HIV in Children
GRAND ROUNDS AND TEACHING FILES
CMV disease
Ira Shah
Consultant in Pediatric Infectious Diseases and Pediatric Hepatology, Nanavati Hospital, Mumbai, India
Incharge, Pediatric HIV and TB Clinic, B J Wadia Hospital for Children, Mumbai, India

A 4 month old boy, 2nd born of third degree consanguineous marriage presented with not gaining weight since birth. He was born at full term by normal vaginal delivery and had a birth weight of 3kg. Mother had fever at 7-8 months of gestation and had received antibiotics orally for same. The child on Day 15 of life developed rash over body with fever which cleared off in 4 days. He was given IV antibiotics for 4 days. He had recurrent cough since 1½ months of age with regurgitation of food since 15 days for which he was advised propped up position. At 2 months of age, he had hematemesis with malena and was given whole blood transfusion and fresh frozen plasma. His milestones and immunization were normal. He was on breast feeds and started on formula feeds, a month ago in view of poor weight gain. An older male child had died at 1½ months of age due to failure to thrive. On examination, he was malnourished (weight = 2.75 kg, length = 56 cm), had pallor, large ears and firm hepatomegaly. Other systems were normal. Investigations showed:
• Hemoglobin = 10.8 gm/dl
• WBC count = 27,300/cumm (78% polymorphs, 20% lymphocytes)
• Platelet count = 8,07,000/cumm
• Venous blood gas = pH = 7.362, bicarbonate = 21 mmol/L
• Urine = Normal
• CRP = Negative
• Bilirubin = 2.5 mg% (direct = 1.3 mg %)
• SGOT = 123 IU/L, SGPT = 66 IU/L (elevated)
• Total proteins = 6.7 gm%, albumin = 2.3 gm%
• S. creatinine, electrolytes, calcium, alkaline phosphatase = Normal
• VDRL, HIV ELISA = Negative
• Ultrasound abdomen = Normal
• Urine for reducing substance = Negative
• TORCH = CMV IgG positive, Rest all IgM & IgG negative
• Blood culture = No growth
• CMV viral load = 3000 copies/ml
• Hearing & eye examination = Normal
• GER = Normal study

After 10 days, liver enzymes and bilirubin were normal and hemogram was also normal and child’s regurgitation episodes also decreased.


Does the CMV infection require treatment?
See Previous Teaching Files
Pediatric Oncall Book Store
NEW ARRIVAL
Infection in Children - Part 2

By Dr. Ira Shah
Case Rounds in Pediatric Liver Disorders
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Tuberculosis
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Management of Pediatric HIV
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Infection in Children
By Dr. Ira Shah