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Vajro P, Mandato C, Fischler B. Acute hepatitis of unknown origin in children: Should we move the discussion from a purely infectious origin also to other plausible causes? Virulence 2024; 15:2318582. [PMID: 38388366 PMCID: PMC10896148 DOI: 10.1080/21505594.2024.2318582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/09/2024] [Indexed: 02/24/2024] Open
Affiliation(s)
- Pietro Vajro
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, Section of Pediatrics, Baronissi, Salerno, Italy
| | - Claudia Mandato
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, Section of Pediatrics, Baronissi, Salerno, Italy
| | - Björn Fischler
- Department of Pediatrics, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
- CLINTEC, Karolinska Institutet, Stockholm, Sweden
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Callaby H, McGuire E, Rajwal S, Stahlschmidt J, Hartley J, Brown RM, Deheragoda M, Quaglia A, Rampling T, Houlihan CF, Claire Gordon N, Brown CS, Simmons R, Samson A, Mandal S, Grammatikopoulos T, Demirjian A. Histopathological findings from the investigation of paediatric acute hepatitis of unknown aetiology, United Kingdom 2022. J Pediatr Gastroenterol Nutr 2024; 78:534-538. [PMID: 38327256 DOI: 10.1002/jpn3.12133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 02/09/2024]
Abstract
In 2022, there were global reports of increased numbers of acute hepatitis not explained by hepatitis A-E virus infection in children. This manuscript summarises histopathology results from 20 patients in the United Kingdom who underwent liver transplant or had a liver biopsy as part of aetiological investigations. All available histopathological samples were reviewed centrally as part of the outbreak investigation. A working group comprised of infection specialists, hepatologists and histopathologists met virtually to review the cases, presentation, investigations and histopathology. All 20 liver samples had evidence of inflammation without significant interface activity, and submassive confluent pan-lobular or multilobular hepatocellular necrosis. Overall, the predominant histopathological findings were of acute nonspecific hepatitis with submassive hepatic necrosis and central vein perivenulitis and endothelitis. Histopathological findings were a poor indicator of aetiology.
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Affiliation(s)
- Helen Callaby
- UKHSA Rare and Imported Pathogen Laboratory, Porton Down, London, UK
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - Emma McGuire
- HCAI, Fungal, AMR, AMU & Sepsis Division, UKHSA, London, UK
| | | | - Jens Stahlschmidt
- Department of Histopathology and Molecular Pathology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jane Hartley
- Liver Unit, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Rachel M Brown
- Department of Histopathology Birmingham Children's Hospital, Birmingham, UK
| | | | - Alberto Quaglia
- Department of Cellular Pathology, Royal Free London, London, UK
| | - Tommy Rampling
- UKHSA Rare and Imported Pathogen Laboratory, Porton Down, London, UK
| | | | - N Claire Gordon
- UKHSA Rare and Imported Pathogen Laboratory, Porton Down, London, UK
| | - Colin S Brown
- HCAI, Fungal, AMR, AMU & Sepsis Division, UKHSA, London, UK
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, London, UK
| | - Ruth Simmons
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
| | - Anda Samson
- HCAI, Fungal, AMR, AMU & Sepsis Division, UKHSA, London, UK
| | - Sema Mandal
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
| | - Tassos Grammatikopoulos
- Paediatric Liver, GI & Nutrition Centre and Mowat Labs, King's College Hospital, London, UK
- Institute of Liver Studies, King's College London, London, UK
| | - Alicia Demirjian
- HCAI, Fungal, AMR, AMU & Sepsis Division, UKHSA, London, UK
- Department of Paediatric Infectious Diseases & Immunology, Evelina London Children's Hospital, London, UK
- Faculty of Life Sciences & Medicine, King's College London, London, UK
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Vajro P, Mandato C, Fischler B. Is paracetamol a missing piece of the severe acute hepatitis of unknown aetiology jigsaw? J Infect 2024; 88:106127. [PMID: 38382858 DOI: 10.1016/j.jinf.2024.106127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/15/2024] [Accepted: 02/16/2024] [Indexed: 02/23/2024]
Affiliation(s)
- Pietro Vajro
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Section of Pediatrics, Baronissi, Salerno, Italy.
| | - Claudia Mandato
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Section of Pediatrics, Baronissi, Salerno, Italy.
| | - Björn Fischler
- Department of Pediatrics, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; CLINTEC, Karolinska Institutet, Stockholm, Sweden.
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