Cholestatic Jaundice and Cytomegalovirus Infection in Children – An Observational Study

Abstract

Background: Cytomegalovirus (CMV) infection is a common congenital viral infection. It is transmitted by close contact and with body fluids. Methodology: The primary objective was to study CMV infection in infants with cholestatic jaundice. The secondary objective was to study the clinical presentation, laboratory parameters, radiological changes, and outcome of infants with cholestatic jaundice. It was an observational study and conducted at the Department of Pediatric Medicine, SMS Medical College, Jaipur, Rajasthan. The study duration was 18 months. Qualitative data were presented in percentage while quantitative data were presented as mean. The sample size was 60 cases. The study was approved by the Institutional Ethics Committee. We included cases with age <1 year with cholestatic jaundice and having CMV real-time polymerase chain reaction (CMV RT PCR) positivity. Those suffering from metabolic, autoimmune, genetic, toxic liver disease and parents/guardian refused for consent were excluded from the study. CMV infection was assessed using RT PCR for CMV DNA in blood or urine. Cases were followed up for 6 months. Results: The mean age of presentation of cases was 3.94 ± 2.39 months. Forty percent of cases with CMV were aged 1–3 months. The mean total and direct bilirubin levels with CMV were 12.65 ± 8.36 and 6.77 ± 4.81 mg/dl, respectively. Most (81.7%) of infants with CMV had ALP level ≥147 IU/L. Conclusion: Jaundice was the most common clinical feature of hepatic CMV infection followed by fever. RT PCR assays were useful for the diagnosis of CMV. Biliary atresia with associated CMV infection had high mortality rates.

Keywords

• children
• cholestatic jaundice
• cytomegalovirus