© Borgis - New Medicine 3/1999, s. 64-65
Anna Sinkiewicz1, Hanna Mackiewicz1, Stanisław Betlejewski1, Renata Sujkowska2
A case of hpv infection in a neonatus
1 Department of Otolaryngology, University of Medical Sciences, Bydgoszcz, Poland
Head of Department: Prof. Stanisław Betlejewski, M.D.
2 Department of Pathomorphology, University of Medical Sience, Bydgoszcz, Poland
Head of Department: Prof. Jan Domaniewski, M.D.
The authors present a rare case of intrauterine HPV foetus infection. The papilloma changes were located on the right auricle and parieto-occcipital area. The authors discussed the clinical picture and therapeutic procedures.
At present about 100 types of human papilloma viruses have been identified. Clinical manifestations of infection by human papilloma virus are skin and mucosa papillas within the oral cavity, airways, sex organs and urinary system.
Traumas of the epidermis, facilitating virus penetrating into the generative cells in the basal layer can be a factor initiating the infection. Incubation time varies from 3 to 8 months. An asymptomatic carrier state is also possible.
HPV duplicates its genetic material in the cell nucleus. Infection stimulates the growth of abnormal cellular forms. Changes do not affect the concern no cornifying stratified squamous epithelium of the respiratory and digestive system or skin cornifying stratified squamous epithelium. Human papilloma virus is the aetiological factor in both condylomas and papillomas, but skin lesions have a different morphological structure. Expansive proliferation with slight stromal infiltration of characteristic for papillomas. Conversely, condylomas mainly grow into skin layers and create interpapillary icicles.
All epithelial layers may be found in the histological structure of the papilla, but the majority of cells are abnormal.
In the upper layers there are dyskeratotic cells with a small nucleus and packed chromatin. Simultaneously there are bigger balloon cells i.e. koilocytes containing sometimes bi- or multilobar, hyperchromatin nuclei with packed or granular chromatin. The presence of HPV in koilocytes nuclei can be determined with the electron microscope.
According to Jabłońska and Orthon, susceptibility to HPV infection is connected with disturbances in cellular immunity (3). Significantly more frequent HPV infections in women, with impaired cellular immunity as well as intensification of papilloma lesions in pregnant women, and an induced hormone influence on the immune system, has been observed. The percentage of positive results showing HPV presence increases with the development of pregnancy, and decreases during the 6 months after labour (2). Condylomas situated in the genital canal can be a source of infection for the neonate. In the aftermath of infection, laryngeal papillomatosis may develop even after a few years of virus latency.
We can refer to congenital or intrauterine infection when the virus was transmitted from mother to foetus, and about newborn infection when the neonate is infected during labour. Intrauterine infection takes place when the virus goes through the placenta with the blood flow (2). HPV is not considered as an especially vital virus in foetus and neonate pathology because it does not reveal a direct teratogenic effect.
With reference to papilloma virus infections, evaluation of the virus type, and patient qualification as high, moderate or low risk group of neoplastic disease development is very important. Types 31,33, 35, 51, 52 are numbered among those at moderate risk; types 16, 18, 45, 56 are the high risk group (2, 3).
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1. Gisssman L.: Immunologic responses to human papilomavirus infection. Obstet-Gynecol-Clin. North-Am. 1996 Sep. 23(3):625-39. 2. Kańtoch M.: Wirusologia lekarska. PZWL., 1998. 3. Mazurkiewicz W.: Obraz kliniczny i histopatologiczny przebieg oraz wyniki leczenia kłykcin kończystych w świetle spostrzeżeń własnych. Akad. Med. W-wa 1986. 4. Moscicki A.B.: Genital HPV infection in children and adolescents. Obstet-Gynecol-Clin. North-Am. 1996 Sep. 23(3):675-97. 5. Pruszewicz A. et al.: Ocena wyników badań immunologicznych w brodawczakach krtani. Otolaryng. Pol., 1983, 1, 15.