Retrospective investigation of lymphocyte distribution and serum i̇mmünglobuli̇n levels in children under 5 years with cmv infection

Objective: Viral infections and live viral vaccines are well known causes of transient suppression in immunity. As CMV causes serious infection in pediatric age group, this study aims to investigate retrospectively , whether there is a suppressive effect on complete blood count, serum immunoglobulin (IgA, IgG, IgM, IgE) and peripheral blood T and B lymphocyte subgroups, during the course of acute CMV infection in young children. Patient and methods: The study included children younger than five years of age who have presented to outpatient clinics of Children's Hospital , Dokuz Eylul University School of Medicine between years 2009- 2019. The patients who were diagnosed as CMV infection according to CMV IgM and CMV PCR positivity were retrospectively studied from their files, and clinical findings (lymphadenomegaly, hepatosplenomegaly) , laboratory values of complete blood count , serum immunoglobulins (IgA, IgG, IgM, IgE), peripheral blood T and B lymphocyte subgroups were evaluated. The results were compared with corresponding laboratory values within the normal percentiles of the same age group in healthy children.SPSS 24.0 program was used for statistical analysis. Results: A total of 84 patients were included in our study. 45.2% of these patients were girls and 54.8% were boys. The ages of the patients were at least one month, maximum 60 months, and the median age was 7.2 months, and the mean age was 12.9 ± 12.2 months. PCR test was performed from plasma samples of 59.5% of 84 patients with anti-CMV Ig M +, and CMV DNA positivity was detected in 86% of those tested. In 14% of the patients, viral DNA was not detected. CMV DNA positivity was more common in patients with leukocytosis than those without (p = 0.015). All of the CMV DNA PCR negative patients were in the group without leukocytosis. In patients whose immunoglobulin value was studied, low IgE was not found in any of the patients, 11.5% had low IgA, 13.6% low IgM and 8.7% low IgG levels. Lymphocyte subgroups were studied from 12 patients, and none of the patients had low T lymphocyte levels. T helper cells; It was observed that it was low in 16.7% of the cases and high in 8.3%. T cytotoxic cells were found to be low in 8.3% of the patients and high in 8.3% of the patients. Elevation of B lymphocyte levels was not observed in any of the patients, while it was low in 20% of the patients, hypogammaglobulinemia was not found in any of these patients. Natural Killer levels were found to be low in 25% of the patients. While no leukopenia was observed , leukocytosis in 34.5%, anemia in 28.6%, thrombocytopenia in 19%, thrombocytosis was found in 39.3% in the complete blood count of the patients. During the first examination, 16.7% hepatomegaly, 9.5% splenomegaly and 14.3% lymphadenopathy were observed. Discussion: CMV infection is usually encountered in the first years of life and is known to affect immune functions .In this retrospective study in small children , CMV infection did not cause significant changes in complete blood count parameters , serum immunoglobulin and peripheral blood lymphocyte subgroup levels. Hepatosplenomegaly and lymphadenopathy were not common on examination. These findings suggested that during the course of CMV infection in immunocompetent young children, close clinical observation before detailed immunological investigations would be appropriate.