Van der Byl, ArinaGoedhals, DominiqueMoodley, Melisha2022-06-292022-06-292020-09http://hdl.handle.net/11660/11730Background: Cytomegalovirus (CMV) can be transmitted from mother to child and can be congenital or postnatally acquired. Emerging evidence has shown that CMV and other congenital and neonatal infections, are under-appreciated causes of morbidity and mortality in African children. Research regarding the mortality rate and characteristics of CMV infected infants, specifically in a population with high HIV prevalence, is limited. Objective: The primary objectives of the study were to establish the mortality rate and final outcomes of inpatients with a positive CMV test. Secondary objectives were to determine the demographical, clinical and laboratory characteristics of these infants, as well as maternal characteristics. Tertiary objectives were to describe the special investigations, morbidity, complications and management of these infants. Methods: A retrospective, descriptive study was conducted by reviewing hospital records of infants younger than 12 months, who had a positive CMV test and were admitted to the academic hospitals in Bloemfontein, South Africa. Results: Inpatient mortality for CMV infected infants was 13.3% (18 of 135 patients). 66.6% (12/18) of patients who died were HIV exposed and 33.3% (6/18) had CMV/HIV co-infection. The most common causes of death were sepsis (38.9%), pneumonia/pneumonitis (33.3%) and multi-organ failure (11.2%). 60.7% (82/135) of all CMV positive infants were HIV exposed and 20.7% (28/135) were HIV infected. 55.6% had a birth weight of less than 2,5 kg and were preterm, and 33.3% were small for gestational age. 5.9% were classified as congenital CMV and 94.1% as postnatally acquired. The most common clinical presentations were CMV pneumonia/pneumonitis (60%) and hepatomegaly (50.4%). Thrombocytopenia was a common finding (41.5%). 33.3% of infants had intra-uterine growth restriction and postnatal growth was suboptimal in 62.2%; 25.2% were underweight, and 37% of infants had failure to thrive. Microcephaly was present at birth in 25.2%, but poor brain growth led to postnatal microcephaly in 46.6%. Infants that were untreated for CMV infection were more likely to have developmental delay (P-value <0.05). 50% (9/18) of the infants that demised were not treated for CMV. Conclusion: CMV infection in infancy is under-appreciated in South Africa. It contributes to morbidity and mortality, particularly in preterm and low birth weight infants, and HIV exposed or infected infants. Clinicians should have a high index of suspicion for CMV infection in infants who have postnatal growth failure and postnatal microcephaly.enDissertation (M.Med. (Paediatrics and Child Health))--University of the Free State, 2020CytomegalovirusInfant mortalityInfant morbidityLow birth weightHIV exposedHIV infectedDemographicalClinicalLaboratory characteristicsDissertationUniversity of the Free State