scholarly journals Difficulties in selecting specific therapy in severe forms of congenital cytomegalovirus infection: view through time

2021 ◽  
pp. 82-89
Author(s):  
E.V. Usachova ◽  
◽  
E.A. Silina ◽  
T.N. Pakholchuk ◽  
O.V. Konakova ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Cytomegalovirus Infection ◽  
Residual Effects ◽  
Congenital Cytomegalovirus Infection ◽  
Specific Therapy ◽  
Congenital Cytomegalovirus ◽  
The Central Nervous System ◽  
Pcr Test ◽  
Clinical Cases

The aim — to show the feasibility of using ganciclovir for congenital cytomegalovirus infection (CMVI) by demonstrating two clinical cases. Clinical cases. Over time, the approaches to the treatment of congenital CMVI have changed from the use of acyclovir to the appointment of ganciclovir. In 2011, a premature baby was diagnosed with congenital CMVI based on the presence of multiple organ lesions (lungs, liver, spleen, pancreas, eyes, central nervous system) and positive result of CMV PCR test in blood, urine and cerebrospinal fluid. Only acyclovir was used as an etiotropic drug due to the lack of evidence at that time on the safety of another antiviral drug — ganciclovir. Treatment was not completely effective: in the follow;up at the age of two the child has a grave violation hearing and vision and profound disability due to the residual effects on the central nervous system. In 2019, a newborn child with severe haemorrhagic syndrome, respiratory disorders and neurological symptoms was diagnosed with congenital CMVI by positive result of CMV PCR test and ganciclovir was prescribed at a dose of 6 mg/kg every 12 hours by an intravenous infusion under the control of a routine complete blood count (CBC) test. On the second week of treatment, positive dynamics was observed clinically, on the 6th week — negative result of CMV PCR test. The child was discharged on day 70th of treatment without residual effects on the central nervous system. At the age of 9 months, deafness of 2–3 degrees was diagnosed, but prosthetics were performed timely with complete restoration of hearing. At age of 12 month this child sits, rolls over, crawls; responds adequately to others; captures the gaze and keep an eye on items. Conclusions. Two clinical cases through the description of changes in approaches to specific therapy of congenital cytomegalovirus disease from acyclovir to ganciclovir and a clear demonstration of the difference in disease outcomes — from severe disability when ganciclovir was not prescribed, to complete rehabilitation with its use demonstrate the feasibility of prescribing ganciclovir. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: congenital cytomegalovirus infection, severe forms, treatment, acyclovir, ganciclovir.

scholarly journals FEATURES OF CENTRAL NERVOUS SYSTEM DAMAGE IN CHILDREN WITH CONGENITAL CYTOMEGALOVIRUS INFECTION

2020 ◽  
Vol 7 (2) ◽  
pp. 89-93
Author(s):  
M. Gonchar ◽  
M. Urivaeva ◽  
G. Muratov ◽  
T. Malich ◽  
O. Omelchenko ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Cytomegalovirus Infection ◽  
Clinical Observation ◽  
First Year ◽  
Congenital Cytomegalovirus Infection ◽  
Central Nervous System Damage ◽  
Congenital Cytomegalovirus ◽  
First Year Of Life ◽  
Ig G

FEATURES OF CENTRAL NERVOUS SYSTEM DAMAGE IN CHILDREN WITH CONGENITAL CYTOMEGALOVIRUS INFECTION Gonchar M., Urivaeva М., Muratov G., Malich T., Omelchenko H., Shapko М., LiesnaA., Poliakova V. The paper discusses the features of central nervous system lesions in children with congenital cytomegalovirus infection at different stages of gestation. In the course of the work, an algorithm for diagnosing congenital cytomegalovirus infection was developed. To demonstrate the complexity of diagnosis and treatment in a child of the first year of life, a clinical observation is given. The positive dynamics in the treatment of children with the use of human anticytomegalovirus immunoglobulin with a high content of IgG is discussed. Key words: damage, central nervous system, congenital, young children, anticytomegalovirus.   Резюме ОСОБЛИВОСТІ УРАЖЕННЯ ЦЕНТРАЛЬНОЇ НЕРВОВОЇ СИСТЕМИ У ДІТЕЙЗ ВРОДЖЕНОЮ ЦИТОМЕГАЛОВІРУСНОЮ ІНФЕКЦІЄЮ Гончарь М. О., Уриваєва М. К., Муратов Г. Р., Маліч Т. С., Омельченко О. В., Шапко М. В., Лєсна А. С., Полякова В.В. У роботі розглядаються особливості ураження центральної нервової системи у дітей з вродженою цитомегаловірусною інфекцією на різних термінах гестації. В ході роботи був розроблений алгоритм діагностики вродженої цитомегаловірусної інфекції. Для демонстрації складності діагностики и лікування у дитини первого року життя наводиться клінічне спостереження. Також обговорюється позитивна динаміка в лікуванні дітей при застосуванны антіцітомегаловірусного імуноглобуліна людини з підвіщенім вмістом Ig G. Ключові слова: ураження, центральна нервова система, вроджена, діти раннього віку, антицитомегаловірусний.   Резюме ОСОБЕННОСТИ ПОРАЖЕНИЯ ЦЕНТРАЛЬНОЙ НЕРВНОЙ СИСТЕМЫ У ДЕТЕЙ С ВРОЖДЕННОЙ ЦИТОМЕГАЛОВИРУСНОЙ ИНФЕКЦИЕЙ Гончарь М. А., Урываева М. К., Муратов Г. Р., Малич Т. Б., Омельченко Е. В.,Шапко М. В., Лесная А. С., Полякова В.В. В работе рассматриваются особенности поражений центральной нервной системы у детей с врожденной цитомегаловирусной инфекцией на разных сроках гестации. В ходе работы был разработан алгоритм диагностики врожденной цитомегаловирусной инфекции. Для демонстрации сложности диагностики и лечения у ребенка первого года жизни приводится клиническое наблюдение. Обсуждается положительная динамика в лечении детей при применении антицитомегаловирусного иммуноглобулина человека с повышенным содержанием Ig G.  Ключевые слова: поражение, центральная нервная система, врождённая, дети раннего возраста, антицитомегаловирусный.

scholarly journals Congenital cytomegalovirus infection: background for manifestation; clinical case; difficulties of treatment

2021 ◽  
pp. 37-44
Author(s):  
E.V. Usachova ◽  
◽  
E.A. Silina ◽  
T.N. Pakholchuk ◽  
O.V. Konakova ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Cytomegalovirus Infection ◽  
Clinical Case ◽  
Congenital Cytomegalovirus Infection ◽  
Specific Therapy ◽  
Congenital Cytomegalovirus ◽  
Igm Antibodies ◽  
Selection Of ◽  
Congenital Cmv

Congenital CMV is the leading cause of congenital infections in newborns worldwide and can lead to significant morbidity, mortality, or long-term consequences. Purpose — to demonstrate the results of screening for cytomegalovirus infection of pregnant women and children in the first months of life and illustrate a clinical case of severe congenital CMV and the difficulties in selecting specific therapy. Materials and methods. The article presents the results of a retrospective analysis of CMV testing of 302 pregnant women at living in the Zaporozhye region. The presence of CMV-specific immunoglobulin G (IgG) and M (IgM) antibodies was assessed. In addition, the clinical manifestations of CMV in 56 infants were retrospectively evaluated. A clinical case of congenital CMV in a newborn complicated by hepatitis, nephritis, carditis, pneumonia, thrombocytopenia, was presented. Statistical processing of the results was carried out by the methods of variation statistics. Results. The result of a study of a specific immunological profile for CMV in pregnant women showed that the majority of women of fertile age, residents of Zaporozhye region were seropositive to CMV. In 3% of pregnant women, CMV-specific IgM antibodies was recorded in the blood, which indicates the manifestation of an acute form of CMV and the possibility of infection of the fetus. Prolonged neonatal jaundice was the dominant clinical symptom of congenital CMV in 59.3% patients. The syndrome of perinatal CNS lesion was the second most frequent in these children. In order to illustrate the features of the course, the difficulties of diagnosis and the selection of specific therapy for severe forms of congenital CMV, a clinical case of the corresponding disease was presented. Conclusions. Most women of fertile age are immune to CMV, and 5% of pregnant women have acute primary CMV infection. CMV is the most common cause of congenital infection with substantial morbidity, mortality, and long$term squeal, including sensorineural hearing loss for newborns. Diagnosis of congenital CMV is complicated by both the polysyndromic manifestations of the disease and the lack of a clear system for testing pregnant women and newborns for CMV. The presence of alertness of neonatologists and pediatricians for CMV is a guarantee of timely diagnosis of the disease in newborns. Difficulties in the selection of specific therapy to congenital CMV due to the low sensitivity of the pathogen to acyclovir and the need to use a toxic drug — ganciclovir. Timely administration of highly specific anti-CMV-therapy not only saves the patient's life, but also improve hearing and developmental outcomes. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: congenital cytomegalovirus infection, newborns, severe forms, diagnostics, manifestations, treatment.

Mechanisms of injury to the central nervous system following experimental cytomegalovirus infection

1990 ◽  
Vol 11 (5) ◽  
pp. 313-317 ◽  
Author(s):  
John Booss ◽  
Pamela R. Dann ◽  
Susan R. Winkler ◽  
Brigitte P. Griffith ◽  
Jung H. Kim
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Cytomegalovirus Infection ◽  
The Central Nervous System
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