CMV infection - symptoms and signs. Cytomegalovirus infection during pregnancy in children
Cytomegalovirus infection in children during pregnancy - symptoms, signs.
Congenital and Perinatal Cytomegalovirus Infection
Infection with cytomegalovirus infection can occur prenatally or intranatally and postnatally. At birth, if clinical manifestations are noted, they consist of intrauterine growth retardation, prematurity, microcephaly, jaundice, petechial rash, hepatosplenomegaly, periven-triular calcifications, chorioretinitis and pneumonitis. At an older age, clinical manifestations include pneumonia, hepatosplenomegaly, hepatitis, thrombocytopenia and atypical lymphocytosis. The diagnosis is based on virus isolation or serological testing. Treatment is supportive. Parenteral administration of ganciclovir can prevent hearing loss, but its use remains controversial.
Cytomegalovirus is often isolated from newborns.Despite the fact that most of the newborns infected with CMV have no clinical manifestations, some develop a life-threatening disease and severe long-term consequences.
It is not known when a woman with a primary CMV infection can safely become pregnant. Since the risk to the fetus is difficult to assess, it is mainly women who have developed primary CMV infection during pregnancy, but some experts recommend routine serological tests for CMV before or during pregnancy in healthy women.
Congenital CMV infection
which is observed in 0.2-2.2% of live births in the world, can be the result of transplacental infection, either primary or recurrent infection in the mother. The most common clinical forms of the disease in newborns develop with primary CMV infection in the mother, especially in the first half of pregnancy. In the US, in some high-income socio-economic groups, 50% of young women have a small amount of antibodies to CMV, which makes them susceptible to primary infection.
Intra- and postnatal CMV infection is transmitted by contact with infected cervical secretions, breast milk or blood products.It is believed that maternal antibodies protect the child, so most of the full-term newborns do not get infected or develop asymptomatic forms. In contrast, severe forms of the disease or death may develop in premature infants, especially through transfusion of CMV-positive blood. Maximum efforts should be made to transfuse only CMV-negative blood or its components to such children.
Symptoms and signs of cytomegalovirus infection (CMV)
In many women, when infected during pregnancy, there are no clinical manifestations; however, some develop mononucleosis-like disease.
Approximately 10% of newborns with congenital CMV infection have no clinical manifestations at birth. If the child has developed a clinical form of the disease, it is manifested by intrauterine growth retardation, prematurity, microcephaly, jaundice, petechial rash, hepatosclerosalgia, periventricular calcification, chorioretinitis and pneumo-nit. With postnatal infection, pneumonia, hepatosclerosis, hepatitis, thrombocytopenia and atypical lymphocytosis can develop, especially if the child is premature.
Congenital CMV infection in the presence of clinical manifestations should be differentiated from other congenital infections, including toxoplasmosis, rubella and syphilis.
In newborns, the main method of diagnosis is the virological secretion of the pathogen; maternal infection can also be confirmed by serological testing. Samples of biological fluids are placed in a refrigerator before inoculation on cell culture. Congenital CMV infection is diagnosed when a virus is isolated from urine or other biological fluids from the first 2 weeks of life. After 2 weeks, a positive result may indicate perinatal or congenital infection. Children can have CMV for several years after any form of CMV infection.
From general clinical methods, a general blood test is carried out with a count of the leukocyte formula and a biochemical blood test to evaluate liver function. An ultrasound or CT scan of the brain and an ophthalmologic examination should also be performed.
Among newborns with obvious forms of the disease, the mortality rate is up to 30%, and 70–90% of those who have survived are later observed to have certain neurological disorders, including hearing loss, mental retardation and visual impairment.In addition, 10% of newborns without clinical manifestations with time manifest neurological effects. Since there is a possibility of hearing impairment, after the period the baby's newborn should be inspected regularly for their detection.
There is no specific treatment. Ganciclovir reduces viral load in newborns with congenital CMV infection and prevents hearing loss in 6 months. When treatment is stopped, the virus is released again; therefore, its role in treatment remains controversial.
Immunocompromised pregnant women should try to limit contact with the virus. For example, since CMV infection is common in children who attend day care centers, pregnant women should always wash their hands thoroughly after contact with children's urine or respiratory secretions. Transfusion-associated postnatal CMV infection can be avoided by transfusing premature babies with blood products from CMV-negative donors or drugs specially treated to make them non-infectious. A vaccine against CMV is being developed.
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