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Published on: July 6, 2013
CMV pneumonia in HIV-infected ventilated infants
1Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa. pgouss@sun.ac.za
Cytomegalovirus (CMV) pneumonia is a significant cause of mortality in ventilated HIV-infected infants with suspected Pneumocystis jiroveci pneumonia (PJP). Empirical ganciclovir treatment is recommended for these critically ill infants.
Area of Science:
- Pediatric Infectious Diseases
- Critical Care Medicine
- Virology
Background:
- Cytomegalovirus (CMV) role in infants treated for Pneumocystis jiroveci pneumonia (PJP) is unclear.
- High-dose steroids for PJP may increase susceptibility to CMV pneumonia in infants.
Purpose of the Study:
- To determine the role of CMV pneumonia in ventilated infants with suspected PJP.
- To investigate the impact of CMV on treatment outcomes and mortality in this cohort.
Main Methods:
- Prospective study of HIV-infected infants ventilated for suspected PJP unresponsive to trimethoprim-sulfamethoxazole (TMP/SMX).
- Open lung biopsy or post-mortem tissue analysis for diagnosis.
- Histology, immunohistochemistry, and viral cultures used for pathogen identification.
Main Results:
- Cytomegalovirus (CMV) pneumonia was diagnosed in 72% of infants failing PJP treatment.
- CMV and PJP dual infection occurred in 36%, CMV pneumonia in 36%, and PJP alone in 24%.
- High mortality rates observed: 72% in PICU and 88% in-hospital.
Conclusions:
- CMV pneumonia significantly contributes to high mortality in ventilated HIV-infected infants with severe pneumonia.
- Empirical ganciclovir treatment is warranted for infants with suspected PJP unresponsive to initial therapy.
- Further research is needed on the role of lung biopsy in diagnosing CMV pneumonia in this population.
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