Morisawa Yutaka, Maeda Akihiko, Sato Tetsuya, Hisakawa Hiroaki, Fujieda Mikiya, Wakiguchi Hiroshi
Department of Pediatrics, Kochi Medical School, Kochi University, Kochi, Japan.
Pediatr Int. 2008 Oct;50(5):654-7. doi: 10.1111/j.1442-200X.2008.02636.x.
Bronchial asthma-like symptoms such as wheezing are commonly associated with respiratory tract infection including respiratory syncytial virus (RSV) infection in infants. No study on the association of wheezing with cytomegalovirus (CMV) infection in infancy has been reported, although CMV infection has been observed to play some role in prolonged and intractable wheezing in limited cases.
The present study investigated 40 hospitalized infants who presented with first-episode wheezing between October 2003 and September 2004. Nasopharyngeal aspirates were tested for RSV, and serum antibodies against CMV were measured. As controls, age-matched infants with no wheezing were examined for CMV serostatus.
RSV-antigen was detected in 21 subjects (53%), and seven (18%) were considered primary CMV infection serologically. Primary CMV infection was found more often in the wheezers than in the controls although the difference was not statistically significant (P = 0.06). The incidence of splenomegaly was significantly higher in wheezers with CMV infection (86%) than in those with RSV infection or without either infection. The duration of wheezing, fever, and radiographic and laboratory findings during hospitalization were not significantly different.
CMV infection based on serologic diagnosis should be considered in infants with first wheezing episode and particularly those with splenomegaly.
喘息等支气管哮喘样症状通常与包括呼吸道合胞病毒(RSV)感染在内的婴儿呼吸道感染有关。尽管在有限的病例中观察到巨细胞病毒(CMV)感染在持续性和难治性喘息中起一定作用,但尚未有关于婴儿期喘息与CMV感染相关性的研究报道。
本研究调查了2003年10月至2004年9月间首次出现喘息的40例住院婴儿。检测鼻咽抽吸物中的RSV,并测定抗CMV的血清抗体。作为对照,对年龄匹配的无喘息婴儿进行CMV血清学状态检查。
21例(53%)受试者检测到RSV抗原,7例(18%)血清学上被认为是原发性CMV感染。原发性CMV感染在喘息婴儿中比在对照组中更常见,尽管差异无统计学意义(P = 0.06)。CMV感染的喘息婴儿脾肿大发生率(86%)显著高于RSV感染或无任何感染的喘息婴儿。住院期间喘息、发热的持续时间以及影像学和实验室检查结果无显著差异。
对于首次出现喘息发作的婴儿,尤其是伴有脾肿大的婴儿,应考虑基于血清学诊断的CMV感染。