Disclosures: Baker does not disclose any relevant financial disclosures. See the full report for all related financial disclosures of other authors.
ADD TOPIC TO email notifications
Receive an email when new articles are posted on
Enter your email address to receive an email when new articles are posted on. “data-action =” subscribe “> Registration We could not process your request. Please try again later. If you continue to have this problem, please contact [email protected] Return to Healio Several cases of acute, severe hepatitis in children in Alabama have provided additional evidence to support a possible link between the disease and adenovirus, according to a report published in the Morbidity and Mortality Weekly Report. “This group, together with possible recent cases in Europe, suggests that the adenovirus should be considered in the differential diagnosis of acute hepatitis of unknown etiology in children,” said Julia M. Baker, PhD, Officer of the National Center for Epidemic Information. CDC on Immunization and Respiratory Diseases, and colleagues, wrote. “Clinicians and laboratories should be aware of possible differences in the sensitivity of the adenovirus test to different types of samples. Whole blood tests may be more sensitive than plasma tests. In a recent CDC report, researchers said that adenovirus should be considered in the diagnosis of acute hepatitis in children. Source: Adobe Stock “The CDC is closely monitoring the situation to understand the possible cause of the disease and to identify possible efforts to prevent or alleviate the disease. “Enhanced surveillance is underway in coordination with relevant public health partners.” From October to November 2021, five pediatric patients with severe hepatitis and adenovirus infection were diagnosed at the Children’s Hospital of Alabama, prompting research by hospital physicians, state and county health departments, and the CDC. Baker and colleagues reviewed hospital records to identify patients with hepatitis and adenovirus infection as diagnosed by PCR test observed on or after October 1, 2021. Four additional children were identified between October 2021 and February 2022, respectively. total in nine (median age, 2 years, 11 months, seven female patients). All children were immunocompetent without clinically significant medical comorbidities. No additional patients were identified following the February 2022 health opinion.
The researchers noted that prior to admission, seven patients reported vomiting, six reported diarrhea, and three reported upper respiratory symptoms. At admission, eight patients had severe sclerosis, seven had hepatomegaly, six had jaundice, and one had encephalopathy. All patients had elevated transaminases and total bilirubin ranged from normal to elevated (range = 0.23-13.5 mg / dL, increased in eight patients). All patients tested negative for hepatitis A, B, and C viruses and many other causes of childhood hepatitis and infections, including autoimmune hepatitis, Wilson’s disease, bacteremia, urinary tract infections, and SARS-2 infection. According to the researchers, real-time PCR detected adenovirus in whole blood samples from all patients, and the hexon gene region hypervariable sequence identified adenovirus type 41 in five patients. In addition, seven patients were co-infected with other viral pathogens, including enterovirus / rhinovirus, post-pneumonia, respiratory syncytial virus, and human coronavirus OC43. Six patients tested positive for Epstein-Barr virus (EBV) by PCR. However, these patients were found to be negative for EBV immunoglobulin M antibodies, suggesting a possible reactivation of a low level of previous infection, instead of an acute infection. Six patients underwent liver biopsies, which revealed varying degrees of hepatitis without viral inclusion or adenovirus immunohistochemical evidence. Acute liver failure developed in three patients, two of whom were treated with unlabeled cidofovir and steroids and later underwent liver transplantation. Both patients were initially negative for adenovirus by real-time PCR in plasma samples, but were later positive for whole blood samples. All patients, including the two LT recipients, have recovered or are recovering. “Clinicians are encouraged to report possible cases of pediatric hepatitis of unknown etiology that occurred on or after October 1, 2021, to the public health authorities for further investigation,” the authors concluded. ADD TOPIC TO email notifications
Receive an email when new articles are posted on
Enter your email address to receive an email when new articles are posted on. “data-action =” subscribe “> Registration We could not process your request. Please try again later. If you continue to have this problem, please contact [email protected] Return to Healio