Cytomegalovirus frequency in neonates with biliary atresia

ABSTRACT

Biliary atresia [BA] is the most severe hepatic disorder in newborns and its etiopathogenesis remains unknown. Viral involvement has been proposed, including the human cytomegalovirus [HCMV]. The aims of the study were to use the polymerase chain reaction [PCR] to screen the liver tissue of neonates with biliary atresia or cholestasis due to non atretic causes for HCMV-DNA and to correlate the results with serological antibodies to CMV and plasma PCR for CMV-DNA. This study was carried on sixty patients suffered from cholestasis, thirty patients suffered from BA [BA group] and thirty patients suffered from cholstasis without BA [Non Atretic cholestasis group]. Patients with BA were divided according to the result of the tissue PCR for CMV-DNA in the liver biopsies into two groups, group I, BA patients with positive tissue PCR and group II, BA patients with negative tissue PCR. All groups were subjected to complete history take, clinical biopsy, CMV [IgG and IgM] antibodies [ELIZA], Plasma-PCR for CMVDNA by Cobas Amplicator Analyzer and tissue PCR for CMV-DNA. Results showed that liver tissues PCR for CMV in BA patients was positive in 43.3%, however its incidence was very low in patients with non Atretic cholestaesis [3.3%], we found also that CMV IgG was positive in [73.3%], CMV IgM was positive in [16.7%], plasma PCR-CMV was positive in [13.3%] in BA group. On other hand IgG was positive in 33.3%, IgM was positive in 10%, plasma PCR was positive in 3.3% in non atretic group with significant differnces p< 0.05. So these results indicate an elevated frequency of CMV in neonates with BA which was more prevalent in females. No significant correlation between groups I and II of BA group as regard clinical picture, laboratory results and pathological changes p>0.05. The accuracy of plasma PCR was 45.9%, CMV IgM was 47.9%and CMV IgG was 46.1% when consider tissue PCR as golden test. In Conclusions, there was high frequency of CMV in neonates with BA which was more prevalent in females. The accuracy of serological testing for CMV using ELISA techniques and plasma CMV-DNA PCR are not reliable and indicate that virological assessment by tissue PCR should be carried out to prove the role of the CMV infection in etiology BA cases