Novel hepatitis in childhood has been reported mainly from UK since this January.
A report from the UK government; here
A news article by Reuter; here
From January to April, there have been 130 cases reported. Among them, 108 cases are from UK. All children.
It should be concerned that 8 cases have been undergone liver transplant procedure. It means the clinical feature at least of these cases was that of fulminant hepatitis, which progresses to liver insufficiency quickly. A case was dead.
The etiology is not definitely known yet. But 77% of cases show laboratory data of infection with Adenovirus. Adenovirus is a kind of the genre of enterovirus and causes common cold. Rarely it won't be the pathogen for fulminant hepatitis in childhood. It prevails among children mostly in summer. Adenovirus is so common that the apparent relationship with this hepatitis could be just coincidence.
If Adenovirus is involved in this hepatitis, there should be changes in the pathogen, the host or the environment. The virus could undergo genomic variation, which leads to more virulence. The patients have been isolated from the group with the same age and have been infected much later than the ordinary natural infection. It could cause different immune response to the virus. SARS CoV2, the pathogen of COVID19, has been reported to alter the immune system. Co infection with SARS CoV2 may occur that change which should be responsible for fulminant hepatitis. The patients have not been immunized with COVID19 vaccine, so that it should be ruled out for the cause.
So far, the number of cases are not large and they are limited only to UK etc in distribution. This is be most likely an infectious hepatitis. In case of gastroenteritis patients in childhood deteriorating to liver dysfunction rapidly, they should be suspected for this fulminant hepatitis.
This has reminded me of Reye Syndrome. I used to see such a case when I was a resident at a med school hospital.
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