Résumé
This work aimed at studying the frequency of cytomegalovirus [CMV] infection in neonates and infants with conjugated hyperbilirubinemia admitted to Alexandria University Children's Hospital. Forty three patients with conjugated hyperbilirubinemia were subjected to a through history taking, clinical examination, laboratory investigations [complete blood picture and liver function tests], cytological examination of urine using Papanicolaou method for detection of viral inclusion bodies, measurement of anti-CMV IgM and IgG by Enzyme Linked immune Sorbent Assay [ELlSA] method, and detection of CMV in the serum by using the polymerase Chain Reaction [PCR] technique. Ultrasonography was done for all patients. The results showed that history of fever during the last trimester was obtained in 4 mothers [three mothers had urinary tract infection and one mother had viral upper respiratory tract infection], low birth weight was reported in 3 infants, the age at onset of jaundice ranged from 5-130 days with a mean of 51.2 days, thirty nine patients had hepatomegaly, fifteen had splenomegaly and ascites was present in 5 infants. Clinical manifestations of hemorrhagic tendency as purpura and/or ecchymosis, or manifestations of CNS involvement as encephalitis were absent. Severe anemia and thrombocytopenia was reported only in one patient. The average values of serum transaminases and alkaline phosphatase showed increased levels in all cases. The average value of serum albumin was normal for age. Ultrasonography revealed no abnormal findings in the biliary system, moderate degree of increased liver echogenicity was seen in 10 infants. Serum PCR for CMV was positive in 6 infants, serum IgM antibodies for CMV were positive in only 4 infants, and the IgG antibodies were positive in 9 cases. Three patients had inclusion bodies bearing cells in the urinary sediment
Conclusion: cytomegalovirus is an important cause of direct hyperbilirubinemia in pediatric age. Diagnosis depending on PCR is more accurate than serology and urinary inclusion bodies bearing cells