Cytomegaly

synonym

Inclusion body disease, salivary gland virus disease

definition

In the Cytomegaly is it a Infectious diseasecaused by a specific virus, namely the Human herpes virus 5 (also "Human Cytomegalovirus") is triggered. The Cytomegaly occurs worldwide only in humans.

Epidemiology

In the western industrial nations the virus (Cytomegaly) can be detected in around 40% of adults, in developing countries the contamination is even significantly greater at almost 100%. Most people become infected in childhood and carry the virus (Cytomegaly) then unnoticed with itself.

Pathogen

That discovered in the 1950s Human herpes virus 5 (Cytomegaly) belongs to the large family of Herpesviridae. A total of 8 different viruses are distinguished here, each causing specific clinical pictures. Everyone Herpesviridae What they have in common is that after an infection they can remain passively in the patient's body for life, possibly with one Defensive weakness reactivation of the viruses.
Depending on the body cells in which the virus resides, a distinction is made between 3 subfamilies of the herpes viruses, namely Alpha, beta and gamma herpes viruses. The Cytomegalovirus belongs to the beta subfamily, which means that it persists in so-called lymphocytes and granulocytes, which are special cells of the Immune defense. The virus (Cytomegaly) reproduces only very slowly, whereby the affected cells of the affected organism are destroyed only very slowly.

Transmission path

The Human herpes virus 5 (Cytomegaly) is transmitted through saliva and other body fluids when the body is in close contact, for example when Kiss or Sexual intercourse. It is also possible for an unborn child to be infected via the placenta if the mother has a high number of viruses in her blood Has. Even during the birth or at Breastfeeding the viruses can be transmitted from mother to child. A transfusion with infected blood is of course a source of infection (cytomegaly).

Symptoms

About 90% of all infections (cytomegaly) are asymptomatic. This means that the affected people, even though they carry the virus, do not develop any symptoms and actually feel healthy, the immune system keeps the virus under control.
In some (rather rare) cases, however, after an incubation period (i.e. the period between infection with the virus and the first appearance of symptoms) of 2-6 weeks also symptoms, the clinical picture then resembles the clinical picture of a Pfeiffer glandular fever.
In addition to a general feeling of illness and malaise, fever and swelling of the lymph nodes can occur, as well as headache and body aches.
Overall, the course of the disease of cytomegaly is rather harmless in otherwise healthy people, but there is fear on the one hand of an infection of an unborn child in the womb and on the other hand an infection of patients who have an inadequately functioning immune system.
If a pregnant woman becomes infected with the virus for the first time in the first or second trimester of pregnancy (cytomegaly), the infection is transmitted to the unborn child in around 40% of cases and can lead to malformations in the latter; in the worst case, such an infection can occur even the death of the unborn fetus in the womb. However, if a woman has already been infected with the virus in the course of her life and now falls ill again, the risk of transmission to the unborn child is much lower at around 1%.
A total of 5-10 infected children per 1000 live births are assumed, again 10% of these infected children show signs of disease during birth (cytomegaly)
Any malformations primarily affect the cardiovascular system and the gastrointestinal tract; for a few weeks to months, these malformations can then, for example, appear as hearing damage, seizures, motor disorders, an enlarged liver and spleen, and inflammation of the choroid or retina of the eye manifest. Furthermore, the occurrence of petechiae, i.e. very small bleeding from the vessels into the skin, which appear as red spots and do not disappear when the skin is pressed, was observed. This bleeding into the skin is based on a pathologically increased bleeding tendency caused by the virus (cytomegaly).
Flu-like symptoms in the mother are suspicious of CMV infection during pregnancy. Since the symptoms are just as similar to those of a flu, cytomegaly is often not recognized.
The second endangered group of patients besides pregnant women consists - as described above - of people with a weakened immune system.
This can be, for example, patients who have just had an organ transplant and in whom the immune system is specifically suppressed by certain drugs so that the body does not reject the foreign organ.
AIDS patients also have a malfunctioning immune system, the HIV virus attacks the body's own immune cells directly, so the patients are very susceptible to actually harmless diseases.
If the immune system does not function adequately, infections with the cytomegalovirus often lead to inflammation throughout the body, and severe pneumonia is very common.

The seizures of premature babies reflect the clinical picture of spastic cerebral palsy. For more information about this serious condition, read our article: Spastic cerebral palsy

Diagnosis

If a patient is suspected of being infected with the CytomegalovirusSo the diagnosis can be made through various laboratory tests and examinations.
In this context, the direct detection of antibodies against the virus in the patient's blood is particularly important. antibody are special proteins that are formed by the immune cells of the affected organism to inactivate the virus.
In addition to the detection of antibodies, direct virus isolation also plays a role in diagnostics (Cytomegaly)
Typical of an infection with the cytomegalovirus are so-called "Owl eye cells", i.e. the body's own cells that change when infected with the virus so that they look like big owl eyes under the microscope.
This characteristic feature of the virus also describes its name: the Greek terms "Kytos" = cell and "Megalo" = large form the term Cytomegaly.

therapy

In the case of a mild form of cytomegaly in an otherwise healthy person, it is usually sufficient to symptomatic take action against the signs of the disease (e.g. lowering the fever) and not attack the virus itself.
However, is it immunocompromised people, so is often therapy with the drug Acyclovir makes sense. Acyclovir is a drug that is locally known as ointment, as tablet or intravenous can be administered and the virus stops replicating in the body.
This works because Acyclovir is very similar to a certain building block of viral DNA (the nucleobase guanine). This DNS-Block Guanine is usually activated by a specific viral enzyme and then built into the DNA of the virus so that it can multiply.However, if acyclovir is present in the body at the same time, it is activated by the viral enzyme due to its great similarity to guanine, the inactivated guanine cannot be used and the viruses cannot multiply.

Acyclovir should not be used during pregnancy, but generally does not have a large number of side effects. Unfortunately, the viruses are becoming increasingly resistant to acyclovir, so in some cases it is used to treat the virus Cytomegaly also the Active ingredient ganciclovir applied.
Ganciclovir is structurally related to acyclovir and is also similar to the DNA building block guanine, the mechanism of action is the same.
Unfortunately, ganciclovir has a higher rate of side effects than acyclovir; it can cause blood disorders, among other things decreased blood platelet count come, there are also complaints in the gastrointestinal tract and central nervous disorders such as a headache, dizziness and hallucinations possible side effects.

prophylaxis

Unfortunately, there is no effective vaccine against the cytomegalovirus yet, but various vaccines are being developed.
Women, the one pregnancy plan, can be tested for the presence of antibodies against the virus in the body, but this is not yet an integral part of prenatal care and is not covered by health insurance companies (the cost is about 13 euros).
If there are no antibodies against the virus, there is a general risk of infection with the virus during pregnancy. In such a case, a check-up is recommended in the 20th to 24th week of pregnancy.
If there is contact with the virus (cytomegaly), antibodies against the virus can be administered passively, but it is not certain whether the unborn child is also completely protected.
Before a planned pregnancy, it is always a good idea to check your partner for cytomegaloviruses, since transmission to the pregnant woman can occur particularly quickly here.