Congenital Cytomegalovirus Conference - Congenital CMV ...

P-34 CMV Association in Extrahepatic Biliary Atresia: Awareness Needed for Prevention and Early Treatment.
Vineeta Khare, Prashant Gupta, Janak Kishore. Department of Microbiology, Sanjay Gandhi Post Graduate
Institute of Medical Sciences, Lucknow, India.
Background: In India, serological surveys have shown the prevalence of CMV antibodies in adult population to be
about 80-90%. Cytomegalovirus (CMV) infection has been implicated in the causation of extrahepatic biliary atresia
(EHBA) in neonates born to CMV infected females. Incidence of EHBA in newborns of CMV infected females is not
known in India. Treatment is surgical and prognosis is good only when it is done before the infant attain the age of 8
weeks thus requiring early referral.
Objectives: To determine the frequency with which patients with EHBA are infected with CMV and to ascertain the
age at referral to a specialty centre for surgical correction of EHBA.
Methods: 74 cases of biopsy proven EHBA were managed at Sanjay Gandhi Post Graduate Institute of Medical
Sciences, Lucknow from January 2005 through May 2008. IgM antibody detection in serum for CMV was done
using ELISA kit. The data analyzed included age, sex, clinical presentation, age at referral, Liver function tests, urine
examination, abdominal ultrasonography, hepatobiliary scintigraphy, liver biopsy, management, complications and
follow-up.
Results: Out of 74 EHBA cases, 53 were male and 21 female. 22 (29.7%) were positive for IgM antibodies for CMV.
Age of onset of jaundice ranged from since birth to 60 days. The mean age at referral was 14 weeks (range 4-32
weeks). Kasai Portoenterostomy (PE) was performed in 19 infants and the mean age at surgery was 15 weeks (range 4
to 36 weeks). 54 children could not undergo Kasai PE because either they were more than 20 weeks old or presented
with extensive liver cirrhosis or due to financial constraints of parents. 1 patient died.
Conclusions: CMV infection was present in 29.7% of patients with EHBA at the time of referral. Although jaundice,
pale stools and dark urine were observed in early infancy, referral was always late. Seeing CMV association in EHBA,
awareness programs among Indian pregnant females for prevention of CMV infection are necessary and possibility
of EHBA must be kept in mind when evaluating jaundiced infants born to CMV positive females.
P-35 Evidence of sub-therapeutic concentrations in a pediatric population receiving ganciclovir.
Suzanne Luck, A. Lovering, P. Griffiths, M. Sharland. Royal Free and University College Medical School, London, UK.
Background: Ganciclovir (GCV) may be commenced in infants with congenitally or postnatally acquired
cytomegalovirus (CMV) infection and in immunocompromised patients who become viraemic. The dose of IV GCV
recommended in the children’s British National Formulary is 5mg/kg twice daily, although higher doses have been
studied for treatment of congenital CMV. Doses of oral valganciclovir used vary even more widely. Reference ranges
are often quoted for adults but some of the evidence on which these are based is contentious and how these relate to
treatment and viral suppression in infants is unknown.
Objectives: To evaluate GCV levels from specimens received for routine diagnostic purposes by a national reference
laboratory in the United Kingdom (UK).
Methods: Serum GCV levels (reported in mg/L) received by the UK Antimicrobial Reference laboratory in Bristol
from 01/11/1999 to 31/3/2007 were reviewed. GCV levels from samples received from different pediatric age groups
were analyzed and compared to those obtained from adults (individuals more than 18 years of age).
Results: 95 specimens were received from 32 patients aged < 6 months (28% of all specimens received and 25% of all
patients). The median trough level seen in infants aged