Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
권호 표지
DOI QR코드

DOI QR Code

A Comparative Study Between Cytomegalovirus Immunoglobulin M-Positive and CMV Immunoglobulin M-Negative Biliary Atresia in Infants Attending a Tertiary Care Hospital in Bangladesh

  • Akter, Sharmin (Department of Pediatric Gastroenterology & Nutrition, Faculty of Pediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU)) ;
  • Karim, ASM Bazlul (Department of Pediatric Gastroenterology & Nutrition, Faculty of Pediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU)) ;
  • Mazumder, Md Wahiduzzaman (Department of Pediatric Gastroenterology & Nutrition, Faculty of Pediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU)) ;
  • Rukunuzzaman, Md (Department of Pediatric Gastroenterology & Nutrition, Faculty of Pediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU)) ;
  • Nahid, Khan Lamia (Department of Pediatric Gastroenterology & Nutrition, Faculty of Pediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU)) ;
  • Dey, Bishnu Pada (Department of Pathology, Bangabandhu Sheikh Mujib Medical University (BSMMU)) ;
  • Sayeed, Maimuna (Department of Gastroenterology, Evercare Hospital) ;
  • Rahman, AZM Raihanur (Department of Pediatric Gastroenterology & Nutrition, Faculty of Pediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU)) ;
  • Fathema, Kaniz (Department of Paediatric Gastroenterology & Nutrition, Sir Salimullah Medical College) ;
  • Khadga, Mukesh (Department of Pediatrics, Sumeru Hospital)
  • Received : 2022.01.21
  • Accepted : 2022.07.07
  • Published : 2022.09.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Perinatal cytomegalovirus (CMV) infection can lead to biliary atresia (BA) in different entities. This study aimed to compare the clinical, hematological, biochemical, and histological features of infants with BA based on their CMV immunoglobulin M (IgM) status at presentation. Methods: This cross-sectional descriptive study was carried out between January 2019 and June 2020 at the Department of Pediatric Gastroenterology and Nutrition at the Bangabandhu Sheikh Mujib Medical University (BSMMU) in Dhaka. Forty-three patients with BA were selected purposively and categorized into either the CMV IgM-positive or CMV IgM-negative BA group. Categorical variables were compared using Fisher's exact test and chi-square tests, while the Student's t-test and Mann-Whitney U-test were used to compare continuous variables. For all statistical tests, a p-value <0.05 was considered statistically significant. Results: Thirty-three (76.7%) of the cases were between 2 and 3 months of age on admission. The clinical, hematological, and biochemical parameters did not differ significantly between the CMV IgM-positive and CMV IgM-negative BA groups. Most (50.0%) of the CMV IgM-positive cases had fibrosis stage F2, while 43.5% of the CMV IgM-negative cases had fibrosis stage F3, with no significant difference between the groups (p=0.391). Conclusion: Our data shows no significant distinction between CMV IgM-positive and CMV IgM-negative BA, suggesting that CMV does not contribute to BA pathogenesis.

Keywords

Acknowledgement

First, I would like to express my profound gratitude to Almighty Allah, the Beneficent, and Merciful for giving me the opportunity and strength to carry out and complete this research. I would also like to thank my respectable and affectionate teacher and guide, Professor ASB Bazlul Karim, for his constant supervision, scholarly guidance, valuable suggestions, encouragement, and constructive criticism. Finally, I would like to thank all the doctors and staff of the Department of Pediatric Gastroenterology and Nutrition, BSMMU, for their support in this study.

References

  1. Hartley JL, Davenport M, Kelly DA. Biliary atresia. Lancet 2009;374:1704-13. https://doi.org/10.1016/S0140-6736(09)60946-6
  2. Bezerra JA, Wells RG, Mack CL, Karpen SJ, Hoofnagle JH, Doo E, et al. Biliary atresia: clinical and research challenges for the twenty-first century. Hepatology 2018;68:1163-73.
  3. Davenport M, Savage M, Mowat AP, Howard ER. Biliary atresia splenic malformation syndrome: an etiologic and prognostic subgroup. Surgery 1993;113:662-8.
  4. Davit-Spraul A, Baussan C, Hermeziu B, Bernard O, Jacquemin E. CFC1 gene involvement in biliary atresia with polysplenia syndrome. J Pediatr Gastroenterol Nutr 2008;46:111-2. https://doi.org/10.1097/01.mpg.0000304465.60788.f4
  5. Mack CL. The pathogenesis of biliary atresia: evidence for a virus-induced autoimmune disease. Semin Liver Dis 2007;27:233-42. https://doi.org/10.1055/s-2007-985068
  6. Barnes BH, Tucker RM, Wehrmann F, Mack DG, Ueno Y, Mack CL. Cholangiocytes as immune modulators in rotavirus-induced murine biliary atresia. Liver Int 2009;29:1253-61. https://doi.org/10.1111/j.1478-3231.2008.01921.x
  7. Landing BH. Considerations of the pathogenesis of neonatal hepatitis, biliary atresia and choledochal cyst--the concept of infantile obstructive cholangiopathy. Prog Pediatr Surg 1974;6:113-39.
  8. Dussaix E, Hadchouel M, Tardieu M, Alagille D. Biliary atresia and reovirus type 3 infection. N Engl J Med 1984;310:658.
  9. Jevon GP, Dimmick JE. Biliary atresia and cytomegalovirus infection: a DNA study. Pediatr Dev Pathol 1999;2:11-4. https://doi.org/10.1007/s100249900083
  10. Morecki R, Glaser JH, Johnson AB, Kress Y. Detection of reovirus type 3 in the porta hepatis of an infant with extrahepatic biliary atresia: ultrastructural and immunocytochemical study. Hepatology 1984;4:1137-42. https://doi.org/10.1002/hep.1840040608
  11. Oliveira NL, Kanawaty FR, Costa SC, Hessel G. Infection by cytomegalovirus in patients with neonatal cholestasis. Arq Gastroenterol 2002;39:132-6. https://doi.org/10.1590/S0004-28032002000200012
  12. De Tommaso AM, Andrade PD, Costa SC, Escanhoela CA, Hessel G. High frequency of human cytomegalovirus DNA in the liver of infants with extrahepatic neonatal cholestasis. BMC Infect Dis 2005;5:108.
  13. Fischler B, Ehrnst A, Forsgren M, Orvell C, Nemeth A. The viral association of neonatal cholestasis in Sweden: a possible link between cytomegalovirus infection and extrahepatic biliary atresia. J Pediatr Gastroenterol Nutr 1998;27:57-64. https://doi.org/10.1097/00005176-199807000-00010
  14. Shen C, Zheng S, Wang W, Xiao XM. Relationship between prognosis of biliary atresia and infection of cytomegalovirus. World J Pediatr 2008;4:123-6. https://doi.org/10.1007/s12519-008-0024-8
  15. Fischler B, Woxenius S, Nemeth A, Papadogiannakis N. Immunoglobulin deposits in liver tissue from infants with biliary atresia and the correlation to cytomegalovirus infection. J Pediatr Surg 2005;40:541-6. https://doi.org/10.1016/j.jpedsurg.2004.11.035
  16. Zani A, Quaglia A, Hadzic N, Zuckerman M, Davenport M. Cytomegalovirus-associated biliary atresia: an aetiological and prognostic subgroup. J Pediatr Surg 2015;50:1739-45. https://doi.org/10.1016/j.jpedsurg.2015.03.001
  17. Rousselet MC, Michalak S, Dupre F, Croue A, Bedossa P, Saint-Andre JP, et al. Sources of variability in histological scoring of chronic viral hepatitis. Hepatology 2005;41:257-64. https://doi.org/10.1002/hep.20535
  18. Bazlul Karim AS, Kamal M. Cholestatic jaundice during infancy: experience at a tertiary-care center in Bangladesh. Indian J Gastroenterol 2005;24:52-4.
  19. Sokol RJ, Mack C, Narkewicz MR, Karrer FM. Pathogenesis and outcome of biliary atresia: current concepts. J Pediatr Gastroenterol Nutr 2003;37:4-21. https://doi.org/10.1097/00005176-200307000-00003
  20. Hamid F, Afroza A, Ray PC. Aetio-clinical profile of cholestatic jaundice during infancy- study of 30 cases in a tertiary care hospital. Bangladesh Med J 2012;41:34-9. https://doi.org/10.3329/bmj.v41i2.18804
  21. Lanari M, Lazzarotto T, Venturi V, Papa I, Gabrielli L, Guerra B, et al. Neonatal cytomegalovirus blood load and risk of sequelae in symptomatic and asymptomatic congenitally infected newborns. Pediatrics 2006;117:e76-83. Erratum in: Pediatrics 2006;117:1467.
  22. Chowdhury FR, Chowdhury K, Karim ASMB. Cholestatic jaundice in infants - an experience in tertiary care hospital. J Bangladesh Coll Phys Surg 2014;32:9-15. https://doi.org/10.3329/jbcps.v32i1.21029
  23. Yaghobi R, Didari M, Gramizadeh B, Rahsaz M, Heidari T, Banihashemi M, et al. Study of viral infections in infants with biliary atresia. Indian J Pediatr 2011;78:478-81. https://doi.org/10.1007/s12098-010-0309-5
  24. Rauschenfels S, Krassmann M, Al-Masri AN, Verhagen W, Leonhardt J, Kuebler JF, et al. Incidence of hepatotropic viruses in biliary atresia. Eur J Pediatr 2009;168:469-76. https://doi.org/10.1007/s00431-008-0774-2
  25. Banan AA, Yaghobi R, Ramzi M, Mehrabani D. Impact of human cytomegalovirus infection UL55-nested polymerase chain reaction method in hematopoietic stem cell transplant donors and recipients. Transplant Proc 2009;41:2898-9. https://doi.org/10.1016/j.transproceed.2009.07.042
  26. Scotto JM, Alvarez F. Biliary artresia and non-A, non-B hepatitis? Gastroenterology 1982;82:393-4. https://doi.org/10.1016/0016-5085(82)90046-4
  27. Fischler B, Svensson JF, Nemeth A. Early cytomegalovirus infection and the long-term outcome of biliary atresia. Acta Paediatr 2009;98:1600-2. https://doi.org/10.1111/j.1651-2227.2009.01416.x
  28. Soomro GB, Abbas Z, Hassan M, Luck N, Memon Y, Khan AW. Is there any association of extra hepatic biliary atresia with cytomegalovirus or other infections? J Pak Med Assoc 2011;61:281-3.
  29. Xu Y, Yu J, Zhang R, Yin Y, Ye J, Tan L, et al. The perinatal infection of cytomegalovirus is an important etiology for biliary atresia in China. Clin Pediatr (Phila) 2012;51:109-13. https://doi.org/10.1177/0009922811406264
  30. Moore SW, Zabiegaj-Zwick C, Nel E. Problems related to CMV infection and biliary atresia. S Afr Med J 2012;102(11 Pt 2):890-2. https://doi.org/10.7196/SAMJ.6163