Cytomegalovirus disease in neonates and infants--clinical presentation, diagnostic and therapeutic problems--own experience.
Anna Liberek, Marlena Rytlewska, Agnieszka Szlagatys-Sidorkiewicz, Wanda Bako, Grazyna Łuczak, Grazyna Sikorska-Wiśniewska, Maria Korzon
Med Sci Monit 2002; 8(12): CR815-820
BACKGROUND: The aim of the study was to present diagnostic problems, different clinical presentations and results of treatment of cytomegalovirus infections in neonates and infants. MATERIAL/METHODS: The study was carried out in a group of 31 children from 10 days to 12 months of age (17 boys, 14 girls). The diagnosis was based on serological investigations (presence of specific IgM antibodies and/or increasing titer of IgG antibodies), presence of intermediate or early CMV antigen in peripheral blood leukocytes or positive blood or urine PCR results. The treatment of 25 cases involved intravenous administration of gancyclovir at 5-7 mg/kg daily doses for 14-21 days. In 1 case, hyperimmunized anti-CMV serum - Cytotect was used. RESULTS: The most common clinical symptoms were jaundice, hepato- and splenomegaly. Clinical investigations demonstrated increased aminotransferese activity and the signs of cholestasis. Other frequent findings included anemia, leukocytosis with atypical lymphocyte forms present, as well as thrombocytopenia. In majority treated patients, rapid regression of the clinical symptoms and normalization of transaminases activity was observed. Good outcome of the therapy was confirmed by immunological investigations. The effects of the terapy were similar irrespective of the dose and duration of gancyclovir treatment. The tolerance of the drug was good - no indications for discontinuation of the treatment were observed in any of the patients. CONCLUSIONS: The clinical presentations of cytomegalovirus disease in infants are varied, the diagnosis of the disease should be considered in children with persistent jaundice, especially if it is accompanied by hepatomegaly and increased aminotransferase activity or signs of cholestasis. Despite relatively good tolerance of the drug by children, the patients should be monitored for possible side effects, especially myelo- and nephrotoxic.
Keywords: Antigens, Viral - blood, Cytomegalovirus Infections - diagnosis, Cytomegalovirus Infections - drug therapy