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Published on: July 6, 2013
Impact of Cytomegalovirus Infection on Short-Term Clinical Outcomes and Operative Histopathology in Infants with
Gayatri Munghate1, Sachit Anand2, Veereshwar Bhatnagar3
1Department of Pediatric Surgery, BJ Wadia Hospital for Children, Mumbai, Maharashtra, India.
Background:
There is limited information on the impact of cytomegalovirus (CMV) infection on clinical outcomes and operative histopathology in children with biliary atresia (BA). We hypothesized that CMV infection is associated with greater histopathological damage and unfavorable short-term clinical outcomes.
Materials And Methods:
A prospective single-center study was conducted with effect from January 2011-July 2012 including all infants with BA who underwent surgery. Diagnosis of CMV infection was confirmed by serum immunoglobulin M (IgM) positivity or the presence of CMV-deoxyribonucleic acid (DNA) in the liver tissue. Four short-term outcome variables were observed. The cohort was divided into subgroups on the basis of seropositivity (IgM + or IgM-); the presence of CMV-DNA in the liver (polymerase chain reaction [PCR]+ or PCR-); and composite CMV groups (Group 1 - IgM+, PCR+; Group 2 - IgM+, PCR-; Group 3 -- IgM-, PCR+; and Group 4 - IgM-, PCR-). Outcomes and histopathology were compared in these subgroups.
Results:
A total of 32 infants with BA were operated at a mean age of 3.5 (range: 1-6) months. Serum IgM+ and PCR+ were observed in 50% and 37.5% of the patients. Unfavorable outcomes showed a significant association with IgM+ and not PCR+. Similarly, outcomes were poor for CMV Groups 1 and 2 at 1-month follow-up. Infants with IgM+ and PCR+ showed a greater degree of histopathological damage in terms of bile duct proliferation and severe bile duct fibrosis, respectively.
Conclusion:
In the present study, there was a high incidence of serum IgM+ (50%) and PCR+ of biopsy specimens (37.5%) in infants with BA. This CMV-infected subgroup was associated with greater histopathological damage and unfavorable short-term outcomes after surgery.
Insights
Cytomegalovirus (CMV) infection in infants with biliary atresia (BA) is linked to worse surgical outcomes and increased liver damage. Early detection of CMV, particularly IgM positivity, is crucial for managing these pediatric patients.
Area of Science:
- Pediatric Surgery
- Hepatology
- Infectious Diseases
Background:
- Biliary atresia (BA) is a serious neonatal liver condition requiring surgical intervention.
- The impact of cytomegalovirus (CMV) infection on BA outcomes and liver pathology is not well-understood.
- CMV infection may exacerbate histopathological damage and worsen clinical outcomes in infants with BA.
Purpose of the Study:
- To investigate the association between CMV infection and clinical outcomes in pediatric BA patients.
- To evaluate the relationship between CMV infection and operative histopathology in BA.
- To determine if CMV infection influences short-term outcomes following BA surgery.
Main Methods:
- Prospective single-center study of infants with BA undergoing surgery (January 2011-July 2012).
- CMV infection diagnosed via serum IgM or liver CMV-DNA (PCR).
- Outcomes and histopathology compared across CMV subgroups (IgM+/-, PCR+/-, composite groups).
Main Results:
- 50% of BA infants had positive serum IgM for CMV; 37.5% had CMV-DNA in liver tissue.
- CMV infection (specifically IgM positivity) correlated with unfavorable short-term outcomes.
- CMV infection was associated with increased bile duct proliferation and fibrosis in liver biopsies.
Conclusions:
- CMV infection is prevalent in infants with BA and linked to poorer surgical outcomes.
- CMV infection contributes to significant histopathological liver damage in BA.
- Identifying CMV infection is important for predicting and managing outcomes in pediatric BA.
