Abstract
Hyperechogenic bowel (HB) is a nonspecific ultrasound finding that can be associated with human cytomegalovirus (CMV) congenital infection. In this study, we investigated HB pathophysiology in CMV-infected fetuses. We examined small and large intestine as well as pancreas in 8 fetuses at 22 weeks of gestation with congenital CMV infection. Ultrasound findings showed 4 fetuses with HB and 4 without. As negative group, 4 fetuses without CMV infection and without HB were studied. Immunohistochemistry for CMV, lymphocytic infiltrate, B-cell leukemia/lymphoma-2 (bcl-2), CD-117, cystic fibrosis transmembrane regulator (CFTR) were performed. HB fetuses showed multiple and sequential CMV-positive ganglion cells of Auerbach’s myenteric plexus. In the ganglia, bcl-2 was weakly expressed representing a reduced neuronal functionality. CD-117 revealed a regular distribution of Cajal cells, the pacemakers of intestinal contractility. Pancreas showed normal CFTR staining, indicating a preserved exocrine secretion, thus unlikely a contributory factor in HB. In CMV-infected fetuses without HB, CMV-positive cells were scatteredly found in ganglion cells and bcl-2 was strongly expressed. Intestinal CD-117 and pancreatic CFTR expression were similar to fetuses with HB. In conclusion, fetal CMV infection of the bowel may lead to peristalsis impairment (paralytic ileus) due to intestinal plexus involvement, which at ultrasound appeared as HB.
Highlights
Human cytomegalovirus (CMV) is the most common congenital infection affecting 0.5–2% of all live births and is a leading cause of hearing and central nervous system impairments in children [1,2]
Hyperechogenic bowel (HB) is a nonspecific ultrasound finding that can be associated with human cytomegalovirus (CMV) congenital infection
Fetal CMV infection of the bowel may lead to peristalsis impairment due to intestinal plexus involvement, which at ultrasound appeared as HB
Summary
Human cytomegalovirus (CMV) is the most common congenital infection affecting 0.5–2% of all live births and is a leading cause of hearing and central nervous system impairments in children [1,2]. When the diagnosis of fetal infection is confirmed through amniocentesis, the prognostic evaluation of fetal infection relies on imaging, using a combination of ultrasound and cerebral magnetic resonance imaging [4]. Prenatal ultrasound findings may be cerebral, such as ventriculomegaly, microcephaly and periventricular leukomalacia, as well as non-cerebral, such as hyperechogenic bowel (HB), enlargement of liver and spleen, ascites, hydrops, pericardial effusion, and placental enlargement [5]. Leruez-Ville M et al reviewed ultrasound findings in fetal infection with CMV in the literature and observed that the most frequent ultrasound anomaly was HB (82 out of 637 cases; 13%) [2]
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