Effect of ganciclovir for the treatment of severe cytomegalovirus-associated pneumonia in children without a specific immunocompromised state

Abstract

BackgroundThis study aimed to evaluate the effectiveness of gancyclovir (GCV) treatment for severe cytomegalovirus (CMV)-associated pneumonia in immunocompetent children.MethodWe enrolled patients with CMV-associated severe pneumonia admitted to the Vietnam National Hospital of Pediatrics, Hanoi, Vietnam, from January 2010 to December 2011. On admission, though respiratory bacteria and viruses were not detected in tracheal aspirates, more than 5 × 103 copies/mL of CMV-DNA were detected in both tracheal aspirates and in blood plasma. GCV was given intravenously at a dose of 10 mg/kg/24 h for a duration of 14 days at most. The dose was then reduced to 5 mg/kg/24 h until CMV-DNA was not detected in plasma. The main study variables included clinical symptoms, complete blood count, hepatic and renal function, chest X-ray, CMV viral load, duration of GCV treatment and outcome.ResultsForty-three patients were enrolled in the study. The median age of patients was 57 (interquartile range [IQR] 45–85) days. Clinical and laboratory findings included anemia (67.4%), leukocytosis (90.7%), hepatosplenomegaly (60.5%), elevated liver enzymes (74.4%), decreased ratio of CD4: CD8-positive T lymphocytes (69.4%), and decreased serum IgG concentration (25.7%). The median duration of GCV treatment was 12 days (IQR 7-21). Thirty-seven patients (86.0%) showed normal chest X-rays at the end of treatment. One infant died (2.3%); the other children (97.7%) were discharged in good condition. There was no severe toxicity associated with GCV treatment.ConclusionGCV is safe and effective for the treatment of severe CMV-associated pneumonia in children.

Cytomegalovirus infection in immunocompetent wheezy infants: the diagnostic value of CMV PCR in bronchoalveolar lavage fluid

“…Thanh Thi Mai Doan et al . investigated 43 patients with CMV‐associated severe pneumonia and showed that the median CMV viral load in plasma was 59·5 × 10 3 copies/mL, whereas that in tracheal aspirate specimens was 120 × 10 3 copies/mL.…”

Surgical manifestations of gastrointestinal cytomegalovirus infection in children: Clinical audit and literature review

“…A third were premature, a risk group known to have impaired Tcell and immunoglobulin response to CMV infection [17][18][19]. The association between NEC and CMV in this group is unclear, as CMV could be secondarily reactivated by the inflammation; however, in HIV positive infants younger than 3 months, an NEC-like presentation with multiple 'punched-out' perforations throughout the small bowel is a distinctive presentation which should prompt CMV work-up, and may represent primary CMV enteritis [20].…”

Cytomegalovirus hepatitis in 49 pediatric patients with normal immunity

“…Although clear data about the duration of anti-CMV therapy in immunocompetent individuals are not present, there are various studies about treatment regimens ranging between 5 and 21 days (2,9,14,15), and even more long-term applications in some cases based on clinical and laboratory findings are present (17,18). Ganciclovir treatment was administered to our patients in the appropriate period specified in the literature.…”