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CMV pneumonia in HIV-infected ventilated infants

P Goussard1, S Kling, R P Gie

  • 1Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa. pgouss@sun.ac.za

Pediatric Pulmonology
|June 25, 2010
PubMed
Abstract

Insights

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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