Clinical, Serological and PCR Evidence of Cytomegalovirus Infection in the Central Nervous System in Infancy and Childhood

Abstract

Over a 3-year-period (Dec. 1990-Nov. 1993) 12 children were found PCR-positive for CMV-DNA in CSF and brain biopsies. Three of the patients were immunologically compromised. During the same period CSF samples from 10 shunt-operated children and 143 virological routine CSF samples were PCR CMV negative. Clinical association with positive PCR-CMV reaction was considered likely in 6 patients: two boys developed prolonged fever and meningoencephalitis following neurosurgery, one infant girl had a course compatible with congenital inclusion disease, and three had prolonged fever following transplantation. Clinical association was deemed probable in 3 infant girls: one had neonatal infection, meningitis and intraventricular haemorrhage, one had neonatal encephalitis and failure to thrive, and one with neonatal seizures and encephalitis developed brain atrophy. Clinical association was judged possible in 3 patients: one infant girl with no signs of encephalitis developed brain atrophy, one had an Aicardi Type 1 syndrome and one 2 1/2-year-old boy had an acute encephalitis with insufficient serological support for CMV but was 12 months later PCR positive for CMV. We conclude that CMV may be an overlooked infectious agent of the CNS also in immunocompetent children. PCR aids in rapid diagnosis of CMV infection in the immunocompromised. CMV may occasionally be disclosed with PCR in other conditions as a probably non-relevant observation.

Abbreviations
ALAT: Alanine-aminotransferase
A.M.: Ad mortem
ASAT: Aspartate-aminotransferase
BMT: Bone marrow transplantation
CMV: Cytomegalovirus
CSF: Cerebrospinal fluid
CT: Computed tomography
EBV: Epstein-Barr virus
EEG: Electroencephalography
ELISA: Enzyme linked immunosorbent assay
HHV6: Human herpes simplex virus 6
HSV1: Herpes simplex virus Type 1
HSV2: Herpes simplex virus Type 2
IVF: In vitro fertilisation
IUGR: Intrauterine growth retardation
IVH: Intraventricular haemorrhage
MR: Magnetic resonance tomography
N.D.: Not done
PAD: Patho-anatomical diagnosis
PCR: Polymerase chain reaction
SCID: Severe combined immunodeficiency
SD: Standard deviation
SPECT: Single photon emission computed tomography
VZV: Varicella-zoster virus
NUD: Not identifieda

Key words

Cytomegalovirus - Central nervous system - Infection - Polymerase chain reaction