Browsing by Author "Lakhan, Aruna"
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- ItemCMV viral load as a predictor of the clinical course of CMV-associated pneumonia in hiv infected and uninfected infants(Stellenbosch : Stellenbosch University, 2017-12) Lakhan, Aruna; Goussard, Pierre; Parker, Noor Mohammed; Stellenbosch University. Faculty pf Health Sciences. Dept. of Paediatrics and Child Health.Background Lower respiratory tract infections is one of the leading causes of death in children under 5 years of age. In the advent of HIV, much of these lower respiratory tract infections are attributed to opportunistic infections such as Pneumocystis jiroveci pneumonia (PJP) and Cytomegalovirus (CMV). Short of a lung biopsy, diagnosing CMV pneumonia has proven difficult. Some studies suggest that blood CMV viral load might be of benefit in making the diagnosis of CMV-associated pneumonia. There is currently a scarcity of literature with regards to classifying severity of CMV-associated pneumonia and whether the CMV viral load can be used as a predictive indicator of severity and outcome of CMV-associated pneumonia. Objectives To determine whether CMV viral load is a positive predictor of severity and outcome of CMV-associated hypoxic pneumonia. Methods This was a retrospective descriptive study done in the Paediatric Intensive Care Unit (PICU) in Tygerberg Children’s Hospital, Western Cape, South Africa. Study participants were identified from the National Health Laboratory Service (NHLS) database as those patients in PICU less than 1 year of age with a positive cytomegalovirus viral load between 1 January 2014 to 31 December 2015. Patient clinical, radiological, and biochemical data was collected and analyzed. Results A total of 87 patients were included in the study. Twenty-seven of these patients were HIV-positive, 3 of which were on antiretroviral therapy. Comparisons were made between two groups (CMV VL ≤ 4 and > 4) based on the median blood CMV viral load in our study of 4.0 (IQR 3.3-4.79). There was no difference in severity of disease based on Pa02/Fi02 ratio and x-ray findings between the two groups. The mortality in the two groups was similar with a 90% survival rate. (p=0.37). Patients with higher CMV VL required a longer duration of high frequency oscillation ventilation (HFOV) (p=0.005), yet the mean length of PICU stay between the two groups was not statistically different. (p=0.43). Patients who had CMV viral load > 4, had an increased incidence of PJP co-infection (p=0.018), lower CD4 counts (p=0.0001) and higher HIV viral loads (p=0.049). All the patients with PJP-CMV co-infection were successfully treated and discharged. Conclusion CMV viral load alone cannot diagnose pneumonia and showed limited utility in predicting the course and outcome of CMV-associated pneumonia in young infants. The association between CMV VL, PJP co-infection, lower blood CD4 count and HIV viral load suggests that CMV-associated pneumonia occurs in more immune suppressed young infants but the lack of disease severity being associated with the CMV VL limits the usefulness of the test in diagnosing CMV-associated pneumonia and the need for antiviral therapy.