Cytomegalovirus hepatitis in 49 pediatric patients with normal immunity

Abstract

Background/aim: Cytomegalovirus (CMV) hepatitis is generally asymptomatic or rarely can lead to severe complications in immunocompetent hosts. This study aims to evaluate CMV hepatitis in immunocompetent young children, which is discussed relatively rarely in the literature. Materials and methods:A retrospective review of 49 pediatric patients with CMV hepatitis from January 2005 to December 2010 was performed. Results:The median age of the patients was 5.81 ± 6.49 months and 57.1% were female. Complaints were prolonged jaundice, vomiting, diarrhea, and abdominal distension. Seventeen patients (34.6%) had congenital or probable congenital CMV infection, while 32/49 (65.3%) had perinatal CMV infection. CMV hepatitis was accompanied by other system findings in 22 patients (44.9%), and only liver involvement was present in 27/49 (55.1%). Alanine aminotransferase and aspartate aminotransferase were elevated together in all patients. Cholestatic hepatitis was present in 13 patients (26.5%). Four patients (8.16%) were treated with ganciclovir. Complete improvement of hepatitis occurred in 48/49 (97.95%). The recovery time of liver function tests was 7-180 days (mean: 53.92 ± 40.8). Conclusion:CMV hepatitis is usually mild and has a good outcome in immunocompetent individuals. However, cases should be carefully evaluated due to the important role of CMV in the etiology of infantile and neonatal hepatitis.

High prevalence of breastmilk‐acquired cytomegalovirus infection in jaundiced infants

“…The diagnosis of CMV infection can be performed in the following ways: (a) exclusion of congenital CMV infection—urine CMV‐DNA test was performed at admission, and there was no definite infection <2 weeks after birth; (b) BM CMV(+)—CMV‐DNA > 500 copies/mL in the BM fed to pathologically jaundiced infants was detected by real‐time fluorescence quantitative polymerase chain reaction( RT‐FQ‐PCR); (c) BM‐acquired CMV infection—after 2 weeks of CMV(+) BM feeding in non‐congenital CMV infection infants, CMV infection was indicated by positive plasma CMV‐DNA, peripheral blood mononuclear cell (PBMC) CMV‐DNA, urine CMV‐DNA, or serum CMV‐IgM; (d) CMV‐IgM test—performed with a fully automatic chemiluminescence analyzer and matching reagents (Liaison); (e) CMV‐DNA test—the reagents (Hunan Sansure Biotech Inc) and RT‐FQ‐PCR method (ABI 7500 fluorescence PCR amplifier; Applied Biosystems) were used; CMV‐DNA was extracted, amplified, and analyzed strictly according to the procedures stipulated in the kit manual; and (f) a positive result was defined as a typical S growth curve of CMV‐DNA, and the laboratory results showed CMV‐DNA > 500 copies/mL; otherwise, the result was negative. CMV‐IgM ≥ 18 U/mL indicated positive, and CMV‐IgM < 18 U/mL indicated negative.…”

Evidence for Viral Induction of Biliary Atresia: A Review

“…CMV infection in normal term infants, when symptomatic, usually presents with transient fever, mild pneumonitis, vomiting, diarrhea, hepatitis, and abnormal blood counts. For those that have liver involvement, liver function tests usually improve by 2 to 3 months 22…”

Hepatic Involvement in Epstein-Barr Virus and Cytomegalovirus Infections: Evaluation of 31 Cases

“…konjenital veya perinatal CMV enfeksiyonu olan 49 olguyu retrospektif olarak değerlendirdikleri çalışmalarında, bağışıklık sistemi normal olmasına rağmen hastaların %55.1'inde sadece karaciğer tutulumunun olduğunu, bu hastalardan %26,5'inde ise kolestatik hepatit tablosunun geliştiğini bildirmektedirler. 20 Çalışmamızda ise yedi olguda CMV hepatit tablosu izlenirken, bunların altısında herhangi bir bağışıklık yetmezliği saptanmamıştır. Bir hastada glioblastoma multiforme tanısıyla aldığı kemoterapi sonrası oluşan immunsupresyon sonucu CMV enfeksiyonu geliş-tiği düşünülmüştür.…”