Urine CMV PCR Positivity and Wheezing in Children under two Years Old: Implications for Management and Public Health

Objective: Wheezing in infants and toddlers poses a challenge to clinical management due to its multifaceted etiology, including viral infections. Cytomegalovirus (CMV) infection has been implicated in respiratory conditions, mostly in immunocompromised individuals, but its potential role in wheezing in young children remains understudied. Methods: A total of 82 children under two years of age with wheezing were enrolled in this study, including 61 infants (<12 >months) and 21 toddlers (12 to 24 months). Children were categorized into CMV-positive (n=49) and CMV-negative (n=33) groups based on urine PCR tests. Hematological profiles were examined on admission in all children. For CMV positive children, additional hematological evaluations were conducted at 2 weeks and 4 weeks following initiation of antiviral therapy. These children received a ganciclovir regimen (Induction: 5 mg/kg IV, q12h for 2 weeks; Maintenance: 5mg/kg IV q24h, 24 weeks). Results: On admission, CMV-positive children had significantly higher white blood cell (WBC) counts (12.16 vs. 8.39 ×109/L, P=0.004), leukocyte counts (6.92 vs. 4.49 ×109/L, P=0.010), and platelet counts (341.02 vs. 258.27 ×109/L, P=0.002) compared to CMV-negative children. During ganciclovir treatment, the elevated WBC, leukocyte, and platelet levels in CMV-positive children showed significant reductions by the second week, with further notable decreases by the fourth week (P<0.05). Notably, wheezing symptoms in CMV-positive children significantly improved after ganciclovir treatment, with subsequent negative CMV test results, indicating a favorable clinical response to antiviral therapy. Conclusion: Considering the multifaceted etiology of wheezing in children under two years of age, this study suggests that CMV infection may be one of the potential causes of wheezing symptoms. These findings highlight the importance of including CMV testing as part of the diagnostic evaluation for wheezing in this population to ensure more comprehensive management.