Cytomegalovirus infection during pregnancy: norm, consequences of positive IgG and IgM antibodies, treatment. The effect of cytomegalovirus on the fetus and woman during pregnancy Igg positive igm negative during pregnancy
A positive test result for IgG to cytomegalovirus means that a person has immunity to this virus and is its carrier.
Moreover, this does not at all mean the course of a cytomegalovirus infection in the active stage or any guaranteed dangers to a person - it all depends on his own physical condition and the strength of the immune system. The most pressing issue of the presence or absence of immunity to cytomegalovirus is for pregnant women - it is on the developing fetus that the virus can have a very serious impact.
Let's understand the meaning of the analysis results in more detail...
Analysis of IgG for cytomegalovirus: the essence of the study
Analysis of IgG for cytomegalovirus means the search for specific antibodies to the virus in various samples from the human body.
For reference: Ig is an abbreviation for the word "immunoglobulin" (in Latin). Immunoglobulin is a protective protein produced by the immune system to destroy the virus. For each new virus that enters the body, the immune system produces its own specific immunoglobulins, and in an adult, the variety of these substances becomes simply enormous. Immunoglobulins are also called antibodies for simplicity.
The letter G is the designation of one of the classes of immunoglobulins. In addition to IgG, there are also immunoglobulins of classes A, M, D and E in humans.
Obviously, if the body has not yet encountered the virus, then it still does not produce the appropriate antibodies to it. And if there are antibodies to the virus in the body, and the analysis for them is positive, then, therefore, the virus has already penetrated into the body at some time. Antibodies of the same class against different viruses are quite different from each other, so the analysis for IgG gives a fairly accurate result.
An important feature of the cytomegalovirus itself is that once it hits the body, it remains in it forever. No medicine or therapy will help to completely get rid of it. But since the immune system develops a strong defense against it, the virus remains in the body in an inconspicuous and practically harmless form, persisting in the cells of the salivary glands, some blood cells and internal organs. Most carriers of the virus are not even aware of its existence in their body.
It is also necessary to understand the differences between the two classes of immunoglobulins - G and M - from each other.
IgM are fast immunoglobulins. They are large and are produced by the body for the fastest possible response to the penetration of the virus. However, IgM do not form immunological memory, and therefore, with their death after 4-5 months (this is the lifetime of an average immunoglobulin molecule), protection against the virus with their help disappears.
IgG are antibodies that, after they appear, are cloned by the body and maintain immunity against a specific virus throughout life. They are much smaller than the previous ones, but are produced later on the basis of IgM, usually after the suppression of the infection.
It can be concluded that if cytomegalovirus-specific IgM is present in the blood, this means that the body has become infected with this virus relatively recently and, perhaps, an exacerbation of the infection is currently taking place. Other details of the analysis may help clarify finer details.
Deciphering some additional data in the analysis results
In addition to just a positive IgG test, the results of the analysis may contain other data. The attending physician should understand and interpret them, however, just to understand the situation, it is useful to know the meanings of some of them:
- Anti- Cytomegalovirus IgM+, Anti- Cytomegalovirus IgG- : Cytomegalovirus-specific IgM is present in the body. The disease proceeds in an acute stage, most likely, the infection was recent;
- Anti- Cytomegalovirus IgM-, Anti- Cytomegalovirus IgG+ : inactive stage of the disease. Infection occurred a long time ago, the body has developed a strong immunity, viral particles that enter the body again are quickly eliminated;
- Anti- Cytomegalovirus IgM-, Anti- Cytomegalovirus IgG- : There is no immunity to CMV infection. The organism had never met her before;
- Anti- Cytomegalovirus IgM+, Anti- Cytomegalovirus IgG+ : virus reactivation, exacerbation of infection;
- Antibody avidity index below 50%: primary infection of the organism;
- Antibody avidity index above 60%: immunity to the virus, carriage or chronic infection;
- Avidity index 50-60%: an uncertain situation, the study must be repeated after a few weeks;
- Avidity index 0 or negative: the organism is not infected with cytomegalovirus.
It should be understood that the different situations described here may have different consequences for each patient. Accordingly, they require an individual interpretation and treatment approach.
A positive test for CMV infection in a person with normal immunity: you can just relax
In immunocompetent people who do not have diseases of the immune system, positive tests for antibodies to cytomegalovirus should not cause any alarm. Whatever stage the disease is in, with strong immunity, it usually proceeds asymptomatically and imperceptibly, only sometimes expressed as a mononucleosis-like syndrome with fever, sore throat and malaise.
It is only important to understand that if the tests indicate an active and acute phase of the infection even without external symptoms, then from a purely ethical point of view, the patient needs to independently reduce social activity for a period of a week or two: less time in public, limit visits to relatives, not communicate with small children and especially with pregnant women (!). At this point, the patient is an active distributor of the virus and is able to infect a person for whom CMV infection can be really dangerous.
Presence of IgG in immunocompromised patients
Perhaps the most dangerous cytomegalovirus for people with various forms of immunodeficiency: congenital, acquired, artificial. In them, a positive IgG test result may be a harbinger of complications of the infection, such as:
- hepatitis and jaundice;
- cytomegalovirus pneumonia, which is the cause of death for more than 90% of AIDS patients in the developed world;
- diseases of the digestive tract (inflammation, exacerbation of peptic ulcers, enteritis);
- encephalitis, accompanied by severe headaches, drowsiness and, in neglected states, paralysis;
- retinitis - inflammation of the retina, leading to blindness in a fifth of patients with immunodeficiencies.
The presence of IgG to cytomegalovirus in these patients indicates a chronic course of the disease and the likelihood of an exacerbation with a generalized course of infection at any time.
Positive test results in pregnant women
In pregnant women, the results of the analysis for antibodies to cytomegalovirus allow you to determine how likely the fetus is to be affected by the virus. Accordingly, it is on the basis of the test results that the attending physician decides on the application of certain therapeutic measures.
A positive IgM test for cytomegalovirus in pregnant women indicates either a primary infection or a relapse of the disease. In any case, this is a rather unfavorable development of the situation.
If this situation occurs in the first 12 weeks of pregnancy, urgent measures must be taken to combat the virus, since the risk of teratogenic effects of the virus on the fetus is high when the mother is first infected. With a relapse, the likelihood of fetal damage is reduced, but still persists.
With a later infection, the development of a congenital cytomegalovirus infection in a child or infection at the time of birth is possible. Accordingly, in the future, specific tactics for managing pregnancy are being developed.
The doctor can conclude that the primary infection or relapse in this case is based on the presence of specific IgG. If the mother has them, it means that there is immunity to the virus, and the exacerbation of the infection is caused by a temporary weakening of the immune system. If there is no IgG to cytomegalovirus, this indicates that the mother became infected with the virus for the first time during pregnancy, and the fetus is likely to be affected by it, like the entire mother's body.
To take specific therapeutic measures, it is necessary to study the patient's medical history, taking into account many additional criteria and features of the situation. However, the mere presence of IgM already indicates that there is a risk to the fetus.
The presence of IgG in newborns: what is it fraught with?
The presence of IgG to cytomegalovirus in a newborn indicates that the baby was infected with the infection either before birth, or at the time of birth, or immediately after them.
Definitely neonatal CMV infection is evidenced by a four-fold increase in IgG titer in two analyzes with an interval of a month. In addition, if specific IgG is observed in the blood of a newborn already in the first three days of life, they usually speak of congenital cytomegalovirus infection.
CMV infection in children can be asymptomatic, or it can be expressed with quite serious symptoms and have complications such as inflammation of the liver, chorioretinitis and subsequent strabismus and blindness, pneumonia, jaundice, and the appearance of petechiae on the skin. Therefore, if cytomegalovirus is suspected in a newborn, the doctor must carefully monitor his condition and development, remaining ready to use the necessary means to prevent complications.
What to do if you test positive for CMV antibodies
If you test positive for cytomegalovirus, you should first consult with your doctor.
The infection itself in most cases does not lead to any consequences, and therefore, in the absence of obvious health problems, it makes sense not to treat the virus at all and entrust the fight against the virus to the body itself.
The drugs used to treat CMV infection have serious side effects and are therefore prescribed only when absolutely necessary, usually in immunocompromised patients. In these situations use:
- Ganciclovir, which blocks the reproduction of the virus, but in parallel causes digestive and hematopoietic disorders;
- Panavir in the form of injections, not recommended for use during pregnancy;
- Foscarnet, which can lead to impaired kidney function;
- Immunoglobulins obtained from immunocompetent donors;
- Interferons.
All these drugs should be used only on the advice of a doctor. In most cases, they are prescribed only to patients with immunodeficiencies or those who are prescribed chemotherapy or organ transplants associated with artificial immune suppression. Only sometimes they treat pregnant women or babies.
In any case, it should be remembered that if earlier there were no warnings about the danger of cytomegalovirus for the patient, then everything is in order with the immune system. And a positive analysis for cytomegalovirus in this case will only inform about the fact of the presence of already formed immunity. It remains only to maintain this immunity.
Video about the danger of cytomegalovirus infection for pregnant women
What is known to almost every person who has had a cold, and this is almost the entire population of the planet. The "accumulation of bubbles" on the lips is considered something very simple and ordinary, which will pass by itself and without a trace. But the herpes virus has many dangerous variations, one of which is cytomegalovirus infection. The detection of cytomegalovirus in pregnant women is a special and important topic, because there are already two organisms at risk - the expectant mother and her unborn baby.
What is it, how can you get infected, what are the symptoms of the disease, how dangerous is it for the child, and how to protect yourself from its serious consequences - these are the main questions that we will try to answer in this article.
Features of the disease
Cytomegalovirus (CMV) is one of the representatives of the herpes viruses. It is included in the group of TORCH infections along with such diseases as rubella, toxoplasmosis and herpes itself. This four has a negative impact on pregnancy, as well as on the condition of the fetus during fetal development and after the baby is born. The presence of cytomegaly was noted according to various statistics in 40-60% of the world's population.
There are such types of the course of the disease in pregnant women and children:
- latent (hidden, asymptomatic). This type of cytomegalovirus flow occurs in people with strong immunity, when the virus does not give clinical manifestations and is in a dormant state. This is called being a carrier. It passes into a reactivated form only with a decrease in the body's defenses. Pregnancy is one such condition;
- mononucleosis-like CMV is characteristic of persons with weak immunity. The symptoms look like a common cold. As a rule, it does not pose a danger, since the body still copes with this “infection”. But CMV does not disappear from the body, but simply after the symptoms disappear, it again becomes inactive and hidden;
- cytomegalovirus hepatitis is extremely rare. The signs resemble a viral disease of the same name: jaundice develops, the color of feces (urine and feces) changes, low temperature and deterioration in general condition. Within a week, the signs begin to disappear, and the disease turns into chronic CMV;
- generalized cytomegalovirus is characterized by a very severe course. With this form, almost all vital organs and systems are affected. It affects children under three months of age, infected in utero, persons with immunodeficiency. Similar manifestations are possible in those patients who underwent a transfusion of blood or its components or transplantation of organs and tissues.
Why is the problem of cytomegalovirus in pregnancy being considered? It is during this period that the immunity of the expectant mother decreases due to absolutely understandable physiological reasons. The so-called "preserved reaction" is triggered, when the immune response is reduced in order for the fetus to develop. In the early stages, it is perceived by the body as a foreign agent. If it were otherwise, mankind simply would not be able to reproduce their own kind, and each pregnancy would end in a miscarriage.
Before we panic about CMV and pregnancy, let's go over everything a mom-to-be and dad-to-be need to know about this highly dangerous infection.
How can a woman or child get infected
There are several ways to become infected with cytomegalovirus in children and adults, among them:
- In everyday life, infection does not occur so often, but it is quite possible. The infection outside the human body lives for a short time, and for infection it must be active. But you can get infected through kissing with carriers, using common personal hygiene items, utensils.
- The sexual route is the most common. So during conception there is a risk of "inheriting" cytomegalovirus, which can cause many pathologies both during pregnancy and after the birth of a child.
- The transfusion method remains also likely, although it occurs in very rare cases. With the development of modern medicine, it is possible to become infected during blood transfusions and organ transplants, but it is extremely rare.
- Placental method - the transmission of pathology from mother to fetus in utero. The virus passes through the placental barrier and infects the baby.
- Breastfeeding is one of the causes of infection of the child.
The highest risk of infection of the baby appears during the primary infection with cytomegalovirus during pregnancy. The presence of antibodies to CMV in a woman even before the child is planned suggests that the effect on the fetus will be minimal or not at all. Such mothers give birth to healthy babies, who are carriers in 85-90% of cases.
What can be the symptoms in women in position?
Cytomegalovirus infection during pregnancy is similar in symptoms to a common cold and therefore does not cause much concern for both the mother herself and her doctor. If a woman’s body is strong, then the immune response will “silence the virus”, that is, go into an inactive form. Or mild symptoms of ARI may be present:
- body aches;
- a slight increase in temperature;
- runny nose;
- sore throat;
- enlarged lymph nodes;
- headaches, as a sign of general intoxication.
Read also related
Types of tests for cytomegalovirus (CMV) and their interpretation
The difference is that an ordinary cold goes away within a week or two, while cytomegalovirus during pregnancy manifests itself with uncomfortable symptoms for up to 8 weeks.
Less commonly, the virus shows itself in the form of a mononucleosis-like form with the corresponding signs (high temperature, severe head pain). It is extremely rare that a generalized form develops, which is of particular danger, since it affects the entire body, the infection strikes many organs and systems of the body.
Diagnostic measures
When planning a pregnancy, a married couple is advised to diagnose for cytomegalovirus before such a crucial step.
To detect CMV during pregnancy, a whole range of measures is used. Each of them makes it possible not only to determine its presence in the mother's blood, but also to calculate the risks for the unborn baby.
- A serological blood test determines the presence of antibodies to CMV. The IgG immunoglobulins present in the results indicate that the woman has long been infected and antibodies to cytomegalovirus have been developed. IgM immunoglobulins are an indicator of primary infection. The absence of antibodies of both groups is a complete norm, but a woman is included in the “risk group”, since there are no antibodies in the body and the possibility of primary infection is high. In babies born to infected mothers, this analysis is regularly performed for the first four months to detect immunoglobulins. If IgG is detected, then the diagnosis of congenital cytomegaly is removed, but if IgM is evidence of an acute stage of pathology.
- PCR (polymerase chain reaction). Any body fluids can be used for research. The analysis makes it possible to detect the presence of cytomegalovirus DNA. If it is present, the result is positive.
- Bakposev. An analysis in which a smear from the vaginal mucosa is usually used, but variations are possible. Using this method, not only the presence of an infection is detected, but its condition (primary infection, remission, reactivation).
- Cytological examination consists in examining the urine or saliva of the patient under a microscope. When a virus is found in the body, its giant cells will be visible.
- Amniocentesis. The method of studying amniotic fluid is considered the most accurate, allowing to detect infection of the fetus with cytomegalovirus in the womb. This procedure can be carried out only after 21 weeks of pregnancy. But at least 6 weeks must pass from the moment of the alleged infection, otherwise the result will be false negative. The absence of the virus indicates a healthy baby. If it is detected, then other tests are prescribed to determine the concentration of CMV (viral load). The higher it is, the worse the consequences for the fetus can be.
An analysis for CMV, which gave a positive result, is not yet a sentence for either the mother or the unborn baby. Many children born with cytomegalovirus are completely healthy and never feel its effects in their lives. But in some cases, quite serious consequences are possible.
What is the danger of pathology
Cytomegalovirus is not always dangerous for a future mother and her baby, but there are certain risks of complications. Everything is determined by the time when the virus entered the body of a woman - before or after the conception of a child. If this happened long before pregnancy, then there are already response mechanisms in the blood - antibodies to the virus have been developed. This is the case when the possibility of getting a problem is minimal. CMV "sleeps" and, most likely, will not disturb either the mother or her child.
But there are about 2% of cases where a relapse occurs during pregnancy. Then they talk about a possible tarnaplacental infection, and the baby is born with CMV (congenital cytomegalovirus infection). Such an exacerbation requires complex treatment in order to avoid possible serious pathologies.
Especially dangerous is the primary infection with cytomegalovirus in the first trimester. Under such a combination of circumstances, it is impossible to predict the further course of pregnancy, the development of the child in the womb and after birth. But the scenarios for further events are not at all rosy:
- fading of pregnancy, fetal death, premature birth due to placental abruption, miscarriages in the early stages;
- the cardiovascular system suffers, congenital heart defects occur;
- microcephaly or hydrocephalus;
- serious organic pathological conditions of the central nervous system;
- mental retardation of varying severity;
- in the future, a lag in development, both physical and mental;
- deafness or hearing loss from birth;
- blindness or low vision from birth;
- lesions of the musculoskeletal system;
- an increase in the size of internal organs;
- frequent hemorrhages in the internal organs.
In some cases, when "brothers in the TORCH company" join the CMV, all further pregnancies will end in failure. Often there are miscarriages in the early stages. Therefore, we plan to conceive - we go through an examination for TORCH infection together with our spouse.
Congenital CMV
But let's calm the nerves of a pregnant woman a little. They are already shattered by her, for obvious reasons. It's not all that scary. Let's look at specific numbers.
Cytomegalovirus is one of the most widespread pathogens on Earth. At the same time, most people do not know about their infection, since the disease in them exists in a latent form for a long time and does not give obvious clinical manifestations.
But for women of childbearing age, the carriage of CMV (cytomegalovirus) is a rather serious problem and requires special attention. This is due to the possibility of intrauterine infection of the developing child. Therefore, the analysis for CMV is included in the list of examinations recommended for planning and pregnancy.
What is important to know about cytomegalovirus
The causative agent of cytomegalovirus infection is a large DNA-containing virus of the herpesvirus family. It has a spherical shape and is covered with a two-layer protective outer shell. On its surface are numerous spike-like outgrowths formed by lipoprotein molecules. They are necessary for recognition of macroorganism cells, attachment and introduction into them.
The features of the life cycle of cytomegalovirus include:
Cytomegalovirus has no gender and age preferences, it can affect people of any race. It is quite stable in the environment, which explains its ubiquitous distribution.
Epidemiology
Cytomegalovirus infection is mainly transmitted by household contact, airborne droplets and sexual contact, and the source of infection can be a person without obvious clinical manifestations of the disease. This explains the high degree of infection of the population. According to WHO, almost 90% of urban residents in developed countries and 60-70% of those living in rural areas are infected with this virus. More than half of healthy children born by school age become carriers of CMV infection.
Of great importance is the vertical route of transmission, which contributes to intrauterine infection of the fetus. The fact is that cytomegalovirus is able to overcome the hematoplacental barrier at any gestational age, which contributes to the development of congenital cytomegalovirus infection. A child can also become infected from an infected mother during the passage of the birth canal and during breastfeeding. In addition, there is a possibility that the fetus will receive the virus from the father if his spermatozoa contain the built-in DNA of this pathogen.
Transmission of cytomegalovirus is possible during organ transplantation and transfusion of blood (and its components) from infected donors. In rare cases, infection occurs through contaminated medical instruments during various medical procedures.
The main manifestations of acquired infection
In people infected during their lifetime, cytomegalovirus infection can exist in several forms:
- latent course, the virus does not lead to the appearance of any external symptoms, but can be detected by laboratory methods;
- subclinical persistent infection, manifestations are minimal and non-specific, viral particles are found in various biological secretions of an infected person;
- the appearance of diseases associated with CMV: pneumonia (pneumonitis), hepatitis, parotitis, cytomegalovirus mononucleosis, enterocolitis, encephalitis, nephritis, chronic urogenital pathology;
- a generalized form of cytomegalovirus infection with multiple organ damage and a severe course, the development of dementia due to chronic encephalitis, with the appearance of multiple bleeding ulcers in various parts of the gastrointestinal tract.
The vast majority of people infected with cytomegalovirus have a latent course of the disease. In this case, the infection is detected during a targeted examination in the period of preparation for transplantation, donation, at the stage of pregnancy planning and treatment.
Activation of the virus occurs most often when the immune status changes with the development of immunodeficiency of any origin. This is possible with HIV, after severe infections, with immunosuppressive therapy after transplants, with certain blood diseases and during chemotherapy. All this can lead to a decrease in immunological control over the existing cytomegalovirus infection and the transition of the pathogen into the active phase. Often there is also reactivation of cytomegalovirus during pregnancy.
The elimination (or correction) of immunodeficiencies and the ongoing treatment contribute to the inhibition of virus replication, a significant purification of biological fluids from viral particles. But pathogens located intracellularly are not destroyed, the infection passes into a latent phase. Repeated violation of the immune status causes a new exacerbation of cytomegalovirus.
Is cytomegalovirus dangerous during pregnancy?
Cytomegalovirus infection during pregnancy may be due to the primary infection of a woman or the reactivation of a virus that she already has. The severity of the symptoms arising in this case depends on the functional state of the immune system, which affects the rate of increase in the level of the pathogen freely circulating in the blood.
Acute CMV infection during pregnancy can manifest itself as an intoxication-fever syndrome, signs of damage to the submandibular and parotid salivary glands, kidneys, liver and lungs. The appearance of mucous discharge from the nose is possible, which, coupled with intoxication, gives rise to false assumptions about SARS. Often it is also noted with an increase in vaginal discharge, which is white-bluish in color and quite liquid in consistency. Such symptoms of cytomegalovirus during pregnancy indicate damage to all new organs, but are not life-threatening for a woman and her developing child.
But cytomegalovirus can also affect the internal genital organs. This poses a threat to the safe carrying of pregnancy, increases the risk of spontaneous abortion in the early stages, premature birth. And if a premature detachment of a normally located placenta occurs against the background of hypertonicity, intrauterine fetal death is possible.
The greatest danger is the defeat of the cytomegalovirus of the placenta. At the same time, cysts are formed in it, its premature aging is noted. And with infection in the early stages of gestation, intimate attachment to the body of the uterus of the chorionic tissue of the placenta is possible, which threatens with uterine atony and bleeding in the postpartum period.
Consequences of cytomegalovirus infection for the fetus
The presence of CMV in a pregnant woman poses an immediate danger to the child. Intrauterine infection is fraught with the development of a congenital form of the disease with the development of severe complications. Therefore, this infection belongs to the TORCH embryopathogenic group; women are advised to be tested for cytomegalovirus when planning pregnancy.
Depending on the gestational age, the newborn may show signs of acute cytomegalovirus infection, the consequences of impaired embryogenesis, or symptoms of chronic damage to many internal organs. Children are often born prematurely, with signs of prematurity. At the same time, an asymptomatic (at first) course of the disease is possible with the onset of the consequences of infection after the first six months of life.
The main clinical signs of congenital intrauterine infection in young children:
- pastosity and yellowness of the skin in newborns, the appearance of characteristic dark blue spots and multiple petechiae is possible;
- tendency to protracted jaundice;
- lethargy, drowsiness, inactivity of children, even with obvious physical discomfort;
- persistently and diffusely reduced muscle tone, tremor of the limbs, lagging behind peers in motor development;
- violation of sucking and swallowing, which causes persistent malnutrition and polyhypovitaminosis;
- microcephaly (with infection in the early stages of gestation);
- hematological abnormalities: anemia of mixed origin and thrombocytopenia;
- cytomegalovirus retinitis with a decrease in visual acuity;
- sensorineural hearing loss with a tendency to gradually increase the degree of hearing loss;
- lag in mental development;
- interstitial pneumonia, nephritis, myocarditis, colitis, pancreatitis and damage to other parenchymal organs and the brain.
When a child is infected shortly before childbirth or in the process of passing through the birth canal, he does not show signs of organ damage. But during the first 20-50 days a condition develops, the clinic of which resembles SARS. It is usually quickly stopped due to the intake of protective antibodies with breast milk, and the infection becomes latent. But in premature and hypotrophic newborns, especially if they are predominantly bottle-fed and suffer from immunodeficiency conditions, a more severe course of the disease with a tendency to generalization is possible.
When and who should be examined for CMV?
In the absence of immunodeficiency in a person, the cytomegalovirus infection that he has does not pose a potential danger to life and usually does not affect its quality. Therefore, a widespread routine examination of the population for cytomegalovirus is not practiced, moreover, the presence of signs of infection (which is observed in almost 90% of people) is not a basis for active therapeutic measures.
Direction for analysis is received by:
- women with a history of habitual;
- infertile couples, including at the stage of preparation before conducting other assisted reproductive technologies;
- suffering from chronic inflammatory diseases of the urogenital area;
- mothers of children born with signs of intrauterine infections;
- persons with immunodeficiencies;
- prospective donors.
But it is advisable to take an analysis for cytomegalovirus when planning pregnancy for all women. Determining the presence of infection and the degree of activity of the process will help to further assess the risk of infection of the fetus.
Diagnostics
Cytomegalovirus infection has no characteristic symptoms, so clinical diagnosis is difficult. And laboratory research is key.
Currently used for diagnostics:
- cultural method (cultivation of a virus taken from biological fluids or tissues on special media);
- PCR - allows you to determine even a small amount of virus DNA in the studied biomaterial (in a smear from the urethra, vagina, cervical canal, in blood, urine, cerebrospinal fluid or saliva);
- ELISA is the most commonly used test based on the determination of different classes of specific antibodies in the blood;
- The cytological method, in which tissue pieces taken by the biopsy method are examined under a microscope, makes it possible to identify characteristic changes in cells.
ELISA is used in everyday clinical practice. This inexpensive and technically relatively simple study is carried out automatically and has no age restrictions. It can be repeated the required number of times, which allows you to dynamically assess the course of the infectious process and approximately determine the duration of infection.
ELISA decoding
When conducting ELISA, the presence and titer of immunoglobulins Ig M and Ig G are determined. These are different classes of specific protective antibodies produced by immune cells. Their ratio must be evaluated if the analysis for cytomegalovirus during pregnancy is positive.
The presence of Ig M indicates a current infectious process, is a sign of a recent infection or activation of cytomegalovirus. The detection of such antibodies requires a decision on the need for treatment, and in pregnancy - a commission risk assessment for the fetus. Ig G indicate the presence of persistent immunity. They appear some time after infection and persist for life. It is this class of antibodies that provides the body with immunological control over the virus, restraining its reproduction and spread.
A result of up to 0.9 IU / ml is the norm of Ig G to cytomegalovirus, indicating the absence of contact with the virus. An indicator of 0.9-1.1 IU / ml is considered doubtful, and above 1.1 IU / ml is positive. In children under 3 months of age, the level of Ig G is not determined. After all, they have not yet developed their own antibodies, and the complexes circulating in the blood were obtained in utero from an infected mother.
A positive Ig M in a pregnant woman with questionable Ig G results indicates an active stage of primary infection. And the combination of a low titer of M-class antibodies with a good level of G is a sign of reactivation of a chronic infection. If only Ig G is positive, the inactive phase of the disease (remission) is diagnosed.
Determining the duration of infection has prognostic value. If a woman has chronic cytomegalovirus activated during pregnancy, its dissemination is restrained by already existing antibodies. The risk of intrauterine infection of the fetus is 3-5%. In the case of fresh infection, the transplacental route of transmission is observed in almost 60% of pregnant women, which is explained by the absence of protective antibodies in them and the unhindered spread of the pathogen.
ELISA is not always informative enough to determine the duration of infection. A more reliable result can be obtained by examining the detected G antibodies for avidity to cytomegalovirus. This determines the strength of their binding to antibodies.
The more stable the resulting immune complexes, the more time has passed since the infection. Avidity above 35% indicates that the infection was more than 3 months ago. An indicator of 50-60% is considered a threshold, it indicates the transition of the disease to the chronic stage. And highly avid antibodies are a sign of carriage or a current chronic infection.
Carrier of CMV during pregnancy: what is it?
The carrier state of cytomegalovirus is the most commonly diagnosed condition. They talk about it when a woman was previously infected, but the pathogen in her body is in an inactive phase. At the same time, no external signs of the disease are detected in her, and ELISA shows only the presence of highly avid Ig G.
Carrying is not dangerous either for a woman or for her developing child in utero. However, every 4-6 weeks, it is advisable for such a pregnant woman to undergo a re-examination to rule out virus activation. Fortunately, in most cases, exacerbation of CMV infection during pregnancy does not occur.
How to treat cytomegalovirus during pregnancy?
Whether cytomegalovirus treatment will be carried out during pregnancy depends on the activity of the process, the duration of infection and the presence of a confirmed immunodeficiency in a woman.
If the obtained laboratory data indicate infection immediately before conception or at the beginning of the first trimester of gestation, expectant management is taken. A dynamic monitoring of the development of the embryo is established. When there is evidence of a violation of embryogenesis and the appearance of defects, a commission makes a decision on the presence of indications for termination of pregnancy for medical reasons. The procedure is carried out only with the consent of the woman. To confirm the infection of the fetus, amniotic fluid can be taken for analysis.
Treatment of CMV during pregnancy is carried out upon receipt of data on a fresh infection (acute phase of the disease) or on the reactivation of an existing virus. Antiviral, vitamin, immunomodulatory drugs are prescribed. Immunoglobulins and interferons can also be used. If necessary, symptomatic remedies are used to alleviate the woman's condition. In case of damage to internal organs, drugs are introduced into the treatment regimen to correct emerging functional disorders.
Infection with cytomegalovirus in pregnant women is by no means a rare occurrence. But, despite the prevalence and relative availability of tests, many women are not aware of the presence of the disease and cannot adequately assess the risks to their unborn child. Although CMV is included in the TORCH group, even a fresh infection in a pregnant woman does not always lead to fetal damage. In addition, if you treat cytomegalovirus in early pregnancy, you can quickly transfer the infection to an inactive phase and avoid damage to the placenta and embryo.
Is it necessary to sound the alarm if antibodies to cytomegalovirus are found in the blood of the expectant mother? After reading the article, you can learn about the features of the infection, the possible risks for the expectant mother and child.
All infections caused by viruses from the HERPESVIRIDAE family (herpesviruses) have a similar pathogenesis: the disease persists, proceeds in a latent or chronic form. So is cytomegalovirus: it can “sleep” in the body for many years, not at all making itself felt or waking up (reactivating) from time to time.
Causes and symptoms of cytomegalovirus
Cytomegalovirus hominis (Human Cytomegalovirus) is a DNA-containing pathogen that belongs to the HERPESVIRIDAE (Herpesviruses) family. The name of the virus, "giant cell", is due to the fact that the cells it affects can be multinucleated and have a huge size.
Cytomegalovirus is also different in that it can persist in the environment for a long time. This partly explains its high contagiousness.
IMPORTANT: According to the WHO (World Health Organization), 2 out of 10 adolescents and 4 out of 10 adults are carriers of a particular strain of Cytomegalovirus hominis.
The source of CMV infection is an infected person. Cytomegalovirus hominis is found in its saliva, tears, nasal secretions, semen, female genital secretions, urine and feces.
Ways of transmission of CMV and forms of CMV infection. Transmitted by Cytomegalovirus hominis, regardless of strain:
- contact (including through objects)
- airborne
- through the placenta from mother to child
- organ transplant or blood transfusion
Infection with cytomegalovirus infection occurs very often, its gateway is the mucous membrane lining the genitals, upper respiratory tract and gastrointestinal tract. Nevertheless, the body of a healthy person copes with it, so the disease in the vast majority of people proceeds in a latent form.
IMPORTANT: The incubation period of CMV infection is 30-60 days. If a person's immunity is strong, it suppresses the disease in 1-2 months. Suppresses, but does not cure: in an inactive form, Cytomegalovirus hominis can live in the host's body for years and reactivate under favorable circumstances, that is, in the case of a decrease in immunity. It is difficult and not always possible to distinguish between primary infection and reactivation of the virus.
Symptoms of the same infection appear in those who are in a state of immunodeficiency. Acquired cytomegalovirus disease is often referred to as mononucleosis-like syndrome and presents as follows:
- weakness
- subfebrile condition or fever
- myalgia (muscle pain)
- swollen lymph nodes
Since Cytomegalovirus hominis can infect the respiratory system and liver, some patients with acute CMV infection may present as influenza or viral hepatitis.
If the human immune system is strong, after 30-60 days anti-CMV immunoglobulin is produced, the symptoms of the disease subside.
IMPORTANT: A carrier of Cytomegalovirus hominis remains contagious for weeks and months after symptoms of CMV infection disappear.
In people with weak immunity, as well as in pregnant women and young children, cytomegalovirus can cause:
- retinitis (inflammation of the retina)
- pneumonia
- hepatitis
- enterocolitis
- ulcers of the esophagus, stomach, intestines
- inflammation of the genitals
- encephalitis
Symptoms of cytomegalovirus during pregnancy. What is cytomegalovirus reactivation during pregnancy?
The development of CMV in pregnant women is possible in two cases:
- with primary infection (the risk of transplacental infection is higher)
- in case of reactivation of a dormant virus in the body (the risk of transplacental infection is lower)
If the expectant mother is a carrier of the virus, but she does not have symptoms of the disease, infection of the child through the placenta may not occur.
Weakness, fever and swollen lymph nodes are signs of CMV infection in an acute form. Clinical forms of infection caused by Cytomegalovirus hominis are also different in expectant mothers.
If the disease is acute, the lungs, liver, eyes, genitals, and brain may be affected. A pregnant woman may have complaints about:
- weakness and fatigue
- specific discharge from the nose or genital tract
- swollen and sore lymph nodes
CMV infection affects the normal course of pregnancy. If the disease is acute, the expectant mother is often diagnosed with:
- vaginitis
- colpitis
- uterine hypertonicity
- premature aging of the placenta
- oligohydramnios
CMV infection can also come back to haunt a pregnant woman:
- premature detachment of the placenta
- weakening of labor activity
- blood loss during childbirth
- postpartum endometritis
VIDEO: Cytomegalovirus infection and pregnancy
Cytomegalovirus during pregnancy: consequences for the fetus
Cytomegalovirus hominis can also affect a baby in the womb.
If intrauterine infection with CMV infection occurs in the early stages, the pregnancy may fail. IMPORTANT: Doctors consider the most dangerous situation to be the one when intranatal infection of a child with cytomegalovirus occurs in the first trimester of pregnancy. There is a risk of fetal death or the occurrence of various severe malformations in it.
Perinatal pathologies caused by CMV infection are:
- Regardless of the gestational age at which the infection occurred: stillbirth, prematurity, fetal malnutrition
- Infection occurred at an early stage: malformations of the nervous system (microcephaly, hydrocephalus), respiratory organs (lung hypoplasia), digestive organs, urination, heart disease
- Infection occurred at a later date: the birth of a child with pneumonia, jaundice of various origins, hemolytic anemia, nephritis, meningocephalitis, etc.
Unfortunately, congenital CMV infection can result in developmental defects and health problems in the child in the future. A child with congenital CMV infection may appear completely healthy at first. But over time, they may appear:
- hearing impairment up to deafness
- visual impairment up to blindness
- decline in intelligence
- speech problems
Cytomegalovirus in pregnancy planning. Analysis for cytomegalovirus during pregnancy
A woman who is serious about planning a pregnancy consults with a gynecologist, and already at this stage she is tested for TORCH infection, which allows her to identify a number of serious diseases that can disrupt the course of pregnancy and affect the health of the child, or antibodies to them .
IMPORTANT: The "C" in TORCH stands for Cytomegalovirus hominis.
Analysis for cytomegalovirus is included in the TORCH complex. A serological blood test reveals the presence of anti-CMV immunoglobulins of class M and G and its titer in a woman.
Antibodies to cytomegalovirus - what does it mean? Deciphering the analysis for cytomegalovirus in pregnant women
The results of a test for Cytomegalovirus hominis in a pregnant woman will allow the doctor to answer three important questions:
- Is the mother-to-be infected with cytomegalovirus?
- if so, when did the infection occur?
- if yes, is the virus active
Deciphering the analysis Indicators of cytomegalovirus during pregnancy, normal. What do cytomegalovirus titers mean during pregnancy?
An analysis that did not reveal IgM and IgG antibodies to Cytomegalovirus hominis is considered normal. This means that the woman is not infected. But there is absolutely no guarantee that infection will not occur in the pre-delivery period of time.
- A high IgM titer in the absence of IgG indicates an acute period of CMV infection and, accordingly, a high risk of infection of the fetus
- A high titer of IgG in the absence of IgM indicates the presence of a virus and the possibility of reactivation.
- Low titer of IgM and IgG - infection at the stage of attenuation
- High titer of IgM and IgG - reactivation of Cytomegalovirus hominis
Change in the titer of antibodies to CMV. Treatment of cytomegalovirus. How to treat cytomegalovirus during pregnancy?
Unfortunately, it is impossible to completely eliminate Cytomegalovirus hominis once it enters the body. But medicine knows ways to mobilize a person's own immunity to fight it.
Pregnant women are usually prescribed antiviral and restorative drugs. These are drugs based on interferon or herbal preparations. Effective, for example, is the drug Proteflazid.
CMV cannot be cured, but it can be controlled. If there are no antibodies to cytomegalovirus in the blood of the expectant mother, she should take preventive measures:
- do not change sexual partner
- use condoms
- follow the rules of personal hygiene
- do not eat from someone else's dishes
- regularly clean the apartment
- take care of your own health
What to do if cytomegalovirus is found during pregnancy: tips and reviews
If Cytomegalovirus hominis is found in a pregnant woman, she should not consider this the end of the world. The key to a normal pregnancy is constant interaction with the doctor and strict adherence to his prescriptions.
In the acute form of the infection, the expectant mother should be tested to control the antibody titer every two weeks, and also regularly examined to monitor the development of the fetus.
VIDEO: Cytomegalovirus during pregnancy
Cytomegalovirus igg (cytomenalovirus infection) ranks first in prevalence among the population. The causative agent of infection is cytomegalovirus (DNA-containing), which belongs to the group of herpesviruses. Once it enters the human body, it remains there forever.
With strong immunity, it is not dangerous, since its reproduction is suppressed by antibodies. But when the protective functions are weakened, the virus becomes active and can affect the internal organs and vital systems of the body. The causative agent of infection is of particular danger to a pregnant woman and a developing fetus.
Almost 80% of the world's inhabitants are infected with cytomegalovirus. At the same time, an infected person may not suspect for a long time that he poses a danger to others, since there are no characteristic symptoms of the disease. The virus can be detected by chance, during a laboratory test (determination of antibodies to cytomegalovirus in the blood).
Cytomegalovirus infection ( cmv) is transmitted only from person to person. The source of infection becomes a patient who is a carrier of the virus, but is unaware of his illness. The virus multiplies and is excreted with biological fluids - blood, saliva, urine, breast milk, semen, vaginal secretions. The main ways of transmission of infection:
- airborne;
- contact household;
- sexual
That is, a healthy person can easily become infected during contact with a sick person, when using some household items with him, through a kiss, sexual contact.
In the process of medical manipulations, cytomegalovirus is transmitted during the transfusion of infected blood and its components. Infection of a child is possible even in the womb (since the virus passes through the placental barrier), during childbirth and breastfeeding.
The herpes virus cytomegalovirus is of particular danger to patients with HIV infection, cancer patients and people who have undergone organ transplantation.
Symptoms of infection
In healthy people with strong immunity, even after infection with cmv , there are no visible symptoms. In the rest, after the expiration of the incubation period (which can be up to 60 days), there are manifestations similar to infectious mononucleosis, which often makes diagnosis difficult.
The patient complains of prolonged fever (within 4-6 weeks), sore throat, weakness, joint and muscle pain, loose stools. But more often, the infection is asymptomatic and manifests itself only during a period of weakened immunity, which may be associated with pregnancy in women, severe chronic diseases, or old age.
Severe forms of cytomegalovirus infection are accompanied by the following symptoms:
- the appearance of a rash;
- enlargement and soreness of the lymph nodes (submandibular, cervical, parotid);
- sore throat (pharyngitis).
Further progression of the infection provokes damage to internal organs (liver, lungs, heart), nervous, genitourinary, reproductive systems of a person. Women have gynecological problems (colpitis, vulvovaginitis, inflammation and erosion of the cervix and body of the uterus). In men, the inflammatory process captures the urethra and spreads to the testicles.
At the same time, the body's immune system tries to fight the virus in the blood, produces antibodies and gradually “drives” the pathogen into the salivary glands and kidney tissues, where it is in a latent (sleeping) state until favorable conditions arise for its activation. .
When asked whether cytomegalovurus infection can be cured, experts answer in the negative. If the virus enters the body, it remains in it for life. It may not manifest itself in any way with strong immunity, but this means that it is only in a latent state and, under favorable conditions, can “wake up” at any moment and begin its destructive activity.
At the current stage of the development of medicine, it is impossible to get rid of cytomegalovirus by existing methods, since the pathogen remains inside the cells and multiplies using DNA replication.
Cytomegalovirus during pregnancy
During pregnancy, the risk of complications increases depending on the type of cytomegalovirus present in the body. With primary infection, the consequences of the disease are much more severe than with cmv reactivation. Women during pregnancy constitute a special risk group.
During this period, they are especially vulnerable due to the physiological decline in immunity. Cytomegalovirus can provoke obstetric pathologies. So, if infection occurs in the first trimester of pregnancy, then 15% of women have a spontaneous miscarriage.
During primary infection, infection of the fetus occurs in 40-50% of cases, since the virus accumulates in the placental tissues and penetrates through the placenta to the embryo. This can lead to various anomalies and deviations in the development of the fetus. With intrauterine infection, the following external manifestations are noted;
- enlargement of the liver and spleen;
- disproportionate small head;
- accumulation of fluid in the abdominal and thoracic cavities.
If a woman has antibodies to cytomegalovirus, it is not worth planning a pregnancy until the course of conservative drug therapy is completed and laboratory tests confirm the normalization of the antibody titer.
Cytomegalovirus igg in children
Congenital cytomegalovirus infection in children develops even in the prenatal period, when the virus is transmitted from the carrier mother. In the early stages of life, this type of infection usually does not show severe symptoms, but later it can lead to serious complications:
- hearing problems (hard of hearing, deafness);
- the occurrence of seizures;
- violation of intelligence, speech, mental retardation;
- eye damage and total blindness.
Acquired CMVI (cytomegalovirus infection) becomes the result of infection of the child from the mother during childbirth and breastfeeding, upon contact with a carrier from among the medical staff.
The risk of infection in children increases dramatically with age, especially during periods when the baby joins the children's team and begins to attend kindergarten and school. In children, the manifestations of cytomegalovirus look like an acute form of SARS, as it is accompanied by the following symptoms:
- runny nose appears;
- the temperature rises;
- enlarged cervical lymph nodes;
- there is profuse salivation and swelling of the salivary glands;
- the child complains of weakness, muscle pain, chills, headache;
- stool disorders (alternating constipation and diarrhea) are noted;
- the liver and spleen increase in size.
On the basis of such a clinical picture, it is impossible to make a correct diagnosis. To identify the pathogen, laboratory research methods are needed that allow the detection of antibodies to the virus and the virus itself in the blood.
What tests should be done to check for infection?
The human immune system begins to produce antibodies to the virus immediately after it enters the body. A number of laboratory tests make it possible to immunologically determine these antibodies and thus understand whether an infection has occurred or not.
Specific antibodies after infection are produced in a certain concentration (titers). The so-called IgM antibodies are formed approximately 7 weeks after infection during the most intensive reproduction of the virus. But over time, they disappear, moreover, these antibodies are also determined when infected with other types of viruses (for example, toxoplasmosis).
IgM antibodies are fast immunoglobulins, they are large in size, but are not able to retain immunological memory, therefore, after their death, protection against the virus disappears after a few months.
A more accurate result is given by an analysis for Igg antibodies, which do not disappear after infection, but accumulate throughout life, which suggests the presence of a cytomegalovirus infection. They appear in the blood within 1-2 weeks after infection and are able to maintain immunity against a certain type of virus throughout life.
In addition, there are several more methods used to detect cytomegalovirus:
- The ELISA method is an immunological study in which traces of cytomegalovirus are found in biological material.
- PCR method - allows you to determine the causative agent of infection in the DNA of the virus. It is considered one of the most accurate analyzes, allowing you to quickly get the most reliable result.
To determine CMVI, they often resort to a virological method, which is precisely based on the determination of IgG antibodies in blood serum.
The norm of cytomegaloviruses in the blood and decoding of the analysis
Normal levels of virus in the blood depend on the sex of the patient. So, in women, the rate of 0.7-2.8 g / l is considered the norm, in men - 0.6 -2.5 g / l. The rate of cytomegalovirus in the blood of a child is determined taking into account the amount of immunoglobulins to the virus when diluted in the blood serum. A level of less than 0.5 g / l is considered a normal indicator. If the indicators are higher, then the analysis is considered positive.
- Cytomegalovirus igg positive - what does it mean? A positive result indicates that the infection is present in the body. If the result of the analysis for the determination of IgM antibodies is also positive, this indicates an acute stage of the disease. But if the IgM test is negative, this is evidence that the body has developed immunity to the virus.
- A negative analysis for cytomegalovirus igg and IgM suggests that a person has never encountered such an infection and has no immunity to the virus. But if the test for igg is negative, and for IgM it is positive, it's time to sound the alarm, since such a result is evidence of a recent infection and the onset of the disease.
The avidity of igg antibodies to the virus is determined in a laboratory study of the patient's biological material. It is this indicator that gives an idea to specialists about the degree of infection of the patient's body. The breakdown of the analysis is as follows:
- With a recent primary infection, the number of detected antibodies does not exceed 50% (low avidity).
- With indicators from 50 to 60% (average avidity), a second laboratory examination is required to clarify the diagnosis, which is carried out several weeks after the first one.
- The chronic form of cytomegalovirus infection, accompanied by active production of antibodies, is indicated by an indicator of more than 60% (high avidity).
Only a specialist can decipher the results of the analyzes. When analyzing the data obtained as a result of the study, the doctor takes into account certain nuances (age and gender of the patient), after which he gives the necessary recommendations and, if necessary, prescribes a course of treatment.
Treatment
Cytomegalovirus infection in a latent variant does not require therapeutic measures. In other cases, the course of therapy is based on the use of antiviral agents and immunomodulators. All appointments must be made by a specialist.
Specific immunoglobulins used in the course of treatment contain up to 60% of antibodies to cytomegalovirus. The drugs are administered intravenously, in exceptional cases it is possible to administer immunoglobulin intramuscularly, but this significantly reduces the effectiveness of therapy.
Nonspecific immunoglobulins are usually prescribed for the prevention of CMVI in people with immunodeficiency states. During pregnancy, immunoglobulin is also the drug of choice, and the risk of fetal damage in this case directly depends on the amount of antibodies to the virus in the woman's blood.
Since it is impossible to completely get rid of cytomegalovirus, the task of complex treatment is to restore the body's defenses. The therapy is complemented by good nutrition, taking vitamins and a healthy lifestyle.
Watch the video where Malysheva talks in detail about the treatment and prevention of Cytomegalovirus:
