Cytomegalovirus infection in children

Cytomegalovirus infection in children (cytomegaly) is a viral disease with polymorphic clinical symptoms that results from the formation of giant cells with typical intranuclear and cytoplasmic inclusions in the salivary glands, visceral organs and the central nervous system.

ICD-10 code

• 825.0 Cytomegalovirus pneumonia.
• 825.1 Cytomegalovirus hepatitis.
• 825.2 Cytomegalovirus pancreatitis.
• 825.8 Other cytomegalovirus diseases.
• 825.9 Cytomegalovirus disease, unspecified.

In addition, in other sections of ICD-10, cytomegalovirus mononucleosis (B27.1) and congenital cytomegalovirus infection (P35.1) are classified.

What causes cytomegalovirus infection in children?

The causative agent of cytomegalovirus infection in children is the DNA-containing virus of the Herpesviridae family . By morphology is similar to the herpes simplex virus, it is well cultivated in the culture of human embryo fibroblasts. When multiplying in a cell, viruses exert a cytopathic effect with the formation of giant cells due to an increase in the nucleus and cytoplasm. In patients with cytomegaly, virus-containing cells can be found in saliva, urine sediment, cerebrospinal fluid, and also in affected organs.

Symptoms of cytomegalovirus infection in children

If infection occurs in the early stages of pregnancy, fetal death and spontaneous miscarriage are possible, and teratogenic effects of cytomegalovirus (developmental defects) are not ruled out. There are microcephaly, microgyria, hydrocephalus, a violation of the architectonics of the substance of the brain with the development of oligophrenia. The defeat of the cardiovascular system is manifested by the non-separation of interventricular and interatrial septa, endocardial fibroelastosis, malformations of the aortic valves, pulmonary trunk. Described the malformations of the gastrointestinal tract, kidneys, lower extremities, lungs and other organs.

When infection in the late stages of pregnancy, developmental malformations usually do not happen. The disease in these cases manifests itself immediately after birth, the first signs of the disease may be jaundice, hepatolienal syndrome, lung damage, gastrointestinal tract, hemorrhagic manifestations.

Classification of cytomegalovirus infection in children

Distinguish the congenital and acquired cytomegaly.

• Congenital cytomegaly is often generalized, with the defeat of many organs and systems.
• Acquired cytomegaly in children of early age proceeds according to the type of mononucleoside-like syndrome, sometimes with predominant lesion of the lungs, GIT, liver or as a generalized form.

Both congenital and acquired cytomegalovirus infection in children can remain asymptomatic. The ratio of manifest and asymptomatic forms is 1:10. In addition, the acute and chronic cytomegalia are distinguished along the course.

[1], [2], [3], [4]

Diagnosis of cytomegalovirus infection

Intravital diagnosis is difficult. The study of urine and saliva on cytomegaloviruses sometimes gives a positive result. In such cases, sepsis is presumed, in connection with which patients receive intensive antibiotic therapy without noticeable effect. For diagnosis, it may be important to detect the patient's lymphocytosis, rather than neutrophilia, as is characteristic of bacterial sepsis. ESR is often normal or moderately elevated. The detection of DNA of the virus in the blood, cerebrospinal fluid, saliva and urine, the detection of specific IgM to the cytomegalovirus (anti-CMV IgM) in the blood serum is crucial for the diagnosis.

[5], [6], [7], [8], [9], [10], [11]

Treatment of cytomegalovirus infection in children

Treatment of cytomegalovirus infection in children is the use of a number of drugs. Assign these drugs, depending on which body was affected by the virus (viral hepatitis, gastroenteritis, etc.). Generalized cytomegalovirus infection in children is treated with the use of the following drugs:

• intravenous specific neocytotect at a rate of 2 ml / kg per course of treatment;
• Ganciclovir from the calculation of 5-10 mg / kg per day in 2 doses for 10 days and longer;
• tsikloferon from the calculation of 10 mg / kg;
• glucocorticoids 2-5 mg / kg per day for prednisolone for 10-15 days.

Prevention of cytomegalovirus infection in children

It is important to observe the rules of personal hygiene when caring for newborns. It makes sense to examine for cytomegaly all pregnant and sick women who are registered in the women's consultation. It is especially important to examine women who have undergone ORZ during pregnancy, as well as newborns with jaundice or toxic-septic disease. To prevent parenteral infection for blood transfusions, it is advisable to use blood and its components only from seronegative donors or to transfuse washed erythrocytes, as well as blood released from leukocytes. When transplanting organs, it is necessary to examine donors for antibodies to cytomegalovirus and prevent organ transplants from seropositive persons from seronegative recipients.

Live prophylaxis and killed vaccines are offered for active prophylaxis, but they have not received any practical application.

What prognosis does cytomegalovirus infection have in children?

With congenital cytomegaly often unfavorable. Cytomegalovirus infection in children can end fatal, and in the course of survival, there may be abnormalities in the function of the central nervous system in the form of a decrease in intelligence, deafness, central paralysis, microcephaly, hypo- and hyperkinesia, oligophrenia, etc. Even in children with asymptomatic congenital cytomegalization, in school, complain about fatigue, insomnia, headaches, etc.