Original Articles
Cytomegalovirus retinitis in immunosuppressed children

https://doi.org/10.1016/S0002-9394(99)00031-8Get rights and content

Abstract

PURPOSE: To describe the ocular and systemic features of children with cytomegalovirus retinitis and their disease outcomes.

METHODS: Review of all cases of cytomegalovirus retinitis diagnosed or treated at a tertiary care pediatric hospital during a 10-year period.

RESULTS: Nine immunocompromised children younger than 16 years were diagnosed as having cytomegalovirus retinitis. The underlying causes of immunocompromise were severe combined immunodeficiency syndrome (n = 2), severe combined immunodeficiency syndrome after bone marrow transplantation (n = 1), acquired immunodeficiency syndrome (AIDS) (n = 2), AIDS and previous bone marrow transplantation for leukemia (n = 1), immunosuppressive therapy after renal transplantation (n = 1), chemotherapy for leukemia (n = 1), and congenital cytomegalovirus infection (n = 1). Five children (56%) had symptomatic extraocular cytomegalovirus infection. Only two children reported visual symptoms with cytomegalovirus retinitis at initial examination. Cytomegalovirus retinitis was bilateral in eight children (89%) and involved the posterior pole in at least one eye of all nine children. Four children (44%) died within 10 months of being diagnosed with cytomegalovirus retinitis. The remaining five children were alive, with follow-up ranging from 14 to 70 months. Successful bone marrow transplantation in one child and discontinuation of immunosuppressive medications in two children improved systemic immune function and permitted discontinuation of anticytomegaloviral therapy.

CONCLUSION: Pediatric cytomegalovirus retinitis is often asymptomatic and bilateral and involves the posterior pole at initial examination. Recovery of systemic immune function may occur in some children. Evaluation of children at risk and prompt treatment of cytomegalovirus retinitis are important to prevent long-term visual morbidity.

Section snippets

Patients and methods

The computerized medical and ophthalmic records at The Hospital for Sick Children in Toronto, Ontario, Canada, were reviewed to identify all children under 16 years of age diagnosed with or treated for cytomegalovirus retinitis from July 1985 to November 1995. The following data were obtained on initial examination with cytomegalovirus retinitis: age, underlying systemic diagnosis, medications, T-lymphocyte subsets (when performed), and extraocular manifestations of cytomegalovirus infection.

Results

Nine children were diagnosed with or treated for cytomegalovirus retinitis during this 10-year interval. The median age at diagnosis of cytomegalovirus retinitis was 2 years (range, 0.3 to 15.9 years). The ratio of males to females was 1.25:1. All nine children had an underlying medical disorder (Table 1) including severe combined immunodeficiency syndrome (n = 3), AIDS (n = 3), congenital cytomegalovirus infection (n = 1), previous renal transplantation (n = 1), and acute lymphocytic leukemia

Discussion

The underlying systemic disorders associated with development of cytomegalovirus retinitis in our series included severe combined immunodeficiency syndrome, AIDS, congenital cytomegalovirus infection, previous renal or bone marrow transplantation, and chemotherapy for acute lymphocytic leukemia. Most of the children exhibited additional signs of disseminated cytomegalovirus infection, including symptomatic extraocular cytomegalovirus infection in 56% and laboratory evidence of acute systemic

References (58)

  • B Kuppermann et al.

    A masked progressive evaluation of outcome parameters for cytomegalovirus-related retinal detachment surgery in patients with acquired immune deficiency syndrome

    Ophthalmology

    (1994)
  • G.N Holland et al.

    Treatment of cytomegalovirus retinopathy with ganciclovir

    Ophthalmology

    (1987)
  • D.A Jabs et al.

    Treatment of cytomegalovirus retinitis with ganciclovir

    Ophthalmology

    (1987)
  • W.L Drew

    Diagnosis of cytomegalovirus infection

    Rev Infect Dis

    (1988)
  • J.E Grundy

    Virologic and pathogenic aspects of cytomegalovirus infection

    Rev Infect Dis

    (1990)
  • A.H Rook

    Interactions of cytomegalovirus with the human immune system

    Rev Infect Dis

    (1988)
  • P.J Dennehy et al.

    Ocular manifestations in pediatric patients with acquired immunodeficiency syndrome

    Arch Ophthalmol

    (1989)
  • L.D Frenkel et al.

    Cytomegalovirus infection in children with AIDS

    Rev Infect Dis

    (1990)
  • M.D De Smet et al.

    The ocular complications of HIV in the pediatric population

  • C.R Baumal et al.

    Screening for cytomegalovirus retinitis in children

    Arch Pediatr Adolesc Med

    (1996)
  • G.B Scott et al.

    Acquired immunodeficiency syndrome in infants

    N Engl J Med

    (1984)
  • C.Y Shen et al.

    Cytomegalovirus transmission in special-care centers for mentally retarded children

    Pediatrics

    (1993)
  • W.C Buhles et al.

    Ganciclovir treatment of life- or sight-threatening cytomegalovirus infectionexperience in 314 immunocompromised patients

    Rev Infect Dis

    (1988)
  • M.M Fanning et al.

    Foscarnet therapy of cytomegalovirus retinitis in AIDS

    J Acquir Immune Defic Syndr

    (1990)
  • S.L Walmsley et al.

    Treatment of cytomegalovirus retinitis with trisodium phosphonoformate hexahydrate (foscarnet)

    J Infect Dis

    (1988)
  • J.G Bartlett
  • W Daus et al.

    Beidseitige Zytomegalie-Retinitis bei einem Saugling mit letal verlaufenem konnatalen AIDS

    Klin Monatsbl Augenheilkd

    (1986)
  • A.V Levin et al.

    Cytomegalovirus retinitis in an infant with acquired immunodeficiency syndrome

    Pediatrics

    (1989)
  • T Jonckheer et al.

    Retinite chez un nourrisson infecte par le VIH

    Arch Fr Pediatr

    (1990)

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