Clinical Analysis Of Cytomegalovirus Pneumonia In Immunocompromised Children

Objective:To explore the diagnosis and treatment of cytomegalovirus pneumonia in immunocompromised children.Methods:A total of 12 children with immunocompromised CMV pneumonia who were diagnosed at the Children’s Hospital Affiliated to the Capital Institute of Pediatrics from January 2015 to December 2019 were selected as subjects.The general situation,host factors,clinical manifestations,imaging findings,laboratory examination results,treatment and prognosis of children with immunocompromised CMV pneumonia were retrospectively analyzed.According to gender,age and basic diseases,16 cases were clinically diagnosed as fungal pneumonia(8 cases of candida pneumonia,8 cases of Aspergillus pneumonia)and 23 cases of bacterial pneumonia.The differences in general conditions,clinical manifestations and chest imaging of the children were compared.Results:Among the 12 cases of CMV pneumonia,9 cases(75%)were male and 3 cases(25%)were female,with a male to female ratio of 3:1.At the time of diagnosis of CMV pneumonia,the age of the children ranged from 1 month to 11 years,with a median age of 3.9(2.2,5.9)years.Of the 12 children with CMV pneumonia,all had host risk factors,6 received hematopoietic stem cell transplantation,4 were treated with immunosuppressant or glucocorticoid therapy,and 2 had an immunodeficiency onset in the neonatal period.In terms of clinical manifestations,11 cases of CMV pneumonia(91.7%)had cough manifestations,4 cases(33.3%)had dyspnea during the course of disease,and 2 cases(16.7%)had hemoptysis.In terms of pulmonary signs,6 cases(50.0%)had wet rile in the lungs,and 3 cases(33.3%)had no signs in the lungs.Besides pulmonary involvement,4 cases(33.3%)had clinical manifestations outside the lungs,among which 3 cases(25.0%)had CMV cystitis,and 1 case(16.7%)had CMV encephalitis and CMV retinitis.Blood routine and CRP examinations were completed in all children.Lymphocyte count decreased in 8 cases(66.7%),neutropenia in 6 cases(50.0%),neutropenia in 1 case(8.3%),and the median CRP was 7.0(1.6,32.5)mg/L.Fiberoptic bronchoscopy was performed in 1 child,and BALF CMV-DNA was positive.Eleven children underwent sputum CMV-DNA examination,of which 10(91.0%)were positive.Of the 11 children who underwent blood CMV-DNA tests,8(72.8%)were positive.Urinary CMV-DNA tests were performed in 7 children,of which 5(71.4%)were positive.CMV-IgM tests were performed in 5 children,of which 1(20.0%)was positive.All the 12 cases were examined for biochemical indexes,among which 8 cases(66.7%)had elevated liver enzymes.The most common chest imaging findings for diagnosis of CMV pneumonia are ground glass opacity and patchy opacity.Twelve children were given respiratory management,respiratory support and antiviral treatment,and some were given symptomatic support of pellet C and CMV globulin.Eleven patients were discharged from hospital after improvement,and the parents of one treatment abandoning.There were statistically significant differences in the time from the onset of clinical symptoms to CT change in the CMV group,and the CMV group was longer than the bacterial and fungal group(P=0.015).Among the three groups,there were statistical differences in nodule,halo sign and patchy/realistic shadow among the three groups(P<0.05).In the distribution of nodule between the CMV group and the fungal group,the CMV group was more prone to diffuse nodule shadow(P=0.001),and the children in the fungal group were more prone to halo sign(P=0.037).The bacteria group was more likely to have patchy/realistic shadow(P=0.001).Compared with the children in the CMV group and the Candida group,there was a statistical difference in CRP values,and The C-reactive protein values in CMV group were significantly lower than those in Candida group(P=0.015).Compared with the two groups,CMV group was more prone to diffuse nodules(P=0.004).Conclusion:There are no specific clinical manifestations and no characteristic imaging changes in children with immunocompromised CMV pneumonia.It is necessary to be vigilant against CMV pneumonia when children with host high risk factors have respiratory symptoms,especially when the lymphatic count is reduced.Imaging changes caused by CMV pneumonia are relatively slow,chest CT mostly shows diffuse distribution and multiple nodules,fungal pneumonia shows relatively limited nodules,bacterial pneumonia mostly shows patchy/consolidation shadows,and the progress is fast.Due to the small sample size,no other imaging signs of differential significance were obtained in this study,and a large sample of clinical studies are still needed for comparison.In clinical work,we should combine imaging with a variety of other detection techniques,such as sputum and BALF CMV-DNA,etc.CMV-DNA examination of respiratory secretions is the key to diagnose CMV pneumonia as soon as possible.For children diagnosed with immunocompromised CMV pneumonia,early use of antiviral drugs is the key to control the disease.