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Rodrigues AS, Correia de Azevedo A, Nobre S, Fonseca P. Multisystemic Disease in a Child and Successful Recovery With Antiviral Treatment. Cureus 2024; 16:e53893. [PMID: 38468986 PMCID: PMC10927160 DOI: 10.7759/cureus.53893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 03/13/2024] Open
Abstract
Cytomegalovirus (CMV), a member of the Herpesviridae family, typically causes asymptomatic infections or mild mononucleosis-like syndromes in immunocompetent individuals. However, severe manifestations are well-documented in immunocompromised populations. This case report presents a previously healthy seven-year-old girl with a rare and complex presentation of primary CMV infection leading to severe multiorgan involvement, hepatosplenomegaly, cholestasis, bicytopenia, and a prolonged disease course. The patient's condition prompted an exhaustive diagnostic investigation, ruling out other potential causes. The diagnosis was confirmed by positive CMV IgM and IgG antibodies and a significantly elevated CMV DNA viral load. Treatment with intravenous ganciclovir resulted in a remarkable recovery. The case underscores the importance of considering CMV as a potential etiology of hepatitis, even in immunocompetent children, and the challenges of diagnosing complicated CMV infections. While guidelines for treating CMV in immunocompetent individuals are lacking, this report suggests that antiviral therapy may be beneficial in severe cases. Further research is needed to establish clear treatment protocols for such instances. This report contributes to the limited body of literature on severe CMV-induced hepatitis in immunocompetent children, emphasizing the need for heightened clinical awareness and timely interventions to prevent progression to acute liver failure.
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Affiliation(s)
| | | | - Susana Nobre
- Paediatric Hepatology and Liver Transplantation Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, PRT
| | - Paula Fonseca
- Pediatrics, Centro Hospitalar do Médio Ave, Vila Nova de Famalicão, PRT
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Chen J, Zhou Y, Tang J, Xu C, Chen L, Xu B, Dai Y, Hu Y, Zhou YH. Minimal adverse outcomes of postnatal cytomegalovirus infection in term or moderate and late preterm infants. Front Pediatr 2023; 11:1048282. [PMID: 36816367 PMCID: PMC9936240 DOI: 10.3389/fped.2023.1048282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/17/2023] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The aim of study was to investigate at what extent breastfeeding and vaginal delivery can increase mother-to-child transmission of cytomegalovirus (CMV) and to observe the clinical outcomes of postnatal infection in term or moderate and late preterm infants. METHODS In this retrospective study of prospectively collected clinical data and serum samples, during 2012-2015, 380 women with CMV IgG positive/IgM negative and their 384 infants (4 twin pairs) with gestational age ≥32 weeks were included. CMV IgG and IgM were measured with enzyme-linked immunosorbent assay. RESULTS Of 384 infants followed up at 10.2 ± 2.3 months age, 177 (46.1%) were defined with CMV infection based on the presence of higher CMV IgG levels than in their mothers. The infection rate in 190 breastfed infants was higher than in 194 formula-fed infants (62.6% vs. 29.9%, P < 0.001). Vaginally delivered infants (172) had higher CMV infection rate than 212 infants delivered by caesarean section (55.2% vs. 38.7%, P = 0.001). Compared with formula feeding and caesarean section, breastfeeding and vaginal delivery increased postnatal CMV infection respectively (OR = 3.801, 95% CI 2.474-5.840, P < 0.001; OR = 1.818, 95% CI 1.182-2.796, P = 0.007). Nevertheless, compared to uninfected infants, CMV-infected infants had comparable height and body weight and showed no adverse effect on the liver enzymes. CONCLUSION Breastfeeding and vaginal delivery can increase postnatal CMV infection; however, the infection does not influence the growth of the term infants or preterm infants with gestational age ≥32 weeks. Thus, breastfeeding should be encouraged in these infants regardless of maternal CMV IgG status.
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Affiliation(s)
- Jie Chen
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Yineng Zhou
- Department of Internal Medicine, Wuxi Children's Hospital, Wuxi, China
| | - Jie Tang
- Department of Obstetrics and Gynecology, Wujin Hospital Affiliated with Jiangsu University, Changzhou, China.,Department of Obstetrics and Gynecology, The Wujin Clinical College of Xuzhou Medical University, Changzhou, China
| | - Chenyu Xu
- Department of Obstetrics and Gynecology, Zhenjiang Fourth People's Hospital, Zhenjiang, China
| | - Liping Chen
- Department of Obstetrics and Gynecology, The First People's Hospital of Nantong, Nantong, China
| | - Biyun Xu
- Medical Statistics and Analysis Center, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Yimin Dai
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Yali Hu
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Yi-Hua Zhou
- Departments of Laboratory Medicine and Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
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Howard-Jones AR, Cristerna-Tarrasa GH, Khan R, Stormon M, Arbuckle S, Britton PN. Severe Postnatal Cytomegalovirus Enterocolitis in Immunocompetent Term Infants Requiring Total Parenteral Nutrition. JPGN REPORTS 2021; 2:e110. [PMID: 37205973 PMCID: PMC10191544 DOI: 10.1097/pg9.0000000000000110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 06/10/2021] [Indexed: 05/21/2023]
Abstract
Postnatal cytomegalovirus enterocolitis is uncommon in immunocompetent infants. We report a 10-week-old term boy with severe and prolonged secretory diarrhea, leading to dependence on total parenteral nutrition and a 10-week hospitalization. Cytomegalovirus enterocolitis was diagnosed based on duodenal biopsy in the context of marked viremia, and the child recovered promptly on initiation of ganciclovir. Collated case reports reveal delayed diagnoses as the norm but rapid improvement with antiviral treatment. Cytomegalovirus enterocolitis should be considered early as a differential diagnosis in infants with refractory diarrhea.
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Affiliation(s)
- Annaleise R. Howard-Jones
- From the Department of Infectious Diseases & Microbiology, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
- Discipline of Child and Adolescent Health, University of Sydney, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | | | - Rabia Khan
- Department of Gastroenterology, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Michael Stormon
- Discipline of Child and Adolescent Health, University of Sydney, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
- Department of Gastroenterology, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Susan Arbuckle
- Discipline of Child and Adolescent Health, University of Sydney, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
- Department of Histopathology, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Philip N. Britton
- From the Department of Infectious Diseases & Microbiology, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
- Discipline of Child and Adolescent Health, University of Sydney, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
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Jin MJ, Kim Y, Choi EM, Shim YJ, Kim HS, Suh JK, Kim JY, Lee KS, Park SY, Lee JM, Hah JO. Clinical characteristics and treatment courses for cytomegalovirus-associated thrombocytopenia in immunocompetent children after neonatal period. Blood Res 2018; 53:110-116. [PMID: 29963516 PMCID: PMC6021578 DOI: 10.5045/br.2018.53.2.110] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/18/2017] [Accepted: 11/18/2017] [Indexed: 12/23/2022] Open
Abstract
Background Cytomegalovirus (CMV) causes severe diseases in premature infants and immunocompromised hosts, and antiviral therapy is often required for disease control. However, the clinical manifestations and treatment courses for CMV-associated thrombocytopenia in immunocompetent children are unclear. Methods Medical records of the children who suffered from thrombocytopenia, and showed positive CMV polymerase chain reaction and CMV-like symptoms were retrospectively analyzed at three university hospitals in Daegu from January 2000 to March 2017. Patients suffering from leukemia, immunodeficiency, and other infections were excluded. Results Among 1,065 children with thrombocytopenia, 29 (2.7%) displayed CMV-associated thrombocytopenia. The median age at diagnosis was 15 months and the median platelet count was 26,000/µL. They were classified into the CMV-induced thrombocytopenia (23/29) and CMV-related secondary immune thrombocytopenia (ITP, 6/29) groups. Fourteen subjects had hepatic dysfunction, four had Evans syndrome, two had pneumonitis, and one had gastritis. IVIG was used for 21 patients, and six patients among them showed recurrence, for whom IVIG or antiviral therapy was used. All, except one, recurrent or chronic cases belonged to the CMV-induced thrombocytopenia group. Antiviral therapy was used more frequently for the CMV-induced thrombocytopenia group (8/23, 34.8%) than for the CMV-related secondary ITP group (0/6); however, the results were not statistically significant (P=0.148). Conclusion CMV is a rare but unique etiology of thrombocytopenia, and observed even in healthy children after the neonatal period. About one-third patients need antiviral therapy for disease control. Further, CMV-induced thrombocytopenia is more complex than CMV-related secondary ITP.
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Affiliation(s)
- Min Ji Jin
- Department of Pediatrics, Keimyung University School of Medicine and Dongsan Medical Center, Daegu, Korea
| | - Yunkyum Kim
- Department of Pediatrics, Keimyung University School of Medicine and Dongsan Medical Center, Daegu, Korea
| | - Eun Mi Choi
- Department of Pediatrics, Keimyung University School of Medicine and Dongsan Medical Center, Daegu, Korea
| | - Ye Jee Shim
- Department of Pediatrics, Keimyung University School of Medicine and Dongsan Medical Center, Daegu, Korea
| | - Heung Sik Kim
- Department of Pediatrics, Keimyung University School of Medicine and Dongsan Medical Center, Daegu, Korea
| | - Jin Kyung Suh
- Department of Pediatrics, Gachon University Gil Medical Center, Incheon, Korea
| | - Ji Yoon Kim
- Department of Pediatrics, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Kun Soo Lee
- Department of Pediatrics, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Sun Young Park
- Department of Pediatrics, College of Medicine, Yeungnam University, Daegu, Korea
| | - Jae Min Lee
- Department of Pediatrics, College of Medicine, Yeungnam University, Daegu, Korea
| | - Jeong Ok Hah
- Department of Pediatrics, Fatima Hospital, Daegu, Korea
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Abstract
When addressing the compatibility of breastfeeding with certain maternal conditions, we need to differentiate between "contraindication" and "obstacle." Failure to distinguish between the two confuses new mothers and their families, and engenders misconceptions about breastfeeding advice by health professionals. Health conditions that may simply impede the initiation and duration of breastfeeding are often wrongly referred to as true contraindications to breastfeed, under the assumption that they might harm the health of the mother and/or that of the nursing infant. Here, we discuss several topics, including breast surgery, prolactinoma, concurrent new pregnancy, hormonal contraception, and use of medications and contrast agents, that continue to raise controversy. While most conditions appear to be compatible with breastfeeding, the major determinants of a woman's final choice of whether to nurse her infant or not are the attitude of health professionals and the state of mind of being an informed mother.
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Affiliation(s)
- Riccardo Davanzo
- Division of Pediatrics and Neonatology, Department of Mother and Child Health, Ospedale Madonna delle Grazie, Matera, Italy.,Task Force on Breastfeeding, Ministry of Health, Rome, Italy
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Berardi A, Spaggiari E, Cattelani C, Roversi MF, Pecorari M, Lazzarotto T, Ferrari F. Persistent intestinal bleeding due to severe CMV-related thrombocytopenia in a preterm newborn. J Matern Fetal Neonatal Med 2017; 31:1246-1249. [PMID: 28395563 DOI: 10.1080/14767058.2017.1312331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The optimal threshold for neonatal platelet transfusions in sick newborns is still uncertain. We report a congenital cytomegalovirus (CMV) infection in a premature neonate with severe thrombocytopenia who subsequently presented with necrotizing enterocolitis and intestinal bleeding. The baby recovered after platelet transfusions were discontinued and the therapy was switched from intravenous ganciclovir to oral valganciclovir. We discuss both measures, speculating on the key role of platelet transfusions.
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Affiliation(s)
- Alberto Berardi
- a Dipartimento Integrato Materno-Infantile , Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Eugenio Spaggiari
- a Dipartimento Integrato Materno-Infantile , Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Chiara Cattelani
- a Dipartimento Integrato Materno-Infantile , Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Maria Federica Roversi
- a Dipartimento Integrato Materno-Infantile , Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Monica Pecorari
- b Struttura Complessa di Microbiologia e Virologia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Tiziana Lazzarotto
- c Unità Operativa di Microbiologia , Azienda Ospedaliero-Universitaria Policlinico S. Orsola Malpighi , Bologna , Italy
| | - Fabrizio Ferrari
- a Dipartimento Integrato Materno-Infantile , Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
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Gupta AK, Maria A, Goyal D, Verma A. Intractable diarrhoea caused by cytomegalovirus enterocolitis in an immunocompetent term neonate. J Trop Pediatr 2013; 59:509-11. [PMID: 23780993 DOI: 10.1093/tropej/fmt052] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Symptomatic cytomegalovirus (CMV) infection mainly affects preterm and immunocompromised infants and usually manifest as rash, pneumonia, hepatospleenomegaly or encephalitis. To our knowledge intractable diarrhoea at two weeks of age caused by postnatally acquired CMV in immunocompetent term neonate is not reported. An unusual case of postnatally acquired CMV enterocolitis manifesting as protracted diarrhoea in an immunocompetent baby in neonatal period is reported. We conclude that CMV should be considered in the differential diagnosis of intractable diarrhoea in neonatal period and treatment with intravenous ganciclovir for CMV enterocolitis is not only indicated but is therapeutic.
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Affiliation(s)
- Amit Kumar Gupta
- Department of Pediatrics, PGIMER & Dr RML Hospital, New Delhi 110001, India
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