CLINICOPATHOLOGIC VARIABLES OF CYTOMEGALOVIRUS INFECTION IN THE LIVER OF THE INFANTS (2 CASE STUDIES)
Ushakova R.A., Krohina N.B., Kobeleva J.M., Shvarz M.A, Tuponogov S.N.
Clinical experience
Abstarct.
Objective: To analyze the peculiarities of neonatal hepatitis in its clinical course and investigate variants of liver anatomic structure disorders in infants presenting with cytomegalovirus infection. Materials and methods: There was obtained the informed consent from parents for percutaneous hepatic biopsy and set of laboratory and instrumental examinations. The presence of TORCH-infection agents there was verified by enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR). The following markers were investigated: Chlamydia trachomatis, Mycoplasma hominis, Mycoplasma genitalis, Ureaplasma urealiticum, Rubella, Hepatitis viruses B and C, Cytomegalovirus hominis (CMV), Herpesviruses hominis1 and 2, Epstein-Barr viruses, Toxoplasma gondii, Human immunodeficiency virus. The biopsy samples underwent the standard histological processing, with hematoxilin-eosin staining or Picro fuchsin according to Van Gieson staining to serial tissue sections. There were performed: Schick reaction with staining inclusions in hepatic cytoplasm and bile duct basal membranes; Perl`s reaction to identify hemosiderin; and rubeanic acid staining to detect copper. Results: There was carried out a retrospective analysis of case studies of two infants aged 1,5 and 4 life months with manifestations of neonatal hepatitis. During the pregnancies there were detected: gestosis (2), threatened miscarriage (2), cytomegalovirus antibodies carriage (2), stillbirth (1), polyhydramnion (1). Infants with weight 4200g. and 3310g. displayed anemia (2), thrombocytopenia (1), patent foramen ovale (2), ventricular septal defect (1), manifestations of hypoxic ishemic genesis, central nervous system disorders (2), pyramidal insufficiency (2), hydrocephaly (1), hyperexcitability syndrome (1), posseting (2), hypotrophy after one month (2). There were detected hyperbilirubinemia (2), acholic stool (2), hepatomegaly (2), enlarged spleen (2), cytolysis (2). High antibody titers IgG against CMV (2) without avidity definition, the other infant presented DNA of CMV in blood. Genetic disorders and biliary atresia were excluded. The first infant displayed pathologic characters of giant cell hepatitis, cholestasis, local transformation of hepatocytes of the “owl eye” type, remaining focuses of extramedullary hemopoiesis, moderate inflammatory activity, mild fibrosis. The other patient presented signs of chronic hepatitis, local necrosis of hepatocytes, moderate inflammatory activity, mild fibrosis, positive staining for hemosiderin.
Key words:
infants, cholestasis, neonatal hepatitis, cytomegalovirus infection, hemochromatosis.
Autors:
Ushakova R.A.
The Ural state medical academy
Russia, 620000, Ekaterinburg, Repin street, 3
e-mail: nikolay_ushakov@olympus.ru
Krohina Nataliya B.
Institute of immunology and physiology of UrO of the Russian Academy of Sciences
Russia, 620000, Ekaterinburg, street May Day, 106
e-mail: krohina@e1.ru
Kobeleva Jaroslava M.
Sverdlovski regional pathoanatomical bureau
Russia, 620000, Ekaterinburg, Volgograd street, 185 a
Shvarz Marina A.
Regional children's clinical hospital №1
Russia, 620000, Ekaterinburg, S.Derjabinoj street, 32
Tuponogov Sergey N.
Regional children's clinical hospital №1
Russia, 620000, Ekaterinburg, S.Derjabinoj street, 32