Cases of hepatitis of unknown origin are on the rise: how to detect and treat it in time

Between October 2021 and May 2022, pediatricians in the US and UK reported sudden onset

an increase in the incidence of severe acutehepatitis of unknown etiology (severe acute hepatitis of unknown causes, SAHUC) and acute liver failure. As of June 22, 2022, 920 cases have been reported worldwide. The disease is of unknown origin, and at least 5% of the total number of cases required liver transplantation, and 2% died. The affected children belonged to the age group of 10 to 16 years or younger.

What is the problem?

Although SAHUC is treatable, ifto detect it in time, the biggest problem for pediatricians is the lack of clarity in its etiology. The lack of consensus on how to define truly confirmed cases (mainly due to uncertainty about the causes of occurrence) further complicates diagnosis and subsequent treatment.

In order to understand the nature of SAHUC, Getu Jaori, chiefeditor of the journal Pediatric Investigation and PhD, conducted an extensive review of the literature available on PubMed, the websites of the World Health Organization, the UK Health Protection Agency, the US CDC and the European Center for Disease Prevention and Control. He collected all the information in a mini-review, which was published in the journal Pediatric Investigation.

This review is an attempt to understand the maincharacteristics of SAHUC, as well as to raise important questions about the disease and discuss preliminary recommendations for its better understanding and control, ”explains the author of the new work.

Main symptoms and tests

After studying 30 articles from databases, the scientist found,that the main symptoms noted by scientists are jaundice, vomiting and diarrhea. However, they varied depending on the geographic location of the patients. With regard to laboratory markers of SAHUC, in most cases, liver enzymes such as alanine aminotransferase and aspartate aminotransferase, as well as serum bilirubin, were high. In addition, liver biopsy reports showed varying degrees of liver inflammation.

Author: Dr. Erskine Palmer, USCDCP License: Free to use CC0

Study results prove suitabilityusing these tests to diagnose SAHUC. The reviewer also suggests using more sensitive laboratory tests and imaging techniques, such as computed tomography and ultrasound of the liver and biliary system, to make a more accurate diagnosis.

Exclusion method

The pediatrician also emphasizes that when diagnosingit is important to exclude infections caused by known viruses that can cause similar symptoms - among them hepatitis viruses A, B, C, E; cytomegalovirus; Epstein-Barr virus and others. It turned out that despite the detection of human adenovirus in several patients, its role in the pathogenesis of SAHUC remains unclear. In addition, a small proportion of reported cases have tested positive for SARS-CoV-2.

Thus, there are several hypotheses aboutcauses of disease, including cofactors that modify adenovirus activity, cofactors that alter host immune response, and immunodeficiency caused by COVID-19. But further research is needed to understand their role in the etiology of SAHUC.

How to treat?

Existing treatment options are mostlylimited to supportive and symptomatic therapy. However, in some cases, doctors have been able to delay the progression of the disease by treating cases with a high adenoviral load with antiviral drugs such as cidofovir, or by using a combination of Western and traditional Chinese drugs. Based on experience with COVID-19, the reviewer recommends using antiviral therapy early, 3 to 5 days after onset.

However, for patients with hepaticfailure, the only treatment option is liver transplantation. “Indications for liver transplantation are very important. Pediatricians working in the hepatology department, intensive care unit or local clinics should be familiar with the main indications for transplantation. This ensures that they do not miss the critical time to prepare the patient and carry out the transplant itself, ”the scientist concludes.

What's the bottom line?

Experts around the world are nowstudies on SAHUC, but a better understanding of the etiology requires careful surveillance and timely informing scientists of all new cases of the disease. The biologists hope the additional information will shed light on the early detection of SAHUC and the development of effective therapeutic approaches.

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Cover photo: Photographer - Alain Grillet, Copyright - Sanofi Pasteur