Clinical features of infant cytomegalovirus infection_Chinese Journal of Ocular Fundus Diseases

Authors：

Liu Ting ¹ , Lu Yuebing ¹ , Yu Jifeng ² , Li Ping ¹ , Sun Shuang ¹ , Cao Honghui ¹ , Guo Yanhong ¹ ,  Sun Xiantao ¹

1. Department of Ophthalmology, Children's Hospital Affiliated of Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450000, China;
2. Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China;

Corresponding?author：

Sun Xiantao, Email: sunxt38019896@163.com

Keywords：

Infant; Cytomegalovirus infections; Cytomegalovirus retinitis; Ganciclovir

DOI：

10.3760/cma.j.cn511434-20211125-00662

Video：

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Objective To observe the ocular clinical features of infantile cytomegalovirus (CMV) infection. Methods A retrospective clinical study. From March 2019 to July 2021, 876 eyes of 438 children with CMV infection who visited Department of Ophthalmology of Henan Provincial Children's Hospital were included in the study. Among them, there were 254 males and 184 females; the age ranged from 3 days to 11 months; the gestational weeks were 28 to 42 weeks; the birth weight was 1 120 to 8 900 g. There were 384 and 54 full-term and premature infants, respectively. Fundus examination was performed in 385 cases (770 eyes) after medical consultation; 53 cases (106 eyes) of premature infants were routinely screened. CMV retinitis (CMVR) was divided into granular type and fulminant type. Patients with CMV-related diseases with moderate to severe symptoms were given intravenous drip and/or oral ganciclovir; patients with severe fundus vasculitis were combined with intravitreal injection of ganciclovir. The follow-up period was from 4 to 28 months, and the characteristics of eye lesions, systemic comorbid diseases and treatment outcomes were observed. Results There were 516 eyes of 258 cases with normal fundus (58.9%, 258/438); 291 eyes of 180 cases with CMVR (41.1%, 180/438), of which binocular and monocular were 111 (61.7%, 111/180) and 69 (38.3%, 69/180) cases. Among the 291 eyes of CMVR, 281 eyes (96.6%, 281/291) of granular type; yellow-white point-like opacity and/or retinal hemorrhage; 10 eyes (3.4%, 10/291) of fulminant type; fundus Showed a typical "cheese ketchup-like" and vascular white sheath-like changes. Among the 180 children with CMVR, 72 patients (118 eyes) were given systemic intravenous drip and/or oral ganciclovir; 5 patients (10 eyes) were given intravitreal ganciclovir, all of which were fulminant CMVR. At the last follow-up, fundus lesions regressed significantly in 100 eyes of 61 cases; 18 eyes of 11 cases had old lesions or uneven retinal pigment; 108 cases were not treated. Conclusion The most common fundus manifestation of CMV infection in infants is granular retinitis, and fulminant retinitis is more severe, and the lesions can be significantly regressed after timely antiviral treatment.

Citation： Liu Ting, Lu Yuebing, Yu Jifeng, Li Ping, Sun Shuang, Cao Honghui, Guo Yanhong, Sun Xiantao. Clinical features of infant cytomegalovirus infection. Chinese Journal of Ocular Fundus Diseases, 2022, 38(7): 573-577. doi: 10.3760/cma.j.cn511434-20211125-00662 Copy

1.	中華醫學會圍產醫學分會, 中華醫學會婦產科學分會產科學組, 《中華圍產醫學雜志》編輯委員會. 妊娠期巨細胞病毒感染篩查與處理專家共識[J]. 中華圍產醫學雜志, 2017, 20(8): 553-556. DOI: 10.3760/cma.j.issn.1007-9408.2017.08.001.Perinatal Medicine Branch of Chinese Medical Association, Obstetrics Group of Obstetrics and Gynecology Branch of Chinese Medical Association, Editorial Board of Chinese Journal of Perinatal Medicine. Expert consensus on screening and management of cytomegalovirus infection in pregnancy[J]. Chin J Perinat Med, 2017, 20(8): 553-556. DOI: 10.3760/cma.j.issn.1007-9408.2017.08.001.
2.	Schleiss MR. Role of breast milk in acquisition of cytomegalovirus infection: recent advances[J]. Curr Opin Pediatr, 2006, 18(1): 48-52. DOI: 10.1097/01.mop.0000192520.48411.fa.
3.	李莉. 新生兒巨細胞病毒感染管理要點[J]. 中華實用兒科臨床雜志, 2019, 34(11): 801-805. DOI: 10.3760/cma.j.issn.2095_428X.2019.11.001.Li L. Keypoints for management of neonatal cytomegalovirus infection[J]. Chin J Appl Clin Pediatr, 2019, 34(11): 801-805. DOI: 10.3760/cma.j.issn.2095_428X.2019.11.001.
4.	許英, 陳淼, 陳穎. 巨細胞病毒性視網膜炎的診治進展[J]. 國際流行病學傳染病學雜志, 2018, 45(2): 133-136. DOI: 10.3760/cma.j.issn.1673-4149.2018.02.015.Xu Y, Chen M, Chen Y. Progress on the diagnosis and therapy of cytomegalovirus retinitis[J]. Inter J Epidemiol Infect Dis, 2018, 45(2): 133-136. DOI: 10.3760/cma.j.issn.1673-4149.2018.02.015.
5.	中華醫學會兒科學分會感染學組, 全國兒科臨床病毒感染協作組, 《中華兒科雜志》編輯委員會. 兒童巨細胞病毒性疾病診斷和防治的建議[J]. 中華兒科雜志, 2012, 50(4): 290-292. DOI: 10.3760/cma.j.issn.0578-1310.2012.04.013.Infections Group of Pediatrics Branch of Chinese Medical Association, National Pediatric Clinical Viral Infection Collaborative Group, Editorial Board of Chinese Journal of Pediatrics. Recommendations for the diagnosis and prevention of cytomegalovirus diseases in children[J]. Chin J Pediatr, 2012, 50(4): 290-292. DOI: 10.3760/cma.j.issn.0578-1310.2012.04.013.
6.	Standardization of Uveitis Nomenclature (SUN) Working Group. Classification criteria for cytomegalovirus retinitis[J]. Am J Ophthalmol, 2021, 228: 245-254. DOI: 10.1016/j.ajo.2021.03.051.
7.	單海冬, 趙培泉. RetCam數字視網膜照相機在早產兒視網膜病變篩查中的應用[J]. 中華眼底病雜志, 2005, 21(5): 323-325. DOI: 10.3760/j.issn:1005-1015.2005.05.016.Shan HD, Zhao PQ. Application of Retcam digital camera in retinopathy of premature screening[J]. Chin J Ocul Fundus Dis, 2005, 21(5): 323-325. DOI: 10.3760/j.issn:1005-1015.2005.05.016.
8.	李雯霖, 林海波, 陳慕丹, 等. 應用Retcam Ⅲ數字化廣域成像系統對新生兒眼病篩查及結果分析[J]. 中國斜視與小兒眼科雜志, 2017, 25(1): 5-8. DOI: 10.3969/J.ISSN.1005-328X.2017.01.002.Li WL, Lin HB, Chen MD, et al. Screening and analysis of neonatal eye diseases by using Retcam Ⅲ[J]. Chinese Journal of Strabismus & Pediatric Ophthalmology, 2017, 25(1): 5-8. DOI: 10.3969/J.ISSN.1005-328X.2017.01.002.
9.	曹云. 感染性疾病/病毒性感染[M]//邵肖梅, 葉鴻瑁, 丘小汕, 等. 實用新生兒學. 北京: 人民衛生出版社, 2019: 480-483.Cao Y. Infectious diseases/viral infection[M]//Shao XM, Ye HM, Qiu XS. Practical neonatology. People's medical publishing house, 2019: 480-483.
10.	Rawlinson WD, Boppana SB, Fowler KB, et al. Congenital cytomegalovirus infection in pregnancy and the neonate: consensus recommendations for prevention, diagnosis, and therapy[J/OL]. Lancet Infect Dis, 2017, 17(6): e177-e188[2017-03-11]. https://pubmed.ncbi.nlm.nih.gov/28291720/. DOI: 10.1016/S1473-3099(17)30143-3.
11.	Tagami M, Honda S, Morioka I, et al. An unusual case of congenital cytomegalovirus infection-related retinopathy[J]. BMC Ophthalmol, 2016, 16: 81. DOI: 10.1186/s12886-016-0246-9.
12.	史彩平, 葛莉莉, 陸斌, 等. 239例癥狀性巨細胞病毒感染的嬰兒眼底分析[J]. 大理大學學報, 2019, 4(10): 1-6. DOI: 10.3969/j.issn.2096-2266.2019.10.001.Shi CP, Ge LL, Lu B, et al. 239 cases of symptomatic cytomegalovirus infection baby fundus analysis[J]. Journal of Dali University, 2019, 4(10): 1-6. DOI: 10.3969/j.issn.2096-2266.2019.10.001.
13.	梁雪梅, 陳善平, 尹瑰娜. 玻璃體腔注射小劑量更昔洛韋治療獲得性免疫缺陷綜合征合并巨細胞病毒性視網膜炎的療效觀察[J]. 中華眼底病雜志, 2020, 36(4): 280-284. DOI: 10.3760/cma.j.cn511434-20190214-00048.Liang XM, Chen SP, Yin GN. Treatment outcomes of reduced-dose intravitreal ganciclovir for acquired immunodeficiency syndrome patients with cytomegalovirus retinitis[J]. Chin J Ocul Fundus Dis, 2020, 36(4): 280-284. DOI: 10.3760/cma.j.cn511434-20190214-00048.
14.	張慧. 兒童巨細胞病毒感染162例臨床分析[D]. 溫州: 溫州醫科大學, 2020.Zhang H. Clinical analysis of 162 pediatric cytomegalovirus infection[D]. Wenzhou: Wenzhou medical university, 2020.
15.	de Vries JJ, van der Eijk AA, Wolthers KC, et al. Real-time PCR versus viral culture on urine as a gold standard in the diagnosis of congenital cytomegalovirus infection[J]. J Clin Virol, 2012, 53(2): 167-170. DOI: 10.1016/j.jcv.2011.11.006.
16.	Jin HD, Demmler-Harrison GJ, Coats DK, et al. Long-term visual and ocular sequelae in patients with congenital cytomegalovirus infection[J]. Pediatr Infect Dis J, 2017, 36(9): 877-882. DOI: 10.1097/INF.0000000000001599.
17.	Ghekiere S, Allegaert K, Cossey V, et al. Ophthalmological findings in congenital cytomegalovirus infection: when to screen, when to treat?[J]. J Pediatr Ophthalmol Strabismus, 2012, 49(5): 274-282. DOI: 10.3928/01913913-20120710-03.

1. 中華醫學會圍產醫學分會, 中華醫學會婦產科學分會產科學組, 《中華圍產醫學雜志》編輯委員會. 妊娠期巨細胞病毒感染篩查與處理專家共識[J]. 中華圍產醫學雜志, 2017, 20(8): 553-556. DOI: 10.3760/cma.j.issn.1007-9408.2017.08.001.Perinatal Medicine Branch of Chinese Medical Association, Obstetrics Group of Obstetrics and Gynecology Branch of Chinese Medical Association, Editorial Board of Chinese Journal of Perinatal Medicine. Expert consensus on screening and management of cytomegalovirus infection in pregnancy[J]. Chin J Perinat Med, 2017, 20(8): 553-556. DOI: 10.3760/cma.j.issn.1007-9408.2017.08.001.
2. Schleiss MR. Role of breast milk in acquisition of cytomegalovirus infection: recent advances[J]. Curr Opin Pediatr, 2006, 18(1): 48-52. DOI: 10.1097/01.mop.0000192520.48411.fa.
3. 李莉. 新生兒巨細胞病毒感染管理要點[J]. 中華實用兒科臨床雜志, 2019, 34(11): 801-805. DOI: 10.3760/cma.j.issn.2095_428X.2019.11.001.Li L. Keypoints for management of neonatal cytomegalovirus infection[J]. Chin J Appl Clin Pediatr, 2019, 34(11): 801-805. DOI: 10.3760/cma.j.issn.2095_428X.2019.11.001.
4. 許英, 陳淼, 陳穎. 巨細胞病毒性視網膜炎的診治進展[J]. 國際流行病學傳染病學雜志, 2018, 45(2): 133-136. DOI: 10.3760/cma.j.issn.1673-4149.2018.02.015.Xu Y, Chen M, Chen Y. Progress on the diagnosis and therapy of cytomegalovirus retinitis[J]. Inter J Epidemiol Infect Dis, 2018, 45(2): 133-136. DOI: 10.3760/cma.j.issn.1673-4149.2018.02.015.
5. 中華醫學會兒科學分會感染學組, 全國兒科臨床病毒感染協作組, 《中華兒科雜志》編輯委員會. 兒童巨細胞病毒性疾病診斷和防治的建議[J]. 中華兒科雜志, 2012, 50(4): 290-292. DOI: 10.3760/cma.j.issn.0578-1310.2012.04.013.Infections Group of Pediatrics Branch of Chinese Medical Association, National Pediatric Clinical Viral Infection Collaborative Group, Editorial Board of Chinese Journal of Pediatrics. Recommendations for the diagnosis and prevention of cytomegalovirus diseases in children[J]. Chin J Pediatr, 2012, 50(4): 290-292. DOI: 10.3760/cma.j.issn.0578-1310.2012.04.013.
6. Standardization of Uveitis Nomenclature (SUN) Working Group. Classification criteria for cytomegalovirus retinitis[J]. Am J Ophthalmol, 2021, 228: 245-254. DOI: 10.1016/j.ajo.2021.03.051.
7. 單海冬, 趙培泉. RetCam數字視網膜照相機在早產兒視網膜病變篩查中的應用[J]. 中華眼底病雜志, 2005, 21(5): 323-325. DOI: 10.3760/j.issn:1005-1015.2005.05.016.Shan HD, Zhao PQ. Application of Retcam digital camera in retinopathy of premature screening[J]. Chin J Ocul Fundus Dis, 2005, 21(5): 323-325. DOI: 10.3760/j.issn:1005-1015.2005.05.016.
8. 李雯霖, 林海波, 陳慕丹, 等. 應用Retcam Ⅲ數字化廣域成像系統對新生兒眼病篩查及結果分析[J]. 中國斜視與小兒眼科雜志, 2017, 25(1): 5-8. DOI: 10.3969/J.ISSN.1005-328X.2017.01.002.Li WL, Lin HB, Chen MD, et al. Screening and analysis of neonatal eye diseases by using Retcam Ⅲ[J]. Chinese Journal of Strabismus & Pediatric Ophthalmology, 2017, 25(1): 5-8. DOI: 10.3969/J.ISSN.1005-328X.2017.01.002.
9. 曹云. 感染性疾病/病毒性感染[M]//邵肖梅, 葉鴻瑁, 丘小汕, 等. 實用新生兒學. 北京: 人民衛生出版社, 2019: 480-483.Cao Y. Infectious diseases/viral infection[M]//Shao XM, Ye HM, Qiu XS. Practical neonatology. People's medical publishing house, 2019: 480-483.
10. Rawlinson WD, Boppana SB, Fowler KB, et al. Congenital cytomegalovirus infection in pregnancy and the neonate: consensus recommendations for prevention, diagnosis, and therapy[J/OL]. Lancet Infect Dis, 2017, 17(6): e177-e188[2017-03-11]. https://pubmed.ncbi.nlm.nih.gov/28291720/. DOI: 10.1016/S1473-3099(17)30143-3.
11. Tagami M, Honda S, Morioka I, et al. An unusual case of congenital cytomegalovirus infection-related retinopathy[J]. BMC Ophthalmol, 2016, 16: 81. DOI: 10.1186/s12886-016-0246-9.
12. 史彩平, 葛莉莉, 陸斌, 等. 239例癥狀性巨細胞病毒感染的嬰兒眼底分析[J]. 大理大學學報, 2019, 4(10): 1-6. DOI: 10.3969/j.issn.2096-2266.2019.10.001.Shi CP, Ge LL, Lu B, et al. 239 cases of symptomatic cytomegalovirus infection baby fundus analysis[J]. Journal of Dali University, 2019, 4(10): 1-6. DOI: 10.3969/j.issn.2096-2266.2019.10.001.
13. 梁雪梅, 陳善平, 尹瑰娜. 玻璃體腔注射小劑量更昔洛韋治療獲得性免疫缺陷綜合征合并巨細胞病毒性視網膜炎的療效觀察[J]. 中華眼底病雜志, 2020, 36(4): 280-284. DOI: 10.3760/cma.j.cn511434-20190214-00048.Liang XM, Chen SP, Yin GN. Treatment outcomes of reduced-dose intravitreal ganciclovir for acquired immunodeficiency syndrome patients with cytomegalovirus retinitis[J]. Chin J Ocul Fundus Dis, 2020, 36(4): 280-284. DOI: 10.3760/cma.j.cn511434-20190214-00048.
14. 張慧. 兒童巨細胞病毒感染162例臨床分析[D]. 溫州: 溫州醫科大學, 2020.Zhang H. Clinical analysis of 162 pediatric cytomegalovirus infection[D]. Wenzhou: Wenzhou medical university, 2020.
15. de Vries JJ, van der Eijk AA, Wolthers KC, et al. Real-time PCR versus viral culture on urine as a gold standard in the diagnosis of congenital cytomegalovirus infection[J]. J Clin Virol, 2012, 53(2): 167-170. DOI: 10.1016/j.jcv.2011.11.006.
16. Jin HD, Demmler-Harrison GJ, Coats DK, et al. Long-term visual and ocular sequelae in patients with congenital cytomegalovirus infection[J]. Pediatr Infect Dis J, 2017, 36(9): 877-882. DOI: 10.1097/INF.0000000000001599.
17. Ghekiere S, Allegaert K, Cossey V, et al. Ophthalmological findings in congenital cytomegalovirus infection: when to screen, when to treat?[J]. J Pediatr Ophthalmol Strabismus, 2012, 49(5): 274-282. DOI: 10.3928/01913913-20120710-03.

Chinese Journal of Ocular Fundus Diseases

Clinical features of infant cytomegalovirus infection

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