Infection of Cytomegalovirus in Cholestasis Infant with Biliary Atresia

Authors

  • Lasmauli Situmorang Division of Hepatology, Department of Child Health, Faculty of Medicine, Airlangga University/Dr. Soetomo Hospital, Surabaya-Indonesia
  • Bagus Setyoboedi Division of Hepatology, Department of Child Health, Faculty of Medicine, Airlangga University/Dr. Soetomo Hospital, Surabaya-Indonesia
  • Gondo Mastutik Department of Anatomy Pathology, Faculty of Medicine, Airlangga University/Dr. Soetomo Hospital, Surabaya-Indonesia
  • Sjamsul Arief Division of Hepatology, Department of Child Health, Faculty of Medicine, Airlangga University/Dr. Soetomo Hospital, Surabaya-Indonesia

DOI:

https://doi.org/10.24293/ijcpml.v26i2.1496

Keywords:

Biliary atresia, cholestasis, cytomegalovirus, polymerase chain reaction

Abstract

Biliary Atresia (BA) is extrahepatic cholestasis that results in death within the first two years if the diagnosis and intervention are delayed. The etiology and pathogenesis of BA are still undetermined. Viral infections, including Cytomegalovirus (CMV), are presumed to be one of the causes. Cytomegalovirus infection is more common in intrahepatic than extrahepatic cholestasis such as BA. There are limited data about Cytomegalovirus infection in cholestatic infants with BA. This study compared the incidence of CMV infection in cholestatic infants with biliary atresia and non-biliary atresia. A cross-sectional study was performed in December 2017 - August 2018 in cholestatic infants aged 1-6 months. Liver biopsy, histopathological examination followed by PCR CMV examination were performed on cholestatic infants. The results of the PCR examination were compared between BA and non-BA infants. Statistical analysis of Chi-Square, t-test independent and Mann-Whitney U resulting in p<0.05 were stated as significant. Thirty-seven children were obtained during the study period, consisting of sixteen children with BA and twenty-one children with non-BA. Biliary atresia was predominantly found in female than male children, despite no differences were found between the groups (p=0.163). There were differences in body weight (p=0.002) age (p=0.009), birth weight (p=0.02) and gestational age (p=0.03) between children with BA and non-BA. There was no significant difference in the incidence of CMV infection in cholestatic infants with BA and non-BA (p=0.338). Cytomegalovirus infection in cholestatic infants with BA was less than non-BA cholestatic infants.

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Author Biographies

Lasmauli Situmorang, Division of Hepatology, Department of Child Health, Faculty of Medicine, Airlangga University/Dr. Soetomo Hospital, Surabaya-Indonesia

Division of Hepatology, Department of Child Health, Faculty of Medicine, Airlangga University/Dr. Soetomo Hospital, Surabaya-Indonesia

Bagus Setyoboedi, Division of Hepatology, Department of Child Health, Faculty of Medicine, Airlangga University/Dr. Soetomo Hospital, Surabaya-Indonesia

Division of Hepatology, Department of Child Health, Faculty of Medicine, Airlangga University/Dr. Soetomo Hospital, Surabaya-Indonesia

Gondo Mastutik, Department of Anatomy Pathology, Faculty of Medicine, Airlangga University/Dr. Soetomo Hospital, Surabaya-Indonesia

Department of Anatomy Pathology, Faculty of Medicine, Airlangga University/Dr. Soetomo Hospital, Surabaya-Indonesia

 

Sjamsul Arief, Division of Hepatology, Department of Child Health, Faculty of Medicine, Airlangga University/Dr. Soetomo Hospital, Surabaya-Indonesia

Division of Hepatology, Department of Child Health, Faculty of Medicine, Airlangga University/Dr. Soetomo Hospital, Surabaya-Indonesia

References

Santos JL, Carvalho E and Bezerra JA. Advances in biliary atresia: from patient care to research. Braz. J. Med. Biol. Res. 2010;43(6): 522-527

Bassett MD and Murray KF. Biliary atresia: recent progress. J. Clin. Gastroenterol. 2008;42: 720-729.

Moreira RK, Cabral R, Cowles RA and Lobritto SJ. Biliary atresia: a multidisciplinary approach to diagnosis and management. Arch. Pathol. Lab. Med. 2012;136: 746-760.

Sira MM, Salem TAH and Sira AM. Biliary Atresia: A Challenging Diagnosis. Global Journal of Gastroenterology. 2013;1: 24-35.

Oliveira NL, Kanawaty FR, Costa SC and Hessel G. Infection by cytomegalovirus in patients with neonatal cholestasis. Arq. Gastroenterol. 2002;39: 132-136.

Buonsenso D, Serranti D, Gargiullo L, Ceccarelli M, Ranno O and Valentini P. Congenital cytomegalovirus infection: current strategies and future perspectives. Eur Rev Med Pharmacol Sci. 2012;16: 919-935.

Caliendo AM, Schuurman R, Yen-Lieberman B, Spector SA, Andersen J, et al. Comparison of quantitative and qualitative PCR assays for cytomegalovirus DNA in plasma. J Clin Microbiol. 2001;39:1334-1338.

Mack CL and RJ Sokol. Unraveling the pathogenesis and etiology of biliary atresia. Pediatr Res. 2005;57: 87-94.

Xu Y, Yu J, Zhang R, Yin Y, Ye J, et al. The perinatal infection of cytomegalovirus is an important etiology for biliary atresia in China. Clin. Pediatr (Phila). 2012;51:109-113.

Rauschenfels S, Krassmann M, Al-Masri AN, Verhagen W, Leonhardt J, et al. Incidence of hepatotropic viruses in biliary atresia. Eur. J. Pediatr. 2009;168: 469-476.

Rashed YK, Saber MA, Tawfik M and Mourad WS. Histopathological features and accuracy for diagnosing biliary atresia by prelaparotomy liver biopsy in Egypt. Egyptian. Pediatric Association Gazette. 2013;61: 42-45.

Rastogi AN, Krishnani K, Yachha V, Khanna U, Poddar, et al. Histopathological features and accuracy for diagnosing biliary atresia by prelaparotomy liver biopsy in developing countries. J. Gastroenterol Hepatol. 2009;24: 97-102.

Lee WS and Looi LM. Usefulness of a scoring system in the interpretation of histology in neonatal cholestasis. World J. Gastroenterol. 2009;15(42): 5326-5333.

Russo P, Magee JC, Boitnott J, et al. Design and validation of the biliary atresia research consortium histologic assessment system for cholestasis in infancy. Clinical Gastroenterology and Hepatology: American Gastroenterological Association. 2011;9(4): 357-362.

Bellomo-Brandao MA, Arnaut LT, Tommaso AM and Hessel G. Differential diagnosis of neonatal cholestasis: clinical and laboratory parameters. J. Pediatr. 2010;86(1): 40-44.

Fischler B, Woxenius S, Nemeth A and Papadogiannakis N. Immunoglobulin deposits in liver tissue from infants with biliary atresia and the correlation to cytomegalovirus infection. J. Pediatr. Surg. 2005;40: 541-546.

Bazlul Karim AS and Kamal M. Cholestasis jaundice during infancy: experience at a tertiary-care center in Bangladesh. Indian. J. Gastroenterol. 2005;24(2): 52-54.

Wibowo S, Santoso NB. Karakteristik Klinik dan Laboratorik Kolestasis Intrahepatal dan Ekstrahepatal di Bangsal Perawatan Anak RSU Dr. Saiful Anwar Malang. M. Med. Indones. 2012; 46: 108-114.

Jahan M. Laboratory Diagnosis of CMV Infection: a review. Bangladesh J. Med. Microbiol. 2010;4(2): 39-44.

Mack CL. The pathogenesis of biliary atresia: evidence for a virus-induced autoimmune disease. Semin. Liver Dis. 2007;27: 233-242.

Lazim HH, Kadhim HS, Arif H and Al Khafaji KR. The association between biliary atresia and cytomegalovirus Hepatitis. J. Nepal Paediatr. Soc. 2015.35(3):269-274.

Wang W, Zheng S, Shong Z and Zhao R. Developmental of a guinea pig model of perinatal cytomegalovirus-induced hepatobiliary inhury. Fetal. Pediatr. Pathol. 2011. 30(5):301–311.

Wang W, Donnelly B dan Bondoc A. The rhesus rotavirus gene encoding VP4 is a major determinant in the pathogenesis of biliary atresia in newborn mice. J. Virol. 2011;85(17): 9069–9077.

Soomro GB, Abbas Z, Hassan M, Luck N, Memon Y and Khan AW. Is there any association of extra hepatic biliary atresia with cytomegalovirus or other infections? J. Pak. Med. Assoc. 2011;61:281-283.

Yaghobi R, Didari M and Gramizadeh B. Study of viral infections in infants with biliary atresia. Indian J. Pediatr. 2011;78(4):478–481.

Von Sochaczewski CO, Pintelon I, Brouns I, et al. Rotavirus particles in the extrahepatic bile duct in experimental biliary atresia. J. Pediatr. Surg. 2014. 49:520–524.

Tyler KL, RJ Sokol and SM Oberhaus. Detection of reovirus RNA in hepatobiliary tissues from patients with extrahepatic biliary atresia and choledochal cysts. Hepatology. 1998;27(6):1475–1482.

Fjaer RB, Bruu AL and Nordbo. Extrahepatic bile duct atresia and viral involvement. Pediatr. Transplant. 2005;9: 68-73.

Domiati-Saad R, Dawson DB and Margraf LR. Cytomegalovirus and human herpesvirus 6, but not human papillomavirus, are present in neonatal giant cell hepatitis and extrahepatic biliary atresia. Pediatr. Dev. Pathol. 2000;3(4):367–373.

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Submitted

2019-03-29

Accepted

2019-05-13

Published

2020-03-31

How to Cite

[1]
Situmorang, L., Setyoboedi, B., Mastutik, G. and Arief, S. 2020. Infection of Cytomegalovirus in Cholestasis Infant with Biliary Atresia. INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY. 26, 2 (Mar. 2020), 175–181. DOI:https://doi.org/10.24293/ijcpml.v26i2.1496.

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