Antibody positive / negative were found to cytomegalovirus igg / igm. What does this mean rate of the baby, women, men, pregnant

Cytomegalovirus (CMV abbreviated or CMV) - is the causative agent of infectious disease, belonging to the family of herpes viruses. Once once in the human body, it stays there forever. The antibodies produced by the immune system in response to penetration of the virus are the primary diagnostic for detecting infection.

What IgG antibody and cytomegalovirus

CMV infection may occur as symptoms, and with multiple lesions of internal organs and systems. In damaged tissues normal cells are transformed into giant, for which the disease gets its name (salivary gland disease: from the Greek. cytos - «cell», megalos - «big»).

In the active stage of development of cytomegalovirus infections cause significant changes in immunity:

• violation of macrophage function, destroying bacteria and viruses;
• suppression of interleukin regulating the activity of immune cells;
• inhibition of IFN synthesis, providing antiviral immunity.

Antibodies to CMV determined using laboratory techniques are the main markers CMV. Their detection in serum allows you to diagnose the disease early, and control the disease.

Species of antibodies to CMV and their features

When ingested foreign body response occurs by the immune system. Produced specific proteins - Antibodies that promote protective inflammatory reactions.

The following types of antibodies to CMV, which differ in structure and role in the formation of immunity:

• IgAWhose main function is to protect the mucous membranes from infections. They are contained in saliva, tear fluid, breast milk, and are also available on the gastrointestinal mucosa, respiratory tract and urinary tract. Antibodies of this type are associated with microbes and prevent their attachment and penetration of the body through the epithelium. Immunoglobulins circulating in the blood, provide local immunity. Their lifetime is only a few days, so they must be periodic study.
• IgGConstituting the bulk of the antibodies in human serum. They can be transmitted from a pregnant woman to the fetus through the placenta, allowing the formation of his passive immunity.
• IgM, Which are the most close view antibodies. They arise when the primary infection in response to the penetration of previously unknown foreign substances. Their main function is to receptor - transmission of the signal inside the cell when attached to an antibody molecule specific chemical.

The ratio of IgG and IgM antibodies can be detected in what stage the disease - acute (primary infection), latent (hidden) or active (reactivation of the "dormant" infection in her carrier).

If infection has occurred for the first time, the number of IgM antibodies, IgA and IgG increases rapidly during the first 2-3 weeks.

The second month from the beginning of their infection levels begin to decline. IgM and IgA can be detected in the body for 6-12 weeks. These types of antibodies are considered not only for the diagnosis of CMV, but also for detection of other infections.

antibodies igg

IgG antibodies are produced by the body at a late stage, sometimes only 1 month after infection, but they persist throughout life, providing lifelong immunity. If there is a risk of re-infection with a different strain of the virus, their production increases dramatically.

Upon contact with the same culture microorganisms formation of protective immunity occurs within a shorter period of time - up to 1-2 weeks. A feature of CMV infection is that the pathogen can avoid the action of immune forces by creating other varieties of the virus. Therefore, modified microbial contamination occurs as during the initial contact.

However, in the human body produced by group-specific immunoglobulins that hinder their active reproduction. Antibodies to the class G cytomegalovirus often identified among the urban population. This is due to the high concentration of people in small areas and weaker immune systems than that of rural residents.

In families with low living standards of CMV infection among children is noted in 40-60% of cases, even before they reach 5 years, and to adulthood antibodies are detected already at 80%.

antibodies igm

IgM antibodies act as a first line of defense. Immediately after the introduction of microorganisms into the body, their concentration increases dramatically, and its peak is observed in the range of from 1 to 4 weeks. Therefore, they are a marker of recent infection, or acute stage flow CMV infection. In the serum, they are stored up to 20 weeks, in rare cases - up to 3 months or more.

The latter phenomenon has been observed in patients with impaired immunity. Reduced IgM levels in the coming months means that even if the treatment is not carried out. However, their absence is not a sufficient basis for a negative result, since infection can occur in a chronic form. When reactivation they also occur, but in smaller numbers.

IgA

IgA antibodies are detected in blood in 1-2 weeks after infection. If untreated, and it is effective, their level decreases after 2-4 months. Repeated infection with CMV also increases their level. Stable high concentration of antibodies of this class is an indication of the chronic form of the disease.

In people with weakened immune IgM is not formed even in the acute phase of phase. For these patients, and also for those who are organ transplantation, positive for IgA assay was carried out it helps to recognize the form of the disease.

avidity antibodies

Under avidity understand the ability of antibodies to bind to viruses. In the initial period of illness is minimal, but gradually increases and reaches a maximum at 2-3 week. During the immune response immunoglobulins evolve, their binding efficiency is increased, and thus there is a "clearance" of microorganisms.

Laboratory diagnosis of this parameter is performed for estimating the time of infection. So, for an acute infection characterized by identification of IgM and IgG antibodies with low avidity. Over time, they become vysokoavidnymi. Low avidity antibodies disappear from the blood in 1-5 months (in rare cases - for longer) and vysokoavidnye remain until the end of life.

Such research is important in the diagnosis of pregnant women. For this category of patients is characterized by frequent false-positive results. If the blood at the same time will be found vysokoavidnye antibodies of IgG, it would eliminate the acute primary infection, the danger to the fetus.

The degree of avidity is dependent on the concentration of viruses, as well as on individual differences of mutations at the molecular level. In the elderly antibody evolution is slower, so after 60 years of reduced resistance to infection and the effect of vaccination.

Norms of blood CMV

The numerical value of the "normal" of antibodies in biological fluids does not exist.

The concept of counting IgG and other types of immunoglobulin has its own characteristics:

• Antibody concentration is determined by titration. Serum was diluted gradually with the specified solvent (1: 2, 1: 6 and other concentrations, two fold). The result is considered positive if the titration is stored reaction to the presence of the test substance. a positive result is detected at a dilution of 1 for cytomegalovirus infections: 100 (threshold titer).
• Titers are the individual response of the organism which depends on the overall state, lifestyle, immune activity and metabolism, age, presence of other pathologies.
• Captions give an idea of ​​the total activity of the antibodies of class A, G, M.
• Each laboratory may use their test systems for the detection of antibodies to a particular sensitivity, so they We must produce already the final interpretation of the results, which are listed in reference (boundary) values ​​and units measurement.

Avidity is estimated as follows (unit -%):

• <30% – low avidity antibody, primary infection which occurred about 3 months ago;
• 30-50% – not possible to accurately determine the result, the analysis should be repeated after 2 weeks;
• >50% – high avidity antibodies, the infection occurred a long time.

adults

Explanation of results for all patient groups produced by the method indicated in the table below.

Table:

Meaning IgG	Meaning IgM	Interpretation
positive	positive	Secondary reinfection. It is necessary to carry out treatment
negative	positive	Primary infection. require treatment
positive	negative	Formed immunity. A person is a carrier of the virus. Worsening of the disease is possible with lowered immunity
negative	negative	No immunity. CMV infection was not. There is a risk of primary infection

Antibodies to cytomegalovirus can be at a low level for several years, while the number of re-infection with other strains of IgG increases rapidly. For accurate diagnostic pattern IgM and IgG levels determined simultaneously, and repeated analysis performed after 2 weeks.

children

The children in the neonatal period and breastfeeding IgG may be present in the blood, they have received from the mother in utero. Their level of a few months begins to decline gradually due to the lack of a permanent source. IgM antibodies often give false-positive or false-negative result. In connection with this diagnosis at this age causes difficulties.

Given the overall clinical picture, immunoassays are interpreted as follows:

• A high level of IgG - aggravation. IgM in the absence of disease severity assessed by IgG concentration. It is recommended additional testing by PCR, which is more accurately detects the presence of the virus. If the DNA of microorganisms will not be found, the child can receive antibodies from the mother. True infection has occurred. Research also need to be repeated in a year - if antibodies are found, the result is interpreted as positive.
  
• Low and average IgG - remission. If it is found in infants at risk, then it indicates a bad state of passive immunity and increases the likelihood of bacterial complications.

Repeated testing allows to determine the time of infection:

• after birth - increasing titer;
• intrauterine - a constant level

during pregnancy

Diagnosis of CMV in pregnant women is carried out on the same principle. If I trimester found that IgG positive, and IgM - negative, it is necessary to pass the PCR analysis to confirm the absence of infection reactivation. In this case, the fetus will receive maternal antibodies that will protect him from the disease.

Doctor prenatal must issue directions to control IgG titre also during trimesters II and III.

If for a period of 12-16 weeks revealed a low avidity index, the infection may have occurred before the onset of pregnancy, the fetus and the probability of infection is almost 100%. At 20-23 week, this risk is reduced to 60%. Determining the time of infection during pregnancy plays an important, since transmission of the virus to the fetus leads to severe pathologies.

Who and why prescribed test for antibodies to CMV

The analysis showed those persons who are included in the development of risk of infection:

• pregnant women (mandatory screening);
  
• preterm infants;
• patients who had a blood transfusion was done;
• patients who have found Oncology, blood diseases, AIDS, HIV, immunodeficiency states of various natures;
• medical workers.

In healthy people with strong immune primary infection is often asymptomatic and without complications. But CMV in the active form is dangerous in immunodeficiency, and pregnancy, as it causes numerous complications. Therefore, doctors recommend to undergo medical examination before the planned conception.

Methods for virus detection and decoding of the research results

All research methods for the determination of CMV can be divided into 2 groups:

• direct - by culture, cytology. Their principle consists in growing the virus culture or exploring the typical changes that occur in cells and tissues under the influence of a microorganism.
• indirect - serology (ELISA, fluorescent antibody technique), molecular biological (PCR). They are used to detect the immune response to infection.

Standard in the diagnosis of this disease is the use of at least two of the above methods.

Analysis of antibody to cytomegalovirus (ELISA - enzyme linked immunosorbent assay)

ELISA method is the most common due to its simplicity, low cost, high accuracy and automation capabilities, eliminating a laboratory error. Analysis can be carried out for 2 hr. Antibody classes IgG, IgA, IgM detected in the blood.

Determination of antibodies to cytomegalovirus as follows:

1. In some wells placed the patient's blood serum, positive control, negative and "threshold" samples. last titer of 1: 100. The plate in which the wells are made of polystyrene. It previously precipitated purified CMV antigens. By reacting with specific antibodies form immune complexes.
2. The plate with sample was placed in an oven where it is kept for 30-60 min.
3. Wash the wells with a special solution and introduced into them a conjugate - a substance with an antibody labeled with an enzyme, and then again placed in an incubator.
4. Washed well and add them in the indicator solution incubated.
5. Stop reagent is added to stop the reaction.
6. The analysis results are recorded in a spectrophotometer - optical density is measured in the patient's serum and two modes are compared with values ​​for control samples and the threshold. To determine the titer construct a calibration graph.

If the sample contains antibodies to CMV, then under the influence of the indicator changes its color (optical density), which is recorded by a spectrophotometer. The disadvantages include the risk of false-positive ELISA results due to cross-reactivity with normal antibodies. The sensitivity of the method is 70-75%.

avidity index is defined similarly. In patient serum samples, a solution that removes low avidity antibody. Then, the conjugate is administered, and the organic matter with the dye, the absorbance is measured and compared to control wells.

Method of polymerase chain reaction (PCR) for diagnosis of cytomegalovirus

SUMMARY PCR is to identify the DNA fragments or RNA virus.

After sample pretreatment produce registration results a two methods:

• electrophoreticIn which the DNA molecules of viruses moving in an electric field, and a special dye causes them to fluoresce (glow) when exposed to ultraviolet rays.
• hybridization. Artificially synthesized DNA segments labeled with a dye, binds to viral DNA in the sample. Next is their fixation.

PCR has greater sensitivity (95%) compared to IFA. Study duration is 1 day. As the body fluids not only the blood serum can be used for analysis, but also amniotic and cerebrospinal fluid, saliva, urine, secretions from the cervical canal.

Currently, this method is the most informative. If the white blood cells found DNA of the virus, it is a sign of the initial infection.

Isolation of cell culture (seeding) for the diagnosis of CMV

Despite the high sensitivity (80-100%), inoculation of cell culture is rarely done, because the following restrictions:

• most labor-intensive methods, runtime analysis takes 5-10 days;
• the need for highly qualified medical personnel;
• precision study is highly dependent on the quality of intake of biological material and time between delivery of the analysis and sowing;
• a large number of false-negative results, particularly for the diagnosis later 2 days.

Just as in the PCR assay, one can determine the specific type of agent. The essence of the study is that the sample taken from the patient is placed in a special culture medium in which the growth of microbes and their subsequent study.

Cytology for the diagnosis of cytomegalovirus

Cytological study refers to the primary types of diagnostics. Its essence lies in the study of cytomegalovirus-cells under a microscope, the presence of which indicates a typical change with CMV. For the analysis usually take saliva and urine. This method may not be the only reliable in the diagnosis of cytomegalovirus infection.

What if IgG antibodies to CMV positive?

Antibodies to cytomegalovirus, found in the blood and other body fluids, may indicate three possible states: an initial or re-infection, and recovery carriers of the virus. Results of analyzes require a comprehensive evaluation.

If IgG positive, to determine the acute phase, the most dangerous to health, it is necessary consult a doctor, infectious diseases, and more research ELISA IgM, IgA, avidity or PCR analysis.

Upon detection of IgG in a child under 1 year is recommended to undergo such examinations and mother. In the event that will be revealed about the same titers of antibodies, it is likely there was a simple transfer of immunoglobulins during pregnancy, rather than infection.

Note that a small amount of IgM can be detected within 2 years or more. Therefore, their presence in the blood is not always a sign of recent infection. In addition, the accuracy of even the best test systems can give both false positive and false negative results.

What does it mean if detected Anti-CMV IgG?

In case of repeated detection of antibodies to CMV, and the absence of other signs of acute infection, the test results indicate that a person is a carrier of the virus for life. In itself, such a condition is not dangerous. However, before planning pregnancy, as well as immunosuppression necessary to periodically monitor the level of immunoglobulins.

In healthy people, this disease occurs in secret, sometimes with the appearance of flu-like symptoms. Recovery indicates that the body has successfully coped with the infection, and lifelong immunity - to develop.

To control the dynamics of the disease tests administered every 2 weeks. If the IgM level is gradually reduced, the patient recovers, otherwise the disease progresses.

Do I need to treat cytomegalovirus?

Completely get rid of cytomegalovirus impossible. If a person is a carrier of the infection, but there are no symptoms, the provision of treatment is required. Of great importance is the prevention of CMV, which is aimed at strengthening the immune system. This allows you to keep the virus in "sleep" state and avoid relapse.

The same tactics are carried out on pregnant women and children. In people with severe immunodeficiency during CMV disease can develop complications such as pneumonia, inflammation of the colon and the retina. For the treatment of this category of persons prescribed powerful anti-viral agents.

How to treat cytomegalovirus

CMV therapy is carried out in phases:

• The acute period - antiviral drugs with activity against herpes virions group; immunomodulating agents, antioxidant vitamins E and C.
  
• phase remission - compliance with rest mode, a vitamin, a diet rich in micronutrients; immunomodulators and adaptogens of plant origin (golden root, lemongrass, sweet flag, and others); In marked decrease immunity - medicaments containing thymus extract.

Depending on which organs are affected virus, the doctor prescribes additional medications.

In severe cases, apply the following therapies:

• for detoxification - with saline drip, Acesol, di-, and tri-salts;
• to reduce edema, inflammation in the CNS - corticosteroids (prednisolone);
• in the case of secondary bacterial infections - antibiotics (ceftriaxone, cefepime, ciprofloxacin, and others).

during pregnancy

Pregnant women, patients with CMV, treatment is conducted by one of the following means indicated in the table below:

Title	release Form	The daily dosage	Average price, RR.
Acute phase, a primary infection
Tsitotekt (human immunoglobulin antitsitomegalovirusny)	Solution for intravenous administration	2 ml per 1 kg of body weight every 2 days	21 ml 000/10
Recombinant interferon alpha 2b (Viferon, Genferon, Giaferon)	rectal suppositories	1 suppository 150,000 IU 2 times daily (every night). At 35-40 weeks of pregnancy - 500 000 IU, 2 times a day every day. Course duration - 10 days	250/10 pc. (150 000 IU)
Reactivation or reinfection
Cymevene (ganciclovir)	Solution for intravenous administration	5 mg / kg, 2 times a day course - 2-3 weeks.	1600/500 mg
valganciclovir	Tablets for oral administration	900 mg 2 times a day for 3 weeks.	000/60 15 pcs.
panavir	Solution for intravenous or rectal suppositories	5 ml, 3 injections with an interval therebetween in 2 days. Candles - 1 pc. at night, 3 times every 48 hours.	1500/5 ampoules; 1600/5 candles

preparations

The basis of the treatment of CMV make antiviral drugs:

• Acyclovir (Zovirax, Viroleks);
  
• ganciclovir;
• valganciclovir;
• panavir;
• Famciclovir (penciclovir) and others.

As an immunomodulating agents doctor may prescribe the following:

• tsikloferon;
• Amiksin;
• Lavomax;
• Galavit;
• Tilorona and other drugs.

Immunomodulators used in remission, and can be used at relapse. After closure of the acute phase of the disease is also shown restorative and physiotherapeutic treatment must eliminate chronic inflammatory and infectious lesions.

Folk remedies

In folk medicine, there are a few recipes for the treatment of CMV infection:

• Grind fresh grass wormwood and squeeze out the juice. Heat 1 liter of dry wine to heat to about 70 ° C (starts to rise whitish haze), add 7 article. l. honey, mix well. Pour 3 tbsp. l. juice of wormwood, turn off the heat, stir. Take "wormwood wine" on the 1 glass a day.
• Wormwood, tansy flowers, crushed roots elecampane mixed in equal proportions. 1 h. l. the mixture is poured 0.5 liters of boiling water. This number of drinking equal portions three times a day, half an hour before a meal. Duration of treatment was collected 2 weeks.
• Shredded bark of alder, aspen and willow are mixed in equal proportions. 1 tbsp. l. collecting brewed 0.5 liters of boiling water and taking the same as in the previous recipe.

Prognosis and complications

Cytomegalovirus infection occurs most often benign, but its symptoms are confused with SARS, since patients have the same symptoms - fever, headache and muscle pain, weakness, chills.

In severe cases, the infection can lead to the following complications:

• pneumonia (Dry cough, shortness of breath, bluish coloration of the skin);
  
• meningoencephalitis (Convulsions, loss of consciousness, mental disorders, epilepsy);
• hepatitis (Enlargement of the liver and her pain, nausea, skin and mucous staining yellow);
• gastrointestinal damage (Nausea, vomiting, loose stools, abdominal pain);
• allergic reactions (rash).

This infection is most dangerous in the early stages of pregnancy, as this often happens fetal death and miscarriage.

In surviving child following congenital abnormalities may occur:

• reduction of brain edema or sizes;
• malformations of the heart, lungs and other organs;
• liver disease - Hepatitis, cirrhosis, biliary tract obstruction;
• Hemolytic disease of the newborn - purpura, bleeding in the mucous, stool and vomiting blood, bleeding from the umbilical wound;
• strabismus;
• muscular disorders - seizures, hypertonicity, asymmetry of the facial muscles and others.

Subsequently can reveal mental retardation. IgG antibodies are detected in the blood are not a sign that the body takes an active CMV-infection. A person may already be formed lifelong immunity to cytomegalovirus. The most difficult to define the diagnostic picture of the newborn. The disease is in the passive form does not require treatment.

Registration of the article: Lozinski Oleg

Video of antibodies to cytomegalovirus

Cytomegalovirus and Igg Igm. IFA and PCR with cytomegalovirus: