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Open Access Research article

Effect of ganciclovir for the treatment of severe cytomegalovirus-associated pneumonia in children without a specific immunocompromised state

Thanh Thi Mai Doan123*, Thuy Thi Bich Phung12, Hung Viet Pham1, Son Hong Pham12 and Liem Thanh Nguyen12

Author Affiliations

1 Vietnam National Hospital of Pediatrics, Hanoi, Vietnam

2 Research Institute for Child Health, Hanoi, Vietnam

3 Respiratory Department, National Hospital of Pediatrics, No. 18, Alley 897, La Thanh Street, Dong Da District, Hanoi, Vietnam

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BMC Infectious Diseases 2013, 13:424  doi:10.1186/1471-2334-13-424

Published: 9 September 2013

Abstract

Background

This study aimed to evaluate the effectiveness of gancyclovir (GCV) treatment for severe cytomegalovirus (CMV)-associated pneumonia in immunocompetent children.

Method

We enrolled patients with CMV-associated severe pneumonia admitted to the Vietnam National Hospital of Pediatrics, Hanoi, Vietnam, from January 2010 to December 2011. On admission, though respiratory bacteria and viruses were not detected in tracheal aspirates, more than 5 × 103 copies/mL of CMV-DNA were detected in both tracheal aspirates and in blood plasma. GCV was given intravenously at a dose of 10 mg/kg/24 h for a duration of 14 days at most. The dose was then reduced to 5 mg/kg/24 h until CMV-DNA was not detected in plasma. The main study variables included clinical symptoms, complete blood count, hepatic and renal function, chest X-ray, CMV viral load, duration of GCV treatment and outcome.

Results

Forty-three patients were enrolled in the study. The median age of patients was 57 (interquartile range [IQR] 45–85) days. Clinical and laboratory findings included anemia (67.4%), leukocytosis (90.7%), hepatosplenomegaly (60.5%), elevated liver enzymes (74.4%), decreased ratio of CD4: CD8-positive T lymphocytes (69.4%), and decreased serum IgG concentration (25.7%). The median duration of GCV treatment was 12 days (IQR 7-21). Thirty-seven patients (86.0%) showed normal chest X-rays at the end of treatment. One infant died (2.3%); the other children (97.7%) were discharged in good condition. There was no severe toxicity associated with GCV treatment.

Conclusion

GCV is safe and effective for the treatment of severe CMV-associated pneumonia in children.

Keywords:
Cytomegalovirus-associated pneumonia; Ganciclovir; Children