Cytomegalovirus infection

What is Cytomegalovirus Infection -

Cytomegalovirus infection(Human Cytomegalovirus Infection, CMV infection, cytomegaly, viral disease of the salivary glands, inclusion cytomegaly, disease with inclusions) is an anthroponotic opportunistic infection that usually occurs latently or easily. It is dangerous in various immunodeficiency states and pregnancy (due to the risk of intrauterine infection of the fetus).

As early as 1882, the German pathologist X. Ribbert discovered peculiar giant cells with inclusions in the nucleus in the renal tubules of a stillborn child. Subsequently, they were called cytomegalic cells (Goodpasture E., Talbot F., 1921). Later, L. Smith and W. Rowe (1956) isolated a virus that causes a disease with the development of characteristic cytomegaly. It was named cytomegalovirus (CMV) and the disease itself was called cytomegalovirus infection.

What provokes / Causes of Cytomegalovirus infection:

The causative agent of cytomegalovirus infection- DNA-genomic virus of the genus Cytomegalovirus (Cytomegalovirus hominis) subfamily Betaherpesvirinae of the family Herpesviridae. Three strains of the virus are known: Davis, AD-169 and Kerr. Slow reproduction of the virus in the cell is possible without damaging it. The virus is inactivated by heating and freezing, and is well preserved at room temperature. At - 90 °C, it remains for a long time, is relatively stable at pH 5.0-9.0, and quickly collapses at pH 3.0.

Reservoir and source of infection- a person with an acute or latent form of the disease. The virus can be found in various biological secretions: saliva, nasopharyngeal secretions, tears, urine, feces, seminal fluid, and cervical secretions.

Transmission mechanisms diverse, transmission routes- airborne, contact (direct and indirect - through household items) and transplacental. Infection is possible through sexual contact, during transplantation of internal organs (kidney or heart) and blood transfusion of an infected donor. Intranatal infection of the child is observed much more often than transplacental. The most dangerous for the fetus is infection of the mother in the first trimester of pregnancy. In such situations, the frequency of intrauterine development disorders is highest.

Natural susceptibility of people high, but widespread latent infection. Clinical manifestations of an infection attributed to opportunistic diseases are possible in conditions of primary or secondary immunodeficiency.

The main epidemiological signs of cytomegalovirus infection. The disease is recorded everywhere, its widespread is evidenced by antiviral antibodies detected in 50-80% of adults. The variety of ways of CMV infection and the polymorphism of the clinical picture determine the epidemiological and social significance of CMV infection. This disease plays an important role in transplantation, hemotransfusiology, perinatal pathology, and can be the cause of prematurity, stillbirth, congenital developmental defects. In adults, CMV infection is encountered as a concomitant disease in various immunodeficiency states. Continued environmental pollution, the use of cytostatics and immunosuppressants contribute to an increase in the frequency of CMV infection. In recent years, its exacerbation in HIV-infected people has become especially relevant. In pregnant women with latent CMV infection, fetal damage does not always occur. The probability of intrauterine infection is much higher with the primary infection of a woman during pregnancy. Seasonal or professional features of morbidity have not been identified.

Pathogenesis (what happens?) during Cytomegalovirus infection:

With various transmission routes, the infection gates can be the mucous membranes of the upper respiratory tract, gastrointestinal tract or genital organs. The virus enters the blood; short-term viremia quickly ends with the localization of the pathogen when it invades leukocytes and mononuclear phagocytes, where it replicates. Infected cells increase in size (cytomegaly), acquire a typical morphology with nuclear inclusions, which are accumulations of the virus. The formation of cytomegalic cells is accompanied by interstitial lymphohistiocytic infiltration, the development of nodular infiltrates, calcifications and fibrosis in various organs, glandular structures in the brain.

The virus is able to persist for a long time and latently in organs rich in lymphoid tissue, being protected from the effects of antibodies and interferon. At the same time, it can suppress cellular immunity by direct action on T-lymphocytes. In various immunodeficiency states (in early childhood, during pregnancy, the use of cytostatics and immunosuppressants, HIV infection) and, above all, in violations of cellular immunity, further aggravated by direct exposure to the virus, reactivation of the pathogen and its hematogenous generalization are possible with damage to almost all organs and systems . In this case, the epitheliotropy of the virus is of great importance. It is especially pronounced in relation to the epithelium of the salivary glands, which under the influence of the virus turns into cytomegalic cells.

Active CMV infection is considered as an indicator of defects in cellular immunity and is included in the group of AIDS-associated conditions.

Symptoms of Cytomegalovirus infection:

International Classification of Diseases X revision
International Statistical Classification of Diseases and Related Health Problems 10th Revision Version for 2006 does not classify cytomegalovirus infection as a sexually transmitted infection and distinguishes between the following CMV-related diseases.
B25.0 Cytomegalovirus disease
B25.0 Cytomegalovirus pneumonitis
B25.1 Cytomegalovirus hepatitis
B25.2 Cytomegalovirus pancreatitis
B25.8 Other cytomegalovirus diseases
B25.9 Cytomegalovirus disease, nonspecific
B27.1 Cytomegalovirus mononucleosis
P35.1 Congenital cytomegalovirus infection

Among the various variants of the course of CMV infection, subclinical forms and latent virus carriers predominate. Clinically expressed infection becomes in conditions of immunodeficiency. A unified clinical classification of CMV infection has not been developed. In accordance with one of the classifications, congenital CMV infection is distinguished in acute and chronic forms and acquired CMV infection in latent, acute mononucleosis or generalized forms.

Congenital CMV infection. In most cases, it is not clinically manifested in the early stages of a child's life, however, in the later stages of its development, a variety of pathologies are revealed: deafness, chorioretinitis with atrophy of the optic nerves, decreased intelligence, and speech disorders. However, in 10-15% of cases with congenital CMV infection, the so-called overt cytomegalovirus syndrome develops. Its manifestations depend on the timing of infection of the fetus during pregnancy.

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- In early pregnancy leads to intrauterine death of the fetus or the birth of a child with a variety of malformations: microcephaly, micro- and macrogyria, pulmonary hypoplasia, esophageal atresia, anomalies in the structure of the kidneys, defects in the atrial and interventricular septa, narrowing of the pulmonary trunk and aorta, etc.

When the fetus is infected in late pregnancy malformations are not formed, however, from the first days of life, newborns show signs of various diseases: hemorrhagic syndrome, hemolytic anemia, jaundice of various origins (due to congenital hepatitis, cirrhosis of the liver, atresia of the biliary tract). Various clinical manifestations are possible, indicating the defeat of various organs and systems: interstitial pneumonia, enteritis and colitis, polycystic pancreas, nephritis, meningoencephalitis, hydrocephalus.

- Acute congenital CMV infection with the development of an obvious cytomegalovirus syndrome, it has a tendency to generalization, a severe course with the addition of secondary infections. Death is often inevitable during the first weeks of a child's life.

Chronic congenital CMV infection. Characterized by microgyria, hydrocephalus, microcephaly, clouding of the lens and vitreous body.

Acquired CMV infection.
- In adults and older children in most cases, it proceeds latently in the form of an asymptomatic carriage or a subclinical form with a chronic course.

- Acute form of acquired CMV infection. Often it may not have clear clinical symptoms, sometimes the main clinical manifestations are similar to influenza, infectious mononucleosis or viral hepatitis.

- In immunocompromised adults of varying severity (from physiological immunosuppression during pregnancy to HIV infection), as well as in children under 3 years of age, CMV reactivation manifests itself in the form of a generalized form with various lesions of organs and systems. The process may involve the central nervous system, lungs, liver, kidneys, gastrointestinal tract, genitourinary system, etc. The most commonly diagnosed hepatitis, interstitial pneumonia, enterocolitis, inflammatory processes of various parts of the genital organs (more often in women), encephalitis. With multiple organ lesions, the disease is characterized by a severe course, it can take on the features of sepsis. The outcome is often unfavorable.

Ulcers of the esophagus, stomach, intestines (thick and thin) may develop. Ulcers can lead to bleeding, with perforation, peritonitis develops. Cytomegalovirus hepatitis often develops. In AIDS patients, cytomegalovirus infection often results in chronic encephalitis or subacute encephalopathy. Apathy builds up and after a few weeks or months turns into dementia. Cytomegaly virus can cause the development of retinitis, which leads to blindness in AIDS patients, as well as in people who have undergone organ transplant surgery. Areas of necrosis appear on the retina, which gradually expand.

Eye lesions must be differentiated from similar changes that are observed in toxoplasmosis, candidiasis and herpes infection.

In addition to HIV-infected patients, cytomegalovirus infection is an important pathogenetic factor complicating organ transplantation operations. When transplanting kidneys, heart, liver, cytomegalovirus causes fever, leukopenia, hepatitis, pneumonia, colitis, retinitis. Most often this occurs within 1-4 months after surgery. It should be noted that with primary infection, the complication is more severe than with the activation of a latent cytomegalovirus infection. The severity of the course and clinical manifestations depend both on the degree of immunosuppression and on the immunosuppressant drugs used.

Cytomegalovirus pneumonia develops in about 20% of patients; undergoing bone marrow transplantation. Mortality in this group of patients is 88%. The maximum risk of developing the disease is observed from the 5th to the 13th week after transplantation. More severe cytomegaly occurs in the elderly. In kidney transplant recipients, cytomegalovirus infection can cause graft dysfunction.

- Manifestations of cytomegalovirus infection in pregnant women. In pregnant women, CMVI has various clinical forms. In acute infection, damage to the liver, lungs, and brain can develop. As a rule, patients complain of general malaise, headache, fatigue, mucous discharge from the nose, whitish-blue discharge from the genitals, enlargement and soreness of the submandibular salivary glands. Some characteristic symptoms are manifested in a complex: pronounced hypertonicity of the uterine body, resistant to ongoing therapy, vaginitis, colpitis, hypertrophy, cysts and premature aging of the placenta, polyhydramnios. Against this background, the weight of the fetus often exceeds the gestational age, and there is also an intimate attachment of the chorionic tissue of the placenta, premature detachment of a normally located placenta, blood loss during childbirth, reaching 1% of the woman's body weight, a clinic of latent postpartum endometritis with the development of menstrual disorders in the future.

Most often, cytomegalovirus infection occurs as a latent infection with periodic exacerbations. When making a diagnosis, the results of a laboratory examination are crucial. An auxiliary role is played by the presence of a burdened obstetric history, the threat of termination of a previous pregnancy, premature birth, the birth of sick children with malformations. In women with chronic CMVI, pseudo-erosion of the cervix, endometritis, ovarian dysfunction, extragenital diseases (hepatitis, chronic cholecystitis, pancreatitis, urolithiasis, chronic sinusitis, pneumonia, chronic diseases of the submandibular and parotid salivary glands) are more often noted.

Any manifestations of CMV infection are considered as indicative of HIV infection. In this case, it is necessary to examine the patient for antibodies to HIV.

Complications of cytomegalovirus infection
Complications are varied and depend on the clinical course of the disease: interstitial or segmental pneumonia, pleurisy, myocarditis, arthritis, encephalitis, Guillain-Barré syndrome, but they are relatively rare. After the acute phase, asthenia persists for many weeks, sometimes vegetative-vascular disorders.

Diagnosis of Cytomegalovirus infection:

Differential diagnosis of CMV infection rather difficult due to the absence or variety of clinical manifestations.

For diagnosis of CMV infection it is necessary to use 2-3 laboratory tests at the same time. Examine saliva, washings obtained during bronchopulmonary lavage, urine, cerebrospinal fluid, blood, breast milk, sectional material, biopsy specimens. Due to the thermolability of the virus, the material for research must be delivered to the laboratory no later than four hours from the time of sampling.

The examination is carried out by virological, cytological, serological methods. Detection of specifically altered CMB cells is the most accessible method, however, its informative value is 50-70%. The most reliable detection in the material of the virus itself or its DNA. The virological method is still the gold standard. It is the most reliable, but its implementation requires a significant amount of time, so the retrospective nature of the diagnosis does not allow for adequate therapy and prevention.

For diagnosis, it is not necessary to isolate the virus itself, it is enough to isolate its antigen. For this, immunofluorescence reaction (RIF), enzyme immunoassay (ELISA), DNA-CMV hybridization, polymerase chain reaction (PCR) are widely used.

PCR method due to its high sensitivity, it detects even a segment of CMV DNA and is considered very progressive. Its most important advantage is the ability to diagnose early stages of the process, latent and persistent infections, but it has two significant drawbacks. Firstly, low predictive value due to the fact that PCR detects virus DNA even in a latent state. Secondly, this method is not specific enough.

In recent years, the most widespread ELISA method, which allows the detection of CMV antigen and specific antibodies of classes G and M. The detection of IgG is of secondary importance. It should be carried out simultaneously with the detection of IgM, especially for the diagnosis of primary infection. With a single detection of IgG, analysis of their level of avidity (ability to retain antigen) can help in differentiating between active and persistent infection.

It must be borne in mind that specific antibodies may not be detected in persons with reduced immunity, with protein starvation, etc. The determination of IgG must be carried out in paired sera with an interval of at least 10 days.

The recurrent form of CMVI is diagnosed when the virus is re-isolated in seropositive individuals.

The diagnosis of intrauterine CMVI is established during the first three weeks of life. The presence of IgM in a newborn up to two weeks of life indicates an intrauterine infection, after - an acquired one.

Affinity and avidity of antibodies
The importance of diagnosing primary cytomegalovirus infection in pregnant women has led to the study of the properties of antibodies produced by the body in response to infection.

Two main properties of antibodies have been established:
Affinity - the degree of specific affinity of an antibody for the antigen of the pathogen
Avidity - the degree of strength of binding of an antibody molecule to an antigen molecule

A close relationship between them has been established, the higher the affinity, the stronger the antibody binds to the antigen (higher avidity). Degrees of affinity and avidity make it possible to determine the age of class G antibodies and use it to judge the duration of infection and the course of the infectious process (latent course, relapse). The primary phase of infection is judged by the presence of virus-specific IgM antibodies, the period of presence of which in the body in the body is several weeks - months. An increase in IgG levels occurs within a few weeks. Initially, low-affinity antibodies are formed, which are formed during the active reproduction of the virus in the body and persist for up to 1.5 months. from the onset of the disease. Further, the body produces high-affinity IgG antibodies that persist for a long time. High-affinity antibodies remain in the body for a long time, providing immunity from infection.

To distinguish between primary and latent infection, avidity of class G antibodies. If low avid IgG is detected in the blood, this indicates a primary infection. Detection of highly avid G antibodies indicates a latent or past infection. If highly avid G and IgM antibodies are present in the body, then reactivation of a latent infection or re-entry of the virus into the body can be assumed. speaks of a secondary immune response in the event of a pathogen entering the body or exacerbation (reactivation).

In quantitative terms, the so-called avidity index is determined.

Avidity index up to 30% indicates the presence of low-avid antibodies and, accordingly, a primary infection, 30-40% indicates a late stage of a primary infection or a recent infection, an index over 40% indicates a long-standing infection.

Treatment of cytomegalovirus infection:

Treatment of cytomegalovirus infection presents certain difficulties, since interferon and many antiviral agents (acyclovir, vidarabine, virazole) were ineffective, and in some cases their use causes paradoxical reactions. Ganciclovir slows down the development of cytomegalovirus retinitis, but has little effect on lesions of the lungs, brain, and gastrointestinal tract. Foscarnet has certain prospects. Perhaps the use of anticytomegalovirus hyperimmune human immunoglobulin. For the treatment of women with a burdened obstetric history, it is proposed to prescribe immunomodulators (levamisole, T-activin).

Mononucleosis-like forms of infection do not require specific treatment.

For the treatment of severe forms of CMVI in immunocompromised individuals and intrauterine CMVI in newborns, ganciclovir is used. It connects to the virus reproduction cycle and interrupts it. After the abolition of ganciclovir, relapses are possible. The drug has a number of side effects in the form of neutropenia, thrombocytopenia, liver and kidney damage, so it is prescribed to children for health reasons. Treatment is carried out under the control of a blood test every two days.

The appointment of interferons is considered effective.

At the present stage, it is important to combine antiviral drugs with interferons, which contributes to the elimination of CMV (combination of acyclovir with a-interferon), and also mutually potentiates the antiviral effect, reduces the toxicity of drugs (ganciclovir with interferon inducers, its most successful combination with amixin). At the same time, drugs are prescribed to correct immune dysfunction.

Specific anticytomegalovirus immunoglobulin is administered intramuscularly in 3 ml daily for 10 days. It contains 60% CMV-specific antibodies.

Nonspecific immunoglobulins for intravenous administration (Sandoglobulin) are prescribed for the prevention of CMVI in immunocompromised individuals. Their effectiveness is lower than specific immunoglobulins.

Effective for the prevention of CMVI in seronegative recipients is the use of immunoglobulins in combination with acyclovir or valaciclovir.

Vaginally use 0.25% bonafton, oxolinic, rhyodoxol, 0.5% tebrofen, florenal, 1% interferon, 3-5% acyclovir ointment 3-5 times a day for 12-15 days (ointments must be changed every 10-14 days).

For the treatment of the oral cavity, the same preparations are used in the form of solutions, as well as 0.5% atonium, 1:5000 furatsilin, 1-5% aminocaproic acid; with fungal complications - 1% iodinol and 0.25% rhyodoxol ointment.

With retinitis, CNS lesions, pneumonia in immunocompromised individuals, ganciclovir or foscarnet are most effective, the course of treatment is 14-21 days.

Prevention of Cytomegalovirus infection:

Specific prophylaxis not developed. When transfusing blood, you should use the blood of healthy donors that do not contain antibodies to CMV, this also applies to transplantation of internal organs. Prophylactic use of specific hyperimmune immunoglobulin in risk groups (recipients of bone marrow, heart, kidneys and liver; patients receiving cytostatic drugs, pregnant women) is shown. In the prevention of congenital infection, the prevention of contacts between pregnant women and patients, strict adherence to the anti-epidemic regime in obstetric institutions is of great importance. Children born to mothers with CMV infection who do not show signs of infection should not be breastfed. In the case of the birth of a child with CMV infection, a second pregnancy can be recommended no earlier than after 2 years.

Measures to prevent CMV infection in pregnant women
No measures can completely eliminate the risk of infection, but following these rules will reduce the likelihood of CMV infection.

1. Wash your hands thoroughly with soap for 15-20 minutes, especially after changing diapers (pampers) for infants
2. Never kiss children under 5 on the lips.
3. Set aside separate dishes and cutlery for yourself and small children
4. If you work in children's institutions (nurseries, kindergartens), take a vacation during pregnancy or drastically limit contact with children.

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Cytomegalovirus in newborns is quite common. Infection occurs during fetal development or after childbirth. Only in 10-15% of cases, signs of the disease appear in babies immediately after birth. Children with asymptomatic cytomegalovirus syndrome are born clinically healthy. It is possible to detect an active form of cytomegalovirus infection in them only after a laboratory test. The sooner you take therapeutic measures against the congenital form of the disease, the better the result will be.

What is cytomegalovirus infection

(cytomegaly) is a viral disease caused by human cytomegalovirus (CMV) from the herpesvirus family. It mainly affects the salivary glands (especially the parotid). In the most severe form, the pathological process spreads to other organs - the lungs, liver, kidneys, adrenal glands, intestines, esophagus, pancreas, retina, and even the brain. Weak and premature babies have internal bleeding and cell death in the body.

Under the action of the virus, cells grow, which increase to gigantic sizes (30–40 times). A dense large intranuclear inclusion appears inside them. It makes the cell look like an owl's eye.

The virus is most dangerous for the fetus at the stage of embryonic development, if the pregnant woman was first infected with cytomegalovirus. Due to the absence of antibodies to the causative agent of the disease in the expectant mother, an unattenuated virus infects the embryo and disrupts its formation. The virus is also serious for the fetus at a later stage of development. Cytomegalovirus is able to overcome the placental barrier and affect the health of the child. During the primary infection of a pregnant woman, infection of the fetus occurs in 40–50% of cases.

1. If a woman is not infected with the virus for the first time, her antibodies weaken the pathogens and reduce their aggressive effect on the fetus. In such cases, the risk of infection of the child is no more than 1-2%.
2. The likelihood of infection is increased by constant stress, malnutrition, a sedentary lifestyle and chronic diseases.
3. The insidiousness of cytomegalovirus infection lies in its ability to proceed hidden or disguise itself as an acute respiratory viral infection. For this reason, the disease in pregnant women is often not diagnosed.

The detection of antibodies to CMV in newborns does not indicate their infection. Transfer of antibodies can be carried out through the placenta from mother to fetus during pregnancy. The diagnosis of cytomegalovirus infection is made by identifying pathogens in urine, blood and saliva.

Congenital cytomegalovirus infection

If a woman was infected with the virus in the first twelve weeks of pregnancy, pathogens can cause spontaneous abortion or fetal death. The embryo has serious developmental disorders that are incompatible with life. If the fetus manages to survive, the virus causes severe defects in it. Some of them are classified as genetic (Dandy-Walker syndrome).

The most serious malformations occur in children if a pregnant woman is diagnosed with cytomegaly for the first time. As a result of the infection, children develop microcephaly (a decrease in the brain), hepatosplenomegaly (an enlargement of the spleen and liver), thrombocytopenia (a decrease in the number of platelets, causing a decrease in blood clotting), and prolonged jaundice (hyperbilirubinemia).

The infection affects the nervous system of the fetus, provoking severe diseases (the debut of the episyndrome and treatment-resistant epilepsy, non-occlusive hydrocephalus, cerebral palsy, autism). In some cases, cytomegalovirus infection in newborns can cause deafness, visual impairment and mental retardation.

But most often the infection causes damage to the brain. With a congenital form of cytomegalovirus infection, meningoencephalitis (inflammation of the membranes and substances of the brain), pathology of the brain ventricles, calcifications (salt deposits in soft tissues) and "calcification" of the cerebral vessels (mineralization vasculopathy) are diagnosed. All these pathologies are accompanied by neurological disorders (cerebral changes, hypertensive-hydrocephalic syndrome). Mineralization vasculopathy often causes convulsive syndrome in the newborn.

1. A common manifestation of cytomegalovirus infection is the blockade of the CSF pathways.
2. It is diagnosed in 7% of cases when the brain is damaged by a viral infection.
3. The virus infects the choroid plexus of the ventricles of the brain and causes the appearance of cysts in it.

If infection occurred in the second and third trimester of pregnancy, the virus can provoke hemorrhagic syndrome, hemolytic anemia, cirrhosis of the liver, interstitial pneumonia, enteritis, colitis, polycystic pancreas and nephritis.

Acquired form of cytomegalovirus infection

Immediately after birth, a newborn in 30% of cases is infected with cytomegalovirus from its mother through biological fluids containing the virus (saliva, breast milk, urine, genital discharge, blood). The baby can also get infected from other people.

According to pediatrician Yevgeny Komarovsky, if a child has a well-developed immune system, pathogens are unable to cause serious illness in him. Premature babies, as well as babies with immunodeficiency, are vulnerable to the virus. They may develop productive peribronchitis or lingering pneumonia.

Sometimes, after infection with cytomegalovirus, weak infants have enlarged lymph nodes, hepatitis develops. In the kidneys, cytomegalic changes in the tubular epithelium may appear. The virus can cause ulcers in the intestines of a child. Such children are difficult and take a long time to recover. They often lag behind in development.

Babies with an acquired form of cytomegalovirus infection do not develop brain damage.

Acute congenital disease

Congenital cytomegalovirus infection can occur in acute and chronic forms. In the acute course of the disease, the first signs of the disease appear immediately after the birth of the child or during the first 24 hours.

The baby's body temperature rises. Bluish-violet spots become noticeable on the face, body and limbs. The infant may develop bleeding into the mucous membranes and blood in the stool (hemocolitis). Sometimes blood continues to ooze from the umbilical wound. The yellowness of the skin will indicate developing hepatitis.

If the brain is affected in newborns, they may experience convulsive syndrome from the first hours of life. It lasts up to 5 days or more. Trembling of the upper extremities occurs against the background of increased drowsiness.

Acute congenital cytomegalovirus infection can manifest as impaired coordination, hearing, and vision. Sometimes it causes blindness. The baby often develops pneumonia. Weak immunity and the addition of another acute infection can lead to the death of a newborn.

Chronic congenital disease

The chronic form of cytomegalovirus infection can be manifest and asymptomatic. Symptoms of the manifest course of the disease are manifested in the form of visual impairment. Clouding of the lens and vitreous body cause deterioration or complete loss of visual perception. An infant has hydrocephalus, epilepsy, microgyria (structural abnormalities in the cerebral cortex), microcephaly, or signs of cerebral palsy.

A baby with a chronic form of cytomegalovirus infection lags behind in development and gains weight poorly. At an older age, speech defects and mental retardation are found.

It is not always diagnosed in the first weeks after the birth of the baby. Therefore, the treatment of the disease is sometimes started too late. Early diagnosis and timely therapy can prevent visual impairment, stop the progression of epilepsy, hydrocephalic syndrome and other pathologies. In most cases, developmental delays can be avoided. Children with autism who have received adequate treatment are able to study in ordinary comprehensive schools.

The most difficult thing is to detect a latent form of chronic cytomegalovirus infection in a newborn. These babies do not show any visible signs of the disease. If laboratory tests were not carried out after the birth of the child, infection will not be detected for a long time.

A characteristic sign of defeat by cytomegalovirus is a tendency to bacterial infections. Often in the first year of a child's life, diseases of bacterial origin overcome. He is diagnosed with pyoderma (purulent skin lesions), recurrent stomatitis, otitis, sinusitis, bronchitis, pneumonia, cystitis, pyelonephritis. In some cases, symptoms of cytomegalovirus infection are detected only at school age.

Vaccinations are contraindicated for such children. Vaccination can give them autism, epilepsy, cerebral palsy, or mental retardation.

Treatment of a viral disease

Currently, with cytomegalovirus infection in newborns, injections of immunoglobulin into a vein are prescribed. Immediately after birth, the infant is injected with Cytotect hyperimmune immunoglobulin. The drug contains 10 times more than other immunoglobulins. It is made from the blood of donors who have a large number of antibodies produced by the body. "Cytotect" also contains antibodies to microbial pathogens that most often affect newborns in the postpartum period.

A significant improvement in the infant's condition is observed 7-8 days after the administration of Cytotect. The blood actively produces its own anti-cytomegalovirus and anti-herpetic antibodies.

Antibiotics are used to treat diseases caused by bacteria. Most often, a combined preparation with a wide spectrum of bactericidal action "Sulperazon" is prescribed to newborns. It contains 3rd generation cephalosporins (cefoperazone and sulbactam). "Sulperazon" is administered first intravenously, and then intramuscularly. The course of treatment is 8-14 days. In order for the baby to recover faster, he is also protected from other infections.

It is hardly possible to meet a person who would never be sick in his life. Sometimes it is difficult to determine the cause of poor health. Under the common cold, pathogens of a wide variety of ailments, including CMV (cytomegaloviruses), are masked.

Cytomegalovirus is a member of the human herpesvirus family. Many are familiar with the disgusting "fever" on the lips. It is caused by the simplexvirus, the cousin of CMV. A distinctive feature of CMV from its brethren is that it affects the internal organs of a person - the kidneys, heart, liver.

A person can be a carrier of the virus for a long time without realizing it. It would seem that if there is no cause for concern, then why is CMV under such scrutiny of scientists? And the thing is that everyone's susceptibility to the virus is different. If for some people the causative agent of cytomegalovirus infection is just an uninvited guest, then for others it can lead to disability and even death.

Who is he?

So, the “culprit” of cytomegalovirus infection is human CMV from the herpesvirus family. It spreads throughout the body, but still the main refuge of the pathogen is the salivary glands.

The geography of the virus is vast: it has been found in absolutely all regions of our planet. Carriers can be people of any socioeconomic group. But the virus is still more common among people of low social status, as well as those living in poor developing countries.

Cytomegalovirus has a complex structure and belongs to human herpesviruses type 5

According to statistics, from 50% to 100% of people (depending on the region) are infected with CMV. This is indicated by antibodies found in the blood of earthly inhabitants. The virus can enter the human body at any time during its life. People with reduced immunity are especially susceptible to infection:

• -infected;
• Taking drugs that weaken the immune response;
• Have undergone a bone marrow or internal organ transplant.

Cytomegalovirus can be both a consequence and a cause of a decrease in immunity.

A more dangerous form of CMV infection is intrauterine.

Possible modes of CMV transmission

CMV infection is not very contagious. To acquire the virus, numerous contacts or long-term close contact with the virus carrier are necessary. Nevertheless, most of the inhabitants of the Earth are infected with it.

The main ways of infection:

1. Sexual. The virus is concentrated in semen, vaginal and cervical mucus.
2. Airborne. Transmitted by coughing, sneezing, talking, kissing.
3. Transfusion of blood or its components that contain leukocytes.
4. Organ transplantation from infected donors.
5. To the fetus from an infected mother.

We are all in a society of our own kind who cough and sneeze, are born to infected women, have multiple sexual partners, receive blood and organs from donors or become one themselves. Therefore, 90 percent can be assumed to have a probability of detecting CMV in a smear, blood, breast milk, saliva, etc.

What is important is not the detection of the virus at all, but the detection of its active form. A sleeping dog, until awakened, is not dangerous. The pathogen “wakes up” only when conditions favorable for it appear in the body.

Options for the development of infection

1) In people with normal immunity

"Uninvited guests" can go unnoticed for a long time. Sometimes there are symptoms resembling SARS. The first signs of the disease appear 20–60 days after the introduction of the virus into the body. But there is a global difference between CMVI and a respiratory disease: if ARVI disappears in the worst case in a week, then a cytomegalovirus infection can remind of itself for a month or more. And the symptoms, at first glance, are very similar:

• Runny nose;
• elevated temperature;
• Weakness;
• Enlarged lymph nodes;
• Headache;
• Chills;
• Inflammation of the joints;
• Enlargement of the liver and spleen;
• The appearance of a rash on the skin.

It should be emphasized that all these manifestations are a normal immune response to CMV activity. After all, elevated temperature is fatal for the virus. And the sites of inflammation are the last refuge of DNA particles. If you completely get rid of the symptoms, the disease becomes protracted. It is necessary to deal with the consequences of infection only in case of their dangerous development.

Good immunity contributes to the formation of antiviral antibodies in the blood, which leads to a quick recovery. However, viruses have been found in human biological fluids for a long time. For many years, pathogenic pathogens are in the body in an inactive form. Their sudden disappearance is also not ruled out.

2) People with weak immune systems

Weak immunity is a paradise for a “sleeping” virus. In such an organism, he does whatever he wants. The disease in patients with reduced immunity can occur with varying degrees of severity. Complications are possible in the form of:

1. Pleurisy;
2. pneumonia;
3. Arthritis;
4. Damage to internal organs;
5. Myocarditis;
6. encephalitis;
7. Vegetative disorders.

Sometimes there may be:

• Eye diseases;
• Inflammatory processes of the brain (up to death);
• Paralysis.

In women, the disease is manifested by erosion of the cervix, inflammation of the genitourinary system. If a woman is pregnant at the same time, then there is a real threat to the fetus. In men, the urethra, testicular tissue may be affected.

But all these complications appear rarely - mainly in people with a reduced immune response.

3) Congenital CMV infection

If during pregnancy (in the first trimester) the fetus becomes infected, a miscarriage may occur. At a later date, cytomegaly develops. It manifests itself in prematurity, pneumonia, enlarged liver, kidney, spleen. Developmental delay, hearing and vision impairment, and dental anomalies may occur.

Diagnostic methods

For the diagnosis of CMVI, the patient's complaints, signs of the disease and the results of laboratory analysis are studied. To make a diagnosis, several laboratory tests are performed at the same time. Researched:

1. Saliva;
2. Liquor;
3. Wash water obtained as a result of lavage of the bronchi and lungs;
4. Biopsies;
5. Urine;
6. Breast milk;
7. Blood;

It is important that no more than four hours elapse from sampling to the start of the study.

Main research methods:

• Detection of antibodies to cytomegalovirus ().

The most accessible laboratory technique is seeding. It does not require sophisticated equipment. With the help of the sowing method, not only the presence of a pathogenic pathogen is determined, but also its type, degree of aggressiveness, form. A very useful addition to the study is the testing of medicinal preparations directly on the colonies of the resulting culture. After all, each case of infection is individual.

The most sensitive method is PCR (polymerase chain reaction). It detects even a small piece of DNA.

The advantage of the PCR technique is to detect infection:

1. Early;
2. Persistent;
3. Latent.

Disadvantages of the technique:

1. Low predictive value;
2. Little specificity.

Last time ELISA method is often used(enzymatic immunoassay). With its help, the CMV antigen is detected, as well. If class M antibodies were detected as a result of a blood test, then a conclusion is made about the primary infection. With intrauterine infection, IgM antibodies are detected in the first 2 weeks of a child's life. A subsequent positive test indicates an acquired infection.

The appearance of IgG antibodies indicates a past illness. What is the standard for this indicator? The presence of an IgG titer in the blood is already the norm, since almost all people sooner or later encounter such a virus. In addition, the presence of antibodies indicates a good immune response - the body reacted to the introduction of the virus and defended itself.

ELISA algorithm for suspected CMV

More accurate is quantitative analysis. Caution should be taken to the growth of IgG titer, which may indicate the progression of pathology. It is important to diagnose the infection as quickly as possible, to identify the stage of the disease, its form and the duration of the infection process.

It should be noted that M and G class antibodies are not always detected. They may not be found in the blood of immunosuppressed patients.

How to treat CMVI?

Unfortunately, it is impossible to completely destroy viruses in the body.. Yes, and it is not necessary. 95% of earthlings have CMVI pathogens, and many people simply do not notice them. They do not notice while the CMV is “sleeping”. And in order to “wake them up”, you have to try very hard - to reach the extreme degree of beriberi, protein starvation or catch HIV.

Treatment of cytomegalovirus infection is required in its active form. But it consists, first of all, in the correction of the immune system. After all, it is in people with a weakened immune response that CMV “wakes up” and begins to destroy the body.

In what cases is treatment prescribed?

• With primary infection with pronounced symptoms of pathology;
• When an immunodeficiency state is detected;
• Pregnant or planning pregnancy in case of primary infection or in case of exacerbation of the disease.

Treat CMV infection strictly according to indications. The detection of a virus in the body cannot be the basis for drug therapy. Self-medication with medicines is unacceptable!

Antiviral drugs may be prescribed, such as ganciclovir, foscarnet, famciclovir. However, they have a hepatotoxic effect and are poorly tolerated by patients. They should not be given to infants and pregnant women. Therefore, funds from the interferon group are more actively used: roferon, intron A, viferon.

To prevent relapses are prescribed panavir and neovir.

In the treatment of CMVI, immunoglobulin enriched with antibodies to this pathogen can be prescribed. Such drugs include cytotect, neo-cytotec.

In case of severe symptoms - pneumonia, encephalitis - a complex of therapeutic measures is carried out aimed at eliminating these symptoms.

Video: cytomegalovirus in the program “Live healthy!”

The specifics of the development of CMVI in children

Most often, the first meeting of a person with CMV occurs in childhood. This does not always happen during fetal development. The child grows up among numerous virus carriers, communicates with children and adults. Avoiding infection in such conditions is almost impossible.

But it's even good. Babies, having met with pathogenic factors in early childhood, acquire immunity to them.

Only 15% of healthy children show symptoms of cytomegalovirus infection. There may be various signs of discomfort.

How to determine the infection in newborns?

Often the baby is born outwardly healthy, without any symptoms of infection. Sometimes there are some temporary signs that pass safely.

Manifestations and complications of CMVI and in general in newborns

Temporary symptoms include:

1. Reduced body weight;
2. Pathological changes in the spleen;
3. Bluish rash on the skin;
4. Liver damage;
5. Jaundice;
6. Lung diseases.

However, a small number of newborns have more persistent disorders that may remain for life.

Common symptoms of CMV include:

• visual impairment;
• Mental retardation;
• Small head;
• Poor coordination of movement;
• Hearing loss.

Sometimes persistent symptoms of CMV show up after several years.

In newborns, the disease is a little different than in older children and adults. Severe symptoms appear in less than 20% of infants. And only a quarter of them require therapeutic treatment.

Any of the manifestations is a reason to visit a pediatrician. Symptoms usually resolve without treatment, but complications do occur, albeit rarely.

Why is CMVI dangerous for children?

The most vulnerable categories for CMVI are newborns with immature immunity, as well as children with immunodeficiency.

The most severe consequences of infection in these children:

1. CNS damage. There are signs of encephalitis: convulsions, increased drowsiness. Hearing damage (up to deafness) is possible.
2. Chorioretinitis is an inflammatory eye disease. The retina is predominantly affected. May lead to blindness.
3. Cytomegalovirus pneumonia. It is considered the main cause of death in immunocompromised patients.
4. Severe encephalitis can lead to the death of a child.

The virus poses a threat to children with leukemia and other cancers, as well as those preparing for organ transplants. Such children must be diagnosed with CMVI. Especially the study is necessary for exacerbation of symptoms of infection.

How to prevent the development of CMV infection in children?

After reading this article, no need to run to the pharmacy for antiviral drugs for parents of healthy children! Only babies with a low immune response should be protected from CMV. If the mother was diagnosed with primary infection, then it is she who should take immunoglobulins. And breast milk transports them to the baby's body.

But still, nothing better has been invented yet than the development and maintenance of children's own immunity through hardening, physical activity, eating vegetables and fruits. For children leading a healthy lifestyle, a pathogenic pathogen that enters the body is not terrible.

Video: pediatrician about cytomegalovirus infection

(other name - CMV infection ) is an infectious disease that belongs to the family herpesviruses . This virus infects a person both in utero and in other ways. So, cytomegalovirus can be transmitted sexually, by airborne droplets through the alimentary route.

According to the existing statistical study, antibodies to cytomegalovirus are found in approximately 10-15% of adolescents. Already at the age of 35, the number of such people increases to 40%.

Cytomegalovirus was discovered by scientists in 1956. A feature of this virus is its affinity for the tissues of the salivary glands. Therefore, if the disease has a localized form, then the virus can be detected exclusively in these glands. This virus is present in the human body for life. However, cytomegalovirus is not highly infectious. As a rule, in order to become infected with the virus, prolonged and repeated contacts, close communication with the carrier are necessary.

Today, there are three groups of people for whom control over the activity of cytomegalovirus is a particularly topical issue. These are pregnant women, people who have recurrent herpes and patients with compromised immune responses.

Causes of cytomegalovirus

A person can become infected with cytomegalovirus in many ways. So, infection can occur by contact, through the use of infected things, in the process of organ transplantation, as well as blood transfusion from a donor previously infected with cytomegalovirus. The disease is transmitted, moreover, through sexual intercourse, by airborne droplets, during pregnancy, in utero and during childbirth. The virus is found in blood, saliva, breast milk, semen, and secretions from the female genital organs. But the virus that enters the human body cannot be recognized immediately, because in this case the duration of the incubation period is about 60 days. These days, the virus may not appear at all, but after the incubation period, the onset of the disease occurs abruptly. Hypothermia and the subsequent decrease in immunity become factors provoking cytomegalovirus. Symptoms of the disease are also manifested due to stress.

Symptoms of cytomegalovirus

If the virus enters the body, then the restructuring of the immune system begins in it. And after the acute phase of the disease is over, the manifestation of vegetative-vascular disorders and asthenia for a long time is possible.

In people with immunodeficiency (people who have undergone chemotherapy, HIV-infected people, and people undergoing immunosuppressive therapy for organ transplants), the presence of cytomegalovirus can provoke the manifestation of very serious diseases. The lesions that occur in such patients can be fatal.

Diagnosis of cytomegalovirus

When diagnosing, one should take into account the fact that the presence of cytomegalovirus can only be detected in the case of special studies of urine, saliva, blood, semen, as well as smears from the genital organs during primary infection with the disease or during an exacerbation of the infection. If the virus is detected at another time, then this is not decisive for diagnosis.

After this infection enters the body, it begins to produce - antibodies to cytomegalovirus. They stop the development of the disease, as a result of which it is asymptomatic. In the course of a laboratory blood test, such antibodies can be detected. However, a single identification of antibody titer does not make it possible to distinguish between a current infection and a past one. Indeed, in the body of the carrier of the virus, both cytomegalovirus and antibodies are constantly present. In this case, antibodies do not prevent infection, and immunity to cytomegalovirus is not produced. In case of ineffective diagnosis, the patient must be tested again after a few weeks.

Treatment of cytomegalovirus

If a person is diagnosed with cytomegalovirus, the treatment of the disease will be aimed at strangling all forms of manifestation of the disease and eliminating unpleasant symptoms. After all, today doctors do not have a tool that destroys the virus in the human body completely.

If symptoms do not appear in patients who have been diagnosed with cytomegalovirus, treatment of the disease is not required. After all, this indicates the normal immunity of the virus carrier.

If a virus is detected in the blood, in this case, therapy involves supporting and strengthening the immune system. Therefore, it is necessary to carry out immunomodulatory, as well as restorative treatment. Vitamin complexes are also prescribed.

In the treatment of cytomegalovirus in children and adults, it is important to use an integrated approach to prescribing therapy. As a rule, the treatment is prescribed to take drugs with antiviral and immune effects. With the right approach to treatment, the body's defenses are activated, and the activation of the latent form of the disease is further controlled.

It is very important to undergo all the necessary examinations and timely determine the exacerbation of the disease during . Accordingly, if a cytomegalovirus is detected in a pregnant woman, the treatment is selected taking into account all the individual characteristics of her body. If the case is severe, it is sometimes recommended to resort to termination of pregnancy. Such a conclusion is based on information obtained as a result of virological studies, clinical indications, ultrasound of the placenta and fetus.

Treatment aimed at maintaining immunity includes procedures to strengthen and harden the body. So, bath procedures are often recommended in this case, and those who have some training can periodically bathe in ice water.

There are many medicinal herbs, decoctions of which stimulate the improvement of the general condition of the body. The use of herbs with a choleretic effect is suitable: dog rose, corn stigmas, immortelle, yarrow. You can rinse your mouth with a weak solution .

The doctors

Medications

Prevention of cytomegalovirus

Prevention of cytomegalovirus is mainly in the careful observance of the rules of both personal and sexual hygiene. It is important to exercise due care when coming into contact with infected people. Care should be taken most carefully during pregnancy: in this case, casual sexual intercourse should not be allowed. Another important point in the issue of the prevention of cytomegalovirus is the support of immunity. You should lead a physically active life, eat right, walk in fresh clean air, take vitamins, and avoid stressful situations. Children need to be taught to the right way of life and hygiene from the first years of life.

Cytomegalovirus in children

When children are infected with cytomegalovirus, the incubation period can last from 15 days to 3 months or even more. Allocate congenital and acquired cytomegalovirus infection. Very often, cytomegalovirus in children occurs without severe symptoms. In the congenital form of the disease, the fetus becomes infected during fetal development, becoming infected from the mother. From the mother's blood, the virus enters the placenta, after which it enters the blood of the fetus and then penetrates into the tissue of the salivary glands. If the fetus was infected in the early stages of pregnancy, it may die. Otherwise, the child is born with a number of severe defects. So, cytomegalovirus in children can cause microcephaly , , as well as other brain pathologies with subsequent development mental retardation . Perhaps the birth of children with pathology of the cardiovascular system, gastrointestinal tract, lungs, respiratory tract. Also, cytomegalovirus in children causes convulsions , .

If the infection of the child occurred at a later date, then the newborn does not have pronounced defects, however, the disease is expressed by severe jaundice , the child's spleen and liver are enlarged, damage to the lungs and intestines is possible.

If there is an acute course of cytomegalovirus infection, then the newborn has a number of symptoms: poor appetite, fever may rise, the child is not gaining weight well, has an unstable stool. Possible hemorrhagic rashes on the skin. After a certain time, due to poor recruitment, it develops anemia , hypotrophy . In general, a very severe course of cytomegalovirus infection is noted, and as a result, it often ends in the death of a child in the first month of life.

If the disease is chronic or asymptomatic, then the child's condition remains satisfactory.

With the acquired form of the disease, the child becomes infected during childbirth, or gets an infection already in the first days of life during contact with the carrier of the infection.

There are two options for the course of cytomegalovirus in children in this case: either the salivary glands are affected in isolation, or several or one organ is affected. As symptoms, the child manifests a high temperature, an increase in lymph nodes both on the neck and in other places. The mucous membrane of the pharynx swells, the tonsils, spleen, liver increase. The child refuses to eat, the stool is disturbed - either diarrhea appears. Lesions of the lungs, gastrointestinal tract, yellowness of the sclera, trembling of the extremities are manifested. Possible and sepsis , but the effect of therapy with antibacterial drugs is not manifested. The course of the disease is long, the diagnosis, as a rule, is difficult to establish, because cytomegalovirus is sometimes not detected in the blood and saliva.

Also, when a child is infected with cytomegalovirus, cytomegalovirus hepatitis . Such children are born with severe hemorrhagic syndrome and a number of malformations described above. Very often, the course of the disease ends in death.

Cytomegalovirus in pregnant women

However, the most serious complications of this disease occur in women who are expecting a baby. Cytomegalovirus and pregnancy is a rather dangerous combination, because infection with this disease sometimes even leads to premature birth. It is cytomegalovirus that is one of the most frequently manifested causes of abortion.

In addition, a child of a sick mother can be born with low body weight, as well as with serious damage to the lungs, liver and central nervous system. Cytomegalovirus and pregnancy is a risk that the child may not survive at all. So, according to various estimates, 12–30% of such newborns die. In children who survived, in about 90% of cases, a number of late complications are observed: they can lose their hearing, sometimes there are speech disorders, and optic nerves atrophy.

Therefore, a very important step is the screening for the presence of cytomegalovirus infection in the process of planning the birth of a child. If you correctly approach the use of both therapeutic and preventive measures, then the negative impact of cytomegalovirus on the course of pregnancy and the likelihood of manifestation of pathologies in a child can be prevented.

Diet, nutrition with cytomegalovirus

List of sources

• Krasnov V.V., Malysheva E.B. Cytomegalovirus infection. Nizhny Novgorod: Publishing House of NGMA, 2004;
• Isakov, V.A., Arkhipova E.I., Isakov D.V. Human herpesvirus infections: a guide for physicians. - St. Petersburg: Special Lit., 2006;
• Samokhin P.A. Cytomegalovirus infection in children. - M.: Medicine, 1987;
• Borisov L.B. Medical microbiology, virology, immunology: M.: Medical Information Agency LLC, 2002.

The name of the virus is due to the fact that when cells are infected with a virus, they increase in size (translated as giant cells).

Depending on the state of the immune system, infection with cytomegalovirus can cause various changes: from an asymptomatic course and a mild mononucleosis-like syndrome to severe systemic infections affecting the lungs, liver, kidneys and other organs.

Causes of the disease

Cytomegalovirus is ubiquitous. Infection can occur through close contact with a carrier of infection or a sick person. The virus is released into the environment with various human biological fluids: saliva, urine, feces, breast milk, semen, vaginal discharge. The routes of transmission include airborne, food, sexual. A newborn baby can become infected from the mother through breast milk. It should be noted the vertical route of transmission of infection from mother to fetus during. When the fetus is infected, a very serious disease, congenital cytomegaly, can develop.

Infection can also occur during blood transfusion (in Russia, donor blood is not tested for the presence of cytomegalovirus) and during organ transplantation from a donor with CMV infection.

Once infected with cytomegalovirus, a person usually remains a carrier of this infection for life.

Symptoms of CMV infection

Distinguish how many variants of the course of CMV infection.

1) CMV infection in individuals with normal immunity.
Most often, primary infection is manifested by a mononucleosis-like syndrome. The incubation period is 20-60 days, the duration of the disease is 2-6 weeks. As a rule, there is fever, weakness, swollen lymph nodes,. With a sufficient immune response, the body produces antibodies against the virus and the disease ends in self-healing. Isolation of viruses in body fluids continues for months and years after recovery. After primary infection, cytomegalovirus can be in the body for decades in an inactive form or spontaneously disappear from the body. On average, 90-95% of the adult population has class G antibodies to CMV.

2) CMV infection in immunocompromised individuals (patients with lymphoproliferative diseases, hemoblastoses, HIV-infected patients, patients after transplantation of internal organs or bone marrow).

In such patients, generalization of the infection may occur, the liver, kidneys, lungs, retina, pancreas and other organs are affected.

3) Congenital cytomegalovirus infection.

Intrauterine infection of the fetus for up to 12 weeks, as a rule, ends; if infected after 12 weeks, the child may develop a serious illness - congenital cytomegaly. According to statistics, about 5% of newborns infected in utero suffer from congenital cytomegaly. Its symptoms include prematurity, enlargement of the liver, kidneys, spleen, pneumonia. In children who have had intrauterine CMV infection and avoided the generalization of the process, psychomotor developmental delay, hearing loss, visual impairment, and anomalies in the development of teeth may be detected.

Diagnostics

The diagnosis of CMV infection is based on the clinical picture and laboratory research methods.

Laboratory methods for the identification of cytomegalovirus include:

• virus isolation in cell culture;
• cytological examination (light microscopy) - detection of specific giant cells with intranuclear inclusion;
• enzyme immunoassay (ELISA) - detection in the blood of specific antibodies to cytomegalovirus classes M and G;
• polymerase chain reaction - allows you to determine the DNA of cytomegalovirus in any biological tissues.

Treatment of cytomegalovirus

Virus carrying and mononucleosis-like syndrome in persons with normal immunity does not require treatment.

Immunocompromised individuals are tried to transfuse blood products and transplant organs from CMV-negative donors.

The main prevention of fetal infection is a test for the presence of cytomegalovirus infection before pregnancy. Antiviral therapy during pregnancy is not used, as it is toxic and has a potential risk to the fetus. If a woman has a cytomegalovirus infection confirmed by laboratory methods, pregnancy is permissible only against the background of achieving a stable remission.