Cytomegalovirus encephalitis in immunocompetent infants: A 15-year retrospective study at a single center.

OBJECTIVE

Cytomegalovirus (CMV) encephalitis is a disease that primarily affects immunocompromised hosts. Only a few cases have been reported in immunocompetent individuals, especially in children. The aim of this study was to investigate the clinical characteristics of immunocompetent children with CMV encephalitis attending a single medical center in southwest China over a 15-year period.

METHODS

The medical records of children with confirmed CMV encephalitis who were hospitalized in the Children's Hospital of Chongqing Medical University during the years 2002-2017 were reviewed. An analysis of the clinical features, laboratory data, and the treatment response to antiviral therapy was performed.

RESULTS

The median age of the patients (n = 18) was 5.1 months. 'Seizures' was the earliest and most common neurological symptom, while fever and poor feeding were also present in most patients. Elevated cerebrospinal fluid (CSF) protein was the most noticeable biochemical finding. After treatment with two-stage ganciclovir, all patients showed a steady clinical improvement. The total adverse drug reaction (ADR) rate was 27.3%, mainly presenting as effects on the hematopoietic system and liver. During follow-up ranging from 3 to 36 months, nine patients showed a complete recovery. At the stage of diagnosis, CMV PCR of CSF was positive in all patients, while anti-CMV IgM was positive in 77.8% of patients. After treatment with two-stage ganciclovir, all patients showed a negative result for CMV genome in the CSF and a clear decrease in the urine.

CONCLUSIONS

The possibility of CMV encephalitis in the immunocompetent child should be kept in mind, especially in those younger than 6 months of age. Suspicion for a diagnosis of CMV encephalitis is needed in the presence of unexplained prominent seizure, fever, poor feeding, and a marked elevation of protein level in the CSF. CMV PCR assays of CSF are necessary to determine the etiology. Furthermore, measurement of the CMV load in CSF and urine may be useful for evaluating the response to treatment and the outcome. Ganciclovir may lead to clinical improvement with limited ADR. CMV encephalitis in the immunocompetent infant does not necessarily indicate a poor short-term prognosis.