Acute hepatitis in children, what we know about the relationship with Covid-19

The cases of hepatitis acute affecting children since early April continue to grow, but theetiology of the disease remains unknown. While, especially in the UK, a possible association has been found with an infection in several patients adenovirusother hypotheses, yet to be proven, suggest this to investigate the relationship between hepatitis and Covid-19: recently, in fact, an article published in the magazine The Lancet Gastroenterology and Hepatologysuggests that hepatitis is due to a series of events related to the immune system and adenovirus infection, but triggered by of an unrecognized Sars-cov-2 infection. However, all other hypotheses remain open.

The spread to date and the possible causes

Almost two months have passed since the first cases of this disease were reported: on April 5, 2022, in fact, 10 patients with severe acute hepatitis of unknown etiology in older children were reported to the l ‘World Health Organization of Scotland Under 10s. . Within days, 74 more cases had been reported in the UK. In the following weeks, hepatitis began to be detected in Europe and other countries around the world: according to the European Center for Disease Prevention and Control (ECDC), from 19 May 2022 in the area of ​​the European Union were identified. 125 cases in 14 countries: Italy is the country with the largest number, 35. There are more than 600 cases in the world, with 14 victims.

As we’ve told you here, it’s about inflammation of the liverin which young patients often present and significantly elevated liver enzyme values. In addition, many cases have reported gastrointestinal symptoms such as abdominal pain, diarrhea, and vomiting that preceded the signs of severe hepatitis. Although these acute diseases are usually caused by hepatitis A, B, C, D and E viruses, these pathogens were not detected in any of the confirmed cases. Among other possible causes, healthcare institutions have excluded international travel or connections with other countries in the world.

As reported by both the ECDC and the WHO, therefore, the etiology of this disease is still unknown. However, there are several hypotheses in this regard, suggested by tests performed on some patients: for example, in at least 74 cases, the infection by a adenovirus called 41F, while in 20 cases the presence of Sars-cov-2 was detected. In addition, it was identified in 19 patients co-infection of Sars-cov-2 and adenovirus. Adenovirus 41F is not a rare viral subtype: it mainly affects young children and immunocompromised individuals, but has never before been reported as a cause of severe acute hepatitis.

Covid-19, adenovirus and ear protein

Two recently published articles seem to go in that direction. According to a study, which has not yet undergone the peer review process and was published in pre-print on medRxivthe children they had COVID-19[feminine] have a higher risk of liver dysfunction (detectable by an increase in liver enzymes) compared with those who did not have a SARS-cov-2 infection. An article published in the section Correspondence of the magazine The Lancet Gastroenterology and Hepatology, instead, he speculates that the cases of acute hepatitis could be the consequence of adenovirus infection in children previously infected with Sars-cov-2. In fact, in the article, the authors hypothesize that coronavirus ear protein particles (called “superantigens”), left in the gastrointestinal tract of children in whom the infection has remained latent and not has manifested with symptoms, may have induced the immune system to overreact to 41F adenovirus. Finally, the inflammatory proteins released by the body would damage the liver, causing hepatitis.

In fact, the WHO noted in an update on April 23, 2022 that among the possible factors for hepatitis could be an increase in susceptibility to adenovirus among young children after a lower level of circulation during the Covid-19 pandemic, the possible appearance of a new adenovirus and the coinfection of adenovirus and Sars-cov-2. In any case, all these hypotheses must be proven, as well as, as the health institution points out, it is It is important to continue exploring other possible explanations as wellinfectious and others.

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