Abstract

Objective: Cytomegalovirus (CMV) pneumonia in immunocompetent children remains underrecognized, and standardized diagnostic criteria are lacking. We aimed to describe the clinical characteristics of immunocompetent children with CMV pneumonia and to evaluate the relationship between bronchoalveolar lavage (BAL) fluid and serum CMV DNA loads and laboratory results.

Materials and Methods: In this retrospective cohort study, medical records of 62 immunocompetent children who underwent flexible bronchoscopy for recurrent pneumonia or persistent wheezing between November 2023 and January 2025 were reviewed. CMV pneumonia was defined by detection of CMV DNA in BAL using real-time polymerase chain reaction (PCR). Quantitative CMV DNA load in BAL and serum were expressed as international units per milliliter (IU/mL). Demographic, clinical, laboratory, and radiological findings were recorded. Correlations between CMV DNA load in BAL and serum and blood indices were analyzed.

Results: Twenty patients (32.2%) were diagnosed with CMV pneumonia. The median age was six years (1.5-9.7), and 55% were male. The most common presenting symptom was chronic cough (85%). Patchy consolidation was the most frequent radiographic finding (45%), while chest computed tomography most commonly demonstrated consolidation (55%), often with bilateral (70%) and multilobar involvement (70%). Serum CMV PCR was positive in six patients (30%). No significant correlation was observed between BAL CMV DNA load (median; 2650 IU/mL; IQR; 311-16874) and serum CMV DNA load (median; 700 IU/mL; IQR; 443-2650) (p > 0.963). BAL CMV DNA load showed a strong positive correlation with serum monocyte count (r = 0.861, p<0.001) and mean platelet volume (MPV) (r = 0.759, p < 0.001). Eleven patients (55%) received intravenous ganciclovir at 5 mg/kg/per dose twice daily for 21 days, and demonstrated clinical and radiological improvement without documented significant adverse effects.

Conclusion: BAL CMV PCR demonstrated a higher detection rate than serum CMV PCR in immunocompetent children with recurrent pneumonia or persistent wheezing. Elevated monocyte count and MPV may reflect CMV-related pulmonary inflammation.

Keywords: Bronchoscopy, bronchoalveolar lavage, children, cytomegalovirus, pneumonia

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1.
Ocak E, Sarıtaş ÜA, Akay Hacı İ, Mert Doğan G, Yılmaz D. Sitomegalovirüs pnömonisi olan bağışıklık sistemi normal olan çocukların klinik özellikleri: Tek merkezli retrospektif kohort çalışması. Turk J Pediatr Dis. 2026;Early View:1-8. https://doi.org/10.12956/TJPD.2025.1297