Cytomegalovirus infection symptoms in women during pregnancy

Cytomegalovirus and pregnancy – what are the consequences?

Cytomegalovirus is a disease which, as a rule, in children or in adults does not cause significant symptoms. Almost 80% of the women reported cytomegalovirus infection without knowing it. However, a positive analysis on SMVI during pregnancy can cause dangerous effects to the fetus.

What is cytomegalovirus infection?

CMV is transmitted from person to person through contact with saliva, urine, products of mucous membranes and blood and can be transmitted sexually. CMV during pregnancy can be transmitted to the fetus before birth or during breastfeeding.

Cytomegalovirus during pregnancy – what are the symptoms of the infection?

Sore throat, joint and muscle pain, fever. In the case of immunosuppression can be reached, for example, to pneumonia. This is not the norm, especially during pregnancy, immediately call your doctor! If the disease is not treated, it is dangerous for the woman and fetus. If necessary, the attending doctor will refer the woman for further tests, explain all the "details" about the disease, will help prevent undesired consequences.

What is dangerous cytomegalovirus during pregnancy for the baby?

Most children who are infected by their mothers during pregnancy, immediately after birth has no clear symptoms. However, they can develop later in life – in particular, the disease is characterized by neurological complications, visual impairments, developmental disabilities. A small proportion of children have problems at birth – enlarged liver, spleen, jaundice. From CMV infection, unfortunately, today there is no protection, including in pregnant women.

Cytomegalovirus igg positive – when there is the greatest risk to the fetus?

Risk to the fetus is highest during the first 20 weeks of pregnancy.

Analysis for cytomegalovirus in pregnancy – what are the diagnostic methods?

Adults determine antibodies to cytomegalovirus (their level – the normal or increased amount) in the blood, newborns have antibodies to CMV measured in physiological fluids. Before birth can be used amniocentesis (sampling amniotic fluid), to determine the presence of virus in amniotic fluid. Also recommended a thorough ultrasound examination and search of defects of development.

Cytomegalovirus in pregnancy – prevention

Important for hygiene, especially for women, who have small children, or who frequently communicate with young children. Given these circumstances, women working in the field of health must study the presence of CMV infection before pregnancy.

CMV: possible risks

Cytomegalovirus is a virus in the salivary glands, which can cause infection in the body. Can be stored in the body in latent form, he is omnipresent. A sick person could transmit it, together with: urine, saliva, blood, milk, feces and ejaculation. The greatest danger is a congenital cytomegalovirus infection, which can contribute to malformations, miscarriage or stillbirth.

The risk for weak and pregnant

Almost 60-90% of the adult population has experienced a CMV infection.

CMV can persist for long periods of time in the human body without causing any problems. Sometimes, however, it affects some organs or affects the Central nervous system.

In some cases, CMV causes swollen lymph nodes – there is cytomegalovirus mononucleosis.

Detection of CMV in pregnant women is a common cause for abortion. There is a serious risk of poor development (malformations), fading of the foetus or stillbirth. Cytomegalovirus also may cause miscarriages.

The family of herpes viruses

Cytomegalovirus belongs to the group of herpes viruses. They are involved in the development of the common cold, infects people with a weakened immune system, which number among the population is constantly growing.

• In adults, CMV may cause mononucleosis or hepatitis.
• Cytomegalovirus can lead to very serious immune disease – chronic fatigue syndrome.
• Cmvi is a serious complication of a weakened immune system that can occur, for example, anemia, HIV infection or AIDS.

Remember — CMV contagious!

Cytomegalovirus can be transmitted from person to person. However, to transfer people should be in very close contact, because the virus is transmitted in the following ways: saliva, urine, breast milk, semen, other body fluids.

CMV is transmitted sexually and also in all types of intimate contacts. Particularly high risk is present in children's institutions, hospitals and social facilities, so it is necessary to observe hygienic precautions: wear masks, wash their hands often with soap and water or use disinfectant for hands. CMV is, however, not ranked among the infectious diseases, the infected person should not be isolated, is not declared a quarantine.

CMV is one of the most common vertically transmitted viral infection, which affects approximately 0.5% to 2.0% of all births. Transmission of CMV may be prenatal (placental infection acquired in the womb), which is the cause of congenital CMV infection, perinatal (infection, transmitted through direct contact during birth) or postnatal. The disease and consequences of cytomegalovirus infection depend on the mode of transmission and immune status of the mother.

Like all herpes viruses, CMV has the tendency to persistence and latency of organisms. During the suppression of cellular immunity could be reactivation of the virus or its subserosal form in place of persistence and, ultimately, to clinical manifestation. Viral disease progress from subclinical forms of the syndrome and infectious mononucleosis to spread infections in people with immunodeficiency and severe congenital lesions in children.

Obvious clinical signs of congenital CMV infection during childbirth show about 10-15% of all live births. Infections can affect any organ, the symptoms may be mild, moderate and severe, literally, lightning-fast spread of the virus as a result, approximately 20% of cases, leads to perinatal mortality.

Intrauterine infection depends on the time of the destruction of the fetus by CMV. Infection in early pregnancy leads to the development of birth defects. We are talking about the so-called congenial cytomegaloviral congenital disease. Creates a similar set of features as in other congenital infections. It is manifested in the following clinical conditions:

• Premature birth.
• Prematurity.
• Hypotrophy.
• Dystrophy.
• Hepatosplenomegaly.
• Prolonged neonatal jaundice.
• Thrombocytopenia purpura.
• Visual impairment.
• Chorioretinitis.
• Brain damage.
• Microcephaly, including vnutridiskovoe calcification.
• Hydrocephalus.
• Neurological symptoms (lethargy, hypotension or hypertension, seizures).
• Mental retardation.
• Growth retardation.
• Sepiamutiny viral syndrome.
• Rare interstitial pneumonia.
• Respiratory distress syndrome.

This infection can cause recurrent miscarriages and birth of dead fetuses. Pregnant women with primary CMV infection may be an abortion.

Infection arising in later pregnancy may not be obvious after birth (i.e. congenital latent "silent" infection – no signs of fetal infection after birth). These children in 80-90% of cases allocated CMV from urine and saliva in 2-3 weeks of age.

In postnatal development, the disease can manifest as developmental disorders, chronic hepatitis, and hearing loss, which is the most common consequence of congenital CMV infection and may be uni - or bilateral, mild to profound deafness.

In addition, in a later age the "norm" for symptoms of infection determined dental defects, mental retardation, optic atrophy, chorioretinitis, speech disorders and disorders of attention. These children may excrete the virus in saliva and urine for several months, but years.

Incidence isglobal, the percentage of infected individuals increases with age. In developing countries low socio-economic level and a higher population density leads to an increase in the frequency of CMV infection. As a rule, the higher the infection rate among children is recorded in closed groups. For adolescents the risk factor is the increase of sexual activity, increasing the risk of congenital CMV infection is present in children born to mothers under the age of 20 years.

The source of infection is always sick person or a carrier. Transmission is possible in the horizontal direction (saliva, urine), by direct contact, including sexual transmission can occur in utero from mother to fetus, during delivery and in the postpartum period with breast milk.

Diagnostics

Diagnostics in the persistence of the virus in the body and its possible reactivation in accordance with a clinical picture occurring in asymptomatic infections are virtually impossible. Therefore, the diagnostic rule is simply the need for additional laboratory tests.

In pregnant women diagnosis is based on serologic detection of specific IgM, IgG and IgA, as well as the determination of avidity of IgG antibodies. Determination of the avidity of IgG antibodies helps to distinguish recent infection from anamnesticeskih antibodies. The presence of IgM and IgA indicate ongoing acute primary infection or reactivation of infection. IgG antibodies are indicative of previous infection, and stored in the body for life.

Prenatal intrauterine diagnosis based in part on the monitoring of fetal development using ultrasound, magnetic resonance imaging (MRI), and in some cases is cordocentesis or amniocentesis. During primary infection in the first trimester of pregnancy, as well as the demonstration of malformations of the fetus, it is necessary to consider termination of pregnancy. In these cases, collaboration with geneticists. Next is isolation of the virus, as well as other hematological and immunological tests, specific IgM serologically determined blood and amniotic fluid.

Newborns sets of specific IgM and IgA and umbilical and venous blood, and then carried out virus isolation from the urine. In neonates and infants IgM and IgG can be formed irregularly and late, so the absence of these antibodies at this time, does not exclude the presence of CMV infection. Next is the ultrasound examination of the brain CT (computed tomography) and MRI (magnetic resonance imaging), spinal tap, eye tests, hearing test and neurological examination. Further studies are recommended in accordance with the clinical picture of the newborn.

Treatment of cytomegalovirus in pregnancy

Standards of treatment of pregnant women with primary CMV infection has not been determined. Safe is probably the use of hyperimmune immunoglobulin against cytomegalovirus. His reception, however, can only reduce the amount of potential injury to the fetus. Treatment with antiviral drugs due to their side effects (nephrotoxicity and myelosuppression) has not yet been approved.

Newborns with severe clinical symptoms of the congenital form of CMV after birth is recommended Ganciclovir (10-12 mg/kg of body weight, divided into 2 doses every 12 hours) is administered for at least 6 weeks. The total time the application has not been determined. Other antivirals with activity against CMV – Foscarnet and Cidofovir – because of their side effects is recommended only for patients 18 years and older. Separately or simultaneously with Ganciclovir, you can enter to newborns with congenital infection also specific hyperimmune immunoglobulin.

Conclusion

Given the severity of the disease newborns with congenital CMV infection remain in the ICU or in the infectious diseases departments, where they are provided with complex symptomatic therapy. This, in most cases, long-term hospitalization is necessary interdisciplinary cooperation and the subsequent long-term observation.