Larochelle Marissa B, Phan Ryan, Craddock John, Abzug Mark J, Curtis Donna, Robinson Christine C, Giller Roger H, Cosgrove Shaun, Siringo Frank, McCourt Emily, Palestine Alan G
Department of Ophthalmology, University of Colorado, Aurora, Colorado.
University of Colorado School of Medicine, Aurora, Colorado.
Am J Ophthalmol. 2017 Mar;175:8-15. doi: 10.1016/j.ajo.2016.09.039. Epub 2016 Oct 14.
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.
Retrospective cross-sectional study.
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.
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.
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.
儿童异基因造血干细胞移植（HSCT）人群中巨细胞病毒（CMV）视网膜炎的发病率尚不清楚。我们报告了在12个月内确诊的5例儿童CMV视网膜炎病例，并将其与此前4年的CMV病毒血症和视网膜炎发生率进行比较。本文展示了针对这一情况制定的眼科筛查方案。
回顾性横断面研究。
对2010年1月至2014年12月期间在科罗拉多儿童医院（CHCO）接受异基因HSCT的患者进行回顾性病历审查。采用Fisher精确检验比较2010年1月至2013年12月期间移植患者与2014年移植患者中CMV病毒血症和CMV视网膜炎的比例。
2010年1月至2013年12月期间，共有101例患者接受了异基因HSCT；32例（32%）CMV病毒血症检测呈阳性。未发现CMV视网膜炎病例。2014年1月至2014年12月，28例患者接受了异基因HSCT；13例患者（46%）出现CMV病毒血症，差异无统计学意义（P = 0.18）。2014年移植的患者中有5例被诊断为CMV视网膜炎，与2010 - 2013年移植的患者相比有统计学显著增加（P = 0.0004）。成立了一个多学科团队来回顾文献并制定了眼科筛查方案。
我们近期在儿童异基因HSCT患者中出现的CMV视网膜炎病例群可能提示CMV视网膜炎发病率上升。我们提出了一种眼科筛查方案，用于在儿童HSCT患者早期（通常无症状阶段）诊断视网膜炎。
