Screening for cytomegalovirus retinitis in children
C. R. Baumal, A. V. Levin, C. C. Kavalec, M. Petric, H. Khan and S. E. Read
Department of Ophthalmology, University of Toronto, Ontario.
OBJECTIVES: To identify immunosuppressed children who are at risk of
cytomegalovirus (CMV) retinitis developing and to evaluate the use of
laboratory results for identifying this risk. DESIGN: Prospective cohort
and retrospective case-control series. SETTING: University hospital
pediatric referral center. PATIENTS: Fifty-six consecutive
immunocompromised children (ie, the prospective group) with laboratory
evidence consistent with acute or recently acquired CMV infection, which
was defined as CMV cultured from the blood, urine, nasopharynx, or biopsy
specimen, recent seroconversion, a 4-fold increase in the CMV antibody
titer, or an antibody titer of 1:512 or greater. Ninety-three
immunocompromised children (ie, the retrospective group) with acute CMV or
previous CMV exposure, which was defined as a CMV titer of 1:4 or greater
and less than 1:512. MAIN OUTCOME MEASURE: Occurrence of CMV retinitis.
RESULTS: Cytomegalovirus retinitis developed in 3 children in the
prospective group and in 4 children in the retrospective group. The causes
of immunosuppression were severe combined immunodeficiency syndrome (n =
2), severe combined immunodeficiency syndrome status post bone marrow
transplantation (n = 1), acquired immunodeficiency syndrome (n = 1), and
acquired immunodeficiency syndrome status post bone marrow transplantation
for leukemia (n = 1), renal transplantation (n = 1), and chemotherapy for
leukemia (n = 1). Cytomegalovirus retinitis was associated with a positive
CMV culture result from the urine (P = .03) or nasopharynx (P < .001) in
the retrospective group. In the retrospective group, one child with
congenital CMV infection and CMV retinitis was excluded from analysis
because laboratory tests for CMV were not obtained prior to ganciclovir
therapy. CONCLUSIONS: Cytomegalovirus retinitis is uncommon in children
compared with adults; it occurred in 5% of the children in our series. A
screening ophthalmologic examination should be considered in
immunocompromised children with positive CMV laboratory results,
particularly positive results of urine or nasopharynx cultures.
