Volume 02 Issue 09-2022
12
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
02
I
SSUE
09
Pages:
12-16
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
OCLC
–
1121105677
METADATA
IF
–
5.654
Publisher:
Oscar Publishing Services
Servi
ABSTRACT
The work is based on the features of clinical manifestations of acute primary and reactivated forms of CMVI in children
aged 1 to 3 years, observed on an outpatient basis. The main group and the comparison group included patients who
applied for an appointment with an infectious disease doctor with symptoms of acute respiratory infection in the
period 2021 to 2022 at the Bukhara Regional Infectious Diseases Hospital.
With primary CMV infection, the acute period of the disease in young children proceeds according to the type of
mononucleosis, the clinical picture of the reactivated form is nonspecific, accompanied by a prolonged fever with
lymphadenopathy. Indirect laboratory markers of active CMVI are: neutropenia (46.1%), hypoimmunoglobulinemia A
(49.0%) and G (51.0%).
KEYWORDS
Cytomegalovirus infection, children, active primary cytomegalovirus infection and reactivated cytomegalovirus
infection.
INTRODUCTION
Cytomegalovirus infection (CMVI) is one of the most
common causes of congenital viral infections and can
cause severe pathologies, up to the death of a child
[2,4]. According to domestic and foreign experts, from
0.5 to 5% of children are born with congenital CMVI, of
which about 90% of children are asymptomatic carriers
Research Article
FEATURES OF CLINICAL MANIFESTATIONS OF CYTOMEGALOVIRUS
INFECTION IN CHILDREN
Submission Date:
September 10, 2022,
Accepted Date:
September 20, 2022,
Published Date:
September 30, 2022
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume02Issue09-04
Jalilova A.S.
Bukhara State Medical Institute, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 02 Issue 09-2022
13
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
02
I
SSUE
09
Pages:
12-16
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
OCLC
–
1121105677
METADATA
IF
–
5.654
Publisher:
Oscar Publishing Services
Servi
[1,6]. At the same time, the subclinical form of CMVI
does not mean a guarantee of well-being in the future
in 5-15% of such children in the next 1-2 years and at a
later date, violations of the central nervous system,
hearing organs, vision, cerebral palsy, mental
retardation, poor school performance are recorded
[3,7].
Diagnosis of CMVI in newborns is often a difficult task
due to the absence of typical symptoms and signs of
CMVI, as well as due to the peculiarities of the immune
system of newborns, premature newborns represent a
high risk group for the development of CMVI, since it is
known that the incidence in such children is increased
compared to full-term newborns [5,9,11]. Despite
numerous studies devoted to this problem, the
development of adequate therapeutic tactics for the
treatment of newborns with CMVI remains an
unsolved task. The importance of solving the problem
of timely detection of congenital and perinatal CMVI is
also explained by the fact that CMVI is often the cause
of death of children in the second half of life [8,10,12].
The purpose of the work.
To study the features of
clinical manifestations of acute primary and
reactivated forms of CMVI in children aged 1 to 3 years,
observed on an outpatient basis.
MATERIALS AND METHODS
The main group and the comparison group included
patients who applied for an appointment with an
infectious disease doctor with symptoms of acute
respiratory infection in the period 2021 to 2022 at the
Bukhara Regional Infectious Diseases Hospital. The
group of conditionally healthy patients included
patients who visited a pediatrician for examination
before routine vaccination. The examination of the
children was carried out after the signing of a voluntary
informed consent by the parents (or other legal
representatives).
To identify a group of patients with active primary and
reactivated CMV infection, 110 children were examined,
referred to a pediatrician with acute respiratory
infection, examined for markers of herpes viral
infections (CMVI, HCV-6, EBV). Of 110 children with
symptoms of acute respiratory infection, 65 had
markers of CMV infection. To solve the problem, a
clinical and laboratory examination of children of the
main group (n=65) with active forms of CMVI was
carried out. The comparison group consisted of 43
children from the initially formed study group (110
patients with ARI symptoms).
THE RESULTS OF THE STUDY AND THEIR DISCUSSION
Among children with ARI (n=110), various CMV markers
were detected in 59% (65), and active CMV infection
was detected in 14% (16). Among clinically healthy CMVI
markers were detected in 71% (46) children, without
signs of activation. During serological examination,
anti-CMV IgG in the main group was determined in 51%
(33) cases, in the comparison group in 81% (35) cases,
among healthy children - in 83% (38) cases with
arithmetic mean values of the level of anti-IgG without
significant differences. Anti-CMV IgM was detected in
55% (36) of children only in the main group.
Laboratory, primary CMVI (PCR+ blood, Ig M=, IgG-)
was tolerated by 49% (32) children of the main group,
51% (33) patients were diagnosed with reactivation.
Primary CMVI was accompanied by a classic set of
symptoms of mononucleosis - fever for more than 7
days and intoxication in all patients, severe
lymphadenopathy, tonsillopharyngitis, moderate liver
enlargement.
Acute
febrile
disease
with
lymphadenopathy was noted in 51% (33) of the children
of the main group, in whom the stage of CMVI
Volume 02 Issue 09-2022
14
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
02
I
SSUE
09
Pages:
12-16
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
OCLC
–
1121105677
METADATA
IF
–
5.654
Publisher:
Oscar Publishing Services
Servi
reactivation was determined (PCR+ blood, IgM±, IgG+).
The clinical picture was nonspecific, localized
lymphadenopathy was noted in 75% (25) of children,
fever for more than 5 days in 65.0% (21),
tonsillopharyngitis in 30% of cases, hepatomegaly was
not noted. When studying the anamnestic data
between the children of the main group and the
comparison group, the differences concerned only the
structure of acute morbidity, namely recurrent otitis,
occurred in 23% (15) children of the main group and 5%
(2) of the comparison group, p=0.001. Significant
differences in clinical manifestations in the compared
groups were found in lymphadenopathy (91% vs. 16%),
rhinorrhea (23% vs. 74%), catarrhal pharyngitis (91% vs.
72%), grade 2-3 palatine tonsillitis (66% vs. 35%), tonsillar
plaque (23% vs. 0%) and hepatomegaly (14% vs. 0%).
Statistically significant differences in deviations of
laboratory parameters were established: neutropenia
was significantly 1.8 times more common in the main
group - 46% (30) versus 16% (7) in the comparison group
(p=0.002). Statistically significant differences were
also obtained for an isolated decrease in total IgA in the
blood in the main group: 49% (32) vs. 28% (12) in the
comparison group (p=0.02) and for a decrease in total
IgG in the blood: 51% (33) vs. 18.6% (8) (p=0.001). ALT
increase was registered only in acute CMVI in the form
of infectious mononucleosis (in the OG): 44% (14)
(p=0.001), always in combination with AST, and in the
comparison group, ALT and AST increases were not
registered in any case (Table №1).
Table № 1. Clinical symptoms and laboratory abnormalities in the main group and the comparison group
Signs
Main group (n= 65)
Comparison group (n= 43)
Abc.
%
Abc.
%
Fever
65
100
43
100
Lymphadenopathy
59
91
7
16
Sialoadenitis
4
6
0
0
Nasal congestion
51
78
36
84
Rhinorrhea
15
23
32
74
Cough
24
37
23
53
Catarrhal pharyngitis
59
91
31
72
GNM 2-3 ct
43
66
15
35
Plaque on the tonsils
15
23
0
0
Volume 02 Issue 09-2022
15
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
02
I
SSUE
09
Pages:
12-16
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
OCLC
–
1121105677
METADATA
IF
–
5.654
Publisher:
Oscar Publishing Services
Servi
Hepatomegaly
9
14
0
0
Leukopenia
19
29
6
14
Leukocytosis
23
35
8
18
Neutropenia
30
46
7
16
Neutrophilosis
13
20
6
14
Lymphocytosis
47
72
10
23
Monocytosis
41
63
16
37
Atypical mononuclears
18
28
0
0
Reduction of
immunoglobulin A
32
49
12
28
Reduction of
immunoglobulin G
33
51
8
18
Increasing ALT and AST
14
21
0
0
CONCLUSIONS
With primary CMV infection, the acute period of the
disease in young children proceeds according to the
type of mononucleosis, the clinical picture of the
reactivated form is nonspecific, accompanied by a
prolonged fever with lymphadenopathy. Indirect
laboratory markers of active CMVI are: neutropenia
(46.1%), hypoimmunoglobulinemia A (49.0%) and G
(51.0%).
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16
International Journal of Medical Sciences And Clinical Research
(ISSN
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2771-2265)
VOLUME
02
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09
Pages:
12-16
SJIF
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694
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5.
893
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OCLC
–
1121105677
METADATA
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5.654
Publisher:
Oscar Publishing Services
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