CLINICAL FEATURES OF ACUTE CYTOMEGALOVIRUS INFECTION ACCOMPANIED BY THROMBOTIC COMPLICATIONS IN IMMUNOCOMPETENT PATIENTS

Objective of the study. To identify and analyse clinical and laboratory features in immunocompetent patients with thrombotic complications in acute cytomegalovirus infection. Development of the algorithm of prognosis and early diagnosis of thrombotic complications in order to reduce the risk of severe course of the disease and lethal outcome.

Materials and Methods. The study included 100 immunocompetent adult patients undergoing inpatient observation and treatment with laboratory-proven acute cytomegalovirus infection. All patients had a detailed clinical and epidemiological history for the possible presence of modifiable and/or non-modifiable prothrombotic risk factors; a multifaceted laboratory and instrumental examination was performed.

Results. Out of one hundred patients with acute cytomegalovirus infection selected in the study, thrombotic diseases were observed in 7 % of cases (in 7 patients). The mean age of the patients was 41 (38; 42) years. Patients were hospitalised on average on 12 (10; 14) days from the onset of the disease. The main complaints on admission were: prolonged fever up to 38 °С and marked general weakness. The patients had elevated ALT and AST in 88 % and 80 % of cases, respectively. The presence of reactive lymphocytes was registered in 57 % of cases. Enlargement of liver and spleen was observed in 67 % and 70 % of cases, respectively. Compared to patients with uncomplicated course of acute cytomegalovirus infection, statistically significant laboratory differences were observed in SRB (p < 0.001) and D-dimers (p < 0.05) in patients who had thrombotic complications. All patients who had genetic material (DNA) to CMV in the blood had positive tests for rr65 antigenemia. The polymorphism of factor V gene G1691A (FVLeiden) was detected in only one patient, who was a carrier of heterozygous GA allele.

Conclusion. Acute cytomegalovirus infection in immunocompetent patients includes a symptom complex consisting of a typical clinical picture (prolonged febrile intoxication, hepatosplenomegaly, elevated hepatic transaminases, CRP and D-dimer levels) and obligatory laboratory detection of the virus (positive PCR and/or Ag pp65 tests for CMV). Cytomegalovirus is an independent and reliable prothrombotic risk factor, with thrombotic complications occurring in 7 % of cases. Patients with risk factors for thrombotic complications with verified acute cytomegalovirus infection are recommended to be prescribed anticoagulant therapy at prophylactic doses. Also, patients with a proven case of thrombotic process on the background of acute cytomegalovirus infection are recommended a course of etiotropic antiviral therapy.

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