organized groups. You can also get infected through blood. Most often this happens during various medical interventions - during blood transfusion or during the setting of injections and droppers.
A fairly common form of the course of this disease is an isolated lesion of the salivary glands. Only in some clinical situations is it possible for viruses to spread to internal organs. Generalized forms of the disease are accompanied by an increase in body temperature. Quite often, its values do not exceed subfebrile values.
A sick baby has a sore throat, which can be of very different intensity. The child has peripheral lymph nodes increase. Most often, a group of cervical lymph nodes is involved in the inflammatory process. Over time, the child's liver and spleen enlarge. In some cases, this is manifested by yellowing of the skin.
Nonspecific symptoms of intoxication include headache, dizziness, increased general weakness, weight loss, decreased appetite and sleep disturbance. The long course of cytomegalovirus infection contributes to the child's lag in physical development from their peers. Many children develop poorly enough and cope with daily stress worse.
When the oropharynx becomes infected, the child develops symptoms that resemble pharyngitis. The mucous membranes of the mouth and throat become red. Quite often, the palatine tonsils increase in size and begin to hang over the entrance to the pharynx.
Generalized forms of the disease, accompanied by liver damage, can also occur with the development of other adverse manifestations of the disease. Various disorders of the gastrointestinal tract are common in sick babies.
As a rule, these disorders are manifested by frequent stools or, conversely, a tendency to constipation.
Severe forms of the disease are accompanied by a pronounced increase in body temperature. In some cases, it can reach values of 39-40 degrees. During the period of febrile condition, the child, as a rule, feels a fever and severe chills. Against the background of a high temperature, a sick baby may vomit. In some babies, febrile condition can persist for a long time - for several weeks.
Diagnostics
Clinical examination for cytomegalovirus infection is mainly of an auxiliary nature. Only an experienced pediatrician can suspect a disease. It is possible to establish the correct diagnosis and carry out differential diagnostics only with the help of laboratory tests.
Such tests can detect an infection that is even in "sleep mode".
Determination of specific antibodies to cytomegalovirus is the main element of diagnosis. The feedback from parents who conducted the research data for their babies is the most positive. They note that only with the help of the tests carried out it became possible to make the correct diagnosis. These studies are practically painless and can be performed on very young children.
Increased cytomegalovirus in the blood of a child is always a significant cause for concern for parents. The emergence of Ig M indicates the first meeting of viruses with a child's body. In some cases, this may indicate that there has been a reinfection of the chronic variant of the disease. Usually, this condition occurs in babies who have undergone severe stress or an exacerbation of a chronic disease the day before.
If, during pregnancy, high titers of immunoglobulins M to cytomegalovirus are found in a woman's blood, this may indicate that an intrauterine variant of infection of her unborn child is also possible. It is possible to detect an increase in Ig M within 1-1.5 months from the moment the viruses first enter the child's body. A fairly high content of these protein molecules is noted for another 15-20 weeks.
With the development of this disease, other immune components appear - immunoglobulins G. Their titer in different babies can vary significantly. As a rule, with a slight decrease in viral replication activity, the number of these protein molecules begins to increase. A positive igG test indicates that the child's body is familiar with this type of virus.
Unfortunately, it is impossible to establish the stage of development of the disease, relying only on laboratory tests. During the course of the disease, analyzes are constantly changing. In order to prevent the development of complications, it is imperative to carry out laboratory control.
It is possible to detect microorganisms inside cells using another modern diagnostic method - the PCR test.
The biological material for research can be very different. In most cases, venous blood or saliva is used for this. In some clinical situations, viruses can be detected in the urine. The quantification of viruses using this test helps to establish the activity of the life process of microorganisms.
It is possible to identify functional disorders in the work of internal organs using biochemical blood test. When the liver is involved in inflammation in the peripheral blood, the amount of hepatic transaminases - ALT and AST - increases. Much less often, a sick baby has an increase in total bilirubin. A decrease in platelets in a complete blood count may be the first laboratory sign of thrombocytopenic purpura.
As a screening during pregnancy, a special pp65-sample. This study helps to identify microorganisms even in pregnant women at different stages of pregnancy. Also, this examination is actively used to control the specific treatment prescribed for cytomegalovirus infection. Such a test allows you to identify the causative agent of the disease even a week before the first adverse symptoms appear. The disadvantage of this study is the rather high cost.
In some clinical cases, material sampling is required several times. In this case, pathogens can be detected quite accurately in the sera. Usually biological material is collected with a difference of a couple of weeks.
If the child has severe adverse symptoms, then blood sampling can be carried out at almost any time.
To identify damage to internal organs, additional consultations are carried out by various doctors. In this case, the pediatrician can refer the sick baby for a consultation with a urologist, gynecologist, gastroenterologist or ophthalmologist. Quite often, with an active form of the inflammatory process, an ultrasound examination of the abdominal organs is performed.
Effects
The development of the disease can be very different. Involvement of internal organs in the inflammatory process is very unfavorable. The prognosis for the development of the disease in this case is markedly worsening. The long course of the disease, especially in a generalized form, is accompanied by a change in metabolism. This ultimately contributes to a pronounced lag of a sick baby in physical development.
Many children who have had cytomegalovirus infection for a long time may differ significantly in appearance from their peers. They are usually smaller in weight and height, their muscle tissue is not sufficiently developed. Even minor physical activity can lead to quick fatigue in babies. At school age, these kids learn worse and get tired quickly even after 2-3 lessons.
As a result of the transferred encephalitis caused by cytomegalovirus, the child may develop some memory and attention disorders. Quite often, this is manifested by the difficulty of remembering specific numbers or events. Failure to switch enough attention is also found in babies who have had cytomegalovirus encephalitis.
Choreoretinitis, which occurs in 10-12% of babies with cytomegalovirus infection, can lead to the development of a child persistent visual impairment. In some cases, a decrease in the work of the visual analyzer develops gradually. Any visual impairment that a child has after suffering from cytomegalovirus choreoretinitis must be identified and treated.
Pediatric neurologists also note that some babies may develop mental impairment, which are also manifested by various deviations in mental development. Quite often, these manifestations occur together with cardiovascular abnormalities. Some babies have and speech disorders... These dangerous complications can develop in children in whom cytomegalovirus infection is asymptomatic.
Treatment
The entire therapy of cytomegalovirus therapy can be divided into two major areas. This is a specific antiviral treatment and symptomatic medical care.Medicines that have a destructive effect on viruses include "Ganciclovir"... This medication can be taken both orally and parenterally. This drug has a pronounced therapeutic effect, which allows you to achieve a good result.
This drug accumulates well in cells. Distribution in the body is very moderate. The drug penetrates well into various internal organs.
It is important to note that the intracellular content is several times higher than in the peripheral circulation. This clinical feature helps not only to achieve a good result, but also to reduce the risk of developing unwanted side effects.
The accumulation of drugs can be in a variety of biological materials, including the cerebrospinal fluid. The vast majority of drug metabolites are excreted through the kidneys. The average elimination half-life is 3.0-3.5 hours. If a child has chronic kidney or urinary tract diseases, the drug can accumulate in the body for much longer.
"Foscarnet" Is another drug used to treat this infection. This agent is only administered parenterally. The metabolites of this drug are also excreted through the kidneys. Taking this medication can contribute to the development of adverse side effects. These include a pronounced decrease in immunity, impaired excretory function of the liver and kidneys.
When using these medicines, laboratory control of blood tests is mandatory several times a week.
If, against the background of taking medication, the child's peripheral blood content has significantly decreased in the content of platelets and neutrophils, then the use of these chemicals completely stops. The selection of further treatment in this case remains with the attending physician.
According to their basic mechanism of action, these drugs are cytostatic. In this case, the appointment of immunostimulating agents is required, which will preserve and replenish the lost immunity. The drug therapy regimen is quite complex and requires mandatory supervision by doctors.
Do not use these medicines on your own! The risk of adverse side effects is high, which may affect the frequency of developed abnormalities in the work of internal organs.
"Cytotect" Is a drug used in immunodeficiency states. In its composition, this agent contains immunoglobulins to cytomegalovirus. The appointment of this drug is carried out by the attending physician with the obligatory establishment of the required dosage. Quite often, taking a drug is accompanied by the appearance of many different side effects. The most common of these are headache, dizziness, nausea and soreness in the abdomen, and excessive sweating.
In some cases, drug resistance occurs. As a rule, this condition occurs with a long course of the disease.
Elimination of drug resistance requires the correct selection of specific therapy. The protracted course of the disease requires the mandatory appointment of supportive immunostimulating treatment. This specific therapy is prescribed by a pediatric immunologist.
For information on how to defeat cytomegalovirus, see the next video.
