Abstract
This study aims to analyze and evaluate the clinic and demographic features of immunocompetent children that have been diagnosed with cytomegalovirus (CMV) infection. The data of children diagnosed with CMV infection between January 2005 and December 2010 and their follow-ups for 2 years were retrospectively evaluated. Ninety-eight patients were included, and the median age at admission was 5.6 months (5 days–36 months). 54.1 % was male. The diagnosis of CMV infection was performed by measurement of serum anti-CMV specific Ig M and IgG titers and PCR method in blood and/or urine. In 3.06 % of the patients, congenital infection was detected, whereas possible congenital infection was observed in 36.7 % of the patients. Furthermore, 44 patients (44.8 %) were detected to have perinatal infection while postnatal infection was spotted in 15.3 % of the patients. The common presenting manifestations were prolonged jaundice, diarrhea, vomiting, abdominal distension, skin eruption, and seizure. And the most common physical examination findings were hepatosplenomegaly, microcephaly, jaundice, and petechia. The mainstream laboratory results were elevated transaminases (50 %), anemia (30.6 %), leukocytosis (27.5 %), and thrombocytopenia (18.3 %). There were intracranial calcification in 5.1 % and eye findings in 5.1 %. On follow-up of patients, complete improvement (59.1 %), neuromotor developmental delay (11.2 %), epilepsy (10.2 %), hearing loss (3.06 %), hemolytic anemia (2.04 %), and growth retardation (1.02 %) were detected.
Conclusion: CMV infection is a significant disease both in congenital and perinatal period. It must be considered that diagnosed patients need to be monitored for a long time with special attention to their neurodevelopmental follow-ups.
What is Known: • Manifestations, follow-up findings, and treatment approaches of CMV infection in immunocompetent individuals have not been extensively revised and have received less attention in the literature. |
What is New: • This study is intended for evaluation of the clinical and demographic characteristics and laboratory findings of immunocompetent children with CMV infection in with a broad series of patients. |
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Abbreviations
- ALT:
-
Alanine aminotransferase
- AST:
-
Aspartate aminotransferase
- CMV:
-
Cytomegalovirus
- CNS:
-
Central nervous system
- CT:
-
Computed tomography
- DNA:
-
Deoxyribonucleic acid
- GGT:
-
Gamma-glutamyl transferase
- MRI:
-
Magnetic resonance imaging
- PCR:
-
Polymerase chain reaction
References
American Academy of Pediatrics (2009) Cytomegalovirus infection. In: Pickering LK, Baker CJ, Long SS, McMillian JA (eds) Red book: 2009 report of the committee on infectious diseases, 28th edn. American Academy of Pediatrics, Elk Grove Village, pp 708–709
Aslam M, Anderson JL, Guglietti D, Cardwell D (2007) CMV-induced neonatal thrombocytopenia: a case report and review of the literature. Am J Perinatol 24:429–434
Boppana SB, Pass RF, Britt WJ, Stagno S, Alford CA (1992) Symptomatic congenital cytomegalovirus infection: neonatal morbidity and mortality. Pediatr Infect Dis J 11:93–99
Bosnjak VM, Daković I, Duranović V, Lujić L, Krakar G, Marn B (2011) Malformations of cortical development in children with congenital cytomegalovirus infection—a study of nine children with proven congenital cytomegalovirus infection. Coll Antropol 35:229–234
Centers for Disease Control and Prevention (2010) Cytomegalovirus (CMV) and Congenital CMV Infection 2010. Available via http://www.cdc.gov/cmv/congenital-infection.html. Accessed on 26 Nov 2014
Chen DH, Jiang H, Lee M, Liu F, Zhou ZH (1999) Three dimensional visualization of tegument/capsid epidemiology and treatment. Interactions in the intact human cytomegalovirus. Virology 260:10–16
Cytomegalovirus SS (2010) In: Kliegman RM, Stanton B, Geme S, Schor N, Behrman RE (eds) Nelson textbook of pediatrics, 19th edn. WB Saunders, Philadelphia, pp 1115–1117
Gandhi KM, Khanna R (2004) Human cytomegalovirus: clinical aspects, immune regulation, and emerging treatments. Lancet Infect Dis 4:725–738
Grosse SD, Ross DS, Dollard SC (2008) Congenital cytomegalovirus (CMV) infection as a cause of permanent bilateral hearing loss: a quantitative assessment. J Clin Virol 41:5762
Hadaya K, Kaiser L, Rubbia-Brandt L, Gervaix A, Diana A (2004) Ganciclovir for severe cytomegalovirus primary infection in an immunocompetent child. Eur J Clin Microbiol Infect Dis 23:218–220
Horwitz CA, Skradski K, Reece E, Lewis FB, Schwartz B, Kelty R, Polesky H (1984) Haemolytic anaemia in previously healthy adult patients with CMV infections: report of two cases and an evaluation of subclinical haemolysis in CMV mononucleosis. Scand J Haematol 33:3542
James SH, Kimberlin DW, Whitley RJ (2009) Antiviral therapy for herpesvirus central nervous system infections: neonatal herpes simplex virus infection, herpes simplex encephalitis, and congenital cytomegalovirus infection. Antiviral Res 83:207–213. doi:10.1016/j.antiviral.2009.04.010
Kang JW, Kim GN, Kim SY, Kim HJ, Park ES, Kim JY, Lee YH (2010) Clinical and radiologic evaluation of cytomegalovirus induced thrombocytopenia in infants between 1 and 6 months of age. Korean J Hematol 45:29–35. doi:10.5045/kjh.2010.45.1.29
Kanik-Yuksek S, Gülhan B, Tezer H, Ozkaya-Parlakay A (2014) A perinatal cytomegalovirus infection in an immunocompetent patient with chorioretinitis. J Trop Pediatr 60:401–403. doi:10.1093/tropej/fmu024
Karltorp E, Hellström S, Lewensohn-Fuchs I, Carlsson-Hansén E, Carlsson PI, Engman ML (2012) Congenital cytomegalovirus infection—a common cause of hearing loss of unknown aetiology. Acta Paediatr 101:357–362. doi:10.1111/j.1651-2227.2012.02711.x
Koyano S, Inoue N, Oka A, Moriuchi H, Asano K, Ito Y, Yamada H, Yoshikawa T, Suzutani T, Japanese Congenital Cytomegalovirus Study Group (2011) Screening for congenital cytomegalovirus infection using newborn urine samples collected on filter paper: feasibility and outcomes from a multicentre study. BMJ Open 29:1. doi:10.1136/bmjopen-2011-000118
Kurtoglu MG, Bozkurt H, Keşli R, Tuncer O, Berktas M (2008) Prevalence of antibodies against rubella, CMV and HSV among children in eastern Turkey. Türk Mikrobiyoloji Cemiyeti Dergisi 38:137–142
Leruez-Ville M, Vauloup-Fellous C, Couderc S, Parat S, Castel C, Avettand-Fenoel V, Guilleminot T, Grangeot-Keros L, Ville Y, Grabar S, Magny JF (2011) Prospective identification of congenital cytomegalovirus infection in newborns using real-time polymerase chain reaction assays in dried blood spots. Clin Infect Dis 52:575–581. doi:10.1093/cid/ciq241
Li RY, Tsutsui Y (2000) Growth retardation and microcephaly induced in mice by placental infection with murine cytomegalovirus. Teratology 62:79–85
Mandell GL, Bennett JE, Dolin R (2010) Principles and practise of infectious diseases, 7th edn. Churchill Livingstone, PA, pp 1971–1987
McGavran MH, Smith MG (1965) Ultrastructural, cytochemical, and microchemical observations on cytomegalovirus (salivary gland virus) infection of human cells in tissue culture. Exp Mol Pathol 76:1–10
Pass RF (1985) Epidemiology and transmission of cytomegalovirus. J Infect Dis 152:243–248
Rafailidis PI, Mourtzoukou EG, Varbobitis IC, Falagas ME (2008) Severe cytomegalovirus infection in apparently immunocompetent patients: a systematic review. Virol J 5:47. doi:10.1186/1743-422X-5-47
Schleiss MR (2005) Antiviral therapy of congenital cytomegalovirus infection. Semin Pediatr Infect Dis 16:50–59
Taglietti F, Drapeau CM, Grilli E, Capone A, Noto P, Topino S, Petrosillo N (2010) Hemolytic anemia due to acute cytomegalovirus infection in an immunocompetent adult: a case report and review of the literature. J Med Case Rep 4:334. doi:10.1186/1752-1947-4-334
Tezer H, Seçmeer G, Kara A, Ceyhan M, Cengiz AB, Devrim I, Us D, Yüce A, Gürakan F, Yildirim I, Ozen H, Saltik-Temizel IN (2008) Cytomegalovirus hepatitis and ganciclovir treatment in immunocompetent children. Turk J Pediatr 50:228–234
Trincado DE, Rawlinson WD (2001) Congenital and perinatal infections with cytomegalovirus. J Paediatr Child Health 37:187–192
White FV, Dehner LP (2004) Viral diseases of the liver in children: diagnostic and differential diagnostic considerations. Pediatr Dev Pathol 7:552–567
Whitley RJ (2004) Congenital cytomegalovirus infection: epidemiology and treatment. Adv Exp Med Biol 549:155–160
Zubiaurre L, Zapata E, Bujanda L, Castillo M, Oyarzabal I, Gutiérrez-Stampa MA, Cosme A (2007) Cytomegalovirus hepatitis and myopericarditis. World J Gastroenterol 13:647–648
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Çelikel, E., Tezer, H., Kanik-Yuksek, S. et al. Evaluation of 98 immunocompetent children with cytomegalovirus infection: importance of neurodevelopmental follow-up. Eur J Pediatr 174, 1101–1107 (2015). https://doi.org/10.1007/s00431-015-2513-9
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DOI: https://doi.org/10.1007/s00431-015-2513-9