title: Characterization of cytomegalovirus lung infection in non-HIV infected children.
abstract: 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%.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Pediatric Pulmonology, Fundacion Hospital La Misericordia, Bogota 111411, Colombia. sm.restrepo@uniandes.edu.co.
authors.forename: Sonia M
authors.initials: SM
authors.lastname: Restrepo-Gualteros
authors.affiliation: Department of Pathology, School of Medicine, Universidad Nacional de Colombia, Bogota 111321, Colombia. millito59@hotmail.com.
authors.forename: Lina E
authors.initials: LE
authors.lastname: Jaramillo-Barberi
authors.affiliation: Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota 111321, Colombia. mikg376@gmail.com.
authors.forename: Monica
authors.initials: M
authors.lastname: Gonzalez-Santos
authors.affiliation: Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota 111321, Colombia. carlos2671@gmail.com.
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Rodriguez-Martinez
authors.affiliation: Division of Pulmonary and Sleep Medicine, Children's National Medical Center, Washington, DC 20010, USA. gperez@childrensnational.org.
authors.forename: Geovanny F
authors.initials: GF
authors.lastname: Perez
authors.affiliation: Division of Pediatric Rheumatology, Allergy and Immunology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA. mgutierrez@hmc.psu.edu.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Gutierrez
authors.affiliation: Division of Pulmonary and Sleep Medicine, Children's National Medical Center, Washington, DC 20010, USA. gnino@childrensnational.org.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Nino
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003587:Cytomegalovirus / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology* / Q000821:virology*; D005260:Female; D015658:HIV Infections; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology / Q000821:virology; D008297:Male; D011024:Pneumonia, Viral / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology* / Q000821:virology*; D011859:Radiography; D012131:Respiratory Insufficiency / Q000453:epidemiology; D016019:Survival Analysis