Cytomegalovirus infection in children

Cytomegalovirus infection in children (cytomegalovirus) is a viral disease with polymorphic clinical symptoms that occurs due to the formation of giant cells with typical intranuclear and cytoplasmic inclusions in the salivary glands, visceral organs and 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, other sections of ICD-10 classify cytomegalovirus mononucleosis (B27.1) and congenital cytomegalovirus infection (P35.1).

What causes cytomegalovirus infection in children?

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

Symptoms of cytomegalovirus infection in children

If infection occurs in the early stages of pregnancy, fetal death and spontaneous abortion are possible, and the teratogenic effect of cytomegalovirus (malformations) cannot be ruled out. There are microcephaly, microgyria, hydrocephaly, disruption of the architectonics of the brain tissue with the development of oligophrenia. Damage to the cardiovascular system is manifested by non-closure of the interventricular and interatrial septa, endocardial fibroelastosis, malformations of the aortic valves, pulmonary trunk. Malformations of the gastrointestinal tract, kidneys, lower limbs, lungs and other organs are described.

When infected in late pregnancy, there are usually no developmental defects. In these cases, the disease manifests itself immediately after birth, the first signs of the disease may be jaundice, hepatosplenic syndrome, lung damage, gastrointestinal tract, hemorrhagic manifestations.

Classification of cytomegalovirus infection in children

A distinction is made between congenital and acquired cytomegaly.

• Congenital cytomegalovirus is often generalized, with damage to many organs and systems.
• Acquired cytomegalovirus in young children occurs as a mononucleosis-like syndrome, sometimes with predominant damage to the lungs, gastrointestinal tract, 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, acute and chronic cytomegalovirus are distinguished according to the course.

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Diagnosis of cytomegalovirus infection

Diagnosis during life is difficult. Urine and saliva tests for cytomegaloviruses sometimes give a positive result. In such cases, sepsis is suspected, and patients receive intensive antibacterial therapy without noticeable effect. For diagnosis, it may be important to detect lymphocytosis in the patient, rather than neutrophilia, as is typical for bacterial sepsis. ESR is often normal or moderately elevated. Of decisive importance for diagnosis is the detection of viral DNA in the blood, cerebrospinal fluid, saliva and urine, and the detection of specific IgM to cytomegalovirus (anti-CMV IgM) in the blood serum.

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Treatment of cytomegalovirus infection in children

Treatment of cytomegalovirus infection in children involves the use of a number of drugs. These medications are prescribed depending on which organ has been affected by the virus (viral hepatitis, gastroenteritis, etc.). Generalized cytomegalovirus infection in children is treated by prescribing the following drugs:

• intravenous specific neocytotect at a rate of 2 ml/kg per course of treatment;
• ganciclovir at a rate of 5-10 mg/kg per day in 2 doses for 10 days or longer;
• cycloferon at the rate of 10 mg/kg;
• glucocorticoids at 2-5 mg/kgprednisolone per day for 10-15 days.

Prevention of cytomegalovirus infection in children

It is important to observe personal hygiene rules when caring for newborns. It makes sense to test all pregnant and sick women registered at the antenatal clinic for cytomegalovirus. It is especially important to test women who had acute respiratory infections during pregnancy, as well as newborns with jaundice or toxic-septic disease. To prevent parenteral infection, it is advisable to use blood and its components only from seronegative donors for blood transfusions or transfuse washed erythrocytes, as well as blood free of leukocytes. When transplanting organs, it is necessary to test donors for antibodies to cytomegalovirus and not allow transplantation of organs from seropositive individuals to seronegative recipients.

Live and killed vaccines have been proposed for active prevention, but they have not found practical application.

What is the prognosis for cytomegalovirus infection in children?

With congenital cytomegaly, it is often unfavorable. Cytomegalovirus infection in children can be fatal, and if they survive, CNS dysfunctions are possible in the form of decreased intelligence, deafness, central paralysis, microcephaly, hypo- and hyperkinesia, oligophrenia, etc. Even children with asymptomatic congenital cytomegaly may have decreased intelligence: they may lag behind in school, complain of fatigue, insomnia, headaches, etc.