Cytomegalovirus encephalitis in immunocompetent infants: A 15-year retrospective study at a single center
Cytomegalovirus encephalitis in immunocompetent infants: A 15-year retrospective study at a single center
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免疫功能正常婴儿的巨细胞病毒脑炎：单中心 15 年回顾性研究
DOI：
10.1016/j.ijid.2019.02.045
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发表时间：
2019-05-01
影响因子：
8.4
通讯作者：
Jiang, Li
中科院分区：
文献类型：
--
作者：
Guo, Yi;Jiang, Li
目的：巨细胞病毒（CMV）脑炎是一种主要影响免疫功能低下宿主的疾病。只有少数病例报告免疫功能正常的人，特别是儿童。本研究的目的是调查中国西南地区单个医疗中心15年内免疫功能正常的CMV脑炎患儿的临床特征。方法：回顾性分析2002-2017年在重庆医科大学附属儿童医院住院确诊的CMV脑炎患儿的病历。分析的临床特点，实验室数据，和抗病毒治疗的治疗反应performed.Results：患者的中位年龄（n = 18）为5.1个月。“癫痫发作”是最早和最常见的神经系统症状，而大多数患者也存在发热和进食不良。脑脊液（CSF）蛋白升高是最明显的生化发现。经两阶段更昔洛韦治疗后，所有患者的临床症状均得到稳定改善。不良反应发生率为27.3%，主要表现为对造血系统和肝脏的影响。在3至36个月的随访期间，9例患者显示完全恢复。确诊时脑脊液CMV-PCR全部阳性，抗-CMV-IgM阳性率为77.8%。两个阶段更昔洛韦治疗后，所有患者表现出阴性结果CMV基因组在CSF和一个明确的减少在urinage.Conclusions：CMV脑炎的可能性在免疫功能正常的儿童应牢记，特别是在那些年龄小于6个月。在出现不明原因的明显癫痫发作、发热、进食不良和脑脊液蛋白水平明显升高时，需要怀疑CMV脑炎的诊断。CSF的CMV PCR检测是确定病因所必需的。此外，测量CSF和尿液中的CMV载量可能有助于评估对治疗的反应和结果。更昔洛韦可改善临床症状，不良反应有限。免疫功能正常的婴儿发生CMV脑炎并不一定意味着短期预后不良。(C)2019作者由爱思唯尔有限公司代表国际传染病学会出版。
Objective: Cytomegalovirus (CMV) encephalitis is a disease that primarily affects immunocompromised hosts. Only a few cases have been reported in immunocompetent individuals, especially in children. The aim of this study was to investigate the clinical characteristics of immunocompetent children with CMV encephalitis attending a single medical center in southwest China over a 15-year period.Methods: The medical records of children with confirmed CMV encephalitis who were hospitalized in the Children's Hospital of Chongqing Medical University during they ears 2002-2017 were reviewed. An analysis of the clinical features, laboratory data, and the treatment response to antiviral therapy was performed.Results: The median age of the patients (n = 18) was 5.1 months. 'Seizures' was the earliest and most common neurological symptom, while fever and poor feeding were also present in most patients. Elevated cerebrospinal fluid (CSF) protein was the most noticeable biochemical finding. After treatment with two-stage ganciclovir, all patients showed a steady clinical improvement. The total adverse drug reaction (ADR) rate was 27.3%, mainly presenting as effects on the hematopoietic system and liver. During follow-up ranging from 3 to 36 months, nine patients showed a complete recovery. At the stage of diagnosis, CMV PCR of CSF was positive in all patients, while anti-CMV IgM was positive in 77.8% of patients. After treatment with two-stage ganciclovir, all patients showed a negative result for CMV genome in the CSF and a clear decrease in the urine.Conclusions: The possibility of CMV encephalitis in the immunocompetent child should be kept in mind, especially in those younger than 6 months of age. Suspicion for a diagnosis of CMV encephalitis is needed in the presence of unexplained prominent seizure, fever, poor feeding, and a marked elevation of protein level in the CSF. CMV PCR assays of CSF are necessary to determine the etiology. Furthermore, measurement of the CMV load in CSF and urine may be useful for evaluating the response to treatment and the outcome. Ganciclovir may lead to clinical improvement with limited ADR. CMV encephalitis in the immunocompetent infant does not necessarily indicate a poor short-term prognosis. (C) 2019 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.