Cytomegalovirus infections during acute childhood leukemia.

Abstract

Cytomegalovirus (CMV) infections were studied longitudinally in 88 leukemic children; 24 patients had cultural evidence of CMV infection at some point. There appeared to be a good correlation between excretion of virus (in urine and/or throat) and presence of complement-fixing (CF) and indirect-hemagglutination (IHA) antibody; however, a few patients had detectable antibody without excretion of virus and vice versa. Compared with patients not excreting virus, patients shedding CMV had significantly more episodes of pneumonitis and fever with rash but did not have more episodes of hepatitis, fever of unknown origin, or upper respiratory-tract infections. Clinical syndromes attributed to CMV correlated with fourfold rises in CMV antibody titer only during hematologic remission. However, dissemination of CMV occurred during hematologic relapse as well as during remission. Three patients who died after fourfold rises in CMV antibody had postmortem evidence of dissemination. Excretion of virus did not correlate with hematologic relapse, appearance of symptoms, antibody levels, or lymphocyte transformation against CMV. These data suggest that the urine and throat should be repeatedly cultured to detect infection with CMV. Moreover, to diagnose disseminated CMV infections in acute childhood leukemia, it may be necessary to repeatedly determine levels of antibody to CMV.