Cytomegalovirus-related hemorrhagic cystitis in an immunocompetent child

Clinical Manifestations of Non-Congenital CMV Infection in Infants and Immunocompetent Children: Review of Cases from the Past Decade

Cytomegalovirus (CMV), the largest of the herpes viruses, is a widespread virus that commonly infects people of all ages. CMV can cause a spectrum of clinical manifestations, ranging from asymptomatic infection to severe disease, particularly in immunocompromised hosts. However, postnatal and acquired CMV infections in immunocompetent children remain under-documented in the literature. In this review, we examine studies published over the past decade to explore the clinical manifestations of CMV infections in the pediatric population, focusing on the variety of symptoms and the severity with which the infection can present. Papers published between 1 January 2014 and 2 December 2024 were selected from PubMed/MEDLINE, Embase, Scopus, and Web of Science. The search was conducted using the following keywords: "cytomegalovirus", "child", and "immunocompetent". The target population ranged from 0 to 17 years of age, with congenital and perinatal infections excluded. Despite the clinical significance of CMV in immunocompetent infants and children, there is a lack of consensus on the use and duration of antiviral therapy. This article aims to enhance clinicians' understanding of the various presentations of CMV infection in immunocompetent children, with the goal of facilitating earlier diagnosis and appropriate management. The reviewed papers indicated that postnatal CMV results in liver symptoms in 67% of cases, followed by hematological disorders and gastrointestinal pathology. In older children, primary infection leads to liver disease in 51% of cases, with greater neurological and pulmonary involvement compared to that in infants. By highlighting the wide-ranging clinical effects of CMV, we hope to improve physicians' ability to recognize and subsequently treat this often overlooked condition in pediatric patients.

Risk factors for hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation in a letermovir-exposed CMV-free population receiving PTCy

Hemorrhagic cystitis (HC) is a highly impacting complication in allogeneic hematopoietic stem cell transplantation (HSCT), occurring in 12%-37% of patients. The impact of transplant- and patient-specific variables has been described, with a possible role for JCV and BKV, which may be cooperating with cytomegalovirus (CMV). Here, we analyze 134 letermovir-exposed, CMV-free patients, treated with the same cyclophosphamide-based graft-versus-host disease (GVHD) prophylaxis, describing risk factors for HC. The overall incidence of HC was 23%. Patients with HLA mismatched transplant, higher comorbidity score, and receiving three alkylating agents with TBF (thiotepa, busulfan, and fludarabine) conditioning regimen had a higher risk of HC in multivariate analysis (OR: 4.48, 6.32, and 1.32, respectively). A HC-score including male gender, TBF conditioning, and HLA-mismatch stratifies the risk of HC in the first 100 days after HSCT. The role of BKV and JCV was not highly impacting in those patients, suggesting a possible synergistic effect between CMV and JCV in causing HC. HC can be interpreted as the combination of patient-related factors, chemotherapy-related toxicities-especially due to alkylating agents-and immunological elements.

Cytomegalovirus infection in non-immunocompromised critically ill patients: A management perspective

Critically ill patients are a vulnerable group at high risk of developing secondary infections. High disease severity, prolonged intensive care unit (ICU) stay, sepsis, and multiple drugs with immunosuppressive activity make these patients prone to immuneparesis and increase the risk of various opportunistic infections, including cytomegalovirus (CMV). CMV seroconversion has been reported in up to 33% of ICU patients, but its impact on patient outcomes remains a matter of debate. Even though there are guidelines regarding the management of CMV infection in immunosuppressive patients with human immunodeficiency virus/ acquired immuno deficiency syndrome, the need for treatment and therapeutic approaches in immunocompetent critically ill patients is still ambiguous. Even the diagnosis of CMV infection may be challenging in such patients due to non-specific symptoms and multiorgan involvement. Hence, a better understanding of the symptomatology, diagnostics, and treatment options may aid intensive care physicians in ensuring accurate diagnoses and instituting therapeutic interventions.