Characterization of cytomegalovirus lung infection in non-HIV infected children

• Published in: Viruses 2014-05, Vol.6 (5), p.2038-2051
• Main Authors: Restrepo-Gualteros, Sonia M, Jaramillo-Barberi, Lina E, Gonzalez-Santos, Monica, Rodriguez-Martinez, Carlos E, Perez, Geovanny F, Gutierrez, Maria J, Nino, Gustavo
• Format: Article
• Language: English
• Subjects: Adolescent; Biopsy; Child; Child, Preschool; children; CMV; Cytomegalovirus; Cytomegalovirus - isolation & purification; Cytomegalovirus Infections - epidemiology; Cytomegalovirus Infections - microbiology; Cytomegalovirus Infections - pathology; Cytomegalovirus Infections - virology; Epidemiology; Female; ground glass; HIV; HIV Infections; Hospitals; Human immunodeficiency virus; Humans; Infant; Infant, Newborn; Infections; lung; Lung - diagnostic imaging; Lung - pathology; Lung - virology; Male; Medicine; Pediatrics; Pneumonia; Pneumonia, Viral - epidemiology; Pneumonia, Viral - microbiology; Pneumonia, Viral - pathology; Pneumonia, Viral - virology; Pulmonology; Radiography; Respiratory Insufficiency - epidemiology; Survival Analysis; Transplants & implants; Viruses
• ISSN: 1999-4915; 1999-4915
• DOI: 10.3390/v6052038

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%. 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.