Cytomegalia – a disease caused by cytomegalovirus, and the manifestation of the formation of peculiar giant cells with intracellular inclusions appearance in human tissues and organs. The virus penetrates initially into the salivary glands. Most children are infected, most of whom are babies.
Ways of infection
In clinical practice, doctors found changes in infants that are typical for the effects of cytomegalovirus. Therefore, it was concluded that the virus was transmitted through the placenta to the fetus from the sick mother. It is also dangerous for the newborn and breast milk, because the so-called alimentary route of infection is relevant.
The fetus can “catch” the virus in any month of pregnancy. The consequences are:
- the birth of a dead child
- birth of premature
- fetopathy
- embryopathy
Forms of cytomegaly
There are two forms of the disease:
- localized
- generalized
The first of these forms leads to pathology of regional lymph nodes and salivary glands. The second, generalized, causes the defeat of many organs:
- gastrointestinal tract
- lungs
- kidneys
- brain
- pituitary
- adrenal glands
- thyroid gland
- pancreas
- liver and other
With this form, the result is fibrosis of the organ. Perhaps the course of cytomegaly as a sepsis or hemolytic disease of the newborn. Symptoms:
- hepatosplenomegaly
- jaundice in clear form
- toxicosis
- hemorrhage under the skin
- pareses and pallas
- convulsions
- cyanosis
- dyspnea (rarely)
- hydrocephalus (rarely)
As for the blood in this form of the disease, they detect thrombocytopenia, erythroblastosis and anemia.
Etiology and pathogenesis of cytomegalovirus
Cytomegalovirus can penetrate into the animal’s body. But, since it affects only a few species, it is unrealistic to infect animals for diagnostic purposes. In the serum of a sick person, the presence of specific antibodies is revealed in the study.
As already noted, the virus is initially “populated” in the salivary glands. In general, the pathology initially covers the parotid glands, but in rare cases there may be fixation in the sublingual or submaxillary glands. The virus spreads through the blood, which is proved by the presence of vasculitides in the affected organs. Infection is rarely generalized without obvious reasons. Basically, this happens after a premature disease, which has weakened the defenses of the body.
Pathological anatomy
Cells, when the virus is introduced into them, become like an owl’s eye. The virus enters the nucleus of the cell, and this inclusion in diameter reaches 8-10 microns. Around it is an enlightened area, around which there is a nuclear envelope. The contours of the latter are underlined by the accumulation of chromatin and nucleoles.
The location of the nucleus in the cytoplasm is eccentric. In the cytoplasm, there is also the inclusion of nucleoprotein grains. If we talk about experiments, a nuclear inclusion is formed on the 12th-15th day after infection. And after another six or eight days there is a cytoplasmic inclusion.
Macroscopic examination with a localized form of cytomegaly reveals a slight increase and fullness of the salivary glands. Regional lymph nodes are also full-blooded and juicy. Very rarely observed a visible increase, then the clinical picture of lymphadenitis is manifested.
Microscopic examination reveals typical giant cells with inclusions in the epithelium of the ducts and secretory sections of the salivary glands. They can be found in smears on the basis of saliva, when they fall into the lumen of the ducts. In the interstitium of the gland, lymphohystocyte infiltrates and granulomas develop. As a result of the process, fibrosis of the organs develops, as already noted above. In the regional lymph nodes, reticular hyperplasia is observed. Sometimes giant cytomegal cells can form.
The generalized form is characterized mainly by the damage to the lungs and kidneys. Less likely, but still happens, the defeat of such organs as listed above.
If the virus leads to changes in the kidneys, there it is located mainly in cells of the proximal parts of the nephron. Interstitial nephritis is observed in interstitial tissue. When cells infected with a virus enter the lumen of the tubules, they can be identified by examining the urine of the patient. If the virus enters the liver, subacute productive hepatitis develops there.
If the virus affects the gastrointestinal tract, ulcers and catarrhal phenomena develop there. Some doctors believe that cytomegaly of the pancreas causes such a disease as cystic fibrosis.
In cases where the process is generalized yet in the embryo, the child’s organs can not normally form. Suffer:
- leather
- liver
- brain
- lungs
- kidneys, and so on.
The fetus is formed during the generalization of cytomegaly changes in the cirrhotic plan. They mainly affect the pancreas and the liver.
It is difficult to diagnose with a macroscopic method the generalized form of the disease. Doctors expect this diagnosis if there is hemorrhagic diathesis, which develops with encephalitis, general jaundice, hepatosplenomegaly, pneumonia. Also in favor of the diagnosis are deviations in the development of organs, which were listed above. Histological diagnosis is needed to accurately deliver or discard the diagnosis of cytomegaly.
Symptoms
Course of the disease:
- protracted
- sharp
- subacute
Lethal outcomes of the latter type of course. Disease in some cases of manifestation is very similar to sepsis. The localized form of the doctors is very difficult to detect, because there is no pronounced symptomatology. The clinical picture is influenced by the age of the person and what organ was affected by the virus.
As already noted, congenital cytomegaly is characterized by malformations, the birth of a premature baby. The baby is diagnosed with hemorrhagic syndrome, hepatolyenal syndrome, anemia or jaundice. Disease at this stage can be confused with hepatitis. In the first days after birth, cytomegalovirus shows jaundice. It can be slightly or strongly pronounced, it lasts at least five weeks, the maximum lasts 3 months. You can confuse it with physiological jaundice.
Disease during the course may worsen or improve. Cal is often yellow or slightly devoid of color. The urine is yellow, in rare cases the tone is saturated. A rise in bilirubin in serum is detected. Perhaps the development of hepatitis even in an unborn fetus, and then the baby who was born will have symptoms of atresia of the biliary tract.
For newborns and infants older are characterized by such symptoms (but they are not in 100% of cases):
- recurrent seizures
- productive meningoencephalitis
- calcification, determined by X-ray diffraction
- hydrocephalus, which progresses quite rapidly
- cytomegalovirus in cerebrospinal fluid
- complete mental retardation
- when the brain is affected, the symptoms of intracranial hemorrhage
- probably defeat of the eyes (malformation, optic neuritis, cataract, etc.)
Symptoms of children from 1 month of life:
- peribronchitis
- bronchitis
- interstitial pneumonia
- cyanosis, more or less
- different degrees of dyspnea
- cough (may not be): first dry, with further enhancement
- wheezing in the lungs (not in all cases)
If bacterial involvement is associated, pneumonia can occur with such complications:
- sepsis
- pyopneumothorax
- pleurisy
- cystic fibrosis (according to some specialists)
- pneumocystis pneumonia (in the opinion of some specialists)
When the kidneys are affected by cytomegalovirus, focal or diffuse nephritis develops. He does not have a vivid symptomatology. In the urine, leucocytes, individual hyaline cylinders and traces of protein are found in a special study. There may be hematuria, but it is rare. If bacterial flora also joins in such cases, then the symptomatology of renal failure develops, erythrocyturia, leukocyturia, etc. are fixed.
In patients with babies from 5 months, there may be duodenitis, ulcerative colitis, or catarrhal colitis. When the endocrine glands are affected, then the following organs are affected:
- thymus
- parathyroid
- thyroid gland
- adrenal glands
- pituitary
- testicles
- ovary
Another 10 years ago it was believed that the prognosis for cytomegaly in children is unfavorable in all cases. But today they discover a disease in mild forms, the outcome of which is considered favorable. Children who recovered develop normally mentally and physically. But, if after birth the child had a nervous symptomatology, he will henceforth have mental and physical backwardness.
In many cases, the disease ends lethal, and quite quickly. The reason for the violation of blood flow to different organs, organ hemorrhage, toxicosis and other processes that arise when other infections join cytomegaly.
Treatment
Specific treatment of cytomegaly has not been developed. Doctors prescribe steroids, mostly prednisolone. The course is from 10 to 30 days. The dose per day is calculated as follows: 0.8-1 mg per 1 kg of the child’s body. It is recommended to re-introduce gamma globulin: every 2 days IM in 3 milliliters. Intravenous infusion of the patient with plasma or blood. If a secondary infection has joined, prescribe antibacterial drugs in individual dosage, as well as treatment for existing symptoms.