Cytomegalovirus

Table of contents:

Definition. Causes of the disease

How is it transmitted?

Development

Symptoms

Mononucleosis-like syndrome

Pathogenesis

Routes of infection

Classification and stages

Complications

Diagnostics

About IgM and IgG antibodies

Treatment

Forecast. Prevention

Literature

Belonging to the herpes family of viruses, it was discovered relatively recently – in 1956. However, doctors have accumulated sufficient data to manage cytomegalovirus infection and maintain and restore patient health. It is quite common, so the public should be informed about how infection occurs, the threat it poses, and the preventative measures to take.

Clinical laboratory studies are ongoing. It is hoped that the global medical community will eventually develop effective preventative measures through immunization. And there is hope that a complete cure will one day be possible.

Definition. Causes of the disease

This is an infectious disease of viral etiology, also known as CMV infection. It is found in tears, urine, saliva, and semen. This explains its rapid spread. Full recovery from infection is impossible. The virus settles in the body and remains with the person forever. However, the carrier may not always realize they are infected. The infection may not manifest itself for years or may never manifest.

In many older people, it is discovered accidentally: for example, during a comprehensive medical examination or preoperative preparation. According to statistics, positive laboratory test results are recorded in 90-91% of cases in people over 80.

The virus persists in leukocytes, brain cells, lungs, liver, and other organs. Due to the wide range of symptoms, it’s not always possible to suspect the development of cytomegalovirus. However, when pathological changes, nervous system damage, or complicated clinical features are detected, doctors begin a differential diagnosis and accurately identify the causative agent.

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Etiology

Belongs to the Herpesviridae family. Species: Cytomegalovirus hominis, subfamily Betaherpesvirinae.

The virus is believed to have significantly influenced the development of immune functions in modern humans. Its structure is heterogeneous and can demonstrate its pathogenicity and virulence in different ways. Compared to other viruses, it has a large nucleocapsid diameter (up to 180 nm). It contains DNA, a double-stranded system (B and H units), and an outer glycoprotein envelope.

Due to its polyotropism, cytomegalovirus can affect tissues without causing cell death or changes in their chromosomal composition.

Epidemiology

It is transmitted only from person to person, either from an infected person or a carrier. Various strains have been identified, but their clear clinical differences are currently unknown.

Up to 80% of pregnant women are carriers of cytomegalovirus. Globally, infection rates reach 88-95%. These figures vary across continents and regions.

How is it transmitted?

Main routes of transmission:

• airborne: the herpes virus can be transmitted by sneezing, coughing, accidental contact with saliva, or by kissing (even briefly, on the cheek or forehead);
• sexual route: penetrates through sperm, vaginal-cervical mucus;
• hemotransfusion: during organ transplantation, skin transplantation, blood transfusion, leukocyte mass, individual components;
• transplacental: transmitted from the expectant mother to the fetus during the intrauterine stage;
• fecal;
• alimentary (when breastfeeding).

It can be transmitted both within a family and from strangers. Outside the human body, CMV can remain viable on surfaces for several days.

Development

After infection, the incubation period ranges from 20 to 60 days. After this period, acute symptoms may appear within 2 to 5 weeks. However, this is not always the case. There may be no symptoms—the disease can remain latent for years or even decades. If the immune system is able to suppress the activity of herpes viruses, they tend not to manifest any activity. However, when the immune system is weakened, they suddenly awaken and attempt to demonstrate their destructive power.

The risk of relapse remains throughout life.

Symptoms

Distinguishing the acute phase of cytomegalovirus infection from other infectious diseases is quite difficult. The symptoms are similar, and it is impossible to differentiate the pathology based solely on clinical signs. However, when collecting a medical history, an experienced physician may be alerted to characteristic symptoms at onset:

• high temperature;
• chills;
• headache;
• general malaise;
• cough;
• weakness and fatigue.

The common nature of CMV means that many people remain unaware of their infection for years. Only logically specific symptoms, such as skin ulcers, can raise doubts.

Congenital form

If the virus is transmitted from the mother, the child usually shows signs in the first month of life:

• trembling of the limbs;
• visual impairment;
• fever;

Babies may be restless, frequently sick, and gain weight slowly. Later, problems with mental development and learning disabilities may be observed.

Acquired form

It often proceeds asymptomatically or is mildly symptomatic. Many experience a typical acute respiratory infection, with no debilitating symptoms. Mild weakness, fever, sore throat, and runny nose disappear within 7-15 days. It feels like a common cold.

Rarely observed:

• prolonged fever;
• enlargement of the salivary glands, the appearance of pain in the area of ​​their projection;
• enlargement of the cervical and submandibular lymph nodes, the appearance of pain in the area of ​​their projection;
• headaches;
• discomfort in the hypochondrium and abdomen;
• severe weakness;
• liver enlargement and skin rash.

Hemogram parameters change. Pathological abnormalities are often detected in liver function tests.

Mononucleosis-like syndrome

The temperature rises to 38.0°C, the infected person experiences weakness, and the lymph nodes become swollen. If further diagnostics are performed, an enlarged liver and spleen are detected, and laboratory virus tests come back positive.

Symptoms in men and women

There are no key differences. The method of infection, the patient’s age, or gender make no difference.

The only differences may be in the specific way the genitals are affected. In 20% of cases, women experience no changes in the genital area. In 27-30% of carriers, itching, discomfort, and possibly questionable vaginal discharge are observed.

In men, the testicles and prostate are targeted.

Cytomegalovirus infection in pregnant women

Despite the fact that the expectant mother’s body becomes more sensitive, cytomegalovirus does not always show its aggressiveness and attack vulnerable areas.

If the infection occurred before conception, several scenarios are possible, ranging from asymptomatic progression to severe complications. The patient is monitored by a gynecologist in conjunction with an infectious disease specialist or immunologist until successful delivery.

If CMV enters the fetus after conception, the outlook is less optimistic. The risk of spontaneous miscarriage is high, and the risk of developing birth defects increases. The kidneys, heart, hearing organs, lungs, and brain of the fetus are all targets. Neuropsychiatric abnormalities are often discovered later in life.

Symptoms of chronic disease

As the severity subsides, the disease becomes more subdued, often leading to the development of vascular-vegetative disorders and associated complications. The patient may not always notice the connection between cytomegalovirus infection and subsequent disorders and dysfunctions. Therefore, regular medical observation is recommended – follow-up visits with a doctor are recommended even when nothing serious seems to be happening.

Possible scenarios:

• inflammatory process in the cavities of the kidneys, spleen, adrenal glands, liver, pancreas;
• bronchitis and pneumonia: in this case, antibiotic therapy does not produce the desired result and is less effective than expected;
• damage to the intestinal walls: this may lead to gastrointestinal dysfunction;
• enlargement of the salivary glands;
• vascular disorders in the cavity of the eyeball;
• vascular lesions of the head;
• uncontrollable skin rash;
• nonspecific inflammation in the organs of the genitourinary system.

Periodically, whitish spots may appear on the tongue, and the tonsils may enlarge. The infected person’s condition worsens as the body cools and its barrier functions weaken.

Cytomegalovirus infection in immunocompetent individuals

A healthy person’s immune system is capable of acting in their best interests and fighting foreign attacks. The stronger the immune system, the greater the likelihood of asymptomatic infection.

The exception is specific studies to detect herpes viruses and antibodies.

If there is a history of AIDS…

Cytomegalovirus infection is almost always severe, with complications. These include:

• renal failure;
• dementia;
• retinal necrosis leading to blindness;
• pneumonia and pneumonitis;
• lesions of the oral cavity, esophagus;
• intestinal dysfunctions and disorders;
• splenomegaly;
• hepatitis;
• heart failure.

The prognosis is often unfavorable. The body’s strength diminishes, and multiple organ failure often occurs. The risk of death reaches its maximum.

And how are the kids?

At first, everything looks like an acute respiratory infection: a sore throat, a runny nose, fever, and chills. Subsequently, mental and central nervous system disturbances, enlarged lymph nodes, and hemorrhagic rashes may occur. The child lags behind in psychodevelopment and may be lethargic, inactive, and passive.

Almost one in five infected children experiences severe and complex health problems. Parents can spend years treating these underlying conditions, complaining of relapses and lack of desired results.

Pathogenesis

The mucous membrane acts as the portal of entry. The respiratory tract, oropharynx, genitourinary structures, and gastrointestinal tract are most commonly affected.

There are no obvious changes in the site of entry. CMV begins to affect monocytes and lymphocytes. The attacked cells acquire a so-called “owl’s eye” appearance. Immature virions form in the nucleus, cell size increases two- to fourfold, and several immune systems become depressed.

The immune system mounts a protective response. Antibodies are produced, and killer T-cells are activated. Pathological cells are not killed; they continue to function, producing a mucus-protein secretion. This masks the viral “settlement,” causing the disease to become chronic and latent.

Routes of infection

It is found in breast milk in 20-60% of cases.

In saliva – 20-30%, in urine – 3-9%, in sperm – up to 35%, in donor blood – about 1%, in the cervical canal and vaginal secretions – up to 20%.

Classification and stages

According to ICD, the following types are distinguished:

• 8 Other cytomegalovirus diseases.
• 2 Cytomegalovirus pancreatitis.
• 1 Congenital cytomegalovirus infection.
• 1 Cytomegalovirus hepatitis.
• 1 Cytomegalovirus mononucleosis.
• 9 Cytomegalovirus disease, unspecified.
• 0 Cytomegalovirus pneumonitis.

By severity:

• mild (asymptomatic);
• moderate (with partial manifestation of symptoms);
• severe (complicated).

Acquired cytomegalovirus is divided into:

• latent;

Congenital cytomegalovirus can be acute or chronic.

Cytomegalovirus disease in patients with HIV status was classified separately.

Complications

These include myocarditis, pneumonia, encephalitis, and arthritis. Nerve damage often leads to mental disorders later in life. Other complications are also possible, and the disease can develop into a fatal outcome.

Diagnostics

A comprehensive examination is required. Cytomegalovirus testing alone is not sufficient to provide an objective health assessment.

At the initial stage the following is prescribed:

• clinical blood test (characteristic: increased ESR, neutropenia, leukocytosis, leukopenia, as well as thrombocytopenia, monocytosis, lymphocytosis);
• determination of the level of IgM antibodies and IgG antibodies;
• biochemical studies: determine the levels of ALT and AST, transaminase indicators, GGT, alkaline phosphatase, etc.;
• PCR tests to determine the phase;
• cytological tests.

The doctor will develop a program of additional examinations on an individual basis. These may include ECG, EEG, ultrasound, CT, MRI, gastroscopy, colposcopy, and other procedures.

About IgM and IgG antibodies

After infection, IgM antibodies begin to be produced within 4-7 weeks. This is a very characteristic reaction, providing unambiguous information: this is not just an infection, but active viral replication. This means that the disease is either onset or relapses.

Subsequently, after recovery, the titer decreases—this occurs within a year. Eventually, it disappears completely.

As viral activity subsides, the level of IgG antibodies increases.

What do cytomegalovirus antibody test results mean?

IgM antibodies:

• if the indicator is normal: there was no infection or there is a long-term remission;
• If the indicator is elevated, then we can say that the virus entered more than 4 weeks ago and has been in the acute stage for no more than 15-20 weeks.

Antibodies IgG:

• If the indicator is normal, then two scenarios are possible: a relapse or the person is not infected;
• If the indicator is elevated, this indicates the body’s ability to cope with attacks: the immune system has coped, and the disease has become latent.

Diagnostics are mandatory for both adults and children!

Treatment

The choice of treatment strategy and the development of a treatment program are the responsibility of an immunologist, infectious disease specialist, or pediatrician. In cases of complicated clinical presentation, the patient is monitored by a gynecologist, ophthalmologist, otolaryngologist, pulmonologist, rheumatologist, or other specialist.

Treatment for asymptomatic cases

A watchful waiting approach is chosen. This means the doctor monitors the patient’s health and orders follow-up tests. As the disease progresses, a decision is made about targeted therapy.

Therapy for mild cases

Hospitalization is not required. A healthy lifestyle, a healthy diet, and cessation of unhealthy habits are recommended. Hardening, vitamin supplements, moderate physical activity, and sunbathing may also be recommended. Supporting the immune system can significantly reduce the risk of progression to a more severe stage.

In some cases, symptomatic therapy is administered to help the patient recover more quickly and return to their normal routine. Typically, even exercise is permitted at this stage. There are no universal recommendations; in any case, it is necessary to consult a doctor for expert advice.

Treatment of moderate and severe forms

Specialists may decide to hospitalize the child. This is especially true for children. Pediatricians immediately refer the child to a specialized hospital for a treatment program and subsequent monitoring with the participation of several pediatric specialists.

For moderate and severe forms, specialists take a comprehensive approach. The main goals are:

• suppression of CMV activity (taking antiviral drugs);
• normalization of the functioning of internal organs and systems (hepatoprotectors, cardiac medications, etc. are prescribed as indicated);
• elimination of symptomatic manifestations (antipyretics, antitussives and other medications may be prescribed);
• prevention of complications (immunomodulators, targeted drugs, etc. are effective);
• prevention of dangerous consequences.

Due to the high risk of disability, the patient is monitored even after the main symptoms have subsided. A temporary improvement in well-being does not necessarily mean the danger has passed.

Drug therapy

Etiotropic therapy is administered to reduce the potential of CMV infection, weaken it, suppress it, and eliminate its circulation. A wide range of antiviral medications is available. The doctor can select the medication that will provide the best therapeutic effect with minimal side effects.

The following may also be prescribed:

• means for relieving symptoms (for example, if there are skin reactions or gastrointestinal disorders);
• antibiotics (if there are concomitant diseases);
• general tonics (immunomodulators, vitamins, etc.).

It’s important to remember that it’s impossible to eradicate cytomegalovirus from the body. But that doesn’t mean you shouldn’t do anything. Quite the contrary. You need to adapt to the situation, pay special attention to your health, and get regular checkups and tests. After infection, you can maintain your previous standard of living!

Diet

A switch to Diet No. 5 is recommended. It involves eating healthy, low-calorie, easily digestible foods and avoiding fried, spicy, and fatty foods. Irritating foods (fast food, smoked meats, etc.) should be kept to a minimum. This helps maintain the function of the liver, pancreas, intestines, and other organs.

You can consult a nutritionist or gastroenterologist about this issue. Never rely on advice on the internet! There’s a lot of misinformation out there!

Outpatient observation

To prevent delayed effects, the patient is monitored until remission is achieved. After that, if there is no deterioration, a medical examination is sufficient. Follow-up appointments should be made according to the doctor’s instructions.

Forecast. Prevention

The prognosis is uncertain. There is no immediate risk if health is monitored. However, various risks may arise during pregnancy, including stillbirth, miscarriage, and others. Therefore, the prognosis depends largely on how well the pregnancy was prepared and whether the conception was planned.

Prevention. Complete protection is impossible. Even with a relatively isolated lifestyle and good personal hygiene, there are no guarantees.

To prevent infection during donation, the task is to strictly select the donor and conduct a thorough examination of the donor material.

Additional recommendations:

• Use condoms during sexual intercourse (including with a regular partner). A partner may be unaware that they are a carrier and may transmit the infection unintentionally.
• If indicated, administer antiviral therapy and strengthen the immune system with immunomodulators to restore protective functions.
• Regular hand washing, use of personal hygiene products.
• Use of antiseptic compounds when visiting public places.

A doctor will develop a list of preventative measures on an individual basis. You can receive personalized recommendations by scheduling a consultation with specialists at the Ramsey Diagnostics Clinic. We provide expert care: we have all the necessary capabilities for the early detection of cytomegalovirus and for providing treatment and recovery. We treat, monitor, and control—you can trust us completely!

Literature

• Kosugi I. Cytomegalovirus (CMV). Virus 2010; 60(2).
• Shakhgildyan V. I. Cytomegalovirus infection in “Viral diseases: a tutorial / edited by N. D. Yushchuk. Moscow: GEOTAR-Media, 2016.
• Skvortsov V. V., Myazin R. G., Emelianov D. N. Cytomegalovirus infection in the clinic of internal diseases. Attending physician 2004; 9.
• Cunha BA Cytomegalovirus pneumonia: community-acquired pneumonia in immunocompetent hosts. Infect. Dis. Clin. North Am. 2010; 24 (1).
• Vikulov G. Kh. Human herpesvirus infections in the new millennium: classification, epidemiology, and medical and social significance. Epidemiology and infectious diseases. Current issues. 2014.
• Kisteneva L. B., Martynov K. A., Khizhnyakova T. M., et al. Cytomegalovirus infection in pregnant women. Diagnosis and interpretation of examination results. Issues of Virology. 2003.