Screening for retinitis in children with probable systemic cytomegalovirus infection at Tygerberg Hospital, Cape Town, South Africa

Abstract

Background. The incidence of immunocompromised children with probable systemic cytomegalovirus (CMV) infection is increasing. Currently, there is no protocol for screening children for CMV retinitis in South Africa. Screening for CMV retinitis may prevent permanent visual impairment.

Objectives. To determine the prevalence of retinitis in children with probable systemic CMV infection. To assess the value of clinical and laboratory data in identifying risk factors for the development of CMV retinitis in children.

Methods. A retrospective, cross-sectional study design was used. All children (≤12 years) with probable systemic CMV infection who underwent ophthalmic screening over a 5-year period, were included. Presumed CMV retinitis was diagnosed by dilated fundoscopy. All cases were evaluated to identify possible risk factors for the development of CMV retinitis.

Results. A total of 164 children were screened. Presumed CMV retinitis was diagnosed in 4.9% of participants. Causes of immunosuppression were HIV infection (n=7) and chemotherapy (n=1). HIV infection showed a definite trend towards association with the development of CMV retinitis in our study population (p=0.064).

Conclusion. The prevalence of CMV retinitis was 4.9% in our sample. Other than HIV, we were not able to identify additional risk factors for CMV retinitis. Our results show that CD4 levels are possibly not a reliable indicator to predict CMV retinitis.