COURSE AND OUTCOME OF CYTOMEGALOVIRUS INFECTION IN YOUNG CHILDREN: ANALYSIS OF CLINICAL OBSERVATIONS

Abstract

Introduction. Cytomegalovirus (CMV) infection in young children poses a significant medical and social challenge due to its wide clinical spectrum. This disease often presents with mainly non-specific symptoms, which complicates its timely detection, especially in children with a complex premorbid background. In this regard, the problem of developing methods for objectifying and assessing the severity of clinical manifestations preceding an unfavorable outcome remains extremely urgent.
Objective. To study the clinical course and outcomes of cytomegalovirus infection in young children in Astana from 2021 to 2024.
Material and methods. The study consisted of observing young children (n=327) with a clinically and laboratory-confirmed diagnosis of CMV treated between 2021 and 2024.
Clinical monitoring of patients was carried out based on the following parameters: general condition of the patient, body temperature, symptoms of intoxication, condition of the skin (color, presence of rash), hemodynamic disorders, catarrhal-respiratory manifestations (dyspnea and its nature/respiratory rate, asthmatic breathing, presence and nature of cough, rhinorrhea, condition of the pharynx), auscultatory changes in the lungs and heart, pathological murmurs in the heart area; abdominal syndrome, flatulence, tenderness on palpation of the abdomen, localization, stool (frequency, consistency, impurities), diuresis; neurological symptoms, other clinical manifestations. All patients received therapy in accordance with the clinical treatment protocol based on their diagnosis.
Results. According to the results of our study, cytomegalovirus infection is characterized by polymorphism of clinical manifestations, with a predominance of intoxication syndrome (70%), respiratory syndrome (74%), and damage to the cardiovascular system (CVS) (46%). In the structure of CNS (central nervous system) damage, cystic formations in the brain of various localizations were predominant, accounting for 35.3%. The presence of hydrocephalus was recorded in 32.4% of patients, and CNS damage of hypoxic-ischemic genesis was observed in 29.4% of children. In the group of children with CNS damage, in the age aspect, patients from 1-3 months prevailed, which amounted to 48.6%, in the same group of children, cardiovascular damage was recorded in 52.2% in the form of minor anomalies of the heart development (MACD), patent foramen ovale (PFO), ventricular septal defect (VSD), atrial septal defect (DMPP).
Discussion. Analysis of clinical observations revealed that the clinical course of CMV is characterized by a wave-like progression, transitioning from asymptomatic carriage to a symptomatic form with long-term consequences. The obtained results corresponded to the literature data, confirming that the general intoxication syndrome manifests the severity upon admission to the hospital: in the form of increased body temperature, weakness, lethargy, decreased appetite (52.9%), then respiratory syndrome (42.5% of cases), anemic syndrome (38%), and neurological deficit ( 33%). In terms of age, children aged 1-3 months were the most prevalent (47.2%). In our study, the central nervous system was frequently involved in the pathological process, accounting for 70% of cases.
Conclusions. These indicators demonstrate the clinical polymorphism of CMV and emphasize the need for an interdisciplinary approach to the diagnosis and treatment of this disease, given the frequency of involvement of vital organs and systems in the pathological process. The results obtained may also be useful in developing clinical routes for early detection and risk stratification in patients with CMV.