Detection of cytomegalovirus (CMV) in fecal samples of cholestasis infants by real-time Polymerase-Chain Reaction - A pilot study

Background: Cholestasis is characterized by yellow symptoms of the skin, eyes, and mucous membranes. Many factors, such as biliary atresia, metabolic disease, and infection, can cause cholestasis. One of the leading causes of cholestasis is cytomegalovirus (CMV) infection. CMV detection is generally done through liver biopsy analysis, serological tests, and, most recently, polymerase-chain reaction (PCR) of body fluids such as blood, urine, and feces. Taking blood or tissue biopsies is invasive while taking urine from babies is difficult. This study aimed to assess the suitability of fecal samples as an alternative sample for detecting CMV in infants with non-biliary atresia cholestasis. Method: The design of this study was observational, with a cross-sectional approach. Clinical data on serological test results were collected from patient medical records. DNA was extracted from fecal samples, and CMV detection was performed using real-time PCR. Results: Four of thirteen (30.77%) patients showed active CMV infection through serological tests characterized by IgG+/IgM+. CMV infection was detected in 6/13 (46.15%) stool samples. The results showed that all patients who developed active CMV infection based on IgM serological testing had CMV DNA in their feces, with 66.67% sensitivity and 100% specificity. The relationship between the results of the anti-CMV serology test and fecal CMV PCR showed a strong correlation with a phi coefficient value of 0.720. Conclusion: The positive CMV PCR result on a fecal sample may be effective, help avoid invasive procedures such as liver biopsy and blood collection, and overcome the difficulties of urine sampling in infants.