Characteristics and outcomes of infants with cytomegalovirus infection in Bloemfontein

Background. Cytomegalovirus (CMV) infection may significantly contribute to morbidity and mortality in infancy. Objectives. To describe the outcomes and characteristics of CMV-infected infants in an HIV-prevalent population. Methods. A retrospective, descriptive study was conducted by reviewing hospital records of infants who had a positive CMV test and were admitted to the academic hospitals in Bloemfontein. Results. Inpatient mortality for CMV-infected infants was 13.3% (n=18/135). Of those, 66.6% (12/18) of patients who died were HIV exposed and 33.3% (6/18) had CMV/HIV co-infection. The most common causes of death were sepsis (38.9%), pneumonia/pneumonitis (33.3%) and multi-organ failure (11.2%). Approximately 60.7% (82/135) of all CMV-positive infants were HIV exposed, while 20.7% (28/135) were HIV infected. More than half (55.6%) of the patients had a birth weight <2.5 kg, while 48.7% were preterm. A third (33.3%) of the patients were small for gestational age at birth, with suboptimal postnatal growth in 62.2%. Microcephaly was present at birth in 25.2%. Poor brain growth led to postnatal microcephaly in 46.6% of patients. The most common clinical presentations were CMV pneumonia/pneumonitis (60%) and hepatomegaly (50.4%). Thrombocytopenia was a common finding (41.5%). Half (50%) of the infants who died were not treated with antiviral medication. Conclusion. CMV infection in infancy is under-appreciated in South Africa. It may contribute to morbidity and mortality, particularly in preterm and low birth weight infants and HIV-exposed or infected infants. Clinicians should have a high index of suspicion for CMV infection in infants who have postnatal growth failure and postnatal microcephaly.