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Electron microscopic examination of congenital cytomegalovirus hepatitis
Abstract:
The electron microscopic features of cytomegalovirus hepatitis in the liver biopsy of a three-week-old infant were studied. The liver cells did not contain virus, but severe alterations similar to virus hepatitis were observed. In the bile duct cells, nuclear and cytoplasmic virus inclusions were demonstrated. In the nuclear inclusions virus particles of various degrees of maturity were embedded in dense granular material. The cytoplasm of the infected cells contained vacuoles with mature viruses. The Golgi zone seemed to play an important role in vacuole formation. In another type of infected cell, viruses were lying free in the cytoplasm and passed into the lumen of the bile ducts. It is concluded that viruses are eliminimated by the bile. Based on this electron microscopical observations, the examination of duodenal fluid is recommended as a new diagnostic procedure for demonstrating viruses.
Insights
Cytomegalovirus (CMV) hepatitis in infants shows severe liver damage without virus in liver cells. Electron microscopy reveals CMV in bile duct cells, suggesting bile elimination and a new diagnostic approach.
Area of Science:
- Pediatric Pathology
- Hepatology
- Virology
Background:
- Cytomegalovirus (CMV) infection is a common cause of neonatal hepatitis.
- Electron microscopy is crucial for identifying viral inclusions in tissue biopsies.
Observation:
- Liver biopsy from a three-week-old infant with CMV hepatitis was examined.
- While liver cells lacked viral particles, severe hepatitis-like alterations were noted.
- Virus inclusions were identified in bile duct cells, both in the nucleus and cytoplasm.
Findings:
- Immature and mature CMV particles were observed within dense granular material in nuclear inclusions.
- Cytoplasmic inclusions contained mature viruses, with the Golgi zone implicated in vacuole formation.
- Viruses were found free in the cytoplasm and released into bile duct lumens, indicating elimination via bile.
Implications:
- The presence of CMV in bile duct cells suggests biliary excretion of the virus.
- Examination of duodenal fluid is proposed as a novel diagnostic method for detecting CMV.
- This study enhances understanding of CMV pathogenesis in neonatal liver disease.