Congenital cytomegalic inclusion disease – an infectious disease which develops at pre-natal or intranatalny infection of the child with a cytomegalovirus and is characterized by multiple defects and damages of internals. The disease often proceeds asymptomatically, at the expressed clinic the main symptoms are damages of a brain (encephalopathies, a mikrotsefaliya, hydrocephaly, etc.), hepatitis, pneumonia, nephrite, sialoadenit, pathology of organs of vision and hearing. The congenital cytomegalic inclusion disease is diagnosed by the IFA and PTsR methods, the virus is found in blood, urine, dab from a throat. A basis of specific treatment – anti-Cytomegaloviral immunoglobulin.
Congenital cytomegalic inclusion disease
Congenital cytomegalic inclusion disease – the most often found congenital infection. Disease frequency among newborns – 0,2-2,5%. If the pregnant woman has primary Cytomegaloviral infection, the probability of a disease of the child fluctuates from 30 to 50%. In case of a secondary infection infection of a fruit occurs at mother extremely seldom and makes 1% of cases. The congenital cytomegalic inclusion disease is an urgent problem for pediatrics. Now incidence considerably increased. Very often overdue diagnostics due to the lack of clinical manifestations right after the child's birth takes place. The huge attention is paid to a question of early prevention of a disease. Training of medical personnel is provided, standards of inspection of pregnant women and newborns change. In due time begun therapy allows to reduce considerably disability level among the children who transferred a congenital cytomegalic inclusion disease. Development of a vaccine against a cytomegalovirus is actively conducted.
Reasons of a congenital cytomegalic inclusion disease
The infection reason – the DNA-containing cytomegalovirus relating herpes viruses to family. In the external environment the virus is steady at the room temperature, however does not maintain influence of 20% of solution of ethyl alcohol and other disinfectants. The activator of a cytomegalic inclusion disease is capable to survive in a cage for many years. The risk of infection of the woman increases if during pregnancy she contacts to patients with a cytomegalic inclusion disease, works in places of a big congestion of people (kindergartens, schools, medical institutions). A special role is played by immunity of the mother. For example, if the woman already had a Cytomegaloviral infection before, then at repeated activation of a virus during pregnancy the child with high probability will be born not infected.
Infection of the child perhaps prenatalno (a transplacentary way) and intranatalno, that is when passing in patrimonial ways. The second option meets considerably more often. With a blood-groove the activator is carried to all fabrics and bodies. A virus to cells of salivary glands, it takes root into these cages first of all. Most often it is found in parotid salivary glands, is more rare – in submaxillary and others. In output channels of salivary glands the virus can breed long time, without going beyond their limits. The virus in unusual way changes cages, and it is easy to find these changes at microscopy. The struck cages considerably increase in sizes and contain the virus congestions (seen under an inclusion microscope). Such cages call tsitomegalam. Except salivary glands, many other bodies, generally parenchymatous are surprised: liver, kidneys, pancreas. Damage of a brain is characteristic of a congenital cytomegalic inclusion disease.
Classification of a congenital cytomegalic inclusion disease
Distinguish the localized and generalized form of a congenital cytomegalic inclusion disease, however such division it is conditional as at the slightest decrease in immunity the infection gets a generalized current from a fruit. The congenital cytomegalic inclusion disease can be sharp, long and chronic. At sharp and long forms characteristic symptoms are observed; if process chronic, it can be diagnosed only on a virusemiya. Some authors separately allocate a gepatoliyenalny, pulmonary, brain and intestinal form of an infection, however as the congenital cytomegalic inclusion disease often is followed by symptoms from several bodies, this classification is also conditional.
Symptoms of a congenital cytomegalic inclusion disease
If infection of the woman occurs on early terms of a gestation, then pregnancy can end with an abortion or pre-natal death of a fruit. At the birth of the infected child in 90% of cases the congenital cytomegalic inclusion disease proceeds asymptomatically (subklinichesk). About 10% of observations are the share of a manifest form, however death rate at clinically expressed form of a disease reaches 10-30%. The manifest form of an infection is followed by a triad of symptoms: jaundice, hemorrhagic syndrome and gepatosplenomegaliya. Since the birth petekhialny rash on all body, hemorrhages in skin and mucous membranes, blood in a chair comes to light. The hemorrhagic syndrome independently passes through 1-2 weeks after the birth.
Difference of a congenital cytomegalic inclusion disease from acquired – obligatory damage of a brain. Encephalopathy, a mikrotsefaliya, hydrocephaly can be diagnosed for the newborn, spasms and a tremor are often noted. Sometimes at a manifest form of a disease encephalitis with the subsequent formation of kaltsifikat in a brain develops. From other bodies pneumonia, damage of kidneys, hepatitis is quite often diagnosed, sialoadenit, a retinopathy, damage of an organ of hearing. Frequency of sensonevralny relative deafness makes, according to different data, from 10 to 25% of cases. Less often congenital heart diseases come to light: defects of a mezhpredserdny and interventricular partition, malformations of valves (aortal, mitralny, pulmonary artery).
Characteristic symptom of a disease is the low body weight of the child. Children are born premature in 30% of cases. Further the hypotrophy accrues that also demands special treatment. Damage of a brain leads to a delay of psychomotor development and mental retardation subsequently. The minimum brain dysfunction takes place even if brain violations did not come to light in the period of a neonatality and the first years of life. The heavy course of Cytomegaloviral hepatitis, as a rule, leads to biliarny cirrhosis aged from 6 up to 12 months.
Diagnostics of a congenital cytomegalic inclusion disease
Prenatal diagnostics is carried out in case future mother has a Cytomegaloviral infection during pregnancy. However it only allows to reveal at a pathology fruit, the accompanying infections, but not a disease. If the congenital cytomegalic inclusion disease was suspected even during pregnancy, then at the newborn blood sampling is surely made for an exception or confirmation of the diagnosis. It is an important point as after the birth infection symptoms in most cases are absent. Therefore laboratory researches play a huge role in diagnostics of a congenital cytomegalic inclusion disease.
The diagnosis is made at detection in blood and urine directly of particles of a virus (PTsR), and also signs of the immune answer to a virusemiya, that is antibodies of IgM and IgG (IFA method). The main difficulties of diagnostics are connected with the fact that antibodies are found in the newborn's blood even if his mother had a disease during pregnancy, and the kid at the same time was not infected. The found antibodies in this case can be maternal. Therefore the IFA-research is conducted in dynamics. Confirmation of the diagnosis requires increase in a caption of IgG-antibodies not less than by 4 times in the repeated analysis which is made in a week after the first.
The congenital cytomegalic inclusion disease is also diagnosed by means of the PTsR method. Virus DNA detection in blood confirms infection for 100%. Minus this method – its duration. Besides, the virusemiya is not a reliable sign of activity of an infection. PTsR-diagnostics allows to confirm the conclusion of IFA therefore it is used in total with other methods.
Due to the frequent asymptomatic current of a congenital cytomegalic inclusion disease an important role is played by standards of diagnostics. The disease of the newborn is surely excluded by the pediatrician if mother transferred a cytomegalic inclusion disease or mononukleozopodobny diseases to pregnancy time, or has cases of abortions or a still birth in the anamnesis. A main objective of diagnostics – early detection of a disease. The earlier treatment is begun, the further forecast for the child is better.
Treatment and prevention of a congenital cytomegalic inclusion disease
Purpose of therapy is possible only after exact diagnosis of a disease. It is very important point because performing treatment without the confirmed diagnosis can do much harm to the child. Treatment is carried out strictly in the conditions of a hospital. Specific anti-Cytomegaloviral immunoglobulin is applied. Medicine contains antibodies against a cytomegalovirus. Getting to blood, they contact particles of a virus and inactivate them. Besides specific therapy, medicines of interferon and inductors of interferon are used. Symptomatic therapy of hepatitis, nephrite, brain violations and other accompanying pathologies is carried out. Treatment is considered successful if the virus is not found in blood.
Prevention of a congenital cytomegalic inclusion disease at the child begins from the first days of pregnancy. It is important to future mother to exclude completely contacts with patients with a Cytomegaloviral infection, and also to avoid places of a big congestion of people. If infection with a virus already happened, very important, as soon as possible to find it. For the purpose of decrease in risk of transfer of a virus from mother to the child anti-Cytomegaloviral immunoglobulin which is entered to intravenously pregnant woman is used. For increase in antiviral immunity interferon inductors are also used. Specific prevention (vaccine) is in a stage of development and clinical trials now.
The congenital cytomegalic inclusion disease is dangerous that the virus, having got to an organism once, remains there forever. The problem of therapy – to stop its reproduction, but a virus all the same remains in cages in the "sleeping" form. If the disease is repeatedly shown in the future, most often it proceeds benign especially as at the had child immunity is created. Therefore the forecast concerning the main disease favorable, except cases of a heavy current when mortality of children reaches 20-30%. The accompanying damage of a brain and hearing considerably worsen the forecast. Further it leads to a delay of mental development. Sensonevralny relative deafness also becomes the disability reason.