CC BY
3
SPECIFICITY OF CYTOMEGALОVIRUS INFECTION, THE IMPORTANCE OF ITS DIAGNOSIS AND TREATMENT METHODS Azizov Yu.D.1, Mirzakarimova D.B.2, Isanova D.T.3
1Azizov Yuriy Daliyevich - Doctor of Medical Sciences, Professor, Head of the Department, DEPARTMENT OF PHTHISIOLOGY, PULMONOLOGY, MICROBIOLOGY, IMMUNOLOGY AND VIROLOGY; 2Mirzakarimova Dildora Bahadirovna - Candidate of Medical Sciences, Associate Professor, Head of the Department,
DEPARTMENT OF INFECTIOUS DISEASES; 3Isanova Dilfuza Tursunovna - Candidate of Medical Sciences, Associate Professor, Head of the Department, DEPARTMENT OF PHTHISIOLOGY, PULMONOLOGY, MICROBIOLOGY, IMMUNOLOGY AND VIROLOGY,
ANDIJAN STATE MEDICAL INSTITUTE, ANDIJAN, REPUBLIC OF UZBEKISTAN
Abstract: in recent years, there has been a tendency towards an increase in the frequency of viral infections among pregnant women and an increase in their ability, under certain conditions, to epidemic spread. The decision of the WHO European Office to include cytomegalovirus infection (CMVI) in the group of diseases clearly demonstrates the increased role of CMVI in the development of a number of serious human diseases. Spontaneous miscarriages, premature births, stillbirths, congenital malformations, fetopathies, diseases of newborns and young children are associated with the participation of CMVI.
In acute CMVI, 30-40% of newborns become infected, 20-30% of them die. Of the surviving children, 90% are disabled and only 10% recover.
Keywords: human immunodeficiency virus, intrauterine infection, Ebstein-Barr virus, blood-brain barrier, deoxyribonucleic acid, iron deficiency anemia.
СПЕЦИФИКА ЦИТОМЕГАЛОВИРУСНОЙ ИНФЕКЦИИ, ЗНАЧЕНИЕ ЕЕ ДИАГНОСТИКИ И МЕТОДОВ ЛЕЧЕНИЯ Азизов Ю.Д.1, Мирзакаримова Д.Б.2, Исанова Д.Т.3
1 Азизов Юрий Далиевич - доктор медицинских наук, профессор, заведующий кафедрой, кафедра фтизиатрии, пульмонологии, микробиологии, иммунологии и вирусологии; 2Мирзакаримова Дильдора Бахадировна - кандидат медицинских наук, доцент, заведующая кафедрой,
кафедра инфекционных болезней; 3Исанова Дильфуза Турсуновна - кандидат медицинских наук, доцент, заведующая кафедрой, кафедра фтизиатрии, пульмонологии, микробиологии, иммунологии и вирусологии, Андижанский государственный медицинский институт, г. Андижан, Республика Узбекистан
Аннотация: в последние годы отмечена тенденция к увеличению среди беременных частоты вирусных инфекций и возросла их способность, при определённых условиях, к эпидемическому распространению. Решение Европейского бюро ВОЗ о включении цитомегаловирусной инфекции (ЦМВИ) в группу заболеваний наглядно демонстрирует возросшую роль ЦМВИ в развитии ряда серьёзных заболеваний человека. С участием ЦМВИ связывают самопроизвольные выкидыши, преждевременные роды, мертворождения, врожденные пороки развития, фетопатии, заболевания новорожденных и детей раннего возраста. При острой ЦМВИ заражается 30 - 40% новорожденных, 20 - 30% из них умирает. Из выживших детей инвалидизируется 90% и выздоравливает лишь 10%.
Ключевые слова: вирус иммунодефицита человека, внутриутробная инфекция, вирус Эбштейна-Барр, гематоэнцефальный барьер, дезоксирибонуклеиновая кислота, железодефицитная анемия.
UDC: 578.825.11+ 616-078
Relevance. Considering the widespread occurrence of CMVI and its probable pathogenicity, it is of particular importance to clarify the need for the use of antiviral and immunocorrective drugs. Due to the intracellular existence of cytomegalovirus infection, it is necessary to select the optimal drugs for treatment that could provide maximum efficiency and availability.
Treatment of CMV infection should be comprehensive, including immune and antiviral therapy. CMV leaves the periphery rather quickly and ceases to be secreted from biological fluids (blood, saliva, breast milk) - the latent phase of infection sets in, - well-performed immunotherapy activates the body's defense mechanisms that further control the activation of latent CMV infection.
Based on the foregoing, the development of criteria for the early diagnosis of infectious pathology and such methods of its treatment that would contribute to the elimination of viral particles from the body has become extremely urgent.
Purpose of the study. In connection with the above, the purpose of this study was to assess the clinical and immunological effectiveness of the pharmacological drug polyoxidonium in the complex therapy of patients with cytomegalovirus infection.
Materials and research methods. Clinical studies were carried out at the Department of Infectious Diseases of the Andijan State Medical Institute, Andi-Zhan Regional Infectious Diseases Hospital in the 4th department. The study included the collection of anamnesis: they clarified the past and present extragenital diseases, the nature and formation of menstrual function, the past diseases, the course of previous pregnancies, the course of pregnancy after pregravid therapy; general examination, study of the state of organs and systems, special external and internal gynecological and obstetric research; traditional clinical and laboratory examination: general analysis of blood, urine, group and Rh-affiliation, blood test for toxoplasmosis, brucellosis, syphilis, AIDS, Australian antigen. In addition, we studied the biochemical parameters in the peripheral blood: the level of total protein, urea, creatinine, sugar, bilirubin, liver enzymes.
These studies were entered into specially designed maps, and subsequently subjected to computer and statistical processing.
The prospective group consisted of 48 women with a burdened obstetric anamnesis aged 19 to 35 years, of which 33 (71.6%) had IgG antibodies to CMV (chronic form) and 15 (28.3%) - IgM - antibodies to CMV (acute form). The main group consisted of 35 women. The comparative group consisted of 33 women with CMVI. In the anamnesis, the examined patients had frequent acute respiratory diseases with complications, acute intestinal infectious diseases, spontaneous abortions, reverse fetal development, stillbirths, premature births and other obstetric pathologies.
All women with AAA who were admitted to the infectious diseases hospital were assigned a full comprehensive examination program (48 women).
Among the surveyed there were no women with severe extragenital, endocrine, autoimmune pathology, which in themselves could be the cause of obstetric pathology. Clinical examination of women included the study of general and obstetric status, laboratory tests were carried out, as well as specific research methods.
Specific research methods included determination of viral DNA in peripheral blood by polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA), blood avidity analysis, and dynamic ultrasound.
Research results. 1 patient of the main and 2 patients of the comparative group with CMVI had a history of low-grade fever without catarrhal phenomena in the nasopharynx for 2-3 days. 17 (74.2%) patients of the main group had papular-vesicular rashes on the skin of the cheeks, the open part of the chest, while in 13 (74.2%) patients of the control group, papular-vesicular rashes were found on the skin of the cheeks, the open part of the chest, although antibodies to herpes simplex virus in their blood serum were not detected
The study of the anamnesis showed that acute CMVI was hidden under the diagnosis of "respiratory" and "flulike" diseases. This assumption is confirmed by the fact that ARVI was 3 times less common in uninfected people than in acute and chronic forms of CMVI. In addition, 13 women with acute CMVI who underwent acute respiratory viral infections had a high titer of IgM to CMV, and 12 had an increase in antibody titer over time.
Thus, in women with CMVI, catarrhal and flu-like manifestations predominate. According to some authors, hyperthermia of unknown origin and papular-vesicular skin rashes in women are also specific manifestations of the cytomegalovirus process. The presence of these diseases and symptoms in combination with elements of a rash should be regarded as an acute form of CMVI.
Thus, in patients of the main group with CMVI, it is disguised as an acute respiratory viral infection (100%), acute bronchitis (80%), tonsillitis (51.4%), catarrhal phenomena of the upper respiratory tract (87.8%), pyelonephritis (82.8%). And in patients of the control group, CMVI is disguised as an acute respiratory viral infection (100%), acute bronchitis (81.8%), tonsillitis (51.5%), catarrhal symptoms of the upper respiratory tract (84.4%), pyelonephritis (84, eight %). Therefore, these patients must be screened for CMV - specific IgM antibodies, which will allow timely detection of the disease and adequate pathogenetic therapy.
Clinical assessment of the course of the process taking into account the form, obstetric-gynecological and general somatic diseases and associated risk factors was carried out in 48 women with CMVI. In the presence of extragenital diseases, CMVI proceeded more severely and for a longer period.
The age of pregnant women is from 19 to 35 years, on average 26.8 ± 0.3 years.
As can be seen from the figure, the number of women with acute and chronic forms of CMVI in different age groups was approximately the same.
According to the results of the analysis of anamnestic data, our women had a burden of obstetric-gynecological and extragenital diseases. So, of the general somatic diseases of the main group, 97.1% of women with CMVI were found to have IDA; in women in the control group, this indication was 93.9.
Output. 1. A plan for examining women with CMVI has been developed. An algorithm for pregravid therapy in women with cytomegaly has been developed.
2. Evaluated the effectiveness of the drug Polyoxidonium in the complex therapy of women with CMVI.
3. The developed scheme of complex pregravid treatment of CMVI with polyoxidonium reduces the frequency of the threat of termination of pregnancy by 2.7 times, gestosis by 3.5 times, intrauterine fetal growth retardation by 3.9 times, weakness of labor by 3.4 times, untimely rupture of amniotic fluid 3.7 times, bleeding 3 times, premature birth 2.2 times.
References / Список литературы
1. Abdullaeva S.D. The role of cytomegalovirus infection in IHD: scientific publication / S.D. Abdullaeva // Cardiology of Uzbekistan. Tashkent, 2013. Volume 28. №1-2K9 / 2013 / 1-2. P. 123-124.
2. Abdullaeva S.D. To the question of the participation of cytomegalovirus antibodies in the development of atherosclerosis in coronary artery disease: scientific publication / S.D. Abdullaeva, L.G. Bazhenov, V.R. Khaibullina // Journal of the theoretical conference of young scientists "Actual issues immunology, immunogenetics and interdisciplinary problems "(to the 22nd anniversary of the Independence of the Republic of Uzbekistan). P. 143 (Code P12013).
3. Abidov A.M. Cytomegalovirus infection in patients with inflammatory processes of the genitourinary organs / AM Abidov, NR Issamukhamedova // Dermatol News. And venerol. Tashkent, 2002. № 1. S. 14-16. Bibliography: 16 titles.
4. Agzamova Sh.A. Influence of cytomegalovirus on pregnancy outcome / Sh.A. Agzamova, S.Sh. Altybaeva, G.K. Koshymbetova // Bulletin of the doctor. Samarkand, 2009. Part II. № 3. P. 347-348. Bibliography: 5 titles.
5. Agzamova Sh.A. Study of cytokines, immunoglobulins in the blood of children with persistent cytomegalovirus infection (PCMVI): scientific publication / Sh.A. Agzamova // Journal of theoretical and clinical medicine. Tashkent, 2010. № 6. S. 78-79 (Code ®1 / 2010/6). Bibliography: 4 titles.
6. Agzamova Sh.A. Interrelation of ELISA markers of cytomegalovirus infection in mothers and newborns / Sh.A. Agzamova // Pediatrics of Uzbekistan: reforming and development strategy: collection of abstracts of the Republican scientific-practical conference (October 4-6, 2007, Tashkent city). Tashkent, 2-7. Volume 1. S. 4041.
7. Dilshodov A.D. Main stages and features of the development of multimedia lectures in physics., Physics in the system of modern education (FSSO-15), 217-219.
8. Aznabaeva M.T. Diagnosis and treatment of cytomegalovirus chorioretinitis: a review / M.T. Aznabaev, V.B. Malkhanov, G.K. Mambetkulova, L.Sh. Ishberdina // Bulletin of Ophthalmology. M., 2004. № 6. S. 41-43. Bibliography: 72 titles.
