Methods: Retrospective analysis of children (age 3 months to 15 years) admitted with HCAMV from January 2005 to December 2015 at Children’s Memorial Hermann Hospital in Houston, Texas. An adverse clinical outcome was defined as a Glasgow Outcome Scale score of 1- 4 where 1 = death, 2 = vegetative state, 3 = severe disability, 4 = moderate disability.
Results: Fifty-two children with a diagnosis of HCAMV were identified. The median age was 3 years (3 months to 15 years), 27 (52%) were females, 27 (52%) were Hispanics, 9 (17.3%) were immunocompromised, 13 (25%) were intubated, 19 (36.5%) were admitted to the intensive care unit (ICU) and 20 (38.4%) patients had intracerebral bleeds. An external ventricular drain was placed in 33 (63.4%) of the patients and 35 (67.3%) developed hydrocephalus with 31 (59.6%) requiring a ventriculoperitoneal shunt (VPS). The cerebrospinal fluid (CSF) cultures were positive in 32 (61.5%) patients and Pseudomonas aeruginosa, Acinetobacter baumannii, methicillin resistant staphylococcus aureus, methicillin sensitive staphylococcus aureus, alpha hemolytic streptococcus and nontuberculous mycobacteria were among some of the organisms detected in the CSF. An adverse clinical outcome was seen in 24 patients (46%). Prognostic factors associated with an adverse clinical outcome (ACO) were focal neurological exam, a Glasgow coma scale <15, need and duration of mechanical ventilation and admission to the intensive care unit (P<0.01).
Conclusion: Although HCAMV was uncommon among hospitalized children, complications were common including intubation, admission to ICU. Over half required either a ventricular drain and/or VPS. For many (39.5%), a pathogen was never identified. Almost half (46%) developed an adverse clinical outcome.
L. Salazar, None
E. Aguilera, None
R. Hasbun, None