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Evaluation of 98 immunocompetent children with cytomegalovirus infection: importance of neurodevelopmental follow-up


This study aims to analyze and evaluate the clinic and demographic features of immunocompetent children that have been diagnosed with cytomegalovirus (CMV) infection. The data of children diagnosed with CMV infection between January 2005 and December 2010 and their follow-ups for 2 years were retrospectively evaluated. Ninety-eight patients were included, and the median age at admission was 5.6 months (5 days–36 months). 54.1 % was male. The diagnosis of CMV infection was performed by measurement of serum anti-CMV specific Ig M and IgG titers and PCR method in blood and/or urine. In 3.06 % of the patients, congenital infection was detected, whereas possible congenital infection was observed in 36.7 % of the patients. Furthermore, 44 patients (44.8 %) were detected to have perinatal infection while postnatal infection was spotted in 15.3 % of the patients. The common presenting manifestations were prolonged jaundice, diarrhea, vomiting, abdominal distension, skin eruption, and seizure. And the most common physical examination findings were hepatosplenomegaly, microcephaly, jaundice, and petechia. The mainstream laboratory results were elevated transaminases (50 %), anemia (30.6 %), leukocytosis (27.5 %), and thrombocytopenia (18.3 %). There were intracranial calcification in 5.1 % and eye findings in 5.1 %. On follow-up of patients, complete improvement (59.1 %), neuromotor developmental delay (11.2 %), epilepsy (10.2 %), hearing loss (3.06 %), hemolytic anemia (2.04 %), and growth retardation (1.02 %) were detected.

Conclusion: CMV infection is a significant disease both in congenital and perinatal period. It must be considered that diagnosed patients need to be monitored for a long time with special attention to their neurodevelopmental follow-ups.

What is Known:
Manifestations, follow-up findings, and treatment approaches of CMV infection in immunocompetent individuals have not been extensively revised and have received less attention in the literature.
What is New:
This study is intended for evaluation of the clinical and demographic characteristics and laboratory findings of immunocompetent children with CMV infection in with a broad series of patients.

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Alanine aminotransferase


Aspartate aminotransferase




Central nervous system


Computed tomography


Deoxyribonucleic acid


Gamma-glutamyl transferase


Magnetic resonance imaging


Polymerase chain reaction


  1. 1.

    American Academy of Pediatrics (2009) Cytomegalovirus infection. In: Pickering LK, Baker CJ, Long SS, McMillian JA (eds) Red book: 2009 report of the committee on infectious diseases, 28th edn. American Academy of Pediatrics, Elk Grove Village, pp 708–709

  2. 2.

    Aslam M, Anderson JL, Guglietti D, Cardwell D (2007) CMV-induced neonatal thrombocytopenia: a case report and review of the literature. Am J Perinatol 24:429–434

  3. 3.

    Boppana SB, Pass RF, Britt WJ, Stagno S, Alford CA (1992) Symptomatic congenital cytomegalovirus infection: neonatal morbidity and mortality. Pediatr Infect Dis J 11:93–99

  4. 4.

    Bosnjak VM, Daković I, Duranović V, Lujić L, Krakar G, Marn B (2011) Malformations of cortical development in children with congenital cytomegalovirus infection—a study of nine children with proven congenital cytomegalovirus infection. Coll Antropol 35:229–234

  5. 5.

    Centers for Disease Control and Prevention (2010) Cytomegalovirus (CMV) and Congenital CMV Infection 2010. Available via Accessed on 26 Nov 2014

  6. 6.

    Chen DH, Jiang H, Lee M, Liu F, Zhou ZH (1999) Three dimensional visualization of tegument/capsid epidemiology and treatment. Interactions in the intact human cytomegalovirus. Virology 260:10–16

  7. 7.

    Cytomegalovirus SS (2010) In: Kliegman RM, Stanton B, Geme S, Schor N, Behrman RE (eds) Nelson textbook of pediatrics, 19th edn. WB Saunders, Philadelphia, pp 1115–1117

  8. 8.

    Gandhi KM, Khanna R (2004) Human cytomegalovirus: clinical aspects, immune regulation, and emerging treatments. Lancet Infect Dis 4:725–738

  9. 9.

    Grosse SD, Ross DS, Dollard SC (2008) Congenital cytomegalovirus (CMV) infection as a cause of permanent bilateral hearing loss: a quantitative assessment. J Clin Virol 41:5762

  10. 10.

    Hadaya K, Kaiser L, Rubbia-Brandt L, Gervaix A, Diana A (2004) Ganciclovir for severe cytomegalovirus primary infection in an immunocompetent child. Eur J Clin Microbiol Infect Dis 23:218–220

  11. 11.

    Horwitz CA, Skradski K, Reece E, Lewis FB, Schwartz B, Kelty R, Polesky H (1984) Haemolytic anaemia in previously healthy adult patients with CMV infections: report of two cases and an evaluation of subclinical haemolysis in CMV mononucleosis. Scand J Haematol 33:3542

  12. 12.

    James SH, Kimberlin DW, Whitley RJ (2009) Antiviral therapy for herpesvirus central nervous system infections: neonatal herpes simplex virus infection, herpes simplex encephalitis, and congenital cytomegalovirus infection. Antiviral Res 83:207–213. doi:10.1016/j.antiviral.2009.04.010

  13. 13.

    Kang JW, Kim GN, Kim SY, Kim HJ, Park ES, Kim JY, Lee YH (2010) Clinical and radiologic evaluation of cytomegalovirus induced thrombocytopenia in infants between 1 and 6 months of age. Korean J Hematol 45:29–35. doi:10.5045/kjh.2010.45.1.29

  14. 14.

    Kanik-Yuksek S, Gülhan B, Tezer H, Ozkaya-Parlakay A (2014) A perinatal cytomegalovirus infection in an immunocompetent patient with chorioretinitis. J Trop Pediatr 60:401–403. doi:10.1093/tropej/fmu024

  15. 15.

    Karltorp E, Hellström S, Lewensohn-Fuchs I, Carlsson-Hansén E, Carlsson PI, Engman ML (2012) Congenital cytomegalovirus infection—a common cause of hearing loss of unknown aetiology. Acta Paediatr 101:357–362. doi:10.1111/j.1651-2227.2012.02711.x

  16. 16.

    Koyano S, Inoue N, Oka A, Moriuchi H, Asano K, Ito Y, Yamada H, Yoshikawa T, Suzutani T, Japanese Congenital Cytomegalovirus Study Group (2011) Screening for congenital cytomegalovirus infection using newborn urine samples collected on filter paper: feasibility and outcomes from a multicentre study. BMJ Open 29:1. doi:10.1136/bmjopen-2011-000118

  17. 17.

    Kurtoglu MG, Bozkurt H, Keşli R, Tuncer O, Berktas M (2008) Prevalence of antibodies against rubella, CMV and HSV among children in eastern Turkey. Türk Mikrobiyoloji Cemiyeti Dergisi 38:137–142

  18. 18.

    Leruez-Ville M, Vauloup-Fellous C, Couderc S, Parat S, Castel C, Avettand-Fenoel V, Guilleminot T, Grangeot-Keros L, Ville Y, Grabar S, Magny JF (2011) Prospective identification of congenital cytomegalovirus infection in newborns using real-time polymerase chain reaction assays in dried blood spots. Clin Infect Dis 52:575–581. doi:10.1093/cid/ciq241

  19. 19.

    Li RY, Tsutsui Y (2000) Growth retardation and microcephaly induced in mice by placental infection with murine cytomegalovirus. Teratology 62:79–85

  20. 20.

    Mandell GL, Bennett JE, Dolin R (2010) Principles and practise of infectious diseases, 7th edn. Churchill Livingstone, PA, pp 1971–1987

  21. 21.

    McGavran MH, Smith MG (1965) Ultrastructural, cytochemical, and microchemical observations on cytomegalovirus (salivary gland virus) infection of human cells in tissue culture. Exp Mol Pathol 76:1–10

  22. 22.

    Pass RF (1985) Epidemiology and transmission of cytomegalovirus. J Infect Dis 152:243–248

  23. 23.

    Rafailidis PI, Mourtzoukou EG, Varbobitis IC, Falagas ME (2008) Severe cytomegalovirus infection in apparently immunocompetent patients: a systematic review. Virol J 5:47. doi:10.1186/1743-422X-5-47

  24. 24.

    Schleiss MR (2005) Antiviral therapy of congenital cytomegalovirus infection. Semin Pediatr Infect Dis 16:50–59

  25. 25.

    Taglietti F, Drapeau CM, Grilli E, Capone A, Noto P, Topino S, Petrosillo N (2010) Hemolytic anemia due to acute cytomegalovirus infection in an immunocompetent adult: a case report and review of the literature. J Med Case Rep 4:334. doi:10.1186/1752-1947-4-334

  26. 26.

    Tezer H, Seçmeer G, Kara A, Ceyhan M, Cengiz AB, Devrim I, Us D, Yüce A, Gürakan F, Yildirim I, Ozen H, Saltik-Temizel IN (2008) Cytomegalovirus hepatitis and ganciclovir treatment in immunocompetent children. Turk J Pediatr 50:228–234

  27. 27.

    Trincado DE, Rawlinson WD (2001) Congenital and perinatal infections with cytomegalovirus. J Paediatr Child Health 37:187–192

  28. 28.

    White FV, Dehner LP (2004) Viral diseases of the liver in children: diagnostic and differential diagnostic considerations. Pediatr Dev Pathol 7:552–567

  29. 29.

    Whitley RJ (2004) Congenital cytomegalovirus infection: epidemiology and treatment. Adv Exp Med Biol 549:155–160

  30. 30.

    Zubiaurre L, Zapata E, Bujanda L, Castillo M, Oyarzabal I, Gutiérrez-Stampa MA, Cosme A (2007) Cytomegalovirus hepatitis and myopericarditis. World J Gastroenterol 13:647–648

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All authors of this article contributed to gathering, analysis and writing of the information.

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Correspondence to Saliha Kanik-Yuksek.

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Communicated by David Nadal

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Çelikel, E., Tezer, H., Kanik-Yuksek, S. et al. Evaluation of 98 immunocompetent children with cytomegalovirus infection: importance of neurodevelopmental follow-up. Eur J Pediatr 174, 1101–1107 (2015).

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  • Cytomegalovirus infection
  • Children
  • Immunocompetent