Characterization of Cytomegalovirus Lung Infection in Non-HIV Infected Children

Abstract

Cytomegalovirus (CMV) is a prevalent pathogen in the immunocompromised host and invasive pneumonia is a feared complication of the virus in this population. In this pediatric case series we characterized CMV lung infection in 15 non-HIV infected children (median age 3 years; IQR 0.2–4.9 years), using current molecular and imaging diagnostic modalities, in combination with respiratory signs and symptoms. The most prominent clinical and laboratory findings included cough (100%), hypoxemia (100%), diffuse adventitious breath sounds (100%) and increased respiratory effort (93%). All patients had abnormal lung images characterized by ground glass opacity/consolidation in 80% of cases. CMV was detected in the lung either by CMV PCR in bronchoalveolar lavage (82% detection rate) or histology/immunohistochemistry in lung biopsy (100% detection rate). CMV caused respiratory failure in 47% of children infected and the overall mortality rate was 13.3%. Conclusion: CMV pneumonia is a potential lethal disease in non-HIV infected children that requires a high-index of suspicion. Common clinical and radiological patterns such as hypoxemia, diffuse adventitious lung sounds and ground-glass pulmonary opacities may allow early identification of CMV lung infection in the pediatric population, which may lead to prompt initiation of antiviral therapy and better clinical outcomes.

Cell‐free DNA next‐generation sequencing successfully detects infectious pathogens in pediatric oncology and hematopoietic stem cell transplant patients at risk for invasive fungal disease

“…Comparing abnormal imaging results to a noninvasive reliable blood test might help establish fungal pathogens as the causal agents. In three of our patients with abnormal imaging and no further evidence of fungal disease, CMV and BK polyomavirus were detected and could explain the radiographic findings …”

“…A second discrepant finding in this study involved the identifica- 38,39 Ultimately, proving a diagnosis of IFD is difficult and routine practice promotes initiation of therapy based on concerning clinical or imaging findings, 40 especially in high-risk neutropenic patients with persistent or recurrent fevers despite broad-spectrum antibiotics. 41,42 In accordance with this practice, 21 of 28 (75%) of enrolled patients at risk for IFD due to prolonged or recrudescent FN were placed on >1 week of treatment dosing antifungal therapy by their primary providers.…”

Human Cytomegalovirus Infection Among Neonates With Symptomatic Congenital Infections and Birth Defects

“…Pneumonitis was found in 28% of symptomatic HCMV infected neonates, a result which is found to be higher than that recorded in a study from Iraq 11.6% among infected infants (24) . In a recent study, a higher frequency of pneumonitis was detected in 47% of symptomatic infected children (36) . The variation in the results may be due to the fact that the clinical diagnosis of HCMV lung infection is challenging in children and often requires a high-index of suspicion (37) .…”

Severity quantification of pediatric viral respiratory illnesses in chest X-ray images

“…For evaluation of lung segmentations, the manual segmentation of lung fields is performed for all 148 cases under the supervision of the two expert pulmonologists. In order to quantify severity of hyperaeration leading to air trapping, basic lucency differentiation across quadrants, representing proximal and distal areas of the upper and lower regions, is evaluated by a board-certified pediatric pulmonologists with expertise in the phenotypical characterization of viral respiratory infections in children [13]. A total of the 8 regions (4 each lung) are independently scored with either 0 (no air trapping), 1 (mild cases), or 2 (severe cases) for a subset of our dataset, comprising of 60 randomly selected cases.…”