Treatment of cytomegalovirus: are there any effective drugs, and why is it so dangerous for expectant mothers

Cytomegalovirus is ubiquitous, and it is easy for them to get sick. By the age of 30, about 40% of people have already formed immunity to the virus. In women with fetal loss, active CMV infection is detected in 50-60% of cases. Pregnant women endure the disease without even knowing about it.

What kind of infection

Cytalomegavirus (CMV or CMV) is still not well understood, so the information about the diseases that it provokes, and even more about their treatment, is very approximate and ambiguous. Here are some facts:

• more than 65% of the total population is infected with the virus;
• after the first contact, he remains in the body forever;
• the probability of activation during pregnancy is very high;
• CMV easily crosses the placenta;
• upon activation, causes dysfunctions of many organs;
• may be in blood, urine, saliva, breast milk, vaginal secretion, semen;
• herpes simplex virus and CMV are often exacerbated together.

How can I get infected

You can only get infected from a sick person at the time of the acute phase of the disease with initial contact with the virus or another exacerbation of the infection. The following transmission paths are characteristic:

• airborne - The salivary glands are the “favorite place” for the virus, so it is easily transmitted by talking, kissing, and also when sneezing and coughing;
• contact household - through common dishes, towels, personal items;
• transplacental - - through the placenta to the baby during pregnancy;
• when breastfeeding - the virus can be found in mother’s milk if she has an active infection;
• during sexual intercourse - CMV is a secret of the cervical canal and vagina, in semen, mucus from the rectum;
• with contaminated blood and organs - during transfusion or after transplantation of donor organs.

Options for development and symptoms of cytomegalovirus in women

Most often, CMV infection occurs unnoticed by humans. The incubation period can vary from 14 days to two months.

Latent current

“Initial acquaintance” proceeds without symptoms, with a clinic similar to SARS. Such a course is typical for healthy people without chronic diseases or immunodeficiency conditions. May bother the following:

• prolonged low-grade fever;
• aches and pains in muscles and joints;
• soreness and sore throat;
• weakness, lethargy;
• enlargement of the mandibular lymph nodes.

Generalized and localized forms

A generalized variant of CMV infection is much less common. Its manifestations are always associated with other diseases that occur in parallel and significantly reduce immunity, for example: acute respiratory viral infections, HIV, after surgical interventions, against the background of cancer. In this case, CMV infection proceeds as SARS or long-term ARI, which is not treatable. The clinical picture is supplemented by corresponding changes in the blood.

Considering that CMV is sexually transmitted, phenomena may prevail in the clinical picture of a localized form cervicitis (inflammation of the cervix) endometritis (inflammation of the uterine cavity), salpingo-oophoritis (inflammation of the appendages). In this case, the virus will be detected in secretions from the genitals.

How to identify and control

Two types of examinations are diagnostic for CMV infection:

• immunological - with the determination of the titer of antibodies to the virus in the blood;
• PCR - A method aimed at detecting the DNA of a virus in biological fluids.

Immunoglobulin titers and the strength of their bonds

The identification of immune complexes for CMV is included in the examination for TORCH infections (those that are transmitted in utero; this also includes toxoplasma, rubella, herpes of the first and second types). The following immunoglobulins are determined:

• Ig M - are produced when they encounter the virus for the first time in the acute period of the disease;
• Ig A - are formed in the subacute period, do not have high information content, therefore, are determined less frequently;
• Ig G - appear in the blood at the end of the recovery period and can persist throughout life.

It is useful to determine not just the presence of immunoglobulins, but their titers. In the future, by increasing or decreasing in dynamics, one can judge the nature of the disease and make a more reliable prognosis. In addition, for Ig G, an indicator such as avidity is determined. It shows how strong complexes of immunoglobulins are. High numbers indicate an old infection, and low numbers (poor protein adhesion) indicate a recent infection in which persistent immunity has not yet developed. The following table will help you understand the results of the analysis.

Table - Results of analysis for cytomegalovirus with titers

Determining only Ig G is not of great diagnostic importance, since it is “one side of the coin”, which does not allow you to see the whole picture of a woman’s health status.

The interpretation of the results of strength and binding to antibodies (avidity) is as follows:

• up to 30% - acute period of the disease;
• 30-40% - The end of the acute phase or recent CMV infection;
• more than 40% - long-standing infection.

What is the role of PCR studies

PCR of any biological fluid or tissue gives an idea of ​​the presence of active forms of CMV in a particular place. The most common fence is the following:

• cervical and vaginal secretions;
• blood;
• swab from the cavity of the pharynx and nose;
• breast milk;
• rectal swab;
• smear from the urethra.

In addition, any tissue can be examined, for example, after removal or biopsy, if there is reason to assume CMV infection.

When pregnant women need to be examined

Ideally, a woman should be screened for TORCH infections when planning a pregnancy. This will allow you to develop a tactic of behavior during gestation or undergo treatment if high Ig M or Ig G titers have been detected at the moment.

If before the conception the diagnosis of the presence of CMV has not been carried out, it is recommended to do this in the near future.

The need for additional examination is determined taking into account the first results obtained. The tactics are as follows:

• all Ig titers are negative - it is necessary to control at 20, as well as at 30-32 weeks of pregnancy in order to exclude primary infection during gestation;
• positive IgG antibodies only - the next examination in relation to cytomegalovirus is carried out only according to indications, for example, if intrauterine infection is suspected;
• positive Ig M regardless of Ig G - additional diagnostics are necessary to clarify the prognosis, indications for treatment or termination of pregnancy.

Based on the course of pregnancy, there are indications for examination for the entire TORCH complex in the following cases:

• with polyhydramnios;
• with identified fetal malformations;
• with the threat of interruption and spotting;
• with suspected intrauterine infection;
• with the death of the fetus in the womb;
• in case of violation of the function of the placenta (according to the results of dopplerometry);
• with blood flow disturbance in the umbilical cord;
• with pathology of blood flow in the main vessels of the fetus (by dopplerometry).

Timely diagnosis and competent interpretation of test results help to avoid neonatal losses, pregnancy complications, fetal malformations.

Risks for the baby

The effects of cytomegalovirus are especially dangerous for women during pregnancy. This is due to the following factors:

• physiologically, at this time, the immunity of a woman decreases;
• CMV easily crosses the placenta;
• permeability of membranes for the virus.

The greater the amount of cytomegalovirus in a woman’s body, the higher the probability and risk of intrauterine infection of the fetus. The most formidable condition is when a woman first encounters the virus during gestation. In her blood at this moment there are no antibodies that can partially neutralize CMV. Therefore, a large portion of pathogens comes to the baby.

Less dangerous, but still a threat is the state of activation of a chronic infection. In this case, antibodies in the blood that formed upon initial contact bind and destroy some of the viruses. Therefore, the likelihood of intrauterine infection, as well as the severe course of the disease, is less likely.

Cytomegalovirus infection in the fetus is manifested as follows:

• in the early stages - Frozen pregnancy, threatened abortion, fetal malformations;
• in late terms - fetal death, premature discharge of amniotic fluid, impaired placental function, congenital cytomegaly.

Signs of cytomegalovirus in a child after birth may not be detected immediately, the clinical picture is not always clear. The following are characteristic:

• prolonged jaundice;
• enlarged liver and spleen;
• increased bleeding;
• hemorrhages on the skin, mucous membranes;
• bleeding from the stomach, rectum, umbilical wound;
• inflammation of the substance of the brain (encephalitis);
• cytomegalovirus pneumonia and kidney damage.

In women who have CMV infection in a smear from the cervix or vagina during pregnancy, the question arises of the safety of natural childbirth. It is proved that the risks of infection of the baby when performing a cesarean section are not less, since the virus is most likely found in other tissues.Therefore, delivery is planned taking into account the obstetric situation.

Does immunity to CMV develop

CMV, like any herpetic virus, after an episode of the disease does not lead to the formation of stable immunity, such as chickenpox. Therefore, there is no vaccination against this dangerous disease.

If a person once suffered from CMV, the virus remains circulated throughout the life of the tissue, and is activated at a “convenient time”. Antibodies that form at the time of the first encounter with the pathogen only slightly mitigate subsequent relapses.

How to recover Treatment regimen

The treatment of cytomegalovirus is the destiny of the future, today there is not a single drug with proven effectiveness. Almost all drugs are prescribed rather with the goal of “suddenly helping”, but this is only an additional burden on the pregnant woman’s liver, as well as potential harm to the fetus. Most often, you have to face the appointment of the following groups of drugs.

• Interferons. For example, “Viferon”, “Geneferon”,“ Kipferon ”, however, many scientific publications question the feasibility of prescribing these drugs. Interferons are useful for the prevention of other viral diseases, which can worsen against the background of CMV and can also adversely affect the course of pregnancy.
• Antiviral. "Valacyclovir", "Acyclovir"," Ganatsiklovir "- drugs are effective against HSV of the first and second types, CMV is not very sensitive to them.
• Human immunoglobulin. The drug is known as "Neocytotec." Represents the concentration of Ig G against CMV. Intravenous administration of the drug is preferred under strict indications; intramuscular injections are less effective. However, even such a medicine will not completely protect against CMV, but will only reduce the likelihood and severity of the negative consequences.

Infection prevention

If a woman has never experienced CMV (this can be seen by blood immunoglobulins), and if she is prone to activate this infection, the following recommendations should be followed during pregnancy.

• Do not contact closely with children under five years of age. Namely - do not kiss, do not eat from one dish, do not lick a dummy, wash your hands after changing diapers. This is especially true for "sadovskih" kids, where the likelihood of picking up CMV increases. It is optimal not to take an older child to preschool institutions at all to prevent infection.
• Avoid sick people. Under the guise of a conventional ARVI, CMV may be hidden.
• Exclude casual sexual intercourse. So you can avoid infection not only CMV, but also other infections - chlamydia, ureaplasma, Trichomonas, mycoplasma.
• Plan pregnancy. It is necessary to be examined before the conception of the baby. In the case of the birth of a child with CMV, the next pregnancy should be planned no earlier than two years later.

Cytomegalovirus infection must be considered not only during gestation, but also at the planning stage. Given the fact that cytomegalovirus in women is detected in more than 70% of cases, the likelihood of its activation during pregnancy directly depends on the state of health and associated diseases of the expectant mother.

Moms reviews and experiences

This virus must be treated immediately, as soon as confirmed.My friend has a sad story, all pregnancy went normally, the doctors did not say anything. Up to 6 months, the girl normally grew and developed, after 6 months. they have a crisis, and all of it began to lag behind its peers. They went to the doctors, and only after they donated blood, they found this virus. We went for treatment to other cities, but it was too late. It turned out that even during pregnancy there was this virus. Girls were diagnosed with cerebral palsy. It is very sad, and it’s a shame, if everyone said it in time, then there would be no problems. Good luck and a healthy baby !!!

Ksyen, https://deti.mail.ru/id1013447626/

No one knows what ... It can turn around, or maybe not. My brother’s wife already found out after the fact that all the pathologies at birth that her baby had (heart disease, nose pathologies (the operation was done in the first days of the baby’s life), pyelonephritis) are the result of the transmitted cytomegalovirus during pregnancy. They operated on everything, they were cured of everything, now their nephew is 11 years old, a good healthy child, he always studied well, is fond of football, and disability was removed at one time. So - cry less, you definitely won’t do it to the child!) I wouldn’t be in a hurry to interrupt ... Is it really impossible to do any tests to identify pathologies in the child? Everything will be fine with you!) I wish you good luck, easy delivery and a healthy baby!)

A guest, https://deti.mail.ru/id1001003178/

During B, CMV was discovered in me, one doctor prescribed medications, I read about them, my hair stood on end. Another doctor advised not to drink serious medicines, but to put candles on Viferon. I did so. The baby was born with a strong enlargement of the liver and spleen, they said that CMV could be the cause. At 2 weeks passed his blood and my milk for analysis, did not find anything. The liver and spleen are not decreasing, at 5 months they again donated blood and urine to different laboratories for analysis .... CMV found both there and there. All family members will have to be treated.

Irdeliz, https://www.u-mama.ru/user/info/121897/index.html

I also detected this cytomegalovirus during pregnancy, also worried, but everything worked out, almost all of my friends knew it was pregnant, and they are doing well. Do not worry!

A guest, http://www.woman.ru/health/Pregnancy/thread/4332284/

I got sick, about the same time, it didn’t affect my pregnancy (but I was calm, like a boa constrictor). we can say that it went perfectly TTT. By the way, I learned that I had been ill for about 20 weeks. passed PCR to CMV before childbirth - it was clean, i.e. it was possible to give birth naturally.
the results of his "work" are visible now. CMV gave us intrauterine hypoxia (although the baby was born beautiful, rosy and immediately screamed, with a clean, good voice), and there was no question of hypoxia on the part of the doctors. Now we have a temporal delay in speech development, which we are actively working on, and a small increase in the ventricles of the brain (and this just needs to be outgrown).

Anya, http://forum.littleone.ru/member.php?u=163129