Characteristics and outcomes of infants with cytomegalovirus infection in Bloemfontein
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Abstract
Background. Cytomegalovirus (CMV) infection may significantly contribute to morbidity and mortality in infancy.
Objectives. To describe the outcomes and characteristics of CMV-infected infants in an HIV-prevalent population.
Methods. A retrospective, descriptive study was conducted by reviewing hospital records of infants who had a positive CMV test and were admitted to the academic hospitals in Bloemfontein.
Results. Inpatient mortality for CMV-infected infants was 13.3% (n=18/135). Of those, 66.6% (12/18) of patients who died were HIV exposed and 33.3% (6/18) had CMV/HIV co-infection. The most common causes of death were sepsis (38.9%), pneumonia/pneumonitis (33.3%) and multi-organ failure (11.2%). Approximately 60.7% (82/135) of all CMV-positive infants were HIV exposed, while 20.7% (28/135) were HIV infected. More than half (55.6%) of the patients had a birth weight <2.5 kg, while 48.7% were preterm. A third (33.3%) of the patients were small for gestational age at birth, with suboptimal postnatal growth in 62.2%. Microcephaly was present at birth in 25.2%. Poor brain growth led to postnatal microcephaly in 46.6% of patients. The most common clinical presentations were CMV pneumonia/pneumonitis (60%) and hepatomegaly (50.4%). Thrombocytopenia was a common finding (41.5%). Half (50%) of the infants who died were not treated with antiviral medication.
Conclusion. CMV infection in infancy is under-appreciated in South Africa. It may contribute to morbidity and mortality, particularly in preterm and low birth weight infants and HIV-exposed or infected infants. Clinicians should have a high index of suspicion for CMV infection in infants who have postnatal growth failure and postnatal microcephaly.
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