Immunomorphological assessment of the systemic inflammatory response in newborns with congenital cytomegalovirus infection

Abstract

Aim. To give an immunomorphological assessment of the systemic inflammatory response in newborns with congenital cytomegalovirus infection. Materials and methods. A study of the concentration of TNF-α in serum of umbilical cord blood, as well as the structure of blood vessels of the pulmonary circulation and loose fibrous connective tissue of the lungs in 41 dead full-term newborns with various antenatal anamneses was carried out. The first group consisted of 25 children from mothers who during pregnancy did not have herpesvirus, cytomegalovirus and acute respiratory viral infections, moderate and severe somatic and obstetric pathology. The death of newborns occurred on 2-5 days of life in the setting of birth trauma, intranatal, postnatal hypoxia, atelectasis and hyaline membranes of the lungs. The second group was represented by 16 newborns diagnosed with congenital cytomegalovirus infection. The reason for their death on days 2-5 of life was cerebral ischemia of moderate and severe degrees, hypertensive-hydrocephalic and convulsive syndromes, pseudocysts of the vascular plexus, subependymal and subarachnoid hemorrhages, monocytosis, vesiculosis, pneumonia, hepatitis and meningoencephalitis. Antenatal viral invasion was observed against the background of prolonged intrauterine hypoxia and chronic subcompensated and decompensated placental insufficiency. Results. In newborns of the second group, the concentration of TNF-α in the umbilical cord blood increased to 47.3±2.25 pg/mL (in the first group – 26.4±2.23 pg/mL, p<0.001). In contrast to the first group, aggregates and hemolysis of erythrocytes, microthrombi, leukocytes, edema of endothelial cells, hyperchromia of their nucleus, as well as desquamation of endotheliocytes into the lumen of blood vessels, were frequent morphological findings in the small-caliber pulmonary arteries in full-term newborns of the second group. In the setting of thickening of the intima of these vessels, dystrophic changes in smooth muscle cells were revealed, and in the adventitia, the tortuosity of collagen fibers. In the perivascular loose fibrous connective tissue, edema, dissociation of collagen fibers and areas of their excessive development, single hemorrhages and accumulations of monocytic-lymphocytic cellular elements were recorded. In the lungs, aspiration and edematous-hemorrhagic pneumopathies, as well as pneumonia, were more common. Conclusion. In case of systemic inflammatory response in newborns with congenital cytomegalovirus infection, markers of endothelial pathology and structural and functional rearrangement of connective tissue are more common in small branches of the pulmonary artery, which increase the predisposition of children to pulmonary hypertension in the postnatal period of their development..