Table 3 Characteristics of this case compared with other Human Cytomegalovirus (CMV) Infections
From: Death from human cytomegalovirus infection in a girl with congenital thymic dysplasia
CMV infection type | Population | Age at onset | Symptoms and signs | Treatment | Outcome |
|---|---|---|---|---|---|
This case | Congenital thymic dysplasia | 3 months old | Refractory CMV disseminated disease (retinitis, pneumonia, and hepatitis) and central nervous system involvement | GCV, V-GCV, and FOS | Death |
Congenital cytomegalovirus( cCMV) Infection | Infants born to CMV-infected mothers | Pregnancy period | a. Asymptomatic; b. Asymptomatic during the newborn period with isolated SNHL; c. Symptomatic cCMV disease (approximately 10%), with manifestations including jaundice, petechiae, purpura, hepatosplenomegaly, microcephaly, intracerebral (typically periventricular) calcifications, SNHL, retinitis, and developmental delays | a. No antiviral therapy for asymptomatic; b. Not routinely receive antiviral treatment for mild symptomatic disease or with isolated SNHL (Uncertain); c. Six months of V-GCV therapy, only most severely affected symptomatic infants who are > 32 weeks gestation and less than 1 month of age; c. Monitoring of hearing and development | Death in 3% to 10% of symptomatic infants associated with primary maternal infections and occurs earlier during gestation; SNHL in approximately 10% of asymptomatic |
Acquired CMV infection | Infants | Perinatal period | a. Asymptomatic and mild infections are the most common; b. Severe symptoms, end-organ disease (e.g., hepatitis, interstitial pneumonia, hematologic abnormalities including thrombocytopenia and leukopenia), and a viral sepsis syndrome | a. Mild cases should not receive antiviral treatment; b. Two weeks of GCV therapy, an additional 1 to 2 weeks can be considered if symptoms and signs have not resolved | The majority of them are curable, and few have a poor prognosis |
Secondary Immunodeficiencies a | Highly variable | Severe symptoms are the same as above | a. Antiviral Pharmacotherapy (GCV, V-GCV, FOS, Cidofovir, Brincidofovir, Letermovir); b. Immune Globulin Intravenous (IGIV) or CMV-IGIV; c. CMV-Specific T-Cells Virus-specific T-cells | Vary with the age and immunocompetence of the host, life-threatening in resistant and refractory CMV infection | |
Primary Immunodeficiencies | Usually during early childhood | a. Severe symptoms are the same as above; b. Haemophagocytic ymphohistiocytosis induces sustained systemic inflammatory responses and immune dysregulation, and autoimmune phenomena; persistence of infection with T-cell exhaustion |