Accuracy of serology IGM anti CMV and clinical manifestations as an alternative diagnostic of cytomegalovirus neonatal hepatitis

Background: Main problem in cytomegalovirus (CMV) neonatal hepatitis diagnostic approach in developing country is the lack of virology examination. Serology is the most affordable examinations. Methods: This cross-sectional study was done at Dr. Soetomo Hospital, December 2011-April 2012. Inclusion criteria were jaundice, hepatomegaly, elevated direct bilirubin >2 mg/dLif total bilirubin 20% if total bilirubin >5 mg/dL, and elevated aminotransferases >1.5 normal within first 3 months. The immunocompromised patient was excluded. McNemar and Kappa analyzed statistics. Results: From 30 enrolled-patients, 12 subjects were positive PCR CMV. The AUC was 0.968 (95% confidence interval 0.915-1.020; p<0.0001). The cut-off of IgM anti-CMV with best sensitivity (sn) and specificity (sp) value was 0.8 (sn 100%, sp 83.3%), 1.0 (sn 91.7%, sp 88.9%), 1.1 (sn 83.3%, sp 88.9%), 1.2 (sn 83.3%, sp 88.9%), dan 1.3 (sn 83.3%, sp 94.4%). Conclusions: The anti-CMV IgM serology examination has a high accuracy in the diagnosis of CMV neonatal hepatitis in a patient with clinical signs of jaundice, hepatomegaly, the increasing of direct bilirubin, and an increase in aminotransferase enzyme, with a cut-off value of 1.3 index units. The anti-CMV IgM serology examination can be applied in lieu of PCR for alternative diagnosis of CMV neonatal hepatitis.