Severe Pneumonia and Cytomegalovirus Coinfection in Infants with Human Immunodeficiency Virus Infection.
Wonashi R Tsanglao, Maitreyee Joshi, Tenukala Aier, Sulanthung Kikon
Author Information
Wonashi R Tsanglao: Consultant, MD Pediatrics, Department of Pediatrics, Christian Institute of Health Sciences and Research, Dimapur, Nagaland, India.
Maitreyee Joshi: DNB Resident, Department of Pediatrics, Christian Institute of Health Sciences and Research, Dimapur, Nagaland, India.
Tenukala Aier: Consultant, MD Pediatrics, Department of Pediatrics, Christian Institute of Health Sciences and Research, Dimapur, Nagaland, India.
Sulanthung Kikon: Head, Department of Pediatrics, Christian Institute of Health Sciences and Research, Dimapur, Nagaland, India.
SUMMARY: Cytomegalovirus (CMV) is known to cause fatal pneumonia in human immunodeficiency virus (HIV) infected children. There is a paucity of literature on pediatric HIV and CMV coinfection in India. We describe six cases of severe pneumonia in infants infected with HIV. Four of these infants also had CMV coinfection, detected by urine polymerase chain reaction. There was a lack of antenatal and postnatal care in all cases. All four infants with CMV coinfection succumbed to severe acute respiratory distress syndrome, whereas the other two survived. In conclusion, a high index of suspicion for CMV should be kept in HIV-infected infants presenting with severe pneumonia, although CMV pneumonia is difficult to diagnose with certainty. The important role of antenatal care for mothers with HIV infection, as well as postnatal care for babies born to HIV-positive mothers, cannot be overstated.
References
Goussard P, Kling S, Gie RP, Nel ED, Heyns L, Rossouw GJ, et al. CMV pneumonia in HIV-infected ventilated infants. Pediatr Pulmonol 2010;45:650–5.
Cloete J, Becker P, Masekela R, Pentz A, Wijnant W, Campos R, et al. Severe pneumonia in HIV-infected and exposed infants in a paediatric ICU. S Afr J Child Health 2015;9:76–80.
Suri D, Jindal AK, Gupta A, Gupta A, Bajgai P, Singh R, et al. Cytomegalovirus disease in HIV-infected children-A single-centre clinical experience over 23 years. J Trop Pediatr 2018;64:215–24.
World Health Organization. Revised WHO Classification and Treatment of Pneumonia in Children at Health Facilities:Evidence Summaries Geneva World Health Organization 2014.
Restrepo-Gualteros SM, Gutierrez MJ, Villamil-Osorio M, Arroyo MA, Nino G. Challenges and clinical implications of the diagnosis of cytomegalovirus lung infection in children. Curr Infect Dis Rep 2019;21:24.
