Cytomegalovirus in adults

What is cytomegalovirus

Cytomegalovirus is a viral infection that can occur both asymptomatically and with damage to internal organs and the central nervous system.

Currently, about 80% of adults have antibodies to this virus. This is evidenced by the presence of specific class G immunoglobulins (IgG). They appear 1-3 months after the disease and remain for life.

There are also specific class M immunoglobulins (IgM). They appear only during the illness and persist for 1-3 months after the illness. The detection of such antibodies in the blood indicates an acute illness.

Causes of cytomegalovirus in adults

The cause of the disease is cytomegalovirus, which belongs to the herpes family of viruses. A feature of this virus is its thermolability – it becomes inactive at temperatures above 56 ˚С and below 20 ˚С. Also, the virus loses its activity when frozen, and at room temperature it persists for several days.

The source of cytomegalovirus infection is a person. The virus enters the body through the mucous membranes of the respiratory tract, digestive organs and genital organs. Infection is possible by airborne droplets, contact and sexual contact, with blood transfusion and organ transplantation, as well as the transition from mother to fetus during pregnancy.

Symptoms of cytomegalovirus in adults

The incubation period of the disease (the time from contact with the infection until the first signs appear) ranges from 15 days to 3 months.

Most often, cytomegalovirus infection is asymptomatic or resembles SARS in a mild form. Patients have weakness, a slight ache in the muscles, sore throat and subfebrile temperature (37–37,5 ° C). Severe symptoms are observed in only 5% of people. The most common signs of the disease:

• fever for 2 weeks (sometimes with an increase in temperature up to 37,5–38,5 ° C);
• fatigue;
• lack of appetite;
• swollen lymph nodes (most often cervical and submandibular);
• headache;
• muscle and joint pain;
• abdominal pain;
• diarrhea;
• pain on palpation of the salivary glands.

Symptoms may differ in different forms of cytomegalovirus and depending on the state of the human immune system.

congenital form

Approximately 1 out of 200 newborns have a cytomegalovirus infection, and one in five will have serious illness in the future because of this. That is why the diagnosis of the mother during pregnancy planning is so important.

Such newborns have low body weight, enlarged liver and spleen, yellowness of the skin and mucous membranes. In the future, damage to the nervous system is possible, which will manifest itself as hearing loss and developmental delay.

Acquired form

Infection most often occurs in childhood and adolescence, since it is during this period of life that frequent contact with other people occurs. Usually the disease is asymptomatic or as ARVI (slight fever, runny nose, sore throat). Even in the absence of treatment, the symptoms stop on their own after 1-2 weeks, and the child develops strong immunity for life.

With infection at a later age, more serious clinical manifestations are possible.

Cytomegalovirus infection in pregnant women

The disease is often asymptomatic or as an acute respiratory viral infection. If the disease occurs during pregnancy, the risk of infection of the fetus is about 90%. Early infection can lead to miscarriage, premature birth, stillbirth, or the birth of children with serious malformations that may be incompatible with life.

Chronic cytomegalovirus infection

This condition is observed with the long-term existence of the virus in the human body and the inability of the immune system to resist it. Chronic cytomegalovirus infection is characterized by a body temperature of 37-37,5 ˚C for a long time, increased fatigue. Perhaps an increase in the size of the liver, spleen, lymph nodes. In the absence of treatment, complications in the heart (myocarditis) are observed.

Cytomegalovirus infection in people with immunodeficiency (HIV, AIDS)

In such patients, the disease is extremely severe, with damage to the liver, lungs, heart, brain and other internal organs. Almost everyone requires hospitalization. With a weakened immune system, the prognosis of the disease is unfavorable.

Treatment of cytomegalovirus in adults

Treatment of cytomegalovirus depends on the period of the disease, the severity of symptoms, the age of the patient, and comorbidities. All appointments are carried out only by a doctor, taking into account the anamnesis, laboratory and instrumental data.

• Antiviral therapy

The main task of this stage is to stop the reproduction of the virus in the body, which will reduce the duration of the disease and the development of complications.

For this, specific antiviral drugs (ganciclovir, foscarnet) are used in combination with interferons. They are prescribed to patients with a severe form of the disease and only in a hospital setting.

Pregnant women may be given a specific cytomegalovirus immunoglobulin. Immunomodulatory therapy is also used, which restores the functions of the body’s immune system and helps fight infection.

• Symptomatic therapy

Helps to reduce the severity of symptoms and alleviate the patient’s condition. For this, antipyretics and painkillers are used, which normalize body temperature and relieve headaches, pain in muscles and joints. In hospital treatment, detoxification therapy is prescribed to reduce the symptoms of intoxication.

• Antibacterial therapy

It is prescribed only in case of accession of a bacterial infection. The most preferred are drugs of the cephalosporin group. They have a wide spectrum of antimicrobial activity and minimal side effects.

Prevention of cytomegalovirus in adults at home

There is currently no specific prophylaxis against cytomegalovirus infection. A vaccine is under development.

Persons with normal immunity should follow the general rules for the prevention of all infections transmitted by airborne droplets and sexually:

• wearing personal protective equipment;
• washing hands with soap;
• general strengthening of the body (taking vitamins, hardening, etc.)
• use only disposable sterile needles, spatulas, catheters and other medical instruments;
• do not conduct promiscuity;
• use of barrier methods of contraception.

When planning pregnancy, a complete examination is necessary, including for infections, in order to prevent infection of the fetus. If an acute cytomegalovirus infection is detected, conception should be postponed until a period of remission.

Popular questions and answers

We discussed important issues related to cytomegalovirus infection with therapist Tatyana Pomerantseva.

Sources of:

1. Clinical guidelines “Cytomegalovirus disease (CMVB) in adults”, 2015;
2. Human herpesvirus infections: a guide for physicians. Isakov V.A., Arkhipova E.I., Isakov D.V. St. Petersburg: SpecLit, 2013.
3. Grose С., Johanson D.C. Transmission of Cytomegalovirus, Epstein–Barr Virus, and Herpes Simplex Virus Infections: From the Lucy Australopithecus Epoch to Modern-Day Netherlands // The Journal of Pediatrics. 2016.
4. Guide to Infectious Diseases / Ed. acad. RAMN, prof. Yu.V. Lobzina, prof. K.V. Zhdanov. St. Petersburg: Foliant Publishing LLC, 2011.