Treatment of cytomegalovirus infection in adults

Human cytomegalovirus (CMV) belongs to herpes viruses. Like other herpes viruses, following primary infection by cytomegalovirus infection in adults and children remains in the body and can be activated in case of violation of the immune system. The infection occurs without symptoms, except in cases of infection of the fetus, newborns (younger children due to exposure to the virus may develop salivary gland disease) and people with compromised immune systems. At the time, as in the fetus CMV causes birth defects in people with an impaired immune system infection with CMV occurs under the form of inflammatory diseases of various organs – liver, lungs, colon, brain tissue and the retina.

What is cytomegalovirus?

Cytomegalovirus is the largest DNA-containing virus that infects people. There are also CMV animals, but it can't be transmitted to humans.

Infected cells after infection increase. Hence it came the name of the virus, as translated from Greek cell is called "kytos," and great is "megas". The virus was first isolated from the salivary glands, therefore the disease was called "disease of the salivary glands".

Transmission of cytomegalovirus

The only source of CMV is the human being – namely, a sick person or a carrier. The infection is transmitted by close personal contact through the mouth air, or by sexual contact. The spread of infection also occurs through blood transfusion, organ transplant, by breast milk and from mother to fetus. The virus is found in blood, saliva, tears, urine, breast milk, semen, vaginal secretions and affected organs. After primary infection, the virus is eliminated for a very long time. The incubation period typically ranges from 20 to 60 days.

Morbidity

Morbidity increases with age and depends on the socio-economic conditions. At that time, as in the total population of the developing world, persons over the age of 5 years are already infected, in developed countries, half of the members of this age group CMV is not affected.

How is the infection?

The cytomegalovirus in adults (men, women) and children gets into the body through the mucous membranes of the respiratory, gastrointestinal or urogenital system, and in the body is spread with white blood cells. Primary infection is often asymptomatic, after which the virus persists in the cells of the kidneys and salivary glands, where for a long time propagated and excreted with the saliva and urine. Once the immune system gains control of the infection, CMV persists in a latent state in certain types of white blood cells (monocytes and macrophages). The activation of infection also may be asymptomatic. Dangerous is the situation in women during pregnancy when the virus crosses the placenta and infects the fetus. Mainly, it affects the formation of liver, brain and blood. In people with a weakened immune system also causes serious symptoms.

Symptoms

In most cases, the disease occurs without symptoms or with unusual characteristics. After occurred the primary infection, the virus remains in the body.

Signs, in accordance with the classification

Congenital CMV infection in babies is a common enough phenomenon in which 50% of cases primary infection occurs via the placenta. Re-infection and activation occurs only in 1% of children. Cytomegalia the disease is more severe in fetuses of non-immune mothers. Affects mainly the brain, liver and blood.

From a disorder of hematopoiesis comes to reducing the number of platelets, this condition is manifested localized pinpoint bleeding of the skin (petechiae). In women the infection can lead to repeated arbitrary abortions and birth of dead fetuses.

Children who are less affected and survive excrete the virus in the long term. Liver and hematopoiesis over time is adjustable, but neurological symptoms and hearing impairment, unfortunately, no.

In healthy adults the infection is characterized by an asymptomatic course rarely causes symptoms similar to infectious mononucleosis.The main and practically the only manifestation may be fever, lasting for several weeks. Swollen lymph nodes in the neck, is usually small, you may experience a sore throat, however, more likely to develop pharyngitis. Often the disease is accompanied nonspecific flu-like symptoms, including General malaise, weakness, pain in the head and muscles, rash, and moderate enlargement of the spleen and liver.

Part of cytomegaloviral mononucleosis is an inflammation of the liver, which, however, can also be an independent disease. Disease characterized febrile course with vomiting, may develop without symptoms, or with hepatic insufficiency. Comes to increase of liver.

Cytomegalovirus infection as a result of transplantation of kidney, heart, and liver occurs approximately in 70-100% of cases. Here the source is a transplanted organ or blood that contains the virus. The clinical picture is under the picture of permanent heat, such as infectious mononucleosis, but severe inflammatory disease with fever, liver disease, colon, stomach upsets and pneumonia. If as a result of the transplant, infection develops, it leads to the worst survival rate of a transplanted organ.

Very difficult is the course of disease in humans after bone marrow transplantation. Approximately 2 months after transplantation of developing CMV pneumonia with a rather poor prognosis.

Infection through blood transfusion is called "perfusion syndrome". Manifestations include fever, swollen lymph nodes and liver.

In HIV-positive individuals, CMV causes inflammation of the lungs, brain, gastrointestinal tract and the retina. The virus likely acts as a factor that promotes the progression of AIDS. People with AIDS have an active CMV infection, which is usually the cause of early death.

CMV retinitis, in most cases, represents the first sign of infection of the whole body. Lose shows blurred vision, gradual loss of sight and, subsequently, leads to a complete loss of vision. Happens patchy death of the retina. In the absence of treatment of cytomegalovirus infection as a consequence of inflammatory processes, complete loss of vision occurs within six months. The disease is often accompanied by inflammatory processes in brain tissue.

The inflammatory process in the nerve plexus of the sacral and lumbar regions is a complication of HIV infection that occurs in the later stages of its development. For the disease characterized by rapidly progressive disorder of motor abilities of the lower limbs, urine retention, fecal incontinence, sensory deficiency.

If it comes to disorders of the gastrointestinal tract, the occurrence of ulcers in the esophagus, which is manifested painful and difficult swallowing.

The inflammatory process in the colon is accompanied by high fever and diarrhea with blood. As a result of this condition, a rupture of the intestine. Ulcers in the mouth and on the lips difficult to treat, they are quite painful and uncomfortable.

Diagnostics

In the case of suspicion of infectious mononucleosis with fever, fatigue and enlarged spleen and liver, the doctor performs basic laboratory tests blood. If there is CMV infection, blood tests show an increased first and then decreased number of white blood cells is characteristic of their increase (atypical mononuclear cells). At the same time determined by elevated liver enzymes.

In healthy adults the most reliable method of detecting the disease are antibodies against cytomegalovirus, or increase their number. From the blood, urine or saliva can be isolated the virus, antigen, or DNA.

In congenital CMV infection diagnostic criteria of the disease based on direct evidence of the presence of typical giant cells in the urine sediment, multiply and transfer the virus to human fibroblasts or evidence of the presence of virus by PCR in saliva or urine.

In patients with a poorly functioning immune system (transplant recipients, HIV-positive) does not reach to develop protective antibodies, so you need to find CMV in a sample of tissue (biopsy), preferably from the liver, or to determine the presence of virus by PCR in the blood.

Therapeutic method

Treatment of cytomegalovirus infection in adults with a good immune system function is directed at reducing the signs.

Treatment of cytomegalovirus in persons who have reached the impaired immunity (HIV or after organ transplantation), when there is a complicated infection course, is assigned to the target therapy and the drugs are injected for the treatment, which aims to eradicate the virus. As additional therapy sometimes in the acute phase are introduced antibodies against CMV (protivotsellyulitnye hyperimmune globulin).

The main criteria of symptomatic therapy submitted by: adhering to peace, restriction of physical activity and appropriate nutrition. As a maintenancetreatment is recommended intake of vitamins and hepatoprotectors, although their meaning is not clearly recognized.

Can help and herbs, particularly medicinal tea from milk Thistle – it helps to leach the same substances as in the case of drugs from the group of hepatoprotectors.

To reduce the heat used antipyretic medication. In this case, two kinds of fever, one remedy contains Paralen, the other Ibuprofen.

Antivirals prevent the reproduction of viruses. We are talking about quite expensive drugs prescribed to people for whom such treatment is needed, they are important, especially for people with disorders of the immune system. Proven antiviral effect of Ganciclovir and Foscarnet. These medications may show efficacy not only in treatment, but, in certain cases, and preventive measures (prevention of infection in predisposed individuals). In the case of severe and prolonged disorders of the immune system, prevention can be recommended throughout a person's life.

The intake of antiviral medications people-recipients after bone marrow transplantation is a controversial issue. The drug Ganciclovir can worsen the complete absence of platelets and neutrophils. Other antiviral drugs have toxic effects on the kidneys. Thus, the introduction of antiviral therapy is individual.

Conclusion

HIV positive people are recommended to undergo periodic eye examination in order was discovered CMV retinitis and treated. This will help prevent loss of vision.