Damay M, Mathé J C, Couprie C, Chevalier J Y, Sardet A, Garbarg-Chenon A, Boccon-Gibod L, Costil J
Réanimation pédiatrique polyvalente, hôpital Trousseau, Paris, France.
Arch Pediatr. 1994 Feb;1(2):137-42.
Cytomegalovirus (CMV) infection can result in major complications in immunocompromised infants and children. CMV pneumonia may be difficult to diagnose and the true pathogenic role of the virus in the disease is not always clear. This report describes a cohort of 20 children who suffered from CMV pneumonia.
Twenty children aged 1 month to 11 years 10 months were admitted to our intensive care unit between 1981 and 1990 because of pneumonia with evidence of CMV infection. They were classified into three groups: group I (cases 1-10) with hemopathy or cancer, group II (cases 11-14) with AIDS, and group III (cases 15-20): non immunodeficient or immunosuppressed children. CMV infection was diagnosed after isolation of CMV from bronchoalveolar lavage (BAL) fluid (15 patients), lung biopsy revealing intranuclear inclusions or CMV antigens, or CMV-positive cultures (four patients), CMV-positive urine cultures (one patient).
Clinical manifestations and X-rays findings were unspecific; interstitial pneumonia was found only in immunodeficient patients. CMV pneumonia was diagnosed only in two patients on post mortem examination. Concomitant pneumocystis carinii was found on BAL in two patients (group I) and two others (group II). Thirteen patients required ventilation. Eleven patients were given ganciclovir for 2 or 3 weeks; one of them was given a single dose. This treatment was well tolerated. Mortality was 90% in group I, 100% in group II and 33% in group III.
Ganciclovir did not appear to benefit the immunocompromised patients with CMV pneumonia. Future treatment should include hyperimmune CMV immunoglobulins plus ganciclovir. Careful hand washing is important for all those caring for these patients to prevent contamination as is the use of CMV-negative blood products.
巨细胞病毒（CMV）感染可导致免疫功能低下的婴幼儿出现严重并发症。CMV肺炎可能难以诊断，且该病毒在疾病中的真正致病作用并不总是很清楚。本报告描述了一组20例患有CMV肺炎的儿童。
1981年至1990年间，20例年龄在1个月至11岁10个月的儿童因肺炎且有CMV感染证据入住我们的重症监护病房。他们被分为三组：第一组（病例1 - 10）患有血液病或癌症，第二组（病例11 - 14）患有艾滋病，第三组（病例15 - 20）：非免疫缺陷或免疫抑制儿童。从支气管肺泡灌洗（BAL）液中分离出CMV后诊断为CMV感染（15例患者），肺活检发现核内包涵体或CMV抗原，或CMV阳性培养物（4例患者），CMV阳性尿培养物（1例患者）。
临床表现和X线检查结果无特异性；间质性肺炎仅在免疫缺陷患者中发现。仅2例患者在尸检时被诊断为CMV肺炎。在BAL中发现2例患者（第一组）和另外2例患者（第二组）合并卡氏肺孢子虫感染。13例患者需要机械通气。11例患者接受了2或3周的更昔洛韦治疗；其中1例接受了单剂量治疗。该治疗耐受性良好。第一组死亡率为90%，第二组为100%，第三组为33%。
更昔洛韦似乎对患有CMV肺炎的免疫功能低下患者没有益处。未来的治疗应包括高免疫CMV免疫球蛋白加更昔洛韦。对于所有照顾这些患者的人来说，仔细洗手以防止污染以及使用CMV阴性血液制品都很重要。
