A positive diagnosis for cytomegalovirus IgG cannot be considered a weighty reason for despair. The conclusion about the presence of this representative of the herpesvirus family in the body is quite natural, and the probability of its detection in an adult is very high. We have to admit that only 10% of the world's population are not carriers of this insidious, temporarily hidden in the body, virus. The only thing that saves us is that the disease is often hidden, and only under certain circumstances does the activation process start, which does not exclude fatal consequences.

It is very easy to become a victim of infection - the virus is actively transmitted by the simplest and most widely available methods. Like representatives of the respiratory constellation of viruses, it penetrates the human body through airborne droplets and household routes, and it does not disdain sexual spread.

Complaining about fate or blaming yourself for lack of caution is an absolutely thankless task - the vast majority of infections occur in childhood. This usually happens before the age of twelve. If all people passed the appropriate analysis today, then positive cytomegalovirus IgG would be found in 90% of those subjected to analysis. Such statistics allow us to assert that today, infection with the virus in question is rather the norm for earthlings, and not the exception.

The nature of the symptoms that signal infection depends on the strength of the immune system. If some patients peacefully coexist with cytomegalovirus for decades, not even suspecting its existence, then others may experience a variety of clinical manifestations and complications of the destructive effects of the virus.

When should I be tested for cytomegalovirus IgG

The risk group includes people who have undergone organ transplantation and people with HIV. Cytomegalovirus is especially dangerous when carrying a child. accompanied by a decrease in immunity, and therefore the risk of activation or, even worse, primary infection increases many times over. The latter, causing infection of the fetus, can not only contribute to the development of dangerous pathologies, but also lead to the death of the fetus. Before pregnancy, you should definitely do an analysis for cytomegalovirus IgG.

It should also be remembered that most children infected with cytomegalovirus become infected in the first six months of life.

What does a positive cytomegalovirus IgG test mean?

When infected, in the human body almost once begins the production of antibodies to IgG. It is these stubborn warriors immune system human, suppressing the development of the virus, become the cause of the asymptomatic course of the disease. The presence of antibodies is determined laboratory analysis blood plasma. If the analysis does not detect antibodies to positive cytomegalovirus IgG, this indicates not only the absence of infection, but also an increased susceptibility to primary infection. At the same time, the presence of antibodies does not at all mean that a person is absolutely protected from future infection. It must be emphasized that stable immunity is not developed against positive cytomegalovirus IgG.

The analysis is carried out by one of the existing methods - ELISA or PCR. The first option involves finding antibodies that show the immune response to the presence of an infection. Positive cytomegalovirus IgG in this case confirms that the primary infection occurred no more than three weeks ago. Excess IgG more than four times indicates the activation of the virus. This, as well as the primary infection, is also indicated by an increased number of IgM antibodies, therefore, the concentration of both immunoglobulins is usually analyzed.

Using the PCR method, it is possible to detect the presence of the virus in urine, semen, saliva, and vaginal secretions.

Cytamegalovirus is a member of the torch infection family, which includes the most dangerous infections-, herpes, chladmidia - they are all deadly to the fetus. Ideally, the test should be taken before pregnancy.

Testing for antibodies to cytomegalovirus is mandatory before pregnancy. Positive cytomegalovirus IgG and negative IgM is what you need before conception, as it confirms the impossibility of primary infection during gestation. But with positive IgM, pregnancy will have to be postponed and the normalization of the indicator will have to be done, resorting to the help of doctors.

And, finally, if both results are negative, you should be especially careful, avoid any physical contact, especially with small children, carefully observe personal hygiene.

Treatment of cytomegalovirus IgG

Alas, it is difficult to deal with cytomegalovirus, and no one has yet been able to cure it completely. Thanks to drug treatment it is only possible to achieve an increase in the period of remission and manage the recurrence of infection. It is impossible to get rid of the virus. The organism is doomed to coexist with the settled insidious neighbor. Our main task is to detect the virus in time. This makes it possible to "lull" the cytomegalovirus for many decades. In the treatment of positive cytomegalovirus IgG doctors use anti-inflammatory drugs - ganciclovir, foxarnet, valganciclovir. It should be clarified that all of them are quite toxic and can cause dangerous complications. That is why they are prescribed very carefully - if the patient's vital signs are forced to do so. A positive diagnosis is also accompanied by the appointment of anticytomegalovirus immunoglobulin (cytotect) to patients.

Important! The specificity of treatment requires it to be carried out exclusively in a hospital under the close supervision of physicians.

Cytomegalovirus is called, which is characterized by danger. If the patient has strong immunity, then he can suffer the disease without pronounced symptoms. For this reason, testing for cytomegalovirus is performed.
Content:

Indications for analysis

It is infected by contact with semen, saliva, cervical and vaginal mucus, blood, lacrimal fluid, etc. This disease is characterized by incubation period, the duration of which is from 20 to 60 days. After this time, the acute phase of the disease begins, the duration of which is from 14 to 42 days. During this period, the patient complains of chills, general weakness, headache.

Testing for cytomegalovirus should be taken as seriously as possible, as this disease can adversely affect your health.

The analysis is assigned when:

• , which is of unknown origin;
• neoplastic diseases;
• Taking cytostatic drugs;
• Feto-placental insufficiency;
• Preparing for pregnancy;
• Immunosuppression in human immunodeficiency virus;
• Signs of infection of the child inside the womb.

With a non-standard course of pneumonia in children, this analysis is also prescribed. If an absolutely healthy person very often has colds, then he also needs to be tested for cytomegalovirus.

With the help of timely diagnosis of this disease, not only its development is prevented, but also its transmission to other people.

Preparatory stage

In order to get reliable results, people need to follow some recommendations. Representatives during menstruation are strictly prohibited from taking an analysis. If the analysis is taken from the male representatives of the urethra, then they are forbidden to wet it for several hours.

If the material during the analysis is taken in a small amount, then its quality will deteriorate significantly. Incorrect sampling of material for research also affects the effectiveness of the analysis. An analysis for cytomegalovirus is performed only after appropriate appointments by a gynecologist or.

Analysis Methods

The presence of cytomegalovirus in human body defined with:

• cytological method;
• Molecular biological method;
• Immunological method;
• Virological method.

The molecular biological method is called polymer chain reaction cytomegalovirus. When using this method, the microorganism of the pathogen DNA is found. This method is characterized by the accuracy of the results, since the causative agent of the disease is a component of DNA-containing viruses. When using this research method, you can get results in a few days.

With the virological method, saliva, semen, blood and other biological materials are taken from the patient and placed in a nutrient medium. It must be nutritious. After a certain period of time, microorganisms appear in the medium, which are identified. The results of the analysis with this method of research must be expected for a long time.

With the immunological method, an enzyme immunoassay is performed, which is considered quite effective in studies of the human body for the presence of cytomegalovirus.

Cytological1 analysis method consists in identifying cytomegalovirus cells under a microscope. The distinguishing features of cells are big sizes and the presence of intranuclear inclusions. At this method you can get the results of the analysis almost immediately. The disadvantage of the method is the low indicator of informativeness.

Absolutely all research methods for cytomegalovirus are very effective. Their choice directly depends on the individual characteristics of the patient and on the manifestations of the disease.

Features of decoding results

The immune system produces immunoglobulins immediately after a virus enters it. The human body can produce immunoglobulins such as IgG, IgM. The first of them indicates the presence of a primary or latex course of the disease. If the patient has a current primary infection or recurrent disease, then this leads to the detection of IgM antibodies.

The decoding of a blood test for cytomegalovirus is to indicate the titers of antibodies of the IgG group. These antibodies are recognized not only during the course of the disease, but also after its treatment. That is why the analysis is repeated. If the IgG antibody titer rises more than four times, then this indicates that the cytomegalovirus has activated. In order to more accurately verify this information, it is necessary to perform an additional analysis, with the help of which antibodies are found in the blood, which belong to the IgM group.

If, after the analysis, there are results of IgM- and IgG +, then this indicates that there is no risk of primary infection, which is explained by the high-quality work of the immune system in relation to the virus. The possibility of exacerbation of the disease depends on performance.

If there are results with IgM- and IgG-, we can talk about the possibility of primary infection. This is due to the lack of response of the immune system to the virus.

If the patient has IgM+ and IgG+ results, then this indicates the presence of a secondary exacerbation of the infection. When such results are obtained, it is mandatory to carry out treatment. In the presence of indicators of IgM + and IgG - it is possible to judge the primary infection. For its treatment it is used drug therapy. If this indicator was found in a female representative who plans, then she needs to wait with this.

Only the doctor who treats the patient should deal with the interpretation of the results obtained. If there is a need or doubts with the doctor, then additional tests are prescribed.

What is IgM and IgG?

Immunoglobulins are proteins that circulate in the intercellular fluid of tissues, the surface of B-lymphocytes and blood. With the help of antibodies, the most effective protection against the progression of infections is provided. A distinctive feature between antibodies is the molecular weight, features of the reaction, structure.

During the analysis for cytomegalovirus, the state of IgM and IgG antibodies is assessed. The first of these antibodies begins to be synthesized during the initial infection at the initial stage of the disease. Their location is serum. The viability of these antibodies lasts from 8 to 10 days.

If these immunoglobulins are present in the serum, then we can talk about a recent human infection. the appearance of these antibodies is also carried out with the recurrence of a long-standing disease. In this case, their number is much less than during the primary infection. A distinctive feature between these reactions is the avidity of immunoglobins.

At the end of a month after human infection, the blood serum is characterized by the appearance of IgG immunoglobins. On the initial stages infection, these antibodies are characterized by low avidity. After 3-7 months after human infection, it increases significantly. These immunoglobins are characterized by the persistence of the body for life.

Due to their presence, the body's defense system has a quick reaction when the activity of the virus increases. The amount of immunoglobins produced by the body directly depends on its individual characteristics. IgG are characterized by the absence of an indicator of the norm.

If the body's defense system has normal activity, then during the primary infection, the number of antibodies increases after 4-6 weeks. Further, there is a decrease in the indicator and its maintenance at the same level. You can see this phenomenon by deciphering the analysis for cytomegalovirus.

IgM and IgG are antibodies that manifest themselves in the presence of cytomegalovirus. Their number and degree of activity can be determined by decoding the analyzes.

In order to confirm the tests, they may be scheduled to be repeated. Only after a detailed examination of the results and confidence in the correctness of the analyzes, the doctor prescribes a rational and most effective one.

Presence of IgG antibodies in pregnant women

Bringing the analysis to pregnant female representatives is carried out up to three months. This is due to the individual characteristics of a pregnant woman. The ideal option would be to conduct an analysis at a certain time before pregnancy. Repeated analyzes should be carried out every three months. Due to the regular conduct of this procedure, the primary infection is determined in time, which allows for the most effective treatment in a timely manner.

In the absence of antibodies during the decoding of the results of the analysis that was performed before, the woman is at risk. If a woman was infected during pregnancy, then there is a 50 percent chance that a child can become infected from her. When infected, a female representative should limit contact with children who are less than six years old. In this case, it is imperative to follow the rules of personal hygiene.

In the event that, during the analysis before pregnancy, the interpretation of the results shows the presence of antibodies of the IgG group, then this indicates that she has recently had a primary infection. Doctors in this case do not recommend conception for several months. This is due to the increased risk of infection of the unborn child in the womb.

In the event that the decoding of the results of a female representative before pregnancy did not show the presence of antibodies, and a second study showed them, then this may indicate the presence of a primary infection. In this case, a woman needs to contact an infectious disease specialist, as well as pass additional tests for PCR.

Dj while watching the video you will learn about the symptoms of the virus.

Conducting on immunoglobulins is necessary in order to determine the period of infection with a human infection. After the analyzes are carried out, they are decoded. medical workers who are experts in this field.

Cytomegalovirus, IgM

Antibodies of the IgM class to cytomegalovirus are specific immunoglobulins produced in the human body in the acute period of cytomegalovirus infection and are an early serological marker of this disease.

Russian synonyms

Antibodies of the IgM class to cytomegalovirus (CMV).

English synonyms

Anti-CMV-IgM, CMV Antibody, IgM.

Research method

Solid-phase chemiluminescent enzyme immunoassay ("sandwich" method).

What biomaterial can be used for research?

Venous, capillary blood.

How to properly prepare for research?

Do not smoke for 30 minutes before donating blood.

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, the virus 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 exacerbation of an old infection may occur, but this form usually does not cause serious consequences.

If a woman has not yet had CMV, then she is at risk and she should pay special attention to the prevention of cytomegalovirus infection. 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 common cause death of patients.

The main symptoms of cytomegalovirus:

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

Antibody production is one way to fight viral infection. There are several classes of antibodies (IgG, IgM, IgA, etc.) that differ in their functions.

Immunoglobulins M (IgM) usually appear first in the blood (earlier than other types of antibodies). Then their number gradually decreases (this process can last several months). If there is an exacerbation of a latent infection, then the level of IgM will rise again.

Thus, IgM are detected:

• with primary infection (in this case, the level of IgM is the highest),
• during an exacerbation of the disease (as well as during reinfection, i.e. infection with a new form of the virus).

What is research used for?

For the diagnosis of acute cytomegalovirus infection.

When is the study scheduled?

• During pregnancy.
• With immunodeficiency (in particular, with HIV infection).
• When a person with normal immunity has symptoms of mononucleosis (if the tests did not reveal the Epstein-Barr virus).
• If CMV infection is suspected in newborns.
• During pregnancy:
  • with symptoms of the disease,
  • if ultrasound revealed fetal developmental disorders,
  • for screening.

CMV infection in pregnant women is often asymptomatic. However, in some cases, the temperature rises, the lymph nodes, liver and / or spleen increase.

With immunodeficiency, the symptoms of CMV infection can be quite diverse: from general malaise to retinitis, colitis, encephalitis, etc.

• An analysis may be prescribed for a newborn if the child has:
  • jaundice, anemia,
  • enlarged spleen and/or liver
  • head size is smaller than normal
  • have hearing or vision impairments,
  • there are neurological disorders (mental retardation, convulsions).

What do the results mean?

Reference values

Result: negative.

S/CO ratio (signal/cutoff): 0 - 0.7.

Negative result

• There is no current CMV infection at the moment. If there are symptoms of a certain disease, then they are caused by another pathogen. In this case, CMV may be present in a latent form. True, if the infection occurred quite recently (a few days ago), then IgM antibodies may not have had time to appear in the blood.

Positive result

• Recent infection (primary infection). In primary infection, IgM levels are higher than in exacerbations.

  After a primary infection, IgM may be detected for several more months.

• Exacerbation of latent infection.

Important Notes

• Sometimes you need to find out if a newborn baby is infected with cytomegalovirus. For this, PCR is used and antibodies are additionally determined. If IgM is detected in the child's blood, then he is really infected with CMV.
• What is reinfection? In nature, there are several varieties of CMV. Therefore, a situation is possible when a person already infected with one type of virus becomes infected 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.

Torch infections

A special place among human infectious diseases is occupied by the so-calledTaboutRCH- infections. "ToRCH" is an abbreviation of the Latin names of four infections: Toxoplasmosis (Toxpolasmosis), Rubella (Rubella), Cytomegalia (CMV), Herpes simplex (). Their peculiarity lies in the wide prevalence and absence, as a rule, of a clearly defined clinical picture, in the predominance of latent forms of the disease, which can turn into acute or subacute forms against the background of secondary immunodeficiencies caused by both physiological (pregnancy) and pathological causes. With primary infection and reactivation of a latent infection during pregnancy, intrauterine infection can occur, leading to miscarriage, stillbirth, the formation of malformations, disability and even death of the child. In this regard, the role of timely laboratory diagnostics is important.TaboutRCH- infections in women of childbearing age and pregnant women.

When is it appropriate to test for TORCH infection:

Planning and preparation for pregnancy;

Monitoring the effectiveness of treatment;

During pregnancy (in dynamics) with established infection with one of the causative agents of Torch infection;

Specific inflammatory processes genitalia, infertility of unknown origin;

miscarriage;

Congenital deformities in history;

Birth of children with signs of intrauterine infection and congenital pneumonia.

Subfebrile condition of unclear etiology (unclear prolonged increase in body temperature up to 37.5 FROM);

Generalized increase lymph nodes, hepatolienal syndrome (enlargement of the liver and spleen)

Damage to the central nervous system (encephalitis, arachnoiditis, polyradiculo and polyneuropathy), eye damage by the type of uveitis.

Algorithm for the examination of women planning pregnancy.

1. All subjects are tested for the presence of class G specific antibodies (IgG).

2. In the case of a positive result, there is no risk of intrauterine infection. Further testing is not advisable.

3. In the event of a negative result, the woman is classified as a risk group during pregnancy and periodically (every 8-12 weeks) is tested for the presence of class M specific antibodies (IgM).

4. A positive IgM result will indicate a primary infection and high risk vertical infection.

Examination during pregnancy

If a woman has not been examined before pregnancy and her serological status is unknown, then she should be periodically (every 8-12 weeks) examined for the presence of class M specific antibodies (IgM).

Examination of newborns

Diagnosis of congenital, rubella, CMVI or BBVI is confirmed only by the presence of the appropriate class M specific antibodies (IgM).

It must be remembered that the risk of intrauterine infection is very high. only for primary infection(fifty%). In the latent (hidden) period, and even in the period of infection reactivation, intrauterine infection unlikely(0.1-0.5%). Therefore, in order to assess how favorably the pregnancy will proceed it is important to establish not so much the presence or absence of infection as the stage at which it is located.Indicators of primary infection are specific antibodies of class M (IgM), which usually appear in the blood in the second week after infection and disappear after 2-3 months. IgM can also appear during exacerbations (but not always). They are replaced by class G antibodies (IgG) in the blood, which only increase in the first 2-3 months of the disease. For some time (6-12 months) the IgG titer remains stable, then decreases slightly, but never completely disappears. In fact, IgG can only testify to a person who has already (it is not known when) contact with an infection.. At the same time, a single titer determination does not make it possible to distinguish primary infection from paste infection or asymptomatic carriage. To determine the stage of infection, it is necessary to compare the antibody titra in the patient's blood samples taken at regular intervals. When using this approach, you may encounter the following difficulties:

there are cases of an atypical course of the immune response, when IgM are present in the blood for a short time, or are not formed at all, or, on the contrary, trace amounts of IgM are found in the blood up to one to two years after infection;

the specificity of test systems for the detection of species-specific IgM may not be absolute due to the presence of rheumatoid factor in the blood or non-specific interaction of IgM with the immunosorbent;

if the patient is not in hospital, regular blood sampling may be difficult.

In this case, it is effective to use the method for determining the avidity index of specificIgG.In the course of the body's immune response to the penetration of an infectious agent, the stimulated clone of lymphocytes begins to produce, first, specific IgM antibodies, and somewhat later, specific IgG antibodies. IgG antibodies have initially low avidity, that is, they bind the antigen rather weakly. Then the development of the immune process gradually (it can be weeks or months) goes towards the synthesis of highly avid IgG antibodies by lymphocytes, which more firmly bind to the corresponding antigens. High avidity of specific IgG-antibodies allows to exclude recent primary infection. The results are given as a percentage of the so-calledvisibility index( IA) .

The detection of antibodies with a visibility index below 40% in the test serum (values ​​may differ from manufacturer to manufacturer) indicates a fresh primary infection of the examined patient. A visibility index greater than 60% indicates that the serum contains highly avid antibodies indicative of past infection. The avidity index of antibodies in the range of 41-60% indicates a late stage of primary infection (while the titerIgGlow), recent activation of the virus in the body or secondary infection. In the second and third cases, the concentrationIgGhigh.

Table 1. Interpretation of the avidity index.

Result

Meaning

Interpretation

<40%

low avidity

confirms the fact acute infection 10 to 100 days ago

41-60%

transitional

Confirms acute infection 101 to 160 days ago

>60%

highly avid

More than 161 days after acute infection or contact, antibodies are protective

ATTENTION! The calculation of the avidity index should be carried out for sera previously tested for the presence of species-specific antibodies of the class ( IgG ).

TOXOPLASMOSIS

Laboratory diagnosis of toxoplasmosis is based only on the determination of specific antibodies, since the Toxoplasma gondii antigen is present in the blood for a very short time. When the pathogen enters the human body, within 7-14 days, the primary immune response begins - the production of IgM antibodies. The maximum level of IgM antibodies is reached by the 20th day from the onset of the disease. Their complete disappearance in most cases occurs within 3-4 months. In the same period, the maximum values ​​of IgG antibodies are noted in the blood. After recovery, there is a gradual decrease in the titer of IgG antibodies to a certain level, which persists for life and indicates the presence of stable immunity.

When determining IgG and IgM antibodies to toxoplasmosis in blood serum, the following results are possible:

+IgG, -IgM – indicates asymptomatic healthy carriage (up to 30% of the adult population). This combination of antibodies in the blood of pregnant women does not pose a threat to the fetus.

-IgG, +IgM or +IgG, +IgM – primary infection, acute or subclinical course.During pregnancy, this situation indicates the possibility of intrauterine infection. In doubtful cases, it is necessary to repeat the analysis after 7-14 days to confirm seroconversion.

– IgG, -IgM – no infection. Pregnant women with this result should be included in the risk group and examined every trimester.

RUBELLA

To establish the diagnosis, IgM antibodies in the blood serum are determined, the maximum titer of which is observed after 2-3 weeks from the onset of the disease, and their complete disappearance occurs after 1-3 months. IgG antibodies are determined from the 7th day of the disease, and the maximum titer - on the 21st day. Then there is a decrease in the titer to a certain level, indicating a stable immunity.

The following combinations of IgG and IgM antibodies in blood serum are possible:

+IgG, -IgM – testifies to the transferred disease and stable immunity.Immunity is developed as a result of the transferred clinically expressed and asymptomatic forms. Recently, evidence has appeared that immunity after rubella is not as strong as previously thought, since adults sometimes get rubella (5% of cases), despite the fact that they had it in childhood. In this case, an increase in virus-neutralizing antibodies (IgG) is observed in the blood serum.

-IgG, +IgM or +IgG, +IgM – primary infection, acute form or asymptomatic course, which is observed in 30% of cases. In this situation, the risk of intrauterine infection is high. When infected in the first trimester, termination of pregnancy is recommended. In doubtful cases, the analysis should be repeated after 7-14 days to confirm seroconversion.

-IgG, -IgM – lack of immunity. According to the latest data, 10-20% of women of childbearing age are not immune to the rubella virus. Therefore, it is necessary to examine women before pregnancy and, in the absence of immunity, recommend vaccination. Pregnant women who do not have IgG antibodies to the rubella virus are included in the risk group and are examined every trimester..

Cytomegalovirus infection (CMVI)

Laboratory diagnosis of CMVI is based on the determination of specific antibodies in blood serum and other biological fluids, along with various methods for determining the antigen and DNA of the virus. The presence in the blood of specific antibodies IgG and IgM class depends on the form and stage of CMVI.

Primary infection (active stage)

Latent form (inactive stage)

active form

Persist.

Reactivation

Superinf.

Clinical symptoms

IgG antibodies

IgM antibodies

Virus DNA isolation

Risk of transmission from mother to fetus (in points)

The following combinations of IgG and IgMantibodies are possible in CMVI:

-IgG, -IgM – no infection. It is observed in 5-10% of the adult population. Pregnant women who do not have IgG antibodies to CMV are included in the risk group and are examined every trimester.

±IgG, +IgM – primary infection. Primary CMVI, which occurs in pregnant women in 1-4% of cases, is accompanied by a greater risk of infection of the fetus than reactivated.

+IgG, ±IgM - persistent infection, reactivation. It can be considered as an indirect sign of viremia and exacerbation of infection. The risk of infection of the fetus is 0.5-2.5%. In most cases, CMVI is asymptomatic, and at the same time, the woman's history contains information about adverse pregnancy outcomes: miscarriages, stillbirths, births of children with malformations.

+IgG, -IgM – . It has been established that the presence of specific IgG antibodies against CMV in the patient's blood indicates infection rather than protection from infection. This situation does not pose an immediate danger to the fetus, but since a state of physiological immunodeficiency develops during pregnancy, both seropositive and seronegative women should be included in the risk group.

Herpes virus infection (HVI)

Laboratory diagnosis of BBVI includes the determination of specific antibodies to the herpes simplex virus (HSV) in the blood serum along with the determination of the HSV antigen in blood cells, urine sediment, and saliva. When making a diagnosis, it is necessary to take into account laboratory data and clinical symptoms.

The following options are possible when determining specific antibodies to HSV:

-IgG, -IgM – no infection. It is observed in 5-10% of the adult population. Pregnant women who do not have IgG antibodies to HSV are included in the risk group and are examined every trimester.

±IgG, +IgM – primary infection. Clinical symptoms are detected in 33% of cases. Transplacental transmission is possible. The risk of infection of the child during childbirth is 50-70%. HSV is transmitted across the placenta at 10 times less common than cytomegalovirus.

+IgG, ±IgM – persistent infection, reactivation. As with CMVI, it can be considered as an indirect sign of viremia and exacerbation of infection. In this case, during pregnancy, the risk of infection of the fetus is 5%. In most cases, VPHI has an atypical course, and at the same time, the woman's history contains information about adverse pregnancy outcomes: miscarriages, stillbirths, births of children with malformations. Women with this history should be screened before pregnancy.

+IgG, -IgM – infection, remission. It has been established that the presence of specific IgG antibodies to HSV, as in CMVI, in the patient's blood indicates infection rather than protection from infection. This situation does not pose an immediate danger to the fetus, but since a state of physiological immunodeficiency develops during pregnancy, both seropositive and seronegative women should be included in the risk group (primary infection and exacerbation of BBVI are also possible). If necessary, both spouses are examined.

For a healthy person, cytomegalovirus is not too dangerous, but under certain circumstances it can lead to serious complications. Testing for cytomegalovirus is especially relevant for women who are carrying a child and planning a pregnancy, for children who have just been born, those who have acquired or have congenital and artificial immunodeficiency. The sooner the examination is carried out, the more effective the therapy will be, therefore, tests should be taken immediately when the first suspicions of this disease appear.

Features of the pathogen

First, let's look at what cytomegalovirus is. It belongs to the family of herpes viruses, which also includes chicken pox, the causative agent of Epstein-Bahr mononucleosis, herpes simplex type I and II. The name is justified by the specific changes that cells undergo under the influence of the pathogen - their size increases markedly.

After infection, the virus can penetrate into almost all body fluids, so urine, blood, vaginal secretions and other materials are tested to detect it. Having penetrated into the human body, this pathogen most often remains there forever, today cytomegalovirus is found in adolescents in about 15% of cases, in the adult population in 40%. One of the dangers of the virus is the difficulty of its detection:

• The duration of the incubation period is up to two months, during which time there may be no symptoms.
• Under the influence of a stressful situation, severe hypothermia, or against the background of a decrease in immunity, a sharp outbreak occurs, while the disease is mistaken for SARS or acute respiratory infections. Considering that the disease has similar symptoms - the temperature rises, general weakness and headache are observed.
• If it is impossible to timely recognize the pathology, pneumonia, encephalitis or arthritis, and other pathologies develop.

How does infection occur and who is shown the analysis

The routes of infection are quite diverse - in adults, the excitation can be transmitted through sexual intercourse, in newborns during the mother's labor activity or during lactation, the older one manifests itself after communicating with infected peers, penetrating into the body with saliva. Despite the fact that pathology can be detected in a child, in 50% of cases people who are 35 years of age or older suffer.

Considering all of the above, it is possible to distinguish certain categories among the population for whom the analysis for cytomegalovirus is indicated in the first place:

• Women who are carrying a child and those representatives of the weaker sex who are undergoing pre-gravid preparation (a set of measures aimed at a full conception, pregnancy and the birth of a healthy baby).
• Newborn babies.
• Children who often have SARS.
• Patients who have immunodeficiency, both congenital and acquired, including HIV.
• Patients of all ages with malignant neoplasms.
• Patients taking cytotoxic drugs.
• affected with clinical symptoms cytomegalovirus.

For women planning to conceive or already those who are registered in the early stages of pregnancy, an analysis for cytomegalovirus is done immediately upon visiting a medical facility. In this case, it is necessary to conduct an analysis for antibodies to cytomegalovirus, which helps to identify their number and determine whether the woman has had this virus before, and whether there is immunity to the pathogen.

If the analysis for cytomegalovirus shows the presence of Anti-CMV IgG antibodies, the danger to the fetus is minimized - the expectant mother has already had a pathology and has developed protection that will also protect the baby. In the absence of immunoglobulins, a virus test will have to be taken more than once during pregnancy, since the body is not prepared to resist infection.

In infants who have just been born, a blood test for cytomegalovirus or a urine test is performed if, when observing a pregnant woman, there is a suspicion of the possibility of a congenital infection or a pathology acquired during childbirth. Diagnosis is carried out in the first 24-48 hours after the birth of the child.

In the presence of immunodeficiency, the test is carried out immediately after its detection. This approach will make it possible to correct the therapeutic course and supplement the regimen with the necessary antiviral drugs, while avoiding a possible relapse or preparing for a possible primary infection.

An analysis for CMV is also necessary when preparing a patient for immunosuppression during organ or tissue transplantation, while the study is prescribed before the start of the procedure.

Types of research and delivery rules

In the presence of normal immunity, it is more than realistic to become infected with a virus and not have a clue about it. The immune system will successfully keep the cytomegalovirus in a suppressed state, and even if pathology develops, the symptoms will be completely absent. If a person’s immunity is absent or weakened, which is especially noticeable in HIV-infected people or in patients with oncological neoplasms, cytomegalovirus can provoke the development of severe pathologies. There is damage to the eyes and lungs, brain, digestive system, the result of complications is often fatal.

To determine the presence of pathology, it is necessary to check the blood for antibodies, while there may be several types of analysis, but the most reliable is an enzyme immunoassay. ELISA allows you to determine the amount and properties of specific Anti-CMV, and the results of decoding a blood test for cytomegalovirus serve as the basis for a conclusion regarding not only the presence of an infection carrier, but also the presence of immunity. In addition, this method is one of the fastest, most accurate and most affordable.

Diagnosis of the presence of pathology will help conduct other studies, among them:

• polymerase chain reaction, which makes it possible to detect virus DNA;
• urine cystoscopy, during which damaged cells are observed;
• cultural method, which consists in growing the virus on nutrient media.

In the human body, there are various types of immunoglobulins, but if we consider cytomegalovirus, IgM, IgG are effective. The first type is developed initial stage infection, ensuring the suppression of the primary infection. The second type is generated later and is designed to protect the body from cytomegalovirus throughout the subsequent life of the victim.

An important fact. The first IgG formed as a response to infection are very weakly associated with viral particles, in this case they speak of their low avidity. After about 14 days, the production of highly avid IgG begins, which are sufficiently effective and are able to easily recognize and bind virions.

Determination of avidity is necessary to establish the duration of infection. At the same time, the concept of “norm” for IgG as such is absent - if a virus is detected during a blood test, regardless of its amount, the pathology is obvious. Now about what properties serological markers IgM and IgG have, we will consider them along with avidity IgG in more detail, for which there is a pivot table:

Immunoglobulins	Description
IgM	Formed first after 5 or 7 days as a response to reactivation or the introduction of the pathogen. Allows identification of primary infection acute stage or exacerbation of chronic pathology. Anti-CMV IgM can show a false positive result against the background of a reaction with other herpes viruses. In the case of a primary infection, antibodies can be detected for about three months. If this is a reactivation, the period is from two to three days to weeks. In newborns, against the background of the characteristics of the immune system, the production of these antibodies may be absent even in case of infection, therefore, an additional PCR analysis may be required that examines various biofluids.
IgG	Anti-CMV IgG are formed two or three weeks after infection, remaining thereafter throughout life, while their level does not allow to determine the activity of the process. An increase in the number of these antibodies indicates the activity of pathogenic processes and requires the development of management tactics. Testing is carried out in the presence of positive IgM in order to exclude the possibility of a false positive result. Also, the test is required to be carried out with negative IgM in order to be able to confirm the absence of reactivation of the infection.
Avidity IgG	Allows you to determine the duration of infection - after the initial infection, low avid antibodies are observed from three to four months, after which they are replaced by highly avid antibodies. In the presence of low avid IgG, they speak of primary infection, which lasts for the last three to four months. In the presence of highly avid IgG, infection is said to have taken place three to four months prior to the examination. This indicator is especially relevant when conducting a survey of pregnant women, if its presence was not checked before conception.

As for molecular diagnostic methods, they are classified as direct: they allow you to determine the presence of a pathogen in the studied materials. At the same time, the selection of biological material is carried out taking into account the development of the stages of the pathological process, its clinical manifestations and the goals of conducting laboratory research.

Most often, blood is used for research, but it should be taken into account that the pathogen is not always in it, respectively, with negative indicators, the infection may well be present in the body. Additional tests will be required to confirm.

Now about how to take the analysis. The test for cytomegalovirus is no different from conventional blood tests taken from a vein. In some cases, an examination of urine, saliva or amniotic fluid is required. None of the tests require any specific preparation, except that the blood is expected to be taken on an empty stomach. After the analysis is passed, and the results are received, they are deciphered by qualified specialists.

How the results are decoded

The decoding of the analysis in the form is the titer of IgG antibodies. As we mentioned above, the norm for this indicator is not provided - it can fluctuate against the background:

• the state of the immune system;
• the presence of chronic pathologies;
• general condition of the body;
• habitual way of life.

It should be borne in mind that IgG is generated not only during infection, but also during periods of exacerbation, and it also remains in the body after a pathology. For these reasons, cytomegalovirus test results can be questionable, and biomaterial studies are often repeated.

Modern laboratories have numerous systems that allow the detection of antibodies to cytomegalovirus. Their sensitivity is different, as well as the composition of the components. But there is a common feature - they are all designed to conduct enzyme immunoassay. In this case, there are also no established norms.

The interpretation of the ELISA results is based on the level of staining of the liquid to which the studied biomaterials are added. The resulting color is compared with pre-prepared samples, both positive and negative.

For faster decoding, laboratory assistants use a test system using the prescribed blood dilution, which allows to slightly reduce the period for obtaining results. Any medical Center uses its own titers for diagnosis, using reference indicators that give either a negative or a positive result.

The results of the analysis indicate the average indicators - the final value is 0.9, if the norm is defined as 0.4. In this case, the degree of staining of the sample, in which there are no antibodies to the virus, is taken as the norm. Here is an example decryption table:

Even in the case when antibodies to cytomegalovirus were detected earlier, additional diagnostic methods can be used by a specialist to clarify the diagnosis.

Separate consideration requires the results of analyzes of women bearing a child. Let's talk about deciphering the indicators in the presence of pregnancy, in this case, the period at which the biomaterial was taken is of great importance:

• Even if favorable results are obtained later than the fourth week of bearing a child, an additional examination will be required, since the data cannot be considered absolutely unambiguous. Infection could affect the body both 12 months ago and at the beginning of pregnancy, which is fraught with damage to the fetus.
• It should be borne in mind that an excessively elevated IgG titer in most cases indicates the body's persistent fight against infection, without being a confirmation of danger.
• In cases where a woman carrying a child is found in the blood of IgM along with low-avid IgG, special treatment should be developed and subsequently carefully monitor how the fetus develops.

In the absence of antibodies specific to the virus, a pregnant woman needs to be more careful and check the presence or absence of cytomegalovirus more than once during the months of bearing a child.

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