Clinical Features, Treatment Courses, and Distribution of Cytomegalovirus Genotypes among Thrombocytopenia Patients Aged Younger than 12 Months

Abstract

Objective The aims of this study were to evaluate the clinical characteristics, laboratory data, and treatment of the cytomegalovirus (CMV)-associated thrombocytopenia in infants aged younger than 12 months and to investigate the possible relationship between genotypes of glycoprotein B (gB) and glycoprotein H (gH) and CMV-associated thrombocytopenia. Study Design Infants with positive identification of cytomegalovirus (CMV) and thrombocytopenia, being treated at Hubei Maternal and Child Health Hospital from January 2015 to June 2019 were included. Genotype of gB and gH analysis were done by nested polymerase chain reaction (nPCR) and restrictions length polymorphism. Results The prevalence of CMV congenital, perinatal, and postnatal infection were 1.4% (76/5428), 29.1% (378/1301), and 41.8% (243/581), respectively. A total of 29 immunocompetent patients with CMV-associated thrombocytopenia were analyzed, including 7 (9.2%, 7/76) congenital infections, 14 (3.7%, 14/378) perinatal infections, and 8 (3.3%, 8/243) postnatal infections. Platelet count at diagnosis <20 × 109/L was the common hematologic finding of CMV-associated thrombocytopenia in perinatal infection (1/7 congenital infection vs. 10/14 perinatal infection vs. 3/8 postnatal infection, Chi-square (χ2) = 6.616, p = 0.037). Notably, significantly higher frequency of hepatobiliary symptoms was found in congenital and perinatal infections groups (4/7 congenital infection vs. 10/14 perinatal infection vs. 1/8 postnatal infection, χ2 = 7.188, p = 0.027). Intravenous immunoglobulin was prescribed for 24 (82.8%, 24/29) patients, and antiviral agents were prescribed for 9 (31.0%, 9/29) patients. The most prevalent genotypes of CMV in the study were gB1 (60.7%, 17/28) and gH2 (57.1%, 16/28). Conclusion There was a substantial percentage of symptomatic CMV infection in patients aged younger than 12 months. Thrombocytopenia is one of the common clinical manifestations in congenital CMV infection. The gB1 genotype had more virulence in infants with acquired CMV infection. There might be an association between gH2 genotype of CMV and CMV-associated thrombocytopenia.

Cytomegalovirus genotype distribution among postnatally infected infants: association of glycoprotein B, glycoprotein N and glycoprotein H types with CMV-associated thrombocytopenia

“…Our previous studies also confirmed that the gB1 genotype had more virulence in infants with symptomatic CMV disease. 3,4 But interestingly, in asymptomatic infected infants, gB1 was also the dominant genotype, and its genotype distribution was not significantly different from that of CMV-associated thrombocytopenia infants.…”

“…Our previous studies also confirmed that the gB1 genotype had more virulence in infants with symptomatic CMV disease. 3 , 4 …”

“…Our previous research revealed that there might be a potential association between the genotypes of CMV and neonatal thrombocytopenia, and the detection of some specific genotypes might be indicative of severe manifestations in infants with CMV infection. 3 , 4 However, the study design and the criteria to define the study population (congenital and non-congenital cases) and the setting of the control group (CMV-associated thrombocytopenia and non-thrombocytopenic cases) were not clearly established. For this reason, we included patients classified on more unambiguous criteria, and the clinical data collected were complete and thoroughly detailed, which allows us to assess the association between genotypes and the outcome in the non-congenital population.…”

A Case of Cytomegalovirus Infection With Severe Thrombocytopenia in an Infant Who Was Successfully Managed With Antiviral Therapy

“…It is one of the major infectious causes that induce thrombocytopenia. Minimal data are available on the association between CMV infection and thrombocytopenia during early infancy [ 2 ]. The most common form of CMV infection is asymptomatic or benign in immunocompetent children [ 3 ], but CMV infections occurring during the neonatal period can be serious or even fatal.…”

Cytomegalovirus Genotype and Virulence in Infants with Congenital Infection

“…1 Several envelope glycoproteins, encoded by UL55, UL73, and UL75, including glycoprotein B (gB), glycoprotein N (gN), and glycoprotein H (gH), respectively, have been evaluated in clinical CMV iso-lates because of their influence on tissue tropism and virulence. [2][3][4] The UL144 polymorphisms are concentrated in the 5′ end of the gene, especially in cysteine-rich domain 1 (CRD1), that may bind the B-and T-lymphocyte attenuator proteins. This domain's activity may vary among polymorphisms, leading to a range of clinical symptoms and prognoses.…”