Cytomegalovirus hepatitis in newborns

May 26, 2018 10:15 | Baby Diseases
Virological studies in newborns have shown that approximately 1% of them are born with an active infection that manifests itself in the release of viruses with urine. At present, the epidemiology of this infection, which occurs with multiple relapses, is well studied, as in herpes, but without clinical manifestations. Infection occurs transplacentally or by direct contact with the virus in the genital tract at birth, or during the first months of life with milk, saliva( with mother's kisses).Epidemiological studies have shown great importance in socio-economic and ethnic factors;As the social level and hygiene conditions improve, the frequency of the virus's transmission in mothers and, consequently, the frequency of its transmission from mother to child sharply decreases. Clinically, two forms of cytomegalovirus hepatitis are distinguished. The septicemic form is diagnosed fairly simply if the following three types of lesions are observed in a premature infant with a small body weight: neurological( microcephaly, tone disorders, retinopathy), hematologic( hemolytic anemia, thrombocytopenia) and hepatic( hepatosplenomegaly, early, very intense jaundice).Detection of cerebral calcifications immediately orientates towards this disease. In the case of a child's survival, when this dramatic picture falls, serious neurological disorders usually develop.

Diagnosis of isolated( jaundiced) cytomegalovirus hepatitis in the absence of damage to other systems is very difficult. In favor of this peculiar etiology may be a combination, albeit impermanent, of externally isolated hepatitis with chorioretinitis. Nonspecific inflammatory reactions( IgC and IgM, sediment assays) that are often positive very early are important.

Evidence of cytomegalovirus infection is currently more convincing, since the available serological methods, following the example of rubella, allow for undeniable diagnosis. These include the technique of indirect agglutination and titration of specific antibodies in various immunoglobulins.

The need for a culture of cytomegaloviruses from blood, urine, cerebrospinal fluid or saliva in any child suspected of cytomegalovirus hepatitis is currently less significant than before. This study can be repeated, since the child continues to isolate the virus within a few weeks after the onset of clinical manifestations of the disease. The definition of cells with inclusions in the urine sediment is almost not carried out at present.

Histological examination of the liver with septicemic or isolated forms of cytomegalovirus hepatitis reveals a pronounced inflammatory response and sometimes cytomegalic inclusions in the parenchyma or biliary tubules.

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