CLINICAL AND MORPHOLOGICAL FEATURES OF CYTOMEGALOVIRUS INFECTION IN CHILDREN
DOI:
https://doi.org/10.32689/2663-0672-2023-4-3Keywords:
сytomegalovirus infection, congenital infection, acquired infection, children, pathomorphological changes, histological examinationsAbstract
The present study investigated 120 patients with cytomegalovirus infection in the congenital form (44 patients, 4 of whom died) and acquired form (76 patients) thorough data analysis in anamnestic cases via clinical exams. Рurpose: to establish the clinical and morpho-histological features of the course of CMV infection in children. Scientific novelty: on the basis of the obtained results, to expand information on the clinical and morpho-histological features of the course of CMV infection in children. Methods. 120 children with CMV infection, aged from 1 month to 12 years, who were treated at the regional children's infectious hospital in Vinnytsia during 2019–2022, were under observation. Results. The congenital cytomegalovirus infection is the major cause of the central nervous and hepatobiliary systems dysfunction, as well as involvement in the gastrointestinal tract, while in the acquired form of the disease leading were: mononucleosis, prolonged subfebrile and respiratory effects. Morphological and histological changes of target organs in children (4 patients) who died of cytomegalovirus infection were characterized by changes in the central nervous system: severe perivascular pericellular edema, foci of thinning, brain tissue loss, vacuolar neuronal dystrophy, widespread hemorrhage. Histological examination of the hepatobiliary system revealed chronic active hepatitis signs with cirrhosis development (granularity and vacuolation of the hepatocytes cytoplasm, necrosis steps, discomplexation of hepatic beams, diffuse lymphoid infiltration of the periportal tract, formations). Significant changes occurred in other organs and systems (thymus, pancreas, kidneys, spleen, respiratory system and circulatory system). Conclusions. CMV infection has become a serious medical and social problem due to the frequent cause of intrauterine pathology, diseases of newborns and older children, as well as a high percentage of fatal consequences. The case of CMV infection, which ended fatally, was characterized by morphological and histological changes in the target organs, mainly hepatobiliary and cardiovascular systems, with the formation of interstitial or cystic fibrosis in them.
References
Harrison GJ. Cytomegalovirus. In: Feigin and Cherry’s Textbook of Pediatric Infectious Diseases, 8th ed, Cherry JD, Harrison GJ, Kaplan SL, Steinbach W, Hotez P, et al (Eds), Elsevier Saunders, 2019. p. 1429.
Beauvais D., Drumez E., Blaise D., de Latour R.P., Forcade E., Ceballos P., Uyttebroeck A., Labussière H., Nguyen S., Bourhis J.-H., et al. Scoring system for clinically significant CMV infection in seropositive recipients following allogenic hematopoietic cell transplant: An SFGM -TC study. Bone Marrow Transplant.2021; 56:1305–1315. doi:10.1038/s41409-020-01178-
Schleiss MR . Persistent and recurring viral infections: the human herpesviruses. Curr Probl Pediatr Adolesc Health Care. 2009 Jan. 39(1):7-23.
Alkhawaja S., Ismaleel A., Botta G., Senok A. Theprevalence of congenital and perinatal cytomegalovirus infection samong new born of seropositive mothers. G. Infect. Dev. Ctries. 2012 May 14. Vol. 6(5) С. 410–415.
Виговська О.В., Юхименко Г.Г., Корбут О.В., Дмитрієва О.А., Буц О.Р. Цитомегаловірусна інфекція у дітей: труднощі діагностики. ЖУРНАЛ «АКТУАЛЬНА ІНФЕКТОЛОГІЯ». ТОМ 7, № 2, 2019.
Rawlinson WD , Boppana SB, Fowler KB, Kimberlin DW , Lazzarotto T, Alain S, et al. Congenital cytomegalovirus infection in pregnancy and the neonate: consensus recommendations for prevention, diagnosis, and therapy. Lancet Infect Dis. 2017 17(6):177-188. DOI : 10.1016/S1473-3099(17)30143-3.
David W. Kimberlin, M.D., Penelope M. Jester, B.S.N., M.P.H., Pablo J. Sánchez, M.D., Amina Ahmed, M.D., Ravit Arav-Boger, M.D., Marian G. Michaels, M.D. et al. Valganciclovir for symptomatic congenital cytomegalovirus disease. N. Engl. J. Med. 2015 372(5); 933–943. DOI : 10.1056/NE JMoa1404599
Stern L., Withers B., Avdic S., Gottlieb D., Abendroth A., Blyth E., Slobedman B. Human Cytomegalovirus Latency and Reactivation in Allogeneic Hematopoietic Stem Cell Transplant Recipients. Front. Microbiol. 2019; 10:1186. doi: 10.3389/fmicb.2019.01186
Martins J.P., Andoniou C.E., Fleming P., Kuns R.D., Schuster I.S., Voigt V., Daly S., Varelias A., Tey S.-K., Degli-Esposti M.A., et al. Strain-specific antibody therapy prevents cytomegalovirus reactivation after transplantation. Science. 2019; 363:288–293. doi:10.1126/science.aat0066.
Cheng S., Caviness K., Buehler J., Smithey M., Nikolich-Žugich J., Goodrum F. Transcriptome-wide characterization of human cytomegalovirus in natural infection and experimental latency. Proc. Natl. Acad. Sci. USA. 2017; 114:E10586–E10595. doi: 10.1073/pnas.1710522114.
Berry R., Watson G.M., Jonjic S., Degli-Esposti M.A., Rossjohn J. Modulation of innate and adaptive immunity by cytomegaloviruses. Nat. Rev. Immunol. 2019; 20:113–127. doi: 10.1038/s41577-019-0225-5.
