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Cytomegalovirus infection in infants with biliary atresia in China: a multi-center investigation study
Yilin Zhao1,2, Xiaodan Xu1,2, Yu Meng1,2
1Department of General Surgery, Tianjin Children's Hospital (Children's Hospital, Tianjin University), Tianjin, China.
Insights
Cytomegalovirus (CMV) infection in infants with biliary atresia (BA) affects 31.3% of cases in China. Antiviral treatment (AVT) shows a positive impact on prognosis for these infants.
Area of Science:
- Pediatrics
- Infectious Diseases
- Hepatology
Background:
- Biliary atresia (BA) concurrent with cytomegalovirus (CMV) infection presents a significant clinical challenge with poorer prognosis.
- Standardized diagnostic criteria and antiviral treatment (AVT) protocols for CMV in BA are currently lacking.
- This condition exhibits a high prevalence in China, necessitating focused investigation.
Purpose of the Study:
- To investigate the current status of CMV infection diagnosis and treatment in infants with BA in China.
- To assess the diagnostic methods and AVT practices in pediatric centers.
- To evaluate the impact of AVT on the prognosis of infants with CMV-infected BA.
Main Methods:
- A multicenter online questionnaire survey was conducted across tertiary pediatric centers in China.
- Centers were categorized by infant BA volume (low/high) and geographic location (south/north).
- A retrospective analysis of 100 randomly selected infants with BA was performed.
Main Results:
- Of 1,276 infants with BA, 31.3% tested positive for CMV, with CMV-IgM being a key diagnostic marker.
- Cytomegalovirus-DNA and CMV-IgM were preferred diagnostic methods (75.0% and 95.0%, respectively).
- High-volume centers more frequently utilized CMV-DNA testing and administered AVT (87.5%).
Conclusions:
- Concomitant CMV infection was identified in 31.3% of infants with BA, a figure lower than previously reported.
- CMV-IgM testing is crucial for diagnosing CMV infection in this population.
- Retrospective analysis suggests AVT positively influences the prognosis of infants with CMV-infected BA.
Background And Objectives:
Biliary atresia (BA) with concurrent cytomegalovirus (CMV) is a distinct subtype that is linked to a poorer prognosis. Currently, there are no standardized criteria for the diagnosis or antiviral treatment (AVT) of this condition. It has a high prevalence in China. The aim was to investigate the infection, diagnosis and treatment of CMV infection in infants with BA through a multicenter questionnaire survey conducted in China.
Methods:
A multicenter investigation was performed through online questionnaire survey. It investigated the diagnosis and treatment of infants with CMV-infected BA in tertiary-level pediatric centers from January 1st, 2018, to January 1st, 2020. The centers were categorized into low and high-volume groups based on number of infants with BA (≤50 or >50) and were also grouped geographically into south and north groups. Afterward, 100 cases were randomly selected from these infants for a retrospective analysis.
Results:
A total of 22 questionnaires were collected, and 20 were included in the analysis. The questionnaire survey encompassed 1,276 infants with type III BA. 31.3% of the infants of BA had CMV detected. According to the survey results, a large proportion of centers preferred using CMV-DNA (75.0%) and CMV-IgM (95.0%) as their preferred methods for CMV detection. In the high-volume group, more centers opted for CMV-DNA detection (100.0% vs. 66.7%) and administered AVT (87.5%). In the retrospective analysis of 100 infants with BA, 39 were found to be CMV-positive and among these, 74.4% received AVT.
Conclusion:
Among the 1,276 infants with BA in this cohort, 31.3% (399 cases) had concomitant CMV infection, representing a decrease compared to previous data. CMV-IgM played a crucial role in the detection of the infection. The retrospective analysis indicated that AVT had a beneficial impact on the prognosis of infants with BA who were infected with CMV.
