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Of "Cotton Balls" and "Owl's eyes"
1ABVIMS and Dr RML Hospital, Department of Pathology, New Delhi, India. sunayanamisra@gmail.com.
Insights
A 3-month-old infant died from cytomegalovirus (CMV) and pneumocystis jiroveci pneumonia (PJP), highlighting severe outcomes in immunocompromised infants. Maternal HIV contributed to the infant's vulnerability to these co-infections.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Immunology
Background:
- Cytomegalovirus (CMV) and pneumocystis jiroveci pneumonia (PJP) are opportunistic infections.
- Co-infections typically occur in immunocompromised individuals, particularly infants.
- Congenital CMV infection can lead to severe multi-systemic disease.
Observation:
- A 3-month-old infant presented with multi-systemic CMV infection (lungs, liver, kidneys) and PJP.
- The infant's mother was HIV-positive with a low CD4 count (160/μl) and CMV IgG positive.
- PJP commonly presents as hypoxic pneumonia in infants.
Findings:
- CMV infection in the infant involved multiple organs.
- Histological findings for CMV included cyto-nucleomegaly and "owl's eye" inclusions.
- PJP presented with characteristic "cotton ball" alveolar exudates.
Implications:
- This case underscores the severe consequences of CMV and PJP co-infection in immunocompromised infants.
- Maternal health status, including HIV and CMV status, is critical for infant outcomes.
- Early diagnosis and management of opportunistic infections in vulnerable infants are crucial.
Abstract:
Report of a 3-month old girl child who died due to multi-systemic infection of cytomegalovirus (CMV) involving the lungs, liver and kidneys along with pneumocystis jiroveci pneumonia (PJP). The mother of the child tested positive for CMV IgG and HIV with a very low CD4 count (160/ μl). Co-infection of cytomegalovirus and pneumocystis jiroveci always occurs in the setting of immunocompromise. Congenital CMV infection is transmitted through the placenta, especially during the first trimester and causes severe multi-systemic disease whereas perinatal infection is acquired during childbirth/ breastfeeding where the babies have maternal protective antibodies leading to much milder or asymptomatic infection. PJP is more common in infancy and presents as hypoxic pneumonia. CMV causes cyto-nucleomegaly and classic "owl's eye" inclusions on histology while PJP presents with characteristic fluffy "cotton ball" alveolar exudates.
