Pulmonary involvement with cytomegalovirus infections in children.

Abstract

SUMMARY Among 40 hospitalized infants and children with cytomegalovirus infection, 14 (35 %) had interstitial pneumonitis, 4 (10%) had wheezing or tachypnoea but without x-ray evidence of classical interstitial pneumonia, the remaining 22 (55 %) were free of pulmonary involvement. Most patients had tachypnoea and nonproductive cough of varying durations: those with underlying pulmonary pathology tended to have persistent and prolonged respiratory symptoms. Mortality and severity of the lung disease were related to the underlying immunodeficiency or concomitant pulmonary process.Clinical presentations of cytomegalovirus (CMV) infection encompass a broad spectrum of symptoms and signs ranging from asymptomatic disease to lethal congenital infection (Hanshaw et al., 1965;Starr and Gold, 1968). The most common features of congenital infection include hepatosplenomegaly, jaundice, petechiae, low birthweight, and microcephaly (Overall and Glasgow, 1970). Acquired CMV infections are often seen in patients with altered host resistance (Hill et al., 1964;Cangir and Sullivan, 1966;Sutton et al., 1967;Neiman et al., 1973), but these infections may also occur in normal hosts (Klemola et al., 1969; Jordan et al., 1973). Various manifestations of acquired CMV infection have been reported, e.g. infectious mononucleosis-like syndrome, hepatitis, postperfusion syndrome, etc. (Hanshaw et al., 1965;Embil et al., 1968;Klemola et al., 1969Klemola et al., , 1972 Jordan et al., 1973).Pneumonia occurs not infrequently in patients dying from CMV infection both in congenital disease (Medearis, 1964;McCracken et al., 1969) and in hosts with altered immunity (Hill et al., 1964;Rifkind et al., 1967

Characterization of Cytomegalovirus Lung Infection in Non-HIV Infected Children

“…CMV is a herpes virus that can produce life-threatening pulmonary infections in immunocompromised hosts [ 4 ]. Although effective antiviral therapy for CMV is available [ 11 , 13 ], timely diagnosis remains a major challenge for this condition, particularly in the pediatric population where CMV often presents with atypical patterns of lung infection [ 5 , 14 ]. The diagnosis of CMV pneumonia can be even more difficult in situations when there is no high-index of suspicion, for instance, in patients that do not have an underlying immunodeficiency syndrome ( i.e.…”

“…In terms of the clinical presentation and respiratory compromise, the onset of symptoms had a mean time of 14 days however there was considerable variation ranging from three days in a patient that required early mechanical ventilatory support, and up to three weeks in one child with nonspecific symptoms, a feature that has previously labeled CMV as an unpredictable respiratory infection [ 5 ]. Overall there was also great heterogeneity in the severity of the respiratory compromise.…”

“…There are few reports that address the specific clinical and pulmonary imaging findings that may suggest this difficult diagnosis. Smith et al in 1977 described the clinical respiratory findings and radiological appearance of CMV pulmonary infection in children using plain X-ray films [ 5 ]. This seminal work enhanced the awareness of the atypical course of CMV infection in the lungs, often described as “CMV pneumonitis” [ 5 ], which includes non-specific pulmonary findings such as interstitial patterns with increased bronchopulmonary markings and bronchiolar disease (diffuse air trapping) [ 5 ].…”

“…Smith et al in 1977 described the clinical respiratory findings and radiological appearance of CMV pulmonary infection in children using plain X-ray films [ 5 ]. This seminal work enhanced the awareness of the atypical course of CMV infection in the lungs, often described as “CMV pneumonitis” [ 5 ], which includes non-specific pulmonary findings such as interstitial patterns with increased bronchopulmonary markings and bronchiolar disease (diffuse air trapping) [ 5 ]. Interestingly, there has been a dramatic change in both the epidemiology of CMV infection and diagnostic techniques available for its diagnosis in children over the last 30 years [ 6 ].…”

Desquamative interstitial pneumonitis and alveolar lipoproteinosis: Diagnostic difficulties and therapy problems with an infant

“…CMV disease of the lung was included as a possible diagnosis because DIP/ALP was not suspected first. Pulmonary involvement in cytomegalovirus disease is severe and of prolonged nature only in the immune-compromised patient [14,15]. The fact that the virus was found neither in tracheal aspirates nor in lung tissue spoke against CMV infection of the lung.…”