Congenital Cytomegalovirus Pneumonitis and Treatment Response Evaluation Using Viral Load during Ganciclovir Therapy: a Case Report

Lee-Yoshimoto, Minsoo; Goishi, Keiji; Torii, Yuka; Ito, Yoshinori; Ono, Hiroya; Mori, Tomoko; Kashiwa, Naoyuki; Hosokawa, Shinichi; Shichino, Hiroyuki

doi:10.7883/yoken.jjid.2017.577

Cited by 10 publications

(7 citation statements)

References 15 publications

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“…An increase in CMV DNAemia was observed in two patients after the ganciclovir therapy. This rebound increase in CMV DNAemia has been reported previously and the significance of reappearance remains incompletely understood (Lee-Yoshimoto et al, 2018). In the early onset stage, CMV PCR on the CSF was positive for all patients, while anti-CMV IgM was positive for 77.8% of the patients.…”

Section: Discussionsupporting

confidence: 69%

Cytomegalovirus encephalitis in immunocompetent infants: A 15-year retrospective study at a single center

Guo

Jiang

2019

International Journal of Infectious Diseases

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Objective: Cytomegalovirus (CMV) encephalitis is a disease that primarily affects immunocompromised hosts. Only a few cases have been reported in immunocompetent individuals, especially in children. The aim of this study was to investigate the clinical characteristics of immunocompetent children with CMV encephalitis attending a single medical center in southwest China over a 15-year period. Methods: The medical records of children with confirmed CMV encephalitis who were hospitalized in the Children's Hospital of Chongqing Medical University during the years 2002-2017 were reviewed. An analysis of the clinical features, laboratory data, and the treatment response to antiviral therapy was performed. Results: The median age of the patients (n = 18) was 5.1 months. 'Seizures' was the earliest and most common neurological symptom, while fever and poor feeding were also present in most patients. Elevated cerebrospinal fluid (CSF) protein was the most noticeable biochemical finding. After treatment with twostage ganciclovir, all patients showed a steady clinical improvement. The total adverse drug reaction (ADR) rate was 27.3%, mainly presenting as effects on the hematopoietic system and liver. During follow-up ranging from 3 to 36 months, nine patients showed a complete recovery. At the stage of diagnosis, CMV PCR of CSF was positive in all patients, while anti-CMV IgM was positive in 77.8% of patients. After treatment with two-stage ganciclovir, all patients showed a negative result for CMV genome in the CSF and a clear decrease in the urine. Conclusions: The possibility of CMV encephalitis in the immunocompetent child should be kept in mind, especially in those younger than 6 months of age. Suspicion for a diagnosis of CMV encephalitis is needed in the presence of unexplained prominent seizure, fever, poor feeding, and a marked elevation of protein level in the CSF. CMV PCR assays of CSF are necessary to determine the etiology. Furthermore, measurement of the CMV load in CSF and urine may be useful for evaluating the response to treatment and the outcome. Ganciclovir may lead to clinical improvement with limited ADR. CMV encephalitis in the immunocompetent infant does not necessarily indicate a poor short-term prognosis.

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Section: Discussionsupporting

confidence: 69%

Cytomegalovirus encephalitis in immunocompetent infants: A 15-year retrospective study at a single center

Guo

Jiang

2019

International Journal of Infectious Diseases

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“…32 Congenital CMV pneumonitis, which can persist for months, is associated with the development of bronchopulmonary dysplasia as a consequence of oxygen supplementation and mechanical ventilation required because of secondary bacterial pneumonitis or diffuse necrotizing pneumonitis with fibrosis. 20,46 Furthermore, the accumulation of CMV in lung tissues can potentially initiate an immunopathogenic reaction, leading to widespread interstitial pneumonitis, a notable decrease in surfactant production and subsequently, the presentation of symptoms of respiratory failure. 20 Infants with CMV pneumonitis may present with fever, lethargy, myalgia, cough, chest retractions or lymphadenopathy.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Complications of Cytomegalovirus Infection in Neonates and Infants: A Systematic Review of Case Reports and Pooled Analysis

Ong,

Fan

2024

Pediatric Infectious Disease Journal

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Background: Cytomegalovirus (CMV) causes intrauterine infections in 0.67% of neonates, with 12.7% displaying symptoms at birth. CMV can lead to severe multiorgan involvement, and mortality in symptomatic cases is around 30%. Pulmonary complications are rare in infants with CMV. This review assesses pulmonary complications and outcomes in infants with CMV infection. Methods: A systematic literature search was conducted using PubMed, SCOPUS and Ovid SP to retrieve case reports on pulmonary complications in infants with congenital or perinatal CMV infection. Descriptive analysis and pooled analysis were conducted for the case reports. Results: A total of 28 articles with 38 patients were included in this systematic review. The reported pulmonary complications in the case reports were CMV pneumonitis (34.2%), persistent pulmonary hypertension of the newborn (18.4%), emphysema and chronic lung disease (15.8%), diaphragmatic dysfunction (13.2%), lung cysts and calcifications (10.5%), Pneumocystis jirovecii infection (7.9%), pulmonary hypoplasia (5.3%) and bronchial atresia (2.6%). Seven (18.4%) of 38 patients passed away because of the pulmonary complications of CMV infection. Congenital transmission (P = 0.0108), maternal CMV (P = 0.0396) and presence of neonatal comorbidities (P = 0.0398) were independent risk factors for mortality. Conclusions: This systematic review demonstrated infrequent occurrence of severe pulmonary involvement in CMV infection but should be considered in infants with persistent or severe respiratory symptoms.

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“…Evidence that premature babies have a higher incidence of cCMV is limited. At birth, clinical features of symptomatic cCMV include microcephaly, intrauterine growth restriction (IUGR), hepatosplenomegaly, petechial rash, jaundice, and seizures [22,23]. Infants with symptomatic cCMV should be identified promptly such that appropriate management can be instituted as early as possible to improve outcomes.…”

Section: Discussionmentioning

confidence: 99%

Congenital Cytomegalovirus in Algiers, Algeria, a Descriptive Case Series Study

AGGOUNE¹

2022

JoMMID

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Cytomegalovirus (CMV) is an endemic ubiquitous herpes virus transmitted through saliva, urine, genital secretions, mononuclear blood cells, and transplanted tissue. It is a common infection with mild symptoms or asymptomatic in the immunocompetent individuals but can be severe in the immunocompromised individuals, e.g., HIV-infected individuals, transplanted and cancer patients, and fetuses. CMV is the leading cause of congenital viral infection and the leading non-hereditary cause of sensorineural hearing loss and mental retardation in early childhood. Here, we describe the clinical and laboratory monitoring of four congenital CMV (cCMV) cases referred to Pediatric Belfort Establishment in Algiers in 2019, 2020, and 2021. All the patients had developed signs and symptoms of postnatal CMV infection with intrauterine growth retardation. The clinical manifestations differed; some presented cytopenia with or without hepatosplenomegaly and others a clinical and biological cholestasis syndrome. All our patients had intrauterine growth retardation. A CMV PCR of a urine sample was positive. Treatment for six weeks based on ganciclovir, with a relay by valganciclovir.

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Congenital Cytomegalovirus Pneumonitis and Treatment Response Evaluation Using Viral Load during Ganciclovir Therapy: a Case Report

Cited by 10 publications

References 15 publications

Cytomegalovirus encephalitis in immunocompetent infants: A 15-year retrospective study at a single center

Cytomegalovirus encephalitis in immunocompetent infants: A 15-year retrospective study at a single center

Pulmonary Complications of Cytomegalovirus Infection in Neonates and Infants: A Systematic Review of Case Reports and Pooled Analysis

Congenital Cytomegalovirus in Algiers, Algeria, a Descriptive Case Series Study

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