Brief introduction of cytomegalovirus disease

Directory 1 Pinyin 2 English Reference 3 Overview 4 Disease Name 5 English Name 6 Cytomegalovirus Alias 7 Classification 8 ICD No.9 Epidemiology 9. 1 Infection Source 9.2 Transmission Route 9.3 Susceptible Population 10 Cytomegalovirus Etiology 1 Pathogenesis 12 Cytomegalovirus Clinic. 2. 1 neonatal cytomegalovirus infection 12.2 adult cytomegalovirus infection 12.4 complications of acquired infection 13 cytomegalovirus disease 14 laboratory examination/auxiliary examination of kloc-0/5/diagnosis of cytomegalovirus disease/kloc. 8 Treatment of cytomegalovirus disease 65436+09 Prognosis 20 Prevention of cytomegalovirus disease 2 1 Related drugs Accessories: 1 Related to cytomegalovirus disease.

2 English reference cytomegalovirus disease

Overview Cytomegalovirus (CMV) infection has attracted more and more attention. Because the infected cells are giant cells with inclusion bodies in cytoplasm and nucleus, it is also called giant cell inclusion disease (CID). After infection, the virus can be confined to salivary glands, while others cause systemic infection. Cytomegalovirus (CMV) infection is mostly subclinical, while dominant infection has various clinical manifestations and can be fatal in severe cases. Because cytomegalovirus can cause stillbirth, abortion, premature delivery and congenital malformation through intrauterine infection, the prevention and treatment of cytomegalovirus disease affects eugenics and population quality. People are generally susceptible, and the younger they are, the higher their susceptibility and the heavier their clinical manifestations.

4 disease name cytomegalovirus disease

5 English name cytomegalovirus disease

Cytomegalovirus is also known as cytomegalovirus inclusion disease; ; Cytomegalovirus; Cytomegalovirus infection; Giant cell inclusion body disease; Giant cell inclusion body disease; Cytomegalovirus infection; Giant cell inclusion body disease; Cell hypertrophy inclusion body disease

7 classification 1. Dermatology >; Viral dermatosis > herpetic dermatosis

2. Infectious Diseases Department >; Viral infection

8 ICD B25

9 Epidemiology 9. 1 Cytomegalovirus (CMV) exists in blood, saliva, urine, cervical secretions, milk, * * *, tears and feces of asymptomatic carriers or patients, and can be detoxified intermittently or for a long time for months or years, becoming the source of infection of this disease.

9.2 Transmission route Vertical transmission from mother to child is an important route of cytomegalovirus infection. The virus is transmitted to perinatal newborns through pregnant women, breastfeeding, droplets or close contact, or directly through the placenta, and the infection rate is about 10%.

Horizontal transmission infected with cytomegalovirus (CMV) mainly occurs through close contact with patients, and may also spread through * * * *, so it is listed as a sexually transmitted disease by the World Health Organization. The virus can exist in epithelial cells, vascular endothelial cells and white blood cells of patients' organs; Therefore, organ transplantation and transfusion of contaminated blood products are also one of the ways of infection.

9.3 Susceptible people are generally susceptible. The younger the age, the higher the susceptibility and the heavier the clinical manifestations. Most older children and adults are recessive infections. The detection rate of serum cytomegalovirus antibody in the population increases with age, and 20% ~ 50% of women of childbearing age are positive, and most adults over 60 are positive. The positive rate of cytomegalovirus antibody in children living in low-income and crowded areas can almost reach 100%.

After cytomegalovirus (CMV) infection, most people can produce antibodies and persist, but it only has incomplete immune protection. Therefore, people with positive serum antibodies may still have latent infection, which is a long-term poisoning state and can be activated under certain circumstances; Even suffer from secondary infection.

Cytomegalovirus (CMV), the cause of 10 cytomegalovirus disease, belongs to β subfamily of human herpesviridae and has obvious host species specificity. It is the largest and most complicated virus in human herpesviridae. Cytomegalovirus (CMV) is spherical, with a diameter of about 300nm, and is surrounded by a double-layer lipid glycoprotein outer membrane. Its genome is a 230kb linear double-stranded DNA molecule, which contains about 200 coding genes of protein. Cytomegalovirus (CMV) has poor resistance to the outside world. It can be inactivated by heating at 65℃ for 30 minutes, ultraviolet irradiation for 5 minutes, ether and other methods. , and it is not acid-resistant. Cytomegalovirus has only one serotype, and ADl69 is often used as the representative strain for serological detection.

1 1 Pathogenesis of cytomegalovirus Cytomegalovirus can widely exist in all organs and tissues of infected patients, and infection can directly damage infected host cells; In addition, it may also produce pathogenic effect through immunopathological mechanism.

Cytomegalovirus mainly invades epithelial cells The main organs of the whole body (lung, liver, brain, kidney, spleen, heart and intestine), glands (salivary glands, gonads) and nervous system can all be involved. Infected cells denature, increase in size and become giant cells, and then disintegrate, leading to local necrosis and inflammation. Granuloma and calcification can occur after brain tissue necrosis. The infected cells have the following characteristics after giant cell-like transformation: the cell volume increases obviously, reaching10 ~ 40μ m; The nucleus also becomes larger, but the cytoplasm is relatively less, and inclusion bodies can appear in both cytoplasm and nucleus. There are eosinophilic inclusions in the nucleus, which are red and surrounded by translucent halo. The halo is separated from the nuclear membrane and looks like an owl's eyes.

12 clinical manifestations of cytomegalovirus disease 12. 1 neonatal cytomegalovirus infection mainly comes from intrauterine infection, or contact infection during delivery or juice extraction, and most of them do not show symptoms. The weak infants with dysplasia show cytomegalovirus (CMV) mononucleosis syndrome, including macula, hepatosplenomegaly and lymphadenopathy, jaundice, intradermal hemorrhage, hemolytic anemia, chorioretinitis and different degrees of nervous system damage, such as hearing loss, microcephaly and optic atrophy. Long-term detoxification of children makes it an important source of cytomegalovirus (CMV) contact infection in the population.

12.2 adult cytomegalovirus infection mostly occurs in patients with immunodeficiency or immunosuppression, especially in patients with organ transplantation and immunosuppressant treatment, or patients with malignant tumors of hematopoietic system and lymphatic reticular system and multiple blood transfusions. 30-year-old women are the most susceptible to infection. The clinical manifestations are usually mononucleosis-like syndrome, such as persistent fever, hemogram changes of mononucleosis and abnormal liver function. Measles-like erythema can appear at the distal extremities of individual patients for several hours to several days. Cytomegalovirus (CMV) pneumonia is the main cause of death, with a mortality rate as high as 90%.

Cytomegalovirus (CMV) infection is one of the causes of morbidity and mortality of AIDS patients. CMV infection is ubiquitous in AIDS. CMV can activate HIV, and HIV is often accompanied by the reactivation of CMV. They interact, mainly involving the central nervous system, gastrointestinal tract and lungs, and often cause retinitis.

Intrauterine infection (12.3) is a cytomegalovirus (CMV) in pregnant women. It is one of the important ways of human cytomegalovirus infection to infect the fetus in the uterus through the placenta. 90% of the infected fetus is recessive infection, and only 10% is clinical infection, but sometimes the consequences are more serious, especially in the first 4 months of pregnancy, which is more likely to cause fetal damage. For example, some infected fetuses are stunted, underweight at birth, or have various forms of congenital malformations, such as microcephaly, limb malformation, congenital heart disease, strabismus, blindness, etc. Or have jaundice, hepatosplenomegaly, pneumonia, myocarditis, bleeding tendency, lethargy, coma, convulsions and other multi-system organ damage in a short time after birth, and may die within a few weeks.

Cytomegalovirus (CMV) intrauterine infection can also lead to stillbirth, abortion and premature delivery. In a group of 38 10 neonatal epidemiological surveys, the positive rate of anti-CMVIgM in umbilical cord blood samples was1.5%; The positive rate of anti-CMVIgM was as high as 32.5% in 40 cases of stillbirth and umbilical cord blood samples of this group.

12.4 Acquired cytomegalovirus infection is mostly recessive infection or mild symptoms, and a few patients have serious clinical manifestations. Neonatal patients with perinatal infection (some of whom may be infected in utero) may develop persistent pneumonia; Cytomegalovirus hepatitis can occur in children and adults (symptoms and signs are similar to general viral hepatitis). Some patients may have chills, fever, sore throat, headache, general aches, and abnormal lymphocytes in the blood, which can be as high as 10% ~ 20%. Its clinical manifestations are quite similar to infectious mononucleosis caused by EB virus infection, but the heterophilic agglutination test is negative, which can be used for differentiation. According to statistics, about 8% of patients with infectious mononucleosis are caused by cytomegalovirus (CMV) infection.

Cytomegalovirus (CMV) infection can lead to severe clinical manifestations in immunosuppressed patients. Cytomegalovirus infection is one of the main causes of serious complications after organ transplantation, such as hepatitis, ulcerative gastroenteritis and pneumonia. Some may lead to postoperative death or forced removal of transplanted organs. Cytomegalovirus (CMV) infection in these patients mainly comes from donors (both donor organs and a large number of blood transfusions needed for transplantation may have latent CMV infection), but it may also be because the original latent CMV infection of patients is activated, but the latter may be milder than the former. Human cytomegalovirus disease is also common among HIV (human immunodeficiency virus) infected people. After HIV infection becomes AIDS patients, it is easy to form systemic disseminated cytomegalovirus (CMV) infection, which is an important cause of death of AIDS patients.

Cytomegalovirus intrauterine infection is a complication of 13 cytomegalovirus disease, which is an important cause of abortion and congenital disability. About 5% ~ 10% of newborns with intrauterine infection who have normal appearance at birth will have different degrees of physical or mental development disorders such as deafness, mental retardation, abnormal behavior and dyskinesia within a few years after birth. In view of toxoplasmosis ("T"), other pathogens ("O"), rubella virus ("R"), cytomegalovirus ("C") and herpes simplex virus ("H").

In addition, studies have shown that cytomegalovirus (CMV) infection may cause cancer and may be one of the causes of coronary artery stenosis.

14 patients with severe cytomegalovirus disease may have leukocytosis and abnormal lymphocytes in their blood; Infants and young children are often accompanied by anemia and thrombocytopenia; Abnormal liver function in patients with cytomegalovirus (CMV) hepatitis with liver involvement.

Detection of cytomegalovirus (CMV) gene by PCR can provide direct evidence for the existence of CMV in patients. It is highly sensitive and can make a test report within a few hours. It has become an important means for clinical diagnosis of cytomegalovirus (CMV) infection or virus-carrying status. However, it should be carried out in an experimental medical laboratory that has passed the technical certification. During the operation, attention should be paid to avoiding pollution and strictly controlling the reaction conditions to eliminate the false positive reaction that may be caused by PCR technology.

Cytomegalovirus disease can be diagnosed by collecting urine, saliva, blood or biopsy samples from patients, inoculating human diploid fibroblasts for in vitro culture and virus isolation. However, the growth of cytomegalovirus is slow, and the pathological changes of cultured cells can only be observed 4 ~ 6 weeks after inoculation, so it is still difficult to popularize and apply it in clinic.

Cytosmear or biopsy pathological examination can find characteristic giant cell-like degeneration cells and eosinophilic inclusions in the nucleus, which is helpful for the diagnosis of cytomegalovirus disease, but the detection rate is not high and can not be used as a diagnostic basis. If CMV antigen is detected by immunohistochemical technique, the positive detection rate can be improved and the diagnosis can be made accordingly.

15 can be used for virus identification in auxiliary examination.

Diagnosis of cytomegalovirus disease 16 Neonates and infants with interstitial pneumonia, or infants with mononucleosis and lymphocytic abnormal hepatitis, especially newborns with congenital malformation, should consider cytomegalovirus disease. Cytomegalovirus (CMV) should also be considered in adults with increased monocytes, abnormal lymphocytes, fever, rash and hepatosplenomegaly after blood transfusion, organ transplantation or immunosuppressive therapy.

Positive anti-CMV IGM in peripheral blood indicates that there is cytomegalovirus (CMV) infection recently, which can be used to diagnose infant cytomegalovirus disease. Because the IgM antibody in maternal peripheral blood can't pass through the placental barrier, if the anti-CMV IgM test in neonatal umbilical cord blood is positive, the intrauterine infection of CMV can be diagnosed (attention should be paid to avoid maternal blood pollution when collecting umbilical cord blood samples). Infants whose peripheral blood is only positive for monoclonal antibody CMV IgG should be followed up for 6 ~ 12 months to see if their titers are significantly increased. Due to the high detection rate of cytomegalovirus antibody in adult population, the significance of detecting cytomegalovirus antibody in the diagnosis of cytomegalovirus disease in adult patients is limited.

Detection of cytomegalovirus gene in patient samples by PCR is helpful for the diagnosis of cytomegalovirus disease. Cytomegalovirus (CMV) can be detected in urine or saliva samples of newborns as early as the first three weeks after birth, which provides evidence for intrauterine infection of CMV.

In recent years, it has been reported that quantitative detection of serum cytomegalovirus (CMV) antigen titers of renal transplant positive donors and recipients with high sensitivity kit is helpful to decide whether to carry out antiviral treatment.

17 heteroagglutination test is negative, which is used for differential diagnosis of cytomegalovirus disease and can be distinguished from infectious mononucleosis caused by EB virus. The way of differential diagnosis should be different from viral hepatitis and hepatomegaly and jaundice caused by other reasons. Patients with congenital malformation or so-called "TORCH syndrome", such as stillbirth, abortion and premature delivery, should be distinguished from other causes of this kind of disease, namely toxoplasmosis, rubella virus infection, herpes simplex virus infection and other possible pathogen infections (such as Treponema pallidum).

The curative effect of 18 on cytomegalovirus disease is 85% higher than that of acyclovir. Clinically, ganciclovir and foscarnet sodium have been proved to be effective in treating CMV infection in allograft recipients and AIDS patients.

So far, there are no satisfactory antiviral drugs for the treatment of cytomegalovirus diseases. Acyclovir is ineffective for this disease. Ganciclovir and foscarnet sodium are two antiviral drugs for cytomegalovirus infection. They have been used to treat AIDS patients, patients complicated with CMV infection after organ transplantation, or preventive drugs after organ transplantation, but the effect after clinical use is not satisfactory.

Ganciclovir is a derivative of acyclovir, which can inhibit the synthesis of cytomegalovirus DNA in laboratory. The clinical trial dose of patients with cytomegalovirus disease is: ganciclovir 2.5mg/kg body weight, 1 time /8h, or 5mg/kg body weight, 1 time/12h, * * * 2 ~ 3 weeks. After preliminary observation, this drug has a certain short-term effect, but after stopping the drug, the virus can replicate actively, so it needs to be maintained for several months or even years. Because this drug has certain toxicity, such as reducing the number of white blood cells and platelets, it is often difficult to persist in long-term use. People who are allergic to acyclovir are also prohibited from using this drug. In addition, some cytomegalovirus (CMV) strains were found to be resistant to ganciclovir in different degrees. Moreover, this medicine is ineffective for cytomegalovirus pneumonia.

Sodium ammonium phosphate can inhibit both cytomegalovirus DNA polymerase and HIV reverse transcriptase, so it is clinically used to treat patients with cytomegalovirus and HIV co-infection.

19 prognosis Most adult or child cytomegalovirus (CMV) patients have a good prognosis after clinical infection. Cytomegalovirus infection can lead to serious clinical manifestations or accelerate the death of immunosuppressed patients, such as organ transplant recipients, AIDS patients and advanced cancer patients receiving chemotherapy or radiotherapy. Cytomegalovirus (CMV) intrauterine infection can lead to abortion or stillbirth.

Prevention of cytomegalovirus disease It is necessary to strengthen perinatal medical care for pregnant women with positive antibodies to cytomegalovirus (CMV). If necessary, amniotic fluid should be taken for cytomegalovirus (CMV) antibody detection, and those who are positive (especially anti-CMV IgM positive) suggest that CMV intrauterine infection has occurred. According to the survey, the probability of intrauterine infection of fetal cytomegalovirus (CMV) in such women is reduced after the second pregnancy, so we can discuss with the patient's couple whether to consider induced abortion in this pregnancy. In particular, this intrauterine infection may occur in the first four months of pregnancy, and this pregnancy is the first time for this woman to conceive, and there is a high risk of cytomegalovirus (CMV) intrauterine infection. Induced abortion may be beneficial to prenatal and postpartum health care. However, if the patient and his wife are difficult to conceive for some reason, and this pregnancy is a treasure, they can't make a hasty decision, and they can make a decision through fetal B-ultrasound.

Strengthening the screening measures for cytomegalovirus diseases of organ transplant donors (including bone marrow transplantation), including the screening of cytomegalovirus diseases used as blood sources in organ transplant operations, is helpful to prevent the onset or latent infection of cytomegalovirus diseases and improve the success rate of organ transplant operations.

A vaccine to prevent cytomegalovirus disease has been developed and is still under observation and trial.

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