Cytomegalovirus IgG: what is it and clinical manifestations. Types of tests for cytomegalovirus (CMV) and their interpretation

Cytomegalovirus is a herpetic type infection, diagnosed in a child or adult by a blood test for igg, igm antibodies. Carriers of this infection are 90% of the world's population. It manifests itself with a significant decrease in immunity and is dangerous for prenatal development. What are the symptoms of cytomegaly, and when is medical treatment needed?

What is cytomegalovirus infection

Cytomegalovirus infection is a herpes type virus. It is called the 6th type of hepatitis or CMV. The disease caused by this virus is called cytomegalovirus. With it, infected cells lose their ability to divide, greatly increase in size. Inflammation develops around the infected cells.

The disease can be localized in any organ - nasal sinuses (rhinitis), bronchi (bronchitis), bladder(cystitis), vagina or urethra (vaginitis or urethritis). However, more often the CMV virus chooses the genitourinary system, although its presence is found in any body fluids ( saliva, vaginal discharge, blood, sweat).

Conditions of infection and chronic carriage

Like other herpes infections, cytomegalovirus is chronic virus. It enters the body once (usually in childhood) and is stored in it for the rest of your life. The form of storage of the virus is called carriage, while the virus is in a latent, dormant form (stored in the ganglia spinal cord). Most people do not realize they are carrying CMV until they the immune system won't crash. Then the dormant virus multiplies and forms visible symptoms.

Unusual situations lead to a significant decrease in immunity in healthy people: organ transplant operations (accompanied by taking drugs that purposefully reduce immunity - this prevents rejection of a transplanted foreign organ), radiation and chemotherapy (in the treatment of oncology), long-term use hormonal drugs(contraceptives), alcohol.

Interesting fact: Availability cytomegalovirus infection diagnosed in 92% of the examined people. Carriage is a chronic form of the virus.

How the virus is transmitted

Even 10 years ago, cytomegalovirus infections were considered sexual. CMV was called " kissing sickness”, believing that the disease is transmitted with kisses. Modern research proved that cytomegalovirus is transmitted in various everyday situations- using common utensils, towels, shaking hands (if there are cracks, abrasions, cuts on the skin of the hands).

The same medical studies found that children are most often infected with cytomegalovirus. Their immunity is in the formation stage, so viruses penetrate into children's body cause disease or form a carrier state.

Herpes infections in children show visible symptoms only when immunity is low ( at frequent illnesses, avitaminosis, serious immune problems). With normal immunity, acquaintance with the CMV virus is asymptomatic. The child becomes infected, but no manifestations (fever, inflammation, runny nose, rash) follow. Immunity copes with an alien invasion without raising the temperature (it forms antibodies and remembers the program for their production).

Cytomegalovirus: manifestations and symptoms

External manifestations of CMV are difficult to distinguish from ordinary acute respiratory infections. The temperature rises, a runny nose appears, the throat hurts. May increase The lymph nodes. The complex of these symptoms is called mononucleosis syndrome. It accompanies many infectious diseases.

It is possible to distinguish CMV from a respiratory infection by the protracted duration of the disease. If a common cold passes in 5-7 days, then cytomegaly lasts longer - up to 1.5 months.

There are special signs of cytomegalovirus infection (they rarely accompany ordinary respiratory infections):

• Inflammation of the salivary glands(the CMV virus multiplies most actively in them).
• In adults - inflammation of the genitals(for this reason, CMV has long been considered a sexual infection) - inflammation of the testicles and urethra in men, uterus or ovaries in women.

Interesting to know: cytomegalovirus in men often occurs without visible symptoms if the virus is localized in the genitourinary system.

CMV is different long period incubation. When infected with a herpes infection of the 6th type ( cytomegalovirus) signs of the disease appear 40-60 days after the entry of the virus.

Cytomegaly in infants

The danger of cytomegaly for children is determined by the state of their immunity and the presence of breastfeeding. Immediately after birth, the child is protected from various infections by the mother's antibodies (they entered his bloodstream during fetal development, and continue to flow during breastfeeding). Therefore, in the first six months or a year (the time of predominantly breastfeeding), the infant is protected by the mother's antibodies. Cytomegalovirus in children under one year old does not cause any symptoms due to the presence of maternal antibodies.

Infection of the child becomes possible with a reduction in the number breastfeeding and incoming antibodies. The next of kin become the source of infection (by kissing, bathing, general care- Recall that the majority of the adult population is infected with the virus). The reaction to the primary infection may be strong or imperceptible (depending on the state of immunity). So by the second or third year of life, many children form their own antibodies to the disease.

Is cytomegalovirus dangerous in an infant?

With normal immunity - no. With a weak and insufficient immune response - yes. It can cause prolonged extensive inflammation.

Dr. Komarovsky also speaks about the relationship between CMV symptoms and immunity: “ Cytomegalovirus in children - does not pose a threat with normal immunity. Exceptions to general group represent children with special diagnoses - AIDS, chemotherapy, tumors».

If the child was born weakened, if his immunity is impaired by taking antibiotics or other strong drugs, infection with cytomegalovirus causes an acute infectious disease - cytomegaly(whose symptoms are similar to a long-term acute respiratory disease).

Cytomegaly in pregnancy

Pregnancy is accompanied by a decrease in maternal immunity. This is a normal reaction of the female body, which prevents the rejection of the embryo as foreign organism. Row physical and chemical processes and hormonal transformations aimed at reducing the immune response and limiting the action of immune forces. Therefore, it is during pregnancy that dormant viruses are able to activate and cause relapses of infectious diseases. So if the cytomegalovirus did not manifest itself in any way before pregnancy, then during gestation it can raise the temperature and form inflammation.

Cytomegalovirus in a pregnant woman may be the result of a primary infection or a secondary relapse. The greatest danger to the developing fetus is the primary infection.(the body does not have time to give a decent response and the CMV virus penetrates through the placenta to the child).

Recurrences of infection during pregnancy in 98% are not dangerous.

Cytomegaly: danger and consequences

Like any herpes infection, the CMV virus is dangerous for a pregnant woman (or rather, for a child in her womb) only during the initial infection. Primary infection forms various malformations, deformities or defects of the brain, pathologies of the central nervous system.

If infection with the CMV virus or other herpes-type pathogen occurred long before pregnancy (in childhood or adolescence), then such a situation for a child in the womb is not terrible, and even useful. During the initial infection, the body produces a certain amount of antibodies that are stored in the blood. In addition, a program is being developed defensive reaction to this virus. Therefore, the recurrence of the virus is much faster taken under control. For a pregnant woman the best way- get infected with CMV in childhood and develop certain mechanisms to fight the infection.

The most dangerous situation for a child is the sterile body of a woman before conception. You can get infections anywhere (more than 90% of the world's population is carriers of herpes-type viruses). At the same time, infection during pregnancy causes a number of disturbances in the development of the fetus, and infection in childhood passes without serious consequences.

Cytomegaly and uterine development

The CMV virus carries the greatest danger to a child in the womb. How does cytomegalovirus affect the fetus?

Infection of the fetus is possible during the initial acquaintance with the virus during pregnancy. If infection occurs for up to 12 weeks - in 15% of cases a miscarriage occurs.

If infection occurs after 12 weeks, miscarriage does not occur, but the child develops symptoms of the disease (this occurs in 75% of cases). 25% of children whose mothers contracted the virus during pregnancy for the first time are born completely healthy.

Cytomegalovirus in a child: symptoms

What are the symptoms of congenital cytomegaly in a child?

• Lag in physical development.
• Strong jaundice.
• Enlarged internal organs.
• foci of inflammation ( congenital pneumonia, hepatitis).

Most dangerous manifestation cytomegaly in newborns - lesions of the nervous system, hydrocephalus, mental retardation, loss of vision, hearing.

Analyzes and decoding

The virus is contained in any liquid media of the body - in the blood, saliva, mucus, in the urine of a child and an adult. Therefore, an analysis to determine CMV infection can be taken from blood, saliva, semen, as well as in the form of a swab from the vagina and pharynx. In the samples taken, they look for cells affected by the virus (they are large in size, they are called "huge cells").

Another diagnostic method examines the blood for the presence of antibodies to the virus. If there are specific immunoglobulins that are formed as a result of the fight against the virus, then there was an infection, and there is a virus in the body. The type of immunoglobulins and their amount can tell whether this is a primary infection or a recurrence of an infection that has been ingested earlier.

This blood test is called enzyme immunoassay (abbreviated as ELISA). In addition to this analysis, there is a PCR examination for cytomegalovirus. It allows you to reliably determine the presence of infection. For PCR analysis, a vaginal swab or amniotic fluid sample is taken. If the result shows the presence of infection, the process is acute. If PCR does not detect the virus in mucus or other secretions, there is no infection (or recurrence of infection) now.

Analysis for cytomegalovirus: Igg or igm?

The human body produces two groups of antibodies:

• primary (they are denoted by M or igm);
• secondary (they are called G or igg).

Primary antibodies to cytomegalovirus M are formed when CMV first enters the human body. The process of their formation is not related to the strength of the manifestation of symptoms. Infection may be asymptomatic, and igm antibodies in the blood will be present. In addition to primary infection, type G antibodies are formed during relapses when the infection got out of control and the virus began to multiply actively. Secondary antibodies are formed to control the dormant virus stored in the ganglia of the spinal cord.

Another indicator of the stage of infection formation is avidity. It diagnoses the maturity of antibodies and the primacy of infection. Low maturity (low avidity - up to 30%) corresponds to the primary infection. If, when analyzing for cytomegalovirus, there is high avidity ( more than 60%), then this is a sign of chronic carriage, the latent stage of the disease. Averages ( from 30 to 60%) - correspond to the recurrence of infection, the activation of a previously dormant virus.

Note: The decoding of a blood test for cytomegalovirus takes into account the amount of antibodies and their type. These data make it possible to draw conclusions about the primacy or secondary infection, as well as the level of the body's own immune response.

Blood for cytomegalovirus: deciphering the results

The main study to determine the presence of CMV infection is a blood test for antibodies (ELISA). Almost all women take an analysis for cytomegalovirus during pregnancy. The results of the analysis look like an enumeration of the types of antibodies and their quantity:

• Cytomegalovirus igg igm - "-" (negative)- this means that there has never been contact with the infection.
• "igg+, igm-"- this result is obtained in most women when examining them when planning a pregnancy. Since the carriage of CMV is almost universal, the presence of group G antibodies indicates acquaintance with the virus and its presence in the body in a dormant form. "Igg+, igm-" - normal performance , which allow you not to worry about a possible infection with the virus while carrying a baby.
• "Igg-, igm +" - the presence of an acute primary disease (igg is absent, which means that the body has encountered an infection for the first time).
• "Igg +, igm +" - the presence of an acute relapse(against the background of igm there are igg, which indicates an earlier acquaintance with the disease). Cytomegalovirus G and M are signs of a relapse of the disease and the presence of a decrease in immunity.

The worst result for a pregnant woman is cytomegalovirus igm positive. During pregnancy, the presence of group M antibodies indicates an acute process, primary infection or recurrence of infection with symptoms (inflammation, runny nose, fever, enlarged lymph nodes). Even worse, if against the background of igm +, cytomenalovirus igg has a “-”. This means that this infection entered the body for the first time. This is the most depressing diagnosis for a future mother. Although the probability of complications in the fetus is only 75%.

Deciphering the analysis of ELISA in children

Cytomegalovirus igg in children is usually found in the first year of life, especially in breastfed babies. This does not mean that the child contracted CMV from the mother. This means that along with milk, maternal immune bodies enter the body, which protect against acute manifestations of infection. Cytomegalovirus igg in a breastfed child is the norm, not a pathology.

Should cytomegalovirus be treated?

Healthy immunity itself controls the amount of CMV and its activity. In the absence of signs of the disease, treatment of cytomegalovirus is not necessary. Therapeutic measures necessary when an immune failure occurred and the virus became more active.

Chronic cytomegalovirus during pregnancy is characterized by the presence of type G antibodies. This is a chronic carriage, it is present in 96% of pregnant women. If cytomegalovirus igg is detected, treatment is not necessary. Treatment is necessary in the acute stage of the disease when visible symptoms appear. It is important to understand that a complete cure for the CMV virus is impossible. Therapeutic measures are aimed at limiting the activity of the virus, its translation into a dormant form.

The titer of group G antibodies decreases over time. For example, cytomegalovirus igg 250 is detected if the infection has occurred in the last few months. Low titer - that the primary infection was a long time ago.

Important: a high titer of the analysis for cytomegalovirus immunoglobulin g indicates a relatively recent infection with the disease.

From the point of view of the pharmaceutical industry, it is necessary to treat everyone who has antibodies to CMV (for any of their type and titer). After all, it is primarily a profit. From the point of view of a woman and her baby in the womb, treating a dormant infection in the presence of igg antibodies is not helpful, and possibly harmful. Preparations for maintaining immunity contain interferon, which is not recommended for use during pregnancy without special indications. Antivirals are also toxic.

How to treat cytomegalovirus during pregnancy

Treatment of cytomegalovirus occurs in two directions:

• Means for the general raising of immunity (immunostimulants, modulators) - preparations with interferon (viferon, geneferon).
• Specific antiviral drugs (their action is directed specifically against the herpes virus type 6 - CMV) - foscarnet, ganciclovir.
• Vitamins (injections of B vitamins), vitamin-mineral complexes are also shown.

How to treat cytomegalovirus in children? The same drugs are used (immune stimulants and antiviral agents), but in reduced dosages.

How to treat cytomegalovirus folk remedies

To treat any viruses, traditional medicine uses natural antimicrobial agents:

• garlic, onion;
• propolis (alcohol and oil tinctures);
• silver water;
• hot spices
• herbal treatment - garlic greens, raspberry leaves, wormwood, echinacea and violet flowers, ginseng rhizomes, rhodiola.

Cytomegalovirus infection (CMV) is a widespread infectious disease. The causative agent of cytomegalovirus infection belongs to the herpes family. Once in the human body, the virus multiplies inside the cell and significantly increases it in size. The result of reproduction of cytomegalovirus can be infection of any tissue and internal organs. The fetus during pregnancy, newborns and children of the first 3-5 years of life are especially sensitive to cytomegalovirus.

Cytomegalovirus in children - causes

Cytomegalovirus in a child can be either congenital or acquired.

Congenital cytomegalovirus infection develops in a child when infected from a mother - a carrier of the virus through the placenta even in the prenatal period. If a woman first catches cytomegalovirus during pregnancy, then the infection through the placenta can enter the baby's body. Congenital cytomegalovirus in most cases does not manifest itself in the early stages of a child's life, but has the most pronounced complications later (hearing loss, decreased intelligence, speech disorders). The degree of this manifestation depends on the timing of infection of the fetus during pregnancy.

Acquired cytomegalovirus infection. Infection of a child can also occur directly during childbirth when the fetus passes through infected birth canal mother or in the first days of life through contact with an infected mother or medical staff. Also, a newborn can be infected through breast milk. With acquired cytomegaly, unlike congenital, the spread of infection is extremely rare.

In preschool children and school age cytomegalovirus enters the body through household contact or by airborne droplets, when in a small space it enters the body of other children from one virus carrier or a sick child. You can become infected with cytomegalovirus from the first days of life and infection increases sharply with age. The virus can live and multiply for a long time in leukocytes and other cells of the human immune system and cause chronic carriage.

Cytomegalovirus in children - symptoms

Usually, cytomegalovirus infection in children is mild and latent (asymptomatic) and doesn't show up at all. And only one out of ten cases of infection will have clinical manifestations, especially with weakened immunity. Therefore, the symptoms of CMV depend not only on the state of the child's immune system, but also on his age, the presence of immunity against cytomegalovirus, the presence concomitant diseases child.

Most often, cytomegalovirus in children manifests itself as an acute respiratory viral infection (ARVI).

The incubation period is from 15 to 60 days. In the acute phase of cytomegalovirus infection, the child develops the following symptoms:

• an increase in body temperature (sometimes periodically and irregularly to febrile figures for three or more weeks);
• coryza, inflammation and enlargement of the salivary glands, with profuse salivation;
• enlarged lymph nodes in the neck;
• chills, weakness, fatigue, headache, muscle pain;
• enlarged spleen (splenomegaly) and liver;
• stool may be disturbed by the type of constipation or diarrhea;
• in the blood of a child, the number of platelets decreases, the absolute and relative content of monocytes increases;
• frequent "causeless" pneumonia, bronchitis;

Due to the lack of specific symptoms in cytomegalovirus, it is impossible to make a diagnosis based on clinical manifestations alone.

To identify the pathogen and specific immune response used laboratory methods. The diagnosis of cytomegalovirus infection is confirmed by finding the virus itself in the blood and tissues, as well as the detection of antibodies to the virus in the blood. In sick patients, cytomegalovirus is found in sediments of urine, saliva, and sputum.

Antibodies to cytomegalovirus

Antibodies to cytomegalovirus begin to be produced immediately after the virus enters the human body. It is the antibodies that fight the viral infection, preventing the cytomegalovirus from developing, and causing the disease to be asymptomatic. There are several classes of antibodies - IgG, IgM, IgA, etc., each of which is responsible for certain functions of the immune system. However, for the diagnosis of cytomegalovirus infection, those that can detect antibodies belonging to the IgM and IgG classes are really useful.

Antibodies to cytomegalovirus - IgG and IgM are detected when laboratory analysis blood.

Availability IgM antibodies usually appear first in the blood and indicates fresh infection or reactivation of a latent (hidden) infection. However, an increase in IgM antibodies may not be detected during the first 4 weeks after the onset of the disease. At the same time, up to a year after recovery, titers may remain high. In this regard, a single determination of the level of IgM antibodies is useless in assessing the severity of the infection. It is important to monitor the level of IgM antibodies (increase or decrease).

In one to two weeks from the moment of infection with cytomegalovirus in the blood serum appear IgG antibodies. These immunoglobulins help the doctor determine if the baby has been formerly infected with cytomegalovirus, as well as a blood test for these antibodies, is given for the diagnosis of acute cytomegalovirus infection. IgG antibodies during primary infection increase in the first weeks and then may remain high years. IgG antibodies appear during the recovery period and can persist for up to 10 years in those who have been ill, so the frequency of detection of IgG antibodies can reach 100% among various groups population.

A single determination of the antibody titer does not make it possible to distinguish the current infection from the transferred one, since the cytomegalovirus is always present in the body of the virus carrier, as well as antibodies to it.

Antibodies to cytomegalovirus - IgG positive

If IgG class immunoglobulins are detected as single marker, then this indicates either infection with cytomegalovirus or the presence of immunity to this infection. The detection of antibodies to cytomegalovirus IgG in children of the first six months of life in the absence of other markers of this infection indicates their maternal origin.

Simultaneous detection of specific antibodies of the IgM and IgG classes in the blood serum of children indicates a disease with cytomegalovirus.

Interpretations of the ratio of antibodies IgG and IgM:

If antibodies to cytomegalovirus are not detected, then it is concluded that the person has not previously been infected with cytomegalovirus and may be particularly susceptible to primary infection. However, the presence of Anti-IgG to cytomegalovirus does not mean protection against infection with this virus in the future. Stable immunity to cytomegalovirus (CMV) is not developed.

In addition to quantity, IgG avidity is also often determined - the strength with which the antibody binds to the antigen. The higher the avidity, the stronger and faster the antibodies bind viral proteins. When a child is first infected with cytomegalovirus, its IgG antibodies have low avidity, then (after three months) it becomes high. IgG avidity measures how long ago the initial infection with CMV occurred.

Treatment of cytomegalovirus in children

specific antiviral treatment does not exist in cytomegalovirus infection. It is impossible to cure cytomegalovirus, treatment should first of all be aimed at recovery protective functions organism. Children are strongly encouraged to lead the correct and good nutrition, vitamin therapy. After recovery, you should ensure that the child does not get cold. Children should be protected from vaccination for several weeks, and preschoolers and schoolchildren should also be protected from physical education.

For the treatment of children of the first year of life with acute cytomegalovirus infection, antiviral drugs are used, for example, Viferon-1, which do not destroy the infectious agent, but suppress its activity.

The course of treatment is required without fail with conditions such as jaundice, hepatitis, disorders of the auditory and visual organs, pneumonia. Treatment usually involves the use antiviral drugs in combination with immunoglobulins. The duration of administration, as well as the dosage, are determined based on the individual characteristics and condition of the child.

It is very difficult to assess the effectiveness of the treatment of cytomegalovirus, since IgG antibodies remain in the blood for life.

disease with quite complicated name is one of the most common infections in the world. It's not just an infection - it's a viral infection. However, the name cytomegalovirus is not known to everyone. Lives all over the world great amount patients who are carriers of this infection, but they themselves do not even know about it. So what if the test for cytomegalovirus igg is positive?

The reason for the ignorance of patients about the disease is that this virus tends to show itself in no way. But there is one small clarification. The virus does not manifest itself in the body of an adult healthy person. If the patient's immunity is weakened, then all the negative consequences of the disease will quickly manifest themselves.

Infants are the main risk group.

This virus is a colleague of the well-known herpes. It belongs to the category of herpes viruses. Cytomegalovirus is widespread, but is not a very dangerous infectious disease. In addition to cytomegalovirus, this category also includes mononucleosis and chickenpox. From this we can conclude that it is possible to become infected with this virus through close contact with biological fluids, which include:

• urine,
• vaginal secret,
• saliva,
• blood,
• sperm,
• a tear.

Most often, you can become infected through sexual contact or kissing. To catch the virus, you need to mix your body fluids with the fluids of the virus owner for a very long time. The danger of infection should not be exaggerated, but it is still worth taking precautions. Doctors recommend that you always use condoms during sexual intercourse. But monogamous relationships reduce the possibility of infection to zero. But there is one worrying factor - the transmission of the virus from a nursing mother to the child's body.

At-risk groups

• Pregnant women. If a woman suffers from this virus, then there are some features of preparing her for bearing a child. It is important to take treatment on time preventive measures in preparation for pregnancy, then you can avoid pernicious influence virus on the body of an unborn child.
• People who suffer from recurrent herpes. As a rule, genital herpes and cytomegalovirus in the complex are very difficult to treat.
• People who have a poor immune response. If the patient is HIV positive, is undergoing chemotherapy, or immunosuppressive therapy, then cytomegalovirus can cause unpredictable consequences. The most severe of them include: damage to the lungs, brain, gastrointestinal tract and eyes, which is fatal.

How to determine the presence of cytomegalovirus in the body?

In order to identify whether there is a cytomegalovirus in your body, it is enough to pass an analysis. For this, smears and scrapings from the genitals, as well as blood tests are used. Change igg analysis for cytomegalovirus is a search for antibodies in the patient's blood to this virus.

The abbreviation igg stands for immunoglobulin (a protein that the immune system produces to destroy the virus). The g at the end is the name of one of the . If the virus has never been in the body, then, accordingly, there will be no antibodies in the blood.

If the penetration of cytomegalovirus has already been, then these antibodies will be found in the blood. Igm are fast immunoglobulins. They are larger than igg. Igm are produced very quickly in order to block the virus as soon as possible. They have one major drawback. Igm have little memory and die four months after the appearance, as a result, the protection disappears. Igg antibodies are replacing igm. Iggs are antibodies produced by the body itself. They maintain immunity against a particular virus for life.

From this we can conclude that if there are components to igm in human blood, then the virus appeared in the body relatively recently. In addition, specific bodies for igm may indicate an exacerbation of the infection. Further more detailed studies of igm antibodies will reveal more details.

What to do if the analysis is positive?

It is important to understand that if the result of the analysis is: cytomegalovirus igg is positive, then the person is a carrier and carrier of cytomegalovirus. However, the presence in igg does not mean at all that the infection is in the active stage or life-threatening. What matters here is how strong your immune system is. There is no serious danger for people with stable immunity, cytomegalovirus igg positive. In such patients positive result for igg antibodies is practically no different from cases where the analysis is negative. But it is important to understand that in cases where an exacerbation of the disease occurs, one should reduce one's social activity.

For those who have problems with immunity, cytomegalovirus can threaten with serious problems. If the test result for igg is positive, you need to carefully consider your condition. elevated temperature, feeling unwell weakness is far from normal. In such patients, the disease proceeds in a chronic form and threatens with frequent exacerbations.

Cytomegalovirus during pregnancy

If the result of the analysis is negative, then you can calm down. But what if the test for cytomegalovirus is positive? During pregnancy, this should be taken as seriously as possible. Subsequently, this can have a deplorable effect on the health of the child. A positive result for cytomegalovirus during pregnancy may indicate both primary infection and relapse. If the infection is detected in the first 12 weeks of pregnancy, you need to take Urgent measures. The virus will adversely affect the health of the child. In later weeks, the risk of infection of the fetus decreases, but the presence of cytomegalovirus in the body of a pregnant woman is far from the norm. If infection occurs in late pregnancy, then the risk of infection of the child during childbirth is high.

But, as the experience of leading doctors shows, infection of a child from a mother does not always take place. The fact that the mother has cytomegalovirus does not mean that the child was infected during pregnancy or after birth. Healthy child from the mother of a carrier of cytomegalovirus - this is the norm. But if the tests of the newborn reveal the presence of antibodies, then it is considered infected. The analysis is taken in the first three weeks of life.

Infection in newborns can occur without any symptoms, and may have quite serious symptoms, manifested in pneumonia, jaundice. That is why it is important to identify cytomegalovirus in a newborn in time and start timely treatment. It is also important to apply all necessary funds prevention of further complications.

Treatment

It is important to understand that cytomegalovirus itself does not lead to serious consequences. If the condition is assessed as normal and everything is in order with health, then you can not carry out treatment, but entrust the body with the fight against the virus. The fact is that many drugs that are used to treat cytomegalovirus can have side effects. Therefore, doctors prescribe such drugs only in case of urgent need, for example, for immunocompromised people. In such cases, drugs such as:

• Panavir (not recommended for pregnant women).
• Ganciclovir - does not allow the virus to multiply, but has a bad effect on the digestive system.
• Immunglobulins
• Foscarnet adversely affects the kidneys.
• Interferon.

These drugs are used strictly on the recommendation of the attending physician. They are appointed only when absolutely necessary.

Thus, it must be understood that the lack of treatment of cytomegalovirus in people with stable immunity is the norm. It is much worse to take drugs without a doctor's prescription. If the virus does not make itself felt, then there are no health problems. It is only important to maintain immunity. But for patients with immunodeficiency, it is extremely important to provide the necessary treatment on time.

Cytomegalovirus, IgG

Antibodies of the IgG class to cytomegalovirus are specific immunoglobulins that are produced in the human body during the period of pronounced clinical manifestations of cytomegalovirus infection and are a serological marker of this disease, as well as a past cytomegalovirus infection.

Russian synonyms

Antibodies of the IgG class to cytomegalovirus (CMV).

English synonyms

Anti-CMV-IgG, CMV Antibody, IgG.

Research method

Electrochemiluminescent immunoassay (ECLIA).

Units

U / ml (unit per milliliter).

What biomaterial can be used for research?

Venous, capillary blood.

How to properly prepare for research?

Do not smoke for 30 minutes prior to the study.

General information about the study

Cytomegalovirus (CMV) belongs to the herpes virus family. Just like other representatives of this group, it can persist in a person for a lifetime. In healthy people with normal immunity, the primary infection is uncomplicated (and often asymptomatic). However, cytomegalovirus is dangerous during pregnancy (for a child) and with immunodeficiency.

Cytomegalovirus can be infected through various biological fluids: saliva, urine, semen, blood. In addition, it is transmitted from mother to child (during pregnancy, childbirth or while feeding).

As a rule, cytomegalovirus infection is asymptomatic. Sometimes the disease is Infectious mononucleosis: the temperature rises, the throat hurts, the lymph nodes increase. In the future, the virus remains inside the cells in an inactive state, but if the body is weakened, it will begin to multiply again.

It is important for a woman to know if she has been infected with CMV in the past, because this is what determines whether there is a risk of pregnancy complications. If it has already been infected before, then the risk is minimal. During pregnancy, an old infection may worsen, but this form usually does not cause serious consequences.

If a woman has not yet had CMV, then she is at risk and should be given special attention CMV prevention. It is the infection that the mother contracted for the first time during pregnancy that is dangerous for the child.

With a primary infection in a pregnant woman, the virus often enters the child's body. This does not mean that he will get sick. As a rule, CMV infection is asymptomatic. However, in about 10% of cases, it leads to congenital pathologies: microcephaly, cerebral calcification, rash, and enlargement of the spleen and liver. This is often accompanied by a decrease in intelligence and deafness, even death is possible.

Thus, it is important for the expectant mother to know if she has been infected with CMV in the past. If yes, then the risk of complications due to possible CMV becomes negligible. If not, you need to be especially careful during pregnancy:

• avoid unprotected sex
• do not come into contact with the saliva of another person (do not kiss, do not share utensils, toothbrushes, etc.),
• observe hygiene rules when playing with children (wash hands if saliva or urine gets on them),
• take an analysis for CMV with signs of general malaise.

In addition, cytomegalovirus is dangerous when the immune system is weakened (for example, due to immunosuppressants or HIV). In AIDS, CMV is severe and is a common cause of death in patients.

The main symptoms of cytomegalovirus infection:

• inflammation of the retina (which can lead to blindness),
• colitis (inflammation of the colon),
• esophagitis (inflammation of the esophagus),
• neurological disorders (encephalitis, etc.).

The production of antibodies is one way to fight a viral infection. There are several classes of antibodies (IgG, IgM, IgA, etc.).

Class G antibodies (IgG) are present in the blood in most(compared to other types of immunoglobulins). In primary infection, their levels increase in the first weeks after infection and may then remain high for years.

In addition to quantity, IgG avidity is also often determined - the strength with which the antibody binds to the antigen. The higher the avidity, the stronger and faster the antibodies bind viral proteins. When a person is first infected with CMV, their IgG antibodies have low avidity, then (after three months) it becomes high. IgG avidity measures how long ago the initial infection with CMV occurred.

What is research used for?

• To determine if a person has been infected with CMV in the past.
• For the diagnosis of cytomegalovirus infection.
• To establish the causative agent of the disease, which is similar to cytomegalovirus infection.

When is the study scheduled?

• During pregnancy (or when planning it) - to assess the risk of complications ( verification study), with symptoms of cytomegalovirus infection, with violations in the fetus according to the results of ultrasound.
• For symptoms of cytomegalovirus infection in immunocompromised people.
• With symptoms of mononucleosis (if the tests did not reveal the Epstein-Barr virus).

What do the results mean?

Reference values

Concentration: 0 - 0.5 U / ml.

Result: negative.

Negative pregnancy result

• A woman has not been infected with CMV before - there is a risk of acquiring a primary CMV infection. However, if no more than 2-3 weeks have passed since the moment of infection, then IgG might not have appeared yet. To exclude this option, you need to pass the analysis again after 2 weeks.

Positive before pregnancy

• The woman has already been infected with CMV in the past - the risk of complications is minimal.

Positive result during pregnancy

• It is impossible to draw an unambiguous conclusion. It is possible that CMV entered the body before pregnancy. But it is possible that the woman became infected recently, at the beginning of pregnancy (a few weeks before the test). This option is dangerous for the child. For accurate diagnosis results of other analyzes are needed (see table).

When trying to identify the causative agent of an unknown disease, a single IgG test provides little information. It is necessary to take into account the results of all analyzes.

Test results in different situations

Important Notes

• Sometimes you need to find out if a newborn baby is infected with cytomegalovirus. However, the analysis for IgG in this case is not informative. IgG can cross the placental barrier, so if the mother has antibodies, then the baby will also have them.
• What is reinfection? In nature, there are several varieties of CMV, so it is possible for a person already infected with one type of virus to become infected again with another.

Who orders the study?

Doctor general practice, therapist, infectious disease specialist, gynecologist.

Literature

• Adler S. P. Screening for cytomegalovirus during Pregnancy. Infect Dis Obstet Gynecol. 2011:1-9.
• Goldman's Cecil Medicine. 24th ed. Goldman L, Schafer A.I., eds. Saunders Elsevier; 2011.
• Lazzarotto T. et al. Why is cytomegalovirus the most frequent cause of congenital infection? Expert Rev Anti Infect Ther. 2011; 9(10): 841-843.

Clinical diagnosis of an infection initiated by is associated with great difficulties due to the diversity of the symptomatic picture of the disease and the lack of diagnostic significant features. Therefore, verification of the disease is impossible without laboratory support.

Tests for cytomegalovirus include a blood test for the presence of antibodies of various classes, the determination of virus DNA by PCR in various human biological fluids. Modern methods diagnostics allow us to assess the duration of infection, the severity of the course of the infection and determine.

photo cytomegalovirus

Currently, the diagnosis of cytomegalovirus infection is carried out using the following groups of methods:

• cytological method;
• virological methods;
• serology;
• molecular genetic.

Modern tests for CMV make it possible to detect specific cellular changes that are unique to CMV, identify the pathogen, grow the virus in cell culture and examine its DNA, and determine the level of antibodies produced against it in the blood serum.

Diagnosis of CMV is not an easy task. Not always affected tissues and biological fluids of the human body can reflect the course of the infectious process.

Verification of CMV infection should be carried out in a complex way: the more methods involved, the more likely it is to diagnose the disease and determine the tactics of treatment.

The cytological method involves the search for cytomegalovirus-specific changes in cells, and the material is the epithelial cells of the most commonly affected organs or their secret ( salivary glands, urinary tract, mammary glands). Virological methods are used to isolate the culture of the virus in order to study their structure, to identify the CMV strain.

The most popular diagnostic methods are serological and molecular genetic: antibodies to cytomegalovirus IgM and IgG, avidity of antibodies to cytomegalovirus, CMV PCR in biofluids. These tests are used primarily when an infection is suspected and are, in a way, screening or screening.

Blood for antibodies to infection

Serology is the most accessible method for patients and simple to perform for the laboratory - the study of blood serum for the presence of specific antibodies (AT) to CMV. In order to identify antibodies to the virus, use:

• immunofluorescence reaction (RIF);
• enzyme immunoassay (ELISA);
• immunochemiluminescence method (ICLA);

RIF and ELISA allow for a short period of time to evaluate class G antibodies to cytomegalovirus as indicators of carriage and infection, and IgM - markers of acute cytomegalovirus infection or its exacerbation.

Important

Serological methods are effective, because even with severe immunodeficiency, antibodies to CMV and IgG and IgM are produced in detectable levels.

Identification of total anti CMV IgM and IgG in blood serum is not considered to be a sufficiently effective method, since almost 95% of the population is infected with the virus and the phase of the disease - acute or chronic - cannot be identified. Summary definition antibodies or immunoglobulins of two classes is called a titer. So, a high titer of IgG and IgM will be assessed as one total figure, which has low information content. This method is called the complement fixation test and is rarely used in the diagnosis of CMV.

The expediency of performing RIF or ELISA is due to the opportunity to obtain reliable information about the features of the course of CMV infection. For example, an accurate indicator that confirms primary infection, is the so-called seroconversion - the identification of antibodies to cytomegalovirus IgM in those individuals whose tests were previously completely negative.

The persistent form of cytomegaly is characterized by virus shedding - determination of CMV on nutrient media - and additionally, as anti CMV IgG positive result, which confirms the infection and the presence of the cytopathic effect of the virus.

The detection of anti-CMV IgG above the norm, according to many experts, is a sign of an incipient exacerbation of the infection, and AT for cytomegalovirus IgG is positive and the result without an increase in reference values ​​is considered a sign of a latent infection, in other words, carriage.

Besides, CMV IgG positive after positive IgM, indicates the emerging recovery after an acute primary infection. As a rule, if a healthy person without signs of disease donates blood for cytomegalovirus and receives positive antibodies to cytomegalovirus IgG, this indicates a carrier state and indicates that the patient has been infected for a long time, and his immune system is familiar with the virus.

For many patients, the result of a blood test for CMV makes one wonder what anti-CMV IgG is elevated and how is it deciphered? If antibodies to cytomegalovirus IgG are positive and their level is very high - it exceeds the permissible threshold by 4 times or more - they speak of reactivation of cytomegalovirus infection.

Specific IgM antibodies are an indicator of the active reproduction of the virus. If the result for antibodies to cytomegalovirus class IgG is positive along with positive IgM, the infection is in the phase of active exacerbation.

If only IgM is positive against the background of negative IgG, the person has become infected for the first time and the virus is active. But such a blood test is not always accompanied by a clinic. With a consistent immune response, the body successfully fights CMV and markers acute phase soon leave the bloodstream, they are replaced by IgG.

Simultaneous elevated levels antibodies, namely IgG positive IgM positive to a large extent (several times), indicate active CMV replication, which is accompanied by clinical symptoms.

Avidity for cytomegalovirus

One of the methods for diagnosing cytomegalovirus infection is the parallel determination of the avidity of antibodies along with counting their number.

Important

Avidity is a term that characterizes the strength and speed of association of antibodies (leukocytes) and antigens (virus) in human blood. The lower the level of avidity, the fresher the infection.

In the process of primary cytomegalovirus infection, there is a regular increase in antibody avidity from minimal levels from the onset of the disease in an acute form to a very high level during the peak period.

In transition acute form into chronic, or rather into carriage, they become positive for cytomegalovirus G - antibodies, and it is these antibodies that have high avidity. But recent infection can be described by low avidity of immunoglobulins G.

Highly avid antibodies rule out recent fresh infection with cytomegalovirus. Determination of such a characteristic of antibodies to CMV makes it possible to distinguish from an exacerbation. Low avidity antibodies are considered as indicators acute infection CMV.

Many are interested in if IgG antibodies to cytomegalovirus are detected - what does this mean with a high level of avidity and positive IgM. In such a situation, one speaks of the reactivation of the virus, in addition, in this case, culture studies often become positive, it is possible to identify the virus on a nutrient medium.

In most laboratories, a value of more than 70% is considered high avidity, less than 40% is considered low, and an intermediate value is a dubious result.

cytological method

Cytomegalovirus has an affinity for a number of cells of the human body, integrating into which it initiates, characteristic only for it. epithelial cells various ducts - salivary glands, bile ducts in the liver, mammary glands - have features characteristic of CMV infection. Also, a lesion of the lymphocytic series of blood cells is found in the form of atypical mononuclear cells.

The material for cytology in case of suspicion of CMV is:

• saliva;
• urine;
• breast milk;
• secret of the cervical canal.

Smears are prepared from the obtained biological material on glass, stained with special dyes, and the result is evaluated under a microscope. The search is carried out in the aspect of atypical giant cells of the cytomegaly.

Epithelial cells affected by the cytomegalovirus have a gigantic size, a rounded shape and a characteristic color that is beyond doubt when making a diagnosis. The nucleus in the cell has a dark shell and is surrounded by a light rim, which resembles an "owl's eye" - this is the term used in cytological diagnostics. Detection of giant cells in the form of an "owl's eye" in smears is reliable sign CMV.

The cytology method is simple, the analysis of CMV-damaged epithelial cells is available and is quick to perform compared, for example, with the determination of cytomegalovirus DNA by PCR or antibody analysis. The only disadvantage is the low sensitivity of the test, since even with obvious clinical signs infections, atypical cytomegalogiant cells are visualized in 40-50% of cases.

In addition, such cells cannot indicate an acute or chronic process, as they are found for 5 years after the disease. On the other hand, if giant cells are absent, this does not exclude the disease. The cytological method is used in complex diagnostics along with antibodies to cytomegalovirus IgG and IgM, CMV DNA in PCR.

Virological method

In order to isolate the virus from the biological fluid, it is necessary to use special nutrient media for the cultivation of CMV. For this purpose, human fibroblasts or cells with a double set of chromosomes are used in the laboratory. Such media are obtained from light embryos.

Any human biological fluid is inoculated on a nutrient medium and placed in an incubator for 5-10 days. The virus, if it is present in the material under study, exerts its pathological effect on the cells, and they become gigantic.

Under the microscope, after staining the material, they are visualized as an "owl's eye", which makes it possible to make a diagnosis of cytomegalovirus infection. Direct identification of CMV is carried out using RIF (immunofluorescence reaction), RN (neutralization reaction) and complement fixation.

The virological method of identification by cultivation in a fibroblast medium is considered the "gold standard" in the diagnosis of CMV infection. The method is considered reliable and highly specific, but at the same time, it is expensive and requires a certain amount of time for its implementation.

An improved version virological method identification of CMV is the addition of the method with monoclonal antibodies - specific proteins that can only bind to certain antigens. In particular, when analyzed for cytomegalovirus, such antibodies form a detectable bond with CMV antigens, which confirms the presence of the disease.

Embryo lung fibroblasts are grown for three days, infected with material from a sick person. Incubate for 2-3 days and use RIF with monoclonal antibodies to verify the virus. The earliest analysis results can be obtained after 6 hours. The method is expensive and requires special equipment. With positive results of a virological study, there are positive antibodies to CMV IgG in the blood, as well as IgM antibodies.

Blood test results

The interpretation of a blood test for cytomegalovirus depends on the method for identifying antibodies in the blood, as well as on the reference values ​​​​of the laboratory. The standards depend on the equipment of each particular laboratory and are evaluated individually.

The results may be as follows:

1. IgG positive IgM negative - the norm of antibodies to cytomegalovirus, which means the presence of memory cells in the human body and in the absence of signs of the disease, indicates the presence of protection. Carriage is safe for health and is observed in 95% of the world's population. With severe immunodeficiency, a possible reactivation of the process and the development of the disease. Some laboratories use IgG grades, such as 10 to 400 IU/mL, indicating a positive result and remission. So, IgG result 250 or anti cmv ​​IgG CMV 200 IU/ml indicate a carrier state. Depending on the serology method, the data may sound differently, but the essence of this does not change. So, for example, anti CMV IgG in the ICLA analysis also means carrier or remission.
2. A positive IgM result and a negative IgG result indicate fresh infection.
3. Positive IgM, positive IgG indicate virus reactivation or exacerbation.
4. Negative immunoglobulins of both classes indicate a complete absence of immunity to CMV and mean that the person has never encountered the virus.

Often in the diagnosis of viral infectious diseases serology methods such as blood tests for antibodies to cardiolipin IgG and IgM are used. Such an analysis is often prescribed to pregnant women with spontaneous miscarriage.

These antibodies are indicative of an autoimmune process. allergic reaction on some proteins of own cells, in particular, on membrane phospholipids. A disease in which antibodies to cardiolipin IgM are elevated, as well as to other classes of antibodies, is called antiphospholipid syndrome.

For some viral infections, and CMV is no exception, there is an increase in antibodies to cardiolipin, but unlike the antiphospholipid syndrome, such antibodies have a high level for only a certain period of time.

What should be the results of tests during pregnancy?

The process of pregnancy planning and the time after conception are necessarily accompanied by analyzes that imply the determination immune status against the cytomegalovirus. Often this analysis is performed within the TORCH complex. Such a block of studies includes the determination of immunoglobulins in a woman's blood for rubella, herpes simplex, CMV, toxoplasma - the most dangerous infections for .

It is known that viruses of the herpes family, as well as rubella, have the most pronounced teratogenic effect, which means the formation of deformities and gross malformations, spontaneous miscarriages. Therefore, the dynamics of these infections in pregnant women is always carried out.

The most suitable time for the delivery of the analysis is the planning period. As long as the woman is not pregnant, any result of the analysis will not pose a threat and will allow timely measures to be taken to strengthen immunity or vaccinate.

Decoding is carried out in the same way as in other patients, regardless of gender and pregnancy planning status. So, if IgG antibodies to CMV are detected in an amount of more than 140 at a laboratory norm of 10 to 400 IU / ml, the result is considered normal and means the presence of a protective immunoglobulin titer. At the same time, the high avidity of IgG antibodies to cytomegalovirus indicates a long-term infection and that nothing threatens the future embryo and fetus.

Since it is necessary to donate blood for immunoglobulins to cytomegalovirus several times: when planning and twice during pregnancy, an infectious disease specialist needs to be consulted to correctly decipher the results in the future. When pregnancy occurs, the immune system naturally reduces its activity, which can lead to reactivation of the infection. Tracking the level of antibodies will allow you to take action in time.

Many women are concerned about what CMV IgG positive means during pregnancy and should they be afraid? As a rule, such a question arises in pregnant women who did not plan to conceive and did not have an analysis before.

If antiCMV IgG is found in the blood of a pregnant woman, this means the presence of circulating protective antibodies and previous infection. This result is the most favorable for the fetus and the pregnant woman.

A good result of the blood test is the absence of markers of acute inflammation. So what does it mean - anti CMV IgM negative? This result stands for the lack of activity and reproduction of the virus in the body of a woman. But the results may not always be good.

What does a positive CMV IgG and IgM in the blood mean during pregnancy? Such data indicate reactivation of the infection and require urgent medical intervention. The virus crosses the placenta to the fetus and can lead to negative consequences up to intrauterine death.

PCR sampling

Molecular genetic studies in the aspect of detecting herpesvirus infections have found quite a wide application.

Important

The sensitivity and specificity of PCR in the diagnosis of cytomegalovirus infection are approaching 97%, which makes the method indispensable in the detection of the disease.

The polymerase chain reaction method is based on the detection of virions in biological material human even in small quantities, due to the ability of the technique to multiply the existing DNA in the substrate to a detectable level. The quantitative PCR variant is of the greatest value in diagnostics, when, in addition to the DNA of the virus, the number of virions is determined. This moment important in assessing the dynamics of the treatment of infection.

For PCR testing, any biological fluid a person, but most often the search for virus DNA is carried out in saliva, blood, urine, cerebrospinal fluid, cervical mucus, sperm. Much depends on the capabilities and equipment of the laboratory.

The study of scrapings from the cervical canal, urethra in men, as well as a blood test for cytomegalovirus are performed most often. The decoding of the PCR analysis is simple: normally, there should not be virus DNA in the biomaterial. Its presence means the reproduction of the virus.

1. If a woman has cytomegalovirus in a smear from the cervical canal, antiviral and immunomodulatory treatment is carried out.
2. If the PCR blood test for cytomegalovirus is positive, this means a generalized infection, characterized by the spread of the virus throughout the body. Usually, given result accompanied and positive antibodies at the CMV. In addition, the blood is tested for the quantitative content of the virus by PCR. The high activity of the virus is indicated by the value of 3 or more log⁵ leukocytes. Indicators of the rate of effectiveness of treatment are characterized by a gradual decrease in this number.
3. Saliva PCR positive for CMV indicates a latent course of infection or sialadenitis - inflammation of the salivary glands. In such situations, even in the absence of vivid clinical manifestations, a person is a source of infection for others.

Many women are concerned about how to test for cytomegalovirus from the cervix correctly? In order not to distort the results, you should refuse 2-3 days before the study from sexual intercourse, douching and the introduction of suppositories, unless otherwise prescribed by the gynecologist.