title: Cytomegalovirus Retinitis in Pediatric Stem Cell Transplants: Report of a Recent Cluster and the Development of a Screening Protocol.
abstract: OBJECTIVE
  The incidence of cytomegalovirus (CMV) retinitis in the pediatric allogeneic hematopoietic stem cell transplant (HSCT) population is unknown. We report a cluster of 5 pediatric patients with CMV retinitis diagnosed in a 12-month period and compare this to the rate of CMV viremia and retinitis in the 4 years prior. Presented is the ophthalmic screening protocol developed in response to this experience.
  
  
  METHODS
  Retrospective cross-sectional study.
  
  
  METHODS
  A retrospective chart review was performed on patients at Children's Hospital of Colorado (CHCO) who received allogeneic HSCT between January 2010 and December 2014. Fisher exact test was used to compare the proportion of CMV viremia and CMV retinitis in patients transplanted between January 2010 and December 2013 with those transplanted in 2014.
  
  
  RESULTS
  A total of 101 patients underwent allogeneic HSCT from January 2010 to December 2013; 32 (32%) tested positive for CMV viremia. No cases of CMV retinitis were identified. From January 2014 to December 2014, 28 patients underwent allogeneic HSCT; 13 patients (46%) had CMV viremia, not a statistically significant increase (P = .18). There were 5 cases of CMV retinitis diagnosed in those transplanted in 2014, a statistically significant increase compared with those transplanted in 2010-2013 (P = .0004). A multidisciplinary team was formed to review the literature and an ophthalmic screening protocol was developed.
  
  
  CONCLUSIONS
  Our recent cluster of CMV retinitis in pediatric allogeneic HSCT patients may suggest a rise in incidence of CMV retinitis. We propose an ophthalmic screening protocol to diagnose retinitis in pediatric HSCT patients in the early, often asymptomatic stage.
authors.affiliation: Department of Ophthalmology, University of Colorado, Aurora, Colorado.
authors.forename: Marissa B
authors.initials: MB
authors.lastname: Larochelle
authors.affiliation: University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Ryan
authors.initials: R
authors.lastname: Phan
authors.affiliation: Pediatric Hematology/Oncology/Bone Marrow Transplant, University of Colorado, Aurora, Colorado.
authors.forename: John
authors.initials: J
authors.lastname: Craddock
authors.affiliation: Pediatric Infectious Diseases, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Abzug
authors.affiliation: Pediatric Infectious Diseases, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado.
authors.forename: Donna
authors.initials: D
authors.lastname: Curtis
authors.affiliation: Department of Pathology and Laboratory Medicine, Children's Hospital Colorado, Aurora, Colorado.
authors.forename: Christine C
authors.initials: CC
authors.lastname: Robinson
authors.affiliation: Pediatric Hematology/Oncology/Bone Marrow Transplant, University of Colorado, Aurora, Colorado.
authors.forename: Roger H
authors.initials: RH
authors.lastname: Giller
authors.affiliation: Pediatric Hematology/Oncology/Bone Marrow Transplant, University of Colorado, Aurora, Colorado.
authors.forename: Shaun
authors.initials: S
authors.lastname: Cosgrove
authors.affiliation: Department of Ophthalmology, University of Colorado, Aurora, Colorado.
authors.forename: Frank
authors.initials: F
authors.lastname: Siringo
authors.affiliation: Department of Ophthalmology, University of Colorado, Aurora, Colorado. Electronic address: Emily.mccourt@ucdenver.edu.
authors.forename: Emily
authors.initials: E
authors.lastname: McCourt
authors.affiliation: Department of Ophthalmology, University of Colorado, Aurora, Colorado.
authors.forename: Alan G
authors.initials: AG
authors.lastname: Palestine
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003120:Colorado / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003587:Cytomegalovirus / Q000235:genetics*; D017726:Cytomegalovirus Retinitis / Q000175:diagnosis / Q000453:epidemiology*; D004279:DNA, Viral / Q000032:analysis*; D005500:Follow-Up Studies; D019337:Hematologic Neoplasms / Q000601:surgery; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D009887:Ophthalmoscopy; D016133:Polymerase Chain Reaction; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D019562:Viral Load
chemical_list: D004279:DNA, Viral