CYTOMEGALOVIRUS PNEUMONIAE IN PEDIATRIC I NTENSIVE-CARE UNITS

Background. - Cytomegalovirus (CMV) infection can result in major comp lications in immunocompromised infants and children. CMV pneumonia may be difficult to diagnose and the true pathogenic role of the virus in the disease is not always clear. This report describes a cohort of 20 children who suffered from CMV pneumonia. Populations and methods. - Twenty children aged 1 months to 11 years 10 months were admitted to o ur intensive care unit between 1981 and 1990 because of pneumonia with evidence of CMV infection. They were classified into three groups: gr oup 1 (cases 1-10) with hemopathy or cancer, group II (cases 11-14) wi th AIDS, and group III (cases 15-20): non immunodeficient or immunosup pressed children. CMV infection was diagnosed after isolation of CMV f rom bronchoalveolar lavage (BAL) fluid (15 patients), lung biopsy reve aling intranuclear inclusions or CMV antigens, or CMV-positive culture s (four patients), CMV-positive urine cultures (one patient). Results. - Clinical manifestations and X-rays findings were unspecific; inters titial pneumonia was found only in immunodeficient patients. CMV pneum onia was diagnosed only in two patients on post mortem examination. Co ncomitant pneumocystis carinii ws found on BAL in two patients (group I) and two others (group II). Thirteen patients required ventilation. Eleven patients were given gangiclovir for 2 or 3 weeks; one of them w as given a single dose. This treatment was well tolerated. Mortality w as 90% in group I, 100% in group II and 33% in group III. Conclusion. - Ganciclovir did not appear to benefit the immunocompromised patients with CMV pneumonia. Future treatment should include hyperimmune CMV i mmunoglobulins plus gangiclovir. Careful hand washing is important for all those caring for these patients to prevent contamination as is th e use of CMV-negative blood products.