Severe Acute Hepatitis in Children of Unknown Etiology

Ng, Vicky L.; Science, Michelle; Feld, Jordan J.; Shah, Hemant; Bitnun, Ari; Bourns, Laura; Campigotto, Aaron; Cohen, Eyal; Gubbay, Jonathan B.; Jiménez-Rivera, Carolina; Orkin, Julia; Razak, Fahad; Saunders, Andrea; Sayed, Blayne A.; Salvadori, M; Yaffe, Barbara; Zygmunt, Austin; Allen, Upton

doi:10.47326/ocsat.2022.03.63.1.0

Cited by 4 publications

(5 citation statements)

References 27 publications

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“…Guidance on the evaluation of severe acute hepatitis is available in the published literature. 6 , 19 Practically, the finding that a diagnostic workup is incomplete can be the result of multiple influences. These include the severity of hepatitis on presentation, the presence of comorbidities, and consultation with the subspecialist.…”

Section: Discussionmentioning

confidence: 99%

Severe acute hepatitis of unknown etiology in a large cohort of children

Mehta,

John,

Feld

et al. 2023

Hepatology Communications

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Background: We evaluated the proportion, clinical features, and outcomes of previously healthy children presenting to a large Canadian quaternary pediatric center with severe acute hepatitis of unknown etiology. Methods: All patients with serum alanine aminotransferase (ALT) > 500 U/L or aspartate aminotransferase (AST) > 500 U/L between June 1, 2018, and May 31, 2022, at The Hospital for Sick Children, were identified. Subjects with only AST > 500 U/L were excluded. Clinical characteristics, investigations, and outcomes for patients without clear etiology for ALT > 500 U/L (severe acute hepatitis of unknown etiology) for our study period and from October 1 to May 31 of each year 2018–2021 were reviewed. Results: Of 977 patients with ALT/AST> 500 U/L, 720 had only ALT > 500 U/L. We excluded age below 6 months (n = 99) or above 16 years (n = 66), known pre-existing liver conditions (n = 66), and ALT > 500 U/L in already admitted patients (n = 151). Among the remaining 338 children with ALT > 500 U/L at presentation, an etiology was identified in 303 subjects. 33 (9.8%) children [median age 6.1 y (range 0.5–15.5); 61% male] were confirmed as severe acute hepatitis of unknown etiology. Twenty patients (60.6%) were tested for blood adenovirus by PCR, and 1 (5%) was positive (serotype B7). Liver tissue specimens from 18 patients revealed no evidence of viral inclusions or adenovirus. Twelve (36.3%) presented with pediatric acute liver failure, with 8 (24.2%) requiring liver transplantation. There were no deaths. Hepatitis-associated aplastic anemia occurred in 5 (15%) patients. Conclusions: Of children presenting with severe acute hepatitis to a quaternary children’s hospital over a 48-month period, 9.8% had unknown etiology with no change over time. Liver transplantation remains an important treatment strategy for those presenting with pediatric acute liver failure phenotype. The frequency of cases associated with human adenovirus infection was noncontributory.

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Section: Discussionmentioning

confidence: 99%

Severe acute hepatitis of unknown etiology in a large cohort of children

Mehta,

John,

Feld

et al. 2023

Hepatology Communications

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“…Input from a pediatric gastroenterologist should be obtained to prioritize investigations, provide anticipatory guidance and discuss management (including use of vitamin K and acetaminophen). 4 Rarely, children may progress to aplastic anemia, which requires consultation with a hematologist. Clinicians should immediately consult a pediatric liver transplatation program for children with suspected encephalopathy, or with an INR above 2.0 that is not corrected with a single dose of intravenous vitamin K (0.3 mg/kg, maximum daily dosage 10 mg).…”

Section: Children With An Alt Level Of More Than 500 Iu/l or An Inr O...mentioning

confidence: 99%

“…Children may present with signs or symptoms that are specific (e.g., jaundice, scleral icterus, dark urine, pale stools, hepatic encephalopathy), nonspecific (e.g., nausea, vomiting, loss of appetite) or systemic (e.g., myalgia, lethargy, fever). 4 …”

Section: Presentation Varies From Mild Symptoms To Acute Liver Failurementioning

confidence: 99%

“…Probable cases should be tested for SARS-CoV-2 (polymerase chain reaction and antibody testing) and adenovirus infection. 4 Differential diagnoses include infectious (hepatotropic and nonhepatotropic viruses) and noninfectious (drug-induced liver injury, autoimmune, metabolic) conditions. 5 …”

Section: The Who Defines a Probable Case As A Child (Age ≤ 16 Yr) Wit...mentioning

confidence: 99%

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Severe acute hepatitis of unknown cause in children

Science

Campigotto

2022

CMAJ

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“…The absence of a connection between these cases of "acute non-HepA-E hepatitis" and the recognized viral hepatitis agents (HAV (hepatitis A virus), HBV (hepatitis B virus), HCV (hepatitis C virus), HDV (hepatitis D virus), HEV(hepatitis E virus)) stimulated research into this growing disease to determine its aetiology and pathogenesis (ECDC, 2022;WHO, 2022). Other causes of hepatitis in children may be unknown autoimmune diseases, drug toxicity or specific drug reactions, and hidden metabolic or genetic disorders (Alexander and Deep, 2022;Ng et al, 2022).…”

Section: Introductionmentioning

confidence: 99%

Pharmacological Effects of Glycyrrhiza glabra L. as Antihepatitis and Hepatoprotective for Children

Muslikh

Priatna

Ekasari

2023

JFIKI

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Background: The incidence of hepatitis in children has grown from the normal number of hepatitis cases since January 2022, and it will continue to rise since the etiology and pathophysiology are unknown. This case is distinct from those caused by the hepatitis A, B, C, D, and E viruses. Glycyrrhiza glabra L. is a medicinal herb that has long been used in medicine to treat respiratory, digestive, and immune system problems, but it is also known to have an inhibitory impact on the virus. Coronavirus-associated acute respiratory syndrome, hepatitis, herpes simplex virus, influenza virus. Objective: This article will look at Glycyrrhiza glabra L.'s antihepatitis and hepatoprotective properties. Methods: The Pubmed, Sage Journal, and Sciencedirect databases were searched using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards and the keywords "Glycyrrhiza glabra for hepatitis." The inclusion and exclusion criteria were followed. Results: From the search results, 17 publications were discovered that explain how Glycyrrhiza glabra L. can operate as an antihepatitis agent through anti-inflammatory, antiapoptotic, and hepatoprotective mechanisms. Conclusion: Glycyrrhiza glabra L. can be used as an anti-hepatitis and hepatoprotective in children at doses ranging from 240-480mg/kg/day.

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Severe Acute Hepatitis in Children of Unknown Etiology

Cited by 4 publications

References 27 publications

Severe acute hepatitis of unknown etiology in a large cohort of children

Severe acute hepatitis of unknown etiology in a large cohort of children

Severe acute hepatitis of unknown cause in children

Pharmacological Effects of Glycyrrhiza glabra L. as Antihepatitis and Hepatoprotective for Children

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