Detection and treatment of cytomegalovirus infection in adults. Drugs for the treatment of cytomegalovirus infection Treatment of cytomegalovirus infection in adults

Cytomegalovirus is a type of herpesvirus. This disease tends to spread easily, due to which it often occurs in both young and adult people. This type of virus in its inactive state can be in the human body for a long time. And if the immune system is strong, then it does not pose any danger, manifesting itself as a common cold, causing general malaise.

But with poor health and during pregnancy, cytomegalovirus can be a serious danger. The virus quickly infects the tissues of important organs, destroying their cells and disrupting normal functioning. The external manifestation of the disease resembles an ulcer or pneumonia with concomitant enlargement of the lymph nodes. And in this case, the person is in a serious condition, which sometimes ends in death. Therefore, it is extremely important to know how to treat cytomegalovirus in order to avoid serious complications.

Fundamentals of treatment

The main task of therapy for cytomegalovirus is to mitigate and suppress the negative impact of a viral infection on the human body. If we are talking about strong immunity, then the initial outbreak of the virus proceeds quite tolerably and there is no need to go to the hospital.
When the disease proceeds with all the accompanying symptoms and significantly changes the usual state of the body, then you should pay a visit to the doctor, who prescribes a set of tests that confirm or refute the preliminary diagnosis. And if cytomegalovirus is detected, then complex treatment is prescribed.

Completely cure cytomegalovirus will not work.

Usually, all therapeutic measures are aimed at eliminating painful symptoms, strengthening the immune system and significantly reducing subsequent relapses of the disease.

The main goal of treatment is to suppress the activity of the virus itself, which, even after extensive therapy, still remains in the human body forever. In this case, you will have to completely reconsider your lifestyle, adjust your diet. In addition, it will be necessary to constantly take vitamin complexes.

In some cases, the attending physician prescribes hospitalization of the patient with cytomegalovirus. At the same time, it is recommended to limit any contact with other people, observe the rules of personal hygiene and adhere to a therapeutic diet for a certain period.

Medical therapy

Medications will help eliminate the symptoms and block the development of cytomegalovirus. Treatment in this case consists of:

• symptomatic remedies;
• drugs that resist the virus;
• syndromic drugs;
• immunoglobulins and immunomodulators;
• vitamin and mineral complexes.

Symptomatic remedies instantly stop the focus of inflammation, reduce it and relieve pain. These can be vasoconstrictor drops and various painkillers. Medicines that oppose the virus suppress the very activity of the infection present in the body. These are Panavir, Ganciclovir, Foscarnet, Cidofovir.

Panavir will be able to suppress the infection and stop the spread of the virus itself

Many drugs have contraindications and cause side effects, so you can’t independently calculate the dosage and self-medicate. Most often, ganciclovir is used to treat the disease. This drug interferes with the cycle of the virus and interrupts it. At the same time, blood tests are done every two days.

Posyndromic drugs accelerate the recovery of damaged tissues and organs, especially if the disease proceeded with complications. Such drugs are prescribed in the form of suppositories, capsules and tablets, injections and various ointments. Immunoglobulins destroy viral particles that live in the body by binding them together. These funds include:

• Cytotect;
• Neocytotec;
• Megalotect.

Usually, specific intramuscular injections are used, which are given for five days. However, when prescribing immunoglobulin, a number of contraindications are also taken into account. These are diabetes mellitus, the body's predisposition to allergic reactions, kidney failure, pregnancy and breastfeeding. Also, if during the period of treatment of cytomegalovirus a person simultaneously undergoes the prescribed course of other vaccinations, then immunoglobulin therapy is canceled.

To enhance the effectiveness of treatment with antiviral drugs allows the additional connection of interferons. Immunomodulators have a positive effect on the immune system, strengthening and stimulating it several times. These are Neovir, Leukinferon, Viferon, Genferon. These drugs have worked well in treating infection during pregnancy (after 12 weeks) and in children.

Vitamin and mineral complexes subsequently support the body and its immunity, preventing recurrences of the disease from reappearing. Therapy with the use of such funds lasts up to several weeks.

Treatment of cytomegalovirus for women and men may be different. The representatives of the stronger sex are always prescribed immunoglobulins with antiviral drugs (Ganciclovir, Foscarnet). Cytomegalovirus in women is treated with anti-inflammatory drugs. Usually it is Acyclovir and Genferon.

Paracetamol should be used to reduce the temperature that always accompanies this type of virus. But Aspirin is not recommended, as unwanted side effects may occur.

Treatment of cytomegalovirus in children and pregnant women

The choice of therapy when cytomegalovirus develops in children will depend on the age of the child. Conservative treatment helps children under six years of age to get rid of unpleasant symptoms, but older children can already be given antiviral drugs. They will suppress the activity of a dangerous infection.

If CMVI affects the retina or lungs, potent drugs (Foscarnet or Cidofovir) are prescribed. But they have increased toxicity and have a negative effect on the kidneys. Therefore, they are used to treat a child only when he is in danger. Usually, in such cases, a council is assembled, at which the question of the advisability of antiviral therapy is decided.

Foscarnet will effectively cope with the disease, but it has a number of side effects.

Treatment of cytomegalovirus in a pregnant woman is also carried out with caution, as increased attention is paid to the health of the unborn baby. If the virus proceeds in an acute form, then for seven days the woman takes Cytotect (2 ml per 1 kg of weight). If the infection managed to get to the cervical canals, then Viferon is prescribed. The duration of treatment with this drug is 21 days.

The applied therapy can be shortened or lengthened, depending on the degree of occurrence of side effects and on the overall clinical picture. With negative dynamics, the antiviral drug is replaced. When cytomegaly proceeds secretly and passively, then during pregnancy this disease is not treated.

Features of therapy depending on immunity

Treatment of cytomegalovirus in men and women with normal immunity does not require any specific measures. Therapy will be similar to that prescribed for colds. It is based on antipyretics and painkillers. And to eliminate intoxication of the body, it is recommended to observe a plentiful drinking regimen.

It will be necessary to treat cytomegalovirus infection in those patients who have malignant tumors or have undergone organ transplantation in stationary conditions. The main drugs are based on ganciclovir. But they usually provoke a number of side effects, so this therapy is not used during pregnancy, as well as for those who suffer from kidney failure. But for those who have a strong immune system, drugs that contain ganciclovir should not be used to treat the virus.

In HIV-infected patients, cytomegalovirus is treated with a drug such as Foscarnet. At the same time, regular medical supervision is mandatory, as he, if necessary, adjusts the dosage of the drug. Sometimes there are such adverse reactions from the body as nausea, impaired urination and electrolyte metabolism.

Using traditional medicine recipes

Treatment of cytomegalovirus should be based on the use of medications. It is useless to try to cope with such a disease only with traditional medicine. But here you can support the immune system with the help of healing recipes.

A good result is given by tea made from raspberry leaves and black currant. You can add some honey to it. Such a drink will help a weakened body recover and get stronger.

Brewed raspberry and currant leaves will give strength to a weakened body

To prevent infection, you can use medicinal herbs and plants. In equal proportions, you need to mix birch buds, wild rosemary, leuzea and succession, yarrow, burnet and thyme. From the resulting mixture, take 10 g and pour a liter of boiled water. Let the broth brew in a thermos during the day. Ready homemade medicine is taken 50 ml three times a day at the time of the meal.

In a similar way, a decoction of leuzea, alder and licorice, pharmacy chamomile and succession, and kopeck is prepared. And you can mix flax seeds, marshmallow root, raspberry leaves and coltsfoot, elecampane and cinquefoil. All components are taken in equal proportions, licorice root is added to them (four times more) and the resulting composition is brewed for three hours. Taken 60 ml before meals.

With CMVI, it is very useful to include garlic and onions in the diet. These products should only be consumed fresh. And if you do this regularly, then it will be possible to reduce the risk of infection by several times.

If someone close to you has already caught cytomegalovirus, then you can stop the spread of this infection by spraying tea tree oil in the air. This should be done in the room where the patient is.

Prevention of CMVI

Since cytomegalovirus is transmitted by airborne droplets, as well as sexually, experts advise using condoms with an unverified partner as a preventive measure, as well as avoid kissing a person who has signs of CMVI. These symptoms include weakness, runny nose and sore throat, high fever.

Pregnant women should be especially careful in this case. Since an infection of this kind, picked up during this important period, poses a serious threat to the baby. It is necessary to treat viral and catarrhal diseases in a timely manner. It is very important to strengthen your body and its immune system. To do this, you can use the following methods:

• taking biologically active additives;
• personal hygiene;
• making the right diet.

Additionally, during the day you can drink brewed lemongrass or echinacea. And if ginseng is added to these components, then the resulting drink will have a tonic and immunostimulating effect.

All those who are faced with the described disease are concerned about the question of whether cytomegalovirus can be cured. But in fact, completely get rid of the infection will not work. But with the help of complex therapy and subsequent preventive measures, the virus can be contained, and it will remain in a passive state for the rest of the time.

One of the most common infections of the TORCH complex is cytomegalovirus infection (CMVI). According to WHO, antibodies to CMVI are found in 40-80% of the adult population, 2% of newborns and 50-60% of children under the age of 1 year. The disease is ubiquitous, has no seasonality, and is not associated with a person's professional activity.

Etiology and epidemiology

This is what the causative agent of cytomegalovirus infection looks like - a virus of the herpesvirus family.

The causative agent of CMVI is a virus of the genus Cytomegalovirus of the Herpesviridae family.

The reservoir and source of cytomegalovirus (CMV) is a person (carrier or patient). It is transmitted by airborne droplets, direct and indirect contact and transplacental. There is evidence of infection of the recipient when an infected organ is transplanted to him and when infected blood is transfused. Newborns are usually infected from the mother during passage through the birth canal, that is, intranatally. Cases of transplacental infection of the fetus are not uncommon. Of particular danger to the fetus is the infection of the expectant mother at an early stage (up to 12 weeks) of pregnancy - severe violations of the intrauterine development of the crumbs are very likely.

50% of newborns become infected by eating contaminated breast milk.

Despite the high natural susceptibility of people to CMV, infection is possible only through repeated close contact with infected secretions of the patient.

The pathogenesis of cytomegalovirus infection

The entrance gates of CMV are the mucous membranes of the upper respiratory tract, organs of the digestive system and genital tract. Tellingly, when this virus invades the body, there are no changes at the site of the infection gate. The virus has a tropism (affinity) for the tissues of the salivary glands, therefore, in the case of localized forms of the disease, it is found only in them. Once in the body, the virus persists in it throughout a person's life. In persons with an adequate immune response, CMV does not cause any signs of the disease, they occur only if the body is exposed to debilitating factors (taking cytostatics, chemotherapy, severe concomitant diseases, HIV).

The fetus of an infected pregnant woman will become infected with CMV only if she has an exacerbation of the latent form, and with the primary infection of the expectant mother, the likelihood of infection of the fetus increases dramatically.

Clinical manifestations of cytomegalovirus infection

Depending on the ways of infection and clinical manifestations, CMV is usually divided into congenital (acute and chronic) and acquired cytomegalovirus infection. The latter, in turn, has 3 forms: latent, acute mononucleosis and generalized. So.

Congenital CMVI

It may not manifest itself immediately after birth, but as the baby grows, deviations will become noticeable: decreased intelligence, deafness, speech impairment, chorioretinitis.

• Acute congenital CMVI. When a future mother becomes infected during pregnancy up to 12 weeks, fetal death in utero or the birth of a child with defects that are often incompatible with life (pathology of the development of the brain, kidneys, heart defects) is possible. When the mother is infected in late pregnancy, severe malformations in the fetus are not formed, however, there are diseases that manifest themselves immediately after the birth of the baby (hemolytic anemia, hemorrhagic syndrome, jaundice, interstitial pneumonia, polycystic pancreas, hydrocephalus, meningoencephalitis). In 10-15% of newborns infected in utero, there is a so-called obvious cytomegalovirus syndrome with a tendency to generalization - many organs and systems are affected simultaneously, due to which the newborn dies within 1-2 weeks.
• Chronic congenital CMVI. This form is characterized by a pathology of brain development in the form of microgyria, as well as micro-, hydrocephalus, clouding of the vitreous body and lens.

Acquired CMVI

• latent form. The most common form occurs in adults and children with normally functioning immunity. Asymptomatic or subclinical.
• Acute mononucleosis form. It is similar in manifestations to influenza, viral hepatitis and infectious mononucleosis.
• generalized form. Occurs in immunocompromised individuals. It is characterized by simultaneous damage to most organs and systems of the body: heart, lungs, kidneys, digestive tract, genitourinary, nervous systems. The outcome of this form of the disease is often unfavorable.

In 20% of persons who have undergone bone marrow transplantation, development is possible, mortality from which is noted in approximately 85% of cases.

CMVI in pregnant women

When a woman is infected during pregnancy, in most cases she develops an acute form of the disease. Possible damage to the lungs, liver, brain. The patient complains about:

• fatigue, headache, general weakness;
• increase and soreness when touching the salivary glands;
• discharge from the nose of a mucous nature;
• whitish discharge from the genital tract;
• abdominal pain (due to increased uterine tone).

After a series of examinations, a woman is diagnosed with diseases such as polyhydramnios, premature aging of the placenta and its cysts, colpitis, vaginitis. There is a risk of premature detachment of the placenta, bleeding during childbirth, endometritis.

Diagnosis of cytomegalovirus infection

In order to search for cytomegalovirus, not only blood is examined, but also other biological fluids - saliva, bronchial washings, urine, and others.

In order to diagnose CMVI, it is necessary to examine several biological fluids in parallel (washing water of the bronchi, saliva, blood, urine, breast milk, tissue biopsies). Since the CMVI pathogen dies under the influence of environmental factors, studies should be carried out no later than 4 hours from the moment the material was taken.

The following diagnostic methods are used:

• cytological (detection of specific cells under a microscope);
• serological (detection of antibodies to the virus by RIF, ELISA, PCR);
• virological.

The presence in the blood of a newborn under the age of 14 days of IgM to CMVI is evidence of intrauterine infection.

Treatment of cytomegalovirus infection

• With latent and subclinical forms of the disease, therapy is not carried out.
• The mononucleosis-like form of CMVI does not require specific treatment; if necessary, symptomatic drugs are prescribed.
• With intrauterine infection in newborns and in individuals with severe CMVI, the drug of choice is Ganciclovir. Since this is a rather serious drug with side effects in the form of damage to the kidneys, liver, blood system, it is prescribed to children only when the benefit outweighs the potential risk. During therapy every 2 days it is necessary to control the complete blood count.
• The combination of an antiviral drug with interferons is considered effective - this mutually enhances their effect and reduces toxicity.
• In order to correct immunity, specific anticytomegalovirus immunoglobulin is used.
• For the treatment of processes localized in the oral cavity, solutions of Furacilin, aminocaproic acid are used.
• When the genital tract is affected, women use oxolinic, rebrofen, acyclovir and interferon ointments.

Prevention of cytomegalovirus infection

To prevent the development of the disease in people with reduced immunity, intravenous administration of nonspecific immunoglobulin - Sandoglobulin is used.

To avoid infection, it is necessary to avoid contact with sick people, observe the rules of personal hygiene.

In order to prevent infection of the newborn with CMVI, timely diagnosis and adequate treatment of the pregnant woman is required.

During heat treatment (72C) for 10 seconds of breast milk, the virus is completely inactivated, and the beneficial properties of milk remain at the same level.

The issue of creating a vaccine against CMVI is being addressed.

Which doctor to contact

Often, the gynecologist who observes the expectant mother deals with the diagnosis of CMV infection. if it is necessary to treat the disease, an infectious disease consultation is indicated. A newborn child with a congenital infection is treated by a neonatologist, then by a pediatrician, a neurologist, an ophthalmologist, and an ENT doctor observe. In adults, when CMV infection is activated, it is necessary to consult an immunologist (often this is one of the signs of AIDS), a pulmonologist and other specialized specialists.

In fact, cytomegalovirus infection is a chronic infectious disease that develops in a person after infection with the virus of the same name.

The causative agent belongs to the family of herpetic viruses, a distinctive feature of which is "eternal residence" in the body of an infected patient.

This fact makes the disease chronic, although in the main percentage of infected people, the infection may not manifest itself outwardly at all. In other cases, a wide range of manifestations is possible, up to cytomegalovirus disease.

Infection with cytomegalovirus infection is very dangerous for pregnant women - the consequences for the fetus can be the most tragic.

At birth, manifestations of this infection are recorded in 0.5 - 2.5% of infants. Often they can lead to severe neonatal pneumonia, requiring treatment in the intensive care unit for the youngest.

The relevance of this issue is especially high, because. the prevalence of cytomegalovirus infection in adult women can reach 50-70%. However, primary infection during pregnancy is especially dangerous, when the patient had not previously encountered this virus.

This is due to the lack of protective antibodies in her blood that limit the virus. Therefore, it easily penetrates directly to the fetus through the placenta. However, first things first…

Causes of the disease

The cause of the disease is the ingress of an infectious agent into the body with its subsequent reproduction, which leads to damage to the cells of many organs.

Persons with disorders of the immune system (HIV, various immunodeficiencies) or due to its immaturity (fetus, newborns, older children) are most at risk of getting sick.

What is CMVI? This is a classic anthroponotic infection, i.e. The "supplier" of the pathogen will always be a person, i.e. it is not possible to get infected from animals or in any other way.

It should be borne in mind that the greatest danger is represented by persons who do not have clear clinical manifestations.

Therefore, others do not even realize that they are in contact with a potential source of the disease, the prevalence of which is very high.

So, in Russia, cytomegalovirus infection of adults is detected in 73-98% of the population, in children these figures are lower.

However, the development of the disease is possible in the presence of those factors:

• Encounter with the virus;
• Implementation of infection pathways in a certain infectious dose, i.e. the virus can only penetrate through specific entrance gates and not every amount of it will be dangerous;
• Reduced immunity - the body is not able to eliminate the penetrated viral particles and cause their inactivation (death).

Transmission of cytomegalovirus is possible in the following ways:

• during pregnancy through the placenta (vertical);
• during childbirth (the virus is in the mucous membrane of the birth canal);
• by inhalation of infected saliva during kissing, close contact;
• during sexual intimacy (the condom is a means of protection);
• parenterally, i.e. through infected blood (blood transfusions, intravenous injections, organ transplants). Therefore, blood and organ donors must be examined for the carriage of cytomegalovirus.

In the external environment, a long-term preservation of virus activity is possible at normal, room temperature. It loses its infecting ability when frozen only at -20 ° C, heated to 56 ° C.

Therefore, seasonality is not typical for this infection - cases of the disease are recorded throughout the year.

Symptoms of cytomegalovirus infection in children and adults

Symptoms of cytomegalovirus infection, photo 1

Symptoms of cytomegalovirus infection can be divided into manifestations of primary pathology (when the virus enters the blood for the first time) and cytomegalovirus disease, the signs of which indicate the progress of the disease (the virus multiplies uncontrollably in the body and leads to numerous lesions of internal organs).

Signs of primary infection are similar to those of infectious mononucleosis.

Therefore, the doctor necessarily conducts a differential diagnosis with this disease using additional examination methods. Of the clinical manifestations indicating cytomegalovirus infection, it should be noted such as:

• high body temperature - it lasts for a long time (more than two weeks), accompanied by headache, muscle and joint pain;
• general malaise, increased fatigue, which is not associated with severe physical and mental stress;
• swollen lymph nodes, their slight soreness;
• enlargement of the liver and spleen, in severe cases, the development of hepatitis and hypersplenism (increased activity of the spleen with the destruction of blood cells, leading to anemia and immunodeficiency) is possible.

Unlike adults, cytomegalovirus infection in children is accompanied by sialodenitis, a specific change in the salivary glands.

Signs of such damage are:

• increased salivation, which can lead to maceration of the skin of the mouth and the formation of ulcers;
• pain during eating, against the background of which the child often refuses it;
• visually determined increase in glands in the submandibular region.

With the development of acute CMVI after a blood transfusion (after 2-8 weeks) or organ transplant (after 8-12 weeks), the following can be observed:

• sudden increase in body temperature up to 39-40°C;
• sore throat;
• weakness;
• enlarged lymph nodes;
• muscle pain;
• development of pneumonia, pleurisy, inflammation of the joints, hepatitis, nephritis.

Without treatment, primary infection after transplantation in 70-80% leads to death. Therefore, patients after organ transplantation are carefully monitored with a comprehensive examination.

It helps to identify a possible infection and treat it in time. This is especially true, because in the vast majority of cases, primary cytomegalovirus infection rarely has symptoms.

Progressing, cytomegalovirus infection in adult women and men is characterized in the literature as a disease of the same name. It starts with CMV syndrome.

Its symptoms are as follows:

• prolonged "incomprehensible" elevated body temperature (38 ° C or more degrees);
• weakness;
• night sweats;
  weight loss that is not associated with a targeted restriction in food.

These symptoms develop gradually, over several weeks. After 1-3 months, pathological changes in different organs begin.

Therefore, various diseases and pathological processes can be diagnosed:

• pneumonia;
• hepatitis;
• ulcerative lesions of the gastrointestinal tract;
• dysfunction of the adrenal glands;
• radiculitis;
• headache;
• damage to the retina up to loss of vision;
• inflammation of the heart muscle;
• deterioration of blood clotting ability.

Identification of specific symptoms of cytomegalovirus infection, the treatment of which will be carried out purposefully, is impossible without laboratory and instrumental diagnostics.

The choice of these or those methods will be determined by the doctor after a detailed survey of the patient. During it, a specialist can reveal important facts, namely:

• the presence of contacts with patients with CMVI;
• unprotected sex;
• episodes of blood transfusions, organ transplants within six months.

All these circumstances require exclusion or confirmation of CMVI.

Therefore, the patient is organized:

1. Special laboratory diagnostics. It consists in conducting a PCR study (the presence of viral DNA), a serological study (the presence of antibodies to the virus in the blood).
2. Instrumental diagnostics. It allows you to detect signs of CMV disease. To do this, use x-ray of the chest cavity, ultrasound, ECG, electroneuromyography. It is important to conduct timely ultrasound diagnostics in pregnant women in order to detect violations in the development of the fetus.

Treatment of cytomegalovirus infection

The phases of the course of the disease, the symptoms of cytomegalovirus infection in women and men are similar, and the treatment is based on 3 important points:

• the end of the life of the virus inside the body;
• prevention of the development of CMV disease;
• prevention of complications and disability.

Patients with severe clinical manifestations should be treated in a hospital.

During pregnancy in women, treatment depends on how great the possibility of infection of the fetus. A very careful attitude and monitoring of the health of both mother and child is required.

The main drugs used in the treatment of CMVI are Valganciclovir and Ganciclovir.

These are their international names (they are written in small letters on the packaging), branded ones may be different depending on the manufacturer. In the active form of the infection with the presence of severe symptoms, any one drug is prescribed for a period of 21 or more days.

Such a duration of therapy is necessary to completely block the virus reproduction cycle.

The criteria for successful treatment is the disappearance of clinical symptoms and the appearance of a negative one.

Therapy can be extended for prophylactic purposes. For this, a smaller dose of the drug is used for an average duration of one month. If the symptoms of cytomegalovirus infection reappear, treatment must be repeated in full.

In a situation where, according to the results of the analysis, virus DNA is present in the blood, but there are no symptoms of the disease, a smaller dose of medication is prescribed for 1 month, after which the blood is checked for the presence of viral nucleic acid (DNA).

Cytomegalovirus infection in pregnant women has the most adverse effects when the fetus is infected in the early stages.

If the mother did not have a virus in her body before conception, but at the same time the infection occurred before 20 weeks of pregnancy, this is regarded as a primary infection. It is the most dangerous, because. in this case, the probability of transmitting the virus to the fetus is high (40%).

If a woman had a virus in her body before pregnancy or she was re-infected with it, the risk of infection of the fetus through the placenta is much lower - 0.2-2.2%.

The result of early infection of the fetus can be:

• the possibility of spontaneous early termination of pregnancy;
• fetal death;
• delay/stop its development;
• stillbirth;
• the formation of defects.

Infection of the fetus in the later stages and during childbirth will result in the child receiving the virus. The further development of the disease depends on the functioning of the immune system. If it is full-fledged, then the virus will be destroyed and the disease will not develop.

In pregnant women, the treatment of cytomegalovirus infection consists in the use of specific anticytomegalovirus immunoglobulin, which is administered intravenously.

The drug is also prescribed to prevent infection of the fetus if the mother has this virus (only the results of PCR analysis are taken into account, serological testing is less informative), and there are no symptoms of acute CMVI.

The use of similar drugs during pregnancy is possible. However, it does not have proven effectiveness due to the insufficient number of studies conducted on this issue.

It is possible that new proven publications on the treatment of CMVI in pregnant women will appear very soon.

Disease prevention

There is no prophylactic vaccine against cytomegalovirus infection. Prevention of infection is possible if the general hygiene principles are observed:

1. sexual intercourse only with the use of condoms;
2. avoiding close contact with an infected person (no kissing during the active period, only your own dishes and hygiene products, etc.);
3. frequent hand washing after using items that may contain the patient's saliva or urine (toys, diapers).

Since cytomegalovirus infection in women is dangerous for the possibility of transmitting the virus to the fetus during pregnancy, it is necessary to examine the blood for the presence of viral DNA and corresponding antibodies. These studies are best done at the stage of pregnancy planning.

An analysis for cytomegalovirus is part of the so-called TORCH study, which is mandatory for pregnant women up to the 20th week. The question of the need for treatment should be decided individually, depending on how previous pregnancies ended.

Cytomegalovirus infection, microbial code 10

According to the international classification of diseases, CMVI is designated by the code:

ICD-10: Class I - B25-B34 (other viral diseases)

Cytomegalovirus disease (B25)

• B25.0 Cytomegalovirus pneumonitis (J17.1*)
• B25.1 Cytomegalovirus hepatitis (K77.0*)
• B25.2 Cytomegalovirus pancreatitis (K87.1*)
• B25.8 Other cytomegalovirus diseases
• B25.9 Cytomegalovirus disease, unspecified

Additionally:

B27.1 Cytomegalovirus mononucleosis

P35.1 Congenital cytomegalovirus infection

Before starting treatment for cytomegalovirus, it is necessary to accurately diagnose the disease and determine whether treatment for CMVI is necessary in your case. Since it is not always required, you need to be aware of it. In addition, it is not easy to diagnose the presence of cytomegalovirus infection and CMV is easily confused with other diseases. Below we will talk about how to cure cytomegalovirus and how it is treated, as well as in what cases it is necessary.

Cytomegalovirus infection should be treated only when the disease is an undeniable danger to the human body. Such cases are clearly identified only by a specialist, after visiting a sick clinic to diagnose the disease. If the body has symptoms of a generalized cytomegalovirus infection, then it is extremely important to contact the clinic. The treatment regimen for cytomegalovirus can only be drawn up after a personal examination of the patient.

A person who has been ill with cytomegalovirus and has undergone an infectious disease without any serious consequences acquires a fairly strong immunity. In the vast majority of cases, cytomegalovirus infection, having struck the human body, does not cause any symptoms. The virus itself in the body takes a sleep mode, remaining in a person forever. And it manifests itself, causing relapses, accompanied by all sorts of complications, only with a strong weakening of the immune system.

In all cases, the treatment of cytomegalovirus infection pursues the goal - to significantly mitigate the negative impact of a viral infection on the human body. Most often, after infection, a person with a sufficiently strong immune system easily endures the primary outbreak of an infectious disease, so there is no need for a person with cytomegalovirus to go to the hospital. In such people, after a short manifestation, the set of symptoms that have been created ceases without a trace. As a result, the disease mostly goes unnoticed.

When is cytomegalovirus treatment really necessary?

The specific circumstances under which the attending physician determines the course of treatment of cytomegalovirus infection in adults or in children include such manifestations as:

• The presence of acquired or congenital immunodeficiency in a patient of any age.
• Generalized stage - the widespread spread of the virus is accompanied by a very painful inflammatory process throughout the body or in a certain organ against the background of the presence of other infections that weaken the basic protective functions of the human body.
• Complicated or exacerbated course of cytomegalovirus or preparation for treatment with allogeneic organ transplantation, pneumonia, encephalitis, oncological diseases - when using therapy that severely suppresses the immune system.
• During the first trimester of pregnancy, immunocompromised women may develop primary cytomegalovirus, which can potentially cause extremely severe damage to the fetus, and may also cause miscarriage.

The generalized stage or symptomatic exacerbation of a cytomegalovirus infection is often characterized by the fact that most patients, and even sometimes some doctors, confuse this viral disease due to its similarity with the symptoms of influenza-like diseases or SARS. As well as other infectious diseases. Often this leads to erroneous treatment and a high risk of developing severe complications.

With absolutely accurate differential diagnosis, the treatment for cytomegalovirus will be prescribed to the patient as adequate as possible. And the medicines are prescribed for the right purpose.

Drugs and vitamins for the treatment of cytomegalovirus infection

Let's look at how to treat cytomegalovirus with drugs. The main medications for cytomegalovirus infection and their treatment are divided into several small groups:

• Symptomatic remedies- provide relief, anesthetize, eliminate inflammation, constrict blood vessels (nasal drops, eye drops, painkillers, anti-inflammatory, folk remedies).
• Antiviral drugs- inhibit the activity of the infection (Ganciclovir, Panavir, Cidofovir, Foscarnet).
• Posyndromic drugs- restore damaged organs and tissues in case of complications (capsules, suppositories, tablets, injections, gels, ointments, drops).
• Immunomodulators- strengthen and stimulate the immune system (Leukinferon, Roferon A, Neovir, Genferon, Viferon).
• Immunoglobulins- bind and destroy viral particles (Neocytotect, Cytotect, Megalotect).
• Vitamin and mineral complex- to support the immune system.

In men, cytomegalovirus is treated with antiviral drugs - Foscarnet, Ganciclovir, Viferon. And immunoglobulins - Cytotect, Megalotect.

In women, cytomegalovirus is treated with antiviral drugs - Acyclovir, Viferon, Genferon, Cycloferon.

List of drugs

1. Foscarnet is an antiviral drug. Infectious cytomegalovirus is treated quite successfully with Foscarnet. It is used in severe cases of the disease and in complex forms of possible exacerbations that can be caused by other diseases. It is advisable to use this drug with a weakened immune system in a patient. When the drug enters the diseased cell, the elongation of the viral chain is disrupted, that is, the drug slows down, and then completely stops the active reproduction of the virus.
2. Ganciclovir is an antiviral drug. The drug is one of the most effective, rather difficult in practical use. The remedy is prescribed during the course of the disease - a cytomegalovirus infection, complicated by especially severe organ pathologies, rather extensive inflammations. It is also used to prevent viral infection, congenital CMV infection. Release form - tablets and crystalline powder from the group of polar hydrophilic solvents. For ophthalmic gel or injection, the drug is available as a lyophilisate. The use of Ganciclovir is advisable in the treatment of cytomegalovirus - a herpes infection.
3. Cytotect - immunoglobulin. For many patients, Cytotect seems to be one of the most optimal means for the treatment of cytomegaluvirus. The drug combines a fairly effective efficiency and an almost complete absence of general toxicity and relative contraindications. Prescribed for prophylaxis in patients with suppressed immune system drugs. Prevents mass manifestations of the disease after infection with CMVI. When applied, it can create: headaches; nausea and vomiting; chills and fever; joint pain and mild back pain; sometimes a decrease in blood pressure.
4. Neovir is an immunostimulant. Solution for injection, used as an immunostimulating drug for the treatment and prevention of cytomegalovirus infection in people with immunodeficiency.
5. Viferon is an immunomodulator. Candles with antiviral action. It is used for complications of infectious diseases, for primary inflammation, as well as for recurrence of cytomegalovirus infection of a localized form. The drug is applied rectally. When applied, it can cause an allergic reaction in the form of a skin rash.
6. Bischofite is an anti-inflammatory drug. Produced in the form of a balm (gel) in a tube or in a glass container in the form of a brine. It is applied topically as therapeutic mud or mineral water.

List of vitamins

1. C - Broad spectrum antioxidant. Stimulates the work of cells that eat bacteria and viruses in the blood. Increases the resistance of the human body to various infections through the resistance of cells to the penetration of infectious agents.
2. B9 - for the powerful maintenance of the production factory (bone marrow) of the human body's immune system.

The general rules for the treatment of cytomegalovirus include hospitalization of the patient in cases where it is absolutely necessary. Since during the treatment period the patient appears to be a very active source of viral infection for others, the patient must significantly limit any contact with people. Ensure maximum peace of mind. Provide the best necessary microclimate conditions. Observe strict rules of personal hygiene. Use a therapeutic and preventive diet.

With strict adherence to these rules and all the recommendations of the attending physician, you can rely on a fairly quick and most effective way to get rid of the infection and prevent complications and relapses.

Treatment with folk remedies

If a person heard that people were treated for cytomegalovirus by home medicine, then this is an erroneous idea that, thanks to traditional medicine, it is possible to cope with such a difficult task. Treatment of such an infection and all sorts of complications should not occur on its own without the supervision of a specialist. But it is quite advisable to support the immune system with folk remedies.

Cytomegalovirus infection- a disease caused by cytomegalovirus - a virus from the subfamily of herpes viruses, which also includes herpes simplex viruses 1 and 2, varicella-zoster virus, zoster virus, Ebstein-Barr virus and human herpesviruses types 6,7 and 8.

Prevalence cytomegalovirus infection extremely high. Once entering the body, cytomegalovirus infection does not leave it - most often it exists in a latent form and manifests itself only with a decrease in immunity.

victims cytomegalovirus infection become HIV-infected, as well as people who have undergone transplantation of internal organs or bone marrow and take drugs that suppress the immune response.

However, an acute infectious disease may occur during the initial infection. Often, infection occurs during the neonatal period and early childhood, especially in developing countries, where the prevalence of cytomegalovirus infection among young people is much higher than in developed countries.

The most dangerous intrauterine form of cytomegalovirus infection, which is typical for children whose mothers suffered a primary cytomegalovirus infection during pregnancy. Congenital cytomegalovirus infection often results in developmental delay as well as numerous adverse outcomes, including mental retardation and hearing loss.

How does cytomegalovirus infection occur?

Cytomegalovirus infection not very contagious. Its transmission requires long-term close communication or repeated contacts.

• Airborne: when talking, coughing, sneezing, kissing, etc.
• Sexual way: during sexual contact, the risk of transmission of the virus is very high, since the virus is shed in semen, vaginal and cervical mucus.
• When transfusing blood and its components containing leukocytes.
• From mother to fetus - most often in primary cytomegalovirus infection or reactivation of a latent infection during pregnancy.

How does the cytomegalovirus infection work?

The virus enters the blood of a healthy person and causes a pronounced immune response, which consists in the formation of antibodies - specific protective proteins - immunoglobulins M (Anti - CMV - IgM), as well as the main protective reaction against viruses - cellular.

CD 4 and CD 8 lymphocytes have potent activity against cytomegaloviruses. Therefore, when the cellular immune response is suppressed, for example, in violation of the formation of CD 4 lymphocytes in AIDS, cytomegalovirus infection actively develops and leads to the reactivation of a previously latent infection.

Immunoglobulins M against cytomegalovirus are formed approximately 4-7 weeks after infection and are in the blood for 16-20 weeks. Their detection in the blood during these periods may be evidence of a primary cytomegalovirus infection. Then immunoglobulins M are replaced by immunoglobulins G (Anti - CMV - IgG), which are present in the blood to varying degrees throughout the rest of life.

In most cases, with normal immunity, cytomegalovirus infection is asymptomatic, although it remains in the body for a long time in the form of a latent infection. Where exactly the virus is stored is unknown, it is assumed that it is present in many organs and tissues.

Cells affected by cytomegalovirus have a characteristic appearance - they increase in size (which determined the name of the virus), and under microscopy they look like an "owl's eye".

Even asymptomatic carriers can transmit the virus to uninfected individuals. An exception is the transmission of the virus from the mother to the fetus, which occurs mainly only with an active infectious process, but only in 5% of cases leads to congenital cytomegaly, in the remaining newborns, cytomegalovirus infection is also asymptomatic.

Mononucleosis-like syndrome

Mononucleosis-like syndrome is the most common form cytomegalovirus infection in persons with normal immunity who have left the neonatal period. Mononucleosis-like syndrome in clinical manifestations cannot be distinguished from infectious mononucleosis, which is caused by another herpes virus, the Ebstein-Barr virus.

The incubation period is 20-60 days. The disease proceeds in the form of a flu-like illness:

• Prolonged high fever, sometimes with chills;
• Severe fatigue, malaise;
• Pain in muscles, joints, headache;
• Sore throat;
• Enlarged lymph nodes;
• Rubella-like skin rash is rare, more common with ampicillin treatment.

Sometimes a primary cytomegalovirus infection is accompanied by signs of hepatitis; jaundice is rare, but an increase in liver enzymes in the blood is often present.

Rarely (in 0-6% of cases) mononucleosis-like syndrome is complicated by pneumonia. However, in immunologically healthy people, it is asymptomatic and is detected only on chest X-ray.

The disease continues for 9-60 days. Most patients recover completely, although residual effects in the form of weakness and malaise, sometimes swollen lymph nodes, persist for several months. Recurrent infections with fever, malaise, hot flashes, and sweating are rare.

Congenital cytomegalovirus infection

Intrauterine infection of the fetus is not always the cause of congenital cytomegaly, in most cases it is asymptomatic, and only in 5% of newborns leads to the development of the disease. Congenital cytomegalovirus occurs in newborns whose mothers have had a primary cytomegalovirus infection.

Manifestations of congenital cytomegaly vary widely:

• Petechiae - skin rashes, which are small hemorrhages, occur in 60-80% of cases;
• Jaundice;
• Intrauterine developmental delay, prematurity occurs in 30-50% of cases;
• Chorioretinitis - inflammation of the retina, which often leads to a decrease and loss of vision;

Mortality in congenital cytomegalovirus infection is 20-30%. Most of the children who survive are mentally retarded or hard of hearing.

Acquired cytomegalovirus infection in newborns

When infected with cytomegalovirus during childbirth (during the passage of the birth canal) or after birth (during breastfeeding or normal contact), in most cases the infection remains asymptomatic.

However, some, especially premature and low birth weight infants cytomegalovirus infection manifested by the development of prolonged pneumonia, which is often accompanied by the addition of a concomitant bacterial infection.

In addition, it is possible to slow down physical development, rash, swollen lymph nodes, hepatitis.

Individuals with weakened immune systems

Immunocompromised individuals include:

• individuals with various types of congenital immunodeficiency.
• persons with acquired immunodeficiency syndrome (AIDS).
• persons who have undergone transplantation of internal organs: kidney, heart, liver, lungs, and bone marrow.

The severity of clinical manifestations depends on the degree of immune suppression, however, chronic use of immunosuppressants leads to more severe manifestations.

Cytomegalovirus infection after transplantation:

• Especially often, cytomegalovirus affects the transplanted organs themselves, causing hepatitis in the transplanted liver, pneumonia in the transplanted lungs, etc.
• After bone marrow transplantation, 15-20% of patients develop cytomegalovirus pneumonia, from which 84-88% of patients die.
• The greatest risk of developing cytomegalovirus infection exists if the donor is infected and the recipient is not.

Cytomegalovirus infection in HIV-infected patients:

Cytomegalovirus infection almost all AIDS patients suffer.

• The onset of infection is usually subacute: fever, malaise, night sweats, muscle and joint pain
• Pneumonia - cough, shortness of breath join the initial signs of the disease
• Ulcers of the esophagus, stomach, intestines, which can lead to bleeding and rupture of the wall
• Hepatitis
• Encephalitis is an inflammation of the substance of the brain. May present with AIDS dementia syndrome or cranial nerve damage, drowsiness, disorientation, nystagmus (rhythmic movements of the eyeballs)
• Retinitis, an inflammation of the retina, is a common cause of vision loss in immunosuppressed patients.
• Multiple organ damage is the defeat of almost all organs by the virus, leading to their dysfunction. Often causes death from cytomegalovirus infection.

Prevention of cytomegalovirus infection

Prevention cytomegalovirus infection it is advisable to carry out in people belonging to the risk group. These include HIV-infected persons, especially those with AIDS; persons who have undergone transplantation of internal organs; persons suffering from immunodeficiency as a result of other causes.

Compliance with the rules of personal hygiene, even the most thorough, does not avoid infection with cytomegaloviruses, since viruses are ubiquitous and are transmitted by airborne droplets. Therefore, prophylaxis in patients at risk is carried out with antiviral drugs: ganciclovir, foscarnet, acyclovir.

In addition, to reduce the likelihood of cytomegalovirus infection among recipients of internal organs and bone marrow, careful selection of donors is recommended, taking into account their infection with cytomegalovirus infection.

Diagnosis of cytomegalovirus infection

Laboratory diagnosis of cytomegalovirus infection is based on serological examinations - the determination of antibodies specific for cytomegalovirus in the blood.

• Immunoglobulins M - Anti - CMV - IgM;

They are markers of acute infection: primary cytomegalovirus infection or reactivation of a chronic infection. If high antibody titers are detected in pregnant women, there is a risk of infection of the fetus. Increase only 4-7 weeks after infection. Remain elevated for 16-20 weeks

• Immunoglobulins G - Anti - CMV - IgG;

The titer of this type of immunoglobulin rises already during the period of decrease in the activity of the infectious process. The presence of Anti - CMV - IgG in the blood indicates only the presence of cytomegalovirus in the body, but does not reflect its activity in any way.

• polymerase chain reaction;

PCR is based on the determination of virus DNA in the blood or in mucosal cells (in scrapings from the urethral, ​​cervical canals, as well as in saliva, sputum, etc.). It is recommended to perform a quantitative PCR reaction, which allows you to judge the degree of reproduction of the virus, and hence the activity of the inflammatory process.

Treatment of cytomegalovirus infection

Mononucleosis-like syndrome with an uncomplicated course does not require special treatment. Traditional treatment is enough, as with a common cold. The main thing is not to forget to drink plenty of fluids.

The drug of choice for the treatment of cytomegalovirus infection in patients at risk is ganciclovir (cymeven). For treatment, intravenous forms of the drug are used. Tablets are effective only in relation to prevention.

Side effects of ganciclovir:

• Inhibition of the formation of blood cells (neutropenia, anemia, thrombocytopenia). Develops in 40% of cases.
• Diarrhea (44%), vomiting, loss of appetite.
• Temperature increase (48% of patients), accompanied by chills, sweating.
• Skin itching.

Warnings:

• Ganciclovir is NOT used in people without immune disorders.
• The use of ganciclovir in pregnant women and children is possible only in life-threatening situations.
• Doses should be adjusted in people with impaired renal function.

For treatment, foscarnet is also used, which is considered more effective in patients with HIV infection.

Side effects:

• Electrolyte disorders: decrease in blood potassium and magnesium.
• Ulcers of the genitals.
• Urinary disorders.
• Nausea.
• Kidney damage: the drug is nephrotoxic, therefore, in case of renal failure, careful use and dose adjustment of the drug is necessary.