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[Cytomegalovirus pneumopathies in pediatric intensive care units]
Insights
Cytomegalovirus (CMV) pneumonia is a serious condition in immunocompromised children. Ganciclovir treatment showed limited benefit, suggesting combined therapies may be more effective for CMV pneumonia.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Critical Care Medicine
Context:
- Cytomegalovirus (CMV) infection poses significant risks to immunocompromised infants and children.
- Diagnosing CMV pneumonia can be challenging, with its exact role in disease often unclear.
- This study examines a cohort of pediatric patients with CMV pneumonia.
Purpose:
- To describe the clinical characteristics, diagnosis, and outcomes of CMV pneumonia in a cohort of 20 children.
- To evaluate the efficacy of ganciclovir treatment in this patient population.
- To identify potential improved therapeutic strategies for CMV pneumonia.
Summary:
- Twenty children (1 month to 11 years 10 months) with CMV pneumonia were classified into three groups: hemopathy/cancer, AIDS, and non-immunocompromised/immunosuppressed.
- Diagnosis involved bronchoalveolar lavage (BAL) for CMV isolation, lung biopsy, or CMV cultures; interstitial pneumonia was noted in immunocompromised patients.
- Mortality rates were high (90% in group I, 100% in group II, 33% in group III), with ganciclovir showing limited benefit in immunocompromised cases.
Impact:
- Ganciclovir alone appears insufficient for treating immunocompromised children with CMV pneumonia.
- Future strategies may benefit from combining hyperimmune CMV immunoglobulins with ganciclovir.
- Emphasizes the importance of infection control measures like hand washing and using CMV-negative blood products.
Background:
Cytomegalovirus (CMV) infection can result in major complications in immunocompromised infants and children. CMV pneumonia may be difficult to diagnose and the true pathogenic role of the virus in the disease is not always clear. This report describes a cohort of 20 children who suffered from CMV pneumonia.
Populations And Methods:
Twenty children aged 1 month to 11 years 10 months were admitted to our intensive care unit between 1981 and 1990 because of pneumonia with evidence of CMV infection. They were classified into three groups: group I (cases 1-10) with hemopathy or cancer, group II (cases 11-14) with AIDS, and group III (cases 15-20): non immunodeficient or immunosuppressed children. CMV infection was diagnosed after isolation of CMV from bronchoalveolar lavage (BAL) fluid (15 patients), lung biopsy revealing intranuclear inclusions or CMV antigens, or CMV-positive cultures (four patients), CMV-positive urine cultures (one patient).
Results:
Clinical manifestations and X-rays findings were unspecific; interstitial pneumonia was found only in immunodeficient patients. CMV pneumonia was diagnosed only in two patients on post mortem examination. Concomitant pneumocystis carinii was found on BAL in two patients (group I) and two others (group II). Thirteen patients required ventilation. Eleven patients were given ganciclovir for 2 or 3 weeks; one of them was given a single dose. This treatment was well tolerated. Mortality was 90% in group I, 100% in group II and 33% in group III.
Conclusion:
Ganciclovir did not appear to benefit the immunocompromised patients with CMV pneumonia. Future treatment should include hyperimmune CMV immunoglobulins plus ganciclovir. Careful hand washing is important for all those caring for these patients to prevent contamination as is the use of CMV-negative blood products.