citomegalovirusuli encefalitis klinikuri SemTxveva

diplomisSemdgomi ganaTlebis saxelmwifo samedicino akademia

dargobrivi rezidentura__infeqciuri sneulebebi

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janmrTelobis dacvis msoflio organizaciis monacemebiT citomegalovirusuli infeqcia “idumalebiT mocul" infeqcias warmoadgens. igi msoflioSi farTod aris gavrcelebuli. mozrdili mosaxleobis 90-96%-Si ganisazRvreba antisxeulebi citomegalovirusis (CMV) mimarT. axalSobilTa 0.5-2% inficirebulia CMV–iT.

gamomwvevi miekuTvneba herpesvirusebis V tips. infeqciis erTaderT wyaros inficirebuli adamiani warmoadgens. viruss Seicavs nerwyvi, bronqebis sekreti, qalis rZe, cervikaluri da vaginaluri sekreti, sperma, Sardi, ganavali, sisxli. infeqciis gadacema xdeba haer-wveTovani, alimenturi, kontaqturi, sqesobrivi gzebiT, inficirebuli sisxlisa da misi preparatebis gadasxmisas da organoTa transplantaciis dros. am infeqciis Seswavlisa da drouli gamovlinebis aqtualoba mdgomareobs imaSic, rom misi gadacema xdeba transplacentarulad da perinatalurad. am SemTxvevaSi udidesi mniSvneloba eniWeba dedis pirvelad inficirebas citomegalvirusiT. nayofisa da axalSobilis klinikurad gamoxatuli infeqcia praqtikulad yovelTvis dedis pirveladi infeqciis Sedegia. dazianebis xasiaTi damokidebulia inficirebis droze. Tandayolili citomegalia viTardeba inficirebul nayofTa 5%-Si. am dros SemTxvevaTa 60-80%-Si klinikurad vlindeba peteqiebi, hepatosplenomegalia da siyviTle, aseve xSiria encefaliti.. letaloba aRwevs 20-30%-s. perinataluri infeqciis dros, axalSobilTa 40-60% seropozitiuri dedis rZiT inficirdeba.  klinikurad vlindeba gaxangrZlivebuli intersticiuli pnevmonia, adenopaTia, hepatiti, anemia.

mozardebsa da axalgazrdebSi CMV  xSirad sqesobrivi gziT gadaecema. mozrdilebSi CMV infeqciis yvelaze xSiri formaa mononukleozis sindromi.

mokled SemogTavazebT uaxles monacemebs virusis struqturisa da infeqciis paTogenezis Sesaxeb. virioni zomiT 150-200 nm-ia dafarulia fosfolipiduri garsiT, romelic Seicavs membranis glikoproteinebsa da ikosaedrul kafsulaSi moTavsebul ormag spiralian dnm-s, poliaminebsa da teguments. fosfolipiduri garsis SemadgenlobaSi Sedis gB, romelic monawileobs virusis maspinZlis ujredidan ujredze gadasvlaSi da ujredSi SeRwevaSi. gH monawileobs maspinZlis ujredebis receptorebze adheziaSi. maspinZlis ujredebze didi raodenobiT aris CMV-is receptorebi, magram isini mkveTrad gansazRvrulia, ris gamoc konkurencia sxva herpesvirusebTan ar xdeba. virusis mimagreba receptorebTan swrafi da efeqturia, magram CMV izrdeba adamianis ujredebis SezRudul ricxvze virusuli genis eqspresiis post-penetraciuli blokis gamo. imunokompetentur maspinZelSi normaluri imunuri pasuxis gamo virusi nela replicirdeba, ujreduli tropizmic SezRudulia da daavadeba klinikurad ar vlindeba. inficirebuli adamiani mTeli sicocxlis manZilze virusmtarebeli rCeba. daavadeba ufro xSirad usimptomod, latenturi infeqciis saxiT mimdinareobs. T ujreduli reaqciis daTrgunva sxvadasxva daavadebisa da iatrogenuli imunosupresiuli mdgomareobis dros xels uwyobs virusis reaqtivaciasa da infeqciis generalizacias.

ganvixilavT citomegalovirusuli encefalitis klinikur SemTxvevas. avadmyofi bavSvi 9 Tvis, romelsac daavadeba daewyo cxelebiT 390С –mde, zemo sasunTqi gzebis kataruli movlenebiT, meore dRes ganuviTarda generalizebuli krunCxva cxelebis fonze. Cvens klinikaSi moTavsda daavadebis me-17 dRes.Semosvlisas zogadi mdgomareoba umZimesi iyo, aRiniSneboda cxeleba. obieqturad – kani fermkrTali, mSrali, turgori da elastiuroba daqveiTebuli. periferiuli limfuri kvanZebi hiperplaziis gareSe. didi yiflibandi daxuruli. pulsi – 136, susti avsebisa da daWimulobis, ritmuli, gulis tonebi sufTa. sunTqva Tavisufali, auskultaciiT - orive mxares saSualo buStukovani sveli xixini, marjvniv beWis kuTxesTan bronquli elferis sunTqva. ena mSrali, xaxa da xaxis rkalebi sustad hiperemiuli, ylapvis gaZnelebis gamo ikvebeboda nazo-gastraluri zondiT. muceli rbili, RviZli scildeboda neknTa rkals 3 sm-iT. elenTa ar isinjeboda. defekacia mounelebeli fafisebri masebiT. Sardva Tavisufali. nevrologiuri statusi – komatozuri mdgomareoba, kisris kunTebis rigidoba, marcxniv kidurebSi hipertonusi, tonuri krunCxva viTardeboda rogorc spontanurad, ise gasinjvis dros. gugebi mrgvali, sinaTleze reaqcia ar iyo. refleqsebi Zlier cocxali, ufro metad marjvniv. sisxlis saerTo analizi – leikocitozi (14.8x109 /l) marcxniv gadaxriT (Cxiri-9%), zomierad momatebuli eds(30 mm/sT), sisxlis bioqimiur analizSi hipoproteinemia disproteinemiiT. sxva maCveneblebi normis farglebSi. Tav-zurg-tvinis siTxe uferuli, citozi 35/3, cila 0.33%o Saqari – 2.89 g/l. serologiuri profili CMV(IFA) Ag(+).kompiuteruli tomografia – tvinis didi hemisferoebis nivTierebis kistozuri gadagvareba (encefalomalacia). gamokvleuli iqna avadmyofis dedis serologiuri profili, riTac gamovlinda antisxeulebi CMV(ELISA) Ig-G(1/1000).  miRebuli klinikur-laboratoriuli da epidanamnezis safuZvelze avadmyofs daesva citomegalovirusuli encefalitis diagnozi. avadmyofis Cautarda saTanado mkurnaloba – farTo speqtris antibiotikebiT, antivirusuli preparatebiT, dezintoqsikaciuri, Sardmdeni, sedatiuri saSualebebiT, antikoagulantebiT, steroiduli hormonebiT, Tavis tvinSi sisxlis mimoqcevisa da nivTierebaTa cvlis makoregirebeli saSualebebiT.

miuxedavad imisa, rom avadmyofi klinikidan stabilur mdgomareobaSi gaewera prognozulad mZime iyo. SeiZleba vivaraudoT, rom bavSvis inficireba moxda saSvilosnosSida peridSi, radgan dedas gamouvlinda latenturi infeqcia (antisxeulebi CMV-is mimarT). vinaidan, orsulobis periodSi ganviTarebuli mwvave infeqcia warmoadgens ZiriTad risk-faqtors nayofisaTvis, rekomendirebulia reproduqciuli asakis yvela qalSi gamokvleul iqnas CMV serologiuri statusi. orsulobis peridSi pirveladi infeqciis gamovlenisas xdeba amnionuri siTxis gamokvleva CMV-ze da   ultrabgeriTi kvleva. nayofis mwvave infeqciisa da Seuqcevadi paTologiis dadgenisas sakiTxi dgeba orsulobis xelovnur Sewyvetaze. aseve rekomendirebulia dabadebis pirvelive dReebSi axalSobilis sisxlis serologiuri gamokvleva da imunoprofilaqtikis daniSvna.

 

 

 

дliteratura:

 

 

1.        Мартин  С.  Хирщ –Цитомегаловирусная инфекция – Справочник Харрисона по внутренним волезням. Москва. 1999

2.        Н.Н.  Русанова и др. –Клинические особенности  цитомегаловирусной инфекции у детей первых месяцев жизни. Педиатрия №1  2000.

3.        А.М. Ожогов и др.  Рабочий вариант классификации цитомегаловирусной инфекции у детей. –Россииский вестник перинатологии и педиатрии. №4. 2000.

4.        Н.В. Каражас и др. Лабораторная диагностика цитомегаловирусной инфекции. –Клиническая лабораторная диагностика.№8 2000.

 

 

SUMMARY

 

 

Many epidemiological stadies have confirmed that severe congenital CMV disease resalts mainly from primary CMV infection in pregnant women.  We discass the case of intrauterine CMV infection in 9 month child born from supposedly primary infected mother. Hence it is recommended that women of childbearing age know their CMV serostatus. In women with confirmed primary infection amnionic fluid PCR can be used to assess the risk of CMV diease for fetus. In case of confirmed acute infection of fetus the abortion is only way out. Also it is recommended to diagnose CMV infection in newborn, by detection of spesific IgM antibodies and to administer immunoprophylactic.