Treating cytomegalovirus infection among infantile cholestasis: a single centre experience

Background: Studies have suggested that various viral infections are associated with intra-hepatic forms of infantile cholestasis. Cytomegalovirus (CMV) is most commonly implicated among infective causes of neonatal cholestasis. We present our experience in a referral centre where we detected 6 cases of CMV infection among infants presenting with cholestasis.

Objectives: To assess the prevalence of CMV infection among infants presenting with cholestasis and the feasibility of antiviral treatment while monitoring for side effects and viral shedding in urine.

Method: In a prospective descriptive study, 19 infants with infantile cholestasis were admitted. They all were evaluated as per Indian Academy of Paediatrics (IAP) consensus for neonatal cholestasis. Urine testing for CMV viral PCR (quantitative) was done for all children.

Results:The median age at presentation was 3 months (range 3 weeks - 11 months). Out of 19 children with cholestasis, 6 (31.6%) were positive for urine CMV PCR and were included in this study. Ongoing CMV infection was defined by quantifying copy numbers in urine CMV PCR. These infants were given intravenous ganciclovir, followed by oral valganciclovir for 6 months or till urine CMV PCR remained positive whichever was later. At end of our study, four patients had good outcome, one intermediate and one infant died. All but one infant responded virologically. None of the patients required withdrawal of ganciclovir or valganciclovir because of adverse effects.

Conclusions: Out of 19 children with cholestasis, 6 (31.6%) were positive for urine CMV PCR. Four patients had good outcome to antiviral therapy.

Sri Lanka Journal of Child Health, 2021; 50(2): 312-317