Presentation of Human Cytomegalovirus (HCMV) in Liver Tissues of Cholestatic Infants with Extrahepatic and Non-Extrahepatic Biliary Atresia

Human cytomegalovirus (HCMV) is associated with cholestasis in infants. Diagnosis of HCMV infection is most often based on serological anti-HCMV. Identification of HCMV in liver tissue has been rarely reported. The aims of this study were to determine the presentation of HCMV in liver tissues and to analyze its association with serological anti-HCMV of cholestatic infants with extrahepatic and non-extrahepatic biliary atresia.

This observational study was performed during December 2017- December 2018 with ethics from our institutions. The parents or guardians of subjects signed the informed consent. Anti-HCMV serological data were collected from patient medical records. Histopathological diagnosis and polymerase chain reaction (PCR) for HCMV were performed from liver biopsy tissues. The data were analyzed by Chi-square.

There were 47 cholestatic infants, 38.3% EBA and 61.7% non-EBA. Anti-HCMV IgM was positive in 38.3% patients and IgG was positive in 91.5% patients. Acute infection or recent infection were 38.3%, past or not acute infection were 53.1%, and uninfected or early infection were 8.5% patients. The presentation of HCMV in liver tissues was 68.1% patients, consisting of 11/18 EBA and 21/29 non-EBA and negative in 31.9% patients, consisting of 7/18 EBA and 8/29 non-EBA. There was no association between serological anti-HCMV and PCR HCMV with histopathological features.

It suggests that PCR can be used as a routine tool to detect the presentation of HCMV DNA in liver tissue. Type of cholestasis in infants, both EBA and non-EBA, cannot be determined based on the serological and PCR examination, but based on histopathological features.