Cytomegalovirus infection: symptoms

The incubation period of cytomegalovirus infection is 2-12 weeks.

[1], [2], [3], [4], [5], [6], [7]

The main symptoms of cytomegalovirus infection and the dynamics of their development

With congenital cytomegalovirus infection, the nature of the affected fetus depends on the duration of infection. Acute cytomegalovirus infection in the mother during the first 20 weeks of pregnancy can lead to severe fetal pathology, resulting in spontaneous abortion, fetal death, induction, blemishes that are in most cases incompatible with life. When infection with cytomegalovirus in late pregnancy, the prognosis for life and normal development of the child is more favorable. The expressed symptoms of cytomegalovirus infection in the first weeks of life have 10-15% of infected newborns with cytomegalovirus. The manifestation of congenital cytomegalovirus infection is characterized by hepatosplenomegaly, persistent jaundice, hemorrhagic or spotted-papular rash, severe thrombocytopenia, increased ALT activity and direct bilirubin level in the blood, increased hemolysis of erythrocytes. Infants are often born prematurely, with a deficiency of body weight, signs of intrauterine hypoxia. The pathology of the central nervous system is typical in the form of microcephaly, less often hydrocephalus, encephaloventriculitis, convulsive syndrome, hearing loss. Cytomegalovirus infection is the main cause of congenital deafness. Possible enterocolitis, pancreatic fibrosis, interstitial nephritis, chronic sialadenitis with fibrous salivary glands, interstitial pneumonia, optic nerve atrophy, congenital cataracts, and generalized organ damage with development of shock. DIC-syndrome and the death of a child. The risk of death in the first 6 weeks of life of newborns with clinically expressed cytomegalovirus infection is 12%. About 90% of surviving children suffering from manifest cytomegalovirus infection have long-term consequences of the disease in the form of reduced mental development, sensorineural deafness or bilateral hearing loss, impaired speech perception with hearing loss, convulsive syndrome, paresis, and loss of vision. With intrauterine infection with cytomegalovirus, an asymptomatic form of infection with a low activity level is possible, when the virus is present only in urine or saliva, and a high degree of activity if the virus is detected in the blood. In 8-15% of cases, antenatal cytomegalovirus infection, without manifesting a clear clinical symptomatology, leads to the formation of late complications in the form of hearing impairment. Reduced vision, convulsive disorders, delayed physical and mental development. The risk of developing a disease with CNS damage is the persistent presence in the whole blood of cytomegalovirus DNA in the period from the moment of the birth of the child to 3 months of life. Children with congenital cytomegalovirus infection should be under medical supervision for 3-5 years, as hearing impairment can progress in the first years of life, and clinically significant complications persist even 5 years after birth.

In the absence of aggravating factors, intranatal or early postnatal cytomegalovirus infection is asymptomatic, manifested clinically only in 2-10% of cases, more often in the form of pneumonia. Preterm weakened children with low birth weight, infected with cytomegalovirus during labor or during the first days of life through blood transfusions, already by the 3rd to 5th week of life a generalized disease develops, manifestations of which are pneumonia, prolonged jaundice. Hepatosplenomegaly, nephropathy. Bowel disease, anemia, thrombocytopenia. Cytomegalovirus infection has a long-term recurrence. The maximum lethality from cytomegalovirus infection falls on the age of 2-4 months.

Symptoms of cytomegalovirus infection acquired in older children and adults depends on the form of infection (primary infection, reinfection, reactivation of the latent virus), ways of infection, the presence and severity of immunosuppression. Primary infection of immunocompetent persons with cytomegalovirus usually proceeds asymptomatically and only in 5% of cases in the form of a mononucleoside syndrome, the distinguishing features of which are high fever, pronounced and prolonged asthenic syndrome, in the blood - relative lymphocytosis. Atypical lymphocytes. Angina and enlarged lymph nodes are not characteristic. Infection with a virus through blood transfusions or transplantation of an infected organ leads to the development of an acute form of the disease, including high fever, asthenia, sore throat, lymphadenopathy, myalgia. Arthralgia, neutropenia, thrombocytopenia, interstitial pneumonia, hepatitis, nephritis and myocarditis. In the absence of pronounced immunological disorders, acute cytomegalovirus infection becomes latent with a lifelong presence of the virus in the human body. The development of lmunosuppression leads to the resumption of cytomegalovirus replication. The appearance of the virus in the blood and the possible manifestation of the disease. Repeated exposure to the virus in the human body against the background of immunodeficiency can also cause viremia and the development of clinically pronounced cytomegalovirus infection. With reinfection, the manifestation of cytomegalovirus infection occurs more frequently and proceeds more severely than when the virus is reactivated.

For cytomegalovirus infection in lmunosuppressive individuals, the development of the disease is gradual for several weeks, the symptoms of cytomegalovirus infection appear in the form of rapid fatigue, weakness, loss of appetite, significant weight loss, prolonged wave-like fever of the wrong type with a rise in body temperature above 38.5 C, nights, arthralgia and myalgia. This complex of symptoms is called "CMV-associated syndrome". In young children, the onset of the disease can occur without pronounced initial toxicosis at normal or subfebrile temperature. With cytomegalovirus infection, a wide spectrum of organ damage is associated, lungs are among the first to suffer. There is gradually increasing dry or unproductive cough, mild dyspnea, the symptoms of intoxication increase. X-ray signs of pulmonary pathology may be absent, but during the height of the disease, two-sided small-focal and infiltrative shadows, located mainly in the middle and lower parts of the lungs, are often identified against the background of a deformed intensified pulmonary pattern. When untimely diagnosis is possible, development of respiratory failure, respiratory distress syndrome and death. The degree of lung damage in patients with cytomegalovirus infection varies from minimally pronounced interstitial pneumonia to common fibrosing bronchiolitis and alveolitis with the formation of bilateral polysegmentary lung fibrosis.

Often, the virus affects the digestive tract. Cytomegalovirus is the main etiological factor of ulcerative digestive tract defects in patients with HIV infection. A typical symptom of cytomegalovirus esophagitis is fever. Retrosternal pain during passage of the food lump, the lack of the effect of antifungal therapy, the presence of shallow rounded ulcers and / or erosions in the distal esophagus. The defeat of the stomach is characterized by the presence of acute or subacute ulcers. The clinical picture of cytomegalovirus colitis or enterocolitis includes diarrhea, persistent abdominal pain, colonic pain during palpation, significant weight loss, severe weakness, fever. Colonoscopy reveals erosion and ulceration of the intestinal mucosa.

Hepatitis is one of the main clinical forms of cytomegalovirus infection in transplacental infection of the child, in recipients after liver transplantation, in patients infected with the virus during blood transfusions. Peculiarity of liver damage in cytomegalovirus infection - frequent involvement in the pathological process of the biliary tract. Cytomegalovirus hepatitis is characterized by mild clinical course, but with the development of sclerosing cholangitis, there are pains in the upper abdomen, nausea, diarrhea, liver soreness, increased activity of alkaline phosphatase and GGTT, cholestasis is possible. The defeat of the liver is the nature of granulomatous hepatitis, in rare cases, there is severe fibrosis and even cirrhosis of the liver. The pathology of the pancreas in patients with cytomegalovirus infection usually occurs asymptomatically or with an erased clinical picture with an increase in the concentration of amylase in the blood. High sensitivity to cytomegalovirus has epithelial cells of small ducts of salivary glands, mainly parotid. Specific changes in salivary glands with cytomegalovirus infection in children occur in the vast majority of cases. For adults with cytomegalovirus infection, sialadenitis is not characteristic.

Cytomegalovirus is one of the causes of adrenal pathology (often in patients with HIV infection) and the development of secondary adrenal insufficiency, manifested by persistent hypotension, weakness, weight loss, anorexia, bowel disturbance, a number of mental abnormalities, and less often hyperpigmentation of the skin and mucous membranes. The presence of cytomegalovirus DNA in the patient's blood, as well as persistent hypotension, asthenia, anorexia requires the determination of the level of potassium, sodium and chlorides in the blood, hormonal studies for the analysis of the functional activity of the adrenal glands. Cytomegalovirus adrenalitis is characterized by an initial lesion of the medulla with the transition of the process to deep, and subsequently to all layers of the cortex.

Manifest cytomegalovirus infection often occurs with the defeat of the nervous system in the form of encephaloventriculitis. Myelitis, polyradiculopathy, polyneuropathy of the lower extremities. Scarcely neurological symptoms (unstable headaches, dizziness, horizontal nystagmus, less often paresis of the oculomotor nerve, facial nerve neuropathy) are characteristic of cytomegalovirus encephalitis in patients with HIV infection, but pronounced changes in mental status (personality changes, gross memory impairment, decreased ability to intellectual activity, a sharp weakening of mental and motor activity, disruption of orientation in place and time, anosognosia, decreased control of pelvis function O bodies). Mystical-intellectual changes often reach the degree of dementia. Children who have transferred cytomegalovirus encephalitis also show a slowing of mental and mental development. Studies of cerebrospinal fluid show an increased amount of protein, no inflammatory response, or mononuclear pleyocytosis. Normal content of glucose and chlorides. The clinical picture of polyneuropathy and polyradiculopathy is characterized by a pain syndrome in the distal parts of the lower limbs, less often in the lumbar region in combination with a feeling of numbness, parasthesia, hyperesthesia, causalgia. Hyperpathy. With polyradiculopathy, a limp paresis of the lower extremities is possible, accompanied by a decrease in pain and tactile sensitivity in the distal parts of the legs. In the spinal cord of patients with polyradiculopathy, an increase in the protein content, lymphocytic pleocytosis, is revealed. Cytomegalovirus plays a leading role in the development of myelitis in HIV-infected patients. The defeat of the spinal cord is diffuse and a late manifestation of cytomegalovirus infection. In the debut, the disease has a clinical picture of polyneuropathy or polyradiculopathy. Further. In accordance with the predominant level of spinal cord lesion, spasmodic tetraplegia or spastic paresis of lower extremities develop, pyramidal signs appear, a significant decrease in all types of sensitivity, primarily in the distal parts of the legs; trophic disorders. All patients suffer from gross disorders of the pelvic organs, mainly in the central type. In the cerebrospinal fluid, a moderate increase in the protein content, lymphocytic pleocytosis, is determined.

Cytomegalovirus retinitis is the most common cause of vision loss in patients with HIV infection. This pathology is also described in recipients of organs, children with congenital cytomegalovirus infection, in single cases - in pregnant women. Patients report the following symptoms of cytomegalovirus infection: floating points, spots, a veil before the eyes, reduced acuity and visual field defects. When ophthalmoscopy on the retina on the periphery of the fundus reveals foci of white with hemorrhages along the course of the retinal vessels. Progression of the process leads to the formation of a diffuse extensive infiltrate with zones of retinal atrophy and foci of hemorrhages along the surface of the lesion. The initial pathology of one eye after 2-4 months acquires a bilateral character and in the absence of etiotropic therapy leads in most cases to loss of vision. In patients with HIV infection who have a history of cytomegalovirus retinitis, on the background of HAART, uveitis can develop as a manifestation of the immune system recovery syndrome.

Sensorynoneural deafness occurs in 60% of children with clinically expressed congenital cytomegalovirus infection. Hearing loss is possible in adults with HIV-infected individuals with a manifest cytomegalovirus infection. At the heart of cytomegalovirus-associated hearing defects is inflammatory and ischemic injury of the cochlea and auditory nerve.

A number of works demonstrate the role of cytomegalovirus as an etiological factor of cardiac pathology (myocarditis, dilated cardiomyopathy), spleen, lymph nodes. Kidney, bone marrow with the development of pancytopenia. Interstitial nephritis caused by cytomegalovirus infection, as a rule, occurs without clinical manifestations. Possible microproteinuria, microhematuria, leukocyturia, rarely secondary nephrotic syndrome and renal failure. Patients with cytomegalovirus infection often have thrombocytopenia, less frequent anemia, leukopenia, lymphopenia and monocytosis.

Classification of cytomegalovirus infection

There is no generally accepted classification of cytomegalovirus infection. The following classification of the disease is desirable.

• Congenital cytomegalovirus infection:
  • asymptomatic form;
  • manifest form (cytomegalovirus).
• Acquired cytomegalovirus infection.
  • Acute cytomegalovirus infection.
    • asymptomatic form;
    • cytomegalovirus mononucleosis;
    • manifest form (cytomegalovirus).
  • Latent cytomegalovirus infection.
  • Active cytomegalovirus infection (reactivation, reinfection):
    • asymptomatic form;
    • cytomegalovirus-associated syndrome;
    • manifest form (cytomegalovirus).

[8], [9], [10], [11], [12], [13], [14]