The clinical presentation and outcome of CMV disease in paediatric patients at Chris Hani Baragwanath Academic Hospital- a retrospective, descriptive study

Abstract

Background The clinical profile and outcomes of patients with cytomegalovirus viraemia in South Africa are unknown. Methods This was a retrospective record review of patients admitted at Chris Hani Baragwanath Academic Hospital (CHBAH), Soweto, South Africa, from January 2016 to December 2017 with suspected CMV disease. Patients younger than 14 years of age with CMV viral load (CMV VL) >137 IU/mL (151copies/mL) were included in the study. Patients were identified through the National Health Laboratory Service (NHLS) CMV VL database. Results A total of 144 patients were identified during the study period. Records were not available for 19 patients. Data were analysed for 125 patients. Most of the children who had a recorded CMV viral load were under one year of age. The median age of presentation was 90 days (IQR 48 to 150; range 1 to 4680). The most common clinical presentations were anaemia in 83/125 (66.4%), pneumonia in 59/125 (47.2%) and thrombocytopenia in 58/125 (46.4%). Of the patients with CMV VL < 10 000IU/mL, the most common clinical presentation was anaemia in 51 (60.7%) and pneumonia in 39 (46.4%). Three (3.6%) had histology confirmed biliary atresia and six (7.1%) had cranial sonar features of CMV disease. Four (28.6%) patients with cranial sonar(cUS) features of CMV disease had CMV VL > 10 000IU/mL. The in- hospital case fatality rate was 19.2 % (n=24). Conclusion Most patients in this group were <1year old. Clinical features compatible with CMV disease are also seen in children with a low CMV VL