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Cytomegaloviremia in children with acute lymphocytic leukemia
Abstract:
Leukocyte and urine cultures were done at monthly intervals in 36 children with acute lymphocytic leukemia known to be excreting cytomegalovirus in their or saliva in order to determine the relationship of viremia to clinical cytomegalic inclusion disease. Eleven of 36 (30.5%) patients had viremia. Viremia was related to clinical disease in only three patients; two with chorioretinitis and one with a CMV monomucleosis syndrom. However, the presence of viremia did not serve as a useful means to determine active CID. Viremic patients with CID all had elevated serum levels of IgM and multiple episodes of viremia. Viremia was not related to the duration, type or number of drugs used in immunosuppression, nor to the hematologic status of leukemia. Viremic patients received more blood transfusions than noviremic patients, but the administration of blood products could not be related to the acquisition of infection. Leukopenia, neutropenia, total lymphocyte count, fourfold rise or fall in complement-fixing titer, and viruria had no consistent relationship to viremia or clinical CID.
Insights
Cytomegalovirus (CMV) viremia in children with acute lymphocytic leukemia (ALL) is common but rarely indicates active disease. Viremia monitoring alone is insufficient for diagnosing cytomegalic inclusion disease (CID) in these patients.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Virology
Background:
- Cytomegalovirus (CMV) is a common opportunistic infection in immunocompromised individuals, particularly children with acute lymphocytic leukemia (ALL).
- Determining the clinical significance of CMV shedding and viremia in this vulnerable population is crucial for patient management.
Purpose of the Study:
- To investigate the relationship between cytomegalovirus (CMV) viremia and the presence of clinical cytomegalic inclusion disease (CID) in children with acute lymphocytic leukemia (ALL).
- To assess the utility of viremia detection as a diagnostic marker for active CID in pediatric ALL patients.
Main Methods:
- Monthly leukocyte and urine cultures were performed in 36 children with ALL known to be excreting CMV.
- Clinical data, including signs of CID, immunosuppression therapy, hematologic status, and blood product transfusions, were collected and analyzed in relation to viremia status.
Main Results:
- CMV viremia was detected in 11 of 36 (30.5%) children.
- Viremia correlated with clinical CID in only three patients (two with chorioretinitis, one with CMV mononucleosis syndrome).
- Viremia was not consistently associated with immunosuppression, leukemia status, or specific laboratory markers like leukopenia or viruria. Viremic patients received more blood transfusions, but this was not linked to infection acquisition.
Conclusions:
- The presence of CMV viremia in children with ALL does not reliably indicate active cytomegalic inclusion disease (CID).
- Monitoring viremia alone is insufficient for diagnosing active CID.
- Further investigation is needed to understand the clinical implications of CMV viremia in pediatric ALL patients.