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Congenital cytomegalovirus infection: three autopsy case reports
Abstract:
We report three autopsy cases of congenital cytomegalovirus (CMV) infection in fetuses with a review of literature. The clinical manifestations in these cases of congenital CMV infection include intrauterine fetal death, hydrops fetalis, and CMV pneumonia associated with cardiovascular defect. The pathological characteristics were as follows: 1) the kidney was the most frequently involved organ, followed by lung and liver, 2) CMV inclusions were found predominantly in epithelial cells and to a lesser degree in endothelial cells, 3) intrahepatic bile duct epithelial cells were frequently involved, and 4) inflammatory reaction around CMV inclusions was not prominent in the early stage of pregnancy. Diagnostic confirmation was obtained by in situ hybridization (ISH) using a biotinylated CMV-DNA probe, which demonstrated intranuclear inclusions and sometimes recognized cells that did not show intranuclear inclusion.
Insights
Congenital cytomegalovirus (CMV) infection in fetuses can lead to severe outcomes like intrauterine fetal death. Autopsy findings reveal kidney, lung, and liver involvement, with diagnostic confirmation via in situ hybridization.
Area of Science:
- Pathology
- Virology
- Obstetrics
Background:
- Congenital cytomegalovirus (CMV) infection is a significant cause of fetal morbidity and mortality.
- Understanding the pathological characteristics and diagnostic methods is crucial for managing congenital CMV.
- This study reviews autopsy cases and literature to elucidate key features of fetal CMV infection.
Observation:
- Three autopsy cases of congenital CMV infection in fetuses were analyzed.
- Clinical manifestations included intrauterine fetal death, hydrops fetalis, and CMV pneumonia with cardiovascular defects.
- Pathological examination highlighted frequent involvement of the kidney, lung, and liver, with CMV inclusions primarily in epithelial cells.
Findings:
- CMV inclusions were predominantly found in epithelial cells, particularly intrahepatic bile duct epithelial cells, and less frequently in endothelial cells.
- The inflammatory response around CMV inclusions was often minimal in early pregnancy.
- In situ hybridization (ISH) confirmed diagnostic findings, identifying intranuclear inclusions and affected cells without visible inclusions.
Implications:
- Early and accurate diagnosis of congenital CMV is essential for timely intervention and improved fetal outcomes.
- The pathological findings provide insights into organ-specific vulnerability and cellular tropism of CMV in utero.
- Further research into the early inflammatory response could inform strategies for preventing or mitigating fetal damage.