Congenital cytomegalovirus hepatitis: cholestatic syndrome and its correction

The article describes the course of the cholestatic variant of congenital cytomegalovirus infection in children with an assessment of the obstetric and gynecological history of mothers and the characteristics of the newbornneonatal period. Pregnancy in women proceeded with signs of fetal-placental insufficiency, which led to the birth of children with a low gestational age, since cytomegalovirus infection developed in an acute form. The newborns had a low Apgar score and signs of hypotrophy of I-II degrees. The clinical picture of congenital cytomegalovirus hepatitis was characterized by a protracted course and had an undulating character, a complete recovery of mass-growth parameters, a symptom of jaundice took place within 3 months. It was revealed that a longer cholestasis syndrome was observed in children who had both congenital cytomegalovirus infection and impaired bilirubin uptake, in particular, Gilbert's syndrome. Ursodeoxycholic acid is the only generally accepted starting drug for the drug effect on cholestasis syndrome in children with liver disease. Complex therapy with the use of the drug Ursodeoxycholic acid at a dose of 15-20 mg/kg per day, at the early stages of treatment, this infectious pathology made it possible to stabilize the clinical and laboratory parameters. In the absence of complaints and clinical manifestations, the levels of ALT, AST and ALP were restored for a long period within 5-6 months, while the cholesterol values returned to normal by 3 months. The chosen scheme of therapy with Ursodeoxycholic acid at a dose of 15-20 mg/kg per day contributed to the prevention of severe complications from the biliary tract, such as chronic cholecystocholangitis, primary biliary cirrhosis. The use of therapeutic tactics, taking into account the individual characteristics of young children, was not accompanied by the presence of side effects.

1. Смирнов А. В., Чуелов С. Б., Брюсова И. Б., Волкова Г. И., Иванова Ю. Н., Карпина Л. М., Россина А. Л., Финогенова Т. А., Малиновская В. В. Лечение хронических герпесвирусных гепатитов // Детские инфекции. 2012; 2: 31-33. [Smirnov A. V., Chuelov S. B., Brjusova I. B., Volkova G. I., Ivanova Ju. N., Karpina L. M., Rossina A. L., Finogenova T. A., Malinovskaja V. V. Treatment of chronic herpesvirus hepatitis // Detskie infektsii. 2012; 2: 31-33.]

2. Cytomegalovirusinfection. Red Book: 2015. Report of the Committee on Infection Diseases.30th ed. Kimberlin D. W., Brady M. T., Jackson M. A., Long S. S. Elk Grove Village, IL: American Academy of Pediatrics, 2015: 317-322.

3. Литвицкий П. Ф., Мальцева Л. Д., Морозова О. Л. Типовые формы патологии печени у детей // Вопросы современной педиатрии. 2018; 17 (1): 38-53. [Litvitskij P. F., Mal'tseva L. D., Morozova O. L. Typical forms of liver pathology in children // Voprosy sovremennoj pediatrii. 2018; 17 (1): 38-53.] DOI: 10.15690/vsp.v1711.1854.

4. Галькевич Н. В., Меньшикова Е. А., Меньшиков C. A. Синдром холестаза при инфекционных и хирургических заболеваниях у детей первого года жизни // Вестник Белорусского государственного медицинского университета, 2013; 7: 12-14. [Gal' kevich N. V., Men'shikova E. A., Men'shikov C. A. Cholestasis syndrome in infectious and surgical diseases in children of the first year of life // Vestnik Belorusskogo gosudarstvennogo meditsinskogo universiteta. 2013; 7: 12-14.]

5. Averbukh L. D., Wu G. Y. Role of Biologics in the Development of Autoimmune Hepatitis: A Review // J Clin Transl Hepatol. 2018; 6 (4): 402- 409. DOI: 10.14218/JCTH.2018.00039. Epub 2018 Dec 15. PMID: 30637218; PMCID: PMC6328740.

6. Li W. W., Shan J. J., Lin L. L., Xie T., He L. L., Yang Y., Wang S. C. Disturbance in Plasma Metabolic Profile in Different Types of Human Cytomegalovirus-Induced Liver Injury in Infants // Sci Rep. 2017; 7 (1): 15696. DOI: 10.1038/s41598-017-16051-8. PMID: 29146975; PMCID: PMC5691185.

7. Rauschenfels S., Krassmann M., Al-Masri A. N. et al. Incidence of hepatotropic viruses in biliary atresia // Eur. J. Pediatr. 2009; 4 (168): 469-476.

8. Goderis J., Keymeulen A., Smets K., Van Hoecke H., De Leenhee E. Hearing in children with congenital cytomegalovirus infection: results of longitudinal study // The Journal of Pediatrics. 2016; 172: 110-115. https://doi.org/10.1016/j-jpeds.2016.01.024.

9. Волянюк Е. В. Алгоритм диагностики и лечения пролонгированной желтухи у детей первых месяцев жизни // Вестник современной клинической медицины. 2016; 2 (9): 42-46. [Voljanjuk E. V. Algorithm for the diagnosis and treatment of prolonged jaundice in children in the first months of life // Vestnik sovremennoj klinicheskoj meditsiny. 2016; 2 (9): 42-46.]

10. Fischler В., Lamireau T. Cholestasis in the newborn and infant // Clin. Res. Hepatol. Gastroenterol. 2014; 38 (3): 263-267.

11. Дегтярева А. В., Мухина Ю. Г., Дегтярев Д. Н. Синдром холестаза у новорожденных детей [Текст]: пособие для врачей. ФГУ «Науч. центр акушерства, гинекологии и перинатологии им. В. И. Кулакова» Минздравсоцразвития России, Российский гос. мед. ун-т им. Н. И. Пирогова. М.: 4ТЕ АРТ, 2011. 36 с.: ил., табл., цв. ил.; 21 см; ISBN 978-5-903274-58-1. [Degtjareva A. V., Muhina Ju. G., Degtjarev D. N. Cholestasis syndrome in newborns [Text]: a guide for doctors; FGU «Nauch. tsentrakusherstva, ginekologii i perinatologii im. V. I. Kulakova» Minzdravsotsrazvitija Rossii, Rossijskij gos. med. un-t im. N. I. Pirogova. Moskva: 4TE ART, 2011. 36 s. :il., tabl., tsv. il.; 21 sm; ISBN 978-5-903274-58-1.]

12. Cheng K., Ashby D., Smyth R. Ursodeoxycholic acid for Cystic Fibrosisrelated liver disease (Cochrane Review) // The Cochrane Library, Cochrane Database Syst. Rev. 2014; 12: CD000222. DOI: 10.1002/14651858.CD000222.pub3.

13. Волынец Г. В., Намазова-Баранова Л. С., Потапов А. С., Геворкян А. И., Смирнов И. Е., Никитин А. В., Скворцова Т. А. Особенности ранней диагностики прогрессирующего семейного внутрипеченочного холестаза // Российский педиатрический журнал. 2016; 19 (6): 332-338. [Volynets G. V., Namazova-Baranova L. S., Potapov A. S., Gevorkjan A. I., Smirnov I. E., Nikitin A. V., Skvortsova T. A. Features of early diagnosis of progressive familial intrahepatic cholestasis // Rossijskij pediatricheskij zhurnal. 2016; 19 (6): 332-338. DOI: http://dx.doi.org/10.18821/1560-9561-2016-19(6)-332-338.]

14. Дегтярева А. В. Дифференциальная диагностика и принципы этиопатогенетического лечения заболеваний печени и желчных путей у новорожденных и детей раннего возраста: автореф. дис. д.м.н.: 14.00.09. М., 2008. 43 с. [Degtjareva A. V. Differential diagnosis and principles of etiopathogenetic treatment of liver and biliary tract diseases in newborns and young children: avtoref. dis. d-ra med. nauk: 14.00.09. Moskva, 2008. 43 s.]

15. Мухина Ю. Г., Дегтярева А. В. Синдром холестаза у детей первых месяцев жизни. Часть 1 // Доктор.Ру. 2010; 1: 22-27. [Mukhina Ju. G., Degtjareva A. V. Cholestasis syndrome in children during the first months of life. Past' 1 // Doktor.Ru. 2010; 1: 22-27.]

16. Галькевич Н. В., Меньшикова Е. А., Меньшиков C. A. Синдром холестаза при инфекционных и хирургических заболеваниях у детей первого года жизни // Вестник Белорусского государственного медицинского университета. 2013; 7: 12-15. [Gal' kevich N. V., Men'shikova E. A., Men'shikov C. A. Cholestasis syndrome in infectious and surgical diseases in children of the first year of life // Vestnik Belorusskogo gosudarstvennogo meditsinskogo universiteta. 2013; 7: 12-15.]

17. Poddar U., Thapa B. R., Das A. et al. Neonatal cholestasis: differentiation of biliary atresia from neonatal hepatitis in a developing country // Acta. Paediatr. 2009; 98, Iss. 8: 1260-1264.

18. Kazyulin A. N., Shestakov V. A., Goncharenko A. Yu. et al. Practice and prospects of clinical application of ursodeoxycholic acid preparations // RMJ. Medical Review. 2018; 3: 42-52.