Effect of ganciclovir for the treatment of severe cytomegalovirus-associated pneumonia in children without a specific immunocompromised state

BACKGROUND This study aimed to evaluate the effectiveness of gancyclovir (GCV) treatment for severe cytomegalovirus (CMV)-associated pneumonia in immunocompetent children. METHOD We enrolled patients with CMV-associated severe pneumonia admitted to the Vietnam National Hospital of Pediatrics, Hanoi, Vietnam, from January 2010 to December 2011. On admission, though respiratory bacteria and viruses were not detected in tracheal aspirates, more than 5 × 10(3) copies/mL of CMV-DNA were detected in both tracheal aspirates and in blood plasma. GCV was given intravenously at a dose of 10 mg/kg/24 h for a duration of 14 days at most. The dose was then reduced to 5 mg/kg/24 h until CMV-DNA was not detected in plasma. The main study variables included clinical symptoms, complete blood count, hepatic and renal function, chest X-ray, CMV viral load, duration of GCV treatment and outcome. RESULTS Forty-three patients were enrolled in the study. The median age of patients was 57 (interquartile range [IQR] 45-85) days. Clinical and laboratory findings included anemia (67.4%), leukocytosis (90.7%), hepatosplenomegaly (60.5%), elevated liver enzymes (74.4%), decreased ratio of CD4: CD8-positive T lymphocytes (69.4%), and decreased serum IgG concentration (25.7%). The median duration of GCV treatment was 12 days (IQR 7-21). Thirty-seven patients (86.0%) showed normal chest X-rays at the end of treatment. One infant died (2.3%); the other children (97.7%) were discharged in good condition. There was no severe toxicity associated with GCV treatment. CONCLUSION GCV is safe and effective for the treatment of severe CMV-associated pneumonia in children.