Viral Infections in Infants with Neonatal Hepatitis Volume 3 - Issue 1

Maryam Monajemzadeh¹*, Amin Rezvani², Mohammad Vasei³, Parin Tanzifi⁴, Reza Khorvash⁵, Farzaneh Motamed⁶ and Maryam Eghbali⁷

• ¹Associate professor in clinical and surgical pathology, Department of Pathology, Children Medical Center Hospital, Tehran University of Medical Sciences, Keshavarz Boulevard, Tehran, Iran
• ²Clinical and surgical pathologist, Department of Pathology, Children Medical Center Hospital, Tehran University of Medical Sciences, Keshavarz Boulevard, Tehran, Iran
• ³Professor in clinical and surgical pathology, Department of Pathology, Children Medical Center Hospital, Tehran University of Medical Sciences, Keshavarz Boulevard, Tehran, Iran
• ⁴Assistant professor in clinical and surgical pathology, Department of Pathology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Keshavarz Boulevard, Tehran, Iran
• ⁵Faculty of Science, McMaster University, Hamilton, Ontario, Canada.
• ⁶Professor in pediatrics gastroenterology, Department of pediatrics gastroenterology, Children Medical Center Hospital, Tehran University of Medical Sciences, Keshavarz Boulevard, Tehran, Iran
• ⁷Department of Pathology, Children Medical Center Hospital, Tehran University of Medical Sciences, Keshavarz Boulevard, Tehran, Iran

Received: December 09, 2020   Published: December 23, 2020

Corresponding author: Maryam Monajemzadeh, Pathology department, children medical center Hospital, Tehran University of Medical Sciences, Keshavarz Boulevard, Tehran, Iran

DOI: 10.32474/PAPN.2020.03.000154

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Abstract

Introduction: Neonatal cholestasis is a common manifestation of various pathologies. These pathologies include direct hepatocellular injury, defects in hepatocyte bile formation, or mechanical obstruction of bile flow. Histologically, most of the biliary tract diseases, infections, genetic and metabolic diseases can display parenchymal inflammation leading to the diagnosis of Neonatal Hepatitis (NH). Hence, NH implies a pattern of neonatal liver disease rather than a specific cause of liver injury. Among non-obstructive causes, various viral infections are associated with NH. The unmasking of the etiology of NH in further patients’ management is extremely important. Also, the prevalence of viral associated NH varies among different studies. Therefore, we planned to investigate the frequency of common viral agents in infants diagnosed with Idiopathic NH (INH).

Objective: A total of 138 consecutive infants with conjugated hyperbilirubinemia undergoing liver biopsy were collected as well as thirty-one umbilical cord tissues belonging to normal infants as controls. Patients with known etiology of NH were excluded from the study, and 74 cases diagnosed with INH were enrolled. Nucleic acid from the liver tissues of patients was extracted and real-time PCR for the detection of EBV, CMV, HSV1, HSV2, and HHV6 was done.

Results: The mean age of the patients at the time of liver biopsy was 70 days (minimum: 22, maximum: 98 days). There were 36 males and 38 females. CMV DNA was detected in six patients and HHV6 DNA was detected in one patient, while all control tissues were negative for the viral DNAs (p<0.05). None of the other tested DNA viruses could be detected in liver tissues. In addition, none of the liver samples were positive for CMV inclusions in hepatocytes or biliary epithelium under the light microscope.

Conclusion: In conclusion, we found CMV DNA in six liver biopsies without any histological evidence of CMV infection. Using more sensitive methods such as PCR is warranted to determine viral DNAs in the liver tissues and establish their role in the development of NH. Further studies with larger populations should be conducted to provide more information regarding the role of viruses in the development of NH and compare their frequency in different populations.

Keywords: Neonatal Hepatitis; Cytomegalovirus; Cholestasis; PCR

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