Vol.12, No 3, 2005 pp. 154 - 158
UC 616.988-053.2

CYTOMEGALOVIRUS INFECTION IN INFANTS WITH HEPATOSPLENOMEGALY
Gordana Tasić1, Dobrila Stanković-Djordjević1, Marina Dinić1, Hristina Stamenković2, Milena Tasić1
1Institute for Public Health, 2Clinic of Pediatrics, Faculty of Medicine, University of Niš, Serbia and Montenegro
 E-mail: mmtas@medfak.ni.ac.yu

Summary.  Cytomegalovirus (CMV) infection is the most common congenital infection with the incidence varying from 1% to 3%. At birth, approximately 10% of intrauterine infected infants demonstrate clinical symptoms and signs of infection which carries a risk of morbidity and mortality. Perinatal infection occurs in the contact of an infant with secretions and excretions of the mother with active CMV infection either by passing the birth canal or by excreting the virus into breast milk. The aim of this paper was to determine the involvement of CMV infection in the occurrence of hepatosplenomegaly in 1-5 month-old-infants and a possible involvement of recurrent maternal CMV infection in symptomatic congenital and perinatal infection. The investigated group included nine 1-5 month-old-infants with hepatosplenomegaly, hyperbilirubinemia, and increased transaminases. None of the investigated infants had evident malformations at birth. All hepatotropic viruses and HIV infection were excluded in all infants.
ELISA test for detection of CMV IgM and IgG antibodies was performed on blood samples taken from mothers and their infants and antigenemia assay for CMV pp65 antigen detection in the blood. By CMV pp65 antigen detection in the blood, active CMV infection was established in 5 of the total of 9 infants with the syndrome of hepatosplenomegaly referred to the virology laboratory. One out of 5 infants was positive for anti CMV IgM antibodies. In 2 of 5 mothers, primary CMV infection in pregnancy was excluded. The presence of hepatosplenomegaly in 1-5 month old infants is indicative of congenital or perinatal CMV infection. Recurrent maternal infection can result in symptomatic, congenital or perinatal infection.
Key words: Cytomegalovirus, hepatosplenomegaly, congenital, perinatal, antigenemia


CITOMEGALOVIRUSNA INFEKCIJA KOD DECE SA HEPATOSPLENOMEGALIJOM
Kratak sadržaj: Citomegalovirusna (CMV) infekcija je najčešća kongenitalna infekcija sa incidencom 1-3%. Na rodjenju oko 10% intrauterino inficirane dece ispoljava kliničke simptome i znake infekcije sa rizikom po morbiditet i mortalitet. Perinatalna infekcija dešava se u kontaktu novorodjenčeta sa sekretima i ekskretima majke koja ima aktivnu CMV infekciju ,bilo prolaskom kroz porodjajni kanal ili majčinim mlekom. Cilj rada bio je da se utvrdi učešće CMV infekcije u nastanku hepatosplenomgalije kod dece starosti 1-5 meseci i eventualno učešće rekurentne CMV infekcije majke u simptomatskoj kongenitalnoj i perinatalnoj infekciji. Ispitivana grupa obuhvatala je 9 dece starosti do 5 meseci koja su imala hepatosplenomegaliju, hiperbilirubinemiju i povećane transaminaze. Nijedno od ispitivane dece nije imalo evidentirane malformacije na rodjenu. Kod sve dece bili su isključeni svi hepatotropni virusi i HIV infekcija.
Iz uzorka krvi,uzetog od dece i njihovih majki, radjen je ELISA test za detekciju CMV IgM i IgG antitela i test za detekciju CMV pp65 u krvi. Od ukupno 9 dece koja su bila upućena u virusološku laboratoriju sa sindromom hepatosplenomegalija kod 5 dece utvrdjena je aktivna CMV infekcija detekcijom CMV pp65 antigena. Jedno od petoro dece imalo je anti CMV IgM. Kod dve od pet majki isključena je primarna CMV infekcija u trudnoci. Prisustvo hepatosplenomegalije kod dece do 5 meseci života indikativno je za kongenitalnu ili perinatalnu CMV infekciju. Rekurentna infekcija majke može da rezultira simptomatskom kongenitalnom ili perinatalnom infekcijom.
Ključne reči: Citomegalovirus, hepatosplenomegalija, kongenitalna, perinatalna, antigenemija