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Viruses 2014, 6(5), 2038-2051; doi:10.3390/v6052038

Characterization of Cytomegalovirus Lung Infection in Non-HIV Infected Children

1 Division of Pediatric Pulmonology, Fundacion Hospital La Misericordia, Bogota 111411, Colombia 2 Department of Pediatrics, School of Medicine, Universidad de los Andes, Fundacion Santa Fe de Bogota, Bogota 110111, Colombia 3 Department of Pathology, School of Medicine, Universidad Nacional de Colombia, Bogota 111321, Colombia 4 Department of Pathology, Fundación Hospital La Misericordia, Bogota 111411, Colombia 5 Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota 111321, Colombia 6 Department of Pediatric Pulmonology and Pediatric Critical Care Medicine, School of Medicine, Universidad El Bosque, Bogota 110111, Colombia 7 Research Unit, Military Hospital of Colombia, Bogota 111321, Colombia 8 Division of Pulmonary and Sleep Medicine, Children's National Medical Center, Washington, DC 20010, USA 9 Division of Pediatric Rheumatology, Allergy and Immunology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA 10 Department of Integrative Systems Biology, Center for Genetic Medicine Research, Children's National Medical Center, George Washington University, Washington, DC 20010, USA
* Author to whom correspondence should be addressed.
Received: 21 January 2014 / Revised: 29 March 2014 / Accepted: 3 April 2014 / Published: 7 May 2014
(This article belongs to the Special Issue Recent CMV Research)
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Cytomegalovirus (CMV) is a prevalent pathogen in the immunocompromised host and invasive pneumonia is a feared complication of the virus in this population. In this pediatric case series we characterized CMV lung infection in 15 non-HIV infected children (median age 3 years; IQR 0.2–4.9 years), using current molecular and imaging diagnostic modalities, in combination with respiratory signs and symptoms. The most prominent clinical and laboratory findings included cough (100%), hypoxemia (100%), diffuse adventitious breath sounds (100%) and increased respiratory effort (93%). All patients had abnormal lung images characterized by ground glass opacity/consolidation in 80% of cases. CMV was detected in the lung either by CMV PCR in bronchoalveolar lavage (82% detection rate) or histology/immunohistochemistry in lung biopsy (100% detection rate). CMV caused respiratory failure in 47% of children infected and the overall mortality rate was 13.3%. Conclusion: CMV pneumonia is a potential lethal disease in non-HIV infected children that requires a high-index of suspicion. Common clinical and radiological patterns such as hypoxemia, diffuse adventitious lung sounds and ground-glass pulmonary opacities may allow early identification of CMV lung infection in the pediatric population, which may lead to prompt initiation of antiviral therapy and better clinical outcomes.
Keywords: CMV; lung; pneumonia; children; ground glass CMV; lung; pneumonia; children; ground glass
This is an open access article distributed under the Creative Commons Attribution License (CC BY 3.0).

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Restrepo-Gualteros, S.M.; Jaramillo-Barberi, L.E.; Gonzalez-Santos, M.; Rodriguez-Martinez, C.E.; Perez, G.F.; Gutierrez, M.J.; Nino, G. Characterization of Cytomegalovirus Lung Infection in Non-HIV Infected Children. Viruses 2014, 6, 2038-2051.

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