Clinical Characteristics Of Human Cytomegalovinis In Bronchoalveolar Lavage Fluid Of Children Will Lower Respiratory Tract Infection

Objective:To explore the epidemiological characteristics and clinical manifestations of human cytomegalovirus(HCMV)infection in the lower respiratory tract of children with normal immune function,and demonstrate the value and significance of detection of HCMV by means of bronchoalveolar lavage fluid in clinical diagnosis.Methods:The children who were hospitalized from January 2017 to December 2018 for lower respiratory tract infection in the respiratory department of Children's Hospital of Soochow University and received BALF during bronchoscopy were selected as the object of study with a sample size of 611.The collected BALF was sent to the laboratory for multi pathogenic detection and quantitative detection of HCMV nucleic acid(PCR fluorescence probe method),and the data of the subjects were collected by retrospective analysis.Based on the quantitative detection of BALF nucleic acid for HCMV,these children were divided into positive and negative detection groups of HCMV to enable comparability of their epidemiological characteristics and clinical performance.Results:1.Of all 611 children with lower respiratory tract infection,the positive rate of HCMV was 30.77%(188/611).The proportion of male children in HCMV positive detection group were significantly higher than those in HCMV negative detection group.The average age of HCMV positive detection group was significantly lower than that of HCMV negative detection group,and the positive rate of HCMV in children under 1 year old was significantly higher than that in other age groups.The percentage of children who were non-artificial feeding was also found to be significantly higher in HCMV positive detection group.The difference was statistically significant,P<0.05.2.The highest detection rate of HCMV using BALF was achieved in spring,with a value of 40.38%(63/156)in spring,followed by 34.58%(37/107)in winter.There was a significant difference between seasons,P<0.01.3.There were significant statistical differences in the observed symptoms of fever,thermal spike,wheezing,dry rale of lung and laryngotracheal malacia between HCMV positive and negative detection groups.The proportion of children with disease course exceeding 4 weeks before admission was higher in HCMV positive detection group.The average length of stay in HCMV positive detection group was also significantly longer.The difference between the two groups was statistically significant,P<0.05.4.The peripheral blood leukocytes in HCMV positive detection group were higher than those negative detection group;The C-reactive protein in HCMV detection positive group was lower than that in HCMV negative detection group;The percentages of children with ALT greater than 35U/L was 22.34%in HCMV positive detection group,higher than the corresponding values of 11.58%in the other group;The percentages of children with AST greater than 67U/L was 13.30%in HCMV positive detection group,higher than the corresponding values of 6.86%in the other group;TB value in HCMV positive detection group greater than 17.1umol/L was 3.72%,which was higher than 0.71%in HCMV negative detection group;CKMB value in HCMV positive detection group greater than 3.7U/L was 38.83%,higher than 14.89%in HCMV negative detection group.There was a statistical difference between the two groups,P<0.05.5.Bronchial pneumonia was 80.32%in HCMV positive detection group,which was significantly more than 53.43%in HCMV negative detection group,and 11.70%in HCMV positive detection group was lobar pneumonia,which was significantly less than the HCMV negative detection group.The pleural effusion in the HCMV positive detection group was 2.13%,which was significantly lower than 10.87%in HCMV negative detection group.The differences were statistically significant,P<0.001.6.The mixed bacterial infection in HCMV positive detection group was significantly higher than that in negative detection group,the difference was statistically significant,P<0.05.Conclusions:1.The positive detection rate of HCMV detection in the children with lower respiratory infections by means of BALF was 30.77%,and the male children were associated with a higher detection rate.HCMV infection was more frequent in infants?1 year old.2.Non-artificial feeding is an important route of transmission for HCMV.The detection rate of HCMV is highest in spring,and then winter.3.The course of HCMV infection was prolonged(long),the treatment was difficult(long time in hospital),symptom of fever was rare,and those who got it were primarily with low and moderate fever.Main manifestation includes cough,wheezing and lung dry rale.The lower respiratory tract infection caused by HCMV was diagnosed as bronchopneumonia,which causes damage to liver and heart.4.HCMV alone is more than sufficient to cause lower respiratory tract infection in children,and it can also be mixed with other pathogens,which is the most likely to be mixed with bacterial infection.5.The positive detection of HCMV by means of BALF may have a more reliable clinical value in accurately reflecting the infection site and indicating an active HCMV infection.