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Namakin K, Naserghandi A, Allameh SF. Severe acute hepatitis of unknown etiology in children in 2022: A Narrative Review. New Microbes New Infect 2023; 51:101087. [PMID: 36755794 PMCID: PMC9900432 DOI: 10.1016/j.nmni.2023.101087] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 01/18/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023] Open
Abstract
Severe cases of acute hepatitis have been reported all around the world since 5 April 2022. Common viral hepatitis agents (HAV, HBV, HCV, HDV, and HEV) were ruled out by laboratory investigations, impelling the term "acute non-A-E hepatitis". Common manifestations consist of abdominal pain, jaundice, and vomiting. A highly elevated level of liver enzymes was a remarkable laboratory finding among the patients. Currently, there is no clear etiology and thus treatment for the condition. Adenovirus serotype 41 (ad-41) was detected in most of the patients even though there is no elucidated link between Adenovirus and acute hepatitis. Other viral agents such as SARS-CoV-2 tested positive in a few cases. Treatment strategies depend on the severity, complications, and sequela of acute hepatitis and can vary widely from supportive therapy to liver transplantation. As of 8 July 2022, 1010 probable cases were reported from 35 countries. More than half were from the European region and were mostly children under the age of 6 years. Among different hypotheses about the etiology of severe acute non-A-E hepatitis, adenovirus-41 is of great importance but further assessments are needed to prove any definite link between ad-41 and severe acute hepatitis.
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Affiliation(s)
- Kosar Namakin
- Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alvand Naserghandi
- Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Farshad Allameh
- Department of Gastroenterology, Imam Khomeini Hospital Complex, Tehran, Iran,Corresponding author. Department of Gastroenterology, Imam Khomeini Hospital Complex, Tehran, 1419733141, Iran.
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D'Ambrosi F, Di Maso M, Viscardi A, Ossola MW, Soldavini CM, Cetera GE, Erra R, Ferrazzi E. Serum hepatic biomarkers in women with obstetric cholestasis and a concurrent SARS-CoV-2 infection. J Obstet Gynaecol Res 2022; 48:2713-2720. [PMID: 35915565 PMCID: PMC9538249 DOI: 10.1111/jog.15383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 07/11/2022] [Accepted: 07/21/2022] [Indexed: 01/08/2023]
Abstract
Aim The aim of the study was to evaluate the association between SARS‐CoV‐2 infection and serum hepatic biomarker levels among women with obstetric cholestasis. Methods In this prospective study, we recruited all pregnant women admitted in our hospital with obstetric cholestasis. Among those with a concurrent SARS‐CoV‐2 infection, we evaluated the following serum hepatic biomarkers: aspartate aminotransferase (AST), alanine aminotransferase (ALT), and biliar acids (BA). Results Among the 88 women enrolled in the study, 20 presented with a SARS‐CoV‐2 infection while 68 were negative. SARS‐CoV‐2 infected women were younger (mean age 30.5 ± 5.7 vs. 34.3 ± 5.4; p < 0.01) and in a greater percentage of non‐Caucasian ethnicity when compared to noninfected women (60.0% vs. 17.6%; p < 0.01). Regarding levels of hepatic biomarkers, they showed higher levels of AST (111.5 ± 134.1 vs. 37.3 ± 43.4 UI/L; p = 0.02), ALT (132.2 ± 115.7 vs. 50.5 ± 73.173.1 UI/L; p < 0.01), and BA (41.4 ± 46.8 vs. 18.4 ± 13.4 μmol/L; p = 0.04) compared to noninfected patients. No significant differences in maternal or fetal outcomes were found between infected and noninfected women. Conclusion SARS‐CoV‐2 infection was associated with higher levels of liver enzymes in patients with obstetric cholestasis. This could be the result of a possible hepatic involvement in patients with SARS‐CoV‐2 infection.
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Affiliation(s)
- Francesco D'Ambrosi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Matteo Di Maso
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro", Università degli Studi di Milano, Milan, Italy
| | - Anna Viscardi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Manuela W Ossola
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Chiara M Soldavini
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Giulia E Cetera
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Roberta Erra
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Enrico Ferrazzi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Frediansyah A, Sallam M, Yufika A, Sharun K, Iqhrammullah M, Chandran D, Mamada SS, Sallam DE, Khader Y, Lemu YK, Yusuf F, Kretchy JP, Abdeen Z, Smith Torres-Roman J, Acharya Y, Bondarenko A, Ikram A, Jamil KF, Kotfis K, Koyanagi A, Smith L, Megawati D, Rademaker M, Emran TB, Memish ZA, Vento S, Nainu F, Harapan H. Acute severe hepatitis of unknown etiology in children: A mini-review. NARRA J 2022; 2:e83. [PMID: 38449700 PMCID: PMC10914120 DOI: 10.52225/narra.v2i2.83] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/07/2022] [Indexed: 09/01/2023]
Abstract
The emergence of acute, severe non hepA-E hepatitis of unknown etiology (ASHUE) has attracted global concern owing to the very young age of the patients and its unknown etiology. Although this condition has been linked to several possible causes, including viral infection, drugs and/or toxin exposure, the exact cause remains unknown; this makes treatment recommendation very difficult. In this review, we summarize recent updates on the clinical manifestations, complemented with laboratory results, case numbers with the global distribution and other epidemiological characteristics, and the possible etiologies. We also provide the proposed actions that could be undertaken to control and prevent further spread of this hepatitis. Since many etiological and pathological aspects of the acute non hepA-E hepatitis remain unclear, further research is needed to minimize the severe impact of this disease.
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Affiliation(s)
- Andri Frediansyah
- National Research and Innovation Agency (BRIN), Yogyakarta, Indonesia
| | - Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman, Jordan
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman Jordan
- Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Amanda Yufika
- Department of Family Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Khan Sharun
- Division of Surgery, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
| | - Muhammad Iqhrammullah
- Graduate School of Mathematics and Applied Sciences, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Deepak Chandran
- Department of Veterinary Sciences and Animal Husbandry, Amrita School of Agricultural Sciences, Amrita Vishwa Vidyapeetham University, Coimbatore, India
| | - Sukamto S. Mamada
- Department of Pharmacy, Faculty of Pharmacy, Hasanuddin University, Makassar, Indonesia
| | - Dina E. Sallam
- Pediatrics and Pediatric Nephrology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Yousef Khader
- Jordan University of Science and Technology, Irbid, Jordan
- Eastern Mediterranean Public Health Network, Jordan
| | - Yohannes K. Lemu
- Department of Health, Behavior and Society, Jimma University, Jimma, Ethiopia
| | - Fauzi Yusuf
- Gastroenterohepatology Division, Internal Medicine Department, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - James-Paul Kretchy
- Public Health Unit, School of Medicine and Health Sciences, Central University, Accra, Ghana
| | - Ziad Abdeen
- Al-Quds Nutrition and Health Research Institute, Faculty of Medicine, Al-Quds University, Abu Dies, Palestine
| | | | - Yogesh Acharya
- Western Vascular Institute, University Hospital Galway, National University of Ireland Galway, Galway, Ireland
| | - Anastasia Bondarenko
- Pediatric Infectious Disease and Pediatric Immunology Department, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Aamer Ikram
- National Institutes of Health, Islamabad, Pakistan
| | - Kurnia F. Jamil
- Division of Tropical Medicine & Infectious Disease, Department of Internal Medicine Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, ICREA, CIBERSAM, ISCIII, Barcelona, Spain
| | - Lee Smith
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Dewi Megawati
- Department of Veterinary Pathobiology, University of Missouri, Columbia, US
- Department of Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Warmadewa University, Denpasar, Indonesia
| | - Marius Rademaker
- Waikato Clinical Campus, University of Auckland Medical School, Hamilton, New Zealand
| | - Talha B. Emran
- Department of Pharmacy, BGC Trust University Bangladesh Chittagong, Bangladesh
| | - Ziad A. Memish
- Research & Innovation CentreKing Saud Medical City, Ministry of Health Riyadh, Saudi Arabia
- College of Medicine, AlFaisal University, Riyadh, Saudi Arabia
| | - Sandro Vento
- Faculty of Medicine, University of Puthisastra, Phnom Penh, Cambodia
| | - Firzan Nainu
- Department of Pharmacy, Faculty of Pharmacy, Hasanuddin University, Makassar, Indonesia
| | - Harapan Harapan
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
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Zhang LY, Huang LS, Yue YH, Fawaz R, Lim JK, Fan JG. Acute Hepatitis of Unknown Origin in Children: Early Observations from the 2022 Outbreak. J Clin Transl Hepatol 2022; 10:522-530. [PMID: 35836761 PMCID: PMC9240245 DOI: 10.14218/jcth.2022.00281] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/15/2022] [Accepted: 06/15/2022] [Indexed: 12/14/2022] Open
Abstract
Recent reports of acute hepatitis of unknown origin in previously healthy children have been increasing worldwide. The main characteristics of the affected children were jaundice and gastrointestinal symptoms. Their serum aminotransaminase levels were above 500 IU/L, with negative tests for hepatitis viruses A-E. By 31 May 2022, the outbreak had affected over 800 children under the age of 16 years in more than 40 countries, resulting in acute liver failure in approximately 10%, including at least 21 deaths and 38 patients requiring liver transplantation. There was still no confirmed cause or causes, although there were several different working hypotheses, such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), adenovirus serotype 41, or SARS-CoV-2 superantigen-mediated immune cell activation. Here, we review early observations of the 2022 outbreak which may inform diagnosis, treatment, and prevention in the context of an overlapping COVID-19 pandemic.
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Affiliation(s)
- Li-Ya Zhang
- Department of Infectious Disease, Xinhua Children’s Hospital, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li-Su Huang
- Department of Infectious Disease, Xinhua Children’s Hospital, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu-Hang Yue
- Department of Infectious Disease, Xinhua Children’s Hospital, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rima Fawaz
- Section of Pediatric Gastroenterology and Hepatology, Yale University School of Medicine, New Haven, CT, USA
| | - Joseph K. Lim
- Section of Digestive Diseases and Yale Liver Center, Yale University School of Medicine, New Haven, CT, USA
| | - Jian-Gao Fan
- Department of Gastroenterology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Lab of Pediatric Gastroenterology and Nutrition, Shanghai, China
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Rabaan AA, Bakhrebah MA, Nassar MS, Natto ZS, Al Mutair A, Alhumaid S, Aljeldah M, Garout M, Alfouzan WA, Alshahrani FS, Sulaiman T, AlFonaisan MK, Alfaresi M, Alshamrani SA, Nainu F, Yong SJ, Choudhary OP, Ahmed N. Suspected Adenovirus Causing an Emerging HEPATITIS among Children below 10 Years: A Review. Pathogens 2022; 11:712. [PMID: 35889958 PMCID: PMC9317240 DOI: 10.3390/pathogens11070712] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 02/01/2023] Open
Abstract
In October 2021, a case of acute hepatic failure without any known cause was identified in the United States of America. Upon further investigation, other children aged 1-6 years were reported to have the same liver failure, and some of them were positive for adenovirus 41 type F. On 21 April 2022, the Centers for Disease Control and Prevention (CDC) released an alert after 74 cases were identified in United Kingdom (UK) between 5 and 8 April in children below 10 years of age, some of whom were also found to be positive for SARS-CoV-2. All the patients showed symptoms such as vomiting, diarrhea, jaundice, and abdominal pain. The patients' liver enzymes were remarkably increased. A total of 650 cases had been reported from 33 countries as of 27 May 2022, among which 222 cases were reported in the UK alone. No connection with SARS-CoV-2 or its vaccine has been found so far. However, the suspected cause is adenovirus, including its genomic variations, because its pathogenesis and laboratory investigations have been positively linked. Until further evidence emerges, hygiene precautions could be helpful to prevent its spread.
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Affiliation(s)
- Ali A. Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
- Department of Public Health and Nutrition, The University of Haripur, Haripur 22610, Pakistan
| | - Muhammed A. Bakhrebah
- Life Science and Environment Research Institute, King Abdulaziz City for Science and Technology (KACST), Riyadh 11442, Saudi Arabia; (M.A.B.); (M.S.N.)
| | - Majed S. Nassar
- Life Science and Environment Research Institute, King Abdulaziz City for Science and Technology (KACST), Riyadh 11442, Saudi Arabia; (M.A.B.); (M.S.N.)
| | - Zuhair S. Natto
- Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| | - Abbas Al Mutair
- Research Center, Almoosa Specialist Hospital, Al-Ahsa 36342, Saudi Arabia;
- College of Nursing, Princess Norah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia
- School of Nursing, Wollongong University, Wollongong, NSW 2522, Australia
- Nursing Department, Prince Sultan Military College of Health Sciences, Dhahran 33048, Saudi Arabia
| | - Saad Alhumaid
- Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa 31982, Saudi Arabia;
| | - Mohammed Aljeldah
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, University of Hafr Al Batin, Hafr Al Batin 39831, Saudi Arabia;
| | - Mohammed Garout
- Department of Community Medicine and Health Care for Pilgrims, Faculty of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia;
| | - Wadha A. Alfouzan
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat 13110, Kuwait;
- Microbiology Unit, Department of Laboratories, Farwania Hospital, Farwania 85000, Kuwait
| | - Fatimah S. Alshahrani
- Department of Internal Medicine, College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia;
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh 11451, Saudi Arabia
| | - Tarek Sulaiman
- Infectious Diseases Section, Medical Specialties Department, King Fahad Medical City, Riyadh 12231, Saudi Arabia;
| | | | - Mubarak Alfaresi
- Department of Pathology and Laboratory Medicine, Sheikh Khalifa General Hospital, Umm Al Quwain P.O. Box 499, United Arab Emirates;
- Department of Pathology, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 505055, United Arab Emirates
| | - Saleh A. Alshamrani
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Najran University, Najran 61441, Saudi Arabia;
| | - Firzan Nainu
- Department of Pharmacy, Faculty of Pharmacy, Hasanuddin University, Makassar 90245, Indonesia;
| | - Shin Jie Yong
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Subang Jaya 47500, Selangor, Malaysia;
| | - Om Prakash Choudhary
- Department of Veterinary Anatomy and Histology, College of Veterinary Sciences and Animal Husbandry, Central Agricultural University (I), Selesih, Aizawl 796 015, Mizoram, India;
| | - Naveed Ahmed
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
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Diagnosis, treatment, and prevention of severe acute hepatitis of unknown etiology in children. World J Pediatr 2022; 18:538-544. [PMID: 35771382 PMCID: PMC9244883 DOI: 10.1007/s12519-022-00581-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 06/06/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Severe acute hepatitis of unknown etiology in children has recently exhibited a global trend of concentrated occurrence. This review aimed to summarize the current available information regarding the outbreak of severe acute hepatitis and introduce our hospital's previous experiences with the diagnosis and treatment of severe acute hepatitis for reference. DATA SOURCES Websites including the UK Health Security Agency, European Centre for Disease Prevention and Control, CDC, WHO, and databases including PubMed/Medline, Cochrane Library, Embase and Web of Science were searched for articles on severe acute hepatitis in children. RESULTS As of May 26, 2022, a total of 650 cases have been reported in 33 countries; at least 38 (6%) children required liver transplantation, and nine (1%) died. Cases are predominantly aged between 3 and 5 years old, and there are no epidemiological links among them. The common manifestations are jaundice, vomiting and pale stools. Adenovirus tested positive in most cases, and SARS-CoV-2 and other viruses were detected in a few cases, but virus particles were not found in liver tissue. Adenovirus immunohistochemistry showed immunoreactivity in the intrasinusoidal lumen from some liver samples. The hierarchical treatment includes symptomatic and supportive therapy, management of coagulation disorders and hepatic encephalopathy, artificial liver support, and liver transplantation (approximately 6%-10% of cases require liver transplant). CONCLUSIONS The etiology of this severe acute hepatitis in children is not clear. The clinical features are severe acute hepatitis with significantly elevated liver enzymes. Clinicians need to be alert to children with hepatitis.
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